frequently asked questions

An Interview With AMA Manual of Style Committee Member Connie Manno

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With the recent release of the 11th edition of the AMA Manual of Style, I was curious to learn more about the members of the style committee, their background, and their experience working on the manual update. After all, these editorial masterminds spent countless hours debating every detail of AMA style to make our jobs as editors easier.

The first person with whom I chose to chat was Connie Manno, Director of the Freelance Editing Unit at JAMA Network and coauthor of chapter 4, Tables, Figures, and Multimedia. (Full disclosure—she’s my manager.)

Background

Connie started working as a coordinator in the freelance unit at the JAMA Network in 1998 after getting started with the organization as a freelance proofreader. In 2017, she was promoted to the director of the unit.

The freelance team currently consists of 5 in-house coordinators, 12 freelance editors, and 4 freelance copyreaders and is constantly growing. The team has doubled since Connie started in the unit to keep up with the increasing number of manuscripts and the greater amount of content published by the JAMA Network.

Expectations for Freelance Editors

When asked about the expectations of the freelance editors, Connie stated that the preference is for each to edit at least 3 major manuscript per week and to handle the initial set of author revisions. The editors are expected to take a substantive editing approach, with strict adherence to the AMA Manual of Style.

They are contacted at least monthly with updates to or reminders about journal style and policy. The coordinators review the work of the freelance editors and provide feedback as necessary. Furthermore, every spring, the freelance editors are invited to a day-long conference to experience a deeper dive into style and policy.

Over the years, Connie has discovered her aptitude and joy in training new freelancers and coordinators. She attributes her knowledge of AMA style to this aspect of her job. She finds that it’s more effective to provide the exact sections of the manual to new editors on their reviewed manuscripts so that they can see why changes were made and know where to look for those items in the future. Like many of your manuals, Connie’s is meticulously organized with tabs, highlights, and underlines.

On Editing Figures

One section of scientific manuscripts that can be particularly challenging to edit is figures. Because of her eye for visual representation of data, Connie was asked to take over development of chapter 4 from Stacy Christiansen, Chair of the AMA Manual of Style and Managing Editor of JAMA. Connie worked on the chapter for the last 3 years of development. Basic editing had been done, but Connie was responsible for finding good examples and, of course, making sure that those examples were edited according to AMA style.

In the process and by working with figure and statistical experts on JAMA for about a year, she gained more in-depth knowledge about which type of figures are best for representing different types of statistics and the data needed for completeness of presentation. You can see Connie’s recent AMA Style Insider post for a summary of updates to the chapter–she hopes that you find it informative and helpful!

Questions?

Please feel free to send your questions about figures and tables style to stylemanual@jamanetwork.org or @AMAManual on Twitter.–Sara Billings

The Temperature on Spacing for Degrees

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Tucked deep within the weighty 10th edition of the AMA Manual of Style were brief entries providing guidelines for reporting measures of temperature. In sum: writers and editors reporting Celsius or Fahrenheit should (1) close up spaces between numerals, degree symbols, and temperature units and (2) repeat the degree symbol and the unit when reporting temperature ranges. For example: 37.5°C-37.9°C.

Simple? Yes—with the possible exception of closing up the space between numerals and degree symbols, as many non-AMA publications include a space between temperature values and degree symbols, and the degree symbol was 1 of only 3 exceptions to the usual AMA style rule to add a full space between an Arabic measure of quantity and the unit of measure. (The other exceptions being the percent sign and the symbols for normal and molar solutions, often closed up in other publications.)

To separate or not to separate? That was the question.

The new (and even more comprehensive) 11th edition aims to ease any resulting separation anxiety, now calling for a full space between temperature values and degree symbols. Moreover, units no longer need be repeated when a hyphen is used. For example: 37.5-37.9 °C.

The 11th edition also makes more explicit that the degree symbol is not used with Kelvin values and highlights that relative temperatures should be expressed as higher and lower rather than warmer or colder.–Phil Sefton

Does Freelancing Pay?

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In addition to my duties as a manuscript editor, I pick up freelance editing assignments when I can. At JAMA Network, I am part of a team of many talented editors and proofreaders who collaborate throughout the editing process, but when freelancing, I am often the only line of defense between clients and catastrophe.

Writing and editing, including in the medical sphere, are largely independent work and conducive to freelancing. But they can also be lonely jobs. Who do you bounce ideas off of when you have a tricky question? Where’s IT when your internet goes down? And how do you know if you are charging your clients enough to cover the overhead costs of your freelance business?

That last question is why I was one of more than 1400 medical communicators who participated in the American Medical Writers Association’s 2019 Medical Communication Compensation Survey.

