The inter-session Intraclass Correlation Coefficient (ICC) is a commonly investigated and clinically important metric of reliability for pressure pain threshold (PPT) measurement. However, current investigations do not account for inter-repetition variability when calculating inter-session ICC, even though a PPT measurement taken at different sessions must also imply different repetitions. The primary aim was to evaluate and report a novel metric of reliability in PPT measurement: the inter-session-repetition ICC. One rater recorded ten repetitions of PPT measurement over the lumbar region bilaterally at two sessions in twenty healthy adults using a pressure algometer. Variance components were computed using linear mixed-models and used to construct ICCs; most notably inter-session ICC and inter-session-repetition ICC. At 70.1% of the total variance, the source of greatest variability was between subjects ($${\sigma }_{subj}^{2}$$
σ
subj
2
= 222.28 N2), whereas the source of least variability (1.5% total variance) was between sessions ($${\sigma }_{sess}^{2}$$
σ
sess
2
= 4.83 N2). Derived inter-session and inter-session-repetition ICCs were 0.88 (95%CI: 0.77 to 0.94) and 0.73 (95%CI: 0.53 to 0.84) respectively. Inter-session-repetition ICC provides a more conservative estimate of reliability than inter-session ICC, with the magnitude of difference being clinically meaningful. Quantifying individual sources of variability enables ICC construction to be reflective of individual testing protocols.
Under rapid city expansion in the twentieth century, efforts on urban conservations did not bear great fruit internationally although progress has been made. From institutional analysis perspective, we posit that the main crux of the problems lies in the misalignment of incentives among various agents in the market and the divergence of private and social costs. With reference to the most recent experiences in the USA, the UK, Serbia, China and Hong Kong, this paper takes stock and investigates the key institutional efforts contributing to the urban conservation market, namely (1) international governance, (2) regulatory frameworks, (3) financial arrangements, (4) social engagements, (5) participatory planning and (6) market innovations. We contend that integrated analyses jointly carried out by scholars in urban conservation and institutions will, on the one hand, fill the gaps in their fields, respectively, and on the other hand, shed new insights on the understanding of the social and economic value of built-heritage in achieving the long-term sustainable development of cities.
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