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The tidal disruption of a star by a supermassive black hole leads to a short-lived thermal flare. Despite extensive searches, radio follow-up observations of known thermal stellar tidal disruption flares (TDFs) have not yet produced a conclusive detection. We present a detection of variable radio emission from a thermal TDF, which we interpret as originating from a newly launched jet. The multiwavelength properties of the source present a natural analogy with accretion-state changes of stellar mass black holes, which suggests that all TDFs could be accompanied by a jet. In the rest frame of the TDF, our radio observations are an order of magnitude more sensitive than nearly all previous upper limits, explaining how these jets, if common, could thus far have escaped detection.

The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps.

Objective. Tenofovir disoproxil fumarate (TDF) is associated with proximal tubular dysfunction (tubulopathy) when used in the treatment of human immunodeficiency virus (HIV) infection. We evaluated whether TDF causes tubulopathy when used as HIV preexposure prophylaxis (PrEP) and whether tubulopathy predicts clinically relevant decline (≥25%) in the estimated glomerular filtration rate (eGFR). Methods. A subgroup analysis of the Partners PrEP Study, a randomized, placebo-controlled trial of daily oral TDF, alone or with emtricitabine (FTC), in HIV-uninfected African men and women (Clinicaltrials. gov NCT00557245). Tubulopathy was assessed in concurrently obtained urine and serum samples at the 24-month or last on-treatment visit, predefined as ≥2 of the following: tubular proteinuria, euglycemic glycosuria, increased urinary phosphate, and uric acid excretion. Results. Of 1549 persons studied (776 receiving FTC-TDF, 773 receiving placebo), 64% were male, and the median age was 37 years. Over a median 24 months of study-drug exposure, the frequency of tubulopathy was 1.7% for FTC-TDF versus 1.3% for placebo (odds ratio, 1.30; 95% confidence interval, .52-3.33; P = .68); Tubulopathy occurred in 2 of 52 persons (3.8%) with versus 3 of 208 (1.4%) without ≥25% eGFR decline (adjusted odds ratio, 1.39; .10-14.0; P>.99). Conclusions. Daily oral FTC-TDF PrEP was not significantly associated with tubulopathy over the course of 24 months, nor did tubulopathy predict clinically relevant eGFR decline.

Objective We compared the efficacy of four treatment strategies for chronic hepatitis B (CHB): tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), tenofovir amibufenamide (TMF), and TDF-to-TAF switch strategies strategy. We conducted a network meta-analysis to provide evidence-based clinical guidance. Methods We systematically retrieved PubMed, Web of Science, Cochrane Library, Embase, and China National Knowledge Infrastructure (CNKI) databases up to April 2025 for randomized controlled trials (RCTs) and cohort studies. We assessed literature quality using the Cochrane Risk of Bias (ROB) tool and Newcastle-Ottawa Scale (NOS). Stata 17 was employed for network meta-analysis, focusing on virological response rate, hepatitis B surface antigen (HBsAg) clearance rate, hepatitis B e antigen (HBeAg) clearance rate, and alanine aminotransferase (ALT) normalization rate. Results Virological response did not differ between TMF monotherapy and TDF-to-TAF switch (OR = -0.03; 95% CI -0.42 to 0.36). HBsAg clearance was similar between TAF and TMF (95% CI: -1.17-1.14). For the rate of HBeAg loss, both TAF and TMF exhibited favorable therapeutic effects. For ALT normalization rate, TMF monotherapy was the most effective, with an average effect size of 0.11 (95% CI: -0.14-0.37), while TDF monotherapy was generally inferior to the other three treatment strategies. Conclusion Our findings may help guide the selection of individualized CHB treatment strategies. However, given the limited evidence and potential bias, these results are preliminary and must be interpreted with caution. For regimens such as TMF that lack robust data, well-established alternatives should be preferred. Long-term, multi-endpoint studies are required to confirm both efficacy and safety before routine clinical adoption.

