usage

Top 10 Mistakes Authors Make

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Publishing a style manual, particularly a lengthy, detailed manual that covers a ridiculous amount of technical material (Hello, AMA Manual of Style!), is a grueling process. In our case, it involved 10 people meeting for at least an hour every week for more than a year, where we tried not to get into arguments about grammar, usage, and the presentation of scientific data. After the meetings there would usually be flurries of e-mails about grammar, usage, and the presentation of scientific data. Then we’d all go home and dream about grammar, usage, and the presentation of scientific data. You get the picture.

My point is that the writers of style manuals are often a little, shall we say, too close to the material. In the case of the AMA Manual of Style, we are all editors as well—and it can be hard for us not to roll our eyes when we run into the same problems on manuscript after manuscript. Come on, authors: there’s a whole book on this stuff!

Which, of course, is precisely the problem. There is a whole THOUSAND-PAGE book that tries to encompass all aspects of medical editing. It’s impossible to expect authors to absorb all the information–they’re just trying to get published, and it’s our job to help them. Here, in classic top-10-list reverse order, are the top 10 editorial problems we see in our submitted and accepted manuscripts, compiled by committee and editorialized upon by me. If any authors happen to read this, maybe it will help them avoid the most common errors; if any journal website–design people read it, maybe they can grab some ideas for more explicit user interface; and if any copy editors read it, maybe they can enjoy shaking their heads in wry commiseration.

10. Missing or incomplete author forms. Most journals require authors to fill out some forms, usually involving things like copyright transfer, an assertion of responsibility for authorship, and so on. These forms are often filled out incorrectly or incompletely. Following a form’s instructions as to signatures and boxes to check can save significant amounts of time in the publication process.

9. Not explaining “behind the scenes” stuff. Values in a table don’t add up—oh, it’s because of rounding. The curve in this figure doesn’t connect the values listed in the “Results” section—oh, we used data smoothing. This kind of thing can be easily explained in a footnote, but many authors forget to do so because it seems so obvious to them.

8. Making life difficult for the copy editor. Authors and editors have the same goal: a polished, published, accurate manuscript. Sure-fire ways authors can ruin what should be a pleasant working relationship are to suggest that the copy editor is making changes in the manuscript for no reason; calling the copy editor to discuss changes without having read the edited manuscript first (this wastes oodles of time); and not reading the cover letter that comes with the edited manuscript. This last is particularly charming when the author then calls the copy editor to ask all the questions that are very nicely answered in said cover letter.

7. Common punctuation and style mistakes (not an exhaustive list). Most frequently we see authors fail to expand abbreviations; use different abbreviations for the same term throughout a manuscript; use commas like seasoning instead of like punctuation marks with actual rules of deployment; and overuse the em dash. However, I’d like to tell any authors reading this not to fret, because that’s the kind of stuff we’re paid to fix. Plus I can’t really throw stones—being a fan of the em dash myself.

6. Errors of grandiosity. Sometimes a perfectly nice and valid study will go hog-wild in the conclusion, claiming to be changing the future of scientific inquiry or heralding a sea-change in the treatment of patients everywhere. Or authors will selectively interpret results, focusing on the positive and ignoring the negative or neutral. It’s natural to want to write an elegant conclusion—it’s one of the few places in a scientific manuscript where one can really let loose with the prose—but it’s always better to err on the side of caution.

5. Wacky references. All journals have a reference citation policy, and across scientific journals it is fairly standard to give reference numbers at the point of citation, cite references in numerical order in the text (as opposed to only in tables or figures), and retain a unique number for each reference no matter how many times it’s cited. However, we still get papers with references handled in all kinds of odd ways (alphabetical, chronological, or seemingly inspired by the full moon). References that include URLs can mean big problems. Often the URL doesn’t work or the site is password-protected, subscription-only, or otherwise useless to the reader. Also aggravating: references that are just the result of the search string for the article and not the URL for the article itself.

4. Duplicate submission. In scientific publication, it is not acceptable to submit a report of original research to multiple journals at the same time. Journal editors are likely to be more disturbed by this if it looks deliberate rather than like a simple mistake (not realizing that a foreign-language journal “counts,” for example) or if the case is debatable (a small section of results was published in another paper, but the new paper adds tons of new material). Remember those forms from the 10th most common mistake? One of them asks about previous submission or publication. We need authors to be up-front about any other articles in the pipeline, even if (especially if) they’re not sure if they might constitute duplicate publication.

