Author: amastyleinsider

Questions From Users of the Manual

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Q:    If a person has multiple advanced degrees, should the medical degree always be listed first, eg, MD, PhD?

A:   We would advise following the author’s preference as far as the order in which degrees are listed.

Q:   I know that journal names are typically italicized in their expanded form, eg, Journal of the American Medical Association. Should the abbreviation also be italic, eg, JAMA?

A:   Yes. The same policy applies to book titles and their expansions. See, for example, International Classification of Diseases, Ninth Revision and ICD-9 in the list in 14.11.

Q:   On page 500, in the list of journal abbreviations, is there a reason that the journal Transplantation is spelled out in full as Transplantation and yet other journals whose titles include that word abbreviate it as Transplant?

A:    Yes, there is a reason. See the sentence on page 479 advising that “Single-word journal titles are not abbreviated.”

Q:    The AMA Manual of Style says that tables should be able to stand independently and not require explanation from the text. Could you clarify “stand independently”? Our publication has taken this rule to an extreme, often adding lengthy definitions of terms already provided in the text. One recent example added 15 footnotes to a single table!

A:   As with so many things editorial, this requires judgment.  We were thinking about things like this:

  • Expansion of any abbreviations, given in the text, provided again in a single footnote to the table.
  • Explanation of things that might not be apparent from the tables (eg, what the various groups are if they are only identified as “group 1, group 2, etc” in the table).
  • Explanation of how to convert units from conventional to SI (or the reverse), if this is important in your publication/to your audience.
  • Explanation of some statistical method that would likely not be familiar to your readers without some information—the bare bones, not a lengthy explanation. If a lengthy explanation is necesssary, simply refer the reader to the relevant section or subsection of the text.
  • Explanation of a phrase used for shorthand in a table stub or column head that might not be clear if all you were looking at was the table (eg, if a column head is “Unstable Vital Signs,” explain in a footnote the specific items and values that this refers to).

It truly is a question of judgment and I suspect that 15 footnotes in a single table is taking it too far.—Cheryl Iverson, MA

Say It Small

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“For sale: baby shoes, never worn.” This six-word story attributed to Ernest Hemingway is the subject of more contests and imitations than one can count. And there’s a reason for it. In just six words, the author manages to introduce the situation and characters, create conflict, and bring the story to its devastating conclusion. It’s this sort of economy of language that Hemingway is known for, and that many writers and editors, myself included, try to imitate.

I’m not suggesting we imitate Hemingway in only giving the reader an eighth of the story, of course. Clarity and directness are more important in scientific work than in fiction. But medical writing is dense, full of words and concepts one doesn’t always use in everyday speech (okay, maybe some physicians do). To have to wade through extra words and punctuation when already trying to concentrate on the subject at hand can be distracting, even exhausting.

Don’t get me wrong – I love words. I have an unnecessarily large Webster’s at home, though I can just as easily look up definitions online, and I will probably lug the thing from apartment to house to retirement home until my great-great-grandchildren finally use it for kindling after the Earth has run out of natural resources. But reading is not a passive activity. Our brains are working. And when there are more words than necessary, our brains must work an unnecessary amount. For the sake of the real economy, doesn’t economy of language make sense, to make readers and writers alike more productive, less taxed? If we all do our part to conserve language, we may even end up using less paper, and delaying my great-great-grandchildren’s postapocalyptic existence for a generation or two.

You want to talk more about Hemingway, you say? I’m happy to oblige.

Some say that Hemingway learned his succinct style through sending telegrams. As a reporter, he often had to get the gist of a situation across in 10 words or fewer; more than 10 would mean paying more for the telegram. He later used this as a device in his work. Jake’s telegram to Brett Ashley near the end of The Sun Also Rises tells the reader all they need to know when he goes over the ten-word limit so he can sign it, “Love.”

So what about text messages, e-mail, tweets? Some argue that these media are dulling the English language, making people lazy, unable to write in complete sentences. Maybe, maybe not. It could be that many people already couldn’t write well, and that these new media are simply putting their limitations on display. Perhaps it will prove beneficial to bring the subject out into the open.

