Variants for Mutation

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Other than in reference to the Teenage Mutant Ninja Turtles, the anthropomorphic crime-fighting turtles who love pizza, there are few instances in which the term mutation, or any form of the word, has a positive connotation.

Because of this negative connotation and the confusion regarding the definitions of the terms mutation and polymorphism across disciplines, the Human Genome Variation Society recommends avoiding these terms.

The 11th edition of the AMA Manual of Style reinforces this recommendation, as well as the suggestion to instead use the terms sequence variant, sequence variation, alteration, or allelic variant.

In light of this recommendation, the term single-nucleotide variation (SNV) is more frequently being used than single-nucleotide polymorphism (SNP). To aid readers’ understanding during this transition, it is suggested that SNV be used at first mention, with SNP included in parentheses as follows: “…SNV (formerly SNP).” This should help authors and readers adjust to the recommended language.–Nicole FioRito

New Edition, New Rules

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As an introduction to some of the new features of the 11th edition of the AMA Manual of Style, the AMA Style Insider will begin a series of short weekly posts highlighting changes in style rules that editors should begin incorporating into their workflows.

This series will start with updates on a time-sensitive topic that is unfolding not only in medical publications, but also across mainstream media outlets: coronavirus disease 2019 (COVID-19).

As the scale of COVID-19 becomes increasingly global, it is essential that editors use nomenclature that is accurate and consistent so readers can trust the integrity of the information being published.

The AMA Manual of Style addresses coronavirus in section 14.14.3, Virus Nomenclature. The disease name COVID-19 was finalized by the World Health Organization and the virus name severe acute respiratory syndrome coronavirus (2 SARS-CoV-2) was finalized by the International Committee on Taxonomy of Viruses. Updates will be provided in Table 14.14-10, Viruses of Humans.

For continued clinical updates on COVID-19, please visit JAMA Network’s designated page for research and educational resources. For situation updates, please refer to the US Centers for Disease Control and Prevention.–Amanda Ehrhardt

Welcome the 11th Edition of the AMA Manual of Style!

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We are pleased to announce the 11th edition of the AMA Manual of Style, now live at https://www.amamanualofstyle.com/ and shipping in hardcover in a few days.

The manual has been thoroughly updated, including comprehensive guidance on reference citations (including how to cite journal articles, books, reports, websites, databases, social media, and more), an expanded chapter on data display (for the first time in full color), a completely up-to-date chapter on ethical and legal issues (covering everything from authorship and open access to corrections and intellectual property), and updated guidance on usage (from patient-first language and terms to avoid to preferred spelling and standards for sociodemographic descriptors).

The section on nomenclature has undergone thorough review and updating, covering many topics from genetics and organisms to drugs and radiology.

The statistics and study design chapter has been extensively expanded, with more examples of usage and terms that link to a related glossary.

Chapters on grammar, punctuation, abbreviations, capitalization, manuscript preparation, and editing feature refreshed examples and new entries (such as allowance of the “singular they”).

The nearly 1200-page book is enriched by a variety of online features. For example, regular updates to address changes in style or policies will be featured in the Updates section. Any corrections will be made online so that you are always looking at the latest guidelines as you use the manual.

New quizzes will be posted to help new or continuing users learn to master the finer points of AMA style, and the units of measure calculator offers easy conversions between the SI system and conventional units, as well as the metric system.

We welcome questions and comments on the manual: write to stylemanual@jamanetwork.org or find us on Twitter (@AMAManual). We look forward to engaging with you. –Stacy Christiansen, for the AMA Manual of Style Committee

ME Without the MD

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One of the occupational hazards of being a medical editor is the inevitability of occasionally working on a highly technical, highly detailed manuscript on a topic about which you know nothing. You don’t need to have a medical degree to be a medical editor, but how do you edit a paper when you’re not sure whether the item under discussion should treated as a plural, or even as a noun?

Of course, an excellent place to start is the AMA Manual of Style, which can provide a general overview sufficient to navigate the complexities of many topics.

For example, you don’t need to know much about respiratory physiology as long as you remember to check section 15.16 (Pulmonary, Respiratory, and Blood Gas Terminology). You’ll be sprinkling cryptoglyphs like V̇, Pb, and v̅ in no time!

You also don’t need to know how to conduct an F test to know that when you see an F score, it should also include the numerator and denominator of the degrees of freedom in subscript (section 20.9, Glossary of Statistical Terms).

In addition to the searchable AMA Manual of Style, the modern age has also bestowed the gift of internet search engines to help decrypt topics of which you may have no knowledge (and had never previously needed knowledge of, for that matter). If you find yourself looking at a topic you’ve never heard of and the Manual doesn’t cover it, a few minutes perusing sites such as Google, PubMed, and Wikipedia can give you tentative grounds on which to make your stand.

