usage

Ex Libris: Grammar Girl’s 101 Words to Sound Smart

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This column wraps up the reviews of Grammar Girl’s 101 words series with Grammar Girl’s 101 Words to Sound Smart. Just as our superhero Grammar Girl came to the rescue of high school graduates who want to appear educated and erudite with her book Grammar Girl’s 101 Words Every High School Graduate Needs to Know, so too does she come to the aid of general readers who want to appear smart. A daunting task to say the least, but our heroine Mignon Fogarty, disguised as her Grammar Girl alter ego, is up to the task. As she writes in her introduction, “It’s a presumptuous task to choose 101 words that ‘smart people’ use. Who says what’s smart?” But difficulty notwithstanding, Grammar Girl forges ahead and forms a list of 101 words to sound smart.

As with the other books in the series, 101 Words to Sound Smart is formatted as a glossary, with words arranged alphabetically and most entries only 1 page long. Each entry includes a quotation illustrating the correct usage of the word in question from authors, reporters, actors, and other notable sources. For example, in the entry on wane, Fogarty quotes the author Evelyn Waugh, “My unhealthy affection for my second daughter has waned. Now I despise all my seven children equally.”

Although 101 Words to Sound Smart is aimed at a general audience, it is a useful guide for editors and particularly writers. Although all these terms can be found in dictionaries, Grammar Girl presents the information more simply and clearly. In addition, her explanations provide a means to understand not only the definitions of terms but also their usage.

For example, one of the terms listed in 101 Words to Sound Smart is Occam’s razor (also spelled Ockham’s razor). Merriam-Webster’s Dictionary defines this term as “a scientific and philosophic rule that entities should not be multiplied unnecessarily which is interpreted as requiring that the simplest of competing theories be preferred to the more complex or that explanations of unknown phenomena be sought first in terms of known quantities.” Huh? Grammar Girl explains it as “a phrase that means the simplest solution is usually the right one.” Oh, now I get it. She then clarifies: “For example, if you find a basket of tomatoes outside your door, it’s conceivable that ninjas are trying to poison you because, although you don’t know it yet, you are essential for their enemy’s evil plan; but Occam’s razor suggests it’s more likely your neighbor who likes to garden, and gave you tomatoes last year, left them there.”

This book serves as a useful compilation of words most readers are generally familiar with but not deeply knowledgeable about. As Fogarty writes, “Many of the words that made the cut are at least familiar to most people, but convey an especially deep meaning when the reader has an understanding of history (Machiavellian, bowdlerize, Rubicon), different cultures (Talmudic, Sisyphean, maudlin), or philosophy (existential). The words are also general enough that most prolific writers could find a reason to use them on occasion.” A few of the entries I found most interesting were anodyne, atavistic, defenestrate, diaspora, ersatz, gestalt, hoi polloi, jejune, nascent, neologism, omertà, peripatetic, sui generis, and zeitgeist.

Overall, Grammar Girl’s 101 words series, including 101 Misused Words You’ll Never Confuse Again, 101 Words Every High School Graduate Needs to Know, 101 Troublesome Words You’ll Master in No Time, and 101 Words to Sound Smart, is a clever, easily readable, and immensely enjoyable quartet of books. Through this series, our superhero Grammar Girl succeeds is vanquishing her arch enemy “the evil Grammar Maven who inspires terror in the untrained and is neither friendly nor helpful” (http://grammar.quickanddirtytips.com/bio/) by offering an alternative to those murky, confusing grammar and usage books editors and writers have had to rely on for years.—Laura King, MA, ELS

Ex Libris: Grammar Girl’s 101 Troublesome Words You’ll Master in No Time

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Of all the books in Grammar Girl’s 101 words series, 101 Troublesome Words You’ll Master in No Time is probably the most useful for editors. This books lists 101 words that, as author Mignon Fogarty puts it, “are only sort of wrong.” These words are particularly challenging for editors. Do we bow to convention and allow established usage to reign or do we forge new ground (as editors often do) by insisting on up-to-date usage? With this book, Grammar Girl guides the way.

Each entry in 101 Troublesome Words You’ll Master in No Time begins with a response to the question, “What’s the trouble?” In her response, Fogarty points out why the designated word is troublesome. For example, in the entry on healthy, she writes, “Some people insist that carrots aren’t healthy; they’re healthful because only healthful can mean ‘conducive to health.’” After outlining the trouble, Fogarty details the history of the problem. For healthy, she writes, “Healthy has long been used to describe things that improve your constitution. Healthful gained ground against healthy starting in the late 1880s, but healthy fought back and now, although healthful isn’t wrong, healthy is the dominant Standard English word we use when describing fruits, vegetables, exercise, and other things we hope will make us live longer.” Finally, Fogarty answers the question all editors ask themselves, “What should you do?” In the case of “healthy,” she states, “Ignore anyone who says you have to use healthful instead of healthy (unless you’re trying to feign an ‘old-timey’ air).” Fogarty concludes each entry with 1 to 2 quotations from pop culture sources (as she does throughout the 101 words series).

