Grammar ill || i| | fl za 76 ! Nouns Sentence Fragments : Ti Modifies (Noun Strings) ' 742 Modifying Gerunds 27 i 333 Subject-Complement Agreement Paraliel Construction 7.2.1 Correlative Conjunctions 22 722 Elipcal Comparivons Pronouns 733 Sertesor Companions 721 Persona Pronouns 734 tise 722 Relative Pronouns 723 Indefinite Pronouns 7 Subject Verb Agreement 13 781 Itervening Phrase vers 782 Fake singlan 131 Voie 783. Fobe Pais 132 Mood 78a Parenthelica sural 733 Teme 783 Collective toune 73a Double Negatives 788 Compound Subject 135 Splltinfnnves and Ve Phrases 787 Shift Number of Subject and Resultant 336 Contracions Subjecevert, Dsagreenart 7488 Subject and Predeate Noun Differ 2a in Number Modifiers 183° Bay and Many a 74 spaced Meiers F810 Onect Those | a2 Verbal Phrase Dangers 3811 Number Hl as 29 iA Dicion The Paragraph Hi 75.1 Homonyms ne 75.2 Idioms, Collequialisms, and Siang (at 733 tuphemisrs i 734 Clenes 1 The difference between the almost right word and ibe right word is really a large matter—ie's the difference between. ibe lightning bug and the lightning. Mark ‘Twain* A clear understanding of grammar is basic to good writing, Many excellent grammar books provide a detailed discussion of specific principles (see 25.3, Resources, General Style and Usage). In this section, the focus is on how to avoid common gearamatical and writing errors, 'The content of this chapter is organized from the smallest parts of speech (eg, notins and pronouns) to larger structures (eg, sentences and paragraphs) Nouns. Nouns (words that name a person, place, thing, or idea) may serve as subjects or objects, 315ieee Modifiers (Noun Strings). Although it: English nouns overuse of noun modifiers can lead! to a lack of clarity. Purists may demand strictes | rules on usage, but, a5 with the use of nouns as verbs (see 11.3, Correct and Preferred Usage, Back formations), the process of linguistic change is inevitable, and grat matical rigor must be tempered by judgment and common sense: diabetic patient Avoid Preferred patient with diaber depressive episode, episode of depression diabetes patient depression episode elderly over-the-counter elderly users of over-the-counter drugs drog users In The Careful Writer, Bernstein’ advises the use of no more than 2 polysyllabic noun: modifiers per noun forthe sake of clasity. However, long noun strings are sometimes dif ficult to avoid, if several of the attributive nouns are read as @ unit, the use of more than 2 may not compromise clarity, especially in scientific or technical communications, Thus, noun strings may be mote acceptable, for the sake of brevity, if the terms have been previously defined without noun strings. Some acceptable examples appear below. community hospital program nicotine replacement program physician provider organization _ placebo pain medication risk factor surveillance system proficiency testing program baseline CD4 cell counts sudden infant death syndrome clinical research organization community outreach groups If there is a possibility of ambiguity, hyphens may be added for clarity Cange-vessel dissection) (see Temporary Compounds in 8.3.1, Punctuation, Hyphens and Dashes, Hyphen). ee a {Q¢22225 Modifying Gerunds. When a noun or pronoun precedes a gerund (a verb form! ending in ~ing that is used as a noun), the noun or pronoun is possessive. (See also 8,7, Punctuation, Apostrophe.) ‘The toxicity of the drug was not a factor in the patient's dying so suddenly. ‘The award recognized the researcher's planning as well as his performance, Present participles (used adjectivally) should not be confused with gerunds, In the >= sentence below, the objective case (shen) is correct = i watched them gathering in the auditorium, a HE the possessive ther were used instead of the objective them, the emphasis would be on the action (gathering). EXE WERE subject-compiement Agreement, Subjects ancl complements should agree in nunt ber. The child can take off his own shoes. ‘We asked trial participants to return their pill dispensers. = However, when the complement is shared by all constituents of the plural remains singular 316 ‘The authors were asked to revise their papes All study sites obtained approval from their institutional review board, Inve tigators inserted a catheter into the study participants’ pulmonary artery. Pronouns. Pronouns replace nouns. In this repla clear and the pronoun must agree with the antecedent in number and gender Avoid: — The authors unravel the process of gathering information about diethylstilbestrol and disseminating it. [Antecedent unclear; does if refer to information or to diethylstifbestrol?] Correct: The authors unravel the process of gathering and disseminating information about diethylstilbestrol, Avoid: A questionnaire was given to each medical student and their spouses. [Disagreement of pronoun with referent in number; the referent is each medical student (singular), but the pronoun used is plural (sheir spouses),) Better. 4 questionnaite was given to the medical students and their spouses. or A questionnaire was given to each medical student and his or her spouse, Note: The possessive pronoun sis should not be confused with the contraction it’s (see aiso 8.7.2, Punctuation, Apostrophe, Possessive Pronouns), Personal Pronouns. Care must be taken t0 use the correct case of personal pronouns: subjective (the pronoun is the subject of the phrase or clause) or objective (the pronoun is the object of the phrase or clause) She was assigned to the active intervention group. (She is the subject.) Collect all the samples and give them to her. (Her is the object) Your decision affects him and me. (Both hint and me are objects.) Do not substitute a reflexive pronoun, ending in -seif or ~selves, fora simple pessonal pronoun, Avoid: — George, Patricia, and myself attended the lecture. The author replied to the editor, illustrator, and myself. Corect: George, Patricia, and I attended the lecture. ‘The author replied to the editor, illustrator, and me: Relative Pronouns. Relative pronouns (who, whon, whose, that, and which) intro- duce a qualifying clause “ Who vs Whom. Wao is used as a subject and whom as an object. The examples below illustrate correct usage. 317 ment, the antecedent must be”: 2.2 Preneuns 318 Give the award to whomever yo" object of the verb preferd Give the award to whoever will benefit most. [ subject of will benefit] Whom did you consult? [Objective the sentence] 20031 Following are examples of a ‘matical problem. Incorrect: Ambiguous Reworded: Who was the consultant on this case? [Subjects He is one of the patients whom Dr Rundle is treating js the abject of ts treating.] He is one of the patients who are receiviny who is the subject of are receiving] That vs Which. Relative pronouns may previous nouns, The word that intro ‘meaning of the noun it describes. 7 one that adds more information with which are preceded by commas. Tw ‘A study on the impact of depression on. 2003 JAMA theme issue on de simnilar topics. [Nonrestrictioe; The issue of JAMA that contained the arti US labor costs was the 2003 depression thousands of issues of /ABEA} 7.23 indefinits'Prenoun Many reports have been based on data from urology practices that may not fully reflect the entire spectrum of illness, [Some particular urology practices do not capture the range of the disease, but others might 1a prefer: [Objective case: whortever is the Subjective case: whoever is the ‘Note: The omission of that to introduce a ciause may cause difficulty in compro- case: whom Is the object of consult) hension. ive case: who is the subject of Avoid: This morning he revealed evidence that calls the study's integrity into question has been verified. : jective case: whom fObject Betier. ‘This morning he revealed that evidence that calls the study's integrity into question has been verified. 1 the placebo. [Subjective case ‘The addition of shat after revealed frees the reader from backtracking to uncover the meaning of the sentence above. The use of that to introduce a clause is particularly helpful when the second verb appears long after the first has been introduced (above, the interval between revealed and bas been verified). be used in subordinate clauses to refer to atroducesa restrictive clause, one that is essential tothe _ ihe word which introduces a nontestrictive clause, ut is not essential to the meaning. Clauses that begin 1 examples of correct usage follow. Indefinite Pronouns. Indefinite pronouns refer to nonspecific persons or things. Most indefinite pronouns express the idea of quantity and share properties of col- lective nouns (see 7.8.5, Subject-Verb Agreement, Collective Nouns). US Sabor costs was: published in the spression, which contains articles on a range Of Pronoun-Verb Agreement, Some indefinite pronouns (eg, each, either, neither, one, ‘ere was only one theme issue on depression in’ ‘no one, everyone, someone, anybody, nobody, somebody)-always take singular verbs; some (eg, several, few, both; many) always take the plural; and some (eg, some, any, none, ail, and most) may take either the singular or the plural, depending on the referents. In the last case, usually the best choice is to use the singular verb when the pronoun refers to a singular word and the plural verb when the pronoup refers to a plural word, even when the noun is omitted. ‘cle on the impact of depression on theme issue. (Restrictive; there are or incorrect usage that highlight this gra mbes! * Singular referent: Some of her improvement is due to the increas dosage Plural referent: Some of his calculations are difficult to follow. Singular referent: Most of the manuscript was typed with a justified ” sight-hand margin, “The high prevalence of antibodies to the 3 Bartonella species, which were examined in the present stucly, indicates that health care workers should be alert to possible infection with any of these organisms when drug users. [There are more than 3 treating intravenous species of Bartonella. Hence, the correct form here would be ©. the 3 Bartonella species that were examined. ..."} Many reports have been based on series of patients from prology practices that may not fully reflect the entire = n [Do the patients or the practices not fully do the reports Phoval referent Most of the manuscripts are edited electronically. Singular referent: Some of the manuscripts had merit, but none was of the caliber of last year’s award winner Plural referent: None of the demographic variables examined were found to be significant risk factors. spectrum of illness. © feflect the entire spectrum of illness? Also, : Pronoun-Pronoun Agreement. The use of an indefinite pronoun as the antecedent of javolve ail or only some urology practicesth another pronoun can create confusion. Some writers try to avoid gender bias by Many reports have been based on patients in urology using their or be/she with plyral indefinite pronouns (eg, Everyone should cite their practices, which may not fully reflect the entire spectrum of sources.). Grammatically, the use of a plural pronoun is not correct, and construc Hiness. (Urology practices in general do not capture the e tions such as s/be are distracting, He or she should be used consistently and the range of the disease] writer should keep the context in mind when making these decisions. Bewer still ‘when possible use the plural throughout* (eg, All authors should cite their sources.) or (See also 11.10.1, Correct and Preferred Usage, Inclusive Language, Sex/Gender.) 3197.3 Verbs He discovered enzymes--RNA polymerases—that directly copy {not copied] IERIE Vorbs. Verbs express an action, an occurtence, ora mode of being, They have voices, the messages encoded in DNA. mood, and tense. For this reason, the present tense is often used to refer to recently published work, incicating that it is still valid, - ” SE RBBRE Voice. In the active voice, the subject does the acting; in the passive voice, the subject, jg acted on. Tn general, authors should use the active voice, except in instances in _ Which the actor is unknown or the interest focuses on what is acted on (as in the following example of passive voice). He was shot in the abdomen and within 10 minutes was brought to the emergency department Ifthe actor is mentioned in the sentence, the active voice is preferred over the passive 2 5 Kaplan and Rose have described this phenosenon, voice. Kilgailen’s assay results demonstrate the highest recorded sensitivity and specificity to date. os ‘The present perfect tense ilustrates actions completed inthe past but connected with the present? or those still ongoing. Itmay be used to refer to a report published in the recent past Uiat continues to have importance, ‘The past tense refers to a completed action. In a biomedical article the past tense is usually used to refer to the methods and results of the study being described: Passive: Data were collected from 5000 patients by physicians. “Active (better): Physicians collected data from 5000 patients. ‘We measured each patient's blood pressure, ‘The definition of bullying used in the survey was taken from previous studies. ‘The authors used previous definitions of bullying in the survey. Passive: Group 1 had a seropositivity rate of 50%. ‘The past tense is also used to refer to an article published months or years ago that Bs aoy primarily of historical value. Frequently a date will be used in such a refer- Active (better): In their 1985 article, Northrup and Miller reported a high ra:e of mortality Mood, Verbs may have 1 of 3 moods: (1 the indicative (the most. common; used for | among children younger than 5 yeais. ondinary objective statements), (2) the imperative (used for requesting or com’ manding), and () the subjunctive. Subjunctive verbs cause the most difficulty, they are used primarily for expressing ‘a wvish (Lwish it were possible), a supposition (IFT were to accept the position ...), OF a vondition that is uncestain or contrary to fact Of that were true...; IFT were = 4 Incorrect: There were no adverse events reported in the conirol group, younger. ,.). The subjunctive occurs in fairly formal situations and usually involves but there are 3 in the intervention group. past (qwere) or present (be) forms. If we were to begin treatment immediately, the patient's prognosis would be excellent. ‘The patient insisted that she be treated immediately. In general, tense must be used consistently: Correct, There were no adverse events reported in the control group, but there were 3 in the intervention group. Past forms: However, tense may vary within a single sentence, as dictated by context and judg- Present form ment. We determined which medications are used most frequen lation. 