AHAEarlyCareerBlogger

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Speak to Me: effective scientific communication

Huan Wang, PhD

What is science communication? What are the differences between a research seminar and a TED-style talk? I recently had a chance to present my research discoveries in a very short (3min) format to fellow colleagues. It didn’t go as well as I planned. I noticed the varieties of styles and topics, so I decided to look into effective ways for science communication. “Science communication is defined as the use of appropriate skills, media, activities, and dialogue to produce one or more of the following personal responses to science: Awareness, Enjoyment, Interest, Opinion-forming, and Understanding”, a contemporary definition of science communication1. Scientists are more aware of the importance of scientific communication in recent decades. The reasons for science communications range from grant requirements, public engagement, to feelings of moral obligation2. Audiences are also very diverse such as interested/non-interested laypeople, engaged stakeholders and policymakers, and scientific colleagues from other disciplines.

Many articles discussed the techniques for effective science communication. They are very accessible through websites. An article published by Steven J. Cooke and colleagues shared a nice collection of useful websites in a table format with emphasis on key resources on science communication for scientists3. With a great wealth of information online, I’m going to share some major points regarding effective science communication.

Know your audiences

For any kind of effective science communication, the first step is to set objectives. Why are you interested in sharing what you know? What do you want your audiences to take home? Then the next question naturally will be who are your audiences? The knowledge depth of your audience decides how you want to present your story. Imagine a nuclear scientist tries to tell a government official that what is radioactive. Think critically about what aspect of your science will reach the target audience. It’s paramount that the information you share is of appropriate complexity. For example, you would describe your research differently to a group of colleagues than to high school students– and even specialized audiences like colleagues are not homogeneous. Some may specialize in a different field.

Avoid acronyms and jargons

One of the biggest obstacles to effective communication is acronyms and jargon. Imagine if you hear a spy uses morse code to communicate. It’s basically the same when a scientist uses his/her “comfortable languages” to talk to “insiders”. Sometimes it forms a special bond and feels very exclusive. Most of the time it saves lots of time and energy to repeat some concepts over and over. Scientific concepts sometimes could be less institutional. Avoid acronyms that could reach a broader audience. Regardless of what forms of communication, acronyms should be critically scrutinized based on necessity and commonality. Multidisciplinary studies embrace effective communication among scientists and acronyms are not going to make it easier. Jargon is a similar but different issue. If you look at the word panel in Fig14. You might find some commonly used words by in the jargon category. When you bury yourself in your specialized field long enough, you might find it harder to distinguish what is jargon and what is not. A group scientists developed a program to help scientists identify jargons4 and there might be other resources online to achieve a similar goal.

Fig1: Screen shot showing words after de-jargoning4.

Focus on the science

It’s not a big surprise for scientists to think and talk about science all the time. Avoiding granular details is one of the top lessons I learned as a graduate student. If you practice this fashion in an extreme way, if could be counterproductive. Good science is the foundation of quality science communication. Don’t lose sight that people are interested in your talk/post because you have a unique science-based perspective. “Avoid patronizing an audience by oversimplifying or glossing over important scientific details, as interested people want to hear about the scientific process and see the data themselves.”3. An effective science communication should include appropriate details which covers significance, background, challenges, as well as results. Be creative, be relatable and be interesting. Most importantly, be true to the data and don’t oversell or overstate the results. Share with the audiences your enthusiasm based on the science, don’t sensationalize and overpromise research outcomes.

Most scientists don’t have formal training in science communication. Universities and government agencies are starting to realize the importance and are working on to incorporating proper training for the next generation scientists. Some universities opened graduate program in science communication major. It’s a fast-growing field that we should all consider improving our science communication skill in the future.

 

References

  1. Burns TW, O’Connor DJ, Stocklmayer SM. Science Communication: A Contemporary Definition. Public Understanding of Science. 2003;12(2):183–202.
  2. Poliakoff E, Webb TL. What Factors Predict Scientists’ Intentions to Participate in Public Engagement of Science Activities? Science Communication. 2007;29(2):242–263.
  3. Cooke S, Gallagher AJ, Sopinka N, Nguyen VM, Skubel R, Hammerschlag N, Boon S, Young N, Danylchuk A. Considerations for effective science communication. In: ; 2017.
  4. Rakedzon T, Segev E, Chapnik N, Yosef R, Baram-Tsabari A. Automatic jargon identifier for scientists engaging with the public and science communication educators. PLOS ONE. 2017;12(8):e0181742.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Studying for Medical Boards as a Foreign International Graduate While Working: tips and experience

Miguel Quintero-Consuegra, MD

When I decided I wanted to take the steps, in January of 2019, to pursue a residency in neurosurgery in the United States, I did what most of us do, I went to Youtube and saw how other people have studied. After a couple of days watching various videos, I felt overwhelmed since most of the videos entailed studying >9 hours, having a dedicated period exclusive for studying, and some of them suggested doing them during medical school.

All of those suggestions were not possible at the time for me, I had just graduated from medical school in December of 2018, and I had accepted a full-time job at Cedars-Sinai. Though I did question if I was going to be able to manage a full-time job on research and study for this life-defining exam, in the end, I pulled it off, and I took step1 in October of 2019 and step2 CK in may of 2020.

Before starting with my personal story of how I studied and managed my time to finish both USMLE while working, I just want to give you peace of mind to all of you that are not in the ideal situation of studying full time or that cant dedicate enormous time of study due to personal responsibilities. All roads lead to Rome; everyone is in a particular economic, social, and educational situation and what each one of us must do is to adapt and make the most out of our conditions!

So, let’s begin.

What was your approach to work and study at the same time?

When I faced this challenge, the first thing I did was to talk to my boss, Dr. Nestor Gonzalez, and my coworker Juan Toscano. I let them both know that while I was going to fulfill my job to the best extent of my abilities, they should know that I was also dedicating all my spare time both at work and outside from work to study.

I believe it’s crucial to the people you work with know what you are going through, and to me, this was extremely helpful, as there were times my coworker took over simple tasks and was very understandable to give me as much time as I could to study. Since my boss knew that I was taking this exam, I was able to take 2 weeks off before my exam date to dedicate 100% of my time to study.

