acronyms

A Short Update on Long COVID

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Stacy L. Christiansen, MA, Managing Editor, JAMA

After infection with SARS-CoV-2, some people develop long-term effects. This condition has been termed post-COVID conditions (PCCs), post-COVID syndrome, postacute sequelae of SARS-CoV-2 infection (PASC), and in common parlance, long COVID.1

Which term to use will depend on the content and the intended audience. The ICD-10 code principally uses the term post COVID-19 condition.2,3

In the JAMA Network journals, we prefer post–COVID-19 condition (PCC), with allowance of long COVID for colloquial use (eg, in narrative or patient-focused content). Note that “long” is lowercase.

Avoid jargon terms, such as “long haulers,” in clinical or scientific content. The online style manual will be updated to include this terminology in chapter 11.1, Correct and Preferred Usage of Common Words and Phrases.

References

  1. US Centers for Disease Control and Prevention. Long COVID or post-COVID conditions. Updated September 1, 2022. Accessed October 28, 2022. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
  2. US Centers for Medicare & Medicaid Services. Post COVID-19 condition: ICD-10-CM official guidelines for coding and reporting. Updated April 1, 2022. Accessed October 14, 2022. https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines-updated-02012022.pdf
  3. World Health Organization. Coronavirus disease (COVID-19): post COVID-19 condition. Accessed October 14, 2022. https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-post-covid-19-condition

IQR You Serious?!

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Amanda Ehrhardt, MA, JAMA Network

Compared with navigating the treacherous waters of causal language, or throwing down the proverbial gauntlet against the terms renal and mutation, upholding AMA Manual of Style rules regarding abbreviations and when to expand them may seem like Not That Big of a Deal. If you had to plot the interquartile range for feelings surrounding this task, it may go something like this:

The median response toward expanding an abbreviation was “Meh” (interquartile range, “Yuck!” to “Yay!”).

However, one of the beautiful things about style rules is that they evolve and adapt with changes in cultural and societal outlooks and the editing process, and they occasionally throw you a colorful floatie while you’re swimming in copy.

That interquartile range that I’ve mentioned several times now? Well, check out the Common Abbreviations and Expansions table in the updated version of 13.11.

That’s right, it’s IQR! From beginning to end! No expansion necessary anymore!

So perhaps we should reassess that statement from the beginning?

The median response to learning that IQR no longer needs to be expanded was “Woohoo!” (IQR, “Cool.” to “Best thing ever!”).

Abbreviating the Pandemic

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If you’ve followed AMA style for at least the last several years, you may remember this big (welcome) announcement:

The companion abbreviation “AIDS” was given expansion-exempt status even before this with the 2007 publication of the 10th edition. It took some time for HIV to catch up.

Why did we decide that these 2 abbreviations no longer needed expansion? For one, they are ubiquitous, instantly recognizable (at least to English-reading audiences), and are long and cumbersome to write out in full.

After more than a year of publishing coronavirus-related content (JAMA’s first article was published in January 2020 by Fauci and colleagues), the AMA Manual committee has determined that COVID-19 and SARS-CoV-2 meet those same criteria to forgo expansion: ubiquity, familiarity, and cumbersome expansions.

  • Before: Protection against coronavirus disease 2019 (COVID-19) is mediated in large part by an immune response directed against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein.
  • After: Protection against COVID-19 is mediated in large part by an immune response directed against the SARS-CoV-2 spike protein.

While we all hope to soon have this pandemic in our collective rearview mirror, it is not likely that we will forget coronavirus disease 2019 or severe acute respiratory syndrome coronavirus 2.–Stacy Christiansen, Chair, AMA Manual of Style

Exhibit A

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There are times when authors question whether they really need copyediting; occasionally, when edits are especially light and authorial moods particularly dark, I even wonder if the idea of skipping it might even be right. But I am never swayed long, because to copyeditors, it is usually clear how tricky English can be, even in its smallest and seemingly simple parts.

Consider exhibit A: a.

English offers 2 indefinite articles, a and an, and the 11th edition of the AMA Manual of Style includes a simple-but-not-easy rule of when to use them: the a goes before consonant sounds and the an before vowel sounds. The hard part is that the sounds, not the written letters, are the deciding factor.

Because English is nonphonetic, words that start with written consonants (such as h) might begin with a vowel sound (as with hour), and those starting with a vowel may be said as an initial consonant sound (as with one). The only way to know the correct article to use is to know how each word is said aloud.

Medical writing further complicates this with prodigious abbreviations. Exactly half of the letters in the English alphabet, including 8 consonants, are said with initial vowel sounds; for example, an N is pronounced “en” and thus must follow an an when it occurs in acronyms such as NSAID. (The other 7 such consonants are F, H, L, M, R, S, and X.)

Making things even worse, acronyms that are pronounced as words (eg, LASIK) must be matched with the indefinite article that goes with their initial sound (in LASIK, “la-,” which means an a should be used), not the sound that matches the spoken letter (the “el” sound of L, which would go with an an). This means it is essential to know which acronym is said as a word and which as a mere cluster of letters.

