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Questions from Users of the Manual

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Q: I’ve been searching the 10th edition to see where the list of footnote symbols from the previous edition is given and I cannot find it. Is that because the lowercase alphabet letters are now going to replace these symbols, as mentioned on page 91?

A: Yes, almost right. We have changed our policy on using superscript symbols for table footnotes and are now using superscript lowercase letters. There are more of them and they are not so “odd.” However, we are continuing to use the old “footnote symbols” for bottom-of-the-page footnotes (see p 43). We only show 2 here…the asterisk and the dagger…because it is not likely that more would be needed (this is the only type of bottom-of-page footnotes that we use in our journals), but if you were to require more, the “old” list would still apply.

Q: I haven’t been able to locate in the 10th edition the place where it says that the symbols “greater than” and “less than” should not be used in running text. (It’s at the top of p 256 in the ninth edition.)

A: You are correct. We neglected to include that this time, but the policy is the same. The examples on page 399 illustrate this, but having the specific statement would be good. It’s a bit like the policy we have of reserving the use of the hyphen for ranges to within parentheses and in tables (and, of course, in references, for the page ranges) and not using it in running text (P values are another exception). It all has to do with “elegance.”—Cheryl Iverson, MA

Quiz Bowl: Practice Editing Tables

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During the past 15 years I have been teaching classes in medical editing. Every year I hear the same question from my students: “How can we practice our editing skills?” It’s a difficult question to answer because usually editors learn their skills on the job. But what do you do if you’re trying to break into the editorial field or have moved from, say, an editorial assistant position to a manuscript editor position? This month’s quiz, entitled Practice Editing Tables, is a first step in helping editors gain editing practice. I have focused on editing tables in this quiz because this is often one of the most challenging tasks for both novice and seasoned editors to master.

Basically, this month’s style quiz is simply to edit a table. Therefore, we have no sample question for you to try. Instead, here’s a general question about tables for you to answer.

Formal tables in scientific articles conventionally contain 5 major elements. Can you name these 5 major elements? (Use your mouse to highlight the text box.)

title, column headings, stubs (row headings), body (data field) consisting of individual cells (data points), and footnotes

Each of these elements has various style and formatting recommendations that are described in detail in the AMA Manual of Style (§4.1.3).

As we continue to post more AMA Manual of Style quizzes on the website, we will strive to provide editors with an opportunity to practice their skills. If you are interested in more practice with tables, check out the Tables Quiz and the Creating Tables and Figures Quiz at www.amamanualofstyle.com—Laura King, MA, ELS

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

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

Questions From Users of the Manual

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Q: Section 3.12.5 describes how to cite books with editors and translators but there is no example showing how to cite a book with both an editor and an editor in chief. Should only the editor in chief be cited if one is given for a book?

A: No, I would not exclude other editors’ names if an editor in chief is given. You could extrapolate from the example in section 3.12.5 that shows how to cite an editor and a consulting editor. In that example, repeated below, just replace “consulting ed” by “ed in chief.”

Klaassen CD. Principles of toxicology and treatment of poisoning. In: Hardman JG, Limbird LE, eds. Gilman AG, consulting ed. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill Book Co; 2001:67-80.

Q: When you cite an online reference that will require a password to access the reference, should you include in the reference citation some indication that access is restricted?

A: We wrestled with this question when preparing the current edition and decided against it because different users would have different access rights.

Q: When citing the same work 2 or more times in a manuscript, do you continue to use the same superscript reference number, or do you use a different superscript reference number and relist the work multiple times in the reference list?

A: It is our style to give a reference one number and to refer to it by that number every time it’s cited. This policy is not stated specifically in the manual and perhaps in the next edition it should be. In the current edition, page 44 discusses the situation in which an author might want to cite different (and specific) page numbers from the same reference. The style used is based on the assumption that a reference number “sticks” throughout a manuscript.

Q: Your manual (pp 22 and 183 in print) advises that clinical trials should be registered and that the URL of the registry and the identifying number should be published as a part of the manuscript. Is this still true if the clinical trial has been terminated?

A: Yes, the identifier should be given even if the clinical trial has been terminated. Anyone who chooses to go to the URL provided will be able to read about the trial and will also see there that it has been terminated.—Cheryl Iverson, MA

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

Questions From Users of the Manual

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Q: I can’t find anywhere in the AMA Manual of Style guidance on having back-to-back sets of parentheses in running text. Here is an example:

 The mean duration of surgery for the computerized-navigation group was 52.6 minutes longer than that of the control group, resulting in a statistically significant difference (P < .05) (Table 1).