1s not eg, where matters of fact—not y by this popu ‘The subjunctive is sometimes used incorrectly, les, the indicative, not the sub supposition—are discussed. In the following exampl junctive, is correct. Alternatively, the past tense and the present tense may be used in the same sentence Therefore, we determined whether there had been [not the subjunctive, to place 2 things in temporal context. were) deviation from the prescribed regimen, lh | Although the previous eport demonstrated a significant response, the “We investigated whether the fracture had been [not the subjunctive, were] set follow-up study does not, incorrectly. v Even when tenses are mixed, however, consistency is still the rule: Incorrect: {found it difficult to accept Dr Smith's contention in chapter 3 that the new agonist has superior pharmacokinetics and was therefore mofé widely used Correct: found it difficult to accept Dr Smith's contention in chapter 3 that the new agonist has superior pharmacokinetics and is therefore more widely used. resent (am), past (was), Fumie (had been), anc future perfect es the time that is Tense. Tense indicates the time relation of a verb: p (Twill be), present perfect (J bave been), past perfect CZ will have been). Iv is irsportant to choose the verb that express intended, Itis equally important to maintain consistency of tense. The present tense is used to express a general truth, a statement of fact, OF © something, continuingly true 320 3247.42 Verbal Phrase Dangl Beiter: Dr Young treated the patients with antidepressanis. or [alternative meaningh Dr Young treated the patients who were Double Negatives. Two negatives used together in a sentence constitute a double negative, The nse ofa double negative to express a positive is acceptable, although f using antidepressants. wields a weaker affirmative than the simpler positive and may be confusing: Unclear: The patient was referted to a specialist with severe bipolar disorder. [Who had the bipolar disorder?) Better’ The patient with severe bipolar disorder was referred to a specialist. ur results are not inconsistent with the prior hypothesis. More disect incentives have produced substantial changes in behavior in the past, although not without adverse consequences. in both groups. Likewise, sometimes itis necessary for clarity to place an adverb within a verb phrase Rheumatologic symptoms were not uncommon i Note the shift in meanii verb is acceptable to use a double negative to emphasize .eaning when the adverb is moved outside of the verb phrase rule negative conveys the opposite of He had just called me. However, it is not grammatically the negative. In the following example, the do what is intended. “The authors cannot barely contain their enthusiasm. He had called just me Use of the word only as a modifier poses particular problems. it most be placed immediately before the word or phrase it modifies for the meaning to be clear. Note often causes the the different meanings achieved depending on placement in the examples below. ‘A double negative is best avo reader to go back and reread the sentence to make sure of the meaning {ERB split infinitives and Verb Phi this proscription—a holdover from Latin grammar, avoidance of split infinitives, svnerein the infinitive is a single word and cannot be split—has been relaxed, Tr Gome cases, moreover, clarity is better served by the split infinitive Only medication can ease the pain. rases. Although some authorities may still advise the _ & Medication can only ease the pain, Medication can ease only the pain, Verbal Phrase Danglers. A participle is a verb form used as an adjective, A dangling “Ambiguous: The auihors planned to promote exercising vigorously. US it the exercising or the promotion of exercising that is vigorous’] participle implies an actor but fails to indicate correctly who or what that actor is. The Cleavers ‘The authors planned to vigorously promote exercising, following examples of dangling participles illustrate the problem, Avoid: Working quickly, the study was completed early by my or ‘The authors planned to promote vigorous exercise. research team. [The participle appears to refer to “the smdy”, however, itis the research feam that was working quickly.} |A contraction consists of 2 words combined by omitting 1 or more Re letter My research team worked quickly and completed the study early. ‘ETS contractions. letters (eg, cam’, aren’). An apostrophe show's where the omission has occured, Contractions are usually avoided in formal writing, or The study was completed early because my research team worked quickly. ERESEE Modifiers. A modifier describes’ another word or word group. Words, phrases (groups of svorts without a subject or predicate, usually introduced by a preposition’ or conjunction), and clauses (groups of words with a subject and verb within 2 compound or complex sentence) may all be modifiers. An adjective modifies a noun verb, an adjective, another adverb, o7 a clause: Avoid: Based on our experience, educational interventions are needed. to foster higher-quality end-of life care. [Are the educational interventions based on the authors’ experience? No—tt is the statement about the need for higher-quality end-of life care that is based on the authors’ experience] of a pronoun, An adverb modifies a Clauses or phrases may serve as adjectives or adverbs. Better: We have found that educational interventions are needed to foster higher-quality end-of-life care. ors Experience has shown that educational interventions are needed 10 foster higher-quality end-of-life care. Misplaced modifiers result from failure to make clear what is placement of a word or phrase can usually be d or phrase appropriately close to the word it,” ESEAS Misplaced Modifiers. being modified, Illogical or ambiguous avoided by placing the modifying wor modifies, Dr Young treated the patients using antidepressants, [Who sed the antidepressants? Ambiguity makes 2 meanings possible | A gerund isa verb form used as a noun (see 7.1.2, Nouns, Modifying Gerunds). Like Unclear: the dangling participle, the dangling gerund implies an actor but does not specify 323 2227.5 Diction vith iple modi qho of what that actor is and sometimes may be confused w fying the wrong entity. Dietary therapy stows the return of hypertension after stopping Avoid: : long-term medical therapy. [This states that dietary therapy aot only slows the return of hypertension but also stops medical fi : therapy Betler, Dietary therapy slows the return of hypertension after cessation of long-term medical therapy. or iAfter patients discontinue long-term medical therapy, dietary therapy slows the return of hypertension, Avoid: Before initiating an exercise program or engaging in heavy physical labor after a myocardial infarction, a physician should review the exercise program carefully. {°A physician” is errone- ously implied to be the actor, the one initiating an exercise program ot engaging in heavy physical labor] Better: Anyone about to initiate an exercise program or engage in heavy physical labor after a myocardial infarction should consult his or her physician, portant for any writing to be understood by its Diction. Diction, or word choice, is imy concrete and specific language is preferred intended audience, In scientific writing, over the abstract and general Avoid: ‘The area under study provides new evidence for a solution. Better: Immunology provides new evidence for a solution. “Avoid: An individual with a medical degree should examine this lesion. Beiter, A physician should examine this lesion. Homonyms. Homonyms are words that sound alike but are spelled differently and have different meanings. They are easily confused, and computer spell-check pro- geams are unable to differentiate them. Common examples include affect/ effect, accept) except, altar/alter, assistance assistants, ctte/' stte) sight, council) counsel, its) tis, patience/pationts, peace/piece, peak peck/pigue, pleural/plural, principal principle, and your) you're. (Sce also 11.1, Correct ancl Preferred Usage, Comrect and Preferred Usage of Common Words and Phrases.) Idioms, Colloquialisms, and Slang. Some language is best avoided in material written for a professional or academic audience. Idioms are fixed expressions that cannot be understood literally (bick the bucket ona roll, put up with, pay sarention). tn addition, some may have multiple meanings that can be understood only in context (pass out, stand for). Idioms are not governed by any rules and each stands on its own, Be wary of using idioms, particularly for audiences that include readers whose first language is not English Colloquialisms (or casualisms’) are characteristic of informal, casual communi- cation (ain't, anyways, cold turkey, flat line, OK, shell-shocked. tax bike) 324 7.7.4 Correiative Conjunctions Slang includes informal, nonstandard terms whose meanings are not readily vndeteed by all speakers of a language. Sometimes slang words are newly coined hick, rinkydink, £40) and sometimes they are created by applying new meant to existing words (bad, cool, awesome, random, killer) vm Colloquialisms and slang should be avoided voided exc 5 “flavorful” prose or direct quotations. ob spect sions Sicha My sense is that part of the reason why Cl why Claude is able to survive is denial. F just says, flat out, “This ain’t happening.” “denis The technical terminology specific to various disciplis ious disciplines is considered jary should be avoided (see 11.4, Comect and Preferred Usage, Jargon). Mares Euphemisms. Euphemisms (from the Greek ex, “good,” and pheme, “voice”) indirect terms used to express something unpleasant. Although such langua; ‘eofien necessary in social situations CHe passed away"), directness Is beter in scientific writing (The patient died."). (See also 11.4, Correct and Preferred Usage, jergon >. Cle. Clichés are worn-out expressions (sleep like a log, dead as a doornail, first an (foremost, crystal clear). Aone time they were clever metaphors, but overuse has left them lifeless, unable to conjure in the reader's mind the original ime clichés like the plague. me nee Avolg Sentence Fragments. A sentence must have at minimum a subject and a verb; it also usually contains modifiers Sentence fragments, which lack 2 subject or a vedo. should not be used in scientific or technical writing (except within the struc wei abstract, see 2.5, Manuscript Preparation, Abstract). Occasionally, writers * pro and poetry use sentence fragments intentionally, for effect, ’ ores Her affect signaled depression, Utter depression, in scientific writing, these fragments are likely to be unintentional definitely gt likely to ‘ional and are Incorrect: The clinival spectrum of disease varying according to the population and age group under study. Correct ‘The clinical spectrum of disease varies according to the population and age group under study, Parallel Construction. Parallel construction can be used to bi sentence " tr 0 build a nce OF TERRES correlative Conjunctions, Parallelism may tely on accepted cues (either/or, nei- te ine, not ond bata borb/and), All elements of the parallelism thatappear oa a 1 coordinatiz ij one sie of hs ing conjunction should match corresponding elements on Avoid: ‘The compleat physician has not only mastered the science of medicine but also its art. Correct: ‘The compleat physician has mastered not only the science of medicine but also its art. 3257.7 Parallel Construction 7.8.4 lntervening Paras i The compleat physician has mastered both the science and Better: the art of medicine: Corect’ There was a tong delay betwreea the purchase of a scanner and its i 6 widespread ust 4 Avoid Poor drug efficacy may be caused by either lack of spread USE if : absorption or by increased clearance. ‘Nore: Avoid the use of nor when the. first negative is expressed by #0? or mo, i yt Correct: Poor drug efficacy may be caused either by lack of ewuses with congenital diaphragmatic hemia who were stillborn would not | : absorption or by increased clearance. have been included in this study ot [not nox in many previously published iH a4 “Also correct: Poor drug efficacy may be caused by either Tack of studies. | fon or increased clearan ‘ absorption or increased! clearance “But: Fetuses with congenital diaphragmatic hernia who were stillborn would - Avoid: “Three patients either took their medication incorrectly or ot have been included in this study, nor would they have been included in not at all. other trials. [Vor is acceptable in nonoorrelative constructions containing Correct: ‘Three patients took their medication either incorrectly or negative in the first element. 5 not at ail tists, Parallel construction is also important in lists, whether run in or set off by " pullets or some other device (see Enumerations in 8.2.2, Punctuation, ‘Comma, Semi- Note: Ritber/or is used with only 2 compasators (use with more than 2 items is colon, Colon, Semicolon, and 19.5, Numbers and Percentages, Enumerations) considered nonstandard). ‘This medication can be taken with cither water, milk, or juice, ‘This medication can be ken with water, milk, or juice. ‘After completing this CME exercise, readers should be able to Incorrect: Gorrect + identify the causal mechanism of the disease; + describe the most common symptoms; i isons. duces an abridged expres- ERE Elliptical Comparisons. The conjunction than often introduces an abricar’ ©sP! + understand the limitations of pharmacologic treatment. sion (eg, “You are younger than 1 fam young)).” Correct placement of than is im: portant to avoid ambiguity: Subject-Verb Agreement. The subject and verb must ageee in number use a Singular subject with a singular verb and a ploral subject with a plural verb, Unfor- Unclear’ Women are more likely to take vitamins than men. Tare cunately, this simple rule is often violated, especially in complex sentences. women more likely to consume vitamins than men are, Or are women more likely to consume vitamins than they are to consume men? Rewritien: Women ate more likely than ren to take vitamins. Intervening Phrase. Plural nouns take plural verbs and singular nouns take singular verbs, even if a phrase ending in a plural noun follows a singular subject or if a © phrase ending in a singular noun follows a plural subject. A veview of all patients with grade 3 tumors was undertaken in the university hospital, [The subject in this sentence is review. Ignore all modifying prep EEE series or Comparisons. Paralel_constzustign may also present a series or make ositional phrases that follow a noun when determining verb agreement] comparisons. In these usages, the elements ofthe series or ofthe comparison should be parallel structures, eg, nouns with nouns, prepositional phrases with prepost tional phrases. Avoid: The patient, one of many study participants given access to state- of-the-art medical cate from the university's clinical researchers, were followed up for more than a year. [The veri should be was followed up—the subject is patient] “Avoid: Stugery, radiation therapy, and to give chemotherapy are possible therapeutic approaches, Correct: Surgery, radiation therapy, and chemotherapy are possible therapeutic approaches, Sometimes the simplest solution is to rewsite it as 2 separate sentences: Better, ‘The patient was followed up for more than a year. She was one of many study participants given access to state-of-the-art medical care from-the university's clinical researchers. “Avoid: When an operation is designed to improve function rather than extirpation of an organ, surgical technique dictates outcome. When an operation is designed to improve the function of an organ rather than to extirpate the organ, surgical technique dictates outcome, Correct: Ifthe intervening phrase is introduced by with, together with, as well as, along with, jin addition to, or similar constructions, the singular verb is preferred if the subject is singular because the intervening phrase does not affect the singularity of the subject. “Avoid: ~ “There was a long delay between the purchase of a scanner and when it started to be widely used, x ¥ ‘The editor, as well as the reviewers, believes that this article is ready for acceptance, . 