There are numerous entries in 101 Troublesome Words You’ll Master in No Time that are applicable to the medical editor and that support (and occasionally refute) information found in the AMA Manual of Style. The following is a table of terms commonly found in medical editing and an explanation of how the AMA and Grammar Girl handle each term.

Term AMA Grammar Girl
African American “For terms such as white, black, and African American, manuscripts editors should follow author usage. … In the United States, the term African American may be preferred to black (not, however, that this term should be allowed only for US citizens of African descent).” “For Americans of African descent, use African American or black. If the person you are describing is from another country, use another appropriate term, such as Caribbean American.”
Aggravate “When an existing condition is made worse, more serious, or more severe, it is aggravated (also, exacerbated), not irritated.” “In formal situations or if you’re feeling especially sticklerish, avoid using aggravate to mean ‘irritate.’”
Billion “The word million signifies the quantity 106, while billion signifies the quantity 109. Although billion has traditionally signified 1012 (1 million million) in Britain, many British medical journals now use billion to indicate the quantity 109. A number may be expressed in million rather than billion if the latter term could create ambiguity. In that case, the decimal should be moved 3 places to the right. Trillion should be used to denote the quantity 1012.” “Today you can safely use billion to mean 1,000,000,000.” When you are reading old or translated documents, however, be aware of their country of origin and remember that the meaning of billion could be 1,000,000,000,000.”
Data “…retain the use of the plural verb with data in all situations.” “In general writing, if information won’t work because you’re using data as a mass noun to mean ‘information collected in a scientific way,’ data can be singular; however, in scientific writing, always treat data as plural.”
Gender “Sex is defined as the classification of living things as male or female according to their reproductive organs and functions assigned by chromosomal complement. Gender refers to a person’s self-representation as man or woman or how that person is responded to be social institutions on the basis of the person’s gender presentation.” “Gender is a social construct, so when you ask someone’s gender, you’re asking whether a person wants to be perceived as what society calls males or society calls female. … If your readers are likely to be extremely squeamish about sex, it’s OK to use gender as a replacement for sex, but if not, try to keep the distinction between the two words.”
Media “In the sense of laboratory culture or contrast media, medium should be used for the singular and media for the plural.” “When media is used as a collective noun, it’s fine to use a singular verb.”
Over “Time: Over may mean either more than or during (for a period of). In cases in which ambiguity might arise, over should be avoided and more than used. … Age: When referring to age groups, over and under should be replaced by the more precise older than and younger than.” “Unless you work for a publication that follows AP style, freely use over to mean more than if it works better in your sentence.”
Percent “The term percent derives from the Latin per centum, meaning by the hundred, or in, to, or for every hundred. The term percent and the symbol % should be used with specific numbers. Percentage is a more general term for any number or amount that can be stated as a percent. Percentile is defined as the value on a scale of 100 that indicates the percentage of the distribution that is equal to or below it.” “When you are writing about increases or decreases in measurements that are themselves percents, it’s often important to be painfully clear whether you changes are percent changes or percentage point changes.  For example, if 6 percent of students attended swim meets last year, and 8 percent of students attended swim meets this year, that’s a 33 percent increase in attendance, but an increase of only 2 percentage points.”
Preventive “As adjectives, preventive and its derivative preventative are equal in meaning. JAMA and the Archives Journals prefer preventive.” “You may certainly choose to use the sleeker preventive, but don’t chide people who prefer the longer form.”
Since “Since should be avoided when it could be construed to mean ‘from the time of’ or ‘from the time that.’” “Don’t be afraid to use since as a synonym for because. Just be sure you aren’t creating ambiguous sentences.”
Unique “An adjective denoting an absolute or extreme state or quality does not logically admit of quantification or comparison. Thus, we do not, or should not, say deadest, more perfect, or somewhat unique. It is generally acceptable, however, to modify adjectives of this kind with adverbs such as almost, apparently, fortunately, nearly, probably, and regrettably. … [Unique] should not be used with a comparative (more, less), superlative (most, least), or quantifying (quite, slightly, very) modifier.” “Unique is an absolute term, but it’s common to hear people modify it, saying such things a very unique. Grammarians call adjectives such as unique, dead, and impossible ‘ungradable.’ It means they can’t be more of what they already are. … Unique means ‘one of a kind’ or ‘having no equal,’ and things can’t become more unique. … Gradable terms can be modified down, however. For example, almost unique is fine. … Reserve unique for things that are truly one of a kind.”
Utilize “Use is almost always preferable to utilize, which has the specific meaning ‘to find a profitable or practical use for,’ suggesting the discovery of a new use for something. However, even where this meaning is intended, use would be acceptable.” “Often, you can replace utilize with use and your sentence will mean the same thing and sound less stuffy. Utilize does have its uses, though. It conveys more of a sense of using something specifically for a purpose or for profit than use does. … Don’t use utilize just because it sounds like a fancy word. When in doubt, choose use. On the other hand, don’t be afraid to use utilize when you’re confident that it’s the right word.”

