Author: amastyleinsider

Questions From Users of the Manual

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Q: What do you recommend regarding the necessity of including state names (or province names or country names) with the names of certain well-known cities?

A: We used to have a list of cities that could stand without a state (or province or country), but we discontinued that with the ninth edition and recommend that a state or country name be included with all cities.  (What is well known to one may not be well known to another.)  For details and exceptions, see section 14.5.

Q: Do you recommend using “eg” or “e.g.”? Since this represents the shortening of 2 words, I believe “e.g.” would be correct.

A: We recommend using “eg,” closed up, with no periods. See the list of Clinical, Technical, and Other Common Terms in section 14.11. It is true that this abbreviation represents 2 words, but within the list in section 14.11 you will note that most of the abbreviations included represent at least 2 words and yet they are joined without periods. This is a fairly common practice.

Q: I can’t find anything in the Manual about “normal saline,” but I seem to remember that this term was not preferred. Help.

A: Your memory is good.  In the ninth edition of the Manual (section 15.11), we did  indicate a preference for isotonic sodium chloride solution over normal saline. However, in the current edition we dropped that preference and consider normal saline acceptable, so there is no need to change it. If an author uses isotonic sodium chloride solution, however, that too may stand.  Both terms are acceptable.—Cheryl Iverson, MA

Let’s Not Be Rash

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“I have a rash all over my back.”

“Physical examination revealed a diffuse rash covering most of the patient’s back.”

One sentence overheard in conversation, the other appearing in a medical report; the former more colloquial, the latter more technical—but both correct, right? Well, not quite. While rash has been used in medical writings since at least the second half of the 19th century, current thought is that rash is a lay term lacking precision and specificity. Thus, while it is perfectly acceptable (and understandable) for a patient to use the term when describing symptoms to a clinician, once the clinician turns to describing an inflammatory (as opposed to a cystic or neoplastic) skin condition for the patient’s record or in a case report or other formal medical literature, rash should be replaced with a more descriptive and specific term.

However, this does not mean that rash has no place in medical literature. Because patients typically use rash when describing their symptoms, the term might legitimately appear, for example, in a report of a patient presenting with specific symptoms and signs or a list of adverse reactions self-reported by participants in a randomized trial; similarly, report forms provided to trial participants might also include rash in a list of potential adverse reactions.

Editors of medical literature, then, need to take into account the context in which rash was originally used as well as the intended audience. The term is appropriate when it appears in passages quoted from patients or when used in materials intended for lay use, eg, instruction sheets, patient care brochures, and medication inserts (however, use of the term skin rash in such materials is redundant and should be avoided [see 11.2.1, Redundant Words, in the AMA Manual of Style, pp 405-406 in print]). In many cases, as noted above, the term is also appropriate in more formal medical literature reporting nondermatological studies in which rash is one of several adverse events listed and any type of rash would be lumped together in one category. In literature describing physical examinations, specific skin-related adverse events, or dermatological studies, rash should be replaced with a more precise term. While skin eruption or dermatitis are often acceptable replacements, ideally the replacement term should be precise enough to describe the appearance of the lesion (eg, macule or patch vs papule, bulla, vesicle, nodule, or pustule) and the suspected specific cause (eg, allergy; heredity; irritation; bacterial, viral, and fungal infections). Replacement terms might also describe the distribution of inflammation and the histological structures involved.

The range of findings and topics reported in JAMA and the Archives Journals allows for the use of rash as well as more specific terms within a single family of publications. For example, rash does appear regularly in JAMA, since many studies in that journal report adverse events that include rash as a category. On the other hand, the editorial staff of the Archives of Dermatology always replaces rash with a more specific term, unless rash appears in material quoted from a patient.— Phil Sefton, ELS

Ode to the Style Manual

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(A poem from a hardcore user of the AMA Manual.) (No, not the cat.)

I study the Manual each day and each night

Coming away with equal questions and answers

Seeking all ways to be right

Are you a temporary compound, both sides with a tall, proud face
or are you with us permanently but deserve only lower case.

