Author: amastyleinsider

A Blueprint for Science Editing

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As a high school student, I stumbled across A Blueprint for Teen-Age Living in a recessed shelf of the library. The book was older than I was with a spine unbroken. Despite these red flags, I believed this William C. Menninger author might have some wisdom for the ages.

The breezy illustrations failed to track against the daily dramas unfolding around me in those years, and its advice did not seem to be applicable to peers. No one else was consulting a book on how to behave. One of the 7 signs of maturity was the ability “to deal constructively with reality.” Real life never arranges itself as in a guide to behavior, so to deal with reality, I began to disregard the Blueprint advice. Let’s just say that A Blueprint did not open any doors.

Happily, as a manuscript editor, I have access to guidebooks that not only open doors but also resolve questions. With the impending arrival of the AMA Manual of Style 11th edition comes the opportunity to take a brief peek at the first edition, which is of about the same vintage as that guide for teenagers.

A reasonable facsimile.

The typeface on the cover is, like the illustrations in A Blueprint, deceptively breezy. The book gets down to business. Even a quick look shows that the book arranged itself according to the real life of an editor. Written by director John H. Talbott, MD, for the Scientific Publications Division, this 70-page Style Book was produced in 1962 for an in-house audience. Stapled with a green cover, it has the look and weight of a fundraising cookbook from church. The Foreword (spelled “Foreward,” a potential mash-up of “foreword” and “forward”) indicates that numerous blank spaces appear on pages for additions the user may wish to enter. How thoughtful, but the version in hand must be a facsimile edition because all pages are jam-packed with scant space for additions.

The Style Book consists of 25 sections, mostly about the conventions of punctuation, with excursions into italics, laboratory values presented as cc instead of mL, drug names, and proofreader’s marks (perhaps the most constant of all sections). The Style Book shouts. CORRECT USAGE. INTERROGATION MARKS. FOOTNOTES. What became of the cover’s breeziness? The CORRECT USAGE section 9 lists “lipid: noun” and “lipoid: adjective,” and “mucous: adjective” and “mucus: noun.” These distinctions have evaporated over the years. In contrast, Section 9.16 advises for “over”: “‘more than’ preferred when numbers are used,” which appears to be an eternal directive.

The current manual directs us not to use a colon if a sentence is continuous without it. No such ruling appears in the first edition, which mentions colons as an indication of an explanation or enumeration to follow, as an introduction to a formal direct quotation, or to separate numbers in time of day, biblical references, and parts of numeric ratios. The book does use colons even when the sentence would be continuous without. In at least one place, the verb “are” is followed by a colon then its predicate nominative string.

One change that won’t surprise those of us in house is the guidance about numbers. NUMBERS 16.00 indicates “In the text all numbers from one through ten should be spelled out.” Current style is to use numbers, which still surprises many authors who return proofs with the instruction to spell out numbers. Another minor change is in capitalization after a colon. CAPITALIZATION 4.00 directs that the first word after a colon in a reference gets capitalized. Now the opposite is true.

In current Common Usage, “utilized” is not preferred because “use” is concise. The Style Book has plentiful examples of “used,” but “utilized “makes at least 1 surreptitious appearance.

It may sound odd to personify a book, but the Style Book has become surer of itself in the last 58 years. I believe it must have gone through the 7 signs of maturity. The original Foreword claims that “Few of the rules contained in this book are inviolable” and that the book “is not to be static,” modest claims presented with a certain authority, not to mention an admirable realism. The current Foreword focuses on the need for communicative writing and the manual’s standing as a more extensive and comprehensive manual than earlier editions.