I would prefer to see something like this:

The mean duration of surgery for the computerized-navigation group was 52.6 minutes longer than that of the control group, resulting in a statistically significant difference (P < .05; Table 1).

But does the manual have a preference?

A: Short answer: The style manual does not include anything about a pref on use of back-to-back parens, so this is something to think about including in the Punctuation chapter for the 11th edition. (Also, as you’ll see from the few examples below, because we don’t have a policy on this, it has not been handled consistently in our publications.)

Longer answer: Although our first response to your specific example was that we liked the avoidance of back-to-back parens and would favor (as you do) the inclusion of both items in a single set of parens, or would find either version OK, on further thought we decided that this answer was too easy and that often both sets of parens should be retained. Reasons: (1) Although in the example provided it makes sense to combine and use the semicolon, in more complicated sentences it might not be the best choice. (2) Table and Figure citations might be easier to find if not combined with other info.

Below are a few examples from The JAMA Network Journals that might illustrate where combining the information in parens might not be as desirable as keeping the parenthetical items separate.

A significantly higher incidence of SSHL was noted in the HIV group compared with the control group, with an incidence rate ratio (IRR) of 2.17 (95% CI, 1.07-4.40), particularly for the male participants, who had an IRR of 2.23 (1.06-4.69) (Table 2).

Here, keeping the table citation separate makes it clear that the table citation relates to BOTH values given in the sentence, not just the second one. Note that in our journals the first citation of a table or figure is set in different type (here, heavy boldface) to make it stand out.

In this example, where info was combined, it would probably have been better to also have kept the table citation separate as it applied to both bits of info in the sentence:

Mean mandible defect lengths were similar for patients undergoing FFF and LSBF reconstruction (7.8 and 7.7 cm, respectively); STFFs were used to reconstruct significantly shorter defects (mean, 6.0 cm, P<.001, Table 1).

And in this example, which does not include a table or figure citation, similar logic would also probably have made retention of back-to-back parens a better choice since the hazard ratio and P value apply to both, not just the second “n”:

Significantly more patients (n=174) withdrew from the placebo group compared with the chelation group (n=115; hazard ratio, 0.66; P=.001).

Splitting or lumping parentheses should depend more on content than strictly on style.—Cheryl Iverson, MA

Quiz Bowl: Editorial Processing and Assessment

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So, what happens to my manuscript once it has been submitted for publication? Who reads it? Who decides its fate? If it is accepted, what happens next? Help!

Many authors are perplexed by the editorial processing and assessment stages of the publication process. Sometimes it seems as if manuscripts are submitted for publication only to disappear into a sinkhole of unpublished data. Never fear, diligent authors. This month’s AMA Manual of Style quiz covers the procedures involved in editorial assessment and processing.

Here’s an example to test your knowledge of this often puzzling process.

Who on the editorial team makes decisions regarding rejection, revision, and acceptance of manuscripts?

editor

peer reviewer

both the editor and peer reviewer

So, what do you think? (Use your mouse to highlight the text box.)

editor

That one wasn’t too hard. The editor is the head honcho after all, although input from the peer reviewers is invaluable.

If you’re interested in learning more about how manuscripts are processed and assessed, check out this month’s quiz at www.amamanualofstyle.com.—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

Questions From Users of the Manual

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Q: Would you hyphenate “white coat hypertension”?

A: We would follow the latest edition of Webster’s New Collegiate Dictionary. The 11th edition recommends inclusion of a hyphen: white-coat hypertension.

Q: If 2 footnote symbols appear next to each other in a table, should any punctuation be introduced between them?

A: Yes. As with the policy for citation of a reference citation and a footnote symbol side by side (see page 95 in the print), add a comma. So, you might have superscript a,b; or superscript a,c-e.

Q: I would like to know how to cite your 10th edition in the style recommended by the 10th edition.

A: Glad to oblige:

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.

Q: Section 3.10 advises beginning the subtitle of a journal article cited in a reference list with a lowercase letter. Is this true even if the title ends with a question mark?

A: Yes. Here is an example, edited to style:

Mayer AP, Files JA, Ko MG, Blair JE. Do socialized gender differences have a role in mentoring? academic advancement of women in medicine. Mayo Clin Proc. 2008;83(2):204-207.

The same policy would apply if the title were to end with an exclamation point, although those are rare in scholarly article titles!—Cheryl Iverson, MA