3. Failing to protect patient identity. Yup, there’s a form for this too! Any time a patient is identifiable, in a photograph or even in text (as in a case report), authors must have the patient’s consent. (Contrary to popular belief, the gossip-mag-style “black bars” over the eyes are not sufficient to conceal identity.) Usually we hear complaints about this, because studies are written long after patients are treated and it can be hard to track people down, but them’s the breaks. If it’s really impossible to obtain after-the-fact patient consent, editors will work with authors to crop photos, take out details, or whatever it takes to “de-identify” patients.

2. Not matching up all the data “bits.” In the abstract, 76 patients were randomized to receive the intervention, but it’s 77 in Table 1. There was a 44.5% reduction in symptoms in the medicated group in the text, but later it’s 44.7%. Sometimes this is because the abstract is written first from the overall results, while the data in a table are more precisely calculated by a statistician; or maybe the number of patients changed along the way and no one went back to revise the earlier data. Either way, it drives copy editors crazy.

1. Not reading a journal’s Instructions for Authors. These days almost all scientific journals have online submission, and almost always there is a link to something called “Information for Authors,” “Guidelines for Manuscript Submission,” or something similar. Judging by the kinds of questions editorial offices receive almost daily, authors rarely read these—but the publication process would often go so much more smoothly if they would.

We are proud of our style manual, although we realize it isn’t the last word in scientific style and format. There can never really be a “last word” because some editor will always want to have it! Anyway, without authors there wouldn’t be anything to edit, so we would never hold any “mistakes” against them. No matter how grievous a manuscript’s misstep, an editor will be there to correct it, because it’s our job. (But mostly because we can’t stop ourselves.)—Brenda Gregoline, ELS

 

Going the Distance: Further or Farther?

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A medical editor who in a manuscript meeting asks, “Should we take this manuscript farther?” sparks the idea for this discussion on the grounds that farther suggests distance and further, “quantity or degree.”1

 
Once decided, the examples of variant use jump unexpectedly forward without my having to crack a book:

• Jack Shephard, spinal surgeon and Lost castaway, pauses amid the lush tropical foliage to ask his guide to Jacob’s lighthouse, “How much further, Hurley?”2 He’s a spine surgeon, not a brain surgeon, I think smugly, feeling confirmed in my theory that fictional characters are only as smart as the people who create them.
• The writer of a blurb on the Adventure Cycle Association itinerary3 for a guided bicycle trip in the Blue Ridge Mountains gets it right when describing what’s in store for riders after they reach Mabry Mill: “Approximately five miles farther down the road, you might want to take a detour of less than a mile off the parkway for a tour and a taste at the popular Chateau Morrisette winery.”
• I am sitting at an Italian restaurant celebrating the birthdays of 2 manuscript editors. Talking about my running schedule, I say that my weekly distance “will extend further.” I pause. “That would be farther.” I smile, lift my brows, and announce that I have selected further and farther for my blog entry.

But once I crack the dictionary and English-language usage books, my smugness at knowing the difference between the two dissolves, for the words “have been used more or less interchangeably throughout most of their history,” says the 11th edition of Merriam-Webster’s Collegiate Dictionary, which allots 11 lines to a discussion of their usage differences, adding that they “are showing signs of diverging.” First, noting that they are not used differently as adverbs “whenever spatial, temporal, or metaphorical distance is involved,” the entry says they “diverge” when the meaning is not conveying distance. In that case, “further is used.” Furthermore, when used as a transitional adverb announcing that the sentence aims to advance a point, the entry says further is used, but farther is not. (However, further is usually changed to furthermore in JAMA in such instances.) Adjectivally, the usage entry continues, “Farther is taking over the meaning of distance.”

 
To put it in perspective, Webster’s Dictionary of English Usage devotes 3 columns to the discussion that begins, “About every usage commentator in the 20th century … has had something to say about farther and further… as to how they should be used or how they seem to be used.”1 This explanation comes after first noting that few of the commentators have ventured little beyond a 1906 “pronouncement”:

Farther should be used to designate longitudinal distance; further to signify quantity or degree.