3277.8 sublea-Verb Agreement 7.8.6 Compound Subject “the patient, fogether with her physician and her feaily, makes this decision. dition to all participants, was expected to abide by the Collective Nouns. A collective noun is one that names moze than 1 person, pl 2 1 person, place, or thing, When the group is re 3 Wh garded as a unit, the singular v hole, Gee also 9.2, Plurals Collecive Nouns) Her verbs the appreprte ‘The investigator, ina institution's safety guidelines ‘The couple has a practi uple is conside: ni 8 2 practice in rural Montana. [Couple is consi The asa practice in [Couple is considered a unit here In these instances, recasting the sentence may eliminate confusion. ‘the patient, physician, and family members make this decision together. qT e: ime j ne Percent of her time is spent on administration, (Twenty percent is thoaglt of as @ ile not as 20 individual units, and so takes the singuler p also , Units of Meas r Subject Verb agreement) ure, Format, Style, and Punctuation, False Singulars. A few plural nouns are used so often in the singular that they are often paired with a singular verb, ‘The agenda has been set for our next meeting. Frequently tteated erroneously in this way are the plurals bacteria, criteria, pbe- nomena, and memoranda, The distinction between singular and plural, however, vhould be retained; when the singular is intended, use bacteria, criterion, phe- nomenon, and memorandum. . ‘Also, many now consider acceptable the use of data as a singulas.” In this usage, datas thought of as a collective noun and, when considered a5 2 ne rather than as, dhe individual items of data that compose it, ittakes the singular verb, However, JAMA vin she Archives Journals prefer to eetain the use of the plural verb with data in all situations. ‘The paramedic crew res} r sponds to these emergency , dean here nd otukes the singuay vero ny STmoweieof When the individual members of the pair o1 ized, rather than the Pale yr group are emphasized, Thee , i The cour: wet both family physicians, (Couple ig thought of as the 2 indi- pose the couple, not as a unit, and so takes the plural verb.] Ten percent of the staff work fl i jexible hours. (Ten percent is tho being composed of each individual staff member, not as a unit, eo aes the plural verb] , inh ang sons Very few data were {not very Hie data tas] available fo suppos OM hy- pothesis, ‘The surgical faculty were from all over the count the word media in the sense of communications media is becoming acceptable in individual members of the faculty, rather than vot lie Hea aoe ey tothe this collective usage, although its use in this sense has no ye reached the accept 0 takes the plural verb group, and ability that agenda has gained and data is close to gaining *° Most scientific journals fetain the distinction between singular and pharal. Singular, ach news medium. shapes jopmalisin fo #5 own constraints, The use of a phrase such as “th eine as “the members of” may make this last example less ‘The members of the surgical faculty were from all over the country. Plural The media give much attention 1 the managed care debate (Here media refers to all types of news coverage] Compound Subject. When 2 words or 2 groups of words, usually joined by and are the subject of the sentence, either » usually Joined By and or oF: , the sin : hould be used for the appropriate, depending on whether the words ee ore aaa fern iy be : tural and on [nthe sense of laboratory culture or contrast media, medium si singular and media for the plural. the connectors used, alge Plurals. Some nouns, by virtue of ending in a “plural” form, ate mistakenly Compound Subject Joined by and. With and, a phural ver a plural verb is usually correct. aaron to be plurals even though they shoul be trestedas singular and ake singular orb (eg, measles, mumps, mathematics, politics, genetics) ‘Gee 9.8, Plurals, False singulars,) ‘The nurse and the physician are discussing my case. ‘A singular verb should be used if the 2 elements are thought of as a unit ; Di coset “esis added parenthetically to a word to express the ation and curettage was suggested. . However, in most instances itis instead, Parenthetical Plurals. When sof possibility of a plural, the v preferable to avoid this construction cror(s) for each stady participant was not always or tefer to the same person or thing ‘The first author and princi it i s 1 ‘pal 1 ‘bili te principal investigator takes responsibility for the data “Acceptable: The risk fa clear. ‘ci 7 Cor ‘ect Joi Better: ‘The risk factors of the study participants were not always compound Subject Joined by or or nor. With a compound subject joined clear. the plural verb is correct if both elements are plural; if bx hele oy eee singular al; if both elen 2 gular, the singular verb is correct. When one is singular and one is plo, "the verb should agree with the noun claser to the verb. 329 ' 1are Agreement 7818 umber ‘The number that responded was prising, ff nor family members were in the Both plural: Neither hospital room. Both singular Neither a false-positive result nor a false-negative result is definitive Meeed: Neither the physicians nor the hospital was responsible for the loss. A number of respondents were concerned about adverse effects. The same is true for the total and a total of, ‘The Paragraph. A paragraph isa cohesive group of sentences. It presents a thought or several related thoughts. Each paragraph should be long enough to stand alone but shot enough to hold the reader's attention and then direct that attention to the next thought. Too many short paragraphs are jarring to the reader, whereas too many long paragraphs strain the reader's attention, Sentences within a single paragriph should use parallel structure and consistent tense as much as possible. Transitions ae words or phrases that signal a connection among ideas, Transi- tons build bridges between parajraphs (and berween sentences) and help the text iow. Shift in Number of Subject and Resultant Subject-Verbs Disagreement, In elliptical: constructions involving the verb Ge, the second verb is omitted because it is under, stood), if the number of the subject changes, the construction is incorrect, Incorrect: Her tests were run and her chart updated, Correct: Her tests were run and her chart was updated. Incorrect The diagnosis was made and physical therapy sessions begun. Correct; ‘The diagnosis was made and physical therapy sessions were To show addition: also, furthermore, in addition, moreover To show contrast: however, yet, conversely, nevertheless, although begun, or 5 To show comparison: similarly, likewise ‘The diagnosis was made and physical therapy begun. 2 gn phy py beg To show results: therefore, thus, as a result, consequently To show time sequence: first (second, third, etc), later, meanwhile, Subject and Predicate Noun Differ in Number. The predicate noun is the comple: subsequently, white ment of a subject; it identifies, describes, or renames the subject. When the subject, and predicate noun differ in number, follow the number of the subject in selecting: the singular or plural verb form. To summarize: hence, in summary, finally ACKNOWLEDGMENT Principal author: Stacy Christiansen, MA Incorrect: ‘The most significant factor that affected the study results were interhospital variations in severity of illness. Correct’ ‘The most significant factor that affected the study results was interhospital variations in severity of illness. : REFERENCES 1. Platt $, ed, Respectfully Quoted: A Dictionary of Quotations Requested From the Congressional Research Service. Washington, DC: Library of Congress; 1989 entry 540. 2. Bemstein TM. The Carefiul Writen A Modern Guide to English Usage. New York, NY: Free Press; 1998, 3. Crews F, Schor S, Hennessy M. The Borzoi Handbook for Writers. 3rd ed. New | , 1 M. rot 10 3rc New York, Every and Many a. When every or many ais used before a word or series of words, | NY: McGraw-Hill Inc; 1993 " use the singular verb form. 4. Huth EJ. Writing and Publishing in Medicine, 3rd ed. Baltimore, MD: Williams & Wilkins; 1999, 5. Burchfield RW, The New Fowler's Modern English Usage. Rev 3rd ed. Oxford, England: Oxford University Press; 2000, 6. The American Heritage Dictionary of the English Language. 4th ed, Boston, MA: Houghton Mifflin Co, 2000. Avoid this by rephrasing: study results were most affected by intethospital variations in severity of illness. Many a clinician does not understand statistics. (But, better yets Many cli Gians do not Understand statistics.) Every issue profiles a leader in medicine ADDITIONAL READINGS AND GENERAL REFERENCES The Chicago Manual of Style; The Essential Guide for Writers, Editors, and Publishers. 15th ed, Chicago, I: University of Chicago Press; 2003, Copy Editor; Language News for she Publishing Professional. New York, NY: McMuny Newsletters, http://www.copyeditor.com., Accessed September 27, 2006. correct, Dr Cotter is one of those researchers who prefer the library to the laboratory. Nomber. The number's singular and a number of is plural (see also 7.8.5, Collecti¥@ ng Nouns). : 330 331fs the Paragraph i s eeicommunications altorial Bye. Alexandsa, ‘TA: Editorial Experts Ine, htpr//swyre eeicomnih i st 27, 2006. com/eye/. Accessed September 27, _ aw Follett W, Modern American Usage: A Guide, Wensberg E, ed, New York, N¥: Hill fang; 1998. ‘ Gordon KE, fhe Deluxe 7 the Innocent, the Eager, and the Doomed. ansitive Vampire: The Ultimate Handbook of Grammar for sew York, N¥: Pantheon Books; 1993. : / KS a 1c; 1985. f i Kilpatrick IJ. Tbe Writer’ Art, Kansas City, KS: Andrews McMeel & Parker inc; 19% oo | feria niam-Webster; 1994 a Weber's Dictionary of English Usage. Springfield, MA: Merriam Webs : — n Publishing Co | sirunk W Js, White EB, Elements of Spe. 3rd ed. New ‘York, NY: Macmilia Inc; 1994. scm udgeon's Guide to the Many Things sing Fnio a Comma: & Curmudg ” ca We wiong tt vent_-and Flow to Avoid Them. Lincolnwood, Ile Contemporary Books: io 2000, ae Punctuation Ba 865 Placement 868 So-called a3 Hyphens and Dashes a7 83.1 Hyphen ‘Apostrophe 85.2 Brackets 86 Quotation Marks Paragraphs 86.4 Single Quotation Marks fier journeying through the world of punctua- tion, ond seeing what st can do, Lam all the more convinced that we should fight like tigers to preserve our punctuation and we should start now. Lyane Truss* mation points are the 3 end-of-sentence punctuation marks Period, Question Mark, Exclamation Point 866 Omission of Opening or B11 Period Closing Quotation Marks 8.12 Question Merk 867 — Coined Words, Slang 8.13 Exclamation Point 8.68 Apologetic Quotation Marks 832 Dashes 87.1 To Show Possession 86.1 Quotations 886 Change in Cepitalization 862 Dialogue 887 Omission of Ellipses 863 Titles 888 Ellipses in Tables Period, Question Mark, Exclamation Point. Periods, question marks, and excls- 82 8.6.10. Common Words Used in a Technical Sense. Comma, Semicolon, Colon 8.6.11 _ Definition or Translation of Non-English- e241 Comma Language Words 822 Semicolon 8.6.12 Titles of Works 823 Colon 8.6.13 Indirect Discourse, Discussions 8.6.14 Block Quotations 872 Possessive Pronouns aa 287.3 Possessive of Compound Terms Forward Slash (Virgule, Solidus) 874 Joint Possession 84.1 Used to Express Equivalence or Duality «87.5 __Using Apostrophes to Form Plurals 84.2 Used to Mean per 8.7.6 Units of Time and Money as Possessive 843 In Dates Adjectives 8.4.4 In Equations 877 Prime 84.5 In Ratios B45 In Phonetics, Poetry 88 Ellipses a5 8.8.1 Omission Within a Sentence Parentheses and Brackets 882 Omission at the End of a Sentence or 35.1 Parentheses Between Complete Sentences Grammatically Incomplete Expressions ‘Omissions in Verse Omissions Between or at the Start of 333 al 44 Period, Question Mark, Exclamation Point anetvation marks. Use a + common end-of-sentence 2 at the end of each table re sentence an "SBE period. Periods are the most period atthe end of @ declarative or imperatl fooinote and each figure legend chnology have saved many lives. Advances in medical te¢ Always listen carefully. [Also use a period after a hetorical question (one not requiring an answen. is the Osler of today. ‘Where, indeed, © placement. The period precedes ending quotation marks and reference citations, ‘The child is rated in 7 areas, such as “acce] appropriately with peers.” Jods of Wilkes et al? pis responsibility” and “interacts We followed the metbi ‘The period follows a closing apostrophe ‘Their data were inconsistent with their associates’ 28885 Enumerations. Use a period after the arabic numeral when enumerating paragraphed items. “The signed authorship form required by the journal inchided the following sections: 1. Authorship responsibility, criteria, and contri 2, Data access and responsibility 3, Financial disclosure 4, Acknowledgment siatement 13 and Percentages, Enumerai ‘examples of ways to fF with bullets.) (See also 19.5, Numbel ions, and the Enumerations section in 8.2.2, Semicolon, for handie enumerations that are un into the text or that are set of Decimals. Use the period as a decimal indicator, (See 19.7.1, Numbers and Percent ages, Forms of Numbers, Decimals.) r=075 32 caliber P< 05 0.1% position indicates multiplication. See also 18.2.2, symbols, Products and Quotients of » Multiplication. The period in raised ‘Expressing Multiplication and Units of Measure, Expressing, Unit Names anc Unit Symbols, and 21.6, Mathematical Compositons Division.) and the Arcbives Journals do not use petiods with fife terms, and abbreviations (exceptions: No. for sn no period is used with Titles and » When Not to Use a Period. JAMA honorifics (courtesy titles), scient Sumber’ and St. when itis part of a person’s name, althoug! ; Stin.a city name, eg, St Louis, Missouri) (see 2.1, Manuscript Preparation, Subtitles; 2.2, Manuscript Pi Sete 22,0 ipt Preparation, Bylines and End-of-Text Signatures; and 14 Dr Hussey JAMA George Hussey, MD NIA George R. Hussey, MD ie E colt eg tences When did he go into private practice? If this article were a work of the 19: we 130s, not the vi differently? And should we? ams weal we wes In Dates, Use the question mark to show doubt about specific data Hippocrates (4607-375 scr) is often referred to as the Father of Medicine. © Placement. Place the question mark inside the end quotation mark (see 8.6.5, Quotation Marks, Placemend, the , Plac , the closing parenthesis, o the end bracket question mark is part of the quoted or parenthetical material. near teas ‘The patient asked her physician of 25 years, “Why are you retising, Doctor?” ‘The chapter on interpretation asks the question “Can I be wrong?" ‘The mandate for health reform (can we agree on this?) will chan, rm (cat i (can we agree on this?) wi ge practice In declarative sentences that contain a question, place the question mark ai the end fat Cor pl of the interrogative statement. Why did I bother to attend this conference? she wondered, 1 ; the first section of the book, “What Medical Advances Made Open Heart turgery Possible? is certain to interest medical historians. The investi a i igators asked the question "Have you ever ver i 2» every study participant. , yecied dee of Wote: The question mark, 1 n Pe Note The stion nak tke the exclamation point [see 8.1.3, Exclamation Point, Placémend, is never combined with another question mark, exclamation point, period, semicolon, or comma; thus, the obs i ed nthe ° a , 3 thus, the need for a comma is obviated i amples above. This usage is sometimes referred. to a spunctest m: me : . .ctimes referred.t0 as “ ” ee ee et times re ‘dueling punctuation marks, Rhetorical questions (thos: we restion ¢ not requiri i era guestions requiring an answer) do not require a questior What is gained by tecountin; : y 1g past losses when we have a chance to sta afresh in our efforts to provide health care to the uninsured. " 335 8.4.2 Question Mark Question Mark. The primary use of the question mark is to end interrogative sen-8.2 Comma, Semicolon, Coton Indivect of reposted speech also does not require a question mark. She wondered why there were no illustrations in the article. xclamation Point, Exclamation points indicate emotion, an outery, or a forceful comment, Try to avoid their use except in direct quotations and in rare and special Gireumstances, ‘They are not appropriate in sciensific manuscripts and are more com- mon in less formal asticles, such 4s book reviews, editorials, and informal essays, here added emphasis may be appropriate. If they are used, limit their use to one Beware! Although it may be refetsed to as the gold standard, nothing is perfect! Lhad almost given up hope of his recovery. He was terribly sick! phasized material, the exclamation point goes sis, or bracket, (The exclamation point, like Mark, Placement), is never combined with, or comma; thus, there Placement. When it completes the emy inside the end quotation mark, parenthe the question mark [see 8.1.2, Question another exclamation point, question mark, period, semicolon, is no comma in the frst example below.) “Jet the reader beware!” the editor warned. ‘The frightened child cried, “I don’t want my tonsils taken out!” jon point is used to indicate a ion and Divi Factorial. In mathematical expressions, the exclam: factorial. (See 21.6, Mathematical Composition, Expressing Multiplicat sion.) 5] = $x4x3x2x1 Comms, semicolons, and colons can be used to in- ght, t0 set off material, oF to introduce a new but and the