The upcoming Foreword characterizes the manual as indispensable for medical journalism and communication, which embodies being “not static.” The new manual is 17 times the size of the 1962 edition, whose Foreword also presented the optimistic expectation of a new edition every year. Unlike A Blueprint, the community of users was accurately assessed. I imagine that even in 1962, people who consulted the Style Book felt like part of a community centered around this makeshift blueprint for science editing. Now the community of users extends around the globe. The AMA Manual of Style also opens doors, not just for editors but also for conversations between editors and authors.–Timothy Gray

The Devil’s in the (Formatting) Details

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When I was completing my thesis during graduate school, one of my most frustrated moments came right at the end of the process while preparing my final manuscript for submission. The school required thesis manuscripts to have a uniform title page, with all the information sized and spaced just so. They provided a template to work from, but somehow, when I converted my finished file to a PDF, one of the signature lines for my advisor’s name kept coming out a fraction of a centimeter too short.

This seemingly simple issue—which ultimately turned out to be a problem with an outdated PDF viewer on an administrative assistant’s computer—required multiple rounds of emails between myself, my department head, and the graduate school office, and at one point led to me crouching over a physical copy of the page with a ruler the day before the final deadline, begging the thesis gods for mercy.

I understood the need for a correctly formatted title page, but it was frustrating having to spend so much time on such a small problem after pouring months of hard work into my thesis. So when a recent study by LeBlanc et al in PLOS One found that authors of research articles reported spending a median 14 hours on formatting their manuscript for publication in a peer-reviewed journal, I was surprised, but not without sympathy.

As an editor, I’m often communicating with authors to resolve relatively small questions about style and format: is the header in this table really meant to cover both of these columns? This figure looks good, but can you resend it in a different file format? When you gave this value as 48.5% in the Methods but 48.45% in the Table, was it inconsistent rounding, or is this a different result?

The Instructions for Authors for JAMA Network’s journals (not to mention the AMA Manual of Style) offer guidance on many of these formatting points, from how to format tables and figures to how to present numbers for certain types of data. It may feel overwhelming or frustrating to authors on top of all the work required to write up their study to have to go through all those seemingly small details before their article has even been accepted. But there is a reason these formatting instructions are given to authors before submission.

Chapter 2 of the AMA Manual of Style focuses on manuscript preparation, and the chapter’s introduction makes the point that properly preparing a manuscript according to journal requirements “may enhance the chances of acceptance and expedite publication.” Just like decent grammar and correct spelling allow a reader to focus on a writer’s message without distraction, a cleanly formatted article makes it easier for editors and reviewers to focus on the content of the work and more quickly ensure that certain required elements are present.

And, of course, formatting requirements are ultimately set with the scientific content in mind, with the goal of ensuring all methods, data, and findings are presented clearly, correctly, and unambiguously. For authors wanting to better understand what goes into a properly formatted article (and for some insight into the why behind certain style and formatting requirements), chapter 2 of the style manual is a valuable reference.

The PLOS One article by LeBlanc et al recently made the rounds in some of the online editing circles I follow, and one commonly raised question was how much unnecessary time authors may be spending following out-of-date instructions. With most publications now having their instructions and submission processes moved online—making them able to update their guidelines more efficiently—I wouldn’t imagine this to be a common risk. For example, the JAMA Network journals have their Instructions for Authors updated regularly to reflect any changes in style or procedure and to correct any inconsistencies that may pop up. There’s a “Last Updated” date posted at the bottom of the instructions page so authors can be sure they’re working with the most recent version.

I would also encourage authors to remember that if they do have a question about formatting or something in the instructions for authors, they can feel welcome to email that question to the journal. Someone in the journal office may be able to provide guidance that will help clarify the process. It’s also possible that a question may lead to the correction of an inconsistency in the instructions, which can make things that much easier for other authors down the road.

And as a final tip, to speak from personal experience: it never hurts to make sure your PDF viewer and other programs are all updated.–Kirby Snell

Resources for References

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Sometimes editing requires a little detective work, especially when the manuscript you’re working on has several incomplete references. You could query the author for the missing information, but with minimal time and effort, you may be able to the find the information you need using 2 free resources: PubMed and Worldcat. Both of these resources have extensive features, and editors can use the basic search interface to find missing reference information.