For how long and how did you prepare for step1 and step2?

I started my step1 preparation on the third week of January 2019, when I started my job. During the first three weeks, I tried to get a sense of how my day to day was going to be at work, identify which hours would be ideal for studying either after work, before work, and also determine what the best time to do questions was, watch videos, read the first aid, etc.

After finishing the First Aid’s first pass (not extremely thorough, just a glimpse to see and get familiarized with the material), I outlined 3 phases of the study.

  • The first (from Feb-April) would be dedicated to learn and review the theory, so 90% of my study day was to read the first aid, watch pathoma/Kaplan/sketchy, and a 10% was to do questions from different banks.
  • The second (may-sept), Was dedicated 90% to Uworld and their respective review, and 10% to review the FA, pathoma, or any gap in my knowledge.
  • The third and last (last week of sept-first of October), I only did questions. These were the 2 weeks my boss gave me to dedicate full time to study. I was able to do during this first week > 4 blocks a day with their respective review, and the last 5 days, I did practice 7 blocks as if I were taking  Step1 (based on the recommendation of my friends Sandra Saade and Andre Monteiro), which was extremely helpful to gain endurance.

Total study time for Step1: From February-October

For step2 was easier to get organized since I would follow the same schedule and balance of work/study. I took a month’s break from step1 and started to study for step2 at the end of November. I studied from November until May 28, 2020 (one day after my birthday).

The approach was pretty similar to that of step1 with the caveat that I started from day 1 to do questions, and I also took one week off from my vacations to dedicate full time to prepare step2. The pandemic changed my preparation timing since we had to deal with the Prometric cancelations due to covid.  

How was a regular workday during step1 and step2 preparation?

I would wake up at 6 am in the morning, and during the first 3 months, I commuted on the bus to my workplace, which was approximately 2 hours away. During these bus rides, I would read first aid; of course, I needed some noise-canceling headphones. I would highlight or repeat the things that I thought were most important. By the time I got to work, depending on the time, I would do 10 questions from any qbank before starting to work at 9 am. Usually, I would leave work by 4-4:30 pm to head back to my place.

On the way back, the commuting was equally long, sometimes a bit longer depending on traffic, so by the time I got to my home, I would have already read first aid on average 3 hours/day from Monday-Friday. I used to get home at around 7:00-7:30, cook dinner and my lunch for the next day, and after an appropriate break watching friends (I had just started to watch it), I would start my night study routine at 9:00 pm. From 9 pm until 1 am, I would watch pathoma, Kaplan, or sketchy videos. My goal from Monday to Friday was to study at least 6 hours per day, and I usually slept from 1 to 6 am (since med school, I had slept 5 hours a day)

In March, to make my commute more manageable, I got a bicycle, so I was biking halfway to work and the other half on the bus.  This allowed me to get some exercise done, which I realized I was missing, and helped me to be more relaxed during this study/work period.  From March until mid-June, I followed the same routine of reading first aid or doing my Anki cards on the bus and then studying at home until 1 am (or if I felt tired before 1 am).  Some days, I had some spare time at work, so I tried to get some study done either by reviewing questions or reading the first aid.

From June-September, I wanted to increase my study time and try to use any free time to study. This routine of study/work with no other activities was highly tiring and stressful, and I knew that I needed something for my mental health, so I decided to join the gym. During this period, I wanted to use my time on my bicycle rides which were more than 50 min a day, so I converted all the pathoma videos into mp3 so I could listen to pathoma while I was riding my bike. Then I would do Anki or read FA on the bus, and at work would still review any question I didn’t finish the night before. Anki became my favorite and most used application, as during any break, at lunchtime, waiting for a meeting to start, or on the bus, I would do a couple of cards, and in the end, this helped me a lot. After work, I would get home at the same time (around 7 pm), eat dinner, and study until 9 pm. Then I would go to the gym and disconnect myself from anything related to the step.  After my workout, I would study again until 1 am.  Since I was increasing my study time during my former free time, I was trying to aim to have more than 6 hours of study a day, even though I had added the gym to my schedule.

I continued this pace until September before my 2 weeks of dedicated, with a few modifications. The closest I was getting to the date of my exam on October 8, I cut back even more from my free time, so once I finished listening pathoma, I transformed to Mp3 all the videos from Boards and Beyond (per Sebastian Gallo suggestion), and I would listen to them instead of listening to music, during my bike rides, while walking and even at the gym. This passive learning was a way of trying to make the most of the time during a working day.

I took 2 weeks off work, and I had the most significant visit at the worst time, from my mother Patricia, but it did give me an energy boost to finish up my studies. I stayed with my aunt Cristina and uncle mike in San Diego for the 2 most stressful weeks of my life so far, where I was studying from 9 to 11 hours a day before the test.

For step2, things were more manageable since I moved 15 min away from the hospital, and not commuting for more than 3 hours a day improved my life and study style a lot. My working schedule did not change, but my study times did. Since I was living so close to the hospital, I arrived at 6:40 am to the hospital and headed to the library to do a block of uworld and study until 9. I would work until 4:30 pm and then head to the library until 9:00 pm to keep doing questions or reviewing questions and then heading to the gym until 11-11:30. I would head back to my place and go to bed at around 12:30 to 1 am and then repeat the same schedule before the pandemic hit.

When the pandemic hit, we were sent to work from home. To adapt to working and studying in the same place as my roommates, that weren’t particularly quiet, I shifted my schedules to go to bed at 6:00 pm and wake up and begin my day at 11:00 pm. This allowed me to have enough space and time to study from 11:00 pm until my workday began at 8 am.  After finishing work at around 4 pm, I would run 3 miles while listening to mp3 of MedEd, then had dinner and go to bed. After 3 cancelations from Prometric, I was able to schedule my step2 for the end of May.

How was your schedule on the weekends?

