Questions From Users of the Manual

Q: Should “least squares mean” be hyphenated? Can the acronym LSM be used or is LS preferred?

A: In the glossary in the statistics chapter, you’ll see that there is no hyphen used in “least squares method,” so I would extrapolate from that to say no hyphen is required in “least squares mean.” If this term comes up so frequently in the manuscript that you feel an abbreviation is warranted, we indicate no preference for what that abbreviation is. Just be sure it’s used consistently throughout.—Cheryl Iverson, MA

Quiz Yourself

Number needed to treat (NNT) is the number of patients who must be treated with an intervention for a specific period to prevent 1 bad outcome or result in 1 good outcome. What is the reciprocal of the NNT? Use your mouse to highlight the answer:

Absolute risk reduction, which is the proportion in the control group experiencing an event minus the proportion in the intervention group experiencing an event, is the reciprocal of the NNT.

See §20.9 for a Glossary of Statistical Terms.—Laura King, MA, MFA, ELS

What Time Is It?

There are dozens of recognized time zones throughout the world. Time zone information may occasionally be included in scientific writing, depending on whether such data are useful for comprehension. In general, however, time zone information may be omitted. If included, the zone’s abbreviation may or may not be added in parentheses (some time zone abbreviations have more than one possible expansion, eg, BST stands for Bangladesh standard time [Asia], Bougainville standard time [Pacific], and British summer time [Europe]).

The international team of investigators scheduled a video conference via Skype at 9 am CST (central standard time) to discuss issues concerning its upcoming clinical trial.

The circadian rhythm aspects of sleep and wakefulness allow us researchers to understand both the normal physiology and the pathophysiology of occasional sleepiness related to shift work among health care workers and to travel across time zones.

Institutions that are interested in applying to become a center for excellence may participate in a webinar on September 12, 2017, from 3 pm to 5 pm EST.

A very useful resource for current times worldwide is available at The World Clock.—Roxanne K. Young, ELS

Questions From Users of the Manual

Q: If I have a title with a colon, is the first word after the colon capitalized or lowercased?

A: If you are speaking about title and subtitle on the manuscript itself, every major word in the title and subtitle, as well as the first word of title and subtitle, would begin with a capital letter.

Endless and Essential:  The Tug-of-War Over Off-Label Use

If you are speaking about the title and subtitle of a journal article as it appears in the reference list, only the first word of the title and any proper nouns would begin with a capital letter.

19. Incollingo J. Endless and essential:  the tug-of-war over off-label use. Cataract & Refractive Surgery Today. 2016;16(5):19-27.

More about capitalization of titles can be found in chapter 10.—Cheryl Iverson, MA

Quiz Yourself

There are 5 instances of jargon in the following sentence. Can you identify them all?

The patient’s physical exam findings were unremarkable and her labs were in the normal range, so she was released from the emergency room and prepped for surgery.

Highlight below for the answer:

The patient’s physical examination findings were unremarkable and her laboratory test results were in the reference range, so she was released from the emergency department and prepared for surgery.

Words and phrases that can be understood in conversation but are vague, confusing, or depersonalizing are generally inappropriate in formal scientific writing. See §11.4 of the AMA Manual of Style for a list of jargon.—Laura King, ELS

Questions From Users of the Manual

Q: Is it necessary to repeat the manufacturer name, city, and country after every repeated mention of a product, or is it sufficient to cite this information only after the first appearance?

A: Mention of the manufacturer’s name after the first mention should be sufficient. Also, please look at our (free) online Updates.

UPDATE:  Manufacturer information for Equipment, Devices, and Reagents:  In section 15.5 (page 583 in the print book), we will no longer require the inclusion of the location of the manufacturer. This is so easy to look up online, should anyone desire more specific details, that we believe it is not necessary to continue to require this. This change was made October 4, 2011.

You’ll see that we no longer require the manufacturer’s location to be included.—Cheryl Iverson, MA


Quiz Yourself

A scientist develops data while working at Harvard University. She then moves to Stanford University, where she publishes an article using the original data in JAMA. Who owns the data?

a. Harvard University
b. Stanford University
c. Scientist

Use your mouse to highlight the answer:   Harvard University

In scientific research, 3 primary arenas exist for ownership of data: the government, the commercial sector, and academic or private institutions or foundations. Although an infrequent occurrence, when data are developed by a scientist without a relationship to a government agency, a commercial entity, or an academic institution, the data are owned by that scientist. Any information produced by an office or employee of a government agency in the course of his or her employment is owned by the government. Data produced by employees in the commercial sector (eg, a pharmaceutical, device, or biotechnology company, health insurance company, or for-profit hospital or managed care organization) are most often governed by the legal relationship between the employee and the commercial employer, granting all rights of data ownership and control to the employer. According to guidelines established by Harvard University in 1988 and subsequently adopted by other US academic institutions, data developed by employees of academic institutions are owned by the institutions (§5.6.1, Ownership and Control of Data, pp 179-183 in print).—Laura King, ELS

Putting P Values in Their Place

Although I am not a statistician, I find something very appealing about mathematics and statistics and am pleased when I find a source to help me understand some of the concepts involved. One of these sources intersects with my obsession with politics: Nate Silver’s website Yesterday, during a scan of fivethirtyeight’s recent posts, this one by Christie Ashwanden caught my eye: “Statisticians Found One Thing They Can Agree On: It’s Time to Stop Misusing P-Values.”