PubMed is an essential resource for medical editing—I use it nearly every day. If you need to fact-check data from a published journal article or online book, find an abstract for background information on a study cohort, or search for a missing volume or issue number for a journal reference, PubMed is the tool for the job. Let’s use it to find the missing volume and last page of the article in this reference:

Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care. CA: a Cancer Journal for Clinicians. 2018;_(5):356.

We’ll start by typing in the author names in the PubMed search field and hitting enter.

Let’s see what we get!

Voila! Now we have the complete reference, and we can even update the journal title. As an added bonus, the full-text article is available with a click of a button on this page. If I need to do any fact-checking, I can access the article directly from PubMed.

That was quick and easy, but PubMed doesn’t index print books. No problem! Worldcat, the world’s largest library catalog, is another free resource that editors can use to find missing publication information. Worldcat allows you to search the collections of libraries around the world; it’s a great resource for materials published in languages other than English. I primarily use it to find chapter titles and publication information for print books. Let’s give it a try with this incomplete reference:

Erinnerungen, Träume, Gedanken von C.G. Jung 1961; Carl Gustav Jung and Aniela Jaffé.

Although I’m almost certain that this is a reference for a book, I’m going to select the “Everything” tab in the Worldcat search field to capture all of the potential results.

This yields 130 results, but in this case, the first result is a close match for the title and authors. The year doesn’t match the information in the incomplete reference, but if we click the “View all editions” link underneath the reference, we can narrow the results even further.

This is what we get:

This looks like a good match! The title and authors match those listed in the incomplete reference. The year doesn’t quite match, but it’s close. I can now ask the author to confirm the complete reference.

Searching for complete publication information for journal articles and books is quick and simple with PubMed and Worldcat. Although these free databases offer many more features, I use the basic search feature most often. Give them a try, and, of course, always check with the author to confirm that the information that you have is correct.–Juliet Orellana

102 Things Journal Publishers Do

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I recently came across an interesting post on The Scholarly Kitchen titled Focusing on Value — 102 Things Journal Publishers Do. Originally posted in 2012, it’s been updated every couple years as journal publishing changes and becomes more complex. Working at JAMA Network, I’ve been amazed at the breadth of skills needed to publish our array of journals. As a copyeditor, I only experience a narrow part of the publishing process, so I appreciate the overview and seeing how all the pieces fit together.-Heather Green

How Many Is They?

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Since I’ve been a manuscript editor, JAMA Network journals have published a few articles about health care for transgender patients. I’ve had the good luck to edit a few—they are always interesting—but this week, I realized that there is a grammatical issue in editing these articles that I have never heard fully addressed.

The issue is not what pronouns to use for transgender individuals—that question is well-known. Because the English language uses gendered pronouns, people who change their gender expression or whose gender isn’t accurately defined by labels are faced with several choices: should they go by she, he, a singular they, or a neologism, such as xe?

The news media has addressed this, including The New York Times articles in 2016 and 2017, with another written by transgender English professor Jennifer Finney Boylan in 2018. These articles often make the same points: that people can get confused by this transformation of language, but that people who want to use pronouns that reflect a gender different from their assigned sex should have their wishes respected. This squares with the approach used in JAMA Network journals.

But it also raises a question rarely addressed: what about verb conjugation? In the present tense, English applies a letter s to the third-person singular (he, she, or it runs) but not to the first-person singular, first-person plural, second-person singular, and third-person plural (I, we, you, and they run). So, if an article uses a singular they, should it be conjugated like the third-person plural (run) or like the third-person singular (runs)?

While editing, I have realized that the default method of using the singular they along with someone’s name (or a descriptor, such as the patient) involves flip-flopping between singular and plural verb conjugations (eg, “The patient is receiving gender-affirming treatment, and they are pleased with the outcome thus far”). A consistent use of the singular they would seem to require using third-person singular conjugations throughout (“The patient is receiving treatment…. They is pleased…”) or plural conjugations throughout (“The patient are receiving treatment…. They are pleased….”). Is either approach correct?

The public discourse on pronouns has not provided much insight. It has prompted the argument that we all use forms of singular they-series pronouns in casual language, in sentences such as “If someone wants gender-affirming treatment, that is their choice” or “Give them an injection.”