But sometimes even all the treasures of the internet and your trusty AMA Manual of Style combined can’t help and you’re adrift on a sea of statistics, biochemistry, gene expression, or whatever your topical Achilles heel may be.

In such cases, it can be useful to think of a sentence like a math equation—you don’t need to know what the subject means, but if you can look at a sentence and know where the subject is, where the object is, and what kind of verb tense you need, you’re more than halfway there.

And, as always, you can and should rely on the author to clarify and correct as needed. The ultimate goal of your work is to improve the author’s work, and that can only be truly accomplished through teamwork.–Rebecca Palmer

Dictionaries: An Editor’s Best Friend

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Part of the fun of editing medical content is learning all about the newest treatments and scientific advances, but as someone without a science background, I find myself looking for resources that can help me understand some of the more technical terminology.

You may ask, “What about Google?” Google offers the collective knowledge of the Internet right at our fingertips, right? Well, sort of. Sometimes I don’t have the time to sort through all of the results. I want the correct answer now! Subject-specific medical dictionaries are just the thing when I’m in a hurry (which is almost always because DEADLINES).Two resources that I use are A Manual of Orthopaedic Terminology (print) and the National Cancer Institute (NCI) dictionaries (web).

In the days when I edited orthopaedic surgery manuscripts, A Manual of Orthopaedic Terminology (Nelson FR, Blauvelt CT. A Manual of Orthopaedic Terminology. 8th ed. Philadelphia, PA: Elsevier Saunders, 2015) was my go-to resource for terminology related to musculoskeletal disease, brief descriptions of imaging techniques, and common orthopaedic abbreviations. The section on fracture classifications saved me from sifting through a ton of search engine results. Don’t even get me started on the eponymous procedures and approaches! As much as I love this resource, it’s not comprehensive. My heart sank when I used this book to look up surgical approaches for hand surgery and saw “Surgical approaches are too numerous and complicated to describe here. Refer to Canale ST, Beaty J, 2013.”Um, okay.

I found the web-based NCI dictionaries one day when I was working on an oncology manuscript and found myself turning to Google for the 10th time in 2 hours (I love you, Google, but this is ridiculous!). Enter the NCI Dictionary of Cancer Terms and the NCI Drug Dictionary to save the day. Of the 2 dictionaries, I use the Dictionary of Cancer Terms the most. The definitions aren’t too technical, and new terms and definitions are added monthly. Right now, 8386 terms are included. The search interface is easy to use, and allows you to search for partial terms.

As you might expect, the definitions and descriptions in the NCI Drug Dictionary are more technical than those in the Dictionary of Cancer Terms. In addition to definitions, the Drug Dictionary entries include alternate drug names and hyperlinks to more information on each drug (such as active clinical trials using the drug). The NCI Drug Dictionary was useful when I recently came across a table with an alphabet soup of chemotherapy regimens. What exactly is the FOLFIRI regimen?

Let’s use the NCI Drug Dictionary to break this down. A search of FOLFIRI returns 4 results (click for larger):

Those definitions seem pretty straightforward. They even include the trade names for some of the regimens (FOLFIRI-Avastin). The NCI Drug Dictionary seems like a good place to begin a search, but it may be a good idea to cross-check some of the drug names using the USAN Council website; “5-fluorouracil” may not be the preferred name. Clicking on the link for the regimen will redirect you to a page that lists the full definition and another link to the NCI Thesaurus. In this case, the full definitions are short and are right here in the search results—no need to click on another link!

Subject-specific dictionaries can be a reliable alternative to wading through thousands of Google results. What about you? Do you use any subject-specific resources? Tell us in the comments.—Juliet Orellana

What’s in a (Drug) Name?

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I’ve recently joined the JAMA Network after a brief career in pharmaceutical editing, where I’ve read everything from the easy-to-digest pamphlets that come with your prescription to the headache-inducing instructions chemists follow when testing that a drug meets its quality compliance requirements.

One of these jobs required the terrifying task that editors, after editing an assignment, would sit together and read aloud entire monographs and articles to confirm all changes.

Real talk: I love editing because I get to read alone all day. I avoid public speaking whenever possible. Mustering the courage to read aloud in front of other people for hours on end—let alone pronounce words I’d never seen before—really revved the ol’ anxiety engine.

After countless sessions of tripping over impossible-to-say generic (or nonproprietary) drug names, I finally decided to do some research on my multisyllabic angst inducers.

Enter the United States Adopted Names (USAN) Council, a team composed of representatives from the American Medical Association, the United States Pharmacopeia, and the American Pharmacists Association, as well as a US Food and Drug Administration liaison and 1 member-at-large. This team “is responsible for selecting simple, informative, and unique nonproprietary (generic) drug names,” according to its website.

