An Interview With AMA Manual of Style Committee Member Connie Manno

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With the recent release of the 11th edition of the AMA Manual of Style, I was curious to learn more about the members of the style committee, their background, and their experience working on the manual update. After all, these editorial masterminds spent countless hours debating every detail of AMA style to make our jobs as editors easier.

The first person with whom I chose to chat was Connie Manno, Director of the Freelance Editing Unit at JAMA Network and coauthor of chapter 4, Tables, Figures, and Multimedia. (Full disclosure—she’s my manager.)

Background

Connie started working as a coordinator in the freelance unit at the JAMA Network in 1998 after getting started with the organization as a freelance proofreader. In 2017, she was promoted to the director of the unit.

The freelance team currently consists of 5 in-house coordinators, 12 freelance editors, and 4 freelance copyreaders and is constantly growing. The team has doubled since Connie started in the unit to keep up with the increasing number of manuscripts and the greater amount of content published by the JAMA Network.

Expectations for Freelance Editors

When asked about the expectations of the freelance editors, Connie stated that the preference is for each to edit at least 3 major manuscript per week and to handle the initial set of author revisions. The editors are expected to take a substantive editing approach, with strict adherence to the AMA Manual of Style.

They are contacted at least monthly with updates to or reminders about journal style and policy. The coordinators review the work of the freelance editors and provide feedback as necessary. Furthermore, every spring, the freelance editors are invited to a day-long conference to experience a deeper dive into style and policy.

Over the years, Connie has discovered her aptitude and joy in training new freelancers and coordinators. She attributes her knowledge of AMA style to this aspect of her job. She finds that it’s more effective to provide the exact sections of the manual to new editors on their reviewed manuscripts so that they can see why changes were made and know where to look for those items in the future. Like many of your manuals, Connie’s is meticulously organized with tabs, highlights, and underlines.

On Editing Figures

One section of scientific manuscripts that can be particularly challenging to edit is figures. Because of her eye for visual representation of data, Connie was asked to take over development of chapter 4 from Stacy Christiansen, Chair of the AMA Manual of Style and Managing Editor of JAMA. Connie worked on the chapter for the last 3 years of development. Basic editing had been done, but Connie was responsible for finding good examples and, of course, making sure that those examples were edited according to AMA style.

In the process and by working with figure and statistical experts on JAMA for about a year, she gained more in-depth knowledge about which type of figures are best for representing different types of statistics and the data needed for completeness of presentation. You can see Connie’s recent AMA Style Insider post for a summary of updates to the chapter–she hopes that you find it informative and helpful!

Questions?

Please feel free to send your questions about figures and tables style to stylemanual@jamanetwork.org or @AMAManual on Twitter.–Sara Billings

Updates to Reporting Black and White as Racial Categories

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Everyone in the business of communication has a responsibility to use and promote the use of clear and accurate language, with words that reflect the world around us. As evidenced by perpetual updates to style manuals, dictionaries, and other resources, nomenclature is never a static enterprise.

Specifying the race or ethnicity of an individual can provide information about the generalizability of the results of a specific study. Because many individuals may have mixed heritage, a racial or ethnic distinction should not be considered absolute, and ideally it should be based on a person’s self-designation.

In the JAMA Network journals, we ask authors to provide an explanation of who classified individuals’ race, ethnicity, or both, the classifications used, and whether the options were defined by the investigator or the participant. In addition, the reasons that race/ethnicity were assessed in the study also should be described (eg, in the Methods section and/or in table footnotes).1

We have received a number of queries about the presentation of racial and ethnic terms in the AMA Manual of Style, in particular the manual’s style current preference for using lowercase for the term black. The 11th edition specifies capitalizing racial and ethnic terms that derive from geographic nouns such as Asian, Alaska Native, and Latina (chapter 10.3.2, Capitalization, Proper Nouns, Sociocultural Designations), but the terms black and white have been lowercased as racial designators (because they are not derived from proper nouns).

However, ongoing and recent events spurred us to reconsider this style recommendation. The manual’s committee met several times, conducted research, and sought input on this issue from multiple sources. We deem this issue too important to wait for change.

In weighing the options (keep black and white lowercase, capitalize just Black, or capitalize both Black and White), we reviewed usage recommendations in a variety of sources, including other style manuals (Chicago Manual of Style,2APA style,3 and the AP Stylebook4), writing by an array of scholars, and guidance on diversity from academic and government sources, such as the US National Institutes of Health.5

The committee has concluded that we will now capitalize both Black and White, which aligns with the capitalization preference applied to other racial/ethnic categories. We acknowledge that there may be instances in which a particular context may merit exception to this guidance, for example, in cases for which capitalization could be perceived as inflammatory or otherwise inappropriate.