But that is distinct from the current issue. In these usages, the pronoun is usually objective (them) or possessive (their or theirs), and the verb is conjugated in the third-person singular alongside another subject. (In the example sentences, these are “someone” and “that,” and in the command, an unspoken “you.”) When the singular they is placed immediately before the verb, the question of conjugation instantly reappears.

Weighing “they run” vs “they runs,” I looked for guidance in the AMA Manual of Style. It offered a few relevant thoughts: “In an effort to avoid both sex-specific pronouns and awkward sentence structure, some writers use plural pronouns with singular indefinite antecedents… Editors of JAMA and the Archives Journals prefer that agreement in number be maintained in formal scientific writing.”

But that seemed short of clear instructions. Still uncertain if constructions like “they is pleased” would please anyone, I reached out to Jennifer Finney Boylan, the New York Times contributor whose article on pronouns was published in 2018.

A quick email to her university address got an equally quick response. “I’m not certain about this,” she wrote. “I want to endorse ‘they is’ because the non-specific pronoun is still referring to a singular individual. On the other hand, ‘they are’ sounds better to my old, English professor ears.”

That seemed similar to how our society is handling the matter. On her authority, I decided to stick with conjugations that shift from singular to plural and let the matter rest until a thoughtful body of grammarians, popular opinion, and perhaps the next edition of the New York Times’ article series on pronouns weigh in with a definitive answer to conjugating verbs after a singular they.—M. Sophia Newman

Follow Instructions!

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It was my first day of high school, and the bell had just rung announcing first period. There I sat in Mrs Ruth’s earth science class at a desk on the opposite side of the room from the blackboard, but not so far away, I hoped, that it was obvious I was trying to make myself invisible among the other wide-eyed freshmen. The desks were arranged in clumps, and as Mrs Ruth introduced herself, she stopped at each one, licking her thumb and counting out worksheets.

“Read the instructions,” Mrs Ruth said, “and then complete the worksheet. It shouldn’t take you more than 2 minutes.”

Two minutes?! I thought. A list of bullet points ran the length of the page. I looked to see if anyone else was feeling similarly overwhelmed, but my new classmates were already scribbling away as fast as they could, so I followed their lead. Per Mrs Ruth’s directions, I read the instructions—“Write your name neatly in the top right-hand corner, and read every question before answering any.”—and moved on to the first bullet point.

  • How many sides does a triangle have?

Three, duh. I scrawled the answer. The second bullet point told me to, from memory, list as many dinosaurs as I could. The class was quiet except for pencils dutifully scratching answers. These questions were a breeze. Maybe this worksheet would only take 2 minutes after all.

  • What is the capital of Ohio?

Columbus!

  • What is Will Smith’s character’s name on The Fresh Prince of Bel-Air?

Will Smith—he plays himself!

And before I knew it, I reached the last bullet point, which, surprisingly, wasn’t a question at all.

  • Do not answer any of the previous questions. Make sure your name is written neatly, and hand in a blank worksheet.

Groans rippled across the room as other students arrived at the last bullet point. When all our pencils were down and our cheeks were red with embarrassment, Mrs Ruth asked who’d read the instructions. Of course, we all raised our hands. But Mrs Ruth corrected us: no, we hadn’t. Reading the instructions meant more than glancing the words. It meant understanding and acting on them; if we’d written anything on the page other than our names, we’d already failed our first high school assignment.

The AMA Manual of Style is, at its core, a gigantic set of instructions, and on top of the style guide, the websites for JAMA and the journals comprising the JAMA Network each contain links to lengthy Instructions for Authors that explain everything from how manuscripts should be formatted to the number of tables, figures, references, words, etc, individual article types allow. A large part of the job of a manuscript editor is to make sure articles follow the instructions they’re supposed to in preparation for publication, and on a surprising number of occasions, I’ve worked with authors who have argued or rejected fundamental style points or have ignored instructions on the website specific to the journal that’s publishing their research. The instructions aren’t arbitrary, and the AMA Manual of Style exists to help ensure the reporting of research and data is rigorous, lucid, and consistent.