“Simple,” they say?

But, in fact, the names are not as daunting as I once thought and are often broken down into a general pattern. Again, from the USAN Council website:

Prefix: Means nothing; differentiates drug from others in class

(See? Nothing to be scared of here.)

Infix: Used occasionally; further subclassifies

Stem: Indicates place in nomenclature scheme; drugs with the same stem are related

(The stem is considered the pharmacologic family name and can be broken into further subgroups.)

An example:

Cobimetinib

Prefix: co-

Infix: -bi-

Stem: -tinib (meaning: tyrosine kinase inhibitors [anticancer drug])

Stem subgroup: -metinib (meaning: MEK inhibitor [anticancer drug specifically to treat melanoma])

It also helps that the USAN Council strives to place any new drug into already existing families, so once you’ve seen several drugs in that family, pronouncing their siblings should be a breeze.

Next up for me: Conquering my Dorland’s Illustrated Medical Dictionary. Wish me luck!—Jamie Scott

A Due Diligence Excursion Into Nomenclature

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You might know the definition of the word “excursion” as it relates to leisure activity. You may also consider its technical definition, which is to do with the movement of something along a path. I recall an unexpected delight once while reading some Prescribing Information. A statement about drug storage and handling indicated that the drug can be stored for up to 4 months at 25°C (77°F). The kicker for me was “excursions permitted to 15-30°C (59-86°F).”

Excursion? Sounds like that drug is in for a treat.

My earliest excursion into professional proofreading and copyediting occurred at a law firm. The required confidentiality agreement lit a fire in me as an initiation into specialized knowledge.

Good, I will know something I am not allowed to talk about.

Flushed with triumph, I sat down to read contracts, deeds, torts, and trusts. Page by page, section by section, paragraph by paragraph, unwieldy sentence by unwieldy sentence, clause by clause, parenthetical phrase by parenthetical phrase.

Confidentiality agreement? A few months into the job revealed that agreement to be a formality. I couldn’t have blabbed about any deals had I wanted to (putting aside the question of who would want to be told any of what I was reading). The baroque legal prose lent itself to pattern recognition instead of language comprehension.

Particular phrasing has stayed with me. Pursuant to. Indemnify, defend, and hold harmless. Any and all claims that arise from or relate to. Including without limitation. As herein before stated. Some terminology has migrated into general use, as when you overhear someone say into a phone, “Do your due diligence, dude.” As a synonym for “preparation,” there are worse choices.

Performing due diligence is a vital component of processing articles for JAMA Network journals. In manuscript editing, the biggest confidentiality issue is the embargoed proof. Knowledge across the specialty journals is not meant to be confidential (after publication). The spread of knowledge requires fixed meanings—or at least is greatly helped by it.

Words slip out of professional and into general use, and from general into professional (although I don’t know the origin of “excursion” in Prescribing Information). A migrated term can lend a patina of mindfulness—“curate” is no longer a member of the clergy in an Anthony Trollope novel but a thing one does on behalf of one’s own “brand”—which once meant the maker of cereal you preferred to eat but now means something like the self you present to the world. Word migration can veer into pretension, depending on your personal threshold.

We routinely consult the AMA Manual of Style to solve usage issues in preparing an article for publication. Changes in usage can be exciting. The manual is too sophisticated to be merely proscriptive; if you admire change, you will find plentiful discussion. If, however, you find yourself wishing to sample a lexicon with a heritage of stability, the AMA Manual of Style is at your service.

Your well-thumbed manual may focus your attention on references, usage, conversion factors, and abbreviations. We all need reminders for those principles that don’t stay in our heads. That raises a question. What about what is not in in our heads to begin with?

You won’t know that you don’t know nomenclature unless you are exposed to what there is to know. Make an excursion into Chapter 15, Nomenclature, the single longest chapter in the manual (followed, in a bit of poetic juxtaposition, by what is likely the shortest, the 5-page treatise on Eponyms).

Why stroll through a 250-page chapter with 17 segments? You will encounter terms for Equipment, Devices, and Reagents, a lexicon of Immunology, and vernacular names for Organisms and Pathogens. One reason to move along this path is that, while editing, you may not realize that usage in your article is imprecise or incorrect. Maybe the author inadvertently mixed up 2 conventions in a single term. The term looks scientific and the author is both MD and PhD, so you might move along with your next task in mind. Perusing Chapter 15, though, can orient you toward terminology in a way that can help you know when to clean it up.

Even though the chapter is enormous, its rationale is simple: “to present style for terms and to explain terms in hopes that they are more easily dealt with.”

In my book, that’s grounds for an excursion.—Timothy Gray