strength of the break: in thought vt Comma, Semicolon, Colon. dicate a breale or pause in thou; connected thought. Bach has specific uses, determines which mark is appropriate, ceful of the 3 marks, There are definite rules for using commas; however, usage is often subjective, Some writers and editors vse the ‘comma frequently to indicate what they see as a natural pause in the flow of words, but commas can be overused. The trend is to use them sparingly. Follow the ac- cepted rules and use comrnas only when breaks are needed for sense or readability or to avoid confusion or misinterpretation. {ERB comma. Commas are the least for ‘The comma is used to separate phrases, clauses, and the grammatical structure and the intended meaning. dent clauses (whether festtictive or not) or Separating Groups of Words. groups of words and to clarify ‘Use a comma after opening depen long opening adverbial phrases. if the infection recuis within 2 weeks, an additional course of antibiotics should bé given. + 8.2.1 Comma When you have to pay for yc y your own health care, does your consi really become more efficient? NS Acomma is not essential if the introductory phrase is short. In some patients midazolam produces paradoxic agitation. Use commas to set off nonrestritive subordinate clauses (See 7.2.2, Grammat, Pro- nouns, Relative Pronouns) or nontestrictive participial phrases : Ms Frederick, who had been waitin “ +n waiting on hold for more than an hi - doned all hope of having her questions answered. onan ‘The numbness, which had be therapy ich had been apparent for 3 days, diseppeared after drug The delegates, attaining consensus, passed the resolution, But avoid setting a phrase off with Bu avo commas where it would make the meaning am- Avoid: Although numerous investigators have called for measures to improve sight in nursing home residents, to our knowledge, none have attempted a study of the effect of a vision restoration- rehabilitation program on function and quality in this population. In the example above, itis not clear whether the phrase “to our knowledge” applies to what precedes it or what follows it. Removing the comnia after tonat precedes tor wha ig the comma after “to our knowledge” Better; Although numerous investigators have called for measures to improve sight in nursing home residents, to our knowledge none have attempted a study of the effect of a vision restoration- rehabilitation program on function and quality in this population, 5 ‘ Use a comma to avoid ambiguous or awkward juxtaposition of words. Outside, the ambulance siren shrieked. Still, noting the wends and highlighting the lack of funding for achieving ‘world health goals does not translate into more positive actions. Use commas to set off appositive e as Uses positives. (Note: Commas precede and follow the apposi- Two colleagues, John Smith and Pesry White, worked with me on this study. The battered-child syndrome, a-clinical condition in young children who have experienced serious physical abuse} is a frequen 2 oi 1 caus lave sperienced se quent cause of permanent Series In a simple coordinate series of 3 or more terms, separate the elements by mmmas. (See 7.1.1, Grammai, Nouns, Modifiers [Noun Strings].) Each patient was asked to complete a 21 F-point, self administe: 3 ‘item, a questionnaire, : “ 378.2 Comma, Semicolon, Colon Use a comma before the conjunction that precedes the fast term in a series to prevent ambiguity (this is often referred to as @ serial comma). Outcomes result from a complex interaction of medical care and genetic, environmental, and behavioral factors. ‘The physician, the nurse, and the family could not convince the patient to take his medication daily. While in the hospital, these patients required neuroleptics, maximal ob- servation, and seclusion. However, a series of 3 or more modifiers should not be separated by commas when the modifiers are seen as 1 term or entity: “The patient has chronic progressive multiple sclerosis. Gray matter magnetic resonance imaging was used to predict longitudinal brain atrophy. Judgment and common sense are required in the interpretation of this rule. If the onder of the adjectives can be rearranged without loss of meaning or clasity, use the comma. ‘The studies selected for inclusion were English-language, randomized, double-blind, controlled trials of newer atypical antipsychotic medications. Data from several large, multicenter, administrative databases were ana- lyzed. Note: When fewer than 3 modifiers are used, avoid adding a comma if the modifiers, and the noun are read as one entity: We conducted a randomized placebo-controlled tial. Data from multicenter administrative databases were analyzed, 2 Names of Organizations. When an enumeration occurs in the name of a company oF organization, the comma is usually omitted before the ampersand, However, follow the punctuation used by the individual firm, except in references. (See 3.12.9, Ref- erences, References to Print Books, Publishers.) Farrar, Straus & Giroux Inc Little, Brown & Co GlaxoSmithKline Pharmaceuticals Mayer, Brown, Rowe & Maw Houghton Mifflin Co: Sidley Austin Brown & Wood BEERESEN setting Off io, eg, viz. Use commas to set off #, eg, and viz and the expanded equivalents, that 4s, for example, and namely. ‘The use of standardized scores, eg, z scores, has, no effect on statistical comparisons. ‘The most important tests, that is, the white blood cell and platelet counts, wert unduly delayed, 338 pose Setting Off Parenthetical Expressions. Use commas to set off parenthetical words, 8.2.1 Comma Note; If an independent clause follows these terms or their equivalents, precede the clause with a semicolon, Our double-blind study compared continuous with cyclic estrogen treat- ment; je, estrogens for 4 weeks were compared with estrogens for 3 weeks followed by placebo for 1 week. = Separating Clauses Joined by Conjunctions, Use commas to separate main clauses joined by coordinating conjunctions (and, but, or, nor, for) - Plasma lipid and lipoprotein concentrations were unchanged afier low? intensity training, but high-intensity training resulted in a reduction in tri- alyceride levels. No subgroup of responders could be identified, and differences between centers were so great that no real comparison was possible, If both clauses are short, punctuation can be omitted. The test may be useful or it may be harmful. Thave read the article and I am concermed about the data collection methods. Be careful not to confuse the coordinating conjunction used between independent clauses with @ coordinating conjunction used to link a compound predicate ‘These facilities are beginning to resemble “minihospiials” and they are losing their identity as freestanding ambulatory surgery centers. Clauses introduced by yet and so and subordinating conjunctions (eg, while, where, after, whereas) are preceded by a comma, (See 11.1, Correct and Preferred Usage, Correct and Preferred Usage of Common Words and Phrases.) He taught medical students, performed careful research, and wrote thought- ful articles, yét was denied tenure. ‘The United States spends more than $1000 per capita per year on paperwork related to health care, whereas Canada spends only about $300 per capita, One recent study found that low literacy was associated with worse mental béalth, whereas another concluded that literacy was not associated with depression. If such conjunctions appear at the beginning of a sentence, however, the comma following the conjunction may not be necessary. Thave seen many cases of vertigo. Yet this one was particularly troubling. phrases, questions, and other expressions that interrupt the continuity of a sentence, eg, therefore, moreover, on the other band, of course, nevertheless, after all, conse- quently, however. (See 8.8:1; Ellipses, Omission Within a Sentence.) ‘The real issue, after all, was how to fund the next study. Therefore, we were disappointed that the article did not include con- sideration of medical schools and their influence on the culture of medicine. 39 |8.2 Comma, Semicoion, Colon What is needed, then, is collective empowerment of practitioners, guided by accountability to the public Note: In some cases, removal of the commas around pasenthetical expressions changes the meaning of the sentence. In the example immediately above, then sugnesis 4 suroming-p, Without chese coramas, then suggests time, #e, what comes next. © setting Off Degrees and Titles. Acaclemic degrees and titles are set off by commas Sinem they follow the name of a person, Although itis not incorrect to set/rand SF off by commas when they follow the name of a person, JAMA and the Archives Journals are now deleting these commas, Berton Smith Jr, MD, and. Priscilla Armstrong, MD, PhD, interprete sadiographic findings in this study. Joyce Predrickson-Smith, MD, PhD, vice-chancellor, attended the con- ference on health system reform. d the NE Addresses. In running text and in affiliation footnotes, use commas to separate the elements in an address. Use commas after the city and before and after the state or country name. (Note: In US and Canadian addresses, commas are not used before the zip of the postal code.) “This year, the editorial board meeting will be held in conjunction with the ‘Academy meeting at the Westin Bonaventure Hotel and Suites, 404 S Fig © ueroa St, Los Angeles, CA 90071 ‘The study was conducted at The Wilmer Institute, Baltimore, Maryland, in 2004. (2822888 Dates. In dates and similar expressions of time, use commas according to the fol- owing examples. Commas are not used when the month and year are given without the day, or berween a holiday and its year. “The first issue of JAMA was published on Saturday, July 14, 1883 ‘The patient’s thinoplasty was scheduled for August 19, 2002, at Strong Memorial Hospital, with postoperative evaluation on August 30, “The terrorist attack in London, England, in July 2005 led to further ex: amination of major disaster preparedness ‘The publication offices were closed on New Year's Day 2005. S250 vumbers. In accordance with SI convention, separate digits with a thin space, nota comma, to indicate place values beyond thousands, (See 18.4.3, Units of Measure, Use of Numerals With Units, Number Spacing.) . 5034-12345 «615478 9.473.209 ‘A comma may.be used to Separate adjacent unrelated numerals if neither can be ex~ pressed easily in words, hut itis preferable to reword the sentence or spell out 1of the numbers. Placement. The comma is placed inside quotation marks (see 8.6.5, Quotation Marks, Placement) and before superscript citation of references and footnote symbols, 8.2.2 Semicolon By December 2003, 929985 cases of AIDS had been reported ins the United States. Better: By December 2003, a total of 929 985 cases of AIDS had been reported in the United States. Units of Measure. Do not use a comin: ve ‘a between 2 or more measures whose unit the same dimension, sues 3 years 4 months 2 days old 31b 402 As a result of the “back-to-sleep campaigns,” a call has been issued for a “back-to-the-bench” campaign. ‘These missed opportunities have been shown to occur during office visits,S” health department appointments," and hospitalizations.’® . To Indicate Omission. The comma is used to indicate omission or to avoid repeating a word when the sense is clear. (See 7.8.7, Grammar, Subject-Verb Agreement, Shift in Number of Subject and Resultant Subject-Verb Disagreement.) ‘Three patients could not be studied: in 1, duration of treatment was too short; in 2, too long. - Dialogue. Commas are often used before direct dialogue or conversation is in- toduced. (See also 8.2.3, Colon, Inttoducing Quotations or Enumerations.) In the middle of the laboratory examination, a student asked, “Would it be OK to take a break?” Semicolon, Semicolons represent a more definite break in thought than commas Generally, semicolons are used to separate 2 independent clauses. Often a comma will suffice if sentences are short; but when the main clauses are long and joined by coordinating conjunctions or conjunctive adverbs, especially if 1 of the clauses has internal punctuation, use a semicolon, . Separating Independent Clauses. Use a semicolon to separate independent clauses in a compound sentence when no connective word is used. In most instances it is equally correct to use a period and create 2 sentences. The conditions of 52% of the patients improved greatly; 4 i 5 4% withdrew from the study. Proved grea 86 of he patenss However, if clauses ate short and similar in form, use a comma, Seventy grafts were patent, 5 were occluded. Use a semicolon between main clauses joi juncti joined by a conjunctive adverb (eg, also, besides, furthermore, then, however, thus, hence, indeed, yet) or a coordinating 3418.2 Comma, Semicolon, Colon conjunction Cand, but, of, for; 207) 61 of the clauses has internal punctuation or is considerably Jong, “The patient's fever had subsided; however, his condition was stil critical Ee “The word normal is often used loosely; indeed, it is not easily defined : Introduction to the knowledge, skills, and attitudes relevant to safety should peg in medical and musing seaook eg, the fist 2 years of medical school may pe the most appropriate (o lear estor science and principles of leadership, {252282 Enumerations. For clarity enumeration within a sentence or in an at least 1 of the items listed. (In a sirnple even with multiword elements, use commas.) estions remain unresolved: (1) whether beverages that con- A number of que tain caffeine are an important factor in arrhythmogenesis; (2) whether such beverages can trigger arshythmias de novo; and (3) whether their arrhyth- mogenie tendency is enhanced by the presence and extent of myocardial impairment. . enumeration that contains serial commas in series with litle or no intemal] punctuation, “The photomicrographic illustrations of the gross and microscopic fearures of normal skin, Spitz congenital and dysplastic nevi, lentigines, and melanoma demonstrated the complexity of pigmented lesions. In less formal writing and where the last element of a series is also a series, commas are acceptable provided that clarity is preserved. ‘The statistician addressed limitations in. case-control studies, cohort studies, and randomized, double-blind, controlled trials. [SEEBBRE colon. The colon is the strongest of the 3 marks used to indicate a decided pause or break in thought. It separates 2 main clauses in which the second clause amplifies oF explains the fest. ‘This dictum is often believed to be in the Hippocratic Oath: First, do no harm. without it S58 when Not to Use a Colon. Do not use @ colon if the sentence is continuous You will need entbusiasm, organization, and a commitment to your beliels. ‘Not You will need: enthusiasm, organization, and a commitment to your beliefs. [Avoid using a colon to separate a preposition from its object or to separate a vet Gncluding to be in all of its manifestations) from its object or predicate nominative. Incorrect: ‘The point is: do not insert the catheter ’t this time. Better. ‘The point is not to insert the catheter at this time. Do not use.a colon after because or forms of the verb include. 342 _ use semicolons between items in a complex of lengthy BREE References. In references, use a colon ( = ices, 1) between title and subtitle; (2) for yd is Between issue number and page numbers; and (3) for books, between pub- lisher’s location and name. (See also 3.0, References.) : ™ | 823 Colon inrsucg Quotations or Enumerations, Use a colon to introduce a formal or exe tended quotation, (if the sentence to follow is in quotation marks, the first word is capitalized.) ete Harold Johnsi cha site ravized: old Johnson, MD, chair of the committee, summarized: “The problems we face in developing a new vaccine are numerous, but foremost a of , but fe s isolating Use a colon to introduce an enumeration, , especially afte: r 5 ina tellus tbe foes pe ly after anticipatory phrasing such ‘The solution included the followin; - g components: phosph: distilled water, and a chelating agent phosplate bien Gobi: Laboratory studies yielded’ the followin, 1g values: hemoglobin, 11.9 g/dl; erythrocyte sedimentation, 104 mm/h; calcu hon, 56 ; calcium, 16.9 mg/dL; and creatinine, 3 mg/dL. ned Phesphoms. 