Author: amastyleinsider

Questions From Users of the Manual

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Q:   If one has a list of laboratory values, does one have to keep repeating the units of measure, eg, albumin levels of 3.8 g/dL, 3.9 g/dL, and 4.0 g/dL, or is once enough, eg, albumin levels of 3.8, 3.9, and 4.0 g/dL.

A:  No, the unit of measure does not have to be repeated:  albumin levels of 3.8, 3.9, and 4.0 g/dL is fine.  The exception to this is for units of measure that are set closed up to the number or value that they follow, such as the degree sign or the percent sign.  In these cases, the unit of measure should be repeated:  38%, 45%, and 53%.

Q:   What abbreviation does JAMA/Archives prefer for adjusted odds ratio?

A:   We prefer AOR.

Q:   Is “data on file” acceptable in a bibliography or in parentheses in the text?  I don’t see this in the Manual.

A:   The phrase “data on file” is a little vague.  What a reader who’s interested in more information might really want to know is how the author of the manuscript saw the data (and how, perhaps, the interested reader might be able to see it too).  Something more granular about how the author came upon the information would be more helpful.  For example, did the author learn about the information through a personal communication (and is that personal communication the “data on file”?)?  If so, see 3.13.9 in the Manual for how to style this as an in-text references.  Is the “data on file” an internal memo at an institution and, if so, does it have a document number that could be listed in the reference list?

Q:   Would you hyphenate “quality of life” when it’s used as a noun as well as when it’s used as an adjective?

A:   We usually hyphenate as an adjective and not as a noun.—Cheryl Iverson, MA

Abbreviation Nation

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Of the reference books I use while editing the Archives journals, my favorite by far is MEDical ABBREViations: 28,000 Conveniences at the Expense of Communication and Safety, 13th Edition, by Neil M. Davis. Not only does it have the most wonderfully snarky title I’ve ever seen on a reference book, but it is the Great Decoder, the book that allows me to make sense of the myriad abbreviations I run across in my daily work.

As much as we are a nation of people who speak largely in cliches and mixed metaphors (I will save my rant about the overused and incorrect “magic bullet” for another day), we are a nation of overabbreviators. The number of organizations that are known by their abbreviation are too many to quantify (NFL, AMA, NORAD). We put out APBs, send out CVs, take our OTC meds, surf our Macs and PCs, and occasionally go AWOL. But when you think about it, do these mean anything? A National Football League is a thing. An NFL is not. What about an AC? Is it an air conditioner? An alternating current? Atlantic City? Though sometimes context can tell us what an abbreviation means, just as often it cannot, and it’s my job to sort these out.

As someone who previously tried to argue that texting is a valid and efficient method of communicating, it may seem hypocritical for me to do a mental fist pump every time I read Mr Davis’ snappy title, but I do. It’s because for every abbreviation that I find easily in my AMA Manual of Style or my MED ABBREV, there are so many that I must ask authors about. This worries me, because I don’t think authors would put these in their articles if they weren’t  routinely used. And though they and their colleagues and most of the American medical community may know exactly what they mean, will readers in Zimbabwe, Thailand, or Argentina? Those readers may have their own set of metaphors, jargon, and abbreviations that makes perfect sense to them. Or they may be students who don’t come across them every day. What happens when we let them slide, or when a journal doesn’t have finicky, know-it-all editors to question them? I worry that it will make journals less accessible, and that it will make medical discourse less accessible. I hate the idea of a medical student somewhere in the world not being able to use one of our articles in his research because I didn’t feel like finding out what something means. And believe me, sometimes I don’t feel like it. But I know I must be persistent, as annoying as it feels to harass a busy professional about something that seems so trivial. And that medical student out there better appreciate it.—Roya Khatiblou, MA

Quiz Bowl: Statistical Terms

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What’s the difference between an α level and a β level? Do you know your y-axis from your x-axis from your z-axis? What term means the spread or dispersion of data? This month’s quiz, which subscribers can find at http://www.amamanualofstyle.com/, can help you learn the answers to these and other questions on statistical terms. On the basis of your understanding of section 20.9 of the AMA Manual of Style, select the correct answer from the choices listed in the following sample quiz question.