Are you a word just colloquial–or maybe even worse–

The ever-intrusive –ology (ie, completely perverse)

Have you been with us 5 times or more

Making a point so precise and succinct

Or are you here fewer times but wind up using more ink

It’s often exhausting, I must admit

I feel like I’m chasing elusive catnip

Each time I move close to the intoxicating scent

I discover new Elements that were recently sent

They arrive in my inbox with regular speed

And though I accept them, I must concede

I’d rather they land in another box I need

I give up and lay (or lie?) down

Staring off into space

Who knew that reading required such mental pace

But eventually I notice the pillow I chose

The source of all I have said

Provides a solid foundation from which to function

Indeed, a good place for my head

Finally

I must admit to own

The penultimate of nerdity

In my discomfort with the structure of

A poem on editing’s absurdity—Donna J. Thordsen

Flaunt, Flout, Vaunt

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Malapropisms: as users of language, we are all guilty of using them sometimes. In the heat of trying to express ourselves, we use one word in place of another—particularly when those words sound similar—and soon we are flaunting accepted usage. Or would that be flouting accepted usage?

To begin with, flaunt relates to vainglorious or ostentatious display, whereas flout denotes an expression of disdain or contempt, often for something forbidden by rule or custom (one grammar blog neatly sums this up by stating that “you flaunt something you like and flout something you don’t”1). Flaunt is used transitively (“Lamilia stopped off to flaunt her ermine and her jewels”) as well as intransitively (“Lamilia came flaunting by, garnished with the jewels whereof she beguiled him”2(p602)) and also is often used in a quasi-transitive sense2(p602) (eg, the currently common “If you’ve got it, flaunt it”). Similarly, flout may be used transitively (eg, the currently common “flout the law”) or intransitively (“It never came into our thoughts… to flout, in so bold a manner”2(p609)). However, flout is not typically used in the quasi-transitive sense.

So flaunt and flout, while often confused, do have distinct meanings. Prescriptive grammarians will point out that flaunt and flout are thus distinct terms and should not be used interchangeably, whereas grammarians with more descriptive leanings will be less inclined to observe a distinction in meaning, in particular maintaining that flaunt may sometimes be used when prescriptive usage would call for flout. Indeed, some authorities, such as Merriam-Webster’s Collegiate Dictionary, now accept the use of flaunt in place of flout in certain constructions—specifically, when the transitive is required (“meting out punishment to the occasional mavericks who operate rigged games, tolerate rowdyism, or otherwise flaunt the law”3). However, at least in relation to this pair of words, the prescriptivists would seem to hold the upper hand. First, flaunt is acceptable (from a descriptive standpoint) in place of flout only when the transitive is required. Second, flout is rarely used in place of flaunt. Third and most importantly, flaunt and flout are similar only in the way they sound, rather than in their (until recently) accepted meanings.

To further complicate matters, though, flaunt is sometimes—albeit quite rarely—confused with vaunt, which denotes boasting or bragging. Like the former, vaunt may be used transitively (“He vaunts his Conquest, She conceals Her Shame”2(p2217)) or intransitively (“They laud their verses, they boast, they vaunt, they jest”2(p2217)) and as early as the 1600s was used in a quasi-transitive sense (“to vant it or vie in gaming”2(p2217)). However, the confusion between flaunt and vaunt stems not only from their marked similarity in sound but also from their somewhat similar meanings (to display oneself boastfully or ostentatiously, often so as to show off one’s attractiveness or possessions, compared with using language boastfully, often to boast of an accomplishment). Indeed, given the similarities in sound and meaning that exist between these two words, it is perhaps surprising that they are not confused more often. On the whole, however, language users usually seem to recognize the difference between these words, and even descriptive usage does not yet support the use of vaunt in place of flaunt or vice versa.

In short, flaunt, flout, and vaunt are sometimes used as malapropisms for one another, particularly in spoken language. However, these terms have distinct meanings and, despite their similarity in sound as well as the increasing support in some circles for sometimes using flaunt in place of flout, currently it is preferable to maintain the distinctions between these terms and to use them as they have predominantly been used over time. Or, to take some liberties with the quasi-transitive:

If you’ve got it, flaunt it;

If you did it, vaunt it;

If they forbid it, flout it.—Phil Sefton, ELS

1. Motivated Grammar: Flout good taste; flaunt your excesses. http://motivatedgrammar.wordpress.com/2008/02/23/flout-good-taste-flaunt-your-excess/. Accessed November 30, 2011.
2. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991.
3. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA; Merriam-Webster Inc; 2003:477.

Condition, Disease, Disorder

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“Disease often fortifies the system against the action of remedies.”

“Disorder often fortifies the system against the action of remedies.”

Which of these sentences is correct? As it happens, the first is an actual quote (H. C. Wood, 1879)1(p445) and so in that sense is the “correct” one. However, the question remains: What are the differences, if any, between disease and disorder? For that matter, where does the often-used condition fit in? While these terms are frequently used interchangeably, differences between them do exist and can assist the person wishing to use them in more specific senses.