36 Phytoestrogens are subdivided int i i Phyoestog into 3 main classes: isoflavones, lignans, and If 2 or more grammatically independ pendent statements follow the colon, they may be treated as complete sentences separated by periods, and the intial words may orm not be capitalized. vormy ‘The following procedure has been established for updating the journal's insrctons for authors: (1) Update and review thé’ Word file. @) Style the ‘ord document according 10 guidelines and send to the electronic media staff, (3) Insert links. af tt links. (4) Proofread final version. (5) Code and post on the qampers. Use a colon to separate chapter and verse numbers in biblical references, murs and minutes in expressions of time, and the elements of ratios when they are expressed as numbers or abbreviations. For ratios expressed as words, use the word wo father than a colon, unless the term conventionally takes a hyphen (eg, “cost- snefit ratio"), In that case, follow the conventional usage and use 4 hyphen. ‘The first Old Testament mention of leprosy is in Exodus 4:6. Medication was given twice a day, at 8:30 am and at 8:30 Pw. ‘The chemicals were mixed in a 4:3 ratio. ‘The controis and study subjects were randomized in a 2:1 ratio. ‘The ACTH:TSH ratio was elevated when the patient was first examined ‘The ratio of albumin 1 in ws ‘ome measures in the in to globulin was one of the outer neasures in t ‘The student to instructor ratio was 7 to 1 3438.3.3 Hyphen L »- adjectival compounds are hyphen- f EEBERRE Hyphens and Dashes. Hyphens and dashes are internal punctuation marks used» for linkage and clarity of expression. : a For compound adjectival articiple compounds, and adie : EXEQESRE Hyphen. The hyphen is a connector; it may join “what is similar and also what is compounds that have bece . = me : pan ve become commonplace and famniliar in everyday ak, digunctive,...it divides as well 2s marties.”* The hyphen connects words, prefixes, "> : 7 sie these phrases or eee ae fee enon evssedey Usa, \ : and suffives pemnianently or temporarily. Certain compound words alwavs.camtain : ‘ify. (ollow The Chicago Momuel oF Site tak ation follow the nour j hyphens. Such hyphens are called orthographic. Examples are merry-go-round fee - , Lsih edition, TS Verify.) i mi a Sora : long-term therapy l | Ror temporary connections, hyphens help prevent am- the commitment was long-term | Jforeall, aad mother-in-lat ‘word breaks at the end of a line ‘iguity, clarify meaning, and indicate In general, when not otherwise specified, hyphens should be used only asanaid = : up-to-date vaccinations to the reader’s understanding, primasily to avoid ambiguity. For capitalization of hy- = the vaccinatior " vaccin ns Were Up-te phenated compounds in tides, subtitles, subheads, and table heads, see 10.2.2, Cap- : ve up-to-date italization, Titles and Headings, Hyphenated Compounds. : state-of-the-art equipment equipment that was state-of-the-art : 4) Hyphenate a combination of 2 or more nquas used coordinately as a unit modifier ‘Y when preceding the noun but not when following — 4 Temporary Compounds. Hyphenate temporary compounds according to current dictionary usage and the following rules: 5 Tiyohenate a compound that contains a nouf or an adver (except for adverbs : > : the Binet-Simon test (But: the test of Binet and Simon) i ‘Not to Use Hyphens) and a participle that together ending in {yz see below, When, precede. Do not use the hyphen ifthe Beer-Lambert law (dizt: the law of Beer and Eambert serve as an adjective modifying the noun they compound follows the nova. ye = decision-making methods (But; methods of decision making) swork was the most read in the Charcot-Marie-Tooth disease (Buf: the disease described by Charcot, Marie, ; ‘ot, Marie, Hosmer-Lemeshow goodness-of fit test (But: the goodness-of-fit test of i mostsead work in the collection (But: The Hosmer and Lemeshow) collection.) the physician-patient relationship (Bus the relationship between the phy rial, (But: The trial was placebo controlled.) sician and the patient) \ i it was a placebo-controlled b This is a well-edited volume. (But: This volume is well edited) The adverse event was Presentation of ratios as numbers or ‘abbreviations is an exception to this rule. In ratios presented as numbers or abbreviations, use a colon (see 8.2.3, Colon), For | ratios presented as words, use the word to of, if the word combination has become j accepted as a single tenn, such as cost-benefit analysis, a hyphen. 5) Hyphenate 2a. Sombinati nf, 2 nouns of equal participation used as a single noun. (See also 8.4.1, Porward Stash [Virgule, Solidus], Used to Express Equivalenc soup. Gee J, Used to Express Equivalence ‘The rash was a treatment-related adverse event. (But: treaument related.) Hiyphenate a compound adjectival phrase when it precedes the noun it modifies but” not when it follows the noun. side-by-side placement (But placed side by side) Hyphenate an adjective-noun compound when it precedes and modifies another ‘William Carlos Williams was a physician-poet. noun but not when it follows the noun. W. Somerset Maugham is considered a great physician-writer, Jow-quality suture materiat (But: surare material of low quality) She is an obstetrician-gynecologist highest quality printing (But: printing of highest quality) Provide the best health care for all, says the citizen-patient; but don't allow Jow-density resolution (But: resolution of low density) costs to rise, says the citizen-taxpayer. low-density nerve fibers (uty nerve fibers of low density) ‘The physician-patient may become impatient with treatment. high-altitude sickness (But: sickness at high altitude) ; The study involved 1000 patient-years. very low-birth-weight children But: children of very low bith weigh) 6} Hyphenate most compound ‘idiins that contain a preposition, Follow the latest edition of Merriam: Webster's Collegiate Dictionary. iow-molecular-weight heparin (But: heparin of low molecular weight) very low-density lipoprotein (But: lipoprotein of very Low density) 3458.3 yphens and Dashes hand-medown —go-between 8.3.4 Hyphen tie-in tie-up follow-up z (But: onlooker, passezby, handout, workup, makeup) phenate adjectival compounds with qudst.._ Aypiypteaate a compound in quasi-legislative group quasi-analytic model precedes the noun it modifies ] e quasi-dipiomatic efforts quasi-experimental design " sjose nouns that begin with quasi are not hyphenated but instead are set open (eg, 18-factor blood chemistry analysis low the Jatest edition of Merriam- Webster's Collegiate Dictionary. Hyphenate some compounds in which the first element is 4 possessive 7-fold increase PD ye itest ection of Merriam: Websier®s Collegiate Dicnonary 2-way street ninth-grade reading level bird's-eye view bullseye d-em increments crow's-feet bird's-nest filter rdinately of 4s conflicting terms whether So cae _pyphenate all prefixes that precede a proper noun, a capitalized word, an abbreviation. 6 )inptenate 2 of more adjectives, they precede the noun or follow n -positive test were noted, the false-positive test results 0 pro-African initiatives ‘The test results were false-positive. e- AIDS We performed a double-blind study. Pr ere ‘The test we used was double-blind. ‘The author provided black-and-white illustrations, ‘The author's illustrations were black-and-white, post-2005 ruling | with « hyphen when an alternative unhyphenated preix k ‘We found a need for pre- and postoperative examination, >) Hyphenate color terms in which the 2 elements are of equal wel blue-gray eyes Patients were categorized as hyper- or hypotensive. blue-black lesions (lesions were blue-black) This could be an in- or outpatient procedure. (But: bluish gray lesions) JAMA ani > Hyphenate compounds formed with the prefines. all self andex-.whether they | © 2 use the Following: precede or follow the noun, self-reported intake one’s self-respect the patient's ex-husband Patients were categorized as hy; all-powerful ruler ‘This could be an inpatient or outpatient procedure When,2 or more hyphenated compounds have a common base, omit edition of Merriam-Webster’s Collegiate but the last. In. unhyphenated compounds written as 1 word, repeat th (Note: With the prefix vice, follow the latest Dictionary, eg, vice-chancellor, vice-consul, but vice president, vice admiral.) yf) Hyphenate compounds made up of the suffixes -type, -elect, and signate. ) “ ans first-, second, and third-grade students Hodgkintype lymphoma president-elect 10- and 15-year-old:boys ‘Valsalva-type maneuver _secretary-cesignate . anterolateral and posterolateral aspects chair-elect ~ compounds Ceonsult the latest edi- sry for absolute accuracy; there are crossmiatchy cross section). Hyphenate most contemporary. adjectival, eras tion of Meriam-Webster's Collegiate Diction exceptions, eg, crossbred, crosshatched, crossover, Numerals.) ‘Thirty-six patients were examined. cuossreacive cross-discipline training cross-contamination cross-coherence analysis ‘Twenty-fifth through 75th percentile rankings were shown, cross-tolerance reaction _cross-reference citation One hundred thirty-two people were killed in the plane crash. 346 © Note: There is growing recognition and acceptance of the use of a stand-alone pre JAMA and the Archives Joumals choose not to follow this trend and instead woul =) Hyphenate compound numbers from 21 t0 99 (cardinal and ordinal) when writen, out, as at the beginning of a sentence. (See 19.1, Numbers and Percentages, Use of Sj asi diploma), although some are Closed up (eg, quasicrystal, quasiparticle), Fol- Consult all 347ayaines non-seli-gaverning non-Englist-language journals non-group-specific blood non-Q-wave myocardial infarction non-brain-injured subjects A A two-thirds majority was needed, ‘The flask was three-fourths full. © expressing Ranges and Dimensions, When expressing ranges or dimensions used as modifiers, use hyphens and spacing in accordance with the following examples in the Jeft-hand column, The alternatives in the right-hand column give the expression of dimensions when not used as modifiers As Modifier Aliernative ina 10- to 14day period 10 to 14 days’ duration a 3x‘-om strip a strip measuring 3x4 om a Sto 10-mg dose a dose of § to 10 mg ina $-, 10-, or 15-mg dose in a dose of 5, 10, or 15 mg a tube Sem in diameter a lesion Sm thick ‘Three-fourths of the questionnaires were returned, clarity. Use hyphens to avoid ambiguity. If a term could be misleading withoue: fiypheh, hyphenate it. As with the use af commas to indicate pauses, the use of the hyphen to provide clatity may be subjective. What is clear to one person may be: source of ambiguity to another, Use the following guidelines and a healthy dose gf common sense. a smail-bowel constriction (constriction of the small bowel) a smnall bowel constriction (a small constriction of the bowel) a single-specialty center (a center devoted to @ single specialty) a single specialty center (1 center devoted to a specialty) a 3-cm-diameter tube ion a large-bowel resection (resection of the laige bowel) (Better 4 colon S-mmn-thick I In the text, do not use hyphens to express ranges. (See 19.4, Numbers and Percent- ages, Use of Digit Spans and Hyphens.) ‘The adverse events were experienced by 5% to 10% of the group. resection) a large bowel resection (a large resection of the bowel) a solic-organ transplantation program (a program for transplantation of solid. ongans) : : - . a solid organ transplantation program (a program for organ tansplantation ‘The exceptions to this rule about ranges are for (1) ranges expressing fiscal years, academic years, life spans, or study spans and (2) ranges given in parentheses that is solid, ie, well established) (Better: a well-established transplantation ‘We present results from the 2002-2004 Renal Study Group. program) 59) Use 2 hyphen after a prefix when the unhyphenated word would have different: “The patients’ median age was 56 years (range, 31-92 years). meaning ~ ‘ 8 Note that no hyphens are needed in the following cases: retreat re-formation a3 to 4 ratio recreation _urvionized : a case of mild t3 moderate prositus Note: Do not hyphenate other forms of these words for which no ambiguity exists: : Word Division. Use hyphens to indicate division of a word at the end of a line (follow a the latest edition of Merriasa Webster's Collegiate Dictionary or Stedman's or Dor retreatment, recreational, id an awk land's medical dictionary). Occasionally, a hyphen is used after a prefix or before a suffix to avi ward combination of letters, such as 2 of the same vowel or 3 of the same consonait (with exceptions noted below, When Not to Use Hyphens). Follow the latest edition: of Merriam-Webster's Collegiate Dictionary or Dorland’s or Stedman's medical dic © When Not to Use Hyphens. Rules also exist for when not to use hyphens. The following common prefixes are not joined by hyphens except when they precede a proper noun, a capitalized word, or an abbreviation: ante-, antt-, bir, co conve, counter, de-, extra-, injra-, inter, intras, micro-, mid-, nom, over, pre-, tri, ultra, un-, under- tionary. semi-independent intra-abdominal holes | bell-like ultrz-atomie anti-inflammatory (post, pro-, psctido-, re-, somt-, sub-, super, supra, trans de-emphasize . antimicrobial nonresident (Some exceptions to this rule include microorganism, cooperation, reenter [see ber coauthor overproduction tow, When Not to Use“Hyphens].} Ae S codisects overrepresented tn complex modifying phrases that include suffixes or prefixes, hyphens and ett 7 coexistence overtreatment coidentity posttraumatic dashes are sometimes used to avoid ambiguity. (See also 8.3.2, Dashes, En Dash.) 349, 348,jphens and Dashes coworker preexisting deidentify reevaluation repossess interrater mnidaxillary wanssacral midbrow, ultramicrotome mabicenter underrepresented te noanegotial interfere with zeadabiliry: co-opt, co-payment, co-twin, intra-aortic mid- is a proper noun of mid-1900s, mid-Atlantic crossing womanhood shoeless manhood insulinkike cavatoniclike probandwise concordance given below. amino acid levels medical school students birth control methods natural killer cell bone marrow biopsy open heart surgery deep venous thrombosis peer review process a foreign body infiltrate primary care physician i health care system public health official E inner ear'disorder small cell carcinoma C fower extremity amputation _ tertiary care center ie Do‘not hyphenate names of disease entities used as modifiers, E basal cell carcinoma connective tissue tumor hyaline membrane disease sickle cell trait clam diggers’ itch grand mal seizures Retain the hyphen if needed to avoid ambiguity or awkward spelling that could. Retain the hyphen when the term after the prefixes anti-, neo-, pre-, Dost, and | ta number (see also above, Temporary Compounds), eg, ‘The following suffixes are joined without a hyphen, with exceptions ifthe clarity: would be obscured (see Temporary Compounds above): -haod, -less, -like, -wise. Some combinations of words are commonly read together a8 4 unit, As such com. binations come into common use, the hyphen tends to be omitted without a sacrifice of clarity. Use the latest editions of Merriam-Webster’s Collegiate Dictionary and = Dorland's and Stedman's medical dictionaries as guides to common usage (@8, broad-spectrum antibiotics is hyphenated in Dorland'’s; open beart surgery, deep venous thrombosis, and small cell carcinonta ace not). For terms not found in these sources, use 4 reader's perspective and the context as guides (eg, J “Archives journals hryphenate soft-tissue, as in soft-tisstie mass, to avoid confusion). When no confusion is likely, leave open. If there is a possibility of confusio: phenate. A short list of examples that can usually be presented without hyphens is © Compound Official Titles. Hyphenate combination positions of office but not com- 3.4 Hyphen Do notuse a hyphen after an adlverb that ends ia fy even when used in 2 compound