My weekends were the days that I studied the most and tried to make up for the study that I could not finish during the week and the sleep I did not get. I would do grocery shopping, take care of my place, and all the labor that entails with being an adult. I would study 8—9 hours on Saturday and Sunday. My goal per week was to study at least 42 hours. Some weeks were more brutal at work, or I was tired and couldn’t finish my 6 hours daily on the weekdays, making the weekends the perfect time to make up for the time that I did not study. The weekends were ideal for taking any assessment, whether Uworld Self-assessment or NBME.

When I joined the gym, I had another activity to do on the weekends, and I wish I had done it sooner to improve my mood at earlier stages of my study preparation.

How did you manage your time?

In the beginning, I was using just a regular clock and writing down how much I was studying per day on an excel sheet. This helped me keep track of how much I was studying, so I would stop the clock every time I grabbed my phone or took breaks. Then I found an app that changed my time management forever that is called aTimeLogger, which allowed me to set goals per day, week, and month depending on the activity that I was doing, that basically were studying, working, exercising, and wasting time (yes, to visually see how much time one wastes on Instagram, Facebook, youtube, is disturbing and helped me to reduce this screen time especially during quarantine).

As I said before, my goals were to reach a doable 6 hours per day or 42 hours of study per week and to do at least 6 hours of exercise per week for mental and physical health. Also to maintain a minumun of 5 hours of sleep per day which is used to be my normal sleeping time since medschool.

How did you balance your social life and working/studying?

Significant endeavors entail enormous sacrifices, so during this working/studying period for step1, I deleted all my social media (Facebook, Instagram, Twitter) and only kept Whats app to talk to my family and close relatives.  Not having the distraction of social media on my phone helped me keep my objective clear, which was to pass with a good score step1/2, and that instead of grabbing my phone to check Instagram, I grabbed it to do Anki.

My social life was nonexistent during my study period. I did go out with my friend and coworker Juan maybe 6 times from January-December, and I saw my family a couple of times for brief moments. Since I had moved to a new country and new city, isolating myself from people was doable and extremely helpful to focus my energy only on studying and working.  My first vacations during 2019 were for my dedicated 2 weeks for step1; they were not the ideal vacations but were necessary to study.

Any final suggestions for someone that is in a position similar to you?

These exams are complicated not only for the amount of time invested and information one has to learn but also the emotional pressure of having a test determining how feasible your dream of becoming a physician in the USA would be.

So, I would suggest:

  1. Committing thoroughly to studying and working, and trying to isolate yourself from most social engagements, talk to your family and friends; they will understand your absence in social engagements and not hold a grudge.
  2. Reducing, if possible, to zero social media from your phone and laptop. This helps you focus on the exam and not feel sad/anxious (which happened to me) because you see your friends and family partying or having fun while you are spending more time with Uworld than with another human being. Remember this is temporary; your life will get better after finishing the exams.
  3. Surround by people that are going through the same process and by those who already took the exam, we know how it feels, and we understand what you are and will go through. I have to say that talking out loud when I felt hopeless, tired, and overwhelmed was a vital pillar of this process of studying/working. So I want to give an enormous shout-out to my very patient friends and were there for me every step (Juan Velez, Sandra Saade, Sebastian Gallo, Andre Monteiro).
  4. Make time, even if little, to do your hobbies. In my case, it was going to the gym. It really changed my mood and gave me more mental stability, and to give yourself a break from studying.
  5. If you feel tired or burnout (because at some point you will), don’t be hard on yourself and take a break. I used to get very mad at myself when I was trying to study but could not focus, or I was falling asleep. Taking a break is also crucial to maintain sanity during difficult and extended periods of studying/working.

Last but not least is to look at the big picture and all that is at stake. While it is thought to work and study simultaneously, it taught me a lot of things, such as resilience, pushing my boundaries, and making the most out of a not ideal situation.  When situations or conditions cannot be changed, one must adapt, and I’m glad I was able to deal with long commutes, working/studying, moving to a new country, and living alone for the first time in my life at the same time. In the end, it was worth it. I passed Step1 (239) and Step2 (236), and I’m thrilled that my dream to become a neurosurgeon is still intact.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Fighting for Health Equity and Social Justice during the COVID-19 pandemic: Insights from the 2021 Epi/Lifestyle Scientific Sessions

Catherina Chang Martinez, PhD

This year’s Epi/Lifestyle Scientific Session took place on May 20-21, 2021. Despite the change in venues to virtual mode because of the COVD-19 pandemic, the conference was a success! Many attendees had the opportunity to participate, network, and learn about the latest science on Epidemiology, prevention, lifestyle, and cardiometabolic health. The opening remarks and keynotes centered on two particularly important topics, health equity, and social justice, and the commitment of the American Heart Association to eliminate health disparities in underserved ethnic communities.

Dr. Mitchell S. V. Elkind, MD, MS, FAAN, FAHA, American Heart Association President, opened the conference, highlighting the commitment of the American Heart Association to health equity and structural racism research, driving systemic public health change, while focusing on removing barriers to equitable health for everyone, everywhere. He also provided updates on new scientific research programs to address health inequities and structural racism, and diversity research opportunities for underrepresented racial and ethnic groups.

From a healthcare provider standpoint, many of these programs offer opportunities to bridge the gap in preventive CVD measures in our communities. Other important contributions highlighted at the conference included the COVID-19 Registry, a hospital-based quality improvement program to explore the links between COVID-19, cardiovascular risk factors, and adverse cardiovascular outcomes.

In alignment with the lead topic of the conference, two keynote speakers, Dr. Olajide A Williams and Dr. Laprincess C. Brewer highlighted the effects of structural racism on the social determinants of health, and their relation to health equity and social justice.  Dr. Olajide A. Williams presented on the relationship between structural racism and poor health. He highlighted the importance of social determinants of health and primordial prevention from the perspective previously reported by Dr. Camara Jones.1

Dr. Jones’ “Cliff Analogy” gives a clear picture of the three dimensions of health interventions to help people who are falling off of the cliff of good health: providing health services, addressing the social determinants of health and equity.1 The deliberate movement of the population away from the edge of the cliff represents our efforts to improve on the social determinants of equity through interventions on the structures, policies, practices, norms, and values that differentially distribute resources and risks along the cliff. By doing so, we can improve health outcomes and eliminate health disparities.1   His presentation is also a call to continue efforts to overcome the long-term effects of structural racism and eliminate its associated disparities by organizations outside of government.