Following a similar structure as the last edition of the survey (published in 2015), the results are broken up into categories for full-time employees and freelancers. Full time was defined as working 32 or more billable hours per week.

Of full-time employees, almost half (46%) reported having a PhD or advanced degree and more than 10 years of experience (42%). The most common employers were pharmaceutical companies (20%), clinical research organizations (14%), medical communications companies (14%), biotechnology companies (9%), medical device companies (8%), health care organizations (7%), and medical schools or universities (7%).

Writers reported a median annual income of $107 000, while editors reported $80 560. The most commonly reported benefits for those employed full time included health insurance (93%), retirement savings plans (85%), life and/or disability insurance (82%), professional development (64%), pretax spending programs (63%), and an annual bonus (60%).

By contrast, of full-time freelance medical communicators, 38% reported having a PhD or other advanced degree, but 72% reported more than 10 years of experience.

There was some overlap with what the first group of employees reported; for freelancers, the most common clients included pharmaceutical companies (21%), medical communications companies (19%), medical education companies (9%), biotechnology companies (8%), medical marketing agencies (6%), medical device companies (5%), and health care organizations (5%).

Full-time writers reported a median annual income of $151 000, while editors reported $77 500. As with the first group of employees, the results note that salaries tend to increase with years worked in the industry.

Because freelancers generally do not receive the same benefits as employees, they tend to charge higher rates to cover expenses (respondents reported an average hourly rate of $116 for writing and $97 for editing). In this survey, respondents reported their most common recurring expenses as professional membership dues, costs of a tax accountant, health insurance, office supplies, and professional development.

The 2019 survey also reported that 55% of all respondents work remotely on a regular basis and of these, 48% only work remotely. This is an industry trend that continues to grow through the use of technology and continued research showing the benefits of remote work.

Organizations, such as the American Medical Writers Association, Council of Science Editors, and Board of Editors in Life Sciences, are valuable in connecting medical communicators with resources and information, especially freelancers or remote workers in need of a network. Sharing data is the core of our careers after all.–Jamie Scott

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

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

Questions From Users of the Manual

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Q: I appreciate the difference between percentile and percentage, but can you shed light on the difference between percentile and centile?

A: Ed Livingston, MD, a JAMA deputy editor and author of the statistics chapter in the 11th edition of our style manual, responds:

Percentile refers to the percentage below which a group of observations fall, ie, 93 percentile means that 93% of the observations fell below that value. If I had a score that was in the 85th percentile, I had a score that was better than 85% of all people taking that test.

Centile refers to which group an observation belongs to when the population is divided into 100 equal groups, like a quartile. With a quartile there are 4 equal-sized groups and with a centile there are 100 equal-sized groups—so in practice it’s the same as a percentile. —Cheryl Iverson, MA

Questions From Users of the Manual

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Q: How should a photograph or illustration be cited in the reference list?

A: In the reference list, cite the article in which the figure you want to reference appears in the “usual” way of citing a journal article. In the text, where you cite the reference, use the following style:

As Christiansen and Fischer [add superscript citation here to the appropriate reference number…you could also include the number of the page on which the figure you are citing appears, in parentheses] illustrate in Figure 1 of their study….

—Cheryl Iverson, MA

Questions From Users of the Manual

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[Editor’s Note: I love the idea of referencing a sound!]

Q: How should a “free sound” from the website Freesound.org be cited in the reference list?

A: We would recommend the following for citation format, altering the accessed date to reflect the date it was accessed:

Crickets.  http://freesound.org/people/rfhache/sounds/52755/.  Posted May 2, 2008.  Accessed February 1, 2016.

We are revising our manual now for the 11th edition and will be including many more examples of electronic references.—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: Should “least squares mean” be hyphenated? Can the acronym LSM be used or is LS preferred?

A: In the glossary in the statistics chapter, you’ll see that there is no hyphen used in “least squares method,” so I would extrapolate from that to say no hyphen is required in “least squares mean.” If this term comes up so frequently in the manuscript that you feel an abbreviation is warranted, we indicate no preference for what that abbreviation is. Just be sure it’s used consistently throughout.—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: If I have a title with a colon, is the first word after the colon capitalized or lowercased?

A: If you are speaking about title and subtitle on the manuscript itself, every major word in the title and subtitle, as well as the first word of title and subtitle, would begin with a capital letter.

Endless and Essential:  The Tug-of-War Over Off-Label Use

If you are speaking about the title and subtitle of a journal article as it appears in the reference list, only the first word of the title and any proper nouns would begin with a capital letter.

19. Incollingo J. Endless and essential:  the tug-of-war over off-label use. Cataract & Refractive Surgery Today. 2016;16(5):19-27.

More about capitalization of titles can be found in chapter 10.—Cheryl Iverson, MA