Which of the following terms means the correlation coefficient for bivariate analysis?
r
R
r2
R2

So, how did you do? Here’s the answer (use your mouse to highlight the blank line):

Which of the following terms means the correlation coefficient for bivariate analysis?
r

R is the correlation coefficient for multivariate analysis. r2 is the coefficient of determination for bivariate analysis. R2 is the coefficient to determination for multivariate analysis.

If you want to further test your knowledge of statistical terms, subscribe to the AMA Manual of Style online and take the full quiz. Stay tuned next month for another edition of Quiz Bowl.—Laura King, MA, ELS

Go, Embargo, Go

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So what’s an embargo, anyway? There’s the economic trade kind, but let’s stick to the news kind (much more relevant for AMA Style Insider readers). I spoke with Jann Ingmire, the JAMA and Archives Journals media relations guru, and she explained that embargoes exist primarily to give reporters the opportunity to cover a story in a more thorough way.

Here’s how they work: Embargoed material is released to members of the press prior to being released to the public, usually a few days early. This gives reporters time to do research, conduct interviews, and write a really great piece. When the embargo lifts, journalists are already prepared to report on newly published scientific studies.

Most of the time, the system works, but occasionally, an embargo is broken. Ms. Ingmire said she tries to give reporters the benefit of the doubt because, usually, it’s simple human error. Sometimes, though, the embargo break is flagrant. When this happens, reporters are sanctioned and stop receiving embargoed material.

Embargoes make it possible for everyone—from the independent blogger to the major media outlet—to have the same opportunity to gather a story. If you want to learn more, read embargowatch.wordpress.com, a blog that chronicles how embargoes affect news coverage.—Lauren Fischer

Dr Readability: Or How I Learned to Stop Worrying and Love the Pronoun

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In academic writing, the current modus operandi seems to be: the more words the better. Why say “children” when we can say “individuals of pediatric age”? Why “time” when “period of time” sounds so much more substantial? Strunk and White1 would surely disapprove. Extraneous verbiage may make one’s writing sound lofty and important, but it can muddle one’s message. Writers should not use circuitous, rhetorical language to persuade their readers. Strong, clear writing, without extra baggage, creates a confident tone and allows the reader to more easily understand a work’s significance.

Here are a few ways to clean up one’s writing for easier reading:

Use the pronoun. Use it.

Writers often repeat nouns instead of using pronouns, as writers fear that readers won’t understand what the writers are saying. Not horrible, but is there confusion over what they refers to in this revised sentence: “Writers often repeat nouns instead of using pronouns, as they fear that readers won’t understand what they are saying”? Repeating the same word or phrase creates reading fatigue, like listening to someone beat on a drum over and over. Trust that your reader has a longer attention span than the time it takes to read half a sentence and there will be no need to use the same nouns over and over and over…

Here’s an example: “Because many people use vitamin therapy, we must determine the efficacy of vitamin therapy compared with other treatments.”

How about this instead: “Because many people use vitamin therapy, we must determine its efficacy compared with that of other treatments.”

Use the verb.

Editors are in agreement that “to be” constructions are weak and should be replaced with the actual verb. I agree!

Substituting “to be” constructions with actual verbs makes writing stronger and more confident. Researchers often use the phrase, “Our findings are indicative of…” See the “to be” hidden in there? How about “Our findings indicate…”? Were “patients in receipt of the drug” or did they “receive the drug”? Were participants “in attendance” or did they “attend”? The meaning is the same, but the writing sounds a whole lot better with the true verb.

This goes hand in hand with the passive voice. We’re not saying that the passive voice is wrong necessarily, it’s just that it is believed by some people that it is not as strong as it could be. Rather, some people believe that the passive voice is weak. In general, the active voice should be used over the passive voice, especially in cases when the “actor” is present. For example, “Patients were monitored by resident physicians” should be changed to “Resident physicians monitored the patients.”

