Matthias Egger

Gender and disciplinary differences in grant proposal peer review: Content and sentiment in 39,280 reports

Peer review by experts is central to the evaluation of grant proposals, but little is known about how gender and disciplinary differences shape the content and tone of grant peer review reports. We analyzed 39,280 review reports submitted to the Swiss National Science Foundation between 2016 and 2023, covering 11,385 proposals for Project Funding across 21 disciplines from the Social Sciences and Humanities (SSH), Life Sciences (LS), and Mathematics, Informatics, Natural Sciences, and Technology (MINT). Using supervised machine learning, we classified over 1.3 million sentences by evaluation criteria and sentiment. Reviews in SSH were significantly longer and more critical, with less focus on the applicant's track record, while those in MINT were more concise and positive, with a greater focus on the track record, as compared to those in LS. Compared to male reviewers, female reviewers wrote longer reviews that more closely aligned with the evaluation criteria and expressed more positive sentiments. Female applicants tended to receive reviews with slightly more positive sentiment than male applicants. The tone, length, and focus of peer review reports varied systematically by applicant gender and disciplinary context. These differences have important implications for fairness and consistency in research funding.

A framework for collating and synthesizing evidence from human and animal studies: the GALENOS approach

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies

Reducing spatial clustering to prevent tuberculosis transmission in a busy Zambian hospital: a modelling study based on person movements, environmental and clinical data

Background Hospitals in high-burden tuberculosis (TB) settings are important sites of Mycobacterium tuberculosis ( Mtb) transmission, yet the impact of infection prevention and control (IPC) measures targeting crowding is poorly understood. We assessed the effects of simple interventions to reduce spatial clustering and airborne transmission in a Zambian hospital. Methods and findings From June to August 2024, we prospectively collected clinical data on presumptive (symptom-based screening) and confirmed (Xpert-positive, chest X-ray) TB patients, indoor CO 2 levels, bioaerosol samples, and continuous person movements (optical sensors) in the hospital’s main waiting hall. Airborne Mtb DNA was detected using hourly cyclonic bioaerosol sampling. Using a spatiotemporal Wells–Riley model integrating ventilation, proximity between visitors, and movement patterns, we estimated Mtb transmission risk under routine conditions and during two IPC interventions: (1) an optimised waiting-area layout with physical distancing measures; and (2) an added one-way patient flow system. During 52 days, 668 presumptive and 45 confirmed TB patients visited the hospital, and 671 840 person movements were recorded. Despite excellent natural ventilation (median CO 2 455 ppm; 8.0 air changes per hour), airborne Mtb was detected on six days. The first intervention reduced spatial clustering by an estimated 24% (95% credible interval [CrI] 13–32) and the second by 13% (95% CrI 1–23). The interventions lowered Mtb transmission risk by an estimated 39% (95% CrI 29–48) and 21% (95% CrI 9–32), respectively. Over the four weeks of implementation, they collectively averted an estimated 16 (95% CrI 8–26) infections. Conclusions In this high-burden, well-ventilated hospital, short-range exposure remained a driver of airborne Mtb transmission. Simple, low-cost operational changes to reduce clustering substantially decreased proximity-driven transmission risk. Integrating proximity-focused strategies can meaningfully strengthen IPC in resource-limited healthcare settings.

The relative contribution of close-proximity contacts, shared classroom exposure and indoor air quality to respiratory virus transmission in schools

Close-proximity interactions are considered a key risk factor for respiratory virus transmission, but their importance relative to shared space and air quality remains unclear. We conducted a six-week longitudinal study in a Swiss secondary school (67 students, aged 14–15). We detected 87 infections in saliva samples and recorded absences to identify plausible transmissions, excluding implausible ones through genomic analysis. Time in close proximity (within 1.5 metres) was measured using wearable sensors and air quality via CO 2 monitors. Students spent 21.2 minutes per day in close proximity (interquartile range 7.8–44.2) and 5.3 hours in shared classrooms (IQR 3.8–6.2), during which air quality was suboptimal for 1.9 hours (IQR 1.2–3.0). Using pairwise survival models, we found that transmission was more likely within than between classes. Close proximity was modestly associated with higher transmission risk overall (rate ratio 1.16 per doubling daily time, 95%-CI 1.01–1.33), while time in shared classrooms (RR 3.17, 95%-CI 1.96–5.17) and suboptimal air quality (RR 1.90 95%-CI 1.23–2.94) also predicted within-class risk. Prolonged exposure in shared, poorly ventilated spaces, which potentially includes several infectious sources, drives respiratory virus transmission more than close contact.

