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A common occurrence in practical design of experiments is that one factor, called a nested factor, can only be varied for some but not all the levels of a categorical factor, called a branching factor. In this case, it is possible, but inefficient, to proceed by performing two experiments. One experiment would be run at the level(s) of the branching factor that allow for varying the second, nested, factor. The other experiment would only include the other level(s) of the branching factor. It is preferable to perform one experiment that allows for assessing the effects of both factors. Clearly, the effect of the nested factor then is conditional on the levels of the branching factor for which it can be varied. For example, consider an experiment comparing the performance of two machines where one machine has a switch that is missing for the other machine. The investigator wants to compare the two machines but also wants to understand the effect of flipping the switch. The main effect of the switch is conditional on the machine. This article describes several example situations involving branching factors and nested factors. We provide a model that is sensible for each situation, present a general method for constructing appropriate models, and show how to generate optimal designs given these models.

Physical activity is associated with a host of positive health outcomes and is shaped by both genetic and environmental factors. We aim to: (1) estimate sibling resemblance in two physical activity phenotypes [total number of steps∙day−1 and minutes for moderate steps per day (min∙day−1)]; and (2) investigate the joint associations of individual characteristics and shared natural environment with intra-pair sibling similarities in each phenotype. We sampled 247 biological siblings from 110 nuclear families, aged 6–17 years, from three Peruvian regions. Physical activity was measured using pedometers and body mass index was calculated. In general, non-significant variations in the intraclass correlation coefficients were found after adjustment for individual characteristics and geographical area for both phenotypes. Further, no significant differences were found between the three sib-ship types. Sister-sister pairs tended to take fewer steps than brother-brother (β = −2908.75 ± 954.31). Older siblings tended to walk fewer steps (β = −81.26 ± 19.83), whereas body mass index was not associated with physical activity. Siblings living at high-altitude and in the Amazon region had higher steps/day (β = 2508.92 ± 737.94; β = 2213.11 ± 776.63, respectively) compared with their peers living at sea-level. In general, we found no influence of sib-types, body mass index, and/or environment on the two physical activity phenotypes.

Assessing and optimising the efficiency of agricultural and pastoral systems is crucial for the long-term development of a country. The presence of shared factors and undesirable outputs increases the complexity of evaluating the efficiency of these systems. To address this issue, we first analysed the production possibility sets of the agricultural subsystems, pastoral subsystems, and agricultural and pastoral systems. Then, two bounded adjusted measure (BAM) models considering shared factors and undesirable outputs were proposed to evaluate the divisional efficiency of agricultural and pastoral subsystems. Additionally, a network BAM model in the presence of shared factors and undesirable outputs was developed to assess overall efficiency. Undesirable outputs were handled by slack-based measures in the three novel models. The proposed models were used to evaluate the efficiency of agricultural and pastoral systems across 30 provinces and cities in China. To explore the impact of undesirable outputs, the efficiency of ignoring undesirable outputs was investigated and compared with that obtained from the new method. These results suggest that ignoring undesirable outputs may misestimate efficiency to a certain extent.

The acts of assessing the efficiency of agricultural and pastoral systems and improving their production levels have profound implications for the sustainable development of the agricultural economy. Agricultural and pastoral systems are composed of agricultural sub-systems and pastoral sub-systems, which encompass both the production stage and the sales stage. These two sub-systems include shared factors and undesirable outputs, the latter of which refer to by-products such as CO2 emissions, among others. These factors create significant challenges in assessing the efficiency of agricultural and pastoral systems. To address this issue, this study first proposes divisional system network bounded adjusted measure (BAM) models that consider shared factors and undesirable outputs for assessing the efficiency of agricultural sub-systems and pastoral sub-systems. Subsequently, an overall efficiency model for evaluating the efficiency of agricultural and pastoral systems is developed. The new method is applied to evaluate the efficiency of agricultural and pastoral systems across 30 provinces and cities in China. To explore the impact of undesirable outputs, the efficiency that ignores undesirable outputs is compared with our method. The results indicate that efficiency may be misestimated when ignoring undesirable outputs. Additionally, efficiency under different conditions of intermediate products is also computed, revealing that efficiency under the fixed link of intermediate products tends to be overestimated compared to the free link method we used.

