Author: amastyleinsider

Questions From Users of the Manual

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Q: I thought AMA supported putting no space following a symbol such as > (eg, age <18) if, in the expression, the symbol is acting more as a modifier, not as an operator (eg, 3 < 4), in which case the symbol would have a space (AMA specifies a thin space).  If I’m mistaken, I need to make a mental adjustment.

A:  This is addressed in section 21.10.  We recommend thin spaces with such symbols as greater than, less than, equals, etc.  So, a small mental adjustment might be needed as we make no distinction between the 2 uses you describe.

Q: Is it true that AMA style no longer requires an expansion of CI (confidence interval) at first mention?

A: Yes, it’s true.  As of July 27, 2011, as announced on Twitter, we are no longer requiring that CI be expanded at first mention.  This is posted on the style manual Web site in “Updates to the Manual” and soon will have a special icon within the text to indicate that this material has been updated.

Q: Does AMA have a preferred format for telephone numbers?  How about international numbers?

A:   The manual does not address this question specifically (and perhaps it should).  However, if you look in section 25.11, you will see many examples (both from the United States and elsewhere) for presentation of telephone numbers.—Cheryl Iverson, MA

 

Purposely, Purposefully

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

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

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

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

The bottom line:

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

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

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

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

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

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

Jarring Jargon

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Theodore M. Bernstein, in The Careful Writer: A Modern Guide to English Usage, describes jargon as “meaningless, unintelligible speech,” which is how some people might describe their last conversation with their physician. In science and medicine, many barriers to clear communication exist, with jargon being one of them. In fact, it’s so difficult for physicians and patients to communicate clearly that a federal program has been created to promote simplified health-related language nationwide. The Health Literacy Action Plan is a “national action plan to improve health literacy.” The entire action plan is 73 pages (which is probably their first mistake) and it highlights the fact that we have a problem.

As editors, we know that jargon is to be avoided in medical literature. While jargon may evolve for the most innocuous of reasons, it is a vocabulary specific to a profession that sometimes is esoteric or pretentious and that can be confusing to those not familiar with it (sometimes to those familiar with it as well). “Inside talk” can be just that by design—it keeps outsiders out. Therein lies the source of the negative feelings about jargon.

In addition to being exclusive, some jargon is offensive and unprofessional. Have you ever seen an FLK? Probably. That’d be a funny-looking kid. “We bagged her in the ER” sounds ominous; what it means is that a patient was given ventilatory assistance with a bag-valve-mask prior to intubation in the emergency department. Hopefully the emergency department physician didn’t describe the patient as a GOMER. This means “get out of my emergency room” and could refer to, for instance, an elderly patient who is demented or unconscious and near death and who perhaps should die peacefully rather than occupy emergency department resources. In this example, jargon diminishes the complexity of a situation that should be dealt with in a more thoughtful way. As Bernstein writes, “All the words that describe the kinds of specialized language that fall within this classification [of inside talk] have connotations that range from faintly to strongly disparaging.”

Jargon also sometimes violates rules of grammar, eg, turning nouns into verbs, “The doctor scoped the patient,” or creating back-formations, like “The patient’s extremities were cyanosed,” instead of “The patient’s extremities showed signs of cyanosis.” Jargon can sometimes appear to depersonalize, by defining a person in terms of a disease. A “bypassed patient” may be one who has undergone coronary artery bypass graft surgery rather than one who has been overlooked. Sometimes, patients might be referred to by their organs, such as “the lung in room 502” instead of “the patient in room 502 with lung disease.”

The AMA Manual of Style lists examples of jargon to avoid in section 11.4, Jargon. Some other examples that we’ve collected over the years are listed here:

* Collodion baby is better phrased as collodion baby phenotype or “the infant had a collodion membrane at birth.”

* Surgeons perform operations or surgical procedures, not surgeries.

* Rather than say a patient has a complaint, describe the patient’s primary concern.

* Do not use shorthand (eg, exam for examination, preemie for premature infant, prepped for prepared).