modifter preceding the word modified; in these cases, ambiguity is unlileely and the hyphen can be dispensed with. “ees the clearly stated puspose biologically mediated therapy 2 highly developed species previously published recommendations dlinically derived databases clinically relevant variables Do not hyphenate names of chemical compounds used as adjectives. . sodium chloride solution tannic acid test Most combinations of proper adjectives derived from geographic entities are not hyphenated when used as noun or adjective formations. Central Americans Pacific Rim countries Southeast Asian countries’ Central American customs African American Latin Americans ‘Mexican American (But: Seotertish ancestry. Here the hyphen is used to indicate 2 countries of origin. Do not hyphenate Latin expressions or non-English-language phrases used in an adjectival sense, Most of these are treated as separate words; a few are joined without a hyphen. Follow the latest edition of Merriam-Webster’s Collegiate Dictioncry. an a priori argument an ex officio member pet diem employees antebellum South prima facie evidence in vivo specimens postmortem examination —_careinoma in situ café au lait spots post hoc testing Note that when post is used as a combining adjectival form, as in postmortem ex- amination, itis set closed up. When it is used as an adverb, as in post boc testing, itis set as 2-Separate words, This distinetion is apparent in the examples below: postpartum depression depression occurring post partum Do not byphenate modifiers in which a letter or number is the second element. grade A eggs study 1 protocol type 1 diabetes mellitus pound designations as follows: 3512.3 Hyphens and Dashes 8.4.1 Used to Express Equivalence or Quality anti-Norwall virus ds ion tree-based analysis non-small cell carcinoma ue secretary-reasurer acting secretary honorary chair stain (But, past view psesia lent, executive vice president, past president) : is qT A 4 2.Em Dash. The 2-em dash is used to indicate missing letters in a wor 1 ©2820) Specie’ Combinations. Special combinations may of tay HEL necessitate the use of hyphens, Constlt Stedman's, Doriand’s, and the latest ection of Mervians-Webster’s é Collegiate Dictionary. See 15.0, Nomenclature, and 17.0, Greek Letters.) B cell Mann-Whitney test The study was conducted at N——- Hospital, noted for its low autopsy rate, 3-£m Dash, The 3-em dash is used to show missing words, Each subject was asked to fill in the blank in the following statement: 7 usually sleep hours per day.” 4 graft-vs-host disease “Tshirt T tube face-lift . admire Dr F sm inthe Becell helper prosate-specific antigen 100 much to expose him in this anecdote {beam Ceshaped beam BPI Forward Slash (Virgule, Solids); The forsard slash is used to represent per ard, T wave forehead-lift ororando divide material (eg, numerator and denominator in fractons month, day, and year in dates (only in tables and figures}; lin % month, day, z T igures); lines of . Ie may Blocker square URLs (see 2.0, Manuscript Preparation). Poetry). Itmay also be used in Jcurve y-globulin Best Used to Express Equivalence or Duality. When 2 terms are of equal weight in an T-cell marker expression and and is implied between them to express this equivalence, the for- brow-lift row-tif ward slash can be retained, ‘The diagnosis and initial treatment/diagnostic plmning were recorded. = Dashes, Dashes a8 another form of intemal punctuation convey a particulay meaning” or emphasize and clarify 2 certain section of material within a semence Compared srith parentheses, dashes may convey a less formal or more emphatic “aside.” “There are 4 types of dashes that differ in length: the em dash, the most common the en dash: the 2-em dash; and the 3-em dash, When preparing a manuscript if ‘ynabols for various dashes are not available in tbe word-processing Progra USS 2 hyphens to indicate ap em dash (-) and 1 for an en dash © If the approval process raises concerns among the researchers or the ethics committee/IRB members, the author may want to explain the resolution of these issues. When the question of duality arises in the he/she construction, change the slash construction when thé gender is to be specified; substitute the word or for the forward slash or, preferably, rephrase to be gender neutral © gm Dash. Em dashes are used to indicate a marked or pronounced ipterruption or ~ reals in thought, It is best to use this mode sparingly; do not use an em dash when another punctuation mark will suffice, for instance, the come oF the colon, or to imnply namely, that is, ox in other woFtds, when an explanation follows Dr Kate Wolf and Dr Rob Cox agreed'to serve on the nomenclature com- mittee, Now I néed to know whether he or she {not he/she] will lead the subcommittee on genetic nomenclature. [sll of these factors—age, severity of symptoms, psychic preparation, and Better; Now 1 need to know which of them will lead the subcommittee choice of anesthetic agent-—determine the patients reaction, a pronoun that is the subject of If the sex is unspecified and does not matter, setain the slash construction, This aspiration technique is one that any physician can master whether or ‘Anem dash may be used to separate a referent from not he/she has surgical expertise an ending clause, , Osier, Billings, Apgar—these were the physicians she tried to emulate ote the trend today is toward rephrasing such sentences and using the plural to avoid sexist language; eg, “This aspiration technique can be mastered by physicians et of not they have surgical expertise.” (See 11.10, e Usage, Inclusive Language.) - Comes and Prcfened hows the forward Slash can be used to indicate alternative or combined states in the same person, such as Jekyll/Hyde personality, it is important that no ambiguity & introduced If there is any likelihood of ambiguity, the sentence should be re- vorde 11 but half the Jength of the em dash. The hyphenated or compound modifier, 1 nated word, or when the word being En Dash, The en dash is longer than a hypher en dash shows relational distinction in a element of which consists of 2 words or a hyphe modified is a compound. post-World War L Winston-Salem-oriented group multiple sclerosis-bke symptoms ician-Jawyer-directed section phy 353ee 85.5 Parentheses | 1) ga Forward Slash (Virgule, Solids) parentheses and Brackets, Parentheses and brackets are internal punctuation marks used {0 set off material that is nonrestrictive or, as in the case of mathematical | aad chemical expressions, t© alert the reader to the special functions occurring | within n, use a forward slash only when (1) the jading time) and (2) at Ieast 1 element he clement immediately adjacent on (2 BBB Used to Mean per, In the “pet” constructio construction involves units of measure (incl includes a specific numerical quantity and G) U arch side ig eithes a specific numerical quantity oF a unit of measure, Tn such cases, See mits of speasure should be abbreviated in accordance with 1412, Abbrevian | dons, Units of Measure (See also 19.7.3, Numbers and Percentages, Forms of Num- 3 a Z Parentheses pets, Reporting Proportions end Percentages) © Supplementary Expressions. Use parentheses to indicate supplementary explana- tions, identification, direction to the reader, or translation, (See also 8.3.2, Dashes. | ‘Yhe hemoglobin level was 14 g/dl. and 8.5.2, Brackets.) iL. ‘The CD4* cell count was 200/ Blood volume was 80 mL/kg of body weight. A known volume of fluid (100 mL} was injected. rave was 98/min. | ‘The differences were not significant (P > .05). Respirations were 60/min; pulse One of us (B.0.G.) saw the patient in 2006. | ‘The drug dosage was 30 mg/d. * pes" construction (1) when a prepositional phrase 2) when no specific numerical quantity is Asymmetry of the upper part of the rib cage (patient 5) and pseudarchrosis of the first and second ribs (patient 8) were incidental anomalies (Table 3). Do not use the forward slash in a intervenes between the 2 units of measure, ( expressed, or (3) in nontechnical expressions. Of the 761 hospitalized patients, 171 (22.5%) were infants (younger than 1 | 4.5 mEq of potassium per liter yea (Avoid: 4.5 mEq/L of potassium; instead reword: a potassium concentration of 45 mEq/L.) In this issue of JAMA (p 1037), successful transplant is reported. . The 3 cusps of the aortic valve (the *Mercedes-Benz sign”) were clearly expressed in milliliters per minute shown on the echocardiogram. If there is a close relationship between the parenthetical material and the rest of the 2. days per year ard slash in dates only in tables and figures to save space sentence, commas are preferred to parentheses. In Dates. Use the forws of Data, Tables, Punctuation). Avoid. Gmonth/day/year) (see 4.1.5, Visual Presentation: this presentation of dates in the text The bh i The hemogicbin Jevel, although ia the normal range, was lower than ex- If the relationship in thought after the expressions namely (viz), that is ie), and for rations that are set on line and tun into the text rathes than example (eg) is incidental, use parentheses instead of commas. [ERR In Equations. In cau centered and set off (see 21.3, Mathematical Composition, stacked vs Unstacked), use the forward slash to 5¢ : He weighed the advice of several commitiee members (namely. Jones, Burke, wparate numerator and denominator. and Easton) before making his proposal piRis written as y = (r+)! ~ Pa) ‘The “stacked” fraction y = 4 Note that when the slash is used for this purpose, parentheses and brackets must often be added to avoid ambiguity. 2 Punctuation Marks With Parentheses. Lise no punctuation before the opening pa- renthesis except in enumerations (see Enumerations below). “ame In Ratios. Although 4 forward slash may ‘Any punctuation mark can follow a closing parenthesis, but only the 3 end marks I ato. A ete a (the period, the question mark, and the exclamation point) may precede it when th fae BU io wn 2 Ja arene e ABO #90 we ation : parenthetical material interrupts the sentence. If a complete sentence is contain ’ tios involving words (the male io female ratio). within parentheses, itis not necessary to have punctuation within the paentheses fw would noticeably interrupt the flow of the sentence. Note that with complete wens ‘ was 2:1) and the word 7o to express ral (See §.2.3, Colon, Numbers.) tences, the initial letter of the first word is capitalized. be used to express @ ratio (eg, the male/ journals recommend use of a ‘The discussion on informed consent lasted 2 hours. (A final draft has yet to asi is also used to set off phionemes and phonetic be written.) The discussion failed to resolve the question. i In Phonetics, Poetry. The forward sla’ transcription and to divide fun-in lines of poetry dy ‘The discussion on informed consent lasted 2 hours (a final draft has yet to be written) and did not resolve the question. sin dog cold-breathed eaith/earth of the skumberiny mountains misty-topped. 12 and liquid wees/earth of the 355 35425 Parentheses and Brackets 255.2 Brackets Tradle Names, If there is.a reason to provide a trade nare fora dmg or for equipment, enclose the trade name in parentheses immediately after the first use of the non. ‘etary name in the text and in the abstzact. Gee also 15.4.3, Nomenclatur ation, suc lane ° > ure, al inchidles special punctuation, such as an exclama. Drugs, Proprietary Names; and 15.5, Nomenclature, Equipment, Devices, and Re- ‘or several statements, termina! punctuation is placed | aggnts.) ° an eternity (It took 2 hours), the discussion on informed After what seemed consent ended. ‘when the parenthetical materi tion point or a question mark, inside the closing parenthesis. _ “ Treatment included oral aéiministration of indomethacin (Indocin), 25 mg When? Where? Who knows? But I read it in a book Sime da y. “anyone who has never Oscar Wilde once said > once upon a time, hence it must be true.) that awritten a book is very feared’? <= Abbreviations. If used in the text, specialized abbreviations (as specified in 14.11, ; Abbreviations, Clinical, Technical, and Other Common Terms) are enclosed in pa- sm identified by letter or number is re rentheses immediately after first mention of the term, which is spelled out in full © Identifying Numbers or Letters. When an iter ea enclose the leter or number in pa- fetted to later by that letter or number only, Explanatory Notes. Explanatory notes, when incorporated into the text, are placed within parentheses. In such instances, terminal punctuation is used before the closing parenthesis, the sentences) within the parentheses being a complete thought but only parenthetical to the text. rentheses: ‘you then follow (3), (3), and (6) to solve the puzzle, IF the category name is used instead, parentheses may be dropped Steps 12, and 9 mabe done oni Parenthetical Expressions Within a Parenthetical Expression. These are enclosed in i brackets. division of a short enumeration that is run in and indicated by Enumerations. For merals or letters in parentheses. numerals or lowercase italic letters, enclose the nur (See also 19.5, Numbers and Percentages, Enumerations.) CAntirejection therapy included parenteral antithymocyte globulin [ATGAM), ata dosage of 15 mg/kg per day.) But: In mathematical expressions, parentheses are. placed inside brackets. See 8.5.2, Brackets, Within Parentheses. “The patient isto bring (1) al pill bottles, (2) pastnedical records, and (3) our questionnaire 10 the first office visit 2 Parenthetical Plurals. Parentheses are sometimes used around the letters 5 of es to express the possibility of a plural when singular or plural could be meant, (See also 7.8.4, Grammar, Subject-Verb Agreement, Parenthetical Plurals.) £5 References in Text. Use parentheses to enclose all or part of a reference given in the text, Gee also 3.3, References, References Given in Text.) \c were seported in the ‘The name(s) of the editor(s) of the book in reference 2 is unknown. “Toco cases of invasive zygomycosis with a fatal ouscom Archives of Dermatology (2005;141{30)-1211-1213). Note: If this construction is used, the verb should be singular, because the s is par- enthetical. In general, try to avoid this construction and use the plural noun instead ses to i y 1 patient and parts of ses to identify a case or patient and p: or rephrase the sentence: In Legends. In legends, use parenthe: : 2 " (See also 4.2.7, Visual Presentation of Data, a composite figure when appropriate Figures, Titles, Legends, and Labels.) Werdo not know the name(s) of the editox(s) of the book in reference 2 Figure 6. Facial paralysis on the right side (patient 2) Brackets Figure 2. Fracture of the left femur (patient 7). fons in fe | Insertions in Quotations. Brackets are used to indicate editorial interpolation within a quotation and to enclose corrections, explanations, or comments in material that is quoted. (See also 8.6.1, Quotation Marks, Quoiations; 8.8.6, Ellipses, Change in Capi- talization; and 8.8.7, Ellipses, Omission of Ellipses.) ‘The date, if given, is similarly enclosed. Figure 2, Fracture of the left femur (patient 7, October 23, 2004) the stain, if relevant, in paren= Figures, Titles, Legends, and Yor photomicrographs, give the magnification and theses (see also 4.2.7, Visuak Presentation of Data, Labels). Figure 3, Marrow aspization 14 weeks al original magnification *600). “Enough questions had arisen {these are not described] to warrant medical consultation.” ‘Thompson stated, “Because of the patient's preferences, surgery was abso- fier transplantation (Wright stain, Jutely contraindicated jiralics added}.” “The following year [1947] was a turing point, 357 356358 otation Marks Note: the spelling or grammar of the 9 tion, As with apologetic quotatics Quotation M Within Parentheses. Use bracket: enthetical expressions. © In Formulas. Quotations. Use quotation mazks to enclose a diteet quotation of ne more than 4 : tan forthe oa bec ne ct lines from textual material or speeches (for longer material, see als 8.6.14, Quot neo ee feding word in the original source of the quota ; ne fr ental materi or speech a marks (see 8.6.8, Quotation