Sarcopenia and pelvic floor disorders (PFDs) are prevalent and often cooccurring conditions in the aging population. However, their bidirectional relationship and underlying mechanisms remain underexplored. This narrative review aims to elucidate this relationship by exploring potential causative interplays, shared pathophysiological mechanisms, and common risk factors. A comprehensive literature search was conducted to identify relevant studies focusing on epidemiological associations, interaction mechanisms, and implications for patient care. While epidemiological studies demonstrate associations between sarcopenia and PFDs, our findings reveal a cyclical relationship where sarcopenia may exacerbate PFDs through mechanisms such as decreased muscle strength and mobility. Conversely, the presence of PFDs often leads to reduced physical activity due to discomfort and mobility issues, which in turn exacerbate the muscle atrophy associated with sarcopenia. Additionally, shared risk factors such as physical inactivity, nutritional deficiencies, metabolic syndrome, and menopausal hormonal changes likely contribute to the onset and progression of both conditions. These interactions underscore the importance of concurrently integrated care approaches that address both conditions. Effective management requires comprehensive screening, the recognition of contributing factors, and tailored exercise regimens supported by a multidisciplinary approach. Future research should focus on longitudinal studies tracking disease progression and evaluating the efficacy of multidisciplinary care models in optimizing patient outcomes.

This study aims to estimate the prevalence of HIV among each of the three key populations in Vietnam: people who inject drugs (PWID), female sex workers (FSW), and men who have sex with men (MSM) and quantify their shared risk factors for HIV infection through a systematic review and meta-analysis of recent literature (published in 2001–2017) in the relevant topics. A total of 17 studies consisting of 16,304 participants were selected in this review. The meta-analysis results revealed that the pooled prevalence estimates with 95% confidence intervals (CIs) among PWID, FSW, and MSM were: 0.293 (0.164, 0.421), 0.075 (0.060, 0.089), and 0.085 (0.044, 0.126), respectively. The findings also indicated that injecting drug use (OR: 9.88, 95%CI: 4.47–15.28), multiperson use of injecting equipment (OR: 2.91, 95%CI: 1.69, 4.17), and inconsistent condom use (OR: 2.11, 95%CI: 1.33, 2.90) were the shared risk factors for HIV infection among these population groups. The findings highlighted the importance of HIV prevention approaches to addressing the shared sexual and drug-related practices among the key populations in consideration of their overlapping social networks.

Cancer patients are at risk of suffering from cardiovascular diseases (CVD). Nevertheless, the impact of cardiovascular comorbidity on all-cause mortality (ACM) in large clinical cohorts is not well investigated. In this retrospective cohort study, we collected data from 40,329 patients who were subjected to cardiac catherization from 01/2006 to 12/2017 at University Hospital Heidelberg. The study population included 3666 patients with a diagnosis of cancer prior to catherization and 3666 propensity-score matched non-cancer patients according to age, gender, diabetes and hypertension. 5-year ACM in cancer patients was higher with a reduced left ventricular function (LVEF < 50%; 68.0% vs 50.9%) or cardiac biomarker elevation (high-sensitivity cardiac troponin T (hs-cTnT; 64.6% vs 44.6%) and N-terminal brain natriuretic peptide (NT-proBNP; 62.9% vs 41.4%) compared to cancer patients without cardiac risk. Compared to non-cancer patients, NT-proBNP was found to be significantly higher (median NT-proBNP cancer: 881 ng/L, IQR [254; 3983 ng/L] vs non-cancer: 668 ng/L, IQR [179; 2704 ng/L]; p < 0.001, Wilcoxon-rank sum test) and turned out to predict ACM more accurately than hs-cTnT (NT-proBNP: AUC: 0.74; hs-cTnT: AUC: 0.63; p < 0.001, DeLong’s test) in cancer patients. Risk factors for atherosclerosis, such as diabetes and age (> 65 years) were significant predictors for increased ACM in cancer patients in a multivariate analysis (OR diabetes: 1.96 (1.39–2.75); p < 0.001; OR age > 65 years: 2.95 (1.68–5.4); p < 0.001, logistic regression). Our data support the notion, that overall outcome in cancer patients who underwent cardiac catherization depends on cardiovascular comorbidities. Therefore, particularly cancer patients may benefit from standardized cardiac care.

