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Children and young people with CF (CYPwCF) get advice about using positive expiratory pressure (PEP) or oscillating PEP (OPEP) devices to clear sticky mucus from their lungs. However, little is known about the quantity (number of treatments, breaths, or sets) or quality (breath pressures and lengths) of these daily airway clearance techniques (ACTs) undertaken at home. This study used electronic pressure sensors to record real time breath-by-breath data from 145 CYPwCF (6-16y) during routine ACTs over 2 months. ACT quantity and quality were benchmarked against individual prescriptions and accepted recommendations for device use. In total 742,084 breaths from 9,081 treatments were recorded. Individual CYPwCF maintained consistent patterns of ACT quantity and quality over time. Overall, 60% of CYPwCF did at least half their prescribed treatments, while 27% did fewer than a quarter. About 77% of pre-teens did the right number of daily treatments compared with only 56% of teenagers. CYPwCF usually did the right number of breaths. ACT quality (recommended breath length and pressure) varied between participants and depended on device. Breath pressures, lengths and pressure-length relationships were significantly different between ACT devices. PEP devices encouraged longer breaths with lower pressures, while OPEP devices encouraged shorter breaths with higher pressures. More breaths per treatment were within advised ranges for both pressure and length using PEP (30-31%) than OPEP devices (1-3%). Objective measures of quantity and quality may help to optimise ACT device selection and support CYPwCF to do regular effective ACTs.

IntroductionDaily physiotherapy is believed to mitigate the progression of cystic fibrosis (CF) lung disease. However, physiotherapy airway clearance techniques (ACTs) are burdensome and the evidence guiding practice remains weak. This paper describes the protocol for Project Fizzyo, which uses innovative technology and analysis methods to remotely capture longitudinal daily data from physiotherapy treatments to measure adherence and prospectively evaluate associations with clinical outcomes.Methods and analysisA cohort of 145 children and young people with CF aged 6–16 years were recruited. Each participant will record their usual physiotherapy sessions daily for 16 months, using remote monitoring sensors: (1) a bespoke ACT sensor, inserted into their usual ACT device and (2) a Fitbit Alta HR activity tracker. Real-time breath pressure during ACTs, and heart rate and daily step counts (Fitbit) are synced using specific software applications. An interrupted time-series design will facilitate evaluation of ACT interventions (feedback and ACT-driven gaming). Baseline, mid and endpoint assessments of spirometry, exercise capacity and quality of life and longitudinal clinical record data will also be collected.This large dataset will be analysed in R using big data analytics approaches. Distinct ACT and physical activity adherence profiles will be identified, using cluster analysis to define groups of individuals based on measured characteristics and any relationships to clinical profiles assessed. Changes in adherence to physiotherapy over time or in relation to ACT interventions will be quantified and evaluated in relation to clinical outcomes.Ethics and disseminationEthical approval for this study (IRAS: 228625) was granted by the London-Brighton and Sussex NREC (18/LO/1038). Findings will be disseminated via peer-reviewed publications, at conferences and via CF clinical networks. The statistical code will be published in the Fizzyo GitHub repository and the dataset stored in the Great Ormond Street Hospital Digital Research Environment.Trial registration numberISRCTN51624752; Pre-results.

Strong education and training systems are viewed as a route to increased labour market participation for groups that have traditionally been excluded from, or marginalised in, the labour market. Engagement in the labour force for such groups has both individual and societal benefits. However, while this emphasis on an increased role for the state in education and training is encouraging, commentators have questioned the ability of ‘Third Way’ discourse to meet the unique needs of women, given the absence of explicit feminist dialogue in wider discussions on associated policy and practice. Informed by this critique, this article aims to evaluate changes in education and training policy and practice in New Zealand since 1999, in terms of the extent to which it enhances opportunities for women’s participation in education and training.

The term 'Workforce Development’ is used with increasing frequency by policy makers, academics and labour market practitioners. On the surface, it is a relatively unproblematic term, yet closer investigation suggests that it is often used as a 'catch-all ' phrase, which may have quite different meanings and implications, depending upon the user and the context. In this exploratory paper, I first trace the genesis of the term, noting its theoretical underpinnings in systems thinking. I then discuss some of the drivers behind the evolution of the concept of Workforce Development and examine why it appears to have supplanted notions of workforce or manpower 'planning’. Using the health and disability sector as a case study, I highlight some of the differences in how the term is used, and discuss the implications. Finally I ask if the use of a new term, reflecting a presumably significant shift in ways of thinking about the 'workforce’, translates into actions that do, in fact, 'develop’ that workforce.

Industry training is designed and driven by industry, and concentrates on workplace learning that raises skills and boosts competitive advantage for busness.1 The 41 Industry Training Organisations (ITOs) are charged with setting skill standards for their industries, and with developing and making arrangements for the delivery of training, and its monitoring and assessing, in order that trainees attain the required skill standards. The increasing maturity and success of the industry training system is reflected in a recent addition to the Industry Training Act, This requires Industry Training Organisations to provide ‘leadership within the industry on matters relating to skill and training needs by: identifying current and future skill needs; developing strategic training plans to assist the industry to meet those needs; and promoting training that will meet those needs to employers and employees’. In order to assist ITOs to develop the capability to meet these requirements, funding was made available from the Tertiary Education Commission’s Innovations and Development Fund for participations ITO’s to develop an Industry Skills Strategy. This paper presents the approaches that two ITOs have taken in fulfilling their future skill needs strategic planning.