I think back to Mrs Ruth and my first day of high school often: if you don’t read, understand, and follow the instructions, you’ve failed before you’ve even begun.—Suzanne Walker

Unconfusing “The Confusables”

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I was recently gifted a copy of Dreyer’s English: An Utterly Correct Guide to Clarity and Style, a book by Random House Copy Chief Benjamin Dreyer. It is one of the latest in a line of modern guides on editing and writing that shed the stuffiness usually associated with language and instead take on the subject with wit and humor.

Amid references to pop culture and classic literature, tips on spelling and punctuation, and even a relatable confession that the rules of grammar aren’t always  interesting (sorry, linguistics enthusiasts), there is a chapter called “The Confusables.” Confusables are homonyms, synonyms, similarly spelled words, words with comparable meaning — a word you thought you meant but did not. As Dreyer puts it, “Spellcheck is a marvelous invention, but it can’t stop you from using the wrong word when the wrong word you’ve used is a word (but the wrong word).”

He’s right. Spellcheck and software like Grammarly are useful, but they don’t perform the same function as an editor. This can feel hard to explain to businesses looking for a way to cut costs. Copy editors are increasingly difficult to find in newsrooms, advertising agencies, and other companies that decide to leave writers to edit their own copy. But, like with many of the finer points of editing, confusables are hard to detect, and a keen, well-trained eye is needed to spot them. (Not to mention it feels pretty darn satisfying to catch one.)

Dreyer includes a list of common confusables in his book. Here are a few I have seen recently:

Affect/effect

This is one of the more common pairs of confusables. There are some subtler differences between the 2 words, but most of the time the RAVEN rule (Remember, Affect is a Verb, and Effect is a Noun) will get you by.

Casual/causal

In medical and scientific editing, we frequently discuss the use of causal language in studies (ie, the inference that there is a relationship between variables).  Casual language might be used to describe a relationship with friends. A misuse of either of these words might be easy to read over because they are very close in spelling, but they are very different in meaning.

Discreet/discrete

To be discreet means to be prudent, while discrete means separate or distinct. I used to have a hard time differentiating these 2 words until a fellow editor shared her mnemonic device that the t between the e’s of discrete keeps them separate from each other.

Intermediate/intermittent

These confusables, though different in definition, have some crossover in usage. Intermediate means in the middle, while intermittent means in intervals. So, sure, a solution could be mixed using either intermediate or intermittent shaking. But how does one quantify an intermediate shake? It’s likely intermittent is meant in this situation, but if something isn’t completely clear, it’s always best to ask the author to clarify.

Peak/peek

This pair is tricky because writers might think of the oft-combined “sneak peek” and want to use the ea spelling for both. However, peak refers to a high point, such as the peak concentration of a drug, and peek means to look. The way I keep these straight is associating the ee of peek with the ee of peer or the 2 e’s in eye.

Rational/rationale

These 2 words have similar spelling and meaning, with only one letter setting them apart. However, rational means to be reasonable while rationale is the reason behind said reasonableness.—Jamie Scott

Talk to Me

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Imagine this scenario: it’s 4:30 pm on a Friday, you’ve been stalking your Outlook account for 7 straight hours, your deadline is coming up fast, and STILL the corresponding author of the article you’ve been working on for the whole week hasn’t gotten in touch via email or phone or passenger pigeon to answer your one SIMPLE QUERY that you probably already know the answer to but for the sake of best practices have to receive from them.

So with the prospect of being late for a much-needed end-of-the-week happy hour hanging over you, you consider your options. Do you ring for reinforcements? Do you call in the cavalry?

Sound familiar?

Communicating with authors is one of the most important and challenging parts of being a manuscript editor. There might be an impulse to jump to stereotypes about physicians when speculating why an author isn’t getting back to you (eg, Mr/Ms Ivory Tower can’t stoop to take time from being important and well-known to speak to Plebeian You) but the truth is that there are myriad reasons why authors can fall behind on their communication. While nobody wants to be the jerk who is insensitive to a busy schedule with patients, family emergencies, or a vigilant spam folder, you also have a job to do. If your work performance is at least partially based on meeting deadlines, you may want to consider one or a few of the following strategies to encourage a response.