Webster’s says that farther and further “are historically the same word” and concludes that their interchangeable use is after all “not surprising.” To buttress the claim that they have the same origin and that they did not stem from the word far, the Webster’s entry reports that, of the two, further is older and “appears to have originated as the comparative form of a Germanic ancestor of the English forth,” whereas “farther originated in Middle English as a variant of further that was influenced by the comparative (spelled ferre) of far (then spelled fer) which it (and further) eventually replaced.”

 
The rest of the entry provides examples of usage, noting when grammatical usage for one eclipses the use by the other. In modern English, Webster’s says that further “used in the sense ‘additional’ … has taken over…” But farther is more frequently used adjectivally when “literal or figurative distance is involved.”

 
The Chicago Manual of Style4 and The Associated Press Stylebook and Libel Manual5 echo the 1906 pronouncement and distinguish the two by distance and degree. However, swerving slightly, the seventh edition of Scientific Style and Format6 suggests that the use of farther as an adverb works for physical or nonphysical distance and suggests that further be reserved for use as a transitive verb: “His theory did little to further our knowledge of the oldest galaxies.”

 
After examining the language usage explanations of the 2 words, perhaps the commentators who have not ventured further than the 1906 pronouncement offer the best understood explanation. I could go farther, but I won’t. —Beverly Stewart, MSJ

1. Webster’s Dictionary of English Usage. Springfield, MA: Merriam-Webster Inc; 1989.
2. Lighthouse. Lost. ABC television. February 23, 2010.
3. Adventure Cycling Association. Blue Ridge Bliss: tour itinerary. http://www.adventurecycling.org/tours/tourdetail.cfm?id=175&t=EV10&p=3. Accessed September 25, 2012.
4. The Chicago Manual of Style: The Essential Guide for Writers, Editors, and Publishers. 15th ed. Chicago, IL: University of Chicago Press; 2003.
5. Goldstein N, ed. The Associated Press Stylebook and Briefing on Media Law. New York, NY: Basic Books; 2007.
6. Council of Science Editors. Scientific Style and Format: The CSE Manual for Authors, Editors, and Publishers. 7th ed. Reston, VA: Council of Science Editors in cooperation with Rockefeller University Press; 2006.

A Peek at a Trio of Homophones to Pique Your Interest and Provide Peak Enjoyment

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Grammarians who pen English usage guides do not seem piqued at the misuse of the words peek, peak, and pique. Theodore M. Bernstein notes only that piqued “takes [the] preposition at or by.” Even college-level writers’ guides make little fuss. Flipping to the usage sections of several writers’ guides, one finds a no-show for the peeks. Webster’s Dictionary of English Usage, however, writes that “[t]hese homophones have a way of being muddled by nodding writers.” Relying on former newspaper columnist and grammarian James J. Kilpatrick, who had caught misuses among the peaks in various news publications, the entry notes that peak most frequently edged out its competitors and inappropriately made its way into print. The entry ends by warning writers “to keep the meaning in mind and match it to the correct spelling.”

English usage of peek is traced to 1374 and stems from the Middle English piken, which some sources speculate comes from the Middle Dutch kieken. Peek means “to glance at quickly, or to peer at furtively, as from a place of concealment.” As a verb, it means that something is “only partially visible…[t]iny crocuses peeked through the snow.” The expression peek-a-boo is “attested from 1599,” according to the Random House Dictionary.

Peak is traced to 1520-1530, perhaps from the Middle Low German words pick and pike, according to Random House. As a noun it has several meanings, some of which point to the top of a mountain, ridge, or summit. It can also be used to describe a “projecting part of a garment,” as in the bill of a hat. Nautically, it means the “upper most corner of a fore-and-aft sail” or the “narrow part of a ship’s bow.” As an intransitive verb, it means reaching “maximum capacity, value, or activity,” as in “My running pace peaked at 10 minutes per mile.” Similarly, as an adjective, reaching peak levels demonstrates that one has maxed out.

In a less common usage, those who grow sick or thin are sometimes spoken of as having peaked or “dwindled away” or, as an adjective, being peaked (2 syllables), “being pale and wan or emaciated: sickly.”