Another keynote speaker, Dr. Laprincess C. Brewer discussed the importance of community-based participatory research as a strategy to promote cardiovascular health for all. She highlighted the importance of diversity in clinical trials and research studies as well as the need to build and maintain community partnerships to dismantle structural inequities, racism, and consequently lead to cardiovascular health equity in our communities.  Innovative approaches through community-based participatory research, involving our communities and key stakeholders have the potential to support lifestyle change for cardiovascular disease (CVD) prevention, especially in ethnic minority groups, such as African Americans, who carry the largest CVD burden.

Dr. Brewer highlighted the ongoing disparities in CDV mortality for African Americans. Despite improvements in mortality rates over the past decades, CVD remains the leading cause of death for African-Americans. She further messaged the American Heart Association’s Life Simple 7 as important factors to address in the fight against cardiovascular disease in ethnic minorities experiencing greater health disparities. Her presentation also highlighted the importance of community stakeholders, including faith-based organizations and community members in the identification of the research problem, development of research questions, as well as interventions that may be relevant to these groups.2 The various types of programs she discussed, including Mobile Health, emergency preparedness, and COVID testing, through a partnership with a faith-based organizations, served as examples of trusted social networks and established stakeholders that underserved communities may be more likely to reach out for support during health crises. These may further contribute to the delivery of culturally sensitive resources through community partnerships aimed to achieve health equity among ethnic minorities.

As I reflect on the message from the speakers during the opening session, it reminds me of the opportunities available in my community for engagement in the prevention of CVD, especially in underserved minority groups, and the need to reach out to key stakeholders trusted by these underserved groups. It is also a call to engage with these stakeholders in the delivery of interventions aimed at disease prevention, setting up guardrails to prevent them from falling off the cliff of good health.

References

  1. Jones CP, Jones CY, Perry GS, Barclay G, Jones CA. Addressing the social determinants of children’s health: a cliff analogy. J Health Care Poor Underserved. 2009;20(4 Suppl):1-12. doi:10.1353/hpu.0.0228
  2. Brewer LC, Hayes SN, Caron AR, et al. Promoting cardiovascular health and wellness among African-Americans: Community participatory approach to design an innovative mobile-health intervention. PLoS One. 2019;14(8):e0218724. Published 2019 Aug 20. doi:10.1371/journal.pone.0218724

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Follow Your Dreams: An Inspiring Journey Of an Electrophysiologist Turned Motivational Speaker and Life Coach

Zain Ul Abideen Asad, MD, MBBS

 

I am excited to interview Dr. Deborah Lockwood who is an electrophysiologist but recently her life took a very interesting turn and she decided to follow her passion outside medicine. She is sharing her incredible life journey with us in this video blog.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Trends in COVID-19 in-hospital mortality: Insights from the AHA COVID-19 CVD registry

Aaysha Cader, MD, MRCP

Information on the survival trends of hospitalized COVID-19 patients is important for physicians to identify trends and track the efficacy of hospital-based care in real-world practice. The American Heart Association’s (AHA) COVID-19 Cardiovascular Disease (CVD) Registry was put in place in April 2020 with the objective of improving nation-wide surveillance of hospitalized patients with COVID-19.1 Early data derived from this registry were presented at scientific sessions #AHA20 last year. This blog summarizes a more recent analysis by Gregory A. Roth and colleagues, looking at trends in patient characteristics and COVID-19 in-hospital mortality in the United States during the pandemic.2

This retrospective study published in JAMA Network Open included 20 736 hospitalized patients from the AHA COVID-19 CVD registry at 107 hospitals in 31 states. Undertaken as part of the Global Burden of Disease Study, the objective was to quantify changes in in-hospital mortality rates during the first 9 months of the pandemic, and understand if any observed changes were associated with differences over time in the characteristics of presenting patients. The data were analyzed to show comparative trends across 4 periods in 2020: March and April; May and June; July and August; and September through November.

There was a gradual decline in the numbers of admitted patients in the registry, with 11 901 patients admitted in March or April, down to 2010 patients in September through November. In terms of the patient demographics, 45.9% were women, the proportion of which slightly increased over time. The mean age was 61.2 ±17.9 years which decreased from March -April through September-November. 58.4% of patients were hypertensive. 35% were diabetic, and 18.3% had pulmonary disease. The mean BMI was in the obese range (30.8 ± 8.5) and increased a small amount through November.

Almost a quarter of patients were receiving supplemental oxygen on admission. This proportion increased from 23% in March – April to 35.9% in September through November. This was despite the presence of interstitial infiltrates on admission decreasing from 70.7% of patients to 60.8% during the corresponding periods. In contrast to supplemental oxygen, however, the use of mechanical ventilation decreased substantially from 23.3% to 13.9% during the same periods. The use of glucocorticoids and remdesivir increased substantially, potentially reflecting the emergence of randomized evidence of its efficacy during that time and the US Food and Drug Administration (FDA) announcement of remdesivir emergency use authorization on May 1, 2020.3 The mean duration of hospital stay also showed a reduction from 10.7±12.1 days to 7.5 ± 6.8 days.

A total of 3271 in-hospital deaths recorded from March through November 2020, corresponding to overall in-hospital mortality of 15.8%. In-hospital mortality rates declined as time progressed, with 19.1% in March-April, 11.9% in May-June, 11% in July-August, and 10.8% in September- November. Adjusted odds for in-hospital death were also significantly lower for all 3 later time periods studied, compared with March-April. Increasing age was the factor most strongly associated with death, with the figure depicting the adjusted odds ratios across different age groups [Figure 1]. Male sex, BMI > 45, and presences of comorbidities, specifically cancer, cerebrovascular disease, diabetes, and heart failure were independently associated with in-hospital death.

