Odds and Ends

Posted by

1

Amanda Ehrhardt, MA, JAMA Network

Earlier this year, several small updates were made to the AMA Manual of Style that clarified some lingering questions that had left some editors potentially perplexed (or perhaps possibly puzzled!).

To Repeat or Not to Repeat?

The debate between the use of repeat vs repeated is no longer an existential crisis worthy of a Danish prince. Chapter 11.1 has been updated to indicate that these terms can be used interchangeably (just like Rosencranz and Guildenstern).

Game, Dataset, Match

One author serves up data in a data set. Another author swings their racket, sending data across the court in a dataset. So who won?

According to Chapter 11.3, author 2 can celebrate with strawberries and cream: dataset is now the preferred spelling.

A Sensitive Matter

To differentiate high-sensitivity troponin T from contemporary assays, it is now being reported in ng/L, which has been updated accordingly in chapter 17.5.

So please add these changes to the Homerian catalog already in your editor’s mind, as we know the evolution of style changes is always an odyssey!

July 12, 2024

Language to Discuss Suicide

Posted by

2

Miriam Cintron, BA, JAMA

Although often regularly used in the past, the term committed suicide may imply that the act of suicide is criminal or morally wrong.1

Likewise, referring to a suicide attempt as a “success” or “failure” implies that “the person who died by suicide has accomplished or not accomplished (a failure) the act of suicide”1 or that death was a favorable outcome.2

Factual and judgment-free language is preferred.1 Language that is careful not to stigmatize suicide, suicidal behavior, or mental health issues3 should always be used. For that reason, terms such as died by suicide or suicide attempt should be used. Such terms contribute to destigmatizing suicide.2

The term suicide should also not be used out of context (eg, “political suicide”) because this may desensitize readers to the term2 or seem insensitive.

Person-first language, which aligns with existing AMA Manual of Style guidelines (chapter 11.12.6), should be used (eg, “person who attempted suicide” instead of “suicide attempter” or “person with suicidal ideation” instead of “suicidal person”).

Avoid:

  • Committed or completed suicide
  • Unsuccessful or successful suicide attempt
  • Failed suicide attempt
  • Suicide epidemic
  • Killed themself
  • Took their own life
  • Ended their life

Preferred:

  • Died by suicide
  • Death by suicide
  • Suicide death
  • Suicide attempt
  • Fatal suicide behavior
  • Person with suicidal ideation

The term “intentional self-harm” should not be used interchangeably with “suicide attempts.”

References

  1. Suicide Prevention Alliance. Changing how we view suicide prevention: suicide language. Accessed March 11, 2024. https://www.suicidepreventionalliance.org/about-suicide/suicide-language/
  2. World Health Organization. Preventing suicide: a resource for media professionals: update 2023. Accessed March 11, 2024. https://iris.who.int/bitstream/handle/10665/372691/9789240076846-eng.pdf
  3. International Association for Suicide Prevention. The language of suicide. Accessed March 11, 2024. https://www.iasp.info/languageguidelines/

May 31, 2024

New Abbreviations for Liver Diseases

Posted by

0

Timothy Gray, PhD, JAMA Network

The designation “nonalcoholic fatty liver disease (NAFLD)” is no longer accepted across JAMA and the JAMA Network journals, except to reflect the language used in data collection for a study (or search terms for a review).

The directive is based on the recommendations of the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver, as well as the Latin American Association for the Study of the Liver.

In collaboration with hepatologists, gastroenterologists, pediatricians, endocrinologists, hepatopathologists, public health and obesity experts, colleagues from industry, regulatory agencies, and patient advocacy organizations, a consensus was developed via the Delphi process for a change in nomenclature.1

The term chosen to replace NAFLD is “metabolic dysfunction–associated steatotic liver disease (MASLD).” In the previous designation, the term nonalcoholic may have been confusing for patients and physicians. The word fatty also has stigmatizing and negative connotations.

The same committee process resulted in another designation change that will be implemented across JAMA and the JAMA Network journals. The designation “nonalcoholic steatohepatitis (NASH)” is now called “metabolic dysfunction–associated steatohepatitis (MASH)” to avoid trivializing the diseases or confusing patients with the possible connotations of the term nonalcoholic.2

It is hoped that these updates will clarify what the diseases are instead of what they are not.

The AMA Manual of Style has added these abbreviations and expansions to the list of clinical terms in chapter 13.11.

References

  1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78:1966-1986.
  2. Eskridge W, Cryer DR, Schattenberg JM, et al. Metabolic dysfunction–associated steatotic liver disease and metabolic dysfunction–associated steatohepatitis: the patient and physician perspective. J Clin Med. 2023;12(19):6216.

May 24, 2024.