Emotion rules pique. It stems from the Vulgar Latin verb piccare, “to pick,” and its usage in English is traced to 1525-1535. It is menacingly linked with pickax and pike. As a noun, it is defined as “a transient feeling of wounded vanity.” Or, as one might say of a woman scorned, “She’s in a fit of pique.” But a woman moves quickly on, pique being a transient emotion. As a verb it means that someone has been “aroused” to “anger or resentment.” Or, as I like to use it, aroused to the state of curiosity.

Although they sound alike and to an extent they look alike, the piques are as different as … Has your interest peaked? (Begs for a pun, doesn’t it?)—Beverly Stewart, MSJ

Around, About, Approximately

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Although each of these words is used to refer to a value that is estimated and therefore imprecise, whether it is acceptable to use them interchangeably depends in part on context and the level of accuracy being implied.

Some speakers and writers will use approximately before turning to the other two—not surprising, because people faced with a choice between words will often choose the most impressive-sounding one. And sometimes that choice happens to be correct. On the other hand, people will often, especially in casual communications, use around or about as a sort of verbal shorthand. And again, sometimes that choice happens to be correct.

So, what’s the scoop? To sort this out, it helps to recognize that authorities for the most part agree that around, about, and approximately lie on a scale from casual to formal. As it happens, around is also thought of as the most imprecise and approximately the most precise, with about falling somewhere in between. It further helps to note that around, meaning merely “with some approach to exactness,”1(p68) is not widely considered an adequate replacement for either about or approximately and thus is often accepted only in casual conversation.2 Hence, in conversation between friends, for example, many speakers will toss off a “See ya around three,” whereas in written communications, as Bernstein maintains, “‘about three o’clock’ is preferable to ‘around three o’clock.’”2

Things get a bit more complicated as one moves along the scale: not only does the choice of word depend in part on the closeness to accuracy required by different types of communication, but the differences between the implied degrees of closeness can be subtle. For example, Merriam-Webster’s defines about as “reasonably close to”1(p4) and approximately as “nearly correct or exact.”1(p61) However, it is safe to say that in nontechnical communications (which presumably often place less emphasis on precision), the use of about is not only accepted but is perhaps preferred. As Garner maintains, “When possible, use about instead of approximately, a formal word”3(p5)—where a “formal” word is defined simply as one “occupying an elevated level of diction.”3(pp153-154) On the other hand, as suggested by the above definitions, about does not emphasize a closeness to accuracy as strongly as approximately does—which helps explain why about seems fine when used to refer to estimated values that have been rounded to multiples of 5 or 10 but can seem strange when used to refer to unrounded values.4 Moreover, around and about each have multiple meanings and can be used in other senses, whereas approximately is used in a single sense only, leading some authorities to maintain that the latter is a better choice for technical communications.5

The bottom line:

● Referring to an inexact value in casual conversation? Around, about, and approximately are all acceptable, but approximately can sound a bit pretentious.

● Referring to an inexact value in nontechnical writing? About is perhaps the best choice, around being too informal and approximately being a tad too formal.

● Referring to an inexact value in medical or other technical writing? Although about may very occasionally be used if one carefully assesses the context, approximately is nearly always the best choice.—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

2. Around. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:44-45.

3. Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000.

4. Yateendra J. About and Around and Approximately: Shades of Difference? Editage website. http://blog.editage.com/about-and-around-and-approximately-shades-of-difference. Accessed August 1, 2012.

5. Scientific English as a Foreign Language: Around, About, Approximately. Worcester Polytechnic Institute website. http://users.wpi.edu/~nab/sci_eng/97_Jun_20.html. 1997. Accessed August 1, 2012.

Questions From Users of the Manual

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Q: How can a user of your online manual tell if use of a particular word (such as namely) is discouraged?

A:  The first place to look might be chapter 11, Correct and Preferred Usage. But the word you used as an example is not included therein. Or you could try a search in the online manual for the word in question. But that too produces nothing helpful, most likely because we have no “official” policy on this word. Next you might consult a good usage book or the usage notes in the American Heritage Dictionary. Finding nothing anywhere, you could decide on a policy for your publication or the document you are working on, if this seems appropriate or desirable.