Background Though bictegravir/emtricitabine/tenofovir (BIC/FTC/TAF) have been regulatory approved and included in the National Reimbursement Drug List in China, due to the affordability concern, generic version of efavirenz + lamivudine + tenofovir (EFV + 3TC + TDF) is still recommended as the first-line therapy in the clinical guideline and widely used in clinical practice. The aim of the study is to assess the persistence with first-line BIC/TAF/TAF and EFV + 3TC + TDF in newly treated HIV-1 patients in the real-world setting in Hunan Province in China. Methods A retrospective analysis of the medical records of HIV patients initiating first-line antiretroviral therapy in the First Hospital of Changsha in January 1st, 2021-July 31st, 2022 was conducted. Persistence was assessed as the number of days on the therapy from the index until treatment discontinuation or end of data availability. Kaplan-Meier Curves and Cox Proportional Hazard models were used to evaluate the discontinuation rates. Subgroup analysis was performed excluding BIC/FTC/TAF patients with treatment discontinuation due to economic reason, and EFV + 3TC + TDF patients with a viral load > 500,000 copies/mL. Results A total of 310 eligible patients were included in the study, with 244 and 66 patients in the BIC/FTC/TAF group and EFV + 3TC + TDF group, respectively. Compared with EFV + 3TC + TDF patients, BIC/FTC/TAF patients were older, more living in the capital city currently, and had significantly higher total cholesterol and low-density level (all p < 0.05). No significant difference was shown in the time to discontinuation between BIC/FTC/TAF patients and EFV + 3TC + TDF patients. After excluding BIC/FTC/TAF patients with treatment discontinuation due to economic reason, EFV + 3TC + TDF group were shown to have a significantly higher risk of discontinuation than BIC/FTC/TAF group (hazard ratio [HR] = 11.1, 95% confidence interval [CI] = 1.3–93.2). After further removing the EFV + 3TC + TDF patients with a viral load > 500,000 copies/mL, the analysis showed similar results (HR = 10.1, 95% CI = 1.2–84.1). 79.4% of the EFV + 3TC + TDF patients discontinued treatment due to clinical reasons, while 83.3% of the BIC/FTC/TAF patients discontinued treatment due to economic reasons. Conclusions Compared with BIC/FTC/TAF, EFV + TDF + 3TC patients were significantly more likely to discontinue the first-line treatment in Hunan Province in China.

Gas accretion onto some massive black holes (MBHs) at the centers of galaxies actively powers luminous emission, but most MBHs are considered dormant. Occasionally, a star passing too near an MBH is torn apart by gravitational forces, leading to a bright tidal disruption flare (TDF). Although the high-energy transient Sw 1644+57 initially displayed none of the theoretically anticipated (nor previously observed) TDF characteristics, we show that observations suggest a sudden accretion event onto a central MBH of mass about 10 6 to 10 7 solar masses. There is evidence for a mildly relativistic outflow, jet collimation, and a spectrum characterized by synchrotron and inverse Compton processes; this leads to a natural analogy of Sw 1644+57 to a temporary smaller-scale blazar.

Background The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers. Methods The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26–59 years, mean age 40.9 [SD = 10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation – Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention. Results Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Motivation was highlighted as a core target for intervention, both reflective  Motivation , such as beliefs about capability and intention and automatic in terms of overcoming habit through reinforcement. Seven intervention functions and three policy categories from the BCW were identified as relevant . Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace. Conclusions The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease sitting in the workplace. Intervention designers should consider the identified BCW factors and BCTs when developing interventions to reduce and break up workplace sitting.