If Hemingway became a master of brevity by sending telegrams, then why can’t we use these new modes of communication to become more effective writers? If we can no longer rely on context and nuance, we may be forced to actually say what we mean. In Jennifer Egan’s gorgeous and inventive new novel, A Visit From the Goon Squad, two characters find themselves exhausted during a conversation gone awry. The woman, Lulu, says in explanation, “…All we’ve got are metaphors, and they’re never exactly right. You can’t ever just Say. The. Thing.” She then asks, “Can I just T you?” and they continue the conversation, much more smoothly, via text message across the table from each other.

The brilliant thing is, Egan doesn’t seem to make much of a judgment about it; it’s simply the evolution of communication. Any linguistics class will teach you that language constantly evolves, and I’m happy to not be speaking Old English today, or sending telegrams for that matter. Nothing can ever replace true human connection and communication for many purposes, but perhaps through e-mails, texts, tweets, and their more sophisticated successors, language will evolve, and we will find new ways of telling each other what we really mean.—Roya Khatiblou, MA

Editors’ Eyes

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The dialog box in Word suggests unironically that I should consider changing antidiabetic to ant diabetic. Is there a hyperglycemic epidemic in the insect population that I missed hearing about?

Spell-check can be a useful tool that improves the quality and readability of content. But as editors and readers know all too well, spell-check can be dangerous if wielded indiscriminately. Instead of making the role of a human editor obsolete, spell-check has only underscored the need for such professionals.

Several papers submitted to JAMA recently proved this point. I usually run spell-check after I complete my editing in case I missed something. In addition to the diabetic ants, Word suggested the following: change metformin to motormen, pertussis to peruses, autonomously to gluttonously, and PDF to puff.

I politely declined all these fine suggestions but was grateful when Word spotted terible that should have been tertile. What a difference a word makes.

Over time spell-check has become more useful because I regularly add words to my locally stored dictionary (“Add to Dictionary” in the dialog box). In addition, Dorland’s offers a medical spell-checker that can be integrated directly into Word and Stedman’s offers a medical spell-checker as well

Despite these useful add-ons, I still like to read articles word-for-word, when time permits, and not rely solely on technology to prevent errors. The ants, I’m afraid, are beyond my expertise.—Stacy L. Christiansen, MA

How Am I? I’m Good. Um, I’m Well … No, Wait: I Feel Good. I’m Doing Well.

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The Oxford English Dictionary (second edition, 1989) devotes a remarkable 7 and 9 pages, respectively, to good and well (in a mixture of 7- and 9-point type). Good and well are not synonyms, but their myriad meanings, interpretations, combinations, and usages are often similar, and thus each has the potential to be used incorrectly, if inadvertently. This post addresses good and well when describing the state of being of something or someone.

In this context, good is an adjective (modifies only nouns):

The researcher has a good idea [modifies a noun].

Her idea is good [modifies a noun and uses a linking verb that expresses a state of being, eg, to be, to seem, to appear].

Well is an adverb (can modify verbs, adjectives, or other adverbs). As an adjective, well can also be used as an adjective to mean “in good health.”

The patient did well [scored well, performed well] on the Mini-Mental State Examination.

The patient spoke well of her physician.

The patient articulated her concerns well.

The patient does not feel well.

Well may also be used to mean good health in its combined form: a well-baby checkup.

But: A usage note in Webster’s1 points out that “An old notion that it is wrong to say ‘I feel good’ in reference to health still occas. [occasionally] appears in print. The origins of this notion are obscure, but they seem to combine someone’s idea that good should be reserved to describe virtue and uncertainty about whether an adverb or an adjective should follow feel. Today nearly everyone agrees that both good and well can be predicate adjectives after feel. Both are used to express good health, but good may connote good spirits in addition to good health.” Moreover, Webster’s reports, “Adverbial good is primarily a spoken form; in writing it occurs in reported and fictional speech and in generally familiar or informal contexts.”

As a general rule of thumb: Things are good. One does things well.

Be well. And be good. —Roxanne K. Young, ELS

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

Questions From Users of the Manual

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Q:    When a bulleted list is introduced by a brief comment, eg, “The principal signs and symptoms of rheumatoid arthritis are as follows,” and all of the items in the bulleted list are from the same source, does a citation need to be placed at the end of each bulleted item or is it sufficient to place the citation at the end of the brief introductory comment?

A:    We would recommend placing the citation within the text that introduces the bulleted list if all the items in the list came from the same source.  If the items came from multiple sources, then placing the appropriate citation at the end of each item would be necessary.