* Euphemisms sometimes are not clear and should be avoided: “The patient died” is preferred to “The patient succumbed or expired”; the same holds true for killed vs sacrificed (in discussion of animal subjects).

* Patients aren’t “put on” medication, they’re treated with medication. Also, patients aren’t “placed on” ventilators, they’re given ventilatory assistance.

Certainly jargon does have its place. It is specialized, and those in the same field can use it to communicate precisely and quickly. However, when it comes to medical and scientific publications, jargon is best avoided. Bernstein ends his entry on “inside talk” with the following: “It must never be forgotten that the function of writing is communication.” Clear enough.—Lauren Fischer

Fit/Fitted

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“The curve was fit to the data points.”

“The curve was fitted to the data points.”

Which is correct? The answer can betray some strong opinions. “Using fit that way makes one sound like a backwoods rustic.” “Using fitted that way makes one sound like a pedant.” “Everyone knows that fitted is simply the adjectival form of fit.” In fact, the story is a bit more involved.

Fitted is indeed the adjectival form of fit (eg, fitted sheet), but it also can be used as the simple past or the past perfect verb form. However, whether fit is also acceptable when forming past tenses is in part a matter of geography. In British usage, fitted is considered always correct; however, many authorities of American usage—Merriam-Webster’s, for example—accept either fit or fitted,1 and even among those holding that fitted is always correct, some—Bernstein, for example—make allowances for the use of fit in casual speech.2 Such allowances often open the door for increased acceptance of a given usage in more formal contexts as well; indeed, whereas fitted was once invariably accepted for both the simple past and the past perfect, the -ed form is gradually going the way of the dodo.3 Moreover, when given the choice, many language users in the United States simply prefer fit over fitted.4

Such preferences aside, however, context can make a difference. For example, fitted is used when referring to the tailoring of clothing3; eg, “I was fitted for a new suit.” In other contexts, it can be helpful to consider if fit is being used in the sense of “to conform to a particular shape or size”1; if so, some might hold that fit is correct for both the simple past and the past perfect.5 If, on the other hand, fit is being used in the sense of “to make or adjust to the right shape and size”1—or the closely related meaning alluded to in the opening examples, “to adjust (a smooth curve of a specified type) to a given set of points”1—fitted is used for the simple past and either fit or fitted for the past perfect.5

Fit to be tied? The bottom line:

●Referring to the tailoring of clothing? Use fitted for both the simple past and past perfect.

●Referring to something being a particular size or shape? If you’re British or Canadian, you’re safest using fitted for both the simple past and the past perfect; if you’re from the United States, you’ll be in good company using fit for both, but be aware that some authorities advocate the use of fitted in writing and formal speech.

●Referring to adjusting something (other than clothing) to a particular shape or size? Referring to the fitting of a curve to data? If you’re British or Canadian, you’re still safest using fitted in all instances. If you’re from the United States, you’re safest using fitted for the simple past and either fit or fitted for the past perfect—but again, using fit in the latter context might be frowned on.—Phil Sefton, ELS

1. Fit. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:473.

2. Fit. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:186.

3. O’Conner PT. Woe Is I: The Grammarphobe’s Guide to Better English in Plain English. New York, NY: Riverhead Books; 1996:65.

4. Fit vs. fitted—two options. Englishpage.com Web site. http://www.englishpage.com/irregularverbs/info/html. Accessed July 15, 2011.

5. Fitted vs fit. English-Test.net Web site. http://www.english-test.net/forum/ftopic19015.html. Accessed July 15, 2011.

Lie/Lay

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If any doctor tells me, as I lie in my hospital bed, that my death will not only help others to live, but be symptomatic of the triumph of humanity, I shall watch him very carefully when he next adjusts my drip.—Julian Barnes1

He lays his hands flat on Addie, rocking her a little.—William Faulkner2(p147)

“[A]s I lie in my hospital bed”? Surely Barnes is correct—although some readers might wonder if this should read “as I lay in my hospital bed.” Similarly, Faulkner’s “He lays his hands flat on Addie” sounds correct, but is it really, in a novel in which sentences such as “You lay you down and rest you”2(p37) are used to so effectively communicate the rich idiom of that fictional world? Moreover, when Faulkner titles his novel As I Lay Dying, is he being grammatically correct or simply giving free rein to Addie Bundren’s vernacular? To further complicate matters, where would “lain” and “laid” fit into all this?