Background Enabling behaviour change in health care is a complex process. Although the use of theory to inform behaviour change interventions is advocated, there is limited information about how this might best be achieved. There are multiple models of behaviour change, however, due to their complexity they can be inaccessible to both researchers and healthcare practitioners. To support health care practitioner behaviour change, this was addressed by the development of the Theoretical Domains Framework (TDF) in 2005. Citations of the TDF and associated papers have increased exponentially. Although not predicted or intended by the authors, the TDF has also been used to investigate health behaviour change interventions. Therefore our aim was to narratively synthesize empirical evidence on how the TDF and subsequent iterations have been applied in health behaviour change to inform future intervention development. Methods Systematic search of four online databases, combined with searches for citations of key papers and key author searches, resulted in 3551 articles eligible for screening. Of these 10 met the pre-determined inclusion criteria. Screening of full-texts, data extraction and quality appraisal were independently performed by both authors. Disagreements regarding eligibility were resolved through discussion. Results Of the 10 included studies three used the TDF and seven used subsequent iterations, the Capability, Opportunity, Motivation to Behaviour / Behaviour Change Wheel to assess and /or categorise behavioural determinants to identify relevant behaviour change techniques. Two studies reported feasibility testing. Most interventions were targeted at diet and exercise. Eight reported an explicit and systematic process in applying the framework. Conclusion There is limited evidence of how the framework has been used to support health behaviour change interventions. In the included studies the process of using the framework is not always reported in detail or with clarity. More recent studies use a systematic and judicious process of framework application. From the limited evidence available we tentatively suggest that the steps proposed in the BCW appear to be sufficient for development of interventions that target health behaviour change interventions. Further research is needed to provide evidence in how the framework may be most effectively applied to intervention development. Protocol registration PROSPERO CRD42018086896 .

Background. Daily, oral use of tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) for preexposure prophylaxis (PrEP) is an effective strategy to prevent acquisition of human immunodeficiency virus (HIV) infection. It is important to monitor PrEP uptake at the national level to increase our understanding of trends in its utilization, but national HIV surveillance data do not include PrEP uptake. Our objective was to develop feasible methods to estimate PrEP uptake and to estimate uptake each year among commercially insured persons during 2010–2014. Methods. We conducted a retrospective analysis of the 2010–2014 MarketScan database, a national sample of persons with commercial health insurance in the United States. We developed an algorithm to identify persons aged ≥ 16 years who were prescribed TDF-FTC for PrEP each year. We generated nationally representative estimates of prevalence of persons prescribed PrEP. Results. We found a significantly increasing trend in the proportion of persons prescribed TDF-FTC for PrEP during the study period, with 417 users in 2010 and 9375 in 2014 (P < .001); 97% of PrEP users were male and 98% lived in metropolitan areas in 2014. During the study period, the numbers of women prescribed PrEP were low. Conclusions. Our analytic method provides the only feasible means to monitor PrEP uptake in the United States. Although a marked increasing trend in uptake was observed for men, the number of women who used PrEP remained very low during the study period. Interventions are needed to increase PrEP use by women at substantial risk of acquiring HIV infection.

High amounts of sedentary behaviour, such as sitting, can lead to adverse health consequences. Interventions to break up prolonged sitting in the workplace have used active workstations, although few studies have used behaviour change theory. This study aimed to combine the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation to Behaviour system (COM-B) to investigate perceived barriers and facilitators to breaking up sitting in desk-based office workers. Semi-structured interviews with 25 desk-based employees investigated barriers and facilitators to breaking up sitting in the workplace. Seven core inductive themes were identified: ‘Knowledge-deficit sitting behaviour’, ‘Willingness to change’, ‘Tied to the desk’, ‘Organisational support and interpersonal influences’, ‘Competing motivations’, ‘Emotional influences’, and ‘Inadequate cognitive resources for action’. These themes were then deductively mapped to 11 of the 14 TDF domains and five of the six COM-B constructs. Participants believed that high amounts of sitting had adverse consequences but lacked knowledge regarding recommendations and were at times unmotivated to change. Physical and social opportunities were identified as key influences, including organisational support and height-adjustable desks. Future research should identify intervention functions, policy categories and behaviour change techniques to inform tailored interventions to change sitting behaviour of office workers.