1. Round up the gang. If a corresponding author isn’t responding to you in a timely way, you may want to reach out to some of the article’s other authors to enlist their help. You could do this in a simple, relatively nonconfrontational way by copying them on correspondence you share with the corresponding author, or you can give them a quick call. This may give you an uncomfortable feeling that you are tattling on the author (I’m not sure what the editorial version of “snitches get stitches” is–maybe “nerds get words”?), but remember that they also have a professional obligation to you. By reaching out you may be giving them an opportunity to re-delegate responsibilities in light of things going on behind the scenes.

2. Phone a friend. Manuscript editors are often only dealing with articles after they’ve been accepted, but it is likely that the authors have talked to multiple people affiliated with the journal along the article’s journey toward publication. If your journal has an editorial office that has shared correspondence with the author or somebody who worked with them during the peer review process, reaching out to them to ask if they can contact the author might yield a result. Some people are more comfortable communicating with people they’ve already dealt with, and a roundabout way of getting the information you need is a better alternative than radio silence.

3. Appeal to a higher power. In a perfect world titles wouldn’t matter, but let’s be real: they do. If the lack of author communication has gotten to the level where it is seriously gumming up the works, and if you can assess that it’s worthy of your supervisor’s time, escalating the situation upward might be your best option. It is truly astonishing how the words “Executive” and “Senior” can expedite a response!

4. Deploy the Shame Lady from Game of Thrones.

(Just kidding.)

So the next time you find yourself with a failure to communicate, don’t despair and whimper “Why won’t you talk to me?” to the computer screen—consider using one of these strategies to get the conversation rolling, the deadline met, and yourself to happy hour.—Amanda Ehrhardt

Race and Ethnicity

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One of my favorite chapters in the AMA Manual of Style is about inclusive language, particularly the section about race/ethnicity (11.10.2). Race/ethnicity is a complicated topic because these categories have cultural and biological implications. In scientific research, it is important to specify race/ethnicity of study participants to understand the generalizability of the results. AMA Style instructs authors to indicate who classified the race/ethnicity of study participants (ie, the investigator or the participant).

Recently, I edited a research article with a table of participant characteristics that listed race/ethnicity as white, black/African American, Asian, and other. AMA Style notes that Asian and Asian American are not equivalent or interchangeable and that authors can be queried to clarify. All participants in this study were from the United States, so I asked the author about using Asian American instead of Asian. The author declined the edit, so Asian it stayed.

The editor in me shrugged it off. Editing is meant to serve authors and their research, and unless something is inaccurate, I have no problem reverting to the author’s original wording. After all, even the CDC website uses Asian and Asian American interchangeably.

The noneditor side of me, though—the child of immigrants who grew up in the United States and spent childhood summers in Hong Kong and Taiwan—was frustrated. I have been told I’m either not Asian enough or not American enough, and I try to explain that I’m both. I’m Asian American.

(As a sidebar, I also want to point out that black/African American presents its own problems. Many researchers do include non-Hispanic black, but where does that leave Afro-Latinx? This could be a whole other blog post.)

Of course, I understand that it may be exhausting to list out all the racial/ethnic groups in a table, especially considering page limits. I do appreciate when authors list more specific racial/ethnic groups, even if for many of them, n = 0. Any type of representation is a big step. However, I’ve also seen manuscripts in which the only race designations are white and nonwhite. The AMA Manual of Style notes that we should avoid using “non-” (eg, white and nonwhite participants) because it is a nonspecific “convenience” grouping. Instead, editors can query the author about using a specific race/ethnicity or using multiracial or people of color to address the heterogeneous ethnic background of many people. As an editor, a human, or even a potential study participant, I would self-report my race/ethnicity as Asian American or a person of color but never as nonwhite.—Iris Y. Lo

Questions From Users of the Manual

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The following are questions from you, faithful AMA Manual of Style users, seeking clarification of AMA style guidelines or guidance on topics not covered in the current edition.