Ah, the joys of irregular verbs. In English, forming the simple past and the past participle forms of most verbs is simple—one simply adds -ed to the root form of the verb and is then free to knock off for the day. However, irregular verbs complicate this otherwise blissful state of affairs by requiring writers to memorize alternate forms for the past tenses. True enough, users of English have things pretty easy in this respect compared with users of some other languages, but English has enough irregular verbs—80 or more—to keep things interesting. Further complicating matters is that even the alternate forms of irregular verbs are sometimes irregularly applied—for example, sometimes the present and the past participle are the same (eg, become [present], became [simple past], become [past participle]), sometimes the simple past and the past participle are the same (deal, dealt, dealt), and sometimes the verb does not change form at all (hurt, hurt, hurt). Fortunately, though, memorizing the alternate forms for most irregular verbs seems to pose little problem for most English users.

So why all the angst when it comes to lie? It is just lie, lay, and lain, right? Well, so far so good—but what leads many English users astray is that lay, the simple past tense of lie, is also the present tense of lay, a different verb with a similar meaning. Lie means “To be or to stay at rest in a horizontal position” or “to assume a horizontal position”3(p717); lay means “To put or set down” or “to place for rest or sleep.”3(p705) The difference is that lie is intransitive, meaning it communicates a complete action by itself; lay, in contrast, is transitive, meaning it needs to act on a direct object to communicate a complete thought. So Barnes’ “as I lie in my hospital bed” is correct—as is an imperative such as “You lie down”—because these sentences need no direct object to communicate a complete action. Similarly, “He lays his hands flat on Addie” is correct, as is As I Lay Dying—the former because the present form of lay describes an action on something (in this case, “his hands”) and the latter because lay in that case is not the present of lay but rather the simple past of lie. On the other hand, Faulkner’s “You lay you down and rest you” is not, in the strictest sense, correct—although this instance is interesting, because while the speaker is correctly using a direct object with the transitive lay, the direct object is not a true object but rather a reflexive (and in this case redundant) element, and the choice of verb is incorrect from the start; in effect, the speaker is saying “place yourself down,” which, if judged apart from the idiom of Faulkner’s novel, would clearly be incorrect. The correct form of the sentence would use the intransitive verb: “You lie down.”

So—presuming the English user wishes to use lie or lay in one of the senses indicated above and is not contemplating telling a lie, communicating with a lay audience, or getting the lay of the land—how to simplify this mess?

A few quick tips:

• Determine the correct verb to be used, remembering that lie is intransitive and lay is transitive and requires an object. It might be helpful to remember that lay is often used to mean “to place (something on)”—or, for the mnemonically minded: “to p-lay-ce (something on).”

• Lied is never correct as either the simple past or the past participle of lie or lay when used in the senses indicated above—lied is used only when, for example, someone has just lied to someone else.

• For lie, the simple past and past participle forms are lay and lain (I lie dying, I lay dying, I have lain dying).

• For lay, the simple past and past participle forms are laid and laid (He lays his hands flat on Addie, He laid his hands flat on Addie, He has laid his hands flat on Addie).—Phil Sefton, ELS

1. Barnes J. Nothing to Be Frightened Of. New York, NY: Alfred A Knopf; 2008:177.

2. Faulkner W. As I Lay Dying: The Corrected Text. New York, NY: Random House; 2000.

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

Citations a-Twitter

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The dizzying speed at which technology has been evolving often leaves those of us entrenched in the world of crediting sources and editing reference lists running to keep up. We have standard citation formats for Web sites (§3.15), publish ahead of print articles (§3.15.1), and e-reader content (Tweet on January 31, 2011). Those of us who edit scientific content do not regularly (if ever) come across a citation to Twitter. That does not mean, however, that Twitter does not offer anything useful to science writers and editors. Government agencies, scientific journals, researchers, and others involved in publishing Tweet constantly.