This is another way to say: Use the delete button.

Close your eyes. Pretend you have a word limit. Now, pretend you have to follow it. Would you rather cut 100 words from the “Results” section or 100 words throughout a manuscript that add nothing of substance substantial? See what I did there?

Here are a few substitutions that reduce wordiness:

–“combined with” instead of “in combination with”
–“important” instead of “of importance”
–“most” instead of “the majority of”
–“can” instead of “is able to”
–“affect” instead of “to have an effect on”

Eliminating exaggerations can also trim one’s writing. How often is quite, very, or rather necessary (or accurate)? Writers should also avoid superlatives like profoundly and significantly when describing a study’s results.

These tips will help eliminate excess verbiage and heighten readability while preserving meaning. What is there to be afraid of fear?—Laura Adamczyk

[author’s note: Some of these ideas came from lectures by Northwestern University professor Bill Savage, PhD.]
1. Strunk W Jr, White EB. The Elements of Style. 4th ed. New York, NY: Longman; 1999.

Ability, Capacity, Capability

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These near-synonyms actually mean slightly different things—but teasing out the subtleties requires a bit of hairsplitting.

To drive the first wedge, distinguish between ability and capacity. Ability denotes actual (as opposed to potential) skill that may be either native or acquired.1 On that point, Merriam-Webster’s Collegiate Dictionary cuts right to the pith, stating that ability is “natural aptitude or acquired proficiency.”2(p3) Capacity, on the other hand, denotes the potential to develop a skill, a native characteristic that one either does or does not have and that cannot be acquired or developed.3 (Language purists might maintain that capacity should be used only to refer to space or volume, but its use to refer to aptitude is well accepted.) Moreover, whereas ability and capacity can each refer to either physical or mental aptitude, capacity is more commonly used in connection with mental aptitude—in particular, to “mental or intellectual receiving power; ability to take in impressions, ideas, knowledge.”4

Persons attempting to keep these subtleties straight might, like William Caxton, well be inclined to exclaim, “My capacity is not sufficient for the proper handling… of such subjects”4—but things get more complicated yet. When differentiating ability from capacity, some language users distinguish between whether a sentence is referring to persons/animals or to things (with ability often used with persons and capacity most often used with either persons or things)1; however, this distinction is rapidly waning, and both words are commonly used to refer either to animate or to inanimate agents. For example, both words are commonly used when referring to inanimate agents such as physiological mechanisms (eg, “The ability/capacity of this pathway to promote….”) or anatomical structures (eg, “The ability/capacity of the liver to clear the body of these toxins….”).

Capability denotes “the quality or state of being capable”2(p182) as well as “a feature or faculty capable of development.”2(p182) Thus, capability comes closer to ability in meaning. However, capability further denotes a unique fitness for achieving a defined end,1 and this specificity makes capability a good choice in contexts requiring a greater degree of precision. So, while capability is all too often simply used as a pretentious substitute for ability—a 10-dollar word lobbed in when a 1-dollar word would have gotten the job done—capability might have been the better choice in the above examples (“The capability of this pathway to promote….”; “The capability of the liver to clear the body of these toxins….”). Furthermore, language users often use capability in place of capacity, likely led astray by the “cap” with which they both begin. However, whereas the use of capability in place of ability is becoming more accepted, particularly when referring to a unique aptitude to accomplish a particular end, the use of capability in place of capacity is usually incorrect.

The bottom line:

Ability = Actual skill, either mental or physical; native or acquired.

Capacity = Potential to develop a skill, usually mental; native, as opposed to acquired.

Capability = Unique fitness for a defined end; sometimes may be used in place of ability, but its use in place of capacity is incorrect.—Phil Sefton, ELS

1. Ability, capacity, capability. Merriam-Webster’s Dictionary of Synonyms. Springfield, MA; Merriam-Webster Inc; 1984:4.

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

3. Ability, capacity. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:5.

4. Capacity. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:209.

For Against As

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Since I have been copyediting at JAMA, I have been trying to reinvigorate the use of for as a coordinating conjunction when authors use the word as as demonstrated in the following construction.