Q: I think I know the answer to this but want to be sure. Do you italicize “ad libitum” in “Animals were provided ad libitum access to standard chow”?

A: The manual (22.5.4: Specific Uses of Fonts, Typography) says this about italics:

[Use italics] for some non-English words and phrases that are not shown among English terms in the current edition of Merriam-Webster’s Collegiate Dictionary or in accepted medical dictionaries. Italics are not used if words or phrases are considered to have become part of the English language, eg, café au lait, in vivo, in vitro, en bloc.

Merriam-Webster’s online dictionary lists “ad libitum,” so there is no need to italicize it. Interestingly, the example is “rats fed ad libitum.”

Q:  I am wondering: How does one cite a clinical trial as a reference? Do we treat them like a PI, or like a website? Do we include the identifier?

A: It would look most like a website and yes, inclusion of the identifier is recommended:

1. Evaluation of phage therapy for the treatment of Escherichia coli and Pseudomonas aeruginosa wound infections in burned patients (PHAGOBURN). ClinicalTrials.gov identifier: NCT02116010. https://www.clinicaltrials.gov/ct2/show/NCT02116010. Updated July 23, 2015. Accessed October 13, 2018.

Q:  Hi, Should there be a comma between a last name and “Jr” in a byline? 

For example:  Krzysztof Goniewicz, PhD; Frederick M. Burkle, Jr, PhD

A: No, AMA style does not include a comma before Jr or Sr, or before III, IV, etc.

See the policy and examples in chapter 8.2.1, Punctuation, Comma.

Q:  Does the manual have any position on whether “24/7” or “24-7” are acceptable in formal prose, with the meaning “at all times”? Thanks!

A:  As far as formatting, it’s not in the current AMA manual, but the Chicago Manual of Style and AP stylebook both use “24/7.”

Merriam-Webster’s dictionary lists “24-7” as the primary entry, with “24/7” as a variant.

The JAMA Network journals have generally preferred “24/7” considering that the slash serves to indicate “per” (24 hours per 7 days). Numbers joined with a hyphen (24-7) could be confused for a range or expression of variability, although the context of the passage should alleviate that.

As to “24/7” being acceptable in formal prose, it’s clearer to say “all the time”  or something less jargony:

            The hospital has stroke expertise available 24/7.

            Rewrite: The hospital has stroke expertise always available.

            Rewrite: The hospital has stroke expertise available around-the-clock.

Q: I know you aren’t supposed to refer to patients by their diseases, eg, “asthmatics.” How does that apply to the following sentence:

 Of the 196 patients, 20.4% (40) were made comfort-focused care, and 79.6% (156) remained full codes. 

What is the alternative for “full code”? 

A: Stylebook committee member Phil Fontanarosa, MD, MBA, replied:

With advance directives, patients can choose to have any or none of these procedures and also can opt for “comfort care,” which usually involves pain control, perhaps some sedation, and other comfort measures.

For the sentence, you could revise as something like the following: “Of the 196 patients, 20.4% (40) decided to have comfort-focused care, and 79.6% (156) opted to receive full resuscitation efforts.” 

Q: Hi, I have 2 questions about authors’ initials:

1.  If the journal typically uses periods after middle initials in the byline and the author has 2 middle initials, should there be a space between them?

2. If the journal uses first and last author initials in the Disclosures section, should there be periods and spaces between them?

A: The answer to both questions is yes.  Here’s an example from the 11th edition (forthcoming later this year) re the second question:

Author Affiliations:  Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong (S. K. W. Chan, S. W. Y. Chan, Hui, Chang, Chen); The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong (S. W. K. Chan, Chang, Chen); School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong (Pang, Yan).

Have a question? Send it in to stylemanual@jamanetwork.org or tweet to @AMAManual.—Stacy L. Christiansen, MA