Inter-assessor reliability of practice based biomechanical assessment of the foot and ankle

Background There is no consensus on which protocols should be used to assess foot and lower limb biomechanics in clinical practice. The reliability of many assessments has been questioned by previous research. The aim of this investigation was to (i) identify (through consensus) what biomechanical examinations are used in clinical practice and (ii) evaluate the inter-assessor reliability of some of these examinations. Methods Part1: Using a modified Delphi technique 12 podiatrists derived consensus on the biomechanical examinations used in clinical practice. Part 2: Eleven podiatrists assessed 6 participants using a subset of the assessment protocol derived in Part 1. Examinations were compared between assessors. Results Clinicians choose to estimate rather than quantitatively measure foot position and motion. Poor inter-assessor reliability was recorded for all examinations. Intra-class correlation coefficient values (ICC) for relaxed calcaneal stance position were less than 0.23 and were less than 0.14 for neutral calcaneal stance position. For the examination of ankle joint dorsiflexion, ICC values suggest moderate reliability (less than 0.61). The results of a random effects ANOVA highlight that participant (up to 5.7°), assessor (up to 5.8°) and random (upto 5.7°) error all contribute to the total error (up to 9.5° for relaxed calcaneal stance position, up to 10.7° for the examination of ankle joint dorsiflexion). Kappa Fleiss values for categorisation of first ray position and mobility were less than 0.05 and for limb length assessment less than 0.02, indicating slight agreement. Conclusion Static biomechanical assessment of the foot, leg and lower limb is an important protocol in clinical practice, but the key examinations used to make inferences about dynamic foot function and to determine orthotic prescription are unreliable

Trade liberalization and relative employment: further evidence from Tunisia

There are increasing studies that address the skill upgrading in developing countries. The theoretical analyses yield different results about which factors affect skill upgrading. The impact of trade openness and technology transfer on the relative demand for skilled labor remains a puzzle, the issue is mainly empirical questions. The empirical findings surrounding this question are in total contradiction with the prediction of traditional trade theory. This paper addresses this puzzle for the Tunisian economy by considering a database covering 12 Tunisian sectors for the period of 1983-2010. Empirical results indicate that trade openness positively affects relative demand of skilled labor. Empirical results also show that the effects of technological change induced by trade on relative demand of skilled labor are ambiguous. First, technology change has positive effects mediated via export channels, this is an evidence of the "learning by exporting" channel. Second, technology change has a negative effect mediated via imports. These empirical findings have important economic implications; for instance Tunisian economic policy should be oriented to improve a firm's competitiveness and labor market capacity to minimize the cost of trade liberalization in terms of employment losses mainly for unskilled workers. 2015, Eurasia Business and Economics Society.Scopu