It is a relief that nearly all of the letter names that start with consonant sounds (B, C, D, G, J, K, P, Q, T, W, Y, and Z) are for actual consonants, making the a their default article—except that, of course, Y is a consonant (said “ya”) and a vowel (“ee”) with a rather inexplicable spoken name (“why”), and…. well, you get the picture. The complexity never ceases.

Anyone can get this stuff wrong, even native English speakers. For authors using English as a foreign language, including those who largely write in rather than speak the language (and therefore do not sound it out much) and those whose native languages do not include indefinite articles (eg, Japanese, Hindi, Polish, many more)—this might be pretty hard to manage. For everyone, there are copyeditors. We hope to handle this and all the rules in our 1200-page style manual, from a to z.–M. Sophia Newman

Advice After Mischief Is Like Medicine After Death

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When acquaintances learn that I am an editor, a common response is “I better watch what I say around you.” I would like everyone to watch what they say around me at all times, but for reasons having nothing to do with my career.

Still, that response is often followed by curiosity and questions. Giving advice is one of life’s simple pleasures. Giving advice is even better when someone actually asks for it. Is any writing more concentrated than an advice column? It’s the written equivalent of a shot of absinthe but better for you. My advice hero is Carolyn Hax, and I have also enjoyed Emily Yoffe and Miss Manners. I won’t claim to belong in their illustrious company but I do have the AMA Manual of Style. I don’t think they do.  

I’ve selected questions from the last year whose answers can get you leafing through the manual. As you read these and have questions in turn of your own, remember that, unlike me, the AMA Manual of Style is always there for you.

Dear AMA Style Manual Guru,

I am indexing binomial organism names and have come up with a shortcut that separates the genus from species when the genus is otherwise repeated. Can you help me justify this decision?

Rogue Editor

Dear Rogue Editor,

We are all learners here and I object to the hierarchy implied when you refer to me as a guru. In the interest of collaboration, please call me Sir.

AMA Style Manual Guru

Dear Sir,

I am indexing binomial organism names and have come up with a shortcut that separates the genus from species when the genus is otherwise repeated. Can you help me justify this decision?

Rogue Editor

Dear RE,

No. See 13.1.1, Alphabetization and Sorting.

Dear Sir,

I’m using an acronym that relies on irregular capitalization when spelled out. I am worried that readers will feel misled or as if the acronym is too forced. How can I handle this discrepancy?  Asking for a friend.

Dear Nameless,

You worry too much. Readers will not question the acronym if they follow 10.6, Acronyms and Initialisms. You should too. Or your friend should. Look, you both should. An irregular use of capitalization will be harder for readers to follow than standard capitalization. By the way this column has a word count, so let’s dispense with salutations and sign offs and stick with Q and A.

Q: If you have a hyphenated compound in a page heading, do you capitalize the second half of the word: First-Line Therapy? or First-line Therapy?

A: Because “first-line” appears in Webster’s as a specific term, the AMA Manual of Style indicates that the “l” would be lowercase. See 10.2.2, Hyphenated Compounds. When each part of a hyphenated term carries equal weight, capitalize the initial letter of both words. I always enjoy capitalization questions. Keep them coming.

Q: Even though you prefer capitalization questions, I have a question about pluralization. In a world in which most signage offends grammarian sensibilities (Free Kitten’s to a Good Home), an editor (not unlike you) noted that my paper used “too many and’s.” How should I respond to this editor?

A: See if you can use serial commas instead of successive and’s and look up 9.6, Plurals of Symbols, Letters, Numbers, and Years. Then thank your editor for helping your article attain clarity for readers. You’re welcome.

Q: Why can’t I use the numerical expression of ordinal numbers? They keep getting edited out and I think they are clear and that the visual effect communicates more quickly than spelled ordinals.

A: This is the third (not 3rd) time you’ve asked. I know it sounds harsh but it’s for your own good and someday you’ll thank me. You just can’t. Now stop asking. Numeric expressions of ordinals may be jarring and interrupt the flow of text (see 19.2.5, Ordinals).

Q: I often see the pronoun “one” presented as the number. What’s this whole world coming to?

A: True, the pronoun should be spelled out (19.2.3, One Used as a Pronoun). You may see someone interpret a pronoun as the countable “1,” and it may get into print even when the pronoun precedes a prepositional phrase (“1 of us” for “one of us”). The only assurance I can offer is that no one was harmed in the publication of that phrase and the sun still rises and sets each day.

Q: “Two weeks of symptoms is expected” or “Two weeks of symptoms are expected”?

A: Smart money is on the first choice. A unit of measure uses a singular verb. See 9.2, Collective Nouns. Noun phrases is are funny that way. Your ears may have to adjust to this new knowledge.

Q: I have a father in law problem. He constantly undermines me. My wife is his only daughter, and when I am at the grill (my specialty!), he maneuvers into my area so he can flip the burgers himself. Then he claims that I don’t know how to grill. How can I get him to stop?