The online style manual will be updated to reflect this change, including the section on race/ethnicity in the Usage chapter  (chapter 11.12.3, Usage, Inclusive Language, Race/Ethnicity) and the aforementioned entry in the Capitalization chapter.

There are additional language issues to consider, including use of “other” as a category and abbreviating racial and ethnic terms. The nonspecific “other” is sometimes used for comparison in data analysis but may also be a “convenience” grouping/label that should be avoided, unless it was a prespecified formal category in a database or research instrument.

In such case, the categories included in “other” should be defined and reported. Authors and researchers are advised to be as specific as possible when reporting on racial/ethnic categories (even if these comprise a small percentage of participants).

Example (not recommended): “The study included 200 White individuals, 100 Black individuals, and 100 of other race/ethnicity.”

In this situation, an editor should ask the author for further explanation, considering that the racial/ethnic background of a quarter of the study is not provided.

Example (preferred): “The study included 200 White individuals, 100 Black individuals, and 100 of other race/ethnicity, which included Chinese, Japanese, Korean, and Native Hawaiian/Pacific Islander and those who reported multiple categories.”

Racial and ethnic terms also should not be abbreviated unless necessary for space constraints (eg, in tables and figures with clear expansion in explanatory footnotes or legends).

The manual’s committee will continue to explore changing trends in usage of other racial and ethnic terms as well, such as Latinx. As with all changes to the style manual, we welcome input from readers. The update to the manual online will be implemented as soon as possible, and the JAMA Network journals will begin to use Black and White as we edit new content.–Stacy Christiansen and Tracy Frey, for the AMA Manual of Style committee

References:

1. Instructions for Authors. JAMA. Updated April 13, 2020. Accessed June 19, 2020.  https://jamanetwork.com/journals/jama/pages/instructions-for-authors#SecReportingRace/Ethnicity

2. Black and White: a matter of capitalization. CMOS Shop Talk. Posted June 22, 2020. Accessed June 22, 2020. https://cmosshoptalk.com/2020/06/22/black-and-white-a-matter-of-capitalization/

3. APA Style. Racial and ethnic identity. Accessed June 20, 2020. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities

4. AP Stylebook. Race-related coverage. Accessed June 22, 2020. https://www.apstylebook.com/race-related-coverage

5. Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes. National Institutes of Health. Released April 8, 2015. Accessed June 20, 2020. https://grants.nih.gov/grants/guide/notice-files/not-od-15-089.html

Nephrology Nuance

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When you’re in quarantine, you have to look for little things to spark joy in your life. I’ve found myself getting excited when I edit an article for which new AMA style guide updates come into play. Recently, while editing an article focusing on patients with end-stage kidney disease, I had the chance to refresh my knowledge on the new guidelines in the 11th edition of the AMA Manual of Style regarding nephrology nomenclature (14.18).

In accordance with the international efforts put forth by KDIGO (Kidney Disease: Improving Global Outcomes), which focus on making terminology more patient-friendly, precise, and universal, the 11th edition has updated the nomenclature used to describe kidney function and disease.

Updates on language choice include:

Kidney vs renal: Select the more patient-friendly term (ie, kidney). Also, avoid using both terms in parallel, as this could lead to confusion over different abbreviations for the same condition (eg, RRT [renal replacement therapy] and KRT [kidney replacement therapy]).

Kidney failure vs end-stage renal disease: Kidney failure is the preferred term except when referring to eligibility for medical care under US legislation or other regulations. Patients with kidney failure should be further described by the presence or absence of therapy by dialysis, transplant, or conservative care and by symptom severity.

Decreased glomerular filtration rate: Use this instead of decreased kidney function. Kidneys execute various functions, not just glomerular filtration, so precision in terminology is preferred.

The final recommendations and a complete glossary of related terms will be available in the near future and used to inform an update to this chapter in the manual online. –Suzanne Walker

Where in the World Is the Publisher’s Location?

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If you’re into vintage video games or, like me, came of age watching copious amounts of PBS programming, you may be familiar with a certain raven-haired, scarlet-bedecked, UNESCO World Heritage Site–stealing woman of mystery.

bustle.com

Where was the elusive Carmen headed, and what thrills were in store on the journey to find her and thwart her devious plans?

