punctuation

The AMA Garden of Hyphens

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Timothy Gray, PhD, JAMA Network

If your professional life requires adherence to AMA style, you may have gotten lost in the weeds styling hyphenated compounds in titles. No capitalization after a hyphen if a prefix or a suffix, if both parts are considered a single word (requiring a field trip to Merriam-Webster), if the compound is temporary, or if the parts do not carry equal weight.

I have long wondered how parts of a compound carry weight, which isn’t to say that I don’t like the idea. As a practical suggestion, though, it lacks a little, uh, practicality.

If you think of a compound as an entity on its own, any word that may carry weight because of its particular part of speech loses that identity (and drops the weight!) when it gets pulled into that magical realm of a hyphenated compound (all adjectives all the time). So “Short-term Effects” and “Full-time Coverage” have always read as weird to me, especially if they have appeared near “Early-Onset Disease.”

How fitting, then, that the AMA Manual of Style has finally addressed the weed problem with hyphenation. No need to kill them. We can just get them out of our way. Let the weeds live happy lives in some other organization’s style manual.

The new guidance in 10.2.2 reads “In titles, subtitles, and text headings, capitalize both parts of a hyphenated compound.” Hence, “Short-Term Effects” and “Full-Time Coverage.” Take a look in the online manual for more information and other new style guidance.

Now when you review capitalization in titles with hyphenated compounds to align with AMA style, you needn’t make excursions to other sources. You can stay in the AMA garden without getting lost in the weeds.

Published August 1, 2023.

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

Social Media: Dos and Don’ts

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Eman Hassaballa Aly, Social Media Manager; Reuben Rios, Social Media Coordinator; Deanna Bellandi, MPH, Manager, Media Relations (JAMA Network)

“All we want are the facts.”

Sgt Joe Friday, Dragnet

Social media is an important tool for promoting content published in JAMA and the JAMA Network family of journals to the research community, physicians and other health professionals, and lay audiences. Doing that means following a set of guidelines meant to ensure accurate and responsible social media posts.

JAMA Network Social Media Guidelines

  • Content published in social media sites is subject to the same norms, standards, and regulations as is all other published content.1
  • Be respectful.2
  • Use proper grammar, spelling, and capitalization.3
  • Abbreviations may be used provided they can be easily understood in context.
  • Avoid texting jargon, such as “U” for “you” or “L8” for “late.”3
  • Do not use sarcasm, irony, satire, or absurdities.4
  • Reflect diversity.4
  • Use language that is nondiscriminatory.5
  • Do not include negative comments directed at any person, group, or institution.
  • Do not use offensive content (including, but not limited to, racist, sexist, ageist, anti-LGBTQ, and antireligious.)6
  • Do not include sexually suggestive images or video (eg, genitalia, breasts, buttocks) or those that portray sexual assault/abuse.
  • Do not use language, images, or other content that reinforces stereotypes.5
  • Use individuals’ preferred pronouns when known; inclusive pronouns (they/them) are acceptable.4,5
  • When reporting the results of a study or describing a specific journal article, replace personal pronouns (I and we found) with reference to the study or the article type (eg, Viewpoint, Review).
  • When mentioning people/Twitter handles, do not editorialize or designate appellations (eg, do not say, “The great [@Twitter handle] discusses…”).
  • Do not use profanity or vulgarity.2,6
  • Do not include emojis based on gender or race.4
  • Do not include identifiable patient content without permission.1
  • Do not share confidential information.7
  • Do not share information that is embargoed or before publication date and time.
  • Do not include quotes, images, photos, or video from other social networking sites or third-party publications without permission and attribution to the source.8
  • Do not share others’ social media posts that do not follow these guidelines.
  • Correct posts with errors transparently and as soon as possible. For example, add a new post clarifying the correction, and include the word “correction.”

Posts that do not follow these guidelines may be removed.

Tweet Formatting

  • The basic format of a tweet consists of text, links, and hashtags handles with optional attached video and images (up to 4 images per tweet).
  • Length: the maximum length for JAMA Network tweets is 257 characters. Twitter limits to 280 characters, but because JAMA Network always includes a link, 23 characters are reserved for the link.
  • Hashtags should be limited to 3 per tweet.
  • Twitter handles should be included if there is room. Handles should be limited to authors and institutions directly related to the content of the tweet.
    • Example: Tweet text (including relevant @mentions and #hashtags), Link, Other @mentions (if not directly mentioned in the tweet), Other hashtags (if any, and if space permits).

References

  1. Christiansen C, Iverson C, Flanagin A, et al. 5.9.5. Social Media and 5.11.19 Social Media. In AMA Manual of Style: A Guide for Authors and Editors. Accessed March 24, 2021. https://www.amamanualofstyle.com/view/10.1093/jama/9780190246556.001.0001/med-9780190246556-chapter-5-div2-230
  2. Grossmont-Cuyamaca Community College District. Social Media Guidelines. Accessed April 2, 2021. https://www.gcccd.edu/marketing-communications/social-media-guidelines.html
  3. Christiansen C, Iverson C, Flanagin A, et al. 7.11. Grammar in Social Media. In AMA Manual of Style: A Guide for Authors and Editors. Accessed March 24, 2021. https://www.amamanualofstyle.com/view/10.1093/jama/9780190246556.001.0001/med-9780190246556-chapter-7-div1-138
  4. Sehl K. How to Create Effective Social Media Guidelines for Your Business. Hootsuite. Blog. February 3, 2020. Accessed April 2, 2021. https://blog.hootsuite.com/social-media-guidelines/
  5. United Nations. Guidelines for gender-inclusive language in English. Accessed April 2, 2021. https://www.un.org/en/gender-inclusive-language/guidelines.shtml
  6. CollegeGrad. 10 Things You Should Never Post on Social Media. Accessed April 2, 2021. https://collegegrad.com/blog/10-things-you-should-never-post-on-social-media
  7. Storey V. Social Media Guidelines or Policy?  Social Media Today. May 17, 2011. Accessed April 2, 2021. https://www.socialmediatoday.com/news/social-media-guidelines-or-policy/475646/
  8. Associated Press. Social Media Guidelines for AP Employees. Revised May 2013. Accessed March 24, 2021.  https://www.ap.org/assets/documents/social-media-guidelines_tcm28-9832.pdf

Citing Online Journal Articles and Data from Repositories

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The new edition of the AMA Manual of Style is here, and it has nearly 200 more pages on everything from reference citations to the ethical and legal issues associated with medical publishing.