There was no significant difference between the study population and the 60 participants who were excluded, as for they had inadequate sample volumes for the assay.

When the typescript came back, my for was deleted and replaced with because. Although I have no objection to because, I like for because it is clear, to the point, and efficient. Despite the continued rejection of my edits, I continue to advocate its use through the editing process, hoping it will take hold, hoping to change enough people’s minds that it will become so common that people will not regard it as “highfalutin” or “dated.”

Besides its efficiencies in language, its use has economic implications: it is shorter than because, for it saves ink and paper, which should please bottom-line conscious editors and publishers. Furthermore, it is grammatically correct and occupies the first place in the mnemonic FANBOYS, which can be found in writing guides to help students remember all of the coordinating conjunctions available to them. Why keep it in the writers’ reference manuals if no one uses it, I ask?

Finally, using as as a coordinating conjunction can be confusing and may steer readers in unintended directions. Coordinating conjunctions are used to show that the clauses of the compound sentence are equivalent. Subordinating conjunctions are designed to show that one idea is more important than another. Both as and because find themselves on the subordinating conjunction list. If they should head the second clause, they should stand alone without the aid of a comma, which when used with coordinating conjunctions announces the compound sentence. So as a copyeditor and a reader, when I see the comma preceding the as I think the author is presenting equivalent ideas rather than subordinating ideas, which is why I am compelled to change as to for. My point is that as when presented in a coordinating conjunction construction is ambiguous and can shift an author’s meaning despite his or her intent. For does not.—Beverly Stewart, MSJ

Minority Report

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Risk factors included racial/ethnic minority status, male sex, higher hemoglobin A1c level, use of insulin, longer duration of diabetes, and higher systolic blood pressure.—From This Week in JAMA, August 11, 2010.

The meaning of the adjective minority in this statement may appear to be clear to the reader. However, what constitutes minority status for race/ethnicity? In which country, population, or time? And in this context—risk factors for diabetic retinopathy—why would minority status per se (as opposed to a specific genetic background, or perhaps lower socioeconomic status and resulting lack of access to health care) be a risk factor? This usage points to a common but probably outdated use of the term minority to refer to a population of people. Why is this term to be avoided in this context?

Merriam-Webster’s Collegiate Dictionary1 defines minority as “a part of a population differing from others in some characteristics and often subjected to differential treatment; … a member of a minority group (an effort to hire more minorities)” and The American Heritage Dictionary of the English Language2 states, “A racial, religious, political, national, or other group regarded as different from the larger group.” These definitions evolved from the more basic meaning of minority. Insofar as usage and equity are concerned, however, historian Amoja Three Rivers stated emphatically 20 years ago that “at least four-fifths of the world’s population consists of people of color. Therefore, it is statistically incorrect as well as ethnocentric to refer to [them] as minorities. The term ‘minority’ is used to reinforce the idea of people of color as ‘other.’”3 The white race is becoming a “minority” in many countries where that had previously not been the case, including the United States. Nor are women to be considered minorities simply by their numbers (as an example of this, in the United States in the academic year 2008–2009, among first-year enrollees in medical school, there were 9619 men and 8889 women, compared with 10 576 men and 6205 women in 1988–19894).

When used as a noun to describe and thus label and marginalize a racial/ethnic, gender-specific, physically disabled, or other group of persons with a common trait, minority (and minorities) is an exclusive term that should be avoided.

Note: Minority (and majority) is appropriate to use when describing, for example, the count (number) in an election, an opinion of a nation’s high court, or in common usage to mean less than half (or more than half) of a given sample.—Roxanne K. Young, ELS, with thanks to Margaret A. Winker, MD

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

2. The American Heritage Dictionary of the English Language. 3rd ed. Boston, MA: Houghton-Mifflin Co; 1992.

3. Maggio R. Talking About People: A Guide to Fair and Accurate Language. Phoenix, AZ: Oryx Press; 1997:273.

4. Barzansky B, Etzel SI. Medical schools in the United States, 2008–2009. JAMA. 2009;302(12):1353(appendix I, table 2).

Criterion Standard

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The expression criterion standard, according to the AMA Manual of Style, represents the “diagnostic standard for a particular disease or condition, used as a basis of comparison for other (usually noninvasive) tests. Ideally, the sensitivity and specificity of the criterion standard for the disease should be 100%.” This definition on its face seems a fairly straightforward way to identify the best method for making a diagnosis or the best treatment plan for a given disease.