In the 10th edition of the AMA Manual of Style, reference citations for books and edited books included the publisher’s location, which at times could be as hard to pinpoint as Ms Sandiego herself. However, the journey to find this information lacked the glamor of international espionage and instead featured fruitless online searches and squinting at the minuscule copyright page of a volume from the 70s that Google allowed for preview.

Particularly perplexing were the occasions when a publisher with multiple offices was listed but no indication was given as to which one produced the book in question. So where in the world was the publisher’s location? Boston? London? Berlin? Hoboken?

Luckily, the 11th edition of the AMA Manual of Style recognizes that this struggle was indeed real, and the publisher’s location is no longer required for reference citations for books and edited books (3.12.8). Now the publisher appears directly after the italicized book title and is followed by the publication year. For example: Tinker R. Who in the World is Carmen Sandiego? HMH IP Company Unlimited Company; 2019.

Hopefully eliminating the publisher’s location from references will save you time during your editing process, time that can be better spent spanning the globe in pursuit of a jet-setting villainess…if you can find her.–Amanda Ehrhardt

The Temperature on Spacing for Degrees

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Tucked deep within the weighty 10th edition of the AMA Manual of Style were brief entries providing guidelines for reporting measures of temperature. In sum: writers and editors reporting Celsius or Fahrenheit should (1) close up spaces between numerals, degree symbols, and temperature units and (2) repeat the degree symbol and the unit when reporting temperature ranges. For example: 37.5°C-37.9°C.

Simple? Yes—with the possible exception of closing up the space between numerals and degree symbols, as many non-AMA publications include a space between temperature values and degree symbols, and the degree symbol was 1 of only 3 exceptions to the usual AMA style rule to add a full space between an Arabic measure of quantity and the unit of measure. (The other exceptions being the percent sign and the symbols for normal and molar solutions, often closed up in other publications.)

To separate or not to separate? That was the question.

The new (and even more comprehensive) 11th edition aims to ease any resulting separation anxiety, now calling for a full space between temperature values and degree symbols. Moreover, units no longer need be repeated when a hyphen is used. For example: 37.5-37.9 °C.

The 11th edition also makes more explicit that the degree symbol is not used with Kelvin values and highlights that relative temperatures should be expressed as higher and lower rather than warmer or colder.–Phil Sefton

Exhibit A

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There are times when authors question whether they really need copyediting; occasionally, when edits are especially light and authorial moods particularly dark, I even wonder if the idea of skipping it might even be right. But I am never swayed long, because to copyeditors, it is usually clear how tricky English can be, even in its smallest and seemingly simple parts.

Consider exhibit A: a.

English offers 2 indefinite articles, a and an, and the 11th edition of the AMA Manual of Style includes a simple-but-not-easy rule of when to use them: the a goes before consonant sounds and the an before vowel sounds. The hard part is that the sounds, not the written letters, are the deciding factor.

Because English is nonphonetic, words that start with written consonants (such as h) might begin with a vowel sound (as with hour), and those starting with a vowel may be said as an initial consonant sound (as with one). The only way to know the correct article to use is to know how each word is said aloud.

Medical writing further complicates this with prodigious abbreviations. Exactly half of the letters in the English alphabet, including 8 consonants, are said with initial vowel sounds; for example, an N is pronounced “en” and thus must follow an an when it occurs in acronyms such as NSAID. (The other 7 such consonants are F, H, L, M, R, S, and X.)

Making things even worse, acronyms that are pronounced as words (eg, LASIK) must be matched with the indefinite article that goes with their initial sound (in LASIK, “la-,” which means an a should be used), not the sound that matches the spoken letter (the “el” sound of L, which would go with an an). This means it is essential to know which acronym is said as a word and which as a mere cluster of letters.

It is a relief that nearly all of the letter names that start with consonant sounds (B, C, D, G, J, K, P, Q, T, W, Y, and Z) are for actual consonants, making the a their default article—except that, of course, Y is a consonant (said “ya”) and a vowel (“ee”) with a rather inexplicable spoken name (“why”), and…. well, you get the picture. The complexity never ceases.

Anyone can get this stuff wrong, even native English speakers. For authors using English as a foreign language, including those who largely write in rather than speak the language (and therefore do not sound it out much) and those whose native languages do not include indefinite articles (eg, Japanese, Hindi, Polish, many more)—this might be pretty hard to manage. For everyone, there are copyeditors. We hope to handle this and all the rules in our 1200-page style manual, from a to z.–M. Sophia Newman

Birthplaces and Social and Economic Descriptions of Countries

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There are more examples of bias-free language in the new edition of the AMA Manual of Style, including 2 new entries in the Correct and Preferred Usage chapter, one discussing the birthplace of study participants and the other describing countries in terms of their economic and social factors.