Embracing the Prepositional Power of Because of and Due to

Posted by

3

Jennifer Clare Ball, MA, JAMA Network

The recent acceptance of due to as a prepositional phrase by the AMA Manual of Style (Chapter 11.1, Correct and Preferred Usage of Common Words and Phrases) is a noteworthy development with substantial implications for professional writers and editors.1

The previous recommendation against its use in this way had sparked debate among grammarians and language enthusiasts, some of whom argued that it should only be used as an adjective phrase modifying a noun.

The relaxation of grammar rules, such as the new guidance on because of vs due to, can positively and negatively affect language depending on the context in which it is used. While it can increase flexibility for writers and make the language more accessible to nonnative speakers, it may also reduce clarity and consistency in some cases. Thus, the creation of official guidance in the AMA Manual of Style is crucial.

The etymology of because of and due to is also worth exploring.2 Because was modeled on the French par cause and has been used with the word of since the late 14th century.

On the other hand, due is from old French deu, past participle of devoir, meaning “to owe.” Due to came about in the early 15th century as “deserved by, merited by,” and its use as a prepositional phrase dates back to 1897.

Current guidance now indicates that because of, caused by, due to, and owing to are acceptable to use as prepositions without restriction.

To illustrate the use of due to in medical writing, below are examples from various JAMA Network articles in which the phrase can now be used interchangeably with because of as a prepositional phrase.

The acceptance of due to as a prepositional phrase by the AMA Manual of Style is a notable milestone in the ongoing debate over its use. It provides greater flexibility for writers and editors while ensuring consistency and clarity in medical writing and other communication formats that follow AMA style.

  • The AMA Manual of Style now accepts “due to” as a prepositional phrase, which impacts authors and medical editors.
  • The debate over “due to” was sparked by its previous disallowance in many instances; some argued for its limited role.
  • Relaxed grammar rules can enhance flexibility and accessibility, but may compromise clarity; this highlights the significance of AMA accepting this change.

References

  1. Frey T, Young RK. Correct and preferred usage. In: Christiansen S, Iverson C, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 11th ed. Oxford University Press; 2020. Accessed February 17, 2023. https://doi.org/10.1093/jama/9780190246556.003.0011
  2. Online etymology dictionary. Accessed February 17, 2023. https://www.etymonline.com/
  3. Srinivas M, Wong NS, Wallace R, et al. Sexually transmitted infection rates and closure of family planning clinics because of abortion restrictions in iowa. JAMA Netw Open. 2022;5(10):e2239063. Published October 3, 2022. doi:10.1001/jamanetworkopen.2022.39063
  4. Martinez FJ, Han MK, Lopez C, et al. Discriminative accuracy of the CAPTURE tool for identifying chronic obstructive pulmonary disease in US primary care settings. JAMA. 2023;329(6):490-501. doi:10.1001/jama.2023.0128
  5. Wang J, Lee CC, Kesselheim AS, Rome BN. Estimated Medicaid spending on original and citrate-free adalimumab from 2014 through 2021. JAMA Intern Med. 2023;183(3):275-276. doi:10.1001/jamainternmed.2022.6299

October 5, 2023.

Do Changes Actually Create Change?

Posted by

0

Amanda Ehrhardt, MA, JAMA Network

Part of the purpose of the AMA Style Insider is to report on changes made in the AMA Manual of Style that aim to improve not only the editing process but also advance ethics and equity in medical publishing. Changes are not made arbitrarily but as a result of many experts building consensus on what represents best practices, and they’re made to create a widespread standard.

However, the manual can only release these standards to the world–what requires more follow up is whether the changes are actually implemented in publishing and how successful they are in creating new standards.

This year, in JAMA Network Open, several JAMA Network editors and staff published a cross-sectional study1 that examined race and ethnicity reporting across 3 JAMA Network journals before (January to March 2019 and May to July 2021) and after (January to March 2022) the implementation of the Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals2 in August 2021 (which was based on revisions made to 11.12.3 of the style guide).

Among the key takeaways were that the number of articles that reported race and ethnicity information for study participants increased by 10.4% from 2019 to 2022, more articles reported participants’ age or sex and gender, and the number of articles that defined categories included in the term “other” increased 58.1% from 2019 to 2022.

Additionally, the number of articles that listed racial and ethnic group categories by alphabetical order increased by 75.9% between 2021 and 2022, and there was a 24.1% increase in the number of articles that defined how race and ethnicity were determined.

Although this study had limitations (which are clearly stated in the article) and more improvement is needed, these results seem encouraging that AMA Style Manual updates are not made just to alter the day-to-day of editors across medical publishing, but to potentially create real and lasting change.

References

  1. Flanagin A, Cintron MY, Christiansen SL, et al. Comparison of reporting race and ethnicity in medical journals before and after implementation of reporting guidance, 2019-2022. JAMA Netw Open. 2023(6):e231706. doi:10.1001/jamanetworkopen.2023.1706
  2. Flanagin A, Frey T, Christiansen SL, et al. Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA. 2021;326(7):621-627. doi:10.1001/jama.2021.13304

September 5, 2023.