How, then, should one cite a Tweet? In deciding AMA style position on this, we first had to resolve whether Twitter constituted a standard citable source or was more in the realm of “personal communications” (such as e-mail). We agreed that Twitter does belong in the citations list because it’s in the public domain, anyone can follow the Tweets of a journal or agency, and the individual posts are maintained by date with a lasting link. In addition, the US Library of Congress is to begin archiving all public Tweets, ensuring their searchability and permanence (http://www.loc.gov/today/pr/2010/10-081.html).

The second decision we had to make was what should be included in the citation. Our final Twitter citation style is based on that of a regular Web site reference:

1. @AMAManual. Many now accept “data” as singular. However, JAMA & Archives Journals retain the use of the plural verb with “data.” http://t.co/auYSgGb. http://twitter.com/#!/AMAManual/status/94117252009431040. Posted July 21, 2011.

2. @AMAManual. Style update! “CI” no longer requires expansion at first mention in AMA Style. So, 95% CI instead of 95% confidence interval (CI). http://twitter.com/#!/AMAManual/status/96287318616440833. Posted July 27, 2011.

In the first position is the author, in this case the “handle” or username on Twitter (@AMAManual). Then follows the full Tweet, the URL of that post (found by clicking on the date stamp), and finally the date of posting.

For those writing and editing in the social and behavioral sciences, the APA style blog also has addressed the citation of Twitter (http://blog.apastyle.org/apastyle/2009/10/how-to-cite-twitter-and-facebook-part-ii.html).

We hope this can help avoid citations sounding like a cacophony of Angry Birds.—Stacy L. Christiansen, MA

Statistical Rounding and the (Mis)Leading Zero

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Sometimes editors (not you or I, of course) obey the rules of their institution’s preferred style manual without fully understanding, or really thinking about, why some of these rules exist. For example, some editors (not you or I, of course) automatically delete (or, if they’re lucky, their editing program deletes for them) the leading zero in a few statistics, but not all. They know exactly when and where to delete the leading zero, but not why. Or they round some statistics, but not all, assuming that all of this has something to do with saving space. It does, of course,1(p830) but this isn’t the only reason we do it.

The AMA Manual of Style defines a P value as “The probability of obtaining the observed data (or data that are more extreme) if the null hypothesis were exactly true.”1(p888) Per AMA style, P values greater than .01 are expressed to a maximum of 2 decimal places and those less than .01 are expressed to a maximum of 3 decimal places. I set out in search of the complicated statistical reason why we use this specific number of decimal places and found that, in addition to saving space, we do it for one simple reason: it’s all we need. Yep, that’s it. It’s all we need to know. P < .00000001 doesn’t tell us any more of value than P < .001. Both tell us that the probability is very low, and that’s good enough. Of course, if the author protests or rounding will make P appear nonsignificant, an exception is made (for example, if P = .046 and significance is set at P = .05).1(pp851-852) Also, studies such as genome-wide association studies report P values of P < .00001 or smaller, often in scientific notation, to address the issue of multiple comparisons; it is essential not to round these. So every rule has exceptions, I guess (remember Spanish class, anyone?).

Why then, you ask, do we not save ourselves the confusion and simply round P < .001 to P = .00? There’s a reason for that, too, and it’s the same reason we don’t use leading zeros with certain probability statistics (ah, you say, it all comes together). If probability is the chance that a given event will occur,2 and we have only surveyed a sample of a given population, probability cannot equal 1.0 or 0 because we can’t say absolutely that a null hypothesis will definitely or definitely not happen in that population.1(p889) And if P can’t equal 1.0 or 0, why include a zero that doesn’t tell us anything new? For this reason, we use P > .99 and P < .001 as the highest and lowest P values. For the same reason, and because they are used often, the leading zero rule applies to α and β probabilities as well. Why? To save space, of course.–Roya Khatiblou, MA

1. 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.