The above table is meant as a guide for the editor. As always, usage depends on whom you’re writing for and what you’re writing. However, before editors can make decisions on usage, they need to know the options and the reasoning behind them. Both the AMA Manual of Style and Grammar Girl’s 101 Troublesome Words You’ll Master in No Time provide useful guidance on how to handle some of the trickier terms encountered while editing.—Laura King, MA, ELS

Significant and Significance

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If there is any doubt about whether significant/significance refers to statistical significance, clinical significance, or simply something “important” or “noteworthy,” choose another word or include a modifier that removes any ambiguity for the reader.

The AMA Manual of Style (§20.9, Glossary of Statistical Terms, pp 893-894 in print) includes definitions for statistical significance (the testing of the null hypothesis of no difference between groups; a significant result rejects the null hypothesis) and clinical significance (involves a judgment as to whether the risk factor or intervention studied would affect a patient’s outcome enough to make a difference for the patient; may be used interchangeably with clinical importance). Significant and significance also are used in more general contexts to describe worthiness or importance.

Often the context in which the word appears will make the meaning clear:

▪ Statistical Significance:

• Exposure to the health care system was a significant protective factor for exclusive throat carriage of Staphylococcus aureus (odds ratio, 0.67; P = .001).

• Most associations remained statistically significant at the adjusted significance level (P < .125).

▪ Clinical Significance:

• Low creatinine values in patients with connective tissue diseases were found to be clinically significant.

• The combination of erythromycin and carbamazepine represents a clinically significant drug interaction and should be avoided when possible.

▪ Worthy/Important:

• His appointment as chair of the department was a significant victory for those who appreciated his skill in teaching.

• A journal’s 100th anniversary is significant and should be celebrated.

Sometimes, however, the context does not clarify the meaning and ambiguity results.

▪ The one truly significant adverse effect that has caused carbon dioxide resurfacing to lose favor is hypopigmentation, which can be unpredictable and resistant to treatment.

To avoid the possibility of ambiguity, some have recommended confining the word to only one of its meanings. However, why cheat a word of one of its legitimate meanings when there are ways to retain its richness and yet not confuse the reader?—Cheryl Iverson, MA

Option, Alternative, Alternate

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Alternate means “one after the other,” whereas alternative means “one instead of the other”1—and option and alternative are essentially the same thing. Easy peasy, no?

Well, no. At least not quite.

Although few writers would incorrectly use alternative in place of alternate in the sense of “one after the other,” there are subtle differences between these words—and between option and alternative, as well—when they are used in other senses. The potential for confusion is readily apparent when one considers, for example, that option has been defined as “something that may be chosen”2(p871); alternative as “one of two or more things, courses, or propositions to be chosen”2(p37); and alternate as “one that substitutes for or alternates with another”.2(p37) And that’s considering only the use of these words as nouns. As an adjective, alternative has been defined as “offering or expressing a choice” and alternate as “constituting an alternative.”2(p37)

So—is there a way through this thicket?

Option and choice are usually considered interchangeable, but an alternative is an option or choice that stands “instead of the other.”1 Thus, a person faced with numerous options (choices) will always have one more option than alternatives.3 (Some authorities have proposed that alternative should be used only when no more than 2 choices are available. However, few writers observe this distinction.3,4) For example, a diner presented with a dessert menu that lists 4 desserts will—assuming a 1-dessert limit—have 4 options (ie, choices) but only 3 alternatives. Furthermore, it is usually assumed that one of the options will be the original or preferred one, to which the others are alternatives. For example, on that dessert menu, the red velvet cake, tiramisu, and crème brûlée might be alternatives to that triple fudge ganache lava brownie that one has been ogling, in the event that the server comes back with the sad news that the brownie has apparently been everyone else’s first choice as well.