Condition is perhaps the least specific, often denoting states of health considered normal or healthy but nevertheless posing implications for the provision of health care (eg, pregnancy). The term might also be used to indicate grades of health (eg, a patient might be described as in stable, serious, or critical condition). While this term is often used in medical discussions to specifically indicate the presence of pathology or illness, Dorland’s Illustrated Medical Dictionary provides no definition of the term used in this sense. Merriam-Webster’s Collegiate Dictionary, however, defines condition as “a usu. defective state of health,”2(p258) and the Oxford English Dictionary similarly opines that it denotes “[a] state of health, esp. one which is poor or abnormal; a malady or sickness.”1(p309) In lay conversation condition is sometimes used euphemistically when a discreet term is desired for reference to a state of health, either well or ill—for example, delicate condition was once commonly used to refer to either pregnancy or alcoholism. Similarly, condition understood specifically to indicate the presence of pathology or illness is sometimes used as a value-neutral term when a stronger term might not be desirable. When such considerations do not come into play, a condition conferring illness can be further classified as a disease or a disorder.

“He was full of such disease. That he may nought the deth escape” (1393).1(p445)

Disease is often used in a general sense when referring to conditions affecting a physical system (eg, cardiovascular disease) or a part of the body (eg, diseases of the foot). The term also may be used in specific senses—for example, a writer might refer in general terms to neurologic disease or in specific terms to Alzheimer disease. But disease is perhaps most often used when referring to a condition that possesses specific characteristics. In this vein, Merriam-Webster’s defines disease as “a condition of the… body or one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms…”2(p358); the Oxford English Dictionary defines the word similarly but particularly stresses structural change as a cause.1(p445) Dorland’s concurs with these sources but makes clear that the impaired functioning associated with the diseased state may constitute “any deviation from or interruption of the normal structure or function…” and further elaborates that “the etiology, pathology, or prognosis may be unclear or unknown.”3(p535)

“A Fever is the first disorder that affects the Blood and Vessels” (1725).1(p449)

Compared with disease, disorder is less restrictive: Merriam-Webster’s defines it simply as “an abnormal physical or mental condition,”2(p360) a definition with which Dorland’s largely concurs.3(p555) The Oxford English Dictionary emphasizes that disorder involves a disturbance of function but again further stresses structural change, this time in negative terms, stating that disorder is “usually a weaker term than DISEASE, and not implying structural change.”1(p449) This emphasis on functional rather than structural change has been in place since at least the late 1800s, when the Lexicon of Medicine and Allied Sciences stated that disorder is “a term frequently used in medicine to imply functional disturbance, in opposition to manifest structural change.”1(p449) Because disorder, like condition, is relatively value-neutral when compared with disease, it is often used in place of the latter term when a less stigmatizing or less alarming term is desirable—eg, a clinician might at first refer to a patient’s disease as a disorder to reduce the patient’s initial anxiety; similarly, the same patient might initially refer to his or her recently diagnosed disease as a disorder in conversations with family and friends.

In short, what distinguishes condition, disease, and disorder from one another would seem to be their relative emphases on functional change, structural change, presence of signs and symptoms, and, perhaps to a lesser extent, the gravity a writer wishes to convey:

• Condition simply indicates a state of health, whether well or ill; a condition conferring illness might be further classified as a disease or a disorder—however, condition might be used in place of disease or disorder when a value-neutral term is desired.
• Disease denotes a condition characterized by functional impairment, structural change, and the presence of specific signs and symptoms. As an aside, Dorland’s equates the terms illness and sickness with disease; while these are often used to indicate the state or experience of disease, they are also sometimes used as value-neutral alternatives for disease.
• Disorder, in contrast, denotes a condition characterized by functional impairment without structural change and, while certain disorders or categories of disorders might be accompanied by specific signs and symptoms, their presence is not required for a condition to be termed a disorder. Like condition, disorder is sometimes used as a value-neutral term in place of disease.—Phil Sefton, ELS

1. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991.
2. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA; Merriam-Webster Inc; 2003.
3. Dorland’s Illustrated Medical Dictionary. 31st ed. Philadelphia, PA: Saunders; 2007.

Quiz Bowl: Study Designs

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Okay, show of hands, who knows the difference between a cost-effectiveness study and a cost-benefit analysis? Can you explain what makes a study retrospective vs prospective? What’s the name for the study that pools the results of 2 or more studies to address a hypothesis?