Marks, Apologetic : ton Mars, lock Guts), Whee quttion as ents se raiks), use sic with discretion. : eons original exactly. The only time this rule does not apply is when the quoted materia eee eet isial. although a complete sentence or part of a complete sentence in its original source, is nis en ose by escort SHORTS now used as part of another complete sentence. In this case, the capital letter in the “Breathing of the ga quoted sentence would be replaced by a lowercase letter in brackets. < to indicate parenthetical expressions within par: terial should be indicated by placing the change in brackets. (See 8.5.2, Brackets, Insertions in Quotations.) To indicate an omission in quoted material, use ellipses, (See 8.8, Ellipses.) To indicate editorial interpoiation in quoted material, use brackets. (See 8.5.2, Brackets, Insertions in Quotations.) Use [sic] after @ misspelled word or aa incorrect cer apparently absurd statement in quoted material to indicate that this is an accurate rendition of the original source. However, when quoting material from another era that uses now obsolete spellings, use sic sparingly. De not use sic with an excla- mation point. (Note: The use of sic is not limited to quoted material; in other in- stances, it means that any unusual or bizarre appearance in the preceding word is intentional, not accidental.) (See 8.5.2, Brackets, Insertions in Quotations.) ‘The author should always verify the quotation from the original source. |A nitrogen mustard (mechlorethamine hydrochloride [MustargenD was one of the drags used. encounters complex parenthetical constructions such as ci one often In scientific text, Parco ets within pat secutive parentheses and brackets within p 2 Her platelet count was 100 00/mss C100 x 1 to 450.000/min? [150 to 450 x 10°/LD. “ 10° /L) Greference range, 150000 ematical formula’ eses are genel ised for the in- entheses are generally used in mathematical formulas, parent pene anged to Ae ale ition, Stacked vs ‘Unstacked.) netmost units, with parent centhetical, (See also 21.3, Mathematical Compos _ EEEBBR Dialogue. with conversational dialogue, enclose thé opening word and the final t=day—") word in quotation marks. “The equation suggested by this phenomenon (t= dir, ~ ra can be applied ina variety of circumstances. see ee tee angen tore nesty heses and brackets; rend is to use only parent enthetc hhas an opening and hnetical or bracketed expression has a: ng and ‘mabo!, Consult the most recent edition of USP Dic Jal Drug Names for drug formulas and The Merck rify the correct use of parentheses and brackets. “OK, if that’s inconvenient for you, [ won't.” In chemical formulas, making sure that every parent closing parenthesis or bracket sy tionary of USAN and Internation: Indes for chemical compounds (© ve ‘ERSEEEEE Titles. within tives (including titles of articles, references, and tables), centered heads, and run-in sideheads, use double quotation marks. The “Sense” of Humor erimental drug (942 sagivoy-1-CaydeonymethyDethonymethy Na. Ae ett eomepalvinus retinopathy in paients wh 86.453) Single Quotation Marks. Use single quotation marks for quotations within quota- tions, c 2 y the author, If the oldes style of parentheses, braces, and brackets has been wed by ae anor x author's inte . stan The noxation wl be eal ore ge eas contains «mathe He looked at us and said, “As my patients alwa hen parenthetical or bracketed insertion in she text contains man He Loi 4 ckets appear, the characters within 1 which parentheses or brackets appeat, the ¢ cowie he formula gotbe left as ven unless that would place 2 identical punctuation 6 bots eg Pop “arentheses) immediately adjacent to each other. To avoid acjacen igen © ae totes change parentheses to brackets or brackets to nen s cal crac Gn om nse ot, stain with paveeses, 0 Brackets bbraces, told me, Be a good Placement. Place closing quotation marks outside commas and periods, inside co- Jons and semicolons. Place question marks, dashes, and exclamation points inside “ quotation marks only when they are part of the quoted material. if they apply to the whole statement, place them outside the quotation marks. Why bother to perform autopsies at ail if the main finding is invariably cv? = [cv} + (cv2/ NRII/NS “edema and congestion of the viscera"? Quotation Marks. Quotation marks are used (0 rectly from another source. i terial that is taken di- “ “— The clinician continues to ask, “Why did he die? 359 In all quoted material, follow the wording, spelling, and punctuation of the Similarly, in legal material any change in initial capital letters from quoted ma- | |86.14 Block Guotati 8.6 Quotation Marks So-called. A word or phrase following so-called should not be enclosed in quotation {I fend you my stethoscope for elinic’—4hen she remembered the last time.” i carks. she had Jent it and said, “On second thought, I'l be needing it myself mar ‘The so-called harm principle holds that competent adulis should have ce s ways needed with quoted material. For example, in the (Wote: Commas are not always needed : velled bas j mpetent als should ave following example commas are not necessary after “said” or to set off he quoted common Words Used in a Technical Sense. Enclose in quotation marits a common, word used in 4 special technical sense when the context does not make the meaning clear. (See also 8.6.11, Definition or Transiation of Non-English-Language Words) material.) He said he had had his “fill of it all” and was “content” to leave the meeting, ESE omissi ir a . The opening quotation mark: Omission of Opening or Closing Quotation Marks, T vatke ped when an anicle beginning with a stand-up or dropped initia should be omitte drop : capital levter also begins with a quotation. Itis best, however, to avokd this construc: tion, In many publications, “running feet” on left-hand pages face the “gutter” at the bottom of the page. “Coma vigil” (akinetic mutism) may be confused with conscious states | Definition or Translation of Non-English-Language Words. The literal translation of a non-English-language word or phrase is usually enclosed in quotation marks if I it follows the word or phrase, whereas the simple definition of the word or phrase i is not. (See also 12.2, Non-English Words, Phrases, and Accent Marks, Accent Marks | {Diacritics}.) Doctors need some patients,” @ sage had said. that consist of several paragraphs, use opening fa paragraph and closing quotation matks only at and 8.6.14, Block Quotations) When excerpting long passages double quotation marks before eac! the end of the final paragraph. (See also 8.8, Ellipses, rds or phrases used words oention There Hysterical patients may exhibit an attitude termed la belle indifférence E 4 : (beautiful indifference” or total unconcern) toward their condition, i My | [ESSEABE coined Words, Slang. Coined words, slang, nicknames, an ° in quota rks at ironically or facetiously may be enclosed in quotation marks after, omit quotation marks, (See also 22.5.4, ‘Typography, Specific Uses of Fonts; Ttalics.) Titles of Works. In the text, use quotation marks to enclose titles of short poems, es- i says, lectures, radio and television progeams, songs, the names of electronic files, i parts of published works (chapters, articles in a periodical), papers read at meetin. i 8, dissertations, theses, and parts of the same article (eg, the “Results” section). (See qa also 10.5, Capitalization, Types and Sections of Anticles, and 22.5.4, Typography, i} Specific Uses of Fonts, rtalics.) i We further hope that, above all, those who have been fed only “docufiction” on this matter, as if it were truth, will cease to be misled. Nelson Essentials of Pediatrics is not a...synopsis of or a companion to the Nelson Textbook of Pediatrics, although initially our associates dubbed i “Baby Nelson,” “Half Nelson,” and “Junior Nelson.” tt has been said that shoes and latrines are the best “medicine” for ancy- Indirect Discourse, Discussions. After indirect discourse, do not use quotation marks. lostomiasis (hookworm disease), ‘The nurse said he would be discharged today. mnphasizing a word, when using a non-English ynen defining a term, In these instances, Do not use quotation marks with yes or no. orwhen s fe Do not use quotation marks when ¢: word, when mentioning a termas aterm, : ‘ 4 italics is preferred. (See also 22.5.4, Typography, Specific Uses of Fonts, Italics.) His answer to the question was no. i ‘The page number is called the folio In interview or discussion formats when the name of the speaker is set off, do not use i | quotation marks. “the eye associated with the greater reduction in hitting ability when dimmed. by a Gilter was termed the dominant eye for motion stereopsis. Dr Black: Now let us review the slides of the bone marrow biopsy. Dr Smith: The first slide reveals complete absence of granulocytic pre- (i Pulsus paradoxus is defined as an exaggeration of the physiologic in- cursors, spiratory drop in systolic blood pressure, Apologetic Quotati for special effect or to indicate irony. In most instances, ~ EXSEEIEE! Block Quotations. If material quoted trom texts or speeches is longer than 4 lines of | * text, the material should be set off in a block, ie, in reduced type and without the quotation marks, Paragraph iadents are generally not used uniess the quoted mate- ., tal is known to begin a paragraph. Space is often adcied both above and below these | longer quotations. ion Marks. Quotation marks are sometimes used around words however, they are unnec= essary. Using their own finances and being informed about the economics of the some may opt for the “boutique class” of heaith care. approach, 361ET ! 87.7 Prime 8.7 Apostrophe Note: When one of the nouns takes 2 possessive pronoun, the other nouns take the | < quotation appeats in a section to be set in. reduced type, do not reduce If the block quotation appears in ite When one the type size of the quoted material further, 1s within 4 block quote, use double quotation mark regardless of the | fF ine tation appeal I presented the intezn's and my workups. If another quotation appea ground the contained quotation, rather than seiting off in block length. ESDRSSEE Apostrophe Using Apostrophes to Form Plurals. Do not use an apostrophe to indicate the piural of a name. Do not use an apostrophe in the name of an organization in which the qualifying term is used as an adjective or an attributive rather than a possessive. Of i course, always follow the official name. . | To Show Possession. Use the apostrophe to show the possessive case of proper: ‘The Chicago Cubs state parks rangers . | nouns in accordance with the following examples (see also 16.2, Eponyms, Non Veterans Affairs vimisicians union possessive Fort): Rainbow Babies Hospital nurses station Jones’ bones (1. person named Jones) the Joneses’ bones (2 or more people named Jones) Ifa singular or plural word does not end in s, add ‘sto form the possessive. ise to indicate the plural of letters, signs, or symbols spoken as such, or words \ referred to as words when s alone would be confusing, Note the italics with inflec- i tional ending in roman type for words, letters, and numbers but not for symbols and I ' signs. a child’s wants men's concems signs. women’s health everyone's answer . Ifa proper noun or name ends ina silent s, z, or, form the possessive by adding. 5. He uses too many and’s. ‘The manuscript editor was mindful of the list of do's and don'ts. ‘Theroux's The Mosquito Coast Mind your p's and q's. . Jacqueline du Pres's recordings There are 9 4's on the page. ESRB possessive Pronouns. Do not use ’s with possessive pronouns: his, hers, ours, its, His 1’s looked like 7's, yours, theirs, whose 4 Do not use an apostrophe to form the plural of an all-capital abbreviation or of ‘The idea was hers, numerals (including years). (See also 9.5, Plurals, Abbreviations.) Give the book: its due. ECGs RBCs Note: Do not confuse the contraction of if és (it's) with the possessive its, eg, “I's an EEGs a woman in her 40s ‘excellent resource. I have not seen its equal. 1s during the late 1990s WBCs V | Hj Units of Time and Money as Possessive Adjectives. With units of time (minute, hour, cay, month, year, etc) used as possessive adjectives, an ‘s is added, The same holds cy meh i father-in-law’s health someone else’s problem editor in chief's decision secretary of health’s naling, {QERIERE Joint Possession. When joint possession is being shown with nouns, or with - organization's or business firm's name, use the possessive form only in the last wor an hours delay 6 months’ gestation i of the noun or name. 5 days’ hard work a dollar's worth i Food and Drug Administration's policy Farrar, Straus & Giroux’s books sign as a symbol of measurement. (See also 15.4.4, Nomenclature, Drugs, Chemical i Centers for Disease Control and Prevention’s Task Force Names.) i Hammond and Horn’s study ‘The methyl group was in the 3 position When possessi6n is individual, each noun takes the possessive form. a day's wait a few hours’ time | | | ‘We matched the infant's and mother’s records, | 363 362 menejose 8.8 Ellipses lots (...) generally used to indicate omission of 1 or sometimes yoi say its smaller, Today data from quoted material (this omission being the ragraph will be used to demonstrate the use Eltipses. Ellipses are 3 spaced d more words, lines, paragraphs, OF ellipsis). Excespts from the following pa ‘you said it was a touch larger, and would change. ‘Mare Straus, MD, “autumi of ellipses, @ Omissions Between or at the Start of Paragraphs. With material in which several paragraphs are being quoted and omissions of full paragraphs occur, period and ellipses at the end of the paragraph preceding the omitted material are sufficient to indicate this omission . 12 a Stand (cover), exhibited in 1882, Caillebote depicts a manner far removed from the traditional cormucopian flow a stark, rectangular grid lit by centers of rounded forms, reds, and purples, light greens, creamy viclets, L within areas of crinkly blue-white paper, the he hotter tones, preventing them from | tn frute Displayed | traditional subject ina of fruit. Instead, he shows brilliantly colored. Vivid oranges and color-flecked gold are cupped cooler shades in the center separating t spilling into each other.