The greatest reduction in the in-hospital mortality rates occurred between March and May 2020, with high mortality rates falling by a massive 38% from March and April 2020 by May and June, followed by a modest further decrease by November. Notably, this difference in mortality rates persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity. In the face of only minor changes in the characteristics of admitted patients described above, the authors have thus put forward some hypotheses that might explain these trends of decreasing mortality rates over time.

One of them is the extremely high hospital census and rapid implementation of new measures (i.e. isolation and personal protection procedures) especially in locations with very high rates of COVID-19 in March and April. This is consistent with the observation of the most rapid declines in mortality rates between the months of March – April and May – June, when health care workers gradually became more familiar with new procedures.

Changes in treatment protocols may also have contributed to this decreased mortality. The observed increased use of supplemental oxygen and decreased use of mechanical ventilation in the registry data could be explained by trends in respiratory care that emerged as the pandemic progressed, particularly the efficacious modalities of noninvasive ventilation, high flow nasal oxygen, and prone positioning, although these modalities were not captured in the registry. Substantially increased use of steroids and remdesivir may also have contributed to better outcomes.

Few limitations exist: the analysis was retrospective, with varying sample sizes due to the voluntary nature of enrolment in the registry. Certain treatment modalities were not captured. There was potential for bias due to confounding from unobserved or unrecorded characteristics in the estimation of associations, and as such causality cannot be inferred. Furthermore, it is important to note that this analysis included data from before the rollout of vaccines, and it would be interesting to see these more contemporary trends from the AHA COVID-19 CVD registry in future analyses.

Needless to say, such registry-based analyses provide important data on trends in mortality and contemporary management practices in the face of rapidly evolving hospital dynamics during the pandemic. While randomized controlled trials are essential to investigate potential treatments and inform evidence-based practice, the utility of such registries in identifying mortality and treatment trends in real-world practice, and indeed using this information to implement best practices, cannot be understated.

References

  1. Alger HM, Rutan C, Williams JH IV, et al. American Heart Association COVID-19 CVD Registry powered by Get With The Guidelines. Circ Cardiovasc Qual Outcomes. 2020;13(8):e006967.
  2. Roth GA, Emmons-Bell S, Alger HM, et al. Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(5):e218828.
  3. US Food and Drug Administration. Emergency Use Authorization (EUA) for emergency use of Veklury® (remdesivir) for the treatment of hospitalized patients with severe 2019 coronavirus disease (COVID-19). Published October 22, 2020. Accessed June 4, 2021. https://www.fda.gov/media/137564/download

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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A Letter From One Postpartum Cardiology Fellow To Another

Kyla Lara-Breitinger, MD

Dr. Postpartum Mom,

Congratulations on bravely bringing a precious life into the world! The morning sickness, exhaustion from the physical demands of pregnancy while taking call, performing procedures in the cath lab, and extinguishing fires in the CICU are all behind you! However, the anxiety of maintaining academic productivity, continuing self-directed learning, preparing for multiple board certifications, and looking for post-training opportunities are some of the newer undertakings you may be experiencing, all while balancing the postpartum physical recovery, sleep deprivation and caring for a newborn life.

I, myself, am 5 weeks postpartum with my second child (I had both during cardiology fellowship) and feel a sense of urgency to not “waste” my maternity leave and instead be productive with research, studying, and getting back to my prepregnancy weight. I am writing this letter with the hope that reading about my experience may resonate with you.

I will preface by stating that I am no expert on how to be great at everything: a mom, wife, cardiology fellow, and physically fit individual. But the following are pearls I have learned over the past 5 weeks and from my last maternity leave.

  1. Be realistic about what you’ll accomplish during maternity leave. I know most people will tell you to just focus on the baby since this is what maternity leave is for but if you’re like me, you’ll want to be productive in some other capacity while at home. Be forewarned, you may not do it all and may miss research deadlines and opportunities. Pick one or two small-to-medium project goals and try your best to complete them. Be honest with whom you’re collaborating with and give yourself grace.
  2. Hire help if you can afford to. I grew up in a very frugal household and my mother did everything herself (cleaning, cooking, and childcare). It has been difficult for me to solicit outside help because of my upbringing but I am learning that if my husband and I can afford to hire help, I will be able to focus more energy on physical activity, academic projects, and goal-setting. For example, we have a cleaning company come every 2 weeks and I have interviewed at least 3 sitters for help with my toddler and newborn. I recently vented to a friend about the guilt I feel hiring people to watch my babies while I’m physically at home, and her response truly resonated: “You can hire help with the tasks that keep you away from your kids like meal-prepping, cooking, laundry, and cleaning up. In turn, you will have more quality time with them.” Truth.
  1. Accept help when offered. In addition to family members, allow your co-fellows and friends to drop by precooked meals and watch the baby while you take a walk, exercise, or sleep for an hour or two. Don’t be embarrassed or shy about it. They offer because they genuinely want to help and you can always return the favor in the future.
  1. It’s impossible to study or maintain self-directed learning if you are sleep deprived.

Try your best to get as much sleep (easier said than done) and when you feel refreshed enough, study and read what you can. I tried making a daily schedule to stick to that includes a dedicated time slot to study, however I have continued to fail at adhering to it when my unpredictable baby decides to stay awake at night or sleep minimally.

  1. Each postpartum recovery period and maternity leave are unique and different.

My first maternity leave was during first year of cardiology fellowship and it was more challenging than my current leave. I was in a new city, had no family around, didn’t know what to expect and was learning how to be a new mother. Besides taking care of the baby, I spent the majority of my time sleeping, watching television, and dealing with transient postpartum blues. This time around I am much more prepared emotionally and physically and I am enjoying my time so much.

This may or may not have helped you. I want to reiterate that if you decide to do nothing but care for and cuddle with your newborn, that is enough and is an achievement in itself.

With love,

Kyla Lara-Breitinger, MD

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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A Cardiology Fellow’s Experience Studying Artificial Intelligence

Sasha Prisco, MD, PhD

For this blog, I am excited to have my co-fellow and husband, Tony Prisco, discuss how he became interested in studying artificial intelligence in cardiovascular diseases and some tips for others who are potentially interested in this field!