Q:  Several questions about the citation of abstracts in a reference list.

  • Section 3.11.9 (Abstracts and Other Material Taken From Another Source) states on page 50 that for abstracts published in the society proceedings of a journal, “the name of the society before which the paper was read need not be included” and that “if a[n abstract] number is included, it is placed in brackets along with the ‘abstract’ designation.” What is not made clear is whether including an “abstract” designation is mandatory or voluntary.   

Should an “abstract” designation be included in the citation to an abstract published in the society proceedings of a journal if neither the society’s name nor an abstract number is being provided? In other words, using example 3 of the book as a base, which of the following would be correct?  

  •  . . . Lemli-Opitz syndrome. Invest Ophthalmol Vis Sci. 2001;42(suppl):S627.  (the reference is not identified as being an abstract)

        or

  • . . . Lemli-Opitz syndrome [abstract]. Invest Ophthalmol Vis Sci. 2001;42(suppl):S627.  (the reference is identified as being an abstract)

If the “[abstract]” designation is not mandatory, is it AMA style to delete it when an author includes it (without an accompanying society name or abstract number) in such a reference?

Also, if an abstract is given an abstract number in the place where it is published, is it considered mandatory or voluntary for its number to be included in the reference citation? The text in the manual says “if a number is included” but the meaning of this is possibly ambiguous (included by the journal in which it was published; or voluntarily included by the author who submits the manuscript as a matter of the submitting author’s preference? It seems most likely that it is the latter, but I’m not certain). 

A:  In order:

  • The if  is meant to signify that the designation as an abstract should be included if it is provided.
  • The second version you provided would be preferred. It’s a nice service to readers to let them know that what is referenced is an abstract.
  • Absolutely not. We would never delete it. It too provides a service to readers, helping them to find the abstract referred to, should they be so inclined.
  • You interpreted the manual correctly—the latter is what is intended.—Cheryl Iverson, MA

Anticipate, Expect

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Although the use of anticipate and expect as synonyms is now largely accepted,1 at least in casual communications, the careful writer will do well to note that some authorities still hold that there is a subtle difference between them.1-3

Although both words refer to a person’s attitude toward a future event, they differ in what they convey about that attitude. For example, some observers hold that the difference between the words relates to the level of certainty toward the future event (ie, anticipate implies that a person is certain that the event will take place, whereas expect implies only that a person predicts that the event will take place3). However, this weak distinction is easily blurred, and in practice it seems that it is not often upheld. A stronger and more often upheld distinction maintains that anticipate is the stronger of the two words, connoting that some action has been taken to prepare for the foreseen event.2,3 This sense possibly arose from an early (late 1500s) use, “To seize or take possession of beforehand.”4 Although that use is now obsolete, by the early 1600s anticipate was being used to suggest simply “to take action beforehand,” a meaning still current.4 Bernstein points out that such action “Need not be taken so literally as to mean the performance of an overt act; it may simply connote an advance accommodation of the mind or the senses, even involuntarily, to the coming event.”2

In any case, if anticipate suggests the taking of some sort of action to prepare for an expected event, it seems clear that one should perhaps not use it when wishing to convey only simple expectation. Interestingly enough, even those who consider anticipate and expect synonyms do not extend the same acceptance to the synonymous use of unanticipated and unexpected.1

The misuse of anticipate in place of expect likely arose from the tendency common among writers and speakers to use larger words.5(pp22-23) It also is an example of what Garner terms “slipshod extension”5(pp22-23)—“the mistaken stretching of a word beyond its accepted meanings, the mistake lying in a misunderstanding of the true sense.”5(pp307-308) Garner further maintains that the use of anticipate in the sense of “to await eagerly” is also incorrect and points out that such use is also likely the result of slipshod extension.5(pp22-23)

The bottom line:

● Referring to a person’s attitude toward a future event? Using anticipate and expect interchangeably is likely acceptable in casual communications, but in more formal contexts one should take care to observe the subtle differences between them.

● Referring to the simple expectation of a foreseen event? Use expect.

● Referring to a state of taking action—whether that action be either concrete, mental, or emotional—in preparation for a foreseen event? Use anticipate.—Phil Sefton, ELS

1. Anticipate. The Free Dictionary website. http://www.thefreedictionary.com/p/anticipate. Accessed June 8, 2012.

2. Anticipate, expect. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:44-45.

3. Anticipate or Expect: What’s Next? Grammatically Correct website. http://www.uhv.edu/ac/newsletters/writing/grammartip2008.05.28.htm. Accessed June 8, 2012.

4. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991: 58.

5. Anticipate. In: Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000.

Right, Almost Right, and Just Plain Wrong: Spelling (and Spacing) Variations

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It is now the work of years for children to learn to spell; and after all, the business is rarely accomplished. A few men, who are bred to some business that requires constant exercise in writing, finally learn to spell most words without hesitation; but most people remain, all their lives, imperfect masters of spelling, and liable to make mistakes, whenever they take up a pen to write a short note. Nay, many people, even of education and fashion, never attempt to write a letter, without frequently consulting a dictionary.—Noah Webster1

The primary nonmedical/nonscientific dictionary used at JAMA and the Archives Journals is Merriam-Webster’s Collegiate Dictionary, and the medical/scientific dictionary of record is Dorland’s Illustrated Medical Dictionary. In the list given below, we show the preferred spelling of frequently misspelled scientific and nonscientific words as indicated by Webster’s and Dorland’s.

Whereas Webster’s shows equal or secondary variants in the entry “head,” Dorland’s uses a single term for the entry head but lists cross-references for variant spellings at the end of the entry for the preferred term. But note that Webster’s also often includes variant spellings in its entries (eg, aesthetic and esthetic). These “equal variants” are indicated by or. If they are given in alphabetical order, “they occur with equal or nearly equal frequency.” If they are given out of alphabetical order, but still joined by or, the first is slightly more common than the second. If they are joined by also, the word given second “occurs appreciably less often” than the first and is considered a “secondary variant.”

The front matter of Webster’s also notes: “Other spelling variants may be flagged with var with some further brief explanation, for example, metre … chiefly Brit var of meter.” Exception: Variant spellings that appear in direct, written (eg, published) quotations should not be changed to US variants.

To maintain consistency within their journals, the editors of JAMA and the Archives Journals prefer the first spelling of the entry of any given word.

Right and Almost Right

acknowledgment (equal variant, out of alphabetical order: acknowledgement)

aesthetic (secondary variant: esthetic)

breastfeeding (Webster’s: breast-feeding)

cutoff (as noun or adjective)

cut off (as verb)

distention (as given in Dorland’s; equal variant in Webster’s: distension)

judgment (equal variant, out of alphabetical order: judgement)

phosphorus (as noun)

phosphorous (as adjective)

sulfur (secondary variant: sulphur)

supersede (secondary variant: supercede)

Just Plain Wrong

accommodate (not accomodate)

ancillary (not ancilary)

arrhythmia (not arhythmia)

brussels sprouts (not brussel sprouts)

cholecystectomy (not cholecysectomy)

consensus (not concensus)

cribriform (not cribiform)

desiccate (not dessicate)

diphtheria (not diptheria)

dyspnea (not dysnea)

embarrass (not embarass)

erythematosus (not erythematosis)

Escherichia (not Echerichia)

fluorescent (not florescent)

fluorouracil (not flourouracil)

Haemophilus (not Hemophilus)

harass (not harrass)

hematopoietic (not hematopoetic)

Legionella pneumophila (not Legionella pneumophilia)

levothyroxine (not levothyroxin)

millennium (not millenium)

minuscule (not miniscule)

Neisseria gonorrhoeae (not Neisseria gonorrhea)

ophthalmology (not opthalmology)

Papanicolaou (not Papanicolou)

pertussis (not pertussus)

pruritus (not pruritis)

sagittal (not saggital)

sinusitis (not sinusitus)

sphygmomanometer (not sphygomamometer)

sulfide (not sulphide)

syphilis (not syphillis)

unwieldy (not unwieldly)

Now, this is nice and neat. But what if the 2 principal dictionaries (medical and nonmedical) differ on the preferred spelling of a word? Which to follow? We make such decisions on a case-by-case basis. For example, anti-inflammatory in Webster’s was chosen instead of antiinflammatory in Dorland’s because the former was considered to be expressed more clearly with a hyphen between the 2 i’s. Similarly, workup (as a noun, meaning a thorough evaluation to arrive at a diagnosis) was chosen over work-up. (But: Use work up as a verb!)

Spacing and punctuation (to hyphenate or not to hyphenate) add further questions of variation. These too are decided on a case-by-case basis. Below is a small sample of some of these decisions.

cost-effective, cost-effectiveness (not cost effective, cost effectiveness)

end point (not endpoint)

health care (not healthcare)

policy maker (not policymaker)

under way (not underway)

A final word to the wise: Until spell-checkers include a read-my-mind function, do not rely on them for solving spelling problems!—Roxanne K. Young, ELS

1. Webster N. An essay on the necessity, advantages, and practicality of reforming the mode of spelling and of rendering the orthography of words correspondent to pronunciation. In: Dissertations on the English Language: With Notes, Historical and Critical, to Which Is Added, by Way of Appendix, an Essay on a Reformed Mode of Spelling, With Dr. Franklin’s Arguments on That Subject. Boston, MA: 1789.

Bucking the “Trend” and Approaching “Approaching Significance”

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I believe we are on an irreversible trend toward more freedom and democracy – but that could change.

—Dan Quayle

In general usage, the concept of trend implies movement. Not only is this implied in its definitions, but the word can be traced to its Middle High German root of trendel, which is a disk or spinning top.1

In scientific writing, when is a trend not a trend? When it is not referring to comparisons of findings across an ordered series of categories or across periods of time. However, this and related terms are often misused in manuscripts and articles.

Most studies are constructed as hypothesis testing. Because an individual study only provides a point estimate of the truth, the researchers must determine before conducting the study an acceptable cutoff for the probability that a finding of an association is due to chance (the α value, most commonly but not universally set at .05 in clinical studies). This creates a dichotomous situation in interpreting the result: the study either does or does not meet this criterion. If the criterion is met, the finding is described as “statistically significant”; if it is not met, the finding is described as “not statistically significant.”

There are many limitations to this approach. Where the α level is set is arbitrary; therefore, in general all findings should be expressed as the study’s point estimate and confidence interval, rather than just the study estimate and the P value. Despite the limitations, if a researcher designs a study on the basis of hypothesis testing, it is not appropriate to change the rules after the results are available, and the results should be interpreted accordingly. The entire study design (such as calculation of the sample size and study power – the ability of a study to detect an actual difference or effect, if one truly exists) is dependent on setting the rules in advance and adhering to them.

If a study does not meet the significance criterion (for example, if the α level was set as < .05, and the P value for the finding was .08), authors sometimes describe the findings as “trending toward significance,” “having a trend toward significance,” “approaching significance,” “borderline significant,” or “nearly significant.” None of these terms is correct. Results do not trend toward significant—they either are or are not statistically significant based on the prespecified study assumptions. Similarly, the results do not include any movement and so cannot “approach” significance; and because of the dichotomous definition, “nearly significant” is no more meaningful than “nearly pregnant.”

When a finding does not meet statistical significance, there are generally 2 possible explanations: (1) There is no real association. (2) There might be an association, but the study was underpowered to detect it, usually because there were not enough participants or outcome events. A finding that does not meet statistical significance may still be clinically important and warrant further consideration.

However, when authors use terms such as trend or approaching significance, they are hedging the interpretation. In effect, they are treating the findings as if the association were statistically significant, or as if it might have been if the study had just gone a little differently. This is not justified. (Lang and Secic2 make the fascinating observation that “Curiously, P values never seem to ‘trend’ away from significance.”)

A proper use of the term trend refers to the results of one of the specific statistical tests for trend, the purpose of which is to estimate the likelihood that differences across 3 or more groups move (increase or decrease) in a meaningful direction more than would be expected by chance. For example, if a population of persons is ranked by evenly divided quintiles based on serum cholesterol level (from lowest to highest), and the risk of subsequent myocardial infarction is measured in each group, the researcher may want to determine whether risk increases in a linear way across the groups. Statistical tests that might be used for analyzing trends include the χ2 test for trend and the Cochran-Armitage test.

Similarly, a researcher may want to test for a directional movement in the values of data over time, such as a month-to-month decrease in prescriptions of a medication following publication of an article describing major adverse effects. A number of analytic approaches can be used for this, including time series and other regression models.

Instead of using these terms, the options are:

1. Delete the reported finding if it is not clinically important or a primary outcome. OR

2. Report the finding with its P value. Describe the result as “not statistically significant,” or “a statistically nonsignificant reduction/increase,” and provide the confidence interval so that the reader can judge whether insufficient power is a likely reason for the lack of statistical significance.

If the finding is considered clinically important, authors should discuss why they believe the results did not achieve statistical significance and provide support for this argument (for example, explaining how the study was underpowered). However, this type of discussion is an interpretation of the finding and should take place in the “Discussion” (or “Comment”) section, not in the “Results” section.

Bottom line:

1. The term trend should only be used when reporting the results of statistical tests for trend.

2. Other uses of trend or approaching significance should be removed and replaced with a simple statement of the findings and the phrase not statistically significant (or the equivalent). Confidence intervals, along with point estimates, should be provided whenever possible.—Robert M. Golub, MD

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

2. Lang TA, Secic M. How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Publishers. 2nd ed. Philadelphia, PA: American College of Physicans; 2006:56, 58.

 

Apt, Liable, Likely

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Although these words are sometimes used interchangeably, particularly in infinitive constructions (apt to fall, liable to fall, likely to fall),1,2 using them interchangeably obscures subtle yet important distinctions between them.

Of the three, it seems that apt is the one most often used in its proper sense—perhaps because, unlike liable and likely, which both stress a potential consequence and thus are often confused, apt simply stresses inherent tendency (eg, “Elmer is apt to be a bit unsteady on his feet”).3 Also, whereas liable and likely refer to consequences and thus most commonly to conditions that will become manifest in the future, apt usually refers to conditions manifest in the past or present.1 In addition, some authorities hold that apt is perhaps most commonly used when referring to persons, although it can refer to nonhuman or inanimate subjects as well.1

So far so good—but, as alluded to above, tossing liable and likely into the mix can muddy the waters a bit. Both stress degrees of potential, but liable is the weaker of the two, used to stress possibility (eg, “Because Elmer is apt to be a bit unsteady on his feet, he’s liable to fall”) rather than outright probability.1 It has sometimes been held that liable should be used only when the subject of the sentence would face unpleasant consequences from the action expressed by the verb (“Because Elmer is apt to be a bit unsteady on his feet, he’s liable to fall and break a hip”).2 Certainly, of the three words under discussion, liable is the one most often taken as indicating that a consequence might be unpleasant or disadvantageous.3

Compared with liable, likely is a stronger term, used to stress probability (eg, “Because Elmer is apt to be a bit unsteady on his feet, he’ll likely fall if the steps are icy”) rather than mere possibility.1 However, unlike apt, likely used alone stresses no particular tendency in the subject that would enhance the probability of the outcome; moreover, unlike liable, it need not suggest the potential for an unpleasant consequence (eg, “Although Elmer is apt to be a bit unsteady on his feet, he’ll likely not fall, even if the steps are icy”).2

The bottom line:

● Looking for a word that stresses inherent tendency, particularly in a person? Use apt.

● Looking for a word that stresses possibility (as opposed to probability)—especially the possibility of some unpleasant consequence? Use liable.

● Looking for a word that stresses probability (as opposed to possibility), whether the perceived consequences be good or ill? Use likely.—Phil Sefton, ELS

1. Apt, liable, likely. Merriam-Webster’s Dictionary of Synonyms. Springfield, MA; Merriam-Webster Inc; 1984:56.

2. Liable. TheFreeDictionary.com website. http://www.thefreedictionary.com/p/liable. Accessed March 8, 2012.

3. Apt, liable, likely. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:48.

Acronym Morph: What’s an Editor to Do?

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

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

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

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

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

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

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

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

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

breast feeding→breast-feeding→breastfeeding

With acronyms it seems to be

U.N.E.S.C.O.→UNESCO→Unesco

With, sometimes, a brief detour to unesco.

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

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

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

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

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

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

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

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