A controversy, however, emerges in a parenthetical phrase that suggests the alternate expression gold standard be avoided because it “is considered jargon by some.” This assertion is supported by a reference to A Dictionary of Epidemiology, third edition, by John M. Last, published in 1995. Treating it as slang, his entry not only presents gold standard in quotes but, to be sure the reader understands his meaning, follows it with the word “jargon” in parentheses before defining it. Last provides no alternate expression and does not include criterion standard in his dictionary. He does, however, include criterion, which he defines as “[a] principle or standard by which something is judged. See also STANDARD.” And that is defined as “[s]omething that serves as a basis for comparison.”

In his fourth edition, however, Last does not include a gold standard entry. His definitions for both criterion and standard remain the same, and because they have nearly identical definitions could account for his not including an entry for criterion standard.

The gold standard entry returns in the fifth edition, edited by Miquel Porta. It is again presented in quotes but omits the parenthetical naming of it as jargon and defines it as “[a] method, procedure, or measurement that is widely accepted as being the best available. Often used to compare with new methods of unknown effectiveness (e.g., a potential new diagnostic test is assessed against the best available diagnostic test).”

Looking at another source, Annals of Internal Medicine Editor Hal Sox in his book Medical Decision Making never mentions the expression criterion standard. He does, however, talk about gold standard, which he takes out of the realm of epidemiology and into clinical practice by defining the gold standard test as “[t]he procedure that is used to define the true state of the patient.”

Although the “when” of its adoption as the preferred expression for JAMA and the Archives Journals seems to have escaped memory, the “why” remains among most of the medical editors. Some suggest avoidance of gold standard because it crosses disciplines from economics to medicine. As an economic term, it had served as the basic support of paper money. Another consideration, offered by former JAMA Deputy Editor Richard Glass, is that “gold standard …implies more of a sense of permanence than is appropriate for scientific topics.” With new knowledge, he reasons, comes new standards.

Practice, however, defies style preference. A search of JAMA articles in 1998 shows that criterion standard was used 7 times while gold standard was used 42 times. Jumping ahead 10 years, the trend holds: criterion standard was used 9 times; gold standard, 35 times.

Yet the practice of using gold standard over the style recommendation may all boil down to what JAMA Deputy Editor Drummond Rennie wrote in an e-mail. “If we are prepared to consider using ‘criterion standard,’ we should really prefer ‘criterion criterion’ (though ‘standard standard’ sounds a tad less pompous, even if just as meaningless). We all know what ‘gold standard’ means. It has the merit of being customary, memorable, understandable.”

And isn’t that the job of editors? — Beverly Stewart, MSJ

Quiz Bowl: Plurals

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It’s time for our second Quiz Bowl! This month’s quiz, which subscribers can find at http://www.amamanualofstyle.com/, examines the use of plurals. Test your knowledge by correcting the error in the following sample question based on your understanding of chapter 9 of the AMA Manual of Style.

Sera from 100 infants in the study were collected at birth.

Okay, time’s up. Did you identify the error? Here’s the answer (use your mouse to highlight the text box):

Serum samples from 100 infants in the study were collected at birth.

Beware of “pluralizing” nouns that cannot stand on their own as plurals (eg, use serum samples not sera and urine tests not urines) (§9.7, When Not to Use Plurals, p 369 in print).

If you want to learn more about how to edit plural words, subscribe to the AMA Manual of Style online and take the full quiz. Stay tuned next month for another edition of Quiz Bowl.—Laura King, MA, ELS