But things get a bit fuzzy when it comes to the choice between alternative and alternate. As suggested above, these words have acquired meanings that are quite close. When a distinction is made, it would seem to hinge on whether a degree of compulsion is in play, with alternative preferred when such compulsion is not present. For example, a person selected to serve as an alternate juror has little choice in the matter; similarly, whereas a person planning a trip might well map out several alternative routes, the same person faced with an unexpected road closure is forced to take an alternate route.5 And, although option and choice can be used interchangeably, alternative has a bit more nuance than choice, suggesting “adequacy for some purpose.”4 Alternative also can suggest a “compulsion to choose”4—although in this case the compulsion is to choose between alternatives (eg, “The alternatives are liberty and death,”4) rather than, as is the case with alternate, a compulsion or duty to serve in place of another (eg, alternate juror, alternate batter).

In practice, although some authorities still advocate maintaining the traditional distinctions between alternative and alternate, actual usage is changing rapidly, and alternative is now often used when a noun is called for and alternate when an adjective is called for.6 However, a big nota bene for medical writers: alternative is used as an adjective in medical contexts when referring to nonallopathic medicine, treatments, or therapies, such as acupuncture, homeopathy, etc. So, the adjective alternate is certainly preferred when referring, for example, to different allopathic treatment choices available to a patient (eg, “the consulting physician recommended surgery but also proposed 3 alternate approaches”).

The bottom line:

● Looking for a word that indicates “one after the other”?1 Use alternate (eg, “Alternate smiles and frowns, both insincere.”7)

● An alternative is by definition an alternative to something else—usually a preferred choice or original plan of action—so one will always have 1 more option than alternatives.

● Although some authorities still maintain the traditional distinctions between alternative and alternate, usage is changing rapidly, and alternative is now often used when a noun is called for and alternate when an adjective is called for—but in medical contexts, the adjective alternative is often used in reference to nonallopathic medicine, treatments, or therapies.—Phil Sefton, ELS

1. Alternate/Alternative. In: O’Conner PT. Woe Is I: The Grammarphobe’s Guide to Better English in Plain English. 3rd ed. New York, NY: Riverhead Books; 2009:88.

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

3. Fogarty M. Quick and Dirty Tips: “Alternate” Versus “Alternative.” Grammar Girl website. http://grammar.quickanddirtytips.com/alternate-versus-alternative.aspx. Accessed January 16, 2013.

4. Alternate; alternative. In: Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000:18.

5. Alternate vs. alternative. Grammarist website. http://www.grammarist.com/usage/alternate-alternative/. Accessed March 27, 2013.

6. Alternate, alternative. English Forums website. http://www.englishforums.com/English/AlternateVsAlternative?bzxvg/post.htm. Accessed January 16, 2013.

7. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:41.

Questions From Users of the Manual

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Q: I have sometimes seen myalgia written in its plural form, myalgias. I would no sooner write myalgias than I would write bone losses.  What is your opinion on this?

A: I took a look at both Webster’s 11th and Dorland’s, our principal dictionaries, and both of them define myalgia as “pain in a muscle or muscles.” I think that this is indication that the singular covers both one and many. So, in short, I am in agreement with your reasoning and would use the singular. I also consulted the author of our Correct and Preferred Usage chapter, and she agrees–she feels the plural form is more “jargon-y.”

Q: In the sentence below, would you change frequently occurring to common?

Constipation is a frequently occurring symptom that can result from dehydration, use of certain medications, prolonged bed rest, lack of physical activity, or mechanical changes resulting from cancer or anticancer therapies.

A:  My instinct is that these 2 are not identical. The notion of “frequently occurring” could apply to frequency in a single individual, I think, whereas “common” signifies that it is something that may be experienced by many people (without any regard to its frequency). Roxanne Young, the author of our Correct and Preferred Usage chapter, concurs. You did not say why you were thinking of making the change, but the opinion from The JAMA Network Journals is that we would retain the distinction, however subtle, between frequently occurring and common.

Q: The author instructions in a journal to which I am about to submit a paper refers to the “standard abbreviations within the AMA 10th edition (see pages 502-525).” I notice that a small number of these abbreviations are followed by an asterisk, indicating that they do not require expansion at first mention. Are these the only “standard abbreviations” to which the guidelines might refer? Does the AMA Manual of Style contain other lists that include such “asterisked” items?

