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Background:The scale of the 2022 global mpox (formerly known as monkeypox) outbreak has been unprecedented. In less than 6 months, non-endemic countries have reported more than 67 000 cases of a disease that had previously been rare outside of Africa. Mortality has been reported as rare but hospital admission has been relatively common. We aimed to describe the clinical and laboratory characteristics and outcomes of individuals admitted to hospital with mpox and associated complications, including tecovirimat recipients. Methods:In this cohort study, we undertook retrospective review of electronic clinical records and pathology data for all individuals admitted between May 6, and Aug 3, 2022, to 16 hospitals from the Specialist and High Consequence Infectious Diseases Network for Monkeypox. The hospitals were located in ten cities in England and Northern Ireland. Inclusion criteria were clinical signs consistent with mpox and MPXV DNA detected from at least one clinical sample by PCR testing. Patients admitted solely for isolation purposes were excluded from the study. Key outcomes included admission indication, complications (including pain, secondary infection, and mortality) and use of antibiotic and anti-viral treatments. Routine biochemistry, haematology, microbiology, and virology data were also collected. Outcomes were assessed in all patients with available data. Findings:156 individuals were admitted to hospital with complicated mpox during the study period. 153 (98%) were male and three (2%) were female, with a median age of 35 years (IQR 30–44). Gender data were collected from electronic patient records, which encompassed full formal review of clincian notes. The prespecified options for data collection for gender were male, female, trans, non-binary, or unknown. 105 (71%) of 148 participants with available ethnicity data were of White ethnicity and 47 (30%) of 155 were living with HIV with a median CD4 count of 510 cells per mm3(IQR 349–828). Rectal or perianal pain (including proctitis) was the most common indication for hospital admission (44 [28%] of 156). Severe pain was reported in 89 (57%) of 156, and secondary bacterial infection in 82 (58%) of 142 individuals with available data. Median admission duration was 5 days (IQR 2–9). Ten individuals required surgery and two cases of encephalitis were reported. 38 (24%) of the 156 individuals received tecovirimat with early cessation in four cases (two owing to hepatic transaminitis, one to rapid treatment response, and one to patient choice). No deaths occurred during the study period. Interpretation:Although life-threatening mpox appears rare in hospitalised populations during the current outbreak, severe mpox and associated complications can occur in immunocompetent individuals. Analgesia and management of superimposed bacterial infection are priorities for patients admitted to hospital.

Exercise is good for health and well-being, yet people experience lapses when trying to adhere to exercise. Self-compassion may help people cope with exercise lapses. Most research on self-compassion and exercise has been conducted with women; men may also benefit from self-compassion. No research has examined whether gender-role schema influences responses to exercise lapses. The authors examined both male and female adult exercisers (N = 220) who reported their self-compassion, recalled an exercise lapse, their reactions to the lapse, and their self-identification of masculinity and femininity. After controlling for self-esteem, age, and lapse importance, self-compassion negatively related to emotional responses (p p p = .004), and positively related to intrinsic motivation (p p = .006), and identified regulation (p = .01). Self-compassion may be an effective resource for exercisers, especially those who identify as highly masculine.

Transactions of the Leicestershire Archaeological and Historical Society, 52, 62-68, New Walk has come full circle; attitudes concerning the desirability of an urban walkway are as strong now as they were in the late eighteenth century. In between there was a longish period (1930-1960) when physical decay coupled with public and official apathy threatened its continued existence. The possibility of New Walk having a future as a non-residential street was indicated by the growing number of commercial concerns locating along it in the post-war years. This, coupled with a realization of its historical uniqueness, provided the necessary stimulus for its regeneration using a conservation approach.

Adjusting identity standards may be preferable to relentless pursuit or abandonment of an identity when facing an identity-challenging life transition. Self-compassion (SC) can help people adjust to challenges. The authors examined whether SC was associated with identity adjustment, exercise, and the moderating effect of identity–behavior discrepancy in 279 women exercisers who reported reduced exercise in motherhood. Participants completed the Self-Compassion Scale and reported the extent of and reflected on their identity discrepant behavior (reduced exercise). Reactions to discrepancy (acceptance, shame, guilt, and rumination), correlates of identity adjustment (subjective well-being, autonomous motivation, controlled motivation, and role conflict), and exercise behavior were assessed. SC associated positively with acceptance, correlates of successful identity adjustment, and exercise behavior. SC associated negatively with shame, rumination, and correlates of unsuccessful adjustment. SC may help exercise-identifying women who exercise less after becoming mothers adaptively cope with this identity challenge and continue exercising.

