grammar

Questions From Users of the Manual

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Q: Is it correct to leave “post” as a separate word in the following sentence? “These activities must take place from prelaunch to post launch.”

A: In section 8.3.1 (“When Not to Use Hyphens”), you’ll see the following:

Note that when post is used as a combining adjectival form, as in postmortem examination, it is set closed up. When it is used as an adverb, as in post hoc testing, it is set as 2 separate words.

So in your example, you would not close up “post launch.” However, the meaning of this sentence is ambiguous to me.  I would suggest rephrasing it to avoid an awkward construction and to clarify exactly what interval you are talking about. How about “These activities must take place both before and after launch.”?—Cheryl Iverson, MA

Quiz Yourself

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Correct the grammar error in the following sentence:

We performed a quantitative overview of randomized trials which tested β-blockers in myocardial infarction, heart failure, and hypertension.

Highlight for the answer:

We performed a quantitative overview of randomized trials that tested β-blockers in myocardial infarction, heart failure, and hypertension.

Incorrect use of relative pronoun (which vs that) (§7.2.2, Relative Pronouns, pp 317-319 in print). That introduces a phrase that is essential to the meaning of the sentence, and which introduces a phrase that adds more information but is not essential to the meaning. Which should always be preceded by a comma. Another example: “He visited the new hospital, which had been built last year” is correct. However, if there were 2 hospitals and only 1 had been built last year, the sentence would read, “He visited the new hospital that had been built last year.”—Laura King, ELS

Questions From Users of the Manual

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Q: I am used to writing “compared with” when discussing results/measurements. Can you please comment on whether this is correct?

A: This is addressed in the glossary in chapter 11. See “compare to, compare with.” You’ll see there that “compare with” is usually used when the aim is to examine similarities or differences in detail.

Q: I was trained in other settings to ignore having to write out the state on first mention if the city is well known, especially if the readership is primarily American. For example, Chicago, Los Angeles, and San Francisco would not require adding the state name on first mention. Something like Spring Green would. What would AMA style require?

A: Please see section 14.5, where this is addressed in detail. The key sentence is this:  “At first mention, the name of a state, territory, possession, province, or country should be spelled out when it follows the name of a city.” In earlier editions, we used to follow a policy something like what you describe but changed that as it was a matter of opinion what was “well known” and what was not.  Also, with the international readership of so many publications, this becomes a trickier question.—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: My colleagues and I are debating the correctness of the following sentence:  If any of the side effects gets serious, contact the study doctor.

A: If you remove the words “of the” from your sentence, you will find the answer(s) readily apparent. If there is one side effect, you’d use the singular:  “If any side effect becomes serious….”  If there is more than one side effect, you’d use the plural:  If any side effects become serious….”

Q: Should “week” or “weeks” be used in the following sentences?

 The changes in serum creatinine remained stable from week/weeks 48 to 96.

Nausea typically develops between the fourth and sixth week/weeks of pregnancy.

A: We would suggest using “weeks” in both examples. It would, of course, not be incorrect to repeat “week,” eg, “…at week 48 and week 96,” but for efficiency you could use “…at weeks 48 and 96.”—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: I understand that the second printing of the AMA Manual of Style is now available and that many of the items in the list of Errata on the companion website (www.amamanualofstyle.com) are corrected therein. How can I tell if I have the first or the second printing? Does the second printing have a different ISBN?

A: Yes, the second printing was published in October 2007 and in it the majority of errata listed on the companion website are corrected. You can tell which printing you have by looking at the copyright page of the book (p iv). In the lower left corner of that page is a string of numbers, beginning, on the left, with 9. The number on the far right of that string will indicate the number of the printing. If the last number on the right is a 2, you have the second printing. The ISBN does not change with printings.

Q: Which is correct: “Qvar has similar systemic effects to those of fluticasone” or “Qvar has similar systemic effects as those of fluticasone”?

A: The correct idiomatic form is “similar…to” not “similar…as,” as with “identical…to” rather than “identical…as.” I suspect the use of “as” in this construction comes from a related idiom: “the same as.” You could also rephrase this to “Qvar and fluticasone have similar systemic effects.” or “Qvar has systemic effects similar to those of fluticasone.”