A:  The list on pages 502-525 (in section 14.11 for those who use the online manual and don’t find page numbers helpful), does indeed contain a few items that have an asterisk to indicate that they do not need to be expanded at first mention. [NOTE:  As of July 27, 2011, an asterisk was also added after CI (confidence interval). See this in the online Updates.] The page numbers 502 through 525 also include the list in 14.12 , Units of Measure. There are many other little lists of abbreviations throughout the manual, but these lists, in the Abbreviations chapter, are the ones most likely to be intended by the instructions for authors you cite.—Cheryl Iverson, MA

Aegis

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“Recognizing that the genetic contribution to health disparities is likely to be relatively limited is not the only reason to question the wisdom of promoting genetic research under the aegis of health disparities.”1

“In several examples published under the aegis of the [Agency for Healthcare Research and Quality], the benefit side rests on the data from randomized controlled trials….”2

“[T]his definition and associated regulations have become de facto rules for US academic and other research institutions and are applied to any work done by their employees or under their aegis regardless of the source of funding.”3

While somewhat infrequently encountered in medical writing, aegis is occasionally used in content related to health policy, institutional oversight, or the conduct of research. It also is occasionally used to refer to a journal’s vouching for the validity of data or other findings published in its pages; when such validity is called into question, a journal may issue a full retraction or simply “withdraw aegis,” ie, issue a statement to the effect that the journal is no longer responsible for the data.4

In its original sense, aegis (Greek aigis [goatskin]) referred to the shield or protective cloak worn by Zeus or Athena in the myths of ancient Greece.5 In the centuries since, the word has by association come to be used idiomatically to indicate defense (“Feeling is the aegis of enthusiasts and fools.”6) or guidance or influence (“They made their valuable individual contributions, but under the Ellington aegis they found themselves constantly enriched musically.”6). Similarly, the word is perhaps most often used in the construction “under the aegis of” to express patronage or sponsorship (“under the aegis of the museum”) and, especially, protection (“a child whose welfare is now under the aegis of the courts”).5

All of which is perfectly comforting. However, the classical roots of the word are far less benign. Whereas aegis-like shields appear in Egyptian, Nubian, and Norse mythology and art,7,8 the most elaborate account of the origins and attributes of the aegis comes, as suggested above, from the narratives of ancient Greek mythology and literature, in which it is consistently depicted as an object possessing fearsome supernatural power.

In one such narrative, the goat deity Amaltheia suckles the infant Zeus, who then—in the curiously detached manner so frequently encountered in mythological accounts—breaks off her horns and flays her hide. From one of her horns Zeus fashions the cornucopia, or horn of plenty; from her hide, he fashions the shield or cloak that would come to be called the aegis, which he then wears, on the counsel of an oracle, into battle against the marauding Titans.9 However, in the hands of Zeus, king of the gods, the aegis is more than a protective device; when in his wrath he shakes the aegis from his perch atop Mount Olympus, thunder crashes, bolts of lightning slash the sky, and fierce storms devastate the land.10 Moreover, in the Iliad, Homer describes the device as the “tempestuous terrible aegis, shaggy [and] conspicuous… given to Zeus to the terror of mortals.”11

But the aegis is associated with deities other than Zeus. In the Iliad, for example, Zeus lends the aegis to Apollo, who wields it to push his enemies back to their ships12; in other accounts, Zeus lends the aegis to his daughter, Athena, goddess of war,12 or presents it to Athena after his conquest of the Titans.9 In the most colorful account, Zeus swallows his wife, Metis, whole—after which Athena is born from Zeus’ head, emerging fully formed and bearing the aegis and other weapons of war.13 Regardless of how Athena comes to possess the aegis, however, in her hands it becomes more formidable still. For example, in the Iliad Homer reverently describes the aegis as no mere goatskin but rather as “ageless and immortal,” worn by “bright-eyed Athene” and adorned with tassels of the purest gold12; moreover, elsewhere in the Iliad he describes the aegis as a dramatic golden cloak fashioned by Hephaistos, god of fire and metalwork,14 to resemble a scaly skin like that of a snake, linked and fringed with writhing serpents, and bearing in its center the severed head of the Gorgon Medusa, eyes rolling and scalp also bristling with serpents.11

Charming as this may be, given the provenance of the word and the fell associations that come with it, how did aegis, apart from its military associations, come to be used to express defense or protection? Perhaps more puzzling, how did it come to be used to express benevolent guidance, influence, or patronage? A possible clue is that whereas early accounts often depict Athena as cultivated, civilized, urbane, and wise, the economy of ancient Greece was bolstered by military pursuits, and in short order Athena came to be depicted as the goddess of war—although, importantly, her military might was tempered by the cultivation and divine wisdom earlier attributed to her.15 Thus, Athena is sometimes viewed as having 2 sides. The first is characterized as wrathful, tempestuous, and destructive; however, the other is characterized as divinely beneficent and endowed with the inclination and ability to grant the gifts of aid, wisdom, and protection to favored mortals.16 The power of both sides is wielded through the supernatural power of the aegis—hence Homer’s description of the device in the Iliad and its depiction in visual art as inky black or brilliant gold.11,12,16