My name is Tony Prisco and I am a PGY-5 at the University of Minnesota in the Physician-Scientist Training Program. I am pursuing my fellowship training in cardiovascular diseases. I finished my PhD in 2014 focusing on mechanisms of angiogenesis induced by adult stem cells. Since then my scientific interests have transformed to mathematical studies, including fluid mechanics and artificial intelligence. The majority of my work since my PhD has focused on blood flow mechanisms in patients with mechanical circulatory support (ventricular assist devices and VA-ECMO).  I had been hearing about various forms of artificial intelligence since at least 2014 but did not realize the potential clinical applications until I started my residency in 2016.

When I started my dedicated research time back in 2019, I initially had planned on continuing studies that used computational fluid dynamics to better understand the mechanisms of cardiovascular diseases and the device-human interface. A month into my research, due to the growth of the field of Artificial Intelligence (AI), I watched several YouTube videos describing the math behind “deep-learning,” which is a form of AI. Interestingly, most of these videos were targeted towards the tinkering hobbyist working to do interesting home projects. They focused on getting started with a very low budget (i.e. free) and minimal computing background. Tutorials were primarily using high-level programming languages such as Python or MATLAB. After a day of struggling, I was then able to successfully recreate an example to train a neural network (type of deep-learning technology) that could identify the numbers 0 – 9 within an image.

I discussed this with my clinic mentor at the time, and after a few weeks we came up with a useful clinical project that I have spent the last 18 months working on. In doing this, I have learned 3 important lessons regarding using artificial intelligence in clinical cardiology:

  1. Artificial intelligence is a great technology to answer a simple question, for example—is a study normal or abnormal? Complex questions, i.e.— “Should I list this patient for a heart transplant?” not so much.
  2. Artificial intelligence will most likely improve patient care by helping physicians to interpret clinical data faster—especially areas where a significant amount of data exists (i.e. imaging and ECGs). Most likely, deep learning algorithms will help to give a “preliminary” interpretation of a piece of clinical data that will ultimately be analyzed by a cardiologist.
  3. Artificial intelligence ultimately is an analysis tool. It does not make up for having a good experimental design and/or following the scientific method.

The underlying mathematical principles of artificial intelligence have been around for at least 50 years. It is only recently that we have had the computational power to apply those principles to clinical data sets. I do not have a background in computer science—but I believe with the resources available online including free courses, tutorials, and software—the barrier to entry is low enough that anyone with enough intellectual curiosity can be up and running within a few weeks. Resources I would recommend looking at for those interested in starting out in this field are:

Software—Python (https://www.python.org/) is free for all. The majority of code available online and tutorials are done in Python. MATLAB is another option and for those at most major universities, this will be free as well. I use MATLAB primarily because it works better with the supercomputer we have at the University of Minnesota, but in most circumstances, this will not be necessary.

Tutorials—there are many available online, including full courses. I went through the lectures of Stanford’s CS221 on YouTube (primarily taught in Python). MATLAB has a few dozen examples on their website as well.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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The Early Career Professional’s Toolbox

Mo Al-Khalaf, PhD

Many professionals must hone several key skills over time to be successful at their jobs. Some of these skills are learned in academic settings. That is especially true for professions that require a prolonged educational stage (yes, I’m particularly winking at the roads toward MD & Ph.D. degrees!). But just as valuable are the skills that early-career professionals gain outside of the formal educational framework. And of course, both personal traits and the element of luck, play important roles in achieving success from an early career standpoint.

This past year has also brought on additional requirements (hello frequent webcam meetings!) that should be highlighted and appropriately incorporated into the early career “skills toolbox”. One must ensure forward momentum and “future-proofing” one’s advancement in an early career path. “Adapting to the times” is key, and there are evergreen tools that are essential to career advancement. Here I’ll share some of what I think are key tools in this present-day moment for an early career professional (specifically from my personal point of view, as a biomedical researcher – but hopefully I’ll add enough general value framework for the wider community as well).

Tool #1: Work ethic

This is obviously the most useful and versatile tool to have when going through early career progression and advancement. There is nothing that can replace dedication and diligence when it comes to building a career. This translates of course to the practice of “putting in the time”, but that’s not all there is to it. Work ethic to me also means figuring out the many ways in which work gets done! Here I’ll highlight the immense value in developing a work ethic that includes learning how to create and be part of a team. Sometimes projects are better served when multiple professionals with varying expertise and experiences team up (multidisciplinary collaborations). Also, work ethic is learning to optimize being both a mentee (learning from multiple mentors is the fastest way to advancing one’s skillsets) and being a mentor (passing on skills to peers and junior team members has immeasurable benefit to the work and community surrounding it).

Tool #2: Networking

I touched on this a little bit earlier, but this is worth spotlighting on its own. Other than creating teams with the explicit goal of accomplishing specific tasks or projects, an early career professional needs to put in effort towards expanding one’s own professional community of contacts. This is generally called networking, and every scientist and most professionals know the classic phrase “it’s not just about what you do, but also it’s who you know, and who knows you!”. Career advancement is a series of challenges that come sometimes routinely, and many times unexpectedly. Networking, having outside perspectives and individuals with various experiences outside of one’s immediate work bubble, is one of the best ways to gain and apply new skills towards overcoming challenges, and therefore securing career advancement. And yes, knowing and connecting with successful individuals, who demonstrated an ability to navigate through the dense forest of early career progression, is worth the effort it takes to network and connects.

Tool #3: Writing

Speaking to many scientists in my early career category, I frequently hear that writing is not a “favorite” activity for many researchers. It’s treated as a counter to the “real work”, which is the active “researching” tasks that we engage in. Writing is thought of as kind of an archiving practice, more passive than advancing the plotline as the research unfolds. I personally feel like this kind of thinking diminishes the importance of writing, not just as a valuable tool in career building, but also as a practice that contributes to personal growth and even enjoyment! There are many strategies developed towards advancing one’s writing potential. Recently my AHA early career blogger colleague Dr. Jennifer Kong wrote an excellent blog about writing strategies titled “25 Useful Tips for Establishing a Writing Routine”, check it out!