The AMA Garden of Hyphens

Posted by

1

Timothy Gray, PhD, JAMA Network

If your professional life requires adherence to AMA style, you may have gotten lost in the weeds styling hyphenated compounds in titles. No capitalization after a hyphen if a prefix or a suffix, if both parts are considered a single word (requiring a field trip to Merriam-Webster), if the compound is temporary, or if the parts do not carry equal weight.

I have long wondered how parts of a compound carry weight, which isn’t to say that I don’t like the idea. As a practical suggestion, though, it lacks a little, uh, practicality.

If you think of a compound as an entity on its own, any word that may carry weight because of its particular part of speech loses that identity (and drops the weight!) when it gets pulled into that magical realm of a hyphenated compound (all adjectives all the time). So “Short-term Effects” and “Full-time Coverage” have always read as weird to me, especially if they have appeared near “Early-Onset Disease.”

How fitting, then, that the AMA Manual of Style has finally addressed the weed problem with hyphenation. No need to kill them. We can just get them out of our way. Let the weeds live happy lives in some other organization’s style manual.

The new guidance in 10.2.2 reads “In titles, subtitles, and text headings, capitalize both parts of a hyphenated compound.” Hence, “Short-Term Effects” and “Full-Time Coverage.” Take a look in the online manual for more information and other new style guidance.

Now when you review capitalization in titles with hyphenated compounds to align with AMA style, you needn’t make excursions to other sources. You can stay in the AMA garden without getting lost in the weeds.

Published August 1, 2023.

New Mpox Name for Monkeypox Disease

Posted by

1

Stacy L. Christiansen, MA, Managing Editor, JAMA

The recent outbreak of monkeypox disease (caused by the monkeypox virus), like COVID-19 and other pathogens before it, raised concern about disease names, particularly those that could negatively affect particular nations, populations, or animals.

The naming of diseases (and in this case, renaming) falls to the World Health Organization (WHO). After reports from individuals and countries raised concerns about the term “monkeypox” being racist or stigmatizing, the WHO met with concerned parties and invited public comment to rename the disease.1

The result is “mpox.”

The AMA Manual of Style will add the term “mpox” to the viruses section in the Nomenclature chapter (14.14) as well as information about the renamed clade I and clade II (formerly Central African and West African, respectively).2

We recommend dual reporting, such as mpox (monkeypox), at first mention to ease adoption of the new terminology. Other organizations, such as the Centers for Disease Control and Prevention3 and AP Stylebook,4 have also announced their adoption of the updated terminology.

The monkeypox virus name has not yet been changed. The International Committee on the Taxonomy of Viruses is responsible for that terminology,1 and when new nomenclature is announced we will update the Manual accordingly.

References

  1. World Health Organization. WHO recommends new name for monkeypox disease. Accessed December 1, 2022. https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease
  2. World Helath Organization. Monkeypox: experts give virus variants new names. Accessed December 1, 2022. https://www.who.int/news/item/12-08-2022-monkeypox–experts-give-virus-variants-new-names
  3. US Centers for Disease Control and Prevention. Monkeypox. Updated November 30, 2022. Accessed December 1, 2022. https://www.cdc.gov/poxvirus/monkeypox/index.html
  4. The Associated Press. mpox. AP Stylebook. November 30, 2022. Accessed December 1, 2022. https://www.apstylebook.com/ap_stylebook/mpox

A Short Update on Long COVID

Posted by

0

Stacy L. Christiansen, MA, Managing Editor, JAMA

After infection with SARS-CoV-2, some people develop long-term effects. This condition has been termed post-COVID conditions (PCCs), post-COVID syndrome, postacute sequelae of SARS-CoV-2 infection (PASC), and in common parlance, long COVID.1

Which term to use will depend on the content and the intended audience. The ICD-10 code principally uses the term post COVID-19 condition.2,3

In the JAMA Network journals, we prefer post–COVID-19 condition (PCC), with allowance of long COVID for colloquial use (eg, in narrative or patient-focused content). Note that “long” is lowercase.

Avoid jargon terms, such as “long haulers,” in clinical or scientific content. The online style manual will be updated to include this terminology in chapter 11.1, Correct and Preferred Usage of Common Words and Phrases.

References

  1. US Centers for Disease Control and Prevention. Long COVID or post-COVID conditions. Updated September 1, 2022. Accessed October 28, 2022. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
  2. US Centers for Medicare & Medicaid Services. Post COVID-19 condition: ICD-10-CM official guidelines for coding and reporting. Updated April 1, 2022. Accessed October 14, 2022. https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines-updated-02012022.pdf
  3. World Health Organization. Coronavirus disease (COVID-19): post COVID-19 condition. Accessed October 14, 2022. https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-post-covid-19-condition

Pregnancy Language Update

Posted by

3

Iris Y. Lo, BA, JAMA Network

The AMA Manual of Style will soon offer guidance on inclusive language when referring to people who are pregnant or people with the capacity for pregnancy.