P values and data in general are frequently on the minds of manuscript editors at the JAMA Network. Instead of just making sure that statistical significance is defined and P values provided, we always ask for odds ratios or 95% confidence intervals to go with them. P values are just not enough anymore, and Ashwanden’s article was really useful in helping me understand why these additional data are needed (as well as making me feel better about not fully understanding the definition of a P value—it turns out I’m not alone. According to another fivethirtyeight article, “Not Even Scientists Can Easily Explain P-Values”). One of the bad things about relying on P values alone is that they are used as a “litmus test” for publication. Findings with low P values but not contextual data are published, yet important studies with high P values are not—and this has real scientific and medical consequences. These articles explain why P values only can  be a cause for concern.

And then there was even more information about statistical significance to think about. A colleague shared a link to a story on by Julia Belluz: “An Unhealthy Obsession With P-Values Is Ruining Science.” This article a discussed a recent report in JAMA  by Chavalarias et al “that should make any nerd think twice about p-values.” The recent “epidemic” of statistical significance means that “as p-values have become more popular, they’ve also become more meaningless.” Belluz also provides a useful example of what a P value will and will not tell researchers in, say, a drug study, and wraps up with highlights of the American Statistical Association’s guide to using P values.—Karen Boyd

Point of View: A Conversation With Cheryl Iverson

(Editor’s Note: Point of View is an occasional series that features an interview with someone in the world of publishing. You are already familiar with Cheryl Iverson from her thoughtful and well-reasoned answers to our “Questions From Users of the Manual” section—so it’s only fitting that she be the first victim participant.—Brenda Gregoline, ELS)

Cheryl Iverson does not peeve about her grammatical peccadilloes as one might imagine of a woman who has spent her career editing, overseeing editing, and serving as the AMA Manual of Style committee chair for the last 3 editions—she continues as co-chair of the 11th edition, a work in progress. Although one might say that she doesn’t have any major pet peeves when it comes to grammar, she does admit, “I still get aggravated at the incorrect use of apostrophes like I – t- apostrophe – s. Those are not things that I would be willing to treat lightly.”

But concerns about splitting an infinitive or ending a sentence with a proposition, “some of those rules that people learned in grammar classes in grade school 50 years ago,” would be better off forgotten. She speculates that people who no longer understand the reason for the rule will either avoid the use or argue adamantly about using, say, different from rather than different than when in the end it doesn’t matter if meaning is clear. “That’s what I think. It’s good that we’ve gotten away from these old rules without understanding where they came from, which makes it hard for people to know when to bend a rule or when to disregard a rule.”

However, such discretion at the start of her career was discouraged.

“When I was a new copyeditor, the stylebook was the Bible. It was all about ‘If you want to publish in our journals, this is what we do.’” The mandate was so deeply impressed on her that it wasn’t until her short stint at the University of Chicago Press in the books  department that she began to rethink the approach.

First, while editing a small book on ancient Egyptian irrigation systems, she assiduously looked up all the city names mentioned in the manuscript and changed them in accordance with her source, an effort that left the author less than pleased.  “He wanted them all reinstated.  He said that there is controversy about some of these names. ‘I don’t care if your source used X. I want Y.’”

The exchange made Iverson pause. “I stopped to think that consistency is far more important in a journal article because all of these articles that are edited by different people are grouped together, whereas a book stands alone, so if your author wants to use something quirky, that’s just that author and it’s just in that book.”

The vise grip of the conforming to the immutable-style-rules directive loosened again when an author challenged a style point, again while she was at the University of Chicago Press. So she brought her question to her supervisor and said, “I looked everywhere in the manual for this. I can’t find it. … This author wants to have such and such.”

“Cheryl,” the boss responded, “the manual is not a Bible. It’s just a guide.”

Iverson’s experience as a young copy editor is not uncommon. “When people are new, they want to know, What’s the rule? What’s the rule about? They want there to be a rule because rules help them”—especially when trying to explain their editing decisions to authors. “But then when you have been editing a while you’re more mellow. I don’t think it is a bad thing in other words. I don’t think it is a bad thing [to relax the rules] as long as you don’t get sloppy and let errors get through.”

Helping new copy editors navigate the rough terrain of medical articles that are filled with jargon, abbreviations, numbers, complex tables, and figures has been a singular pleasure. “I loved when a relatively new editor would learn the job,” Iverson said, describing how individuals would come to her and say, “‘I don’t know what to do with this table.’ Then later, they would come in and say, ‘This table is really difficult, but I thought I would do X.’ You could see that they were starting to develop their own judgment.” Although she remains in partial retirement, Iverson responds to questions from AMA Manual of Style users and posts answers on the AMA Style Insider blog. The questions range from as simple as how many spaces go after a period to as difficult as coaching a writer whose bosses disagree with a grammatical decision despite all kinds of evidence supporting her or his position. She responds to those questions with the same compassion and sense. And she receives the same pleasure in coaching them to resolution.

“I see [that] our job as editors is to facilitate reading so that you don’t have to stop and go back and say wait what did that say again?”

To illustrate her point she recalled a cartoon presented at a Council of Science Editors conference. In the cartoon, the characters debated, “Who is more important, the author or the editor?” Each character argued for the author or the editor until the final panel, which said “The reader is what is important. That’s who we are working for.”—Beverly Stewart



Quiz Yourself

Which of the following sentences is correctly punctuated?

We conducted a randomized placebo-controlled trial.


We conducted a randomized, placebo-controlled trial.


We conducted a randomized placebo-controlled trial.

When fewer than 3 modifiers are used, avoid adding a comma if the modifiers and the noun are read as one entity, such as randomized placebo-controlled trial.—Laura King, ELS