> Indeed, it is no moie than the just desert of Dr Theodore Schott and his late brother to attribute to them the credit of having introdaced and elaborated a method capable of restoring most cases of heart disease to a state of com- plete compensation, after the failure of other means, such as digitalis. If the initial word(s) or the first sentence of the paragraph being quoted is omitted, begin that paragraph with a paragraph indention and ellipses to indicate that this is not the beginning of that paragraph. [EBIRBH omission Within a Sentence. Ifthe ellipsis occurs within @ sentence, ellipses reps resent the omission. it is no more than the just desert of Dr Theodore Schott and his late brother to attribute to them the credit of having introduced and elaborated a method capable of restoring most cases of heart disease to a state of com- plete compensation, after the failure of other means, such as digitalis, Instead, he shows &...gtid lit by centers of rounded forms, brilliantly colored. additional punctuation may be used on either side of the tence or better shows the omission. Jn some such instances, ellipses if it helps the sense of the se Change in Capitalization. The first word after the end pufictuation mark and the ellipses should use the original capitalization, particularly in legal and scholarly ‘documests. This facilitates finding the material in the original source and avoids any change of meaning. Ifa change in the original capitalization is made, brackets should be used around the letter in question. (See also 8.5.2, Brackets, Insertions in Quo- tations, and 8.6.1, Quotation Marks, Quotations.) , brilliantly colored. Instead, he shows a stark, rectangular grid - If the quotation tself contains ellipses, to make clear that the ellipses were Pare ofthe original a note to this effect shouid be included in brackets Jentence or Between Complete Sentences. Jf the ellipsis ete sentence, of between 2 complete sentences, ellipses + final punctiation mark being set close to the 1d ig not the final word in that sentence in the Omission at the End of a S occurs at the end of a compl follow the final punctuation mark, the word preceding it, even when this wor original In Fruit Displayed on a Stand (cover), exhibited in 1882, Cailiebowe oops a traditional subject in a manrner far removed from the traditional. -Insteat, he shows a stati, xectangular gril lit by centers of rounded forms, beilliantly colored. {Hie shows a stark, rectangular grid lit by centers of rounded forms, brilliantly colored. In the cover story, the artist is described as using “(vivid oranges, reds, and purples, light greens, creamy violets, and color-flecked gold” to depict “a traditional, subject.” es. Ellipses are not necessary at the beginning and end of « quo- tation if the quoted material is a complete sentence from the original, In a 1985 JAMA Cover story, Martha Bier wrote, “Instead, he shows a stark, rectangular grid lit by centers of rounded forms, brilliantly colored. entence within which an ellipsis 0 ression. Flowever, ellipses and 10 that it is purposely, {QUEST Grammatically Incomplete Expressions. The s° curs should besa grammatically complete exp: @ petiod may be used at the end of a sentence fragment to indicate grammatically incomplete. Omit ellipses within a quotation when the omitted words occur at the same place asa bracketed editorial insertion, (See also 8.5.2, Brackets, Insertions in Quotations.) ” in 20 words or less. “[Cailleboxtel shows a stark, rectangular grid lit by centers of rounded forms, Complete the sentence “When I retire, | plan to- brilliantly colored.” =~ ission of a full lineor When a quoted phrase is an incomplete sentence, readers understand that something Omissions in Verse. Use tine of em-spaced dots to indicate om} precedes and follows; therefore, ellipses are not used. several consecutive lines of verse. 365ag Ellipses Caillebotte does not use “centers of jed grays and purples In Place de L’Burope on a Rainy Day rounded forms, brilliantly colored” but instead uses mus : to give the feel of the rain. the first part of the sentence is deleted llipses are generally not needed whe otte “depicts a traditional subject in a manner far removed from Here Caillebs the traditional, 94 ses may he used, for example, to indicate that no: i Ellipses in Tables. in tables, ellip: ene ware available or that a specific category of data 18 90 applicable. (See also 4.1.3, Visual Presentation of Data, Tables, Table Components.) An explanatory foot: 82 sreve should always be included if itis not absolutely clear from the context what the ellipses represent. Spllipses indicate no test performed. 94 ACKNOWLEDGMENT Principal author: Cheryl Iverson, MA 4, Behrman R, Kleigraa Saunders; 1999. 5, Bier ML. The Cover. JAMA, 1985 :254(8):1000. Plurals Collective Nouns ‘Microorganisms How Plurals Are Formed 93 tatin and Greek vs English How Plurals Are Formed, The plurals of most nouns are formed by adding -sor -es. Howev i a jowever, English is irregular enough that it pays to, consult a dictionary for most os Abbreviations 96 . Plurals of Symbols, Letters, Numbers, and Years 27 ‘When Not to Use Plurals 98 R e Singulars REFERENCES 1, Truss L. Eats, Shoots & Leaves: The Zero Tolerance “Approach to Punctuation. Neer Singular Plural ‘York, N¥: Gotham Books; 2003-201. book books 2, Shields C. Invention. In: Dressing Up for he Carnival New ‘Yorks, NY: Penguin Putnam = church churches Ine; 2000:151 decision decisions “ 5, Ball P. The Unauthorized Biography af @ Local Doctor Or From Infancy Throwg 4 Puberty and On to Senility. Hagerstown, MD: Exponent Publishers; 1993. isease diseases er Nelson's Essentials of Pediatrics, Philadelphia, PA: WB turnip turnips yort yarts Singular Phavat woman women baby babies tooth, teeth wolf wolves child — children, Colle Collective Nouns Callecve nouns may take either singular of plural verbs, de- er the word refers to the group as * pending 1p as a unit or to its members as inva n American English mest nouns naning a rou regarded as a unit are as singular. (See also 7.8.5, Grammar, Subject-Verb Agreement, Collective Nouns.) Fifty percent of my time is spent on administration. Fifty percent of all physicians do not exercise regularly ‘The audience was enthralled. 3679.4 Microorganisms ingulars ‘This gathering is becoming noisy. salmonella salmonetlae ‘At noon today the jury delivers its verdict Staphylococeus staphylococet Streptococcus streptoco For a unit of measure, use a singular verb. Abbreviations. For most all-capital abbreviations, the plufal is formed by adding 5 Do not use an apostrophe before the s. (See also 8.7.5, Punctuation, Apostrophe, Using Apostrophes to Form Phurals.} Five milliliters was injected, ‘Two weeks of symptoms is common. EERE Latin and Greek vs English. There is « trend toward using English plurals rather Cs HMOs than the traditional Latin or Greek. However, in most cases the latest edition of neces Tce . “Mervians- Webster's Collegiate Dictionary ot Dorland’s ot Stedman's medical dictio” a hoe s s nary should be followed. Consistency within a manuscript is key. : ‘Note: When plural all-capitalletter abbreviations are found in an all-capital setting, Singular Preferred Plural a — me oo such as a Girst-leve! heading, the plural s is still lowercase. alga al amoeba amoebas REFERRAL PATTERNS IN MIDWESTERN HMOs. Plurals of Symbols, Letters, Numbers, and Years. Use ‘$10 indicate the plural of letters, signs, or symbols spoken as such, or for words referred to as words when s alone would be confusing, Note the use of italics with the inflectional ending in roman type for words, letters, and numbers but not for symbols and signs. Gee also 8.75, Punctuation, Apostrophe, Using Apostrophes to Form Plurals.) appendixes or appendices [consult dictionary appendix for specific usagel cannula cannulas condyloma acuminatum —condylomata accuminata {with 2-word Latin plurals, both parts become plurall He uses too many and’s. “ cranium crania fistula fistulas All of the capital P’s should be underlined. formula formulas Please use +’s to indicate a positive result genus genera index indices or indexes [consult dictionary for Note; if the symbol can be easily expressed using words, this is preferred: specific usage] Please use plus signs to indicate positive results. maxilla maxillas Do not use an apostrophe to form the plural of numerals (including years). orbit orbits during the 1920s rhytid thytids a woman in her 50s sequela sequelae vertebra vertebrae When Not to Use Plurals. Beware of “pluralizing” nouns that cannot stand on their own as plurals serum samples (not “sera”) {EERE microorganisms. When referring to the common vernacular plural of a genus, use urine tests (not “urines") roman lowercase letters. Consult the latest edition of Dorland’s or Stedman's medical = dictionary. For organisms that do not have @ comnion plural, add the word spectes O°, organisms to the genus name to indicate a plural use (see also 15.44, Nomenclature, Organisms and Pathogens), False Singulars. Some nouns, because they end in a “plural” form, are mistakenly taken to be plurals even though they should be treated as singular and take a singular verb (eg, measles, mumps, mathematics, genetics). Gens Phiral Noun Form Chlamydia chlamydia Measles is 2 deadly disease in underdeveloped countries, Escherichia Escherichia organisms ‘A few nouns are usually used in the plural form; however, the distinction between Mycobacterium mycobacteria plural and singular should be retained where appropriate. (See also 7.8.3, Grammar, Proteus Proteus species Subject-Verb Agreement, False Plurals.) Psendemonas pseudomonads 3699.8 False Singulars Singular ee datum criteria criterion media medium [for a specific type: Television is a good medium for disseminating important health news.) phenomena phenomenon ACKNOWLEDGMENT Principal author: Brenda Gregoline, ELS Capitalization 40.1 1038 Tess First Word of Sentences, Statements, Quotations, 10.3.9 Official Names ‘Titles, Subtitles, and Table Headings. 10.3.10 Titles and Degrees of Persons 102 10.4 Titles and Headings Designators 02.1 Titles of Medical Articles 1022 Hyphenated Compounds 105 ‘Types and Sections of Articles 103 © Proper Nouns 106 103.1. Geographic Names Acronyms and lnitiatisms $032 Sociocultural Designations $03.3 Events, Awards, and Legislation 10.7 40.3.4 Eponyms and Words Derived Capitalized Computer Terms From Proper Nouns 103.5 Proprietary Nernes 108 10.3.5 Organisms “intercapped” Compounds 103.7 Seasons, Delties, Holidays rst Word of Sentences, Statements, Quotations, Titles, Subtitles, and Table Headings. The first word of every complete sentence should be capitalized. ‘The following should also be capitalized: > The first word of a formal statement that follows a colon Our conclusions may be stated thus: More research is needed. © The first word of a direct quotation (but see 8.6.1, Punctuation, Quotation Marks, Quotations) The report noted: “A candidate may be admitted after completing 2 years of medical school,” Kurt Vonnegut put it best when he said, “Writers can treat their mental illnesses every day.” Note: If the quotation is sun into the sentence, a lowercase letter on the first word may be preferable (see 8.6.1, Punctuation, Quotation Marks, Quotations). ‘The patient described her headache pain as feeling like “needies behind the eyes.” ® Each major word in the title of a table (see 10.2.1, Titles and Headings, Titles of Medical Articles, and 4.1.3, Visual Presentation of Data, Tables, Table Compo- nents). In column and row headings (table stubs), only the initial word should be capitalized. If a symbol, numeral, or lowercase Greek letter begins the stub, the first word that follows should be capitalized. 37110.2 Titles and Readings (SUERBZ Titles and Headings. Capitalize major words in titles, subtidles, and headings of © publications, musical compositions, plays (stage and screen), radio and television, programs, movies, paintings and other works of att, sofware programs, Web stesand sweblogs, electronic systems, trademarks, and names of ships, airplanes, spacecraft, awards, corporations, and monuments somef Do not capitalize a coordinating conjunction, an article, or a preposition of 3 fewer letters, except when itis the frst or last word in a tite dy subUile. (Por oF Oa sjpeface cules when iéferring to works of ar, see 22.5.4, Typography, Specific Uses a of Fonts, Italics, and 8.6.3, Punctuation, Quotation Marks, Titles.) S et All My Children MetaFilter the Monitor and the Merrimac My Man Godfrey the New England Journal of Per eee ae the Cochrane Database the USS Gole the space shuttle Endeavor The Four Seasons by Antonio Vivaldi Medicine Lucian Freud’s Gir With @ White Dog oneal Golden Globe Award PubMe Internet The Sopranos symphony No. 8, “Symphony of oe puma! of the American Medicat pthousand,” by Gustav Mahler ssociat he Kitty Hawk the Tomb of the Unknown Soldier the Kitty Haw! The Lasker Award Wisden the Lincoln Memorial WordPerfect LINE World Wide Web (the Web, nese Web site) MeSH [Medica Subject Headings} Note: The may be dropped from titles ifthe syntax of the sentence improves without it. [OER Titles of Medical Articles. Titles of articles take initial capitals when they are in the title position but not when they are in the reference position. Title: Autonomic Response in Depersonalization Disorder Reference: Sierra M, Senior C, Dalton J, Autonomic response in. depersonalization disorder. Arch Gen Psychiatry. 2002;59(8): 100-103. In titles and headings, capitalize 2-letter verbs, such. as go, do, am, is, be. Note: In ticle, oz preposition of 3 or fewer letters, except when its the first word ip the title or subtitle. ‘What Is Sarcoma? We Do Need to Treat Mild Hypertension Where the World Will Be in the Year 2020 372 infinitives, “to” is not capitalized. Do not capitalize a coordinating conjunction, at 10.2.2 Hyphenated-Compounds Defining the Role of Computed Tomography in Injuries Resulting From Blunt Abdominal Trauma Cardiovascular Risk Factors in Patients With Type 2 Diabetes, Opportunities for Comprehensive Risk Management In compound terms from languages other than English, capitalize all parts of the expression. Fluorescence In Situ Hybridization in Surgical Specimens of Lung Cancer Nephrectomy With Concomitant En Bloc Adrenalectomy With a phrasal verb, such as “follow up,” capitalize both parts ina tile, ‘The Need to Follow Up the Patient With Esophageal Cancer Hyphenated Compounds, In titles, subtitles, table headings, and text headings, do not capitalize the second part of a hyphenated compound in the following instances: ‘ Ifeither part is a hyphenated prefix or suffix (see Temporary Compounds in 8.3.1, Punctuation, Hyphens and Dashes, Hyphen) Nonsteroidal Aati-inflammatory Drugs Self-referral to Psychiatrists compound words with the prefix self. are con- sidered one word] “ Intra-abdominal Surgety = If both parts together constitute a single word (consult the current edition of Merriam-Webster's Collegiate Dictionary or Stedman’s ot Dorland’s medical dic- tionary) Long-term Treatment of Diabetes Pollow-up Studies of Patients With Leukemia Part-time Nursing Staff How to Interpret X-ray Films However, in the case of a temporary compound, in which each part of the hy- phenated term carries equal weight, capitalize both words. Cost-Benefit Analysis Low-Level Activity Dmg-Resistant Bacteria B-Cell Lymphoma Obsessive-Compulsive Disorder Age-Related Macular Degeneration In titles, subtitles, table heads, text headings, and line art, capitalize the first letter of a word that follows a lowercase (but nota capital) Greek letter (see 17.2, Greek Letters, Capitalization After a Greek Leer), a-numeral (except when an abbreviated unit of 37310.3 Proper Nouns measure that never is capitalized follows), a symbol, or an italicized organic chem- istry prefix such as trans- and cis- Systemic Adverse Effects of Ophthalmic P-Blockers Enhancement of A-aminolevulinic Acid Photodynamic Therapy Effectiveness of Timolol at 10% Sirength High-Dose 308-nm Excimer Laser for the Treatment of Psosiasis 2y-Amtitrypsin Inhibits Overexptessed Serine Proteinases During inflammation Both genus and species should be capitalized in all-capital text headings. HELICOBACTER PYLORI AND THE PATIENT WITH ULCERS However, they should be treated nommally in mixed capital and lowercase headings Gee 10.3.6, Proper Nouns, Organisms, and 15.14.3, Nomenclature, Organisms and Pathogens, Biological Nomenclature). Helicobacter pylori and the Patient With Ulcers EQEBRIM Proper Nouns. Proper nouns are words used as names for unique individuals, events, objects, or places. EQOERIRE Geographic Names. Capitalize names of cities, towns, counties, states, countries, continents, islands, airports, peninsulas, bodies of water, mountains and mountain ranges, streets, parks, forests, canyons, dams, and regions. the Antarctic the Loop [Chicago} Arabian Gulf Mexico City the Bay Area Mississippi River Central America New Hampshire the 23rd Congressional District New York State (bu: the state of New York} Cook County Dismal Swamp El Paso the Florida Panhandie Grand Canyon Oman or Sultanate of Oman [either is correct] Quebec City Saudi Arabia or Kingdom of Saudi Arabia [either is correct] Hoover Dar the Silk Route the Iron Curtain: ‘Third World the Isle of Skye United Kingdom Kennedy Expressway Upstate New York, LaGuaudia Inernational APOF’ he west Coast Lake Placid 10.8.2 Sociocultural Designations Ifa common noun is capitalized in the sin a gular, it is gen ot capita tas generally not capitalized in the Atlantic and Pacific oceans Kennedy and Eisenhower expressways Mississippi and Missouri rivers, Compass directions are not capitalized unle e general re inalize ss they ar erally ace] erms mp y are generally accepted terms for ‘There is a large time difference between Europe and the Far East ‘Walk east unti) you amive at the lake. There is no party like a We he party ