editing process

Transitions of Note, As Such

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I come to praise the lowly transition, the chemical drain opener of scientific writing. A transition unclogs copy. Just pour it in and it works.

In our daily responsibilities, time does not always allow for an examination of language functionality at that level of detail.  More pressing concerns prevail.

In processing a manuscript into final article form for JAMA Network journals, an editor applies several rounds of detailed attention to the information. The process involves many musts. The title must not be declarative or give away the conclusion. The abstract must be complete. The type of study must be specified. The results section must include appropriate data. The methods section must identify ethical or institutional review board approval or waiver as well as informed patient consent. The statistical analysis section must specify the statistical tests used and not present P values alone without comparative data. Figure and table elements must be complete. Abbreviations must be tracked for consistent use. The discussion must include a paragraph about the limitations of the study type. The conclusions must not be overstated or absolute.

Along with including these musts, the copy must follow JAMA Network style conventions, from the picayune (no period after “vs”) to the consequential (wording presents patient first: patients with diabetes instead of diabetics). The end matter also has to follow the author contribution, conflicts of interest disclosures, and identification of funding requirements.

The introduction, methods, results, and discussion format for scientific articles lead readers from section to section. Within those sections, subheads guide readers from one major topic to another.

What about finer divisions of thought than can be accommodated by subheads? In the dash to process 3000 words according to scientific format and AMA style directives, something often gets lost in the shuffle: the utility of the transitions used to move the reader within and between paragraphs of a subsection. One could argue that if transitions go unnoticed then they have done their job. Readers have gone from point A to point B, and no one has gotten hurt.

There is no must for transitions, but the AMA Manual of Style lists 6 functions of a transition with standard examples that perform those functions.

When I review a proof after the list of musts has been confirmed, I am sometimes startled that a conjunction or transition at the paragraph level appears several times in rapid succession. Three uses of of note occur at the end of the discussion section. Four occurrences of as such appear as an opening phrase. Even that being said has slipped by although no one is actually talking. A couple of buts might more properly be ands. Suddenly I am surrounded by however, furthermore, in addition or additionally, and therefore. A little CTRL + 4 action shows 7 however, 4 furthermore, and a walloping 9 additionally uses all within a 9-page original investigation.

Gliding across all-purpose transitions is quite easy as one goes about identifying and focusing on the musts. An all-purpose transition works because it is a transition regardless of whether it functions specifically.  When faced with rapid-succession infelicities, I strike them, perhaps keeping the first. Items of note are apparent from their inclusion. As such in most cases has no actual antecedent. A congenial and from a misbegotten but adds to readability. A quick note to the author usually begets a response ranging from “ok thanks” to something a little more effusive but not overboard.

We have become accustomed to reading right past transitions perhaps because we are not striving for literary awards. No one throws a parade to celebrate a sentence whose dispatched as such has hit the bricks.

Why note how transitions are used? I’m not advocating parades, which would eat significant processing time. Accurate transition use is part of a standard of completeness. Every movement toward specificity is worthwhile to give readers a clearer view of the author’s point. With this in mind, every transition, as such, is of note.—Timothy Gray

What’s the Magic Word?

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At the beginning of this year, I had the opportunity to escape the slowing thawing tundra of Chicago to attend the 2018 Council of Science Editors Annual Meeting in sunny, Spanish moss–scented New Orleans. In between trips on the streetcar (where I resisted yelling “STELLA!!!” out the window at French Quarter passersby) and consuming half of the Western Hemisphere’s stock of powdered sugar on a plate of beignets, I—along with several women from JAMA Network (#squadgoals)—took in panels on several pressing topics in the scientific publishing community, such preprint servers, image manipulation, diversity in publication staffing, social media, and data sharing.

One of the most highly anticipated discussions was the last panel on the last day, and although conference fatigue was beginning to set in, we sipped our Diet Cokes with determination to soldier through and gain insight from “The Copy Editor–Author Relationship: A Delicate Balance.”

The panel was led by Peter Olson, Senior Copyediting Coordinator at Sheridan Press, and Jessica LaPointe, Managing Copy Editor at the American Meteorological Society. Mr Olson was the first to present and spoke on the “Anatomy of an Author Query.” He highlighted the symbiotic relationship between copy editors and authors and the various challenges that are involved in the editorial process, including tight deadlines, busy schedules, the differing interpretation of editing comments, and the need to convey complex concepts in a way that maximizes the author’s experience and answers the questions of what, when, and why. He offered 4 central tenets for copy and manuscript editors to follow when querying authors:

  1. Be clear. When queries are unclear it can confuse and/or annoy the author, and you may get an equally unclear response. You can’t assume that the author has a perspective on the comment’s meaning or on the ins and outs of your publication’s editorial process or style guide. Instead of simply asking if edits are okay, provide a brief rationale for the change being suggested and indicate if something is a journal/style requirement. When asking the author to clarify something in the text, articulate what is unclear and, if possible, suggest an edit.
  2. Be concise. If your queries are concisely worded then it saves the author time in reading and understanding them, which can make them happier with the editorial process in general. Try to imagine the author’s perspective when creating queries and consider consolidating comments into 1 query (eg, “Please approve all edits in the sentence beginning…” or “Please provide corresponding data for all P values in this paragraph”). Formulating and using standardized queries for comments that you find yourself frequently making in manuscripts can also help save time for you and the author.
  3. Be accurate. Make sure that the way you have phrased your query reflects the edits that need to be made. Although there are no doubt highly trained PhDs and statisticians among us, many manuscript editors (present company included) do not come from a scientific background, and on occasion it may be appropriate to indicate that you are unclear of the subject matter of the sentence. For example, it is better to point out a perceived inconsistency than to just make a change in cases in which the same abbreviation is used to mean 2 different things, or if a sentence has multiple subjects and it unclear to which one data are referring.
  4. Be professional. Avoid language that is informal, flippant, curt, contentious, critical, or hostile, as well as casual abbreviations and exclamation points. Instead of making an open-ended comment like “Can we be more specific here?” specify what needs to be explained. Comments like “This reference needs to be sourced” provide a directive but are not helpful in indicating what information is needed. With authors you sometimes get more with sugar than with spice, so please be sure to actually use the word please and ask them for the exact thing that you need for them to do. As my mother used to say when I pleaded for a Fruit Roll-Up or the chance to watch Bill Nye the Science Guy, “What’s the magic word?”

Ms LaPointe was up next with her presentation on “Maintaining the Delicate Balance.” She stressed the importance of using a light touch to balance editing for clarity with changing meaning and taking your time during editing to potentially lessen the number of queries you need to make. Additionally, she focused on how to work successfully with international authors and presented a series of myths on the challenges that dynamic presents:

Myth 1: Papers from Asia present particular challenges. These authors actually usually write very clearly, utilize effective editing services before submitting articles, and consult with English-speaking colleagues extensively during the writing process.

Myth 2: An extensive English-language education eliminates problems. Authors who are very familiar with English, such as European authors, may have more confidence in than ability with the language and may be reluctant to use US English.

Myth 3: Copy editors prefer editing for English speakers. I think that we can all attest that courteous, cooperative authors are the best authors, no matter where they come from!

Ms LaPointe finished her presentation with a reminder that frankly, English is hard (even for native speakers!), and pointed out some common errors to look for when working with international authors, including preposition confusion (on words such as associated, accompanied, based, center, dissimilar, identical, off, and trade), plural vs singular, disconnected sentences, word choice, the confusion of “eg” and “ie,” and the incorrect use of “et al.”

We all know that maintaining the delicate balance between applying style rules and accommodating author satisfaction can sometimes feel like being stuck in a hamster wheel, but hopefully some of these tips will prove helpful for your editorial process and professional interactions. Just remember the magic word, and if all else fails (and you don’t happen to work on a cardiology publication), you can always treat yourself to the best cure-all for all author woes—a heaping plate of beignets piled with powdered sugar.—Amanda Ehrhardt

Pop Quiz, Hotshot

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What’s the most important quality to have as a manuscript editor?

A few obvious traits come to mind, like attention to detail and command of the language and style.

When I was hired a few years ago, I wasn’t worried about developing those skills because I figured they would all get better with time and experience. My biggest worry—and what I thought was the most important quality—was speed.

I had 2 types of speed in mind. I wasn’t as worried about speed of editing for style because I knew I just needed to keep working with the style guide. After enough repetitions, of course I wouldn’t need to refer to the book as frequently, and the recognition of a style point would become recall of the answer.

No, I was most anxious about speed of reading. Obviously, reading comprehension was the key, but I even Googled how to strengthen eye muscles to prevent fatigue. Manuscript editing is sort of professional reading, so I thought the best editors should be the best readers.

I don’t know when exactly my anxiety went away. I don’t think it was just the repeated advice from my manager and coworkers—I heard that for months without it truly sinking in. But eventually, I stopped thinking about it, started focusing on other aspects to improve, and fell into a steady editing pace.

The change in thinking has been good for my sanity, but I’m not convinced my original idea is entirely wrong. Reading speed isn’t as important for me as I once feared, but I still wonder where speed ranks in the list of necessary qualities for an editor.

Freelancers, proofreaders, and managers: how important is reading speed in your job? Leave us a comment!—Kevin Brown

AMA Style in the Wild

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For many years, my best friend Conchita (not her real name—but she’ll appreciate this reference) and I lived accidentally parallel lives. We were band geeks together, shined in the back row of the chorus during high school musicals, and scrambled to compose an extremely derivative opera (a recording of which I’m pretty sure still exists, unfortunately) to satisfy a creative writing assignment in physics class. But whereas I dreaded said physics class with the fire of a thousand burning suns, Connie excelled in all things scientific. It was no surprise to me when she earned her Masters in Public Health, but it was a surprise when we both ended up in careers relating to the medical field. What was especially enjoyable was that the idle chit-chat usually reserved for whichever high school classmate had just had a baby could now be applied to hyperspecific work-related things, including our beloved AMA style.

Although initially I seized on our collective use of AMA style to complain about authors who had only used abbreviations 4 times, I became interested in learning how she used it in her corner, as I had previously assumed that AMA style was the domain of journal manuscript editors. So I gathered some questions together and polled both Connie and Edgar (name also changed), a former colleague of my fellow blogger Iris, to ask how they used AMA style in different areas of medical communications.

Edgar is an editor for a global advertising company whose clients provide products such as pharmaceuticals, medical devices, and guides relating to health and wellness. The writers and account managers creating their copy are required to be familiar with AMA style, and the style guide for each account has a template of “[X drug] uses AMA style with the following exceptions.” These exceptions usually come in the form of client preferences for the text and layout, which leaves Edgar with the challenge of how to be the resident style stickler while keeping the client’s dictates in mind. Ultimately, while a client’s spatial limitations may not allow for the correct number of thin spaces between P values, “no client style guide can match the AMA for depth and breadth” and it is an important organizing tool.   The final product represents a mix of both AMA style and client preferences, but, as Edgar puts it, “One veteran editor told me years ago, rather cheekily, ‘Not even AMA uses AMA style.’ … What he was getting at was that it’s a great tool to be adapted rather than followed in strict orthodoxy.”

In Connie’s previous role in the editorial services group of a medical communications agency, “The AMA Manual of Style was THE BIBLE. Past colleagues achieved mythical status for their ability to recall which section of the AMA manual housed the elusive answer to the day’s grammatical conundrum.” (As you can see, Connie also excelled in English class.) She now works for a pharmaceutical company in their labeling and product packaging divisions, which comes with its own set of complicated rules. The documents she works on (such as a product insert for a specific drug) are not organized with any one editorial style in mind, but rather in terms of their audience (eg, patients vs prescribers). Because these documents are written by multiple authors and pass through many hands before Connie sees them, the text can sometimes represent a hodgepodge of styles. However, because the text is also regulated by the FDA and any changes beyond simple typos would be subject to review by medical, legal, and regulatory teams, these inconsistencies often remain intact. In the rare opportunity when Connie is allowed to make edits on small items, she uses AMA style as a guide on things like italicization, reference lists, and capitalization to make her process more straightforward and efficient.

So my takeaway from these conversations is that while nobody will probably ever apply AMA style as strictly as manuscript editors do (and if we’re honest with ourselves, we probably take some proud satisfaction in that!), AMA style is a useful and important fall-back in other areas of medical communications because of its consistency, specificity, and efficiency. But for your sake, I promise that Connie and I won’t compose an opera about it.—Amanda Ehrhardt

Stranger Than Fiction

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Like many others working at JAMA Network, I’m a writer as well as an editor—and not just of blog posts! I’ve written the script for a graphic novel, Mooncakes, that will be published in 2019, and my first short story was published last year. I’ve been writing science fiction and fantasy for a long time now, but I only started working as a manuscript editor for the JAMA Network 3 years ago. Since I’ve started working here, a question I get asked frequently is: how has editing medical articles and working with AMA style affected your writing?

The short and simple answer is: not much. Science fiction writing and medical writing are such vastly different spheres that it’s pretty easy for me to ignore my medical editing brain when writing, or when I’m editing my fellow writers’ stories.

However, the long answer is a bit more complicated. I can ignore my medical editing instincts, but I can’t ever fully turn them off—I have to restrain myself from changing “though” to “although,” or “compared to” to “compared with,” if making that kind of a change would interfere with the author’s or character’s voice.

Other times, though (see what I did there?), I’ve found that listening to my AMA-editor voice has made me a better writer. For one thing, it’s encouraged me to be more succinct. My colleague Iris Lo wrote a post about removing redundancies in a manuscript, and I’ve found that this is an important guiding principle in all genres of writing. It’s especially useful when writing short stories—I have a tendency to be overly verbose in my writing, but in a tale of 4000 words or less, every word needs to matter. When I look back at my writing from 3 years ago and compare it to my writing now, I’ve found that my prose is sharper, and I’m enjoying my first publication success as a result. Most of that is just the natural shape of writing progression, but I’d be remiss if I didn’t attribute a part of it to my work here at the AMA.

And, every so often, I’ll have a character say “compared with” instead of “compared to.” Because grammar sticklers exist in every universe!—Suzanne Walker

 

 

Check It Twice

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Of all the magic a word processor can perform, I find spell-check to be the most useful, especially while editing dense medical copy. But I’m not too proud to admit that it’s not even the most sinisterly complicated words that my spell-check corrects most often. While I’m focusing on making sure “dysosteogenesis” or “hemocytopoiesis” are spelled correctly, I tend to gloss over the more commonplace language. Sometimes I’ll invert letters (“otolaryngoolgy”) or repeat articles (“the the procedure”) and, thank goodness, spell-check will catch it.

But spell-check is not without its shortcomings. It’s still just a computer program, and it isn’t tuned to the nuances of language with the same attention as a human brain. Spell-check will miss that I meant “through” when I’ve typed “though,” and of course there’s a long list of homophones that spell-check will inevitably ignore (ie, “knew/new,” “waist/waste,” “aisle/isle”). The bottom line is that reading back through your work and not relying solely on spell-check (or any automated process) to do the thinking for you could save you (and has certainly saved me!) a lot embarrassment. For example…

 

 

Spell-check couldn’t have saved those eager tweeters from themselves before they released their thoughts on followers, friends, and family. But a little more attention to detail could have. Tools like spell-check are helpful, but they’re still only tools. When it comes to writing, editing, and engaging in any form of written communication, nothing will serve you better than your own brain— and one more read-through.—Sam Wilder

Dial “A” for Author

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It’s a cold winter day, and the wind is howling. You are at your computer quietly editing a manuscript while sipping your coffee. Maybe you are in a cube at an office surrounded by matching cubes occupied by your colleagues. Maybe you are in your home office with your cat snoozing on your lap. Suddenly, you are startled by a noise. Brring, brring…brrring, brrring. Your cat springs off your lap; you spill your coffee on the keyboard. Gasp, it’s the phone! You look at the caller ID, and it’s an author to whom you recently sent an edited manuscript with many queries. Your heart races. What should you do? Should you answer? Should you pretend you’re not there, curl up in a ball with the cat under your desk, and wait for a voicemail?

I think that many of us at some point in our careers have felt dread when the phone rings. We may fear that an author is going call us to express disapproval or even anger about our edits and want to fight about style. And some of us are so introverted, we don’t like talking on the phone in general. The author call can be daunting, but remember that copy editors and authors have the same goal–to communicate the authors’ research accurately, consistently, clearly, and according to AMA style.

I find that most author phone calls are simply for clarity about the edits or for questions about publication information. However, in some instances, authors will insist on providing their comments on all of the edits over the phone. Communicating more than a few changes over the phone leaves a lot of room for error, can be time consuming, and relies on good note-taking. To avoid this situation, I usually suggest to the author that they provide their edits in an email or a marked-up version of their manuscript to ensure that their edits are accurately incorporated into the document.

On (hopefully) rare occasions, authors will call to express distaste with the edits. My strategy is to be calm, listen, and wait for the author’s exasperation to pass. We may need to negotiate with authors. If they insist on using a term that is contrary to style that I can’t budge on, I offer them a style variation that they want elswehere in the manuscript for which the rules are less strict. But if the author is really disrespectful, I let the appropriate person know. It’s not fair to be belittled for doing our job.

Then there are the authors who enjoy a personal connection and just like to chat. I recently had an author call me and tell me about his chihuahua. I am always up to talk about pets in the midst of reading about medical conditions all day. Even though the call required some time out of my busy day, the author was appreciative of my willingness to chat.

It’s always possible that you will work with an author again in the future, so it’s never a bad idea to establish a cordial, trusting relationship through open communication. So we must take a deep breath, answer that phone, put on our best nice voice, and be ready to cite the AMA Manual of Style.—Sara M. Billings

Living With Style

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Did you know that the Chicago Museum of Science and Industry doesn’t follow AMA style? Here’s proof:

There are a few things I would change if I could edit that. Amanda, author of “People-First Language,” texted this to me and a few other JAMA Network editors a few weeks ago. It got me thinking about some stuff. Namely: am I becoming a style snob?

I know I’m not a grammar snob. I’m a lazy talker who don’t always speak good. No matter how many times I’m corrected, “my friends and I” never hang out, but “me and my friends” do. I don’t really care about parallel structure or flat adverbs when talking because—when it comes to speech—I think communication is more important than talking proper.

But that’s grammar. Like Amanda, I’m noticing style in everyday life, and I can’t not want to correct it. Whenever my girlfriend talks about side effects, I mutter “adverse” under my breath. I joke with a friend that she isn’t “suffering” through the day but simply “experiencing” it. I’m starting to change “compared to”s to “compared with”s on the fly when reading children’s books aloud. Seriously: I’m starting to change children’s books to style.

All of this is pretty harmless, and I’d imagine my manager is happy that some style changes are becoming automatic. But outside of work? I don’t want to be so automatic that I change, for example, “Alzheimer’s” to “Alzheimer,” shifting the focus of the conversation from illness to eponyms and the nonvirtue of ’s. I don’t want to derail trains of thought because I keep mumbling corrections when listening to people talk. I don’t want to be a style snob.

I’ve only been editing exclusively to AMA style for 2 years. For those with more time dedicated to one style guide: how bad have you gotten? Leave us a comment!—Kevin Brown

Get to the Point!

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Here comes Hank. Too late, he’s spotted you, and now you’re in for another story—or rather, a litany of unnecessary details. “I said this, and she said that, and then I said, ‘Really!’” Hank never edits himself; he simply tells you E-V-E-R-Y-T-H-I-N-G until you’re screaming inwardly, “Get to the point!”

While editing manuscripts, I periodically encounter a “Hank” author. Every tidbit of information is important and, in his view, absolutely necessary. Along with his manuscript, which includes the maximum-allowed 5 tables and/or figures, he provides a Supplement that comprises 3 eMethods sections, an eResults, 14 eTables, and 9 eFigures. Data, data, and more data, until the Supplement resembles a closet stuffed by an 8-year-old who was told to clean her room. Everything. It’s all in there.

Consider the busy physician-reader. After perusing the array of freshly published articles in the journal website’s New Online section, she may click on Hank’s title and see that long list of supplemental material populating the scholar’s margin. However transparent the author endeavored to be by providing so much information, she doesn’t have time to read it all now; she needs summaries.

AMA style advocates that “tables and figures demonstrate relationships among data and other types of information” and that “a figure should be used if the relationships are complex….Like a paragraph, each…figure should be cohesive and focused.”

With that reader in mind, the manuscript editor reformats the author’s originally supplied figures to journal style and hones each one to present the material clearly. No chartjunk, no extraneous elements, no distracting line treatments.

Flow diagrams show the numerical progression of patients through the study: the number screened for inclusion, the number excluded for these reasons, the number enrolled, and the number at each stage, with those excluded or lost to follow-up at each stage also accounted for. The last box shows how many patients made it to the end of the study or were included in the primary analysis. From top to bottom, the progression of numbers makes perfect arithmetic sense.

Figures of multiple clinical, radiologic, or histologic images are labeled to guide the reader: before surgery, 6 months after surgery, 2 years later; magnetic resonance images of brains from patients 1 and 4; or specimens from a healthy individual and a patient with disease preceding another from the patient 1 year after treatment.

Graphs are appropriate to the data presented: bars for frequencies, data markers and error bars for summary data, forest plots for meta-analyses. All axes and ticks are clearly labeled, curves are identified by direct labeling or by the inclusion of concise figure keys, and bars and data markers are a solid color for the patients who received treatment and without color for those who received placebo. The numbers of patients at risk at each time point lend additional meaning to Kaplan-Meier survival curves. Forest plots include numerical data in addition to the illustrated plot points, with labels on either side of the graph’s vertical line at 1.0 to indicate whether each data marker’s location favored treatment or no treatment.

Back to our reader. Time is short, so she starts with the abstract. Words are read quickly, their meaning filtered through her years of accumulated knowledge and absorbed. She takes in the tables next. Row upon row of data; numbers represent baseline characteristics, laboratory results, and statistical analysis. Again, the numbers are filtered for meaning and digested for information that can help the reader treat her own patients. She studies the figures, and their meaning is immediately apparent: the bar for affected patients from one age group is taller, a survival curve is higher and longer for patients who received the lower dosage, the difference between 2 clinical images before and after treatment is obvious. No filter needed. Instantly clear. Results from years of the author’s research are visually summarized, seen by the reader, grasped, and understood.

The Supplement stands ready for closer investigation, but first the point must not be obscured. State it—illustrate it—clearly.—Connie Manno, ELS

 

 

 

Discard the Rest

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For several years, I have had a healthy curiosity with minimalism. I’ve listened to TED talks and watched documentaries about the topic and pared down my items accordingly. Last year, I read The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing by Marie Kondo. The author describes a process in which you go through every item you own, keep only what sparks joy or is necessary, and discard the rest. Once you have tidied up your belongings, your mind is free to tackle other issues. This process resonated with me, perhaps because it seemed quite similar to my approach to medical editing.

Part of our job as editors is to remove redundancy in manuscripts—to tidy it up, if you will. We go through a manuscript word for word and carefully discard what phrases or words that do not serve the science (with the author’s approval, of course). Omitting unnecessary words can improve readability. In making an author’s work clearer and more concise, readers are able to tackle other issues, such as responding to the research or designing their own studies. Moreover, scientific writing should be as precise as possible to avoid misinterpretation. Below are some tips, adapted from AMA Manual of Style 11.1.

Some common redundancies that can typically be avoided (redundant words are italicized):

  • first initiated
  • skin rash
  • herein we describe
  • past history
  • period of time, time period, point in time
  • whether or not [unless the intent is to give equal emphasis to the alternative]
  • younger [older] than 50 years of age

Here are some common words and phrases that can usually be omitted without affecting meaning:

  • as already stated
  • it goes without saying
  • it is important [interesting] to note
  • it was demonstrated that
  • take steps to

And here are some expressions to avoid and what to use instead:

Avoid Better
in terms of in, of, for
an increased [decreased] number of more [fewer]
as the result of because of
during the time that while
in close proximity to near
in regard to, with regard to about, regarding
the majority of most
have an effect [impact] on affect

When editing and reducing redundancy, a balance must be struck. Deleting or rewriting too much may lead to accidentally altering the author’s intended meaning, which could adversely affect the author-editor relationship or perhaps even result in a correction after publication. I have been tempted to rewrite sentences, but I have to remind myself that this is the author’s work, not mine. Our responsibility as manuscript editors is to make a research paper as readable as possible so the science is the main focus.—Iris Y. Lo