Objective: To explore university students' knowledge, self-efficacy, outcome expectations, barriers and ideas related to reducing sedentary behavior using a qualitative approach. Participants: Nineteen students from a Canadian university participated. Methods: Four focus groups were conducted. Discussions were recorded, transcribed, and coded to identify categories and themes. Results: Some students lacked knowledge of the concept, but most were generally aware of health risks associated with sedentary behavior. Most students were confident they could reduce sedentary behavior, but felt it would be unlikely they would actually do so because: (a) it is not a priority, (b) the health consequences are distal, (c) increasing standing and light-intensity activity would not provide meaningful health benefits, and (d) class schedules/norms/infrastructure encourage sitting and are not under their control to change. Conclusion: Findings from this study may help inform intervention strategies aimed at decreasing excessive sedentary behavior among university students.

Smoke plume dynamic science focuses on understanding the various smoke processes that control the movement and mixing of smoke. A current challenge facing this research is providing timely and accurate smoke information for the increasing area burned by wildfires in the western USA. This chapter synthesizes smoke plume research from the past decade to evaluate the current state of science and identify future research needs. Major advances have been achieved in measurements and modeling of smoke plume rise, dispersion, transport, and superfog; interactions with fire, atmosphere, and canopy; and applications to smoke management. The biggest remaining gaps are the lack of high-resolution coupled fire, smoke, and atmospheric modeling systems, and simultaneous measurements of these components. The science of smoke plume dynamics is likely to improve through development and implementation of: improved observational capabilities and computational power; new approaches and tools for data integration; varied levels of observations, partnerships, and projects focused on field campaigns and operational management; and new efforts to implement fire and stewardship strategies and transition research on smoke dynamics into operational tools. Recent research on a number of key smoke plume dynamics has improved our understanding of coupled smoke modeling systems, modeling tools that use field campaign data, real-time smoke modeling and prediction, and smoke from duff burning. This new research will lead to better predictions of smoke production and transport, including the influence of a warmer climate on smoke.

Sleep quality (SQ) impacts health yet many university students get poor sleep. Self-compassion (SC)—care for oneself during challenging times—is associated with SQ yet how SC has these effects is unclear. This study cross-sectionally examined whether SC is negatively related to poor SQ and whether proactive health focus and cognitive emotional regulation strategies (CERS) mediate this relationship. University students ( N = 193) self-reported SC, proactive health focus, CERS, and SQ. SC negatively associated with poor SQ ( r = −0.34) and self-blame mediated this ( b = 0.08, 95% CI [0.01, 0.16]). SC may improve SQ through reducing self-blame.

Objective To evaluate the long‐term safety of rituximab in an observational cohort of patients with rheumatoid arthritis (RA) who had an inadequate response to ≥1 anti–tumor necrosis factor therapy in the US (SUNSTONE [Study of the Safety of Rituxan in Patients With Rheumatoid Arthritis After an Inadequate Response to Previous Anti‐TNF Therapy] registry). Methods In this prospective, observational cohort study, patients received rituximab according to their physician's standard practice and were evaluated at standard‐of‐care follow‐up visits at least every 6 months. The primary outcome was the incidence of protocol‐defined significant infections. Secondary outcomes included serious adverse events potentially associated with rituximab, cardiovascular or thrombotic events, seizures, deaths, and pregnancies. Post hoc analyses assessed outcomes by concomitant medication use. Results Overall, 989 patients (safety‐evaluable population) received ≥1 dose of rituximab, with a total follow‐up of 3,844 patient‐years (mean duration 3.9 years). In total, 341 significant infections occurred in 197 patients (19.9%). The incidence rates (95% confidence intervals [95% CIs]) for significant infections, cardiovascular or thrombotic events, and seizures were 8.87 (95% CI 7.98–9.86), 1.95 (95% CI 1.56–2.45), and 0.18 (95% CI 0.09–0.38) per 100 patient‐years, respectively. The incidence of significant infections did not increase with time or with cumulative rituximab exposure. During the study, 64 patients died (crude mortality rate 1.66 per 100 patient‐years [95% CI 1.30–2.13]). The most common causes of death were infections (n = 19), malignancy (n = 14), and cardiovascular events (n = 13). Eight pregnancies were reported in 7 patients. Conclusion In patients with RA treated with rituximab for up to 5 years, the rates of significant infections were stable over time and higher in patients who received long‐term systemic steroid treatment.