Tool #4: Public Speaking

This is by far one of the hardest tools to get comfortable with, especially in an early career stage! It’s been said that some folks have a greater fear of public speaking than death. It’s an extremely difficult skill to practice, let alone master. But the fact is: Public speaking is more integrated into many career paths than it is apparent at first glance. You don’t have to be standing in front of a podium in a lecture hall or stadium to require the use of public speaking skills. Company conference rooms, group meetings, office planning sessions, work retreats, team project implementations, all of these are examples where public speaking as a tool becomes essential. To focus a little bit back on science and medicine, researchers are very aware of the frequency in which their work requires them to publicly speak in front of peers, internal and external stakeholders, and sometimes the wider interested public. Oftentimes public speaking ends up being the main factor in elevating comparable applicants or competitors for a position or award. More importantly, public speaking is a valuable tool to utilize, amplify, and deliver acquired knowledge to a greater number of individuals that benefit and further advance the work. It is hard, but I would argue it’s one of the most important tools to get comfortable within an early career professional setting!

So after reading this blog post (thanks, by the way!), maybe find some time to think about the four tools spotlighted here, and see how they rank, in terms of ease of use and frequency of utilization, in your own current working environment. Identify which of these tools needs honing and sharpening to be more useful to your current situation. Then plan out a way to work towards getting comfortable at using that skill to improve your career progression.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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COVID-19 and BMI – What Have We Learned? More insights from the United Kingdom

Barinder Hansra, MD

The COVID-19 pandemic has skyrocketed many fields of healthcare – basic science research, outcome-based research, and epidemiological factors affecting healthcare. We already know obesity affects >4 in 10 adults in the United States and contributes to diabetes, heart disease, ultimately leading to increased morbidity and mortality1.  Based on prior experience, we have learned that obesity is associated with an increased risk of other respiratory viruses, such as influenza. These same patients tended to have a higher risk of hospitalization and death, along with longer lengths of stay and mechanical ventilation compared to patients who have normal weight2.

In January of 2021, researchers used the American Heart Association’s COVID-19 Cardiovascular Disease Registry to look at the effect of obesity across different groups’ mortality, need for mechanical ventilation or both. Analysis of data from 88 hospitals in the US showed that classes I to III obesity were associated with a higher risk of in-hospital death or mechanical ventilation compared to normal weight when these patients are hospitalized with COVID-19. The association was strongest in adults <50 and weakest in adults >70 years of age. This was the first study to show the harmful effects of obesity on COVID-19 outcomes may be limited to people under 50 rather than those that are older and obese. There could be a number of reasons for this observation – including comorbid conditions such as diabetes, hypertension, or even delays in seeking care3. As a critical care provider, this study definitely made me evaluate risk factors for younger patients (and even family members) differently.

In a time where one study is not simply the end-all-be-all, a more recent study from the United Kingdom had a similar message. The study was led by Nuffield Department of Primary Care Health Sciences and had 6.9 million patients – which is an outstanding number! And what did they discover??

Figure A shows patients with low BMI (<18.5) had an increase in COVID-19 related admissions to the ICU along with a steady increase in admissions to the ICU as the BMI increased. Figure B shows a linear association across the whole BMI range for death due to COVID-194.  Dr. Carmen Piernas, lead author of the study said: “Our Study shows that even very modest excess weight is associated with greater risks of severe COVID-19 complications and the risks rise sharply as BMI increases. Also, risks associated with excess weight are greatest in people <50 years, while weight has little to no effect on your chances of developing severe COVID-19 after age 80. These findings suggest that vaccination policies should prioritize people with obesity.” The impact of obesity was most marked in people in the youngest age range of 20-39. The study shows that obesity is not only a chronic disease but also a risk factor for acute illness or death. Taking it one step further, health care providers across the spectrum will have to work harder to help provide evidence-based treatments for patients to help reduce their weight.

One of the most striking aspects of this study was the number of patients they tracked in the outpatient setting who ended up needing to go to the hospital. They tracked these patients in their disease course in hopes of giving us information for people in the general community rather than those already admitted to the hospital. At this time, there is no study looking to see if weight reduction specifically reduces the risk of severe COVID-19 outcomes, but I would be interested in such a study.

There was also a significant interaction between BMI and self-reported ethnicity for hospital admissions and death due to COVID-19, with Black people having a higher risk than white people. It’s unclear as to why this association exists in a country where all the citizens have free access to healthcare. There are a few hypotheses but nothing concrete has been established.

Overall, with the addition of this large study plus what we have known before, we can be confident that obesity continues to have significant health implications. I hope we never see another pandemic but if we do, I’m confident what we have learned over the past year will help us treat our patients more efficiently and effectively.

References

  1. Romero-Coral A, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancent. 2006;368:666-678.
  2. Jain S, Chaves SS. Obesity and influenza. Clinic Infect Disease. 2011;53:422-424.
  3. Hendren N, et al. Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19 results from the American Heart Association COVID-19 cardiovascular disease registry. Circ. 2021;143:135-144
  4. Gao M, et al. Associations between body-mass index and COVID-19 severity in 6.9 million people in England: a prospective, community-based, cohort study. Lancet. 2021;

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Atherosclerosis and Osteoarthritis: Understanding the Impact of being Physical Active

Patrick Tomko

Nearly everyone can experience health benefits from being physically active.  Simply, brisk walking can be “go to” for a safe and effective tool to improve or maintain current activity levels.

Physical activity continues to be encouraged because of the staggering impact it has on delaying death from all causes (i.e. heart disease).

The Physical Activity Guidelines for Americans report people who are physically active for approximately 150 minutes a week to have a 33 percent lower risk of all-cause mortality. More importantly, these 150 minutes can be spread throughout a 24 hour period. The benefits accumulate (CDC, 2021).

Thus, avoiding a sedentary lifestyle or even prolonged periods of sitting will maintain a healthy vascular system and keep the heart pumping the way you need it. There is evidence showing that as little as 10 minutes of sitting results in changes that impact microcirculation of blood (Vranish et al., 2018). This microcirculation area is the final destination of the cardiovascular system, and ultimately where oxygen is exchanged.