2. Merriam-Webster’s Collegiate Dictionary. 10th ed. Springfield, MA: Merriam-Webster Inc; 1997.

Quiz Bowl: It’s All Greek to Me!

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Is it interferon-gamma or interferon-γ? Do we use kappa or κ free light chain? I don’t know—it’s all Greek to me! If you’re like me, you struggle with whether to use Greek words or letters.  Test your knowledge on the usage of Greek letters vs words by selecting which italicized term is correct in the following sentence. For further explanation of the correct answer, refer to chapter 17 (pp 781-783 in print). Then check out this month’s quiz, which subscribers can find at http://www.amamanualofstyle.com/ for more questions.

An elevated serum alpha-fetoprotein or α-fetoprotein level before orthotopic liver transplantation is predictive of mortality after orthotopic liver transplantation for hepatocellular carcinoma.

So, what do you think? Would you use alpha-fetoprotein or α-fetoprotein? Here’s the answer (use your mouse to highlight the text box):

An elevated serum α-fetoprotein level before orthotopic liver transplantation is predictive of mortality after orthotopic liver transplantation for hepatocellular carcinoma.

The AMA Manual of Style recommends the use of Greek letters rather than spelled-out words, unless usage dictates otherwise. Consult Dorland’s and Stedman’s medical dictionaries for general terms. These sources may differ in the representation of terms, ie, α-fetoprotein (Stedman’s) and alpha fetoprotein (Dorland’s). If the Greek letter, rather than the word, is found in either of these sources for the item in question, use the letter in preference to the word (§17.1, Greek Letter vs Word, p 781 in print).

If you want to learn more about usage of Greek letters vs words, take the full quiz on the AMA Manual of Style online—Laura King, MA, ELS

Questions From Users of the Manual

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Q: I’m not sure when I should use “rheumatologic” vs “rheumatological.”  Is there a subtle difference I don’t know about?

A: The use of “-ic” vs “-ical” is addressed in the Manual on page 396 in the Correct and Preferred Usage chapter.  You’ll note that there are a few instances in which the choice of ending does make a difference in meaning.  With “rheumatologic” vs “rheumatological” I do not believe there is such a difference in meaning and we would be more likely to choose the “-ic” ending for the rationale described on page 396.

Q: I’ve always followed Edie Schwager’s advice in Medical English Usage and Abusage (p 153):

If you remember to prevent, you’ll never choose the obsolete “preventative” instead of “preventive.”  The noun is prevention, not “preventation.”

Do you agree?

A: We agree with Edie.  We also prefer preventive.  Webster’s 11th edition shows the 2 words as equal in meaning but shows a preference for preventive as well.  Consensus!

Q: In section 3.15.3 of the Manual, the words “Web site” are used in examples 1 through 3 and 6, but are not used in examples 4 and 5.  What is the rationale for these differences?

A: This is an excellent question and points out an inconsistency that should be corrected.  I would include “Web site” in examples 4 and 5 as well.  In our next edition, I think we will need to consider if the inclusion of “Web site” is necessary or helpful.  In the current edition, we decided to drop the inclusion of “Available from:” before the URL as we thought that URLs were now well enough known that they did not need this extra identifier.  Perhaps this will also become the case with “Web site.”

Q: When an author’s surname includes 2 names not joined by a hyphen, which name should be included in the reference citation?