Let’s admit it. Most manuscript editors are at a loss when it comes to understanding the different medical study designs, but at least a cursory knowledge in this area will help as you edit manuscripts. This month’s AMA Manual of Style quiz is on study designs. Test your knowledge in this area by answering the following sample question from the quiz:

Which type of study compares those who have had an outcome or event with those who have not?

case-control study

case series

cohort study

meta-analysis

Here’s the answer (use your mouse to highlight the text box):

case-control study

Of the multiple answer options given, case-control study is the most appropriate. According to the AMA Manual of Style, “Case-control studies, which are always retrospective, compare those who have had an outcome or event (cases) with those who have not (controls). A case series “describes characteristics of a group of patients with a particular disease or patients who have undergone a particular procedure.” A cohort study “follows a group or cohort of individuals who are initially free of the outcome of interest.” Finally, a meta-analysis “is a systematic pooling of the results of 2 or more studies to address a question of interest or hypothesis.”

If you want more examples to test your knowledge on study designs, take the Study Design Quiz on the AMA Manual of Style online.—Laura King, MA, ELS

Cheat Sheet for Abbreviations Style

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Abbreviations are a convenience, a time saver, a space saver, and a way of avoiding the possibility of misspelling words. However, a price can be paid for their use. Abbreviations are sometimes not understood. They can be misread, or are interpreted incorrectly. … The person who uses an abbreviation must take responsibility for making sure that it is properly interpreted.—Neil M. Davis1

Abbreviations are used widely in medical articles, and great care should be taken to provide expansions that define these abbreviations. The AMA Manual of Style includes a straightforward rule regarding the use of abbreviations: Define abbreviations at first mention by providing the expanded term first, followed by the abbreviation in parentheses, and the abbreviation is used thereafter.

But for every rule, there are exceptions.

Some Exceptions:

• Avoid creating abbreviations for terms that are easy to spell out and do not take up a lot of space. For example, it is not advisable to abbreviate “catheter ablation” as “CA” or “immune response” as “IR.” Also, avoid using too many abbreviations in any one article.

• If a term is better known as an abbreviation, provide the abbreviation first with the definition following in parentheses. “The TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling) staining assay was carried out using an apoptosis detection kit.”

• It is inelegant to begin sentences with abbreviations, unless the expansion is so unwieldy that using the abbreviation makes sense. The previous example, TUNEL, also works here. Rather than begin a sentence with the cumbersome expansion, it is acceptable to begin the sentence with the abbreviation TUNEL.

• Abbreviations should not be introduced in headings. If an abbreviation is being used for the first time in a heading, expand the abbreviation in the heading; then, at first mention in the running text after the heading, expand the abbreviation again, with the abbreviation following in parentheses. Use the abbreviation thereafter.

• Some very common abbreviations do not require expanding at first mention, such as AIDS, TNM, UV, and CD-ROM. A complete list of these abbreviations is provided in section 14.11, with those that do not require expansion denoted by an asterisk.

• The efficiency of using an abbreviation is lost if the abbreviation is used only one time, so as a rule of thumb, introduce an abbreviation only if it is used at least 2 or 3 times.

Items of Note:

• Tables, figures, and abstracts are treated as separate items from the text, so abbreviated terms must be reexpanded in each of these items.

• Use the appropriate article (a or an) before an abbreviation according to the sound following the article (eg, a UN resolution, an HMO plan).

• Use a lowercase s (and no apostrophe) when making abbreviations plural (eg, NSAIDs).—Lauren B. Fischer

1. Davis NM. MEDical ABBREViations: 28,000 Conveniences at the Expense of Communication and Safety. 13th ed. Warminster, PA: Neil M Davis Associates; 2007:1.

Masterful, Masterly

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Writers are often taught that masterful and masterly mean different things and to ensure that they are used correctly. Masterful, so such thinking goes, is taken to mean “suggestive of a domineering nature,” or “inclined and [usually] competent to act as master,”1 whereas masterly is used to denote “having the power and skill of a master.”1

However, the use of masterful to mean “skillful” is now widespread; as Bernstein, clearly a proponent of maintaining the distinction, pithily puts it, “masterly is never misused; masterful often is….”2 Moreover, it seems that the distinction has not always been observed. Whereas masterful has been used in the sense of “domineering” since the 1330s,3 it also was used to mean “skillful” as early as 1613.3 And whereas masterly was used in the sense of “skillful” since the mid 1600s,3 it also was used to mean “domineering” as early as the 1530s,3 although that use has been obsolete since the late 18th century.3

In short, both words have been used to indicate “skillful” since roughly the time of King James I of England. However, the idea that writers should distinguish between them is comparatively new1—and such a late addition of a distinction is the reverse of the more common case, in which a distinction between words ceases to hold sway as the language evolves.