Interestingly, however, while Athena extends divine beneficence and protection—backed by the wrathfulness also attributed to her—she does not authorize those mortals fortunate enough to come under her favor to act on her behalf. Thus, whereas in current usage aegis is correctly used to express defense, protection, guidance, influence, patronage, or sponsorship, its use to indicate “under the jurisdiction of” is considered incorrect.17 —Phil Sefton, ELS

1. Sankar P, Cho MK, Condit CM, et al. Genetic research and health disparities. JAMA. 2004;291(24):2985-2989.

2. Vandenbroucke JP, Psaty BM. Benefits and risks of drug treatments: how to combine the best evidence on benefits with the best data about adverse effects. JAMA. 2008;300(2):2417-2419.

3. 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; 2007:157.

4. Hammerschmidt DE, Franklin M. The limits and power of peer review. Minn Med.

http://www.minnesotamedicine.com/PastIssues/PastIssues2006/June2006/CommentaryHammerschmidtJune2006/tabid/2527/Default.aspx. June 2006. Accessed February 13, 2013.

5. Aegis. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:19.

6. Aegis. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:22.

7. Aegis: in Egyptian and Nubian mythology. Museum of Learning Web site.

http://www.museumstuff.com/learn/topics/aegis::sub::In_Egyptian_And_Nubian_Mythology. Accessed February 15, 2011. 8. Aegis: in Norse mythology. Museum of Learning Web site. http://www.museumstuff.com/learn/topics/aegis::sub::In_Norse_Mythology. Accessed February 15, 2011.

9. Amaltheia. Theoi Project Web site. http://www.theoi.com/Ther/AixAmaltheia.html. Accessed February 13, 2013.

10. Zeus. Theoi Project website. http://www.theoi.com/Olympios/Zeus.html. Accessed February 13, 2013.

11. Hephaistos Works 2. Theoi Greek Mythology Web site. http://www.theoi.com/Olympios/HephaistosWorks2.html. Accessed February 13, 2013.

12. Teleporter: aegis mound. Entropia Planets Web site. http://www.entropiaplanets.com/wiki/Teleporter:Aegis_Mound. Accessed February 13, 2013.

13. Athena. Theoi Project Web site. http://www.theoi.com/Olympios/Athena.html. Accessed February 13, 2013.

14. Hephaistos. Theoi Project Web site. http://www.theoi.com/Olympios/Hephaistos.html. Accessed February 13, 2013.

15. Athena. Encyclopedia Britannica Online. http://www.britannica.com/EBchecked/topic/40681/Athena?anchor+ref85160. Accessed February 13, 2013.

16. Deacy S, Villing A. What was the colour of Athena’s aegis? J Hellenic Stud. 2009;129:111-129. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=6779888. Accessed February 13, 2013.

17. Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:29.

Emergency, Emergent, Urgent

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As I was editing a manuscript on patients undergoing surgery for brain tumors, I came across the sentence, “Patients who required emergency care were admitted to the hospital and classified as needing emergent or urgent surgery.” As I reread the sentence, the terms emergency, emergent, and urgent started to swim before my eyes, each backstroking to take the place of the other. Soon I was reading, “Patients who required urgent care were admitted to the hospital and classified as needing emergency or emergent surgery.” And then, “Patients who required emergent care were admitted to the hospital and classified as needing emergency or urgent surgery.” What was going on? Was my late-night habit of perusing stylebooks and usage guides before bedtime starting to produce side effects (oops, I mean adverse effects)? Was I no longer able to delineate the difference between commonly used medical terms? I had to take action.

Diligent medical copy editor that I am, I turned to my bookshelf, which is chock full of dictionaries and grammar, usage, and editing books. Now I would be able to solve this conundrum. I would take this problem step by step, or rather word by word, and find the resolution. Here’s what I found:

Emergency

Stedman’s Medical Dictionary1 defines emergency as “an unexpected development or happening; a sudden need for action.”

Dorland’s Illustrated Medical Dictionary2 defines emergency as “an unlooked for or sudden occurrence, often dangerous, such as an accident or an urgent or pressing need.”

Merriam-Webster’s Collegiate Dictionary3 defines emergency as “an unforeseen combination of circumstances or the resulting state that calls for immediate action.”