Standardizing the Fried criteria (S-FC) using cutoffs specific to the patient population improves adverse outcome prediction. However, there is limited evidence to determine if a S-FC assessment can improve discrimination of cardiovascular disease (CVD) risk in middle-aged and older women.The objective of this cross-sectional analysis was to compare the ability of the Fried frailty phenotype criteria (FC) to discriminate between individuals at higher risk for CVD according to the Framingham Risk Score and Rasmussen Disease Score in comparison to the S-FC.Asper Clinical Research Institute, St. Boniface Hospital Research Centre.985 women 55 years of age or older with no previous history of CVD.Discrimination of individuals with high CVD risk according to the Framingham and Rasmussen Disease scores was assessed using receiver operating characteristic (ROC) curves, integrated discrimination index (IDI) and net reclassification index (NRI).The S-FC showed superior ability to discriminate CVD risk as assessed by area under the ROC curve (AUROC) based on the Framingham (0.728 vs 0.634, p 0.001), but not for the Rasmussen (0.594 vs 0.552, p = 0.079) risk score. Net reclassification index identified improved discrimination for both the Framingham (67.9%, p 0.001) and Rasmussen Disease scores (26.0%, p = 0.003). Integrated discrimination index also identified improved CVD risk discrimination with the Framingham (3.0%, p 0.001) and Rasmussen Disease scores (1.5%, p 0.001).In this study, the Fried frailty phenotype better discriminated cardiovascular disease risk when standardized to the study population.

Self-compassion is associated with many positive outcomes and is generally viewed as an adaptive way of responding during difficult times. But self-compassion has also been positively associated with savoring, a way of responding to positive experiences that involves attempting to sustain or intensify positive emotions, and little is known about the direction of this relationship or whether it generalizes to responses immediately after a positive event. We conducted two studies to learn more about the directionality (Study 1) and generalizability (Study 2) of this relationship. In Study 1, athletes (N = 298) completed assessments of self-compassion and savoring capacity at two time-points throughout a season. We tested a cross-lagged panel model and found that self-compassion predicted increases in savoring, but savoring did not predict change in self-compassion. In Study 2, sports fans (N = 244) reported the extent to which they engaged in savoring immediately after their favorite team had won a championship game. The results showed that self-compassion was positively associated with savoring following the game. Overall, this research reveals more about the directionality and generalizability of the relationship between self-compassion and savoring, and shows that the effects of self-compassion extend to the positive side of the human experience.

Self-compassion predicts mothers’ engagement in health behaviours yet some mothers fear self-compassion. We examined relationships between both self-compassion and fear of self-compassion with mothers’ reactions to prioritizing health behaviours. Mothers rated their self-compassion, fear of self-compassion, read a scenario about prioritizing health behaviours and rated adjectives describing themselves if they behaved as described in the scenario. Self-compassion was positively related to positive reactions to engaging in health behaviours in the midst of motherhood. Fear of self-compassion led to negative reactions. This research provides insight into why some mothers feel better about incorporating health behaviours into their lives than others.

Supplemental material, sj-pdf-1-hpq-10.1177_1359105321995979 for Put MY mask on first: Mothers’ reactions to prioritizing health behaviours as a function of self-compassion and fear of self-compassion by Kaeley M Simpson, Brittany N Semenchuk and Shaelyn M Strachan in Journal of Health Psychology

The high rate of global physical inactivity has led researchers to explore the psychological variables that impact physical activity (PA) behaviours. Drawing from tenets of control theory and literature on self-conscious emotions, the current study investigated the experience of guilt and shame in response to engaged in and missed PA. One hundred and fifty-four adults (Mage = 34.02, SD = 12.27) completed online questionnaires over a three-week period. Paired sample t-tests showed participants experience more guilt and shame after a missed intended PA session than an engaged-in session and, of the two, guilt is felt more strongly (t (150) = 8.31, p