The origin of the distinction? Merriam-Websters posits that it was “excogitated by a 20th century pundit”1—this “pundit” apparently none other than Henry Watson Fowler, editor of The Pocket Oxford Dictionary, coeditor of The Concise Oxford Dictionary and The King’s English, and author of A Dictionary of Modern English Usage.4 In the latter work, Fowler established a distinction between masterful and masterly that was taken up by authorities such as Bernstein2 and that continues to be trumpeted to this day.5 Fowler’s reason for introducing the distinction? Masterly has only 1 sense (at least since its use to mean “domineering” became obsolete), so masterful should be limited to a single sense as well.1

However, some also have argued for the use of masterful in place of masterly in adverbial constructions, pointing out that although masterly is properly used as an adverb as well as an adjective, its use as an adverb seems awkward, even incorrect; eg, “He paints masterly.”2 Moreover, masterly, like many words ending in “y,” is what Bernstein (who nevertheless advocates distinguishing between the words) calls a “reluctant” adverb—ie, a word that resists serving as or being turned into an adverb.6 To make matters worse, masterly takes another adverbial form, the admittedly horrid masterlily.

Where does this leave the conscientious writer? Like Fowler, several modern authorities deem the distinction a valuable one5 and often advocate recasting a sentence to allow a more mellifluous use of a reluctant adverb5,6: hence, the sentence “Its wooden gables… showed how masterly they had been carved of old”3 might be recast as “Its wooden gables… showed the masterly manner in which they had been carved of old,” or similar. “A retreat of this kind,” Bernstein maintains, “is better than clumsy bravado.”6

At least one like-minded authority, however, has conceded that the battle to maintain the distinction—whatever its merits—has likely been lost.5 The prevalence of masterful in everyday usage confirms that opinion, receiving further support from the fact that the words have developed in roughly parallel fashion over time.3 Merriam-Websters concurs, maintaining that masterful used in the sense of “skillful” “has continued in reputable use all along; it cannot rationally be called an error.”1 Moreover, it has been suggested that using masterful in its original sense might even confuse readers now accustomed to the use of masterful to mean “skillful.”7

The bottom line:

● Using masterful in place of masterly to mean “skillful”? You’re in good company, and that usage has a long history. However:

● Set on maintaining a distinction between masterful and masterly? You can’t go wrong there, either. True enough, some readers might be confused by the use of masterful in its original sense—but since when do writers shrink from using words correctly to avoid confusion?—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:764.

2. Masterful, masterly. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:269.

3. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:1045.

4. Sheidlower J. Elegant variation and all that. The Atlantic Online Web site. http://www.theatlantic.com/past/docs/issues/96dec/fowler/fowler.htm. December 1996. Accessed September 16, 2011.

5. Masterful, masterly. Good English Rules! Web site. http://www.goodenglishrules.com/masterful_masterly.htm. Accessed September 16, 2011.

6. Adverbs, reluctant. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:27.

7. Masterful vs. masterly. Grammarist Web site. http://www.grammarist.com/usage/masterful-masterly/. Accessed September 16, 2011.

Questions From Users of the Manual

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Q: I am a medical writer (and writer, in general) and have always questioned the use of the lowercase “b” in the word “blacks.”  The “w” in “Whites” is normally capitalized when talking about that population.  Although this question is not limited to the AMA Manual of Style, how might I go about getting it changed so that the “b” in “blacks” is also capitalized, for consistency?

A: You will have noticed that in section 11.10.2 of the manual we do not use intial caps on either “white” or “black.”  Webster’s 11th seems to follow this policy also, as you will find definitions related to both races presented without initial caps. I also checked the Chicago Manual and, in section 8.39, they indicate a similar policy. “Common designation of ethnic groups by color are usually lowercased unless a particular publisher or author prefers otherwise.” So, there does seem to be consensus among this small sampling, but it is in the direction of using initial lowercase letters rather than initial caps for these terms.

Q: Are there courses that teach proper use of the AMA Manual of Style?

A: I know of one such course. It is the Medical Writing and Editing Certificate Program that is offered by the University of Chicago Graham School. See https://grahamschool.uchicago.edu/php/medicalwritingandediting/.