Q: Has the policy on SI units changed? If so, how?

A: Yes. These changes are addressed in detail in section 18.5.10. For laboratory values reported in JAMA Network Journals, factors for converting conventional units to SI units should be provided in the article. In text, the conversion factor should be given once, at first mention of the laboratory value, in parentheses following the conventional unit.

The blood glucose concentration of 126 mg/dL (to convert to millimoles per liter, multiply by 0.055) was used as a criterion for diagnosing diabetes.

For articles in which several laboratory values are reported in the text, the conversion factors may be provided in a paragraph at the end of the “Methods” section. In tables and figures, this information can be provided in the footnote or legend.

Q: Although the 10th edition recommends spelling out state names except in full addresses and the reference list (for location of publishers), I notice that you still show “DC” for District of Columbia. Is this an exception?

A: Yes.

Q: If a state’s full name is spelled out on first mention in running text, per the new style, what do you do when numerous cities in the same state are mentioned in an article? Should the state name be spelled out every time it is mentioned, every time a new city is mentioned, or should the 2-letter postal code be used after the first time the state name is spelled out in running text?

A: The answer will depend on the context. If the article is about cities in a particular state, you might not need to include the state name with the individual cities at all, as it will be clear what the state is, eg, “6 cities in Massachusetts.” If the state name is spelled out at the first mention of each new city, it shouldn’t need to be repeated, unless there are instances in the manuscript of a city that exists in more than 1 state (eg, Springfield, Massachusetts, and Springfield, Illinois).—Cheryl Iverson, MA

Split Infinitives

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Would you convey my compliments to the purist who reads your proofs and tell him or her that I write in a sort of broken-down patois which is something like the way a Swiss waiter talks, and that when I split an infinitive [expletive deleted], I split it so it will stay split….—Raymond Chandler1

The proscription against splitting infinitives—the insertion of one or more words between the particle to and the bare verb2 (eg, to really try, to quickly go)—dates from the early 19th century, when an 1834 magazine article fired perhaps the first shot in the war against the construction.3 Other observers such as Henry Alford (A Plea for the Queen’s English [1864])4 quickly followed suit, and soon a full-blown battle was afoot. The timing of all of this is not surprising, given the affection of the Victorian era for Latin,4 a language in which the infinitive cannot be split because it is a single word.5,6

It should be noted, however, that writers of English have been making free use of the split infinitive since the 14th century3 and that “Noteworthy splitters include John Donne, Daniel Defoe, George Eliot, Benjamin Franklin, Abraham Lincoln, William Wordsworth, and Willa Cather”6—and Raymond Chandler, who once took the admirably firm stance noted above.1 Moreover, the split infinitive has enjoyed renewed support since at least the 1930s, and many authorities now agree with Sterling Leonard, who in 1932 wrote that “The evidence in favor of the judiciously split infinitive is sufficiently clear to make it obvious that teachers who condemn it are wasting their time and that of their pupils.”7 Part of the reason for the support is that because the particle to is not truly part of the infinitive, technically “there’s nothing to split.”4 Furthermore, a split infinitive sounds natural because in English, the best place for an adverb… is right in front of the word it describes.”4

However, some discretion is necessary. Some split infinitives are acceptable because the adverb will not make sense anywhere else in the sentence. Others simply sound better owing to the rise and fall of accented syllables (consider, for example, perhaps the most famous split infinitive of all time—Star Trek’s “To boldly go where no man has gone before….”).2,3,7 Still others are acceptable on the grounds that unsplitting them would result in an awkward construction or, worse, change the sense altogether7—consider, for example, the different meanings of “I want to live simply,” “I simply want to live,” and “I want to simply live.”8