This work was supported by the Rural & Environment Science & Analytical Services Division of the Scottish Government, the BBSRC, through the joint projects CRF/2009/SCRI/SOP 0929, BB/L008025/1 and BB/K018299/1. Additional funding was obtained through the James Hutton Institute SEEDCORN initiative, AHDB Potato, the Perry Foundation and The Felix Cobbold Trust. Amanpreet Kaur was supported by the Commonwealth Scholarship Commission through a Commonwealth split-site Ph.D. grant. Key message: The nematode resistance gene H2 was mapped to the distal end of chromosome 5 in tetraploid potato. The H2 resistance gene, introduced into cultivated potatoes from the wild diploid species Solanum multidissectum, confers a high level of resistance to the Pa1 pathotype of the potato cyst nematode Globodera pallida. A cross between tetraploid H2-containing breeding clone P55/7 and susceptible potato variety Picasso yielded an F1 population that segregated approximately 1:1 for the resistance phenotype, which is consistent with a single dominant gene in a simplex configuration. Using genome reduction methodologies RenSeq and GenSeq, the segregating F1 population enabled the genetic characterisation of the resistance through a bulked segregant analysis. A diagnostic RenSeq analysis of the parents confirmed that the resistance in P55/7 cannot be explained by previously characterised resistance genes. Only the variety Picasso contained functionally characterised disease resistance genes Rpi-R1, Rpi-R3a, Rpi-R3b variant, Gpa2 and Rx, which was independently confirmed through effector vacuum infiltration assays. RenSeq and GenSeq independently identified sequence polymorphisms linked to the H2 resistance on the top end of potato chromosome 5. Allele-specific KASP markers further defined the locus containing the H2 gene to a 4.7 Mb interval on the distal short arm of potato chromosome 5 and to positions that correspond to 1.4 MB and 6.1 MB in the potato reference genome. Publisher PDF

The aim of this study was to determine whether self-compassion—orientation to care for oneself during challenges—helps people at risk of cardiovascular disease deal with emotional reactions and assist with self-regulating health behaviors. This observational study recruited women ( N = 102) who attended three research visits over 3 weeks to gather information on emotions, intentions, and engagement in health behaviors after women received news they were at risk of cardiovascular disease. Self-compassion negatively associated with emotional responses and associated with intentions and engagement in health behaviors after receiving news of their cardiovascular disease risk. Self-compassion was associated with adaptive lifestyle behaviors.

BACKGROUND Research about exercise adherence amongst adults with arthritis has been largely correlational, and theoretically based causal studies are needed. We used an experimental design to test the social cognitive theory premise that high self-efficacy helps to overcome challenging barriers to action. METHODS Exercising individuals (N = 86; female = 78%; M age = 53; BMI = 27) with differential self-regulatory efficacy for managing salient, non-disease barriers were randomly assigned to many or few barrier conditions. Individuals responded about the strength of their anticipated persistence to continue exercise, and their self-regulatory efficacy to use exercise-enabling coping strategies. RESULTS In the many barriers condition, higher barriers-efficacy individuals expressed (a) greater persistence (Cohen's d = 0.75 [-0.029, 1.79]) and (b) more confidence in their coping solutions (Cohen's d = 0.65 [-0.30, 1.60]) than lower barriers-efficacy counterparts. CONCLUSION Experimental support was obtained for the theoretical premise that when facing the greatest barrier challenge, individuals highest in self-regulatory efficacy still view exercise as possible. Findings suggest that identifying lower efficacy exercisers with arthritis to tailor their exercise to increase self-regulatory efficacy might also improve their adherence.

Objectives We examined exercisers’ affective and self-presentational reactions to identity confirming or disconfirming feedback in the presence of another person. Design Randomized Experiment. Methods Adult exercisers completed baseline measures prior to a laboratory session. Participants were randomly assigned to receive exercise identity confirming (n = 54) or disconfirming (n = 47) feedback in the presence of a confederate participant. After, participants indicated their level of agreement and completed measures of affect. Lastly, participants were provided with an opportunity for impression construction and completed an additional affect measure. Results A MANOVA comparing groups revealed group differences, F (94, 6) = 31.88, p Discussion Findings provide support for an understudied tenet of identity theory and suggest that exercise identity feedback from others may be a legitimate source of exercise identity feedback.