The effect of long-acting cabotegravir and rilpivirine treatment on drug resistance in South Africa: a modelling study

BACKGROUND: Long-acting injectable cabotegravir and rilpivirine (LAI cabotegravir and rilpivirine) is recommended as maintenance therapy for people living with HIV who achieved viral suppression on oral antiretroviral therapy (ART). However, its effect on drug resistance evolution in resource-limited settings remains uncertain. We aimed to assess this effect under different roll-out strategies and explore key factors for resistance. METHODS: We extended the Modelling Antiretroviral Drug Resistance In South Africa (MARISA) model to assess the effect of introducing LAI cabotegravir and rilpivirine in South Africa from 2025 to 2045. The HIV transmission rate was recalibrated using incidence estimates from the Thembisa model. We considered three strategies: dolutegravir-based ART as per current guidelines; LAI cabotegravir and rilpivirine as a switching option for those with viral suppression; and LAI cabotegravir and rilpivirine for both switching and ART initiation. We assumed faster development of integrase strand transfer inhibitor (INSTI) resistance in individuals with viraemia (≥1000 copies/mL) on LAI cabotegravir and rilpivirine than those with viraemia on dolutegravir-based ART. We evaluated their effect on pre-treatment drug resistance (PDR) and transmitted drug resistance (TDR) for INSTI and rilpivirine, explored resistance mitigation strategies, and identified key uncertainties through one-at-a-time local and global sensitivity analyses. FINDINGS: By 2045, using LAI cabotegravir and rilpivirine for both switching and ART initiation was estimated to lead to higher INSTI resistance levels, with 30·6% INSTI PDR and 11·3% INSTI TDR at 30% LAI cabotegravir and rilpivirine coverage, compared with 14·0% INSTI PDR and 6·9% INSTI TDR with continued oral dolutegravir-based ART. Rilpivirine resistance under the LAI cabotegravir and rilpivirine initiation and switch strategy was estimated to increase to 41·0% PDR and 30·0% TDR, compared with 6·7% and 4·5% with oral dolutegravir-based ART. Resistance levels were similar for LAI cabotegravir and rilpivirine as a switching option for those with viral suppression. A course of oral ART after LAI cabotegravir and rilpivirine interruption (oral bridging) decreased the risk of drug resistance due to the long pharmacokinetic tail, resulting in 22·3% INSTI PDR and 26·0% rilpivirine PDR when using LAI cabotegravir and rilpivirine for both switching and ART initiation. Key factors influencing resistance levels were care disengagement rates, LAI cabotegravir and rilpivirine coverage, and INSTI mutation reversion rates. INTERPRETATION: LAI cabotegravir and rilpivirine roll-out in South Africa should be cautious and targeted. Resistance risks may be mitigated through pre-treatment resistance testing, close monitoring of treatment outcomes, and efforts to increase retention in care.

Immunodeficiency, HIV Viremia, and Incident Anal Cancer Among People With HIV in South Africa

Among 130 992 people with HIV (PWH) in South Africa, 60 anal cancers were diagnosed. Lower CD4 counts and, to a lesser extent, higher HIV RNA viral loads were associated with an increased anal cancer risk. Maintaining high CD4 counts may contribute to anal cancer prevention among PWH in South Africa.

Novel integrase mutations linked to genotypic DTG resistance in non-B HIV-1 strains from African participants: The DTG RESIST study

Absences, Symptoms and Respiratory Viruses in a Swiss School: Longitudinal Study With Serial Saliva Sampling

Incidence and prognostic factors of self-harm and subsequent unnatural death in South Africa: A cohort study

Transparent Reporting of Observational Studies Emulating a Target Trial—The TARGET Statement

Transparent reporting of observational studies emulating a target trial: the TARGET Statement.

Anal cancer incidence rates among men and women with and without HIV in South Africa

A Supervised Machine Learning Approach for Assessing Grant Peer Review Reports

The relative contribution of close-proximity contacts, shared classroom exposure and indoor air quality to respiratory virus transmission in schools.

Mental, physical, and respiratory health in people with tuberculosis in Southern Africa: a multi-country cohort analysis

Life‐years lost associated with mental disorders in people with HIV: a cohort study in South Africa, Canada and the United States

Is suicide risk 100‐fold higher in people with HIV? A critical appraisal of a meta‐analysis

To the editor: “A recent systematic review shows that the risk of death by suicide is 100 times higher in people living with HIV than in the general population”—World Health Organization, 2022The estimate that the risk of suicide is 100-fold higher in people with HIV (PWH) than in the general population is widely cited, including in the World Health Organization’s (WHO’s) World Mental Health report from which the above quote is taken.

Drug Resistance in People With Viremia on Dolutegravir-based Antiretroviral Therapy in Sub-Saharan Africa: The DTG RESIST Study

Dolutegravir resistance is an increasing concern. An analysis of the DTG RESIST study found that among 227 integrase sequences from 7 African countries (all non-B subtypes), 59 (26.0%) had at least 1 major drug resistance mutation (primarily G118R and E138A/K/T), with 49 (21.6%) predicted to have high-level resistance to dolutegravir.

Measuring the Performance of Survival Models to Personalize Treatment Choices

Various statistical and machine learning algorithms can be used to predict treatment effects at the patient level using data from randomized clinical trials (RCTs). Such predictions can facilitate individualized treatment decisions. Recently, a range of methods and metrics were developed for assessing the accuracy of such predictions. Here, we extend these methods, focusing on the case of survival (time-to-event) outcomes. We start by providing alternative definitions of the participant-level treatment benefit; subsequently, we summarize existing and propose new measures for assessing the performance of models estimating participant-level treatment benefits. We explore metrics assessing discrimination and calibration for benefit and decision accuracy. These measures can be used to assess the performance of statistical as well as machine learning models and can be useful during model development (i.e., for model selection or for internal validation) or when testing a model in new settings (i.e., in an external validation). We illustrate methods using simulated data and real data from the OPERAM trial, an RCT in multimorbid older people, which randomized participants to either standard care or a pharmacotherapy optimization intervention. We provide R codes for implementing all models and measures.