This is not to say that all infinitives can or should be split. Given the lingering wariness toward the construction, avoiding splits is advisable when writing for unfamiliar audiences or for those known to favor the proscription; in such cases, if “a split is easily fixed by putting the adverb at the end of the phrase and the meaning remains the same, then avoiding the split is the best course.”7 Also, writers should carefully assess splits involving the insertion of 2 or more words between the particle and the bare verb to ensure that the intended meaning is not changed or simply obscured by a list of adverbs. Last, writers should also take special care to avoid ambiguity that can arise when only the first infinitive in a series of infinitives contains the particle, because it can be unclear whether the adverb modifies only the first infinitive or all of the infinitives in the series.7

The bottom line:

● Splitting infinitives is not incorrect—but deciding whether to split is a matter of having “a good ear and a keen eye.”7

● Whenever possible, take into account the perceived tastes of the audience—and always take into account the rhythm and sound of the construction, the number of adverbs in use, and any ambiguity that might result from placement of the adverb(s).

● Recasting a sentence to avoid using an infinitive altogether is always an option.

● If it seems that splitting is justifiable, by all means go for it—and know that you are in good company.—Phil Sefton, ELS

1. Chandler R. Letter to Atlantic Monthly editor Edward Weeks. Dictionary.com website. http://quotes.dictionary.com/would_you_convey_my_compliments_to_the_purist. January 18, 1948. Accessed November 8, 2012.

2. Fogarty M. Quick and Dirty Tips: Split Infinitives. Grammar Girl website. http://grammar.quickanddirtytips.com/split-infinitives.aspx. Accessed October 9, 2012.

3. Nordquist R. Grammar & Composition: Split Infinitive. About.com website. http://grammar.about.com/od/rs/g/splitinfinitive.htm?p=1. Accessed October 9, 2012.

4. O’Conner PT. Woe Is I: The Grammarphobe’s Guide to Better English in Plain English. 3rd ed. New York, NY: Riverhead Books; 2009:210-213.

5. Iverson C, Christiansen S, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007:322.

6. Split Infinitive. thefreedictionary.com website. http://www.thefreedictionary.com/p/Splits%20the%20infinitive. Accessed October 9, 2012.

7. Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000:314-315.

8. Maddox M. What Is a Split Infinitive? DailyWritingTips website. http://www.dailywritingtips.com/what-is-a-split-infinitive/. Accessed November 8, 2012.

Quiz Bowl: Articles

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Once again it’s time for a historic Quiz Bowl. Okay, maybe historic is a bit much, but I’m trying to make a point here. The point has to do with the subject of this month’s AMA Manual of Style quiz—articles. Is it a historic or an historic Quiz Bowl? Did you guess a historic? If so, you’re right. The article a is used before the aspirate h (eg, a historic occasion) and nonvocalic y (eg, a ubiquitous organism) (§11.9, Articles, p 412 in print).

Try another example from this month’s quiz.

The physician told that patient that he should have a/an ultrasound examination performed.

Here’s a hint. Sometimes it helps to read the sentence aloud.

The answer is as follows (use your mouse to highlight the text box):

The physician told that patient that he should have an ultrasound examination performed.

Words beginning with vowels are preceded by a or an according to the sound following (in this case, the u sound) (§11.9, Articles, p 412 in print).

Sound plays an important role in determining whether to use a or an. Test your skills by taking the full Articles Quiz on the AMA Manual of Style online. It will be a (or is that an?) unique experience.—Laura King, MA, ELS

Around, About, Approximately

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Although each of these words is used to refer to a value that is estimated and therefore imprecise, whether it is acceptable to use them interchangeably depends in part on context and the level of accuracy being implied.

Some speakers and writers will use approximately before turning to the other two—not surprising, because people faced with a choice between words will often choose the most impressive-sounding one. And sometimes that choice happens to be correct. On the other hand, people will often, especially in casual communications, use around or about as a sort of verbal shorthand. And again, sometimes that choice happens to be correct.