We revise the data fitting in our original paper [The dissolution rates of simulated UK Magnox - ThORP blend nuclear waste glass as a function of pH, temperature and waste loading, Miner. Mag.79 (2015) 1529–1542]. The intrinsic rate constant data were calculated incorrectly, the corrected data are presented herein. To support the corrected analysis we have also taken the opportunity to report some additional 90°C data. The conclusions of the original paper remain sound.

Self-compassion facilitates health behavior self-regulation; few studies have examined self-compassion and exercise. This online, cross-sectional study investigated self-compassion's relationship with exercise self-regulation of an exercise setback. Adults (N = 105) who had experienced an exercise setback within the last 6 months completed baseline measures, recalled an exercise setback, and completed questionnaires assessing self-regulation in this context. Self-compassion associated with self-determined motivations and exercise goal reengagement, and negatively related to extrinsic motivations, state rumination, and negative affect. Self-compassion predicted unique variance, beyond self-esteem, in exercise goal reengagement, external regulation, state rumination, and negative affect experienced after an exercise setback. Self-compassion and self-esteem had unique relationships with goal reengagement, state rumination, and situational motivation, while having a complementary relationship with negative affect. This research adds to the few studies that examine the role of self-compassion in exercise self-regulation by examining how self-compassion and self-esteem relate to reactions to a recalled exercise setback.

Exercise is strongly linked to well-being, although a better understanding of mechanisms underlying this relationship is needed. Concepts from Identity Theory and the Dualistic Model of Passion sho...

Seeing oneself as a physically active person is one of the strongest predictors of physical activity behaviour and self-regulatory strategies. Determining whether and how physical activity self-perceptions can be stimulated may help low-active individuals who do not see themselves as a physically active person become more active. Cross-sectional research has tested the Physical Activity Self-Definition (PASD) model among active samples; longitudinal studies among low-active adults have yet to be done. The purpose of this study was to test the predictive power of the PASD model among low-active adults over a 16-week physical activity intervention. Participants completed surveys of validated questionnaires in-person at baseline (pre-intervention) and at 16-weeks (end of intervention) at one of two primary care facilities. The final sample included 119 low-active adults. Partial least squares-structural equation modeling indicated that the original model had small-medium predictive power (Q2 = 0.22; SRMR = 0.13 [0.05, 0.07]; RMSE = 1.13; MAE = 0.9; BIC = 1348.40). Two paths were added in the revised model (perceived wanting—PASD; perceived ability—perceived commitment), which explained an additional 4% and 5% of the variance in perceived commitment (R2 = 0.62 [0.48, 0.72]) and PASD (R2 = 0.74 [0.64, 0.80]; all p’s

Various rate equations for the dissolution of silicate glasses have been discussed in the literature. In this article, the published results from studies are discussed in which the dissolution rate data are collected under high flow conditions such that saturation with respect to alteration products is avoided. Additionally, the studies also covered broad ranges of temperature and pH. Starting with nuclear waste glass studies, a two-term rate expression is used to fit data with the result that the data point toward a three-term expression offered by Kohler et al. (2003). These rate expressions contain two or three pre-exponential or rate constants. However, it appears that a single rate constant, an intrinsic rate constant, is consistent with the data. Thus, a rate expression of the form R = k i exp - E a H + RT a H η H + exp - E a H 2 O RT + exp - E a OH - RT a OH η OH appears to be applicable to a broad range of glasses. Here, R is the rate of dissolution, mol/(m2·s) or similar; E is the activation energy associated with the acid, water, or hydroxide activated reactions, kJ/mol; a is the activity of H+, H2O, or OH−, unitless; η is the order of the reaction with respect to H+, H2O, or OH−; R is the gas constant, kJ/(mol·K); T is the temperature, Kelvin; and ki is the intrinsic rate constant, mol/(m2·s) or similar. The contribution to the overall rate from the ‘water’ term is evident as a minor contribution in the middle pH range for some glass compositions and a major contributor for others. One nuclear waste glass (the Japanese P0798), a basalt glass (Kohler et al., 2003), and a glass with a mineral composition (Bourcier, 1998) exhibit this contribution as a relatively flat response to changes in pH in the range of 5–8. However, to distinguish between the possible rate laws, more experiments and more carefully constrained experimentation are needed. These may include experiments at pH values that differ by as little as 0.25. Lastly, experiments with glasses of different compositions are needed to determine the dependence of the intrinsic rate constant on the glass composition and structure, i.e. non-bridging oxygens, Si–O–Si and Si–O–X (X = a matrix-forming element, e.g. Al or Fe), and other glass structural properties, e.g. binding energies.