Q: I have been working as an APA style editor for nearly 3 years.  I would like to be able to work as an AMA style editor.  I need to learn the AMA style.  Which version of the manual do you recommend?  Is this manual available online?

A: You can visit the AMA Manual of Style Online site (www.amamanualofstyle.com) and you can see that you can purchase a book, an online subscription, or a “bundle” of both. You can also subscribe to the blog and sign up for tweets at no charge. Good luck to you!

Q: Does AMA have a preference for “versus” vs “vs”? If so, can you include the rationale behind the choice?

A: Yes, we prefer “vs” as an abbreviation for “versus” (except in the names of legal cases, where we use the conventional “v”). See the list of abbreviations (14.11) re our preference for how to abbreviate “versus” and also note that we do not require this abbreviation ever to be expanded.  Note too that the use of the lowercase italic “vee” is preferred in legal cases, per convention.  As to our rationale, we have been doing this for so long it is hard to recall exactly.  I suspect it was a combination of “vs” taking up less space than “versus” and being well recognized and understood by all/most.

Q: Is it 0.9 second or 0.9 seconds? The AMA Manual of Style doesn’t seem to address this particular question.

A: This question originally arose on the AMWA Editing-Writing Listserv. There was much good discussion and various sources were cited. After considering all the comments and polling our own staff, we come down on the side of Words Into Type and Edie Schwager’s Medical English Usage and Abusage (for print usage:  prefer the singular).  But when spoken, we prefer the advice of the Chicago Manual (section 10.68)—in general, prefer the plural.—Cheryl Iverson, MA

Quiz Bowl: To Capitalize or Not to Capitalize

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Flipping through the table of contents of the most recent issues of JAMA and the Archives journals, I realize how challenging it can be to correctly capitalize article titles and subtitles. Do hyphenated compounds use initial capital letters on both terms? Are words of 2 letters or fewer capitalized? How do you capitalize genus and species names? Much like Hamlet’s “To Be or Not to Be” conundrum, I am often found muttering to myself “To Capitalize or Not to Capitalize.”

This month in the Archives of Internal Medicine, an article on hip fracture and increased short-term but not long-term mortality in healthy older women appears. But how should this be capitalized as a title? Is it “Hip Fracture and Increased Short-Term But Not Long-Term Mortality in Healthy Older Women,” “Hip Fracture and Increased Short-term But Not Long-term Mortality in Healthy Older Women,” or “Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women”?

This month’s JAMA contains an article on the need for critical reappraisal of intra-aortic balloon counterpulsation. But is it the “Need for Critical Reappraisal of Intra-Aortic Balloon Counterpulsation” or the “Need for Critical Reappraisal of Intra-aortic Balloon Counterpulsation”?

Finally, in the Archives of Otolaryngology–Head & Neck Surgery, an article on leiomyosarcoma of the head and neck: a population-based analysis is published. But did the authors perform “A Population-Based Study” or “A Population-based Study”?

Capitalizing titles can provide editors with a sea of troubles, which is why we have chosen the topic for this month’s quiz. Test your ability to correctly capitalize the title in the following example. For further explanation of the correct answer, refer to section 10.2 (pp 372-374 in print). Then check out this month’s quiz (which subscribers can find at http://www.amamanualofstyle.com/) for more titles and subtitles to capitalize.

tolcapone in patients with parkinson disease: a randomized, double-blind, placebo-controlled trial

Okay, back to the original question—to capitalize or not to capitalize? How did you handle this title and subtitle? Did you know that double-blind and placebo-controlled are treated differently? Here’s the answer (use your mouse to highlight the text box):

Tolcapone in Patients With Parkinson Disease: A Randomized, Double-blind, Placebo-Controlled Trial

The A should be capitalized because it is the first word of the subtitle (§10.2, Titles and Headings, p 372 in print). Double-blind is a hyphenated compound considered a single word (ie, it can be found as a single entry in Webster’s); therefore, blind should not be capitalized. Placebo and controlled are 2 separate terms operating together as a temporary compound; therefore, both parts of the hyphenated compound should be capitalized (§10.2.2, Hyphenated Compounds, pp 373-374 in print).

For the record, those titles I mentioned earlier should be capitalized as follows:

Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women
Need for Critical Reappraisal of Intra-aortic Balloon Counterpulsation
Leiomyosarcoma of the Head and Neck: A Population-Based Analysis

If you want more examples to help you solve the puzzle surrounding correct capitalization of titles and subtitles, take the Capitalization of Titles and Subtitles Quiz on the AMA Manual of Style online.—Laura King, MA, ELS