Background Adolescents are more susceptible to the shared risk factors of noncommunicable diseases (NCDs), including physical inactivity, tobacco use (smoking and smokeless), and unhealthy diets. However, there is limited literature from Pakistan that involves school-going adolescents in developing and delivering NCD risk-reduction interventions among their younger peers. Objective This study aims to assess the feasibility of co-creating and delivering a youth-led NCD risk reduction intervention in schools of slums in Karachi, Pakistan. Methods Using a mixed-methods, pre- and post-intervention design approach, we will conduct the study in 10 randomly selected schools (5 government and 5 private) in Azam Basti and Mehmoodabad, the urban slums in Karachi. The study comprises five sequential phases: Phase I involves identifying shared risk factors of NCDs among younger peers aged 9 to 12 (grades 5 and 6 students) ( n  = 100) using structured diaries, which will also serve as a pre-intervention assessment. Phase II entails conducting qualitative interviews with youth aged 14 to 16 (grades 9 and 10 students) ( n  = 40), their parents, school head teachers, class teachers, and canteen staff to discuss intervention components, materials, and delivery methods. In Phase III, workshops will be held to co-create the intervention with the help of youth. Phase IV will involve 3 days of comprehensive youth training by a qualified nutritionist on delivering the intervention to their younger peers. Finally, in Phase V, youth will deliver the intervention among all grades 5 and 6 students in their schools, followed by a post-intervention assessment, in which the younger peers will complete the structured diaries for the shared risk factors. Two independent data collectors will also perform fidelity checks of the intervention delivery using a checklist. The expected outcomes will include the feasibility of developing and implementing a culturally relevant youth-led NCD risk reduction intervention and youth training manual. The feasibility of the intervention will be assessed using the recruitment and retention rates for schools, youth, and younger peers, youth attendance at workshops and training sessions, structured diaries completion rates at pre- and post-intervention, the fidelity of delivering the intervention, and the preliminary change in the risk factors at post-intervention compared to the baseline. Ethics and dissemination The study was approved by the Ethical Review Committee of the Aga Khan University (ref.: 2024–9763-29,256). If the intervention proves feasible, we will disseminate our findings to both academic and nonacademic audiences. Additionally, we will implement a definitive trial across various slum settings in Karachi, Pakistan. Trial registration ClinicalTrials.gov, NCT06465771. Registered 20 June 2024—prospectively registered,  https://clinicaltrials.gov/study/NCT06465771 .

Data on the leading shared risk factors of cancer and mental disorders are limited. We included 98,958 participants (54.8% women) aged 45–64 years from the 45 and Up Study who were free of cancer, depression, and anxiety at baseline (2006–2009). The incidence of cancer, mental disorders, and multimorbidity (concurrent cancer and mental disorders) was identified using claim databases during follow-up until 31 December 2016. During a nine-year follow-up, the cumulative incidence of cancer, mental disorders, and multimorbidity was 8.8%, 17.4%, and 2.2%, respectively. Participants with cancer were 3.41 times more likely to develop mental disorders, while individuals with mental disorders were 3.06 times more likely to develop cancer than people without these conditions. The shared risk factors for cancer and mental disorders were older age, female gender, smoking, psychological distress, low fruit intake, poor/fair self-rated health, hypertension, arthritis, asthma, and diabetes. Low education, low income, overweight/obesity, and family history of depression were risk factors for mental disorders and multimorbidity but not cancer. In conclusion, smoking, low fruit intake, and obesity are key modifiable factors for the prevention of cancer and mental disorders. Individuals with poor/fair self-rated health, high psychological distress, asthma, hypertension, arthritis, or diabetes should be targeted for the prevention and screening of cancer and mental disorders.

This paper studies how households choose organic products on a given store visit. We develop a three-stage purchase incidence/brand choice/purchase quantity model for organic products. Shared random effects parameters link the three stages of the model. We empirically quantify the effects of category variables, marketing mix, and demographic variables on the purchase of organic products using a unique household panel dataset that includes actual organic purchase data from two markets, by over 4,500 households in 25 stores for the period between January 2004 and June 2009. First, we find that the purchase of organic products is greater among the high income, college educated, and older families as well as among consumers holding high-level occupations. Second, households tend not to purchase organic products when buying in concentrated categories. Third, on average, households tend to buy organic store brands more than the organic national brands. Promotions of organic brands (feature ad and display) are less likely to drive households to buy organic brands and so does the organic brand's distribution breadth. Finally, price has an inverted U-shaped effect. We discuss the implications of these results for retailers, manufacturers and researchers.