BACKGROUND The study of exercise adherence during an arthritis flare is recommended by arthritis researchers. Studies to date have been correlational. METHODS Social cognitions of exercising individuals with arthritis who consider exercise adherence under different levels of challenge of an arthritis flare were examined using an experimental design. Exercising individuals with differential self-regulatory efficacy for managing arthritis flare symptoms (SRE-flare) were randomly assigned to conditions where flare symptoms were perceived as either many or few. Individuals in each condition responded about the strength of their anticipated persistence to continue exercise, and their self-regulatory efficacy to use coping strategies to enable exercise. RESULTS Higher SRE-flare individuals expressed significantly (a) greater persistence (Cohen's d = 1.17) and (b) more confidence to use their flare coping solutions (Cohen's d = 1.44). CONCLUSION Main findings were as hypothesised. When exposed to the condition with more limiting flare symptoms (i.e. greater challenge), high SRE participants were the most confident in dealing with flare symptoms and exercising. Identifying lower SRE-flare individuals less likely to persist with exercise during arthritis flares may improve tailored exercise counselling.

Objectives The act of reflecting on physically active possible selves can increase physical activity (PA). According to theory, possible selves that include strategies for achieving them (self-regulatory possible selves) should have the greatest impact on behavior. Our aim was to examine whether forming a self-regulatory physically active possible self is more effective at increasing PA than forming a possible self that focuses only on the image of the possible self (self-enhancing possible self) or engaging in a control activity. Task self-efficacy was examined as a moderator. Design An online, randomized experimental study. Method Insufficiently active adults (n = 244) completed task self-efficacy and PA measures before the intervention, and 4 and 8 weeks after. Results Repeated measures ANOVA revealed a 'time by condition' interaction whereby reported PA levels were higher for participants in the self-enhancing condition than for those in the control condition 4 weeks post-intervention. Reported PA levels were also higher for participants in the self-regulatory condition than those in the control condition at both follow-up time points. There was also a 'time by condition by self-efficacy' interaction, whereby participants in the self-enhancing condition reported more PA than controls at both follow-up points when they also reported high self-efficacy. Participants in the self-regulatory condition reported more physical activity than all other participants when they were also low on self-efficacy, but only at the four-week follow-up point. Conclusion The findings extend the PA possible selves literature by suggesting that different types of possible selves interventions may work best depending on participants' task self-efficacy levels.

This study comprehensively examined sedentary behavior and physical activity patterns in people with severe knee osteoarthritis awaiting total knee arthroplasty (TKA) and in individuals after TKA.Preoperative (n = 32, mean ± SD = 69.9 ± 5.3 yr) and 1-yr postoperative participants with TKA (n = 38, 67.9 ± 7.3 yr) wore ActiGraph GT3X+ activity monitors for 6.8 ± 0.6 d. Total sedentary time, time in long sedentary bouts (≥30 min), and physical activity outcomes (steps, time in moderate-to-vigorous physical activity [MVPA], cadence) were examined.There were no differences between pre- and postoperative groups for total sedentary time (9.3 ± 1.4 vs 9.2 ± 1.4 h·d, P = 0.62) and number of long sedentary bouts per day (median [interquartile range] = 3.4 [1.9] vs 3.1 [2.0], P = 0.37). Daily steps, peak 30-min cadence, and peak 1-min cadence values were greater in people after TKA compared with those awaiting surgery (5935 [3316] vs 3724 [2338], 55.6 [31.0] vs 35.9 [19.3], and 91.5 ± 20.6 vs 70.0 ± 23.7, respectively, all P0.01). There were no differences in lifestyle MVPA between groups. The number of bouts of Freedson MVPA was greater in postoperative participants, but the differences were not substantial (one bout per week).Patients report less knee pain and improved function after TKA; however, sedentary behavior does not differ and physical activity is only marginally increased compared with those awaiting surgery. After TKA, daily walking at slow, moderate, and brisk paces and engagement in MVPA do not match levels seen in healthy older adults, which, when combined with high levels of sedentary behavior, leaves patients at increased risk for physical disability and cardiovascular disease.