A: You have a father-in-law problem. See Hyphen, 8.3.1. —Timothy Gray

Acronym Morph: What’s an Editor to Do?

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Sometimes we see things out of the corner of our eye. Then we think, “Did I really see that?” Lately, I’ve had that experience with certain acronyms morphing from all capital letters (eg, UNESCO) to initial capital letters (Unesco).

When acronyms drop their periods, I take it in without a second thought—it looks cleaner to me, someone used to the omission of periods in most acronyms from years of editing using the AMA Manual of Style. But this move from all-caps to only an initial cap jarred me, once I stopped and looked it in the eye. I was puzzled, too, by the pattern (or lack of one) behind this shift.

A little investigation seemed in order. The AMA Manual of Style distinguishes between acronyms and initialisms1 and indicates that periods are usually not used with them. But there is no mention of an all-cap or initial-cap style or preference. The Chicago Manual of Style2 notes that “Usage rather than logic determines whether abbreviations other than those standing for proper names are given in upper- or lowercase letters. Noun forms are usually uppercase (HIV, VP), adverbial forms lowercase (rpm, mpg). Note also that acronyms, especially those of five or more letters, tend to become lowercase with frequent use (NAFTA/Nafta, WASP/Wasp).” Special mention of this morph is made in discussing associations and the like: “Whether acronyms or initialisms…, such abbreviations appear in full capitals and without periods. Acronyms of five letters or more may be spelled with only an initial capital….” Chicago cites ERISA/Erisa (Employment Retirement Income Security Act) as an example.

Now we’re getting somewhere. Maybe there isn’t logic but maybe there is a pattern. Editors like both.

The Associated Press Stylebook3 advises, with regard to acronyms, “Use only an initial cap and then lowercase for acronyms of more than six letters, unless listed otherwise in this Stylebook or Webster’s New World College Dictionary.” So, it does seem to be related to length. How long is long enough to trigger this style change—5 letters? 6 letters?

This set me to thinking about things that began as acronyms and then morphed even further than becoming “proper nouns,” with an initial cap, to becoming “regular” words, all lowercase, as if they had never worn the guise of an acronym at all. The first such word that came to my mind was posh because I loved knowing that this word began as P.O.S.H. to stand for “port out, starboard home,” the location of the most expensive berths on luxury liners. However, I was chagrined to read in The Phrase Finder4 that this story was probably “dreamed up retrospectively to match an existing meaning.” It therefore is not an acronym but a backronym (a “reverse acronym,” a word or phrase constructed after the fact to make an existing word or words into an acronym”5).

What are other such words that we use as if they were fresh words but that began life as acronyms? I knew about snafu (“situation normal, all f—ed up”), which is so often used that most people don’t even know it had an earlier existence. Another one that, for some reason, I think most people do realize used to stand for something is scuba (“self-contained underwater breathing apparatus”). One that I see every day in reading medical journals that I hadn’t known started as an acronym is laser (“light amplification by stimulated emission of radiation”). Wonderful. Finding out the history of each of these acronyms is like opening a small treasure chest. Then there’s a host of others that all joined the language in the 1980s: yuppie (“young urban professional” or “young upwardly mobile professional”), buppie (“black urban professional”), guppie (“gay urban professional”), dink (“double income, no kids”). This is fun.

Some acronyms come from other languages: flak (from German: Fliegerabwehrkanonen, from Flieger flyer + Abwehr defense + Kanonen cannons).6 Some company names began as acronyms: Qantas began as QANTAS (Queensland and Northern Territory Aerial Services).

Getting back to the yen for logic and a pattern, with words there is a pattern that editors often chart, like physicians charting a patient’s temperature in a hospital record…watching to see when the temperature is right for them to jump in. Here the pattern is to begin with 2 separate words, then link them with a hyphen, then join them completely.

breast feeding→breast-feeding→breastfeeding

With acronyms it seems to be

U.N.E.S.C.O.→UNESCO→Unesco

With, sometimes, a brief detour to unesco.

For those of us who care about these details, we each need to decide (with words, with capital letters) when—watching the temperature—it’s time to jump in. For medical journals, vis-à-vis this acronym morph, we are going to continue to monitor the temperature before deciding to jump in for a swim.

Acronyms, backronyms. Words take us on a wonderful journey. Sometimes they are a journey in themselves.—Cheryl Iverson, MA

1. Iverson C, Flanagin A, Christiansen S, et al. AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007:441-442.

2. The Chicago Manual of Style. 15th ed. Chicago, IL: University of Chicago Press; 2003:559.

3. Christian D, Jacobsen S, Minthorn D, eds. The Associated Press Stylebook and Briefing on Media Law. Philadelphia, PA: Perseus Basic Books; 2009:2.

4. POSH. The Phrase Finder. http://www.phrases.org.uk/meanings. Accessed June 4, 2012.

5. Backronym. Wikipedia. http://en.wikipedia.org/wiki/Backronym. Accessed June 4, 2012.

6. Mish FC, ed in chief. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:475.