So, what’s the scoop? To sort this out, it helps to recognize that authorities for the most part agree that around, about, and approximately lie on a scale from casual to formal. As it happens, around is also thought of as the most imprecise and approximately the most precise, with about falling somewhere in between. It further helps to note that around, meaning merely “with some approach to exactness,”1(p68) is not widely considered an adequate replacement for either about or approximately and thus is often accepted only in casual conversation.2 Hence, in conversation between friends, for example, many speakers will toss off a “See ya around three,” whereas in written communications, as Bernstein maintains, “‘about three o’clock’ is preferable to ‘around three o’clock.’”2

Things get a bit more complicated as one moves along the scale: not only does the choice of word depend in part on the closeness to accuracy required by different types of communication, but the differences between the implied degrees of closeness can be subtle. For example, Merriam-Webster’s defines about as “reasonably close to”1(p4) and approximately as “nearly correct or exact.”1(p61) However, it is safe to say that in nontechnical communications (which presumably often place less emphasis on precision), the use of about is not only accepted but is perhaps preferred. As Garner maintains, “When possible, use about instead of approximately, a formal word”3(p5)—where a “formal” word is defined simply as one “occupying an elevated level of diction.”3(pp153-154) On the other hand, as suggested by the above definitions, about does not emphasize a closeness to accuracy as strongly as approximately does—which helps explain why about seems fine when used to refer to estimated values that have been rounded to multiples of 5 or 10 but can seem strange when used to refer to unrounded values.4 Moreover, around and about each have multiple meanings and can be used in other senses, whereas approximately is used in a single sense only, leading some authorities to maintain that the latter is a better choice for technical communications.5

The bottom line:

● Referring to an inexact value in casual conversation? Around, about, and approximately are all acceptable, but approximately can sound a bit pretentious.

● Referring to an inexact value in nontechnical writing? About is perhaps the best choice, around being too informal and approximately being a tad too formal.

● Referring to an inexact value in medical or other technical writing? Although about may very occasionally be used if one carefully assesses the context, approximately is nearly always the best choice.—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

2. Around. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:44-45.

3. Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000.

4. Yateendra J. About and Around and Approximately: Shades of Difference? Editage website. http://blog.editage.com/about-and-around-and-approximately-shades-of-difference. Accessed August 1, 2012.

5. Scientific English as a Foreign Language: Around, About, Approximately. Worcester Polytechnic Institute website. http://users.wpi.edu/~nab/sci_eng/97_Jun_20.html. 1997. Accessed August 1, 2012.

Purposely, Purposefully

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These words sound similar, and over time their meanings have come to overlap somewhat. Generally, however, they are regarded as having different meanings and uses—although the differences are admittedly subtle—and in choosing between them, writers should carefully consider the message they wish to convey.

Purposely—meaning “with a deliberate or express purpose”1 or “intentionally”2—was first on the scene, entering usage in the late 1400s.2 A second meaning, “to good purpose; effectively,” came into use about 100 years later but is now considered obsolete.2

In contrast, purposefully—meaning “full of determination”1—was a relative latecomer, not coming into use until the mid 1800s,2 and is still used in those senses. Over time, though, purposefully also has come to be used interchangeably with purposely in the sense of “intentionally,”2 perhaps because something done with determination is also done intentionally. But of course the reverse is not necessarily true, which suggests that writers should use purposely when referring to intention alone.

To some ears, however, purposely sounds uneducated or incorrect, leading some writers to instead use purposefully in error; moreover, writers simply looking for a more impressive word will also sometimes instead use purposefully—again incorrectly.3 But even when purposefully is the correct choice, writers should take care that their intended meaning is not misconstrued. For example, the statement “On occasion, a clinician might purposely elicit pain” likely simply means that the clinician is intentionally eliciting pain (for the purpose of making a diagnosis). On the other hand, the statement “On occasion, a clinician might purposefully elicit pain” might imply that the clinician is determinedly eliciting pain (again—one can only hope—for the purpose of making a diagnosis). In both instances, careful handling of the context can make clear that the elicitation of pain is a necessary evil in service of a worthy end. For example, simply ending either of the above statements with “to help make a diagnosis” can go a long way toward ensuring that the clinician is not construed as something of a sadist.

The bottom line:

●Is “intentionally” the intended message? Use purposely.

●Is “full of determination” the intended message? Use purposefully.

●In both cases, however, take care to ensure that the context helps readers determine the intended meaning.—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:1011.

2. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:1474.

3. Purposefully, purposely. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:376.