If the amount of new content seems overwhelming, may I suggest starting with the basics?

I dove in by reviewing the References chapter.

Online Journal References

According to section 3.11.4, “Online Journal Articles, Preprints, and Manuscripts,” the basic components of an online journal reference haven’t changed: authors’ surnames and initials, the title of the article, abbreviated name of the journal, publication year, pagination, the date the article was accessed, and the DOI or URL.

What has changed it that the date accessed should now be listed before the DOI or URL, and the URL is not followed by a period.

Data Repositories

I’ve also edited a few articles that included an analysis of data sets from a repository. Data repositories serve as archives for isolated data sets that allow data to be mined for secondary use in research. In a situation like this, the data set used and the original source for the data should be cited.

In the example shown below, the information for the original source for the data is listed first, followed by the name of depository, the date of data deposit, and the DOI for the data set.

DeLeon TT, Almquist D, Kipp BR, et al. Data from: Assessment of clinical outcomes with immune checkpoint inhibitor therapy in melanoma patients with CDKN2A and TP53 pathogenic mutations. Dryad Digital Repository. Deposited March 12, 2020. doi:10.5061/dryad.m0cfxpp0g

Accurate references are a critical element of any published article. The updated guidelines on references ensure that readers are directed to additional resources for more information.—Juliet Orellana

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

Birthplaces and Social and Economic Descriptions of Countries

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There are more examples of bias-free language in the new edition of the AMA Manual of Style, including 2 new entries in the Correct and Preferred Usage chapter, one discussing the birthplace of study participants and the other describing countries in terms of their economic and social factors.

The first new entry discusses not using the term foreign-born. We see this descriptor all the time in studies describing participants who aren’t from the country where the study was conducted but this term may be considered derogatory and should be avoided.

The easiest solution is to say that the person was born outside the country of interest or born abroad. For example, for a study that took place in the United States, use “non–US born participants” or “participants born outside the United States.” Also, it’s preferred to use US or United States vs American or America for clarity.

The second new entry is a little trickier and refers to adjectives used to describe a nation, region, or group in which most of the population lives on far less money—with far fewer basic public services—than the population in wealthy countries.

There is no universal, agreed-on criterion for describing a country in terms of its economic or human “development” and which countries fit these different categories, although there are different reference points, such as a nation’s gross domestic product per capita or the limited nation’s Human Development Index (HDI) compared with that of other nations.

The appropriate term should be based on context and respectfully reflect a specific country’s economic and social situations. The AMA Manual of Style suggests limited-income, low-income, resource-limited, resource-poor, and transitional.

Avoid the terms first world/third world and developed/developing. The term third world is pejorative and archaic, and while developing might seem like an acceptable alternative, it too can be considered pejorative and insensitive to the many complexities of metrics used to measure economic, political, resource, and social factors.

Best practice is to avoid such general terms and use specific terms that reflect what is being compared, such as low-income or high-income for an article comparing countries based on measures such as gross national product per capita.–Tracy Frey

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

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

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

Offensive Words and Apologetic Quotation Marks: Sorry Not Sorry

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News organizations everywhere had an important editorial decision to make in early January 2018 when President Trump categorized certain countries in a defamatory manner during a closed-door discussion about immigration in the Oval Office with Senators Dick Durbin and Lindsay Graham, among others.

  • “Trump decries immigrants from ‘shithole countries’ coming to US” (CNN headline)
  • “Trump derides protections for immigrants from ‘shithole’ countries” (Washington Post headline)
  • “‘Fox & Friends’ host called for Trump to clarify ‘s—hole’ comment shortly before denial” (The Hill headline)

In scientific reporting, as in politics and life, things sometimes get ugly, and when they do, we turn to apologetic quotation marks. In the examples above, the term shithole is a part of the story; without using the offensive term, the story’s meaning is lost. It’s interesting that these 3 examples apply the apologetic quotation marks in 3 different ways. The first example includes “countries” within the quotation marks, which is not necessary. The Washington Post example gets it right. And the example from The Hill is not fooling anyone. If you’re going to include it, include it. Crossing out a few letters in the offensive term is the literary equivalent to putting black bars over a patient’s eyes to make the patient “unidentifiable.” (←ironic use of apologetic quotation marks.) 

This is not a picture of my cat:

This is not an offensive word:

S—HOLE

You get the point.

The revised edition of the AMA Manual of Style will provide expanded guidance in the “Apologetic Quotation Marks” section of the Punctuation chapter, which currently only states that apologetic quotation marks are “sometimes used around words for special effect or to indicate irony.” Additional guidance will note that in some instances, the use of a potentially offensive term might be unavoidable if it is a direct quotation that is important to an article (eg, in a news story). In such cases, the offensive term may be published within quotation marks. The New York Times occasionally opens up its policy on including offensive terms in print. Ultimately, whether or not to include offensive language in an article is an editorial decision that comes down to how the term relates to the meaning of a story.—Lauren Fischer