Consensus! There’s nothing a copy editor likes better.

Resolution: An emergency is basically an unexpected event that requires immediate action.

Emergent

Dorland’s defines emergent first as “pertaining to an emergency” and second as “coming into being through consecutive stages of development, as in emergent evolution.”

Stedman’s omits the definition stemming from the term emergency and defines emergent first as “arising suddenly and unexpectedly, calling for quick judgment and prompt action” and second as “coming out; leaving a cavity or other part.”

Merriam-Webster’s defines emergent as “arising unexpectedly” or “calling for prompt action.”

This one’s a little trickier. Dorland’s relates the term emergent to emergency and Stedman’s and Webster’s simply define emergent as the adjectival form of the noun emergency. So, is there a difference between these 2 words or are they synonymous? It was time to reach deeper into my bookshelf.

I first turned to the classic text A Dictionary of Modern English Usage by H. W. Fowler.4 I knew Fowler wouldn’t let me down. Fowler’s entry on emergence and emergency reads as follows, “The two are now completely differentiated, -ce meaning emerging or coming into notice, and -cy meaning a juncture that has arisen, especially one that calls for prompt measures.”

After some additional research, I found this entry in Common Errors in English Usage by Paul Brians5: “The error of considering ‘emergent’ to be the adjectival form of ‘emergency’ is common only in medical writing, but it is becoming widespread. ‘Emergent’ properly means ‘emerging’ and normally refers to events that are just beginning—barely noticeable rather than catastrophic. ‘Emergency’ is an adjective as well as a noun, so rather than writing ‘emergent care,’ use the homely ‘emergency care.’”

Eureka! Emergent means beginning to arise and emergency means arising unexpectedly.

Resolution: Use emergent to mean emerging (as in Dorland’s section definition of “coming into being through consecutive stages of development, as in emergent evolution”) and emergency to mean an unexpected event that calls for immediate attention.

But then what about urgent?

Urgent

Neither Dorland’s nor Stedman’s defines the term urgent.

Merriam-Webster’s Collegiate Dictionary defines urgent as “calling for immediate action.”

So, can urgent and emergency be used interchangeably? The Children’s Hospital of Wisconsin website provides a list of surgery types. It groups urgent or emergency surgery and defines it as surgery “done in response to an urgent medical need, such as the correction of a life-threatening congenital heart malformation or the repair of injured internal organs after an automobile accident.”6 However, the website Trivology.com states, “There is major difference between elective, urgent, emergency surgery. In urgent surgery we can wait until the patient’s health is unwavering but it has to be performed in 1-2 days. But emergency surgery needs to be performed without any impediment otherwise there will be colossal risk to patient’s life.”7

Therefore, in medical editing, be careful of changing emergency to urgent because emergency means immediate attention is required and urgent indicates quick but not immediate action is required. There is no such thing as emergent surgery unless you mean surgery that is just beginning.

Resolution: Although emergent and urgent both indicate calls for swift action, urgent is more, well, urgent.

Well, there you have it. I guess that original sentence I was editing makes sense after all. “Patients who required emergency surgery [immediate surgery because of the unforeseen nature of the incident] were admitted to the hospital and classified as needing emergent [with a few hours] or urgent [within 24 hours] care.”— Laura King, MA, ELS (January 2013)

1. Stedman’s Medical Dictionary. 26th ed. Baltimore, MD: Williams & Wilkins; 1995.

2. Dorland’s Illustrated Medical Dictionary. 32nd ed. Philadelphia, PA: Elsevier Saunders; 2012.

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

4. Fowler HW. A Dictionary of Modern English Usage. 2nd ed. Oxford, England: Oxford University Press; 1965.

5. Brians P. Common Errors in English Usage. 2nd ed. Sherwood, OR: Williams James & Co; 2008.

6. The Children’s Hospital of Wisconsin website. Types of Surgery. http://www.chw.org/display/PPF/DocID/22082/router.asp. Accessed January 10, 2013.

7. Trivology.com. http://www.trivology.com/articles/209/what-is-elective-surgery.html. Accessed January 10, 2013.

Ex Libris: Grammar Girl’s 101 Words Every High School Graduate Needs to Know

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Last month’s Ex Libris column reviewed Grammar Girl’s 101 Misused Words You’ll Never Confuse Again, the first in a series of 4 titles in the 101 Words series by Grammar Girl alter ego Mignon Fogarty (http://www.quickanddirtytips.com/). This month’s column reviews Grammar Girl’s 101 Words Every High School Graduate Needs to Know. Just as Grammar Girl soared to the aid of grammarians in their quest to avoid misusing commonly confused words, so too does she come to the rescue of recent high school graduates (and those not so recent graduates) who want to appear educated and erudite. As Fogarty writes in her introduction, “You may or may not have been taught these words in high school, but they’ll serve you well from here on out. Use them in your college entrance essays or during job interviews to show that you’re well-read and well-spoken.”