This wording has more general use and can include individuals who were assigned female at birth, transgender men, nonbinary individuals, gender-nonconforming individuals, and gender-fluid individuals–basically anyone who is physically able to become pregnant.

This language should be used when study investigators have not explicitly asked participants to self-identify their gender. In studies in which participants have all identified as women, it is appropriate to use terms like pregnant women.

However, if study participants have not completley self-reported their gender as women, terms such as pregnant participants, pregnant individuals, and pregnant patients are more accurate. In these cases, birthing parent rather than mother is a more accurate term and should be used for the same reasons.

The JAMA Network has internally started to follow this guidance, joining many other scientific journals, such as Nature, and medical associations and societies, such as the Society for Maternal-Fetal Medicine. The US Preventive Services Task Force also uses this type of language.

Style vs Substance—Is There Room for Both?

Posted by

0

Peter J. Olson, ELS, JAMA Network

There’s a scene in the film Pirates of the Caribbean: The Curse of the Black Pearl in which the heroine, Elizabeth, is taken captive by the infamous Captain Barbosa aboard his ship. In an attempt to negotiate her release, she invokes the Pirates Code, a set of rules to which she knows Barbosa is beholden. Barbosa initially appears to comply, then abruptly reneges. When Elizabeth protests his disregard for the Code, Barbosa defends his decision with a snide retort:

“The Code is more what you’d call guidelines than actual rules.”

His deviousness aside, the Captain has a point. As humans, we have an innate tendency to create rules with the intent of establishing order and certainty, yet those rules are occasionally subject to exceptions, inapplicability, and multiple interpretations. Try as we might, it’s virtually impossible to anticipate every possible scenario and account for it, which means there will be times when the rules we make for ourselves simply do not apply—and editorial style rules are no exception.

The question is: does style always supersede substance?

The AMA Manual of Style is a renowned and authoritative reference manual, and for good reason. It’s a meticulously crafted, oft-updated repository of linguistic and stylistic information steeped in authentic medical language and policy, and the guidance within its pages is critical to physicians, authors, and editors alike.

In that sense, the argument could be made that when it comes to the AMA Manual, style is substance. However, as editors, we at times find ourselves in scenarios in which adhering to a particular style point is akin to the proverbial placement of a square peg in a round hole. The gadget doesn’t quite fit into the device, and the results can be ugly. It’s those circumstances in which the absence of a peg may be preferable to the sight of a horribly splintered one.

What’s more, rules are almost always subject to change, and depending on the impetus behind an amendment, it can take the purveyors of a style manual weeks, months, even years to discuss and formulate a responsible and sustainable update before disseminating it to the manual’s users.

Take the topic of race and ethnicity language (Chapter 11.12.3), which continues to evolve at an unprecedentedly rapid pace—enough so that the requisite section in the AMA Manual was updated less than a year after the release of the 11th edition.1 Language and terms that may have been deemed acceptable just months previously may shift suddenly, and the intuitive and attentive editor may need to set aside current style guidelines to align with cultural and/or societal trends.

That said, style deviations should be made only after careful consideration of the potential ramifications, especially those involving reader perception. In other words: if you’re going to deviate from style, you’d better have a really good explanation ready.

Authors are often quick to point out style infractions in previously published material, either to defend their own infringements or to object to style-adherent edits (“If this author got to do it, why can’t I?”), and trivial or inexplicable noncompliance can undermine the authority of your style manual as well as your publication. If you can’t justify a style detour that goes beyond “I just thought it sounded better that way,” you probably shouldn’t take it.

Fictional though he may be, I expect that Captain Barbosa fully honors the Pirates Code—he is a pirate, after all. Yet even he knows to adapt the rules when necessary to achieve his goals. This is not to suggest that editors should swashbuckle their way through a manuscript, playing fast and loose with the style rules they’ve sworn to uphold. Those rules are there for a reason, and they wouldn’t exist if they didn’t almost always apply.

However, absolutism is fraught with its own perils, and the astute editor must be mindful of those rare situations in which a rule may need to be bent—or perhaps broken—for the greater good. And although there’s no single, comprehensive answer to the question of whether and when to sacrifice style for substance, if preserving the integrity of a publication is given precedence, the answers will at least be easier to identify.

Reference

  1. Frey T, Young RK. Race and ethnicity. In: Christiansen SL, Iverson C, Flanagin A, et al, eds. AMA Manual of Style: a Guide for Authors and Editors. 11th ed. Oxford University Press; 2020:545-547.