Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system

BACKGROUND: Clinical tests to assess peripheral nerve disorders can be classified into two categories: tests for afferent/efferent nerve function such as nerve conduction (bedside neurological examination) and tests for increased mechanosensitivity (e.g. upper limb neurodynamic tests (ULNTs) and nerve palpation). Reliability reports of nerve palpation and the interpretation of neurodynamic tests are scarce. This study therefore investigated the intertester reliability of nerve palpation and ULNTs. ULNTs were interpreted based on symptom reproduction and structural differentiation. To put the reliability of these tests in perspective, a comparison with the reliability of clinical tests for nerve function was made. METHODS: Two experienced clinicians examined 31 patients with unilateral arm and/or neck pain. The examination included clinical tests for nerve function (sensory testing, reflexes and manual muscle testing (MMT)) and mechanosensitivity (ULNTs and palpation of the median, radial and ulnar nerve). Kappa statistics were calculated to evaluate intertester reliability. A meta-analysis determined an overall kappa for the domains with multiple kappa values (MMT, ULNT, palpation). We then compared the difference in reliability between the tests of mechanosensitivity and nerve function using a one-sample t-test. RESULTS: We observed moderate to substantial reliability for the tests for afferent/efferent nerve function (sensory testing: kappa = 0.53; MMT: kappa = 0.68; no kappa was calculated for reflexes due to a lack of variation). Tests to investigate mechanosensitivity demonstrated moderate reliability (ULNT: kappa = 0.45; palpation: kappa = 0.59). When compared statistically, there was no difference in reliability for tests for nerve function and mechanosensitivity (p = 0.06). CONCLUSION: This study demonstrates that clinical tests which evaluate increased nerve mechanosensitivity and afferent/efferent nerve function have comparable moderate to substantial reliability. To further investigate the clinometric properties of these tests, more studies are needed to evaluate their validity

Alternative energy policy for mitigating the asynchrony of the wind-power industry’s supply chain in Brazil

High dependency on hydroelectricity has revealed drawbacks in the security of power supplies as a consequence of the climate variability in South America. Under these conditions, Brazil is starting to consider alternative renewable sources for energy production, seeking to avoid periods of scarcity while also promoting clean technologies in its electricity market. Since 2004, wind power has shown a significant rise in terms of installed capacity in this country. Despite increases in wind-power units, Brazil suffers from delays in setting up its transmission infrastructure, which affects the performance of the wind-power supply chain. This chapter presents a simulation model that helps assess the long-term effects of an alternative sustainable energy policy, which may contribute to overcoming the asynchrony between renewable generation policy and the insufficiency of transmission infrastructure. Using lessons learned from simulations, the research concludes that the transmission industry in Brazil requires appropriate investment incentives for just-in-time synchrony with the expansion of the wind industry