Although this book could easily have become 1001 Words Every High School Graduate Needs to Know, Fogarty wisely narrows her list to 4 to 6 words from each letter of the alphabet from a variety of disciplines (eg, politics, science, and economics). As with 101 Misused Words You’ll Never Confuse Again, 101 Words Every High School Graduate Needs to Know is a fun-to-read and easy-to-use paperback that is formatted as a glossary, with words arranged alphabetically and most entries only 1-page long. Each entry includes a quotation illustrating the correct usage of the word in question from such historical and cultural icons as Harry Truman, Andy Warhol, and Homer Simpson. For example, in the entry on Tenacious, Fogarty quotes the Belgian philosopher Paul De Man, “Metaphors are much more tenacious than facts.”

For users of the AMA Manual of Style, a few entries are particularly useful because they directly relate to the guidelines outlined in the manual (www.amamanualofstyle.com). For the term chronic, Fogarty writes, “In medicine, the opposite of a chronic disease (something that comes on slowly and will progress over a long time) is an acute disease (something that comes on suddenly, is severe, and is likely to end). For example, type II diabetes is a chronic condition and a stroke is an acute condition.” This supports the entry from the AMA Manual of Style, which states that the terms acute and chronic “are most often preferred for descriptions of symptoms, conditions, or diseases; they refer to duration, not severity.”

For the term malignant, Fogarty writes, “Malignant diseases and situations are aggressive, out of control, and dangerous. In medicine, only malignant tumors are called cancer; less invasive tumors are called benign.” In the AMA Manual of Style, the usage note for malignant reads, “When referring to a specific tumor, use malignant neoplasm or malignant tumor rather than malignancy. Malignancy refers to the quality of being malignant.”

Fogarty also defines the term correlation and provides the useful tip, “A common scientific phrase is correlation does not equal causation—a reminder that studies often find that events happen at the same time without proving that one causes the other.” This is similar to the AMA Manual of Style’s definition of the term correlation as the “description of the strength of an association among 2 or more variables, each of which has been sampled by means of a representative or naturalistic method from a population of interest. … There are many reasons why 2 variables may be correlated, and thus correlation alone does not prove causation.”

Finally, both Fogarty and the AMA Manual of Style describe the difference between the terms quantitative and qualitative. Fogarty writes, “People often confuse quantitative and qualitative, in part because qualitative results can be presented in ways that makes them look quantitative, for example, when researchers ask qualitative questions, but have subjects answer on numerical scales: How happy were you to see the dolphins? Answer on a scale from 1 to 10.” According to the AMA Manual of Style, qualitative data is “data that fit into discrete categories according to their attributes, such as nominal or ordinal data, as opposed to quantitative data,” which is “data in numerical quantities such as continuous data or counts (as opposed to qualitative data).”

Although Grammar Girl’s 101 Words Every High School Graduate Needs to Know was written with a general audience in mind, much can be gained by the medical editor reader. Not only the entries on specific medical words but also the entries on general terms commonly encountered in scientific writing, such as ad hoc, epitome, jargon, kilometer, and mandate, are helpful for the editor.—Laura King, MA, ELS

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.

Questions From Users of the Manual

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Q: What is the source for the statement in section 11.10.5 that “The term sexual preference  should be avoided because it implies a voluntary choice of sexual orientation not supported by the scientific literature”?

A: The source is what is shown as reference 20:  Maggio’s Talking About People:  A Guide to Fair and Accurate Language. This was published by Oryx Press in 1997 and we are not aware of a newer edition.

Q: Is there a list in the manual, or in a source recommended by the manual, as to when it is appropriate to refer to an individual as “Dr”? It is sometimes difficult to know if a non-US degree is equivalent to an MD degree.

A: Great question. We do include a few of these in the manual (eg, MBBS), but you might try Google. It can provide helpful information on various degrees.

Q: Would you use “e-visit” or “E-visit” when it appears at the beginning of a sentence?

A: Based on the advice we give in 10.7 for “e-mail” (use “E-mail” if it appears at the beginning of a sentence), I would use “E-visit” at the start of a sentence.

Q: How do you cite the online AMA Manual of Style?

A:  I would recommend the following, based on 3.15.2 in the manual:

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.  www.amamanualofstyle.com.  Published online 2009.

—Cheryl Iverson, MA