The first new entry discusses not using the term foreign-born. We see this descriptor all the time in studies describing participants who aren’t from the country where the study was conducted but this term may be considered derogatory and should be avoided.

The easiest solution is to say that the person was born outside the country of interest or born abroad. For example, for a study that took place in the United States, use “non–US born participants” or “participants born outside the United States.” Also, it’s preferred to use US or United States vs American or America for clarity.

The second new entry is a little trickier and refers to adjectives used to describe a nation, region, or group in which most of the population lives on far less money—with far fewer basic public services—than the population in wealthy countries.

There is no universal, agreed-on criterion for describing a country in terms of its economic or human “development” and which countries fit these different categories, although there are different reference points, such as a nation’s gross domestic product per capita or the limited nation’s Human Development Index (HDI) compared with that of other nations.

The appropriate term should be based on context and respectfully reflect a specific country’s economic and social situations. The AMA Manual of Style suggests limited-income, low-income, resource-limited, resource-poor, and transitional.

Avoid the terms first world/third world and developed/developing. The term third world is pejorative and archaic, and while developing might seem like an acceptable alternative, it too can be considered pejorative and insensitive to the many complexities of metrics used to measure economic, political, resource, and social factors.

Best practice is to avoid such general terms and use specific terms that reflect what is being compared, such as low-income or high-income for an article comparing countries based on measures such as gross national product per capita.–Tracy Frey

Variants for Mutation

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Other than in reference to the Teenage Mutant Ninja Turtles, the anthropomorphic crime-fighting turtles who love pizza, there are few instances in which the term mutation, or any form of the word, has a positive connotation.

Because of this negative connotation and the confusion regarding the definitions of the terms mutation and polymorphism across disciplines, the Human Genome Variation Society recommends avoiding these terms.

The 11th edition of the AMA Manual of Style reinforces this recommendation, as well as the suggestion to instead use the terms sequence variant, sequence variation, alteration, or allelic variant.

In light of this recommendation, the term single-nucleotide variation (SNV) is more frequently being used than single-nucleotide polymorphism (SNP). To aid readers’ understanding during this transition, it is suggested that SNV be used at first mention, with SNP included in parentheses as follows: “…SNV (formerly SNP).” This should help authors and readers adjust to the recommended language.–Nicole FioRito

Fellowship Designations

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In the 10th edition of the AMA Manual of Style, writers and editors were instructed to remove US fellowship designations and honorary degrees (PhD[Hon]) but to keep non-US designations, such as the British FRCP or FRCS and the Canadian FRCPC. The idea was that many of these non-US designations were attained through a series of qualifying examinations.

For me, following this rule usually meant copying and pasting the designation into an online search engine to find the associated country and then explaining to the authors in a query why some designations were removed while others were allowed to remain.

With the 11th edition, fellowship designations will be removed altogether from the byline. The emphasis will now be placed on academic degrees (which means even honorific addresses like knighthood won’t appear in the byline).

Like the 10th edition, we will continue to publish academic degrees (eg, MD, MBBS, PhD, MS) in bylines as well as licensing and certifications (eg, RN, ELS). We hope this updated style rule will keep byline presentations fair and consistent. –Iris Y. Lo

New Edition, New Rules

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As an introduction to some of the new features of the 11th edition of the AMA Manual of Style, the AMA Style Insider will begin a series of short weekly posts highlighting changes in style rules that editors should begin incorporating into their workflows.

This series will start with updates on a time-sensitive topic that is unfolding not only in medical publications, but also across mainstream media outlets: coronavirus disease 2019 (COVID-19).

As the scale of COVID-19 becomes increasingly global, it is essential that editors use nomenclature that is accurate and consistent so readers can trust the integrity of the information being published.

The AMA Manual of Style addresses coronavirus in section 14.14.3, Virus Nomenclature. The disease name COVID-19 was finalized by the World Health Organization and the virus name severe acute respiratory syndrome coronavirus (2 SARS-CoV-2) was finalized by the International Committee on Taxonomy of Viruses. Updates will be provided in Table 14.14-10, Viruses of Humans.

For continued clinical updates on COVID-19, please visit JAMA Network’s designated page for research and educational resources. For situation updates, please refer to the US Centers for Disease Control and Prevention.–Amanda Ehrhardt