Breaking up the day into brief bouts of activity goes a long way. So those reminders on the fitness trackers, make sure to use them to your advantage. If you have some health goals you want to meet, use physical activity tracking as a supplement to your plan. Walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and cardiovascular disease morbidity and mortality in adults (Hall et al., 2020).

A study published by Wolf et. al. showed that even four-second bouts of intense activity between bouts of sitting can carry benefits that extend into the next day. In a model of 8 hours of inactivity, study participants cycled five times every hour over a 6 hour period. These exercise bouts from the previous day reduced levels of fat in the blood by 31% (Wolfe et al., 2020).

However, not everyone can just get up and move. Individuals that are diagnosed with osteoarthritis of the hip and knee represent one of the leading causes of global disability (Skou et al., 2018). Thus, a group like this will struggle to meet activity guidelines and is likely to share an increased burden of cardiovascular disease risk. The presence of osteoarthritis in a large prospective cohort (1,775) followed over a mean of 8 years showed an increased risk of cardiovascular disease by 27% (Veronese et al., 2018).  Determining ways to encourage physical activity even in disabling scenarios/conditions, continues to be a challenge. Magnetic resonance (MR) imaging, one of the most advanced imaging techniques used clinically, could be used to inform physicians how to best to approach this challenge. In a brief review by Liu et. al., MR images were used to visualize lower limbs to aid in the development of biomarker development and/or predict patients with risk to PAD. This could patients who are inactive because of the severity of osteoarthritis (Liu et al., 2019).

Hopefully, we evolve in our approach for activity recommendations and potentially pain management in groups that exhibit disabling conditions like osteoarthritis. I think this brings another point about the pathology of the two conditions and the relatedness. There has been evidence to support a vascular etiology and its ability to predict structural progression of osteoarthritis over 10 years (Jonsson et al., 2019; Wang et al., 2015). There is also data that relates use of statins to treat atherosclerosis and knee osteoarthritis progression (Clockaerts et al., 2012). Recently a nutritional link has been brought to light with Vitamin K and osteoarthritis. Vitamin K is commonly known for its role in blood coagulation (Loeser et al., 2021). Below is the figure Loeser et. al., uses to illustrate vitamin K role in osteoarthritis.

In the next figure below, Findlay 2007, shows how the subchondral vasculature is related to the initiation and/or progression of osteoarthritis. The left side shows healthy articular cartilage and the right side shows some cartilage erosion that may be related to changes due to an occlusion of blood supply.

References:

CDC, 2021. Benefits of Physical Activity [WWW Document]. Cent. Dis. Control Prev. URL https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm (accessed 5.20.21).

Clockaerts, S., Osch, G.J.V.M.V., Bastiaansen-Jenniskens, Y.M., Verhaar, J. a. N., Glabbeek, F.V., Meurs, J.B.V., Kerkhof, H.J.M., Hofman, A., Stricker, B.H.C., Bierma-Zeinstra, S.M., 2012. Statin use is associated with reduced incidence and progression of knee osteoarthritis in the Rotterdam study. Ann. Rheum. Dis. 71, 642–647. https://doi.org/10.1136/annrheumdis-2011-200092

Hall, K.S., Hyde, E.T., Bassett, D.R., Carlson, S.A., Carnethon, M.R., Ekelund, U., Evenson, K.R., Galuska, D.A., Kraus, W.E., Lee, I.-M., Matthews, C.E., Omura, J.D., Paluch, A.E., Thomas, W.I., Fulton, J.E., 2020. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int. J. Behav. Nutr. Phys. Act. 17, 78. https://doi.org/10.1186/s12966-020-00978-9

Jonsson, H., Fisher, D.E., Eiriksdottir, G., Aspelund, T., Klein, R., Gudnason, V., Cotch, M.F., 2019. Hand and knee osteoarthritis are associated with reduced diameters in retinal vessels: the AGES-Reykjavik study. Rheumatol. Int. 39, 669–677. https://doi.org/10.1007/s00296-019-04243-6

Liu, W., Balu, N., Canton, G., Hippe, D.S., Watase, H., Waterton, J.C., Hatsukami, T., Yuan, C., 2019. Understanding Atherosclerosis Through an Osteoarthritis Data Set. Arterioscler. Thromb. Vasc. Biol. 39, 1018–1025. https://doi.org/10.1161/ATVBAHA.119.312513

Loeser, R.F., Berenbaum, F., Kloppenburg, M., 2021. Vitamin K and osteoarthritis: is there a link? Ann. Rheum. Dis. 80, 547–549. https://doi.org/10.1136/annrheumdis-2020-219765

Skou, S.T., Pedersen, B.K., Abbott, J.H., Patterson, B., Barton, C., 2018. Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. J. Orthop. Sports Phys. Ther. 48, 439–447. https://doi.org/10.2519/jospt.2018.7877

Veronese, N., Stubbs, B., Solmi, M., Smith, T.O., Reginster, J.-Y., Maggi, S., 2018. Osteoarthristis Increases the Risk of Cardiovascular Disease: Data from the Osteoarthritis Initiative. J. Nutr. Health Aging 22, 371–376. https://doi.org/10.1007/s12603-017-0941-0

Vranish, J.R., Young, B.E., Stephens, B.Y., Kaur, J., Padilla, J., Fadel, P.J., 2018. Brief periods of inactivity reduce leg microvascular, but not macrovascular, function in healthy young men. Exp. Physiol. 103, 1425–1434. https://doi.org/10.1113/EP086918

Wang, Y., Dawson, C., Hanna, F., Fairley, J., Cicuttini, F.M., 2015. Association between popliteal artery wall thickness and knee cartilage volume loss in community-based middle-aged women without clinical knee disease. Maturitas 82, 222–227. https://doi.org/10.1016/j.maturitas.2015.07.010

Wolfe, A.S., Burton, H.M., Vardarli, E., Coyle, E.F., 2020. Hourly 4-s Sprints Prevent Impairment of Postprandial Fat Metabolism from Inactivity. Med. Sci. Sports Exerc. 52, 2262–2269. https://doi.org/10.1249/MSS.0000000000002367

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”