Q:    In this example, would you hyphenate “well child”?

  • He was taken for a well-child [or well child] checkup.

A:    Yes, we would hyphenate in this case.

Q:    The Manual says nothing about how to treat reference citations in the abstract.  Should such citations simply be deleted from the abstract and from the reference list or should complete bibliographic details about the reference be inserted in the abstract parenthetically?

A:    You are quite right that the Manual does not mention how to treat references in the abstract as we never include reference citations (either as superscript numbers or within parentheses in the text) in the abstract (see 2.3, fourth bullet, re not citing references in an abstract).  If an author has included references in an abstract, it doesn’t seem advisable to delete the references altogether.  Discuss with the author trying to include the references early on in the manuscript itself.  It seems unlikely that an author would consider a reference important enough to include in the abstract and then not cite it in the text.

Q:   I don’t see anything in the Manual about how to style “e-mail,” ie, with or without a hyphen.  Help, please.

A:   Although the Manual doesn’t specifically address this point, it does include guidance on capping (see 10.7) and, in that section, it’s clear that the Manual recommends a hyphen in “e-mail.”  If you use the Manual online, for questions like this the “quick search” box is invaluable.  Just type the term you are looking for into the search box and the results should guide you.  If you had begun with “email,” you would have gotten no results, which would—I hope—have tipped you off to try “e-mail,” which produces 3 pages of results.—Cheryl Iverson, MA

Discomfit, Discomfort, Disconcert

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These words are commonly confused, perhaps because they begin with the same four letters and sound similar to boot. Moreover, they now have similar meanings thematically related to the original meaning of discomfit. How necessary is it to distinguish between them?

Discomfit was first on the scene (early 1200s1) and originally was used in the sense of “to defeat in battle.”2 The related form discomfiture, meaning “complete disconcertment or putting to confusion”1—a sense clearly related thematically to the original sense—appeared little more than a century later.

Discomfort also appeared slightly later (late 1300s1) and originally was used in the sense of “Undoing or a loss of courage; discouragement, disheartening.” In a related vein, discomfort also was used at roughly the same time to indicate “Absence or deprivation of comfort or gladness, desolation, distress, grief, sorrow, annoyance.”1 Both of these uses are now largely obsolete, although the word is still often used in a somewhat weaker sense to indicate one’s feeling mildly uncomfortable, either physically or emotionally.1,2

Disconcert was the late bloomer, not bandied about until the late 1600s,1 when it was used in the sense of “To throw into confusion, disarrange, derange, spoil, frustrate”1—again, a meaning clearly thematically linked to defeat in battle. The word is still often used, albeit in a weaker sense, ie, “to disturb the composure of.”2

The upshot? Purists will advocate maintaining the distinction between discomfit and discomfort, using the former only in its original sense of indicating defeat in battle.3 However, as is so often the case, usage is becoming more permissive, and while purists certainly will cringe at the thought, the interchangeable use of these words is gaining increased acceptance. Nevertheless, a few distinctions are worth preserving:

● Discomfit, while occasionally still used in the sense of “to frustrate or thwart,” is currently most often used to indicate mental, rather than physical, states, specifically in the sense of one’s being perplexed or embarrassed—ie, disconcerted. However, its use as either a verb or an adjective now seems stilted or pretentious. For example, Edmund Crispin’s “Widger was not wholly without Schadenfreude at seeing his informative colleague discomfited for once”4 conjures images of Niles and Frasier Crane slouching about in Harris Tweed, sipping sherry and exchanging witty asides. Most speakers will use disconcerted or, finding even disconcerted a tad too uppity, will simply use embarrassed.

● Discomfort is most often used to indicate one’s feeling physically or emotionally uncomfortable, resulting either from the efforts of others or from personal excess: “The excitement produced by the cigar is followed by a feeling of discomfort.”1

● Disconcert, indicating perplexity or disturbed composure, is still occasionally used as a verb but currently is used much more frequently as an adjective, eg, “I find all this very disconcerting.”—Phil Sefton, ELS

1. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:443.

2. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:356.

3. The pedant: comfit and cloy. The Times Web site. http://women.timesonline.co.uk/tol/life_and_style/women/the_way_we_live/article6953527.ece. December 12, 2009. Accessed May 12, 2011.