A: To assist in answering this question, I consulted Lou Knecht, Deputy Chief, Bibliographic Services Division, at the National Library of Medicine (NLM).  She said that the surname is determined by the preference of the author and she stressed the important role played by the author in presenting this information clearly to the publisher. Publishers also play an important role in clarifying the surname, for example, by using some  typographic device (eg, boldface on the author’s surname in the byline or in the table of contents) to make clear which is the surname.  She notes, “If the journal does not use some sort of surname indicator technique, then both the journal and NLM are left to make their best guesses.  And we frequently guess wrong.”   If NLM is contacted by an author to correct an incorrect surname (ie, the name is presented in direct order in the text and you cannot tell what the surname is), they will gladly do this.  They also monitor authors’ preferences for surname, so once NLM is contacted the first time about an incorrect surname, they enter the complicated surname into a table for the future.  If, however, the surname is published incorrectly, this requires an erratum.—Cheryl Iverson, MA

Ventilate or Ventilation

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“The patient was ventilated.”

“We decided to ventilate the patient.”

Such statements are commonly overheard in critical care units and other areas when clinicians discuss the care of a patient experiencing insufficient or absent respiration. Both statements use forms of ventilate in ways that—because they appear in this sense in the latest edition of Merriam-Webster’s Collegiate Dictionary—are correct and so may be used in medical journals. However, writers and editors have a valuable opportunity to ensure the continuing precision of the language through careful use of such terms and their variants, referred to as back-formations.

As discussed in the 10th edition of the AMA Manual of Style, “Back-formation is the creation of a new word in the mistaken belief that is was the source of an existing word” (see §11.3, Back-formations, in the AMA Manual of Style, p 407 in print). Back-formations are formed by the removal of a suffix (either a derivational suffix such as -ion or an inflectional suffix such as the plural -s) from a word that actually appeared first, changing its part of speech and forming a new word. Thus, the verb ventilate when used in the clinical sense may well be such a form, as suggested by its appearance in common use slightly later than the appearance of the noun ventilation (early 1900s vs 1890s, respectively).1 Interestingly, however, users of the English language had been busily back-forming for some time before that: ventilate as used in the closely related sense of exposing the blood to air, now obsolete or nearly so apart from its use in the study of physiology, likely also represents a back-formation that appeared some 50 years after ventilation as used in this sense (1660s vs early 1600s, respectively).2

Back-formation plays a valuable role in language evolution, producing neologisms that often subsequently enter common use. However, coining verbs through back-formation can result in medical jargon (see §11.4, Jargon, in the AMA Manual of Style, pp 408-409 in print) that is vague, depersonalizing, and sometimes downright comical in the images it can evoke. Taking the case in point, for example, what does “the patient was ventilated” mean, exactly? Was the patient perforated? Fitted with louvers? Left outdoors?

While it is commonly understood that the use of ventilated in this sense in spoken English denotes the use of a mechanical ventilator or other means of artificial respiratory assistance (eg, use of a bag-valve-mask apparatus), it typically refers to the former. However, in written materials, the use of mechanical ventilation should be explicitly reported when appropriate. In addition, eschewing the use of assistance altogether is perhaps advisable, and certain constructions (eg, “was” or “on” constructions) should be avoided if they lead to ambiguity such as that noted above. For example, “the patient was ventilated” and “the patient was placed on a mechanical ventilator” should be rewritten to read “the patient underwent mechanical ventilation.” In some instances, it might also be helpful to report additional information to clarify whether the intervention was invasive (ie, required endotracheal intubation, nasotracheal intubation, or tracheostomy) or nonvasive (eg, used a mechanical, sealed-mask approach such as BPAP [bilevel positive airway pressure]).

Writers and editors of medical information, then, should be vigilant when using terms coined through back-formation. Such terms should not be used if they do not appear in a current dictionary of reference. Those that do—eg, ventilated—may be used, but writers and editors should take care to ensure that they are not used in ways that are vague, depersonalizing, or unintentionally comical. Ultimately, however, a bit of back-formation is not a bad thing—for example, edit is a back-formation coined from editor.3—Phil Sefton, ELS

1. Ventilate. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:2223.
2. Ventilation. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:2223.
3. Back-formation. In: Hoad TF, ed. The Concise Oxford Dictionary of English Etymology. Encyclopedia.com Web site. http://www.encyclopedia.com. Accessed August 5, 2011.