4. Discomfit. Answers.com Web site. http://www.answers.com/topic/discomfit. Accessed May 12, 2011.

Mistakes Were Made

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The January-March 2011 issue of Science Editor is devoted to the theme of correcting the scientific literature, something that happens to our journals on a regular basis. In 2011 alone, we’ve already logged more than 70 corrections. With the advent of rushing to get everything online as soon as possible, sometimes it seems like we are doing more corrections than ever. Or maybe it just feels that way because with online articles, we can go in and fix that darn typo rather than just let it be. Hard to say.

You can check out the post about it at the Science Editor Editor’s Blog, and (if you are a Council of Science Editors member) read the whole thing at the CSE site. Also, feel free to leave a comment and let us know how your publication handles corrections in print and online.—Lauren Fischer

Who Was That Masked Manual?

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No one wants to be a don’t, a fashion faux pas splashed in full color across the page of a widely circulated fashion magazine. In an attempt to protect the identity of the don’t, one such periodical places black bars over the eyes of each fashion offender. Is this technique sufficient to spare the person the potential humiliation and ridicule that may follow? The AMA Manual of Style offers a resounding no.

Reports of medical cases and research can be greatly enhanced by a photographic or illustrative example of the condition under discussion. Imagine reading a case report of a unique rash with no accompanying photograph, or an article about a newly developed surgical technique without before-and-after images or an illustration of the surgeon’s approach. A picture, it is often said, is worth a thousand words (see 7.5.4, Clichés).

Medical journals have a responsibility to protect patients’ rights to privacy and anonymity, including the deletion of patients’ names, initials, and assigned numbers from case reports; the removal of identifying information from radiographs, digital images, and laboratory slides; and the deletion of identifying details from descriptions of patients or study participants in published articles (see 5.8.2, Patients’ Rights to Privacy and Anonymity).

Until the late 1980s, placing black bars over the eyes of patients in photographs was accepted as a way to protect their identities. However, some journals began to discontinue this practice when it became apparent that bars across the eyes do not preserve confidentiality (see 5.8.2, Patients’ Rights to Privacy and Anonymity). The Uniform Requirements for Manuscripts Submitted to Biomedical Journals concurs, noting that “masking the eye region in photographs of patients is inadequate protection of anonymity.”1

When detailed descriptions, photographs, or videos of faces or identifiable body parts are included with a manuscript that might permit any patient to be identified (even if only by the patient himself or herself), authors should obtain written permission from the identifiable patients (or legally authorized representatives) to publish the information. An example of the patient permission form used by JAMA and the Archives Journals is available at http://pubs.ama-assn.org/misc/patientconsent.pdf. The journal may wish to state (eg, in the Acknowledgment) that the patient shown and/or described has provided written permission.

If such permission cannot be obtained, another approach the journal might take is to remove nonessential potentially identifying details. For example, a patient described as a “20-year-old woman from suburban St Louis with end-stage renal disease undergoing dialysis” could be rewritten as a “young adult woman with end-stage renal disease undergoing dialysis.”

However, altering descriptive characteristics (eg, sex) is not appropriate because it is a form of falsification and may be misunderstood by readers and others conducting secondary analyses of published reports. The best way to provide complete information while protecting patient rights is to obtain informed consent for publication. Informed consent for this purpose requires that an identifiable patient be shown the manuscript to be published or waive his/her right to review the paper.1

To protect patients and to spare potential legal woes, medical journals should not use black bars on photographs in the attempt to preserve confidentiality. The image should be replaced with one that has permission for publication or one in which identifiability is not an issue, or the article should run sans photograph.—Stacy L. Christiansen, MA

1. Uniform Requirements for Manuscripts Submitted to Biomedical Journals: ethical considerations in the conduct and reporting of research: privacy and confidentiality—patients and study participants. http://www.icmje.org/ethical_5privacy.html. Accessed May 9, 2011.

Quiz Bowl: Units of Measure

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Welcome, participants, to the AMA Manual of Style Quiz Bowl. Every month at http://www.amamanualofstyle.com/, we offer subscribers a quiz on different aspects of the manual that help participants master AMA style and improve their editing skills. Previous quizzes have covered topics as varied as correct and preferred usage, genetics, tables, figures, and ethics, as well as numerous other subjects. In this blog, we will offer a sample question from each month’s quiz to whet your appetite. This month’s quiz is on Units of Measure: Format, Style, and Punctuation. So, here goes.

Edit the following sentence based on your understanding of section 18.3 of the AMA Manual of Style.

A total of 50 mg of etanercept were administered subcutaneously twice weekly for 12 weeks.

Well, how did you do? Did you identify the problem? Here’s the answer (use your mouse to highlight the text box):

A total of 50 mg of etanercept was administered subcutaneously twice weekly for 12 weeks.

Units of measure are treated as collective singular (not plural) nouns and require a singular verb (§18.3.3, Subject-Verb Agreement, p 791 in print).

So, did you enjoy this tidbit? If you are not sated, subscribe to the AMA Manual of Style online and take the full quiz.—Laura King, MA, ELS

Are You Nauseous or Nauseated?

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Writers and editors rushing to meet deadlines know the feeling. The effects of stress, a few too many cups of coffee, and perhaps a candy bar or bag of chips in place of a meal can conspire to make the most steely-nerved wordsmith feel a tad nauseated. Or is it nauseous? And what of that stress, that coffee, that ill-chosen meal replacement—are its effects nauseating or nauseous?

Grammarians with more prescriptive leanings (ie, those concerned with language as it “should” be used, which presumably would include most writers and editors) would say that a person feels nauseated and that which has made him or her feel that way is nauseous. Those with more descriptive leanings (those concerned with language as it is actually used, which includes professional linguists as well as armchair observers of language) are eager to point out that while nauseated is still more often used to mean feeling the effects of nausea, the use of nauseous in that subjective sense is rapidly gaining acceptance. Similarly, while nauseous is still more often used to mean causing nausea, the use of nauseating in that causative sense will soon be more prevalent, if it is not already. Debates on the merits of prescriptive vs descriptive use of these terms can be quite heated, and current dictionaries and usage guides often attempt to walk a line between the two camps—which, considering the potential for rancor, is probably not a bad idea, particularly taking into account the ever-evolving nature of language as well as the history of these terms.

So first, a little history. Despite the pronouncements of some prescriptive grammarians promoting the idea that nauseous, when used to mean “feeling the effects of nausea,” is yet another example of a weed newly sprung up in the garden of educated usage, it appears that the term was used in that sense as early as 1604. What is more, it was likely not used to mean “causing nausea” until 1612 or later. At some point, the rule was set forth dictating that nauseous should be used to indicate causing nausea and nauseated to indicate the subjective feeling of nausea—a rule that for the most part held sway until the mid-20th century, when nauseous once again began to be used by persons describing how they feel.

Nauseous, then, when used to describe the feeling of nausea, is something of a grammatical atavism, a throwback to an earlier usage that seems to have fallen into disfavor in the intervening centuries. The term has regained its original meaning in a few generations, a resurrection only accelerated by today’s fast-paced media mix. For example, when comedian Mike Myers’ Saturday Night Live character, Linda Richman, claimed that something “makes me nauseous” (always pronounced as two syllables, with the slightest of pauses when pronouncing the first: “naaw′ shus”), the use of the term in that sense gathered steam in short order, gaining an ever-widening circulation as viewers of the program used it in conversation and e-mails; it likely now lives a healthy and happy life in the various social networking media. Other related terms from the 17th century—nauseation, nauseative, nauseity, nausity—are now obsolete or used very rarely, but for now nauseous as used to describe the subjective state of nausea seems here to stay.

So how does all of this pan out for the person seeking guidance on the use of nauseous, nauseated, and nauseating? As is often the case, an answer—very seldom is there such a thing as the answer—lies in the ever-shifting borders between the spoken and the written word. Whereas the use of nauseous in the subjective sense when speaking now seems a given, nauseated is still holding its own in text. Conversely, the use of nauseous to indicate the cause of nausea is rapidly falling into disuse in spoken conversation (and when it is used, it is sometimes confused with noxious), whereas it maintains only a rapidly diminishing tenuous lead over nauseating in text.

Accordingly, JAMA and the Archives Journals very seldom use nauseous in the causative sense and not at all in the subjective sense (unless part of quoted material); nauseating is used for the former and nauseated for the latter, at least until the dust has settled on another generation or two of language evolution. In the meantime, writers and editors rushing to meet deadlines are encouraged to take steps to eliminate or reduce stress, consume coffee in moderation, and make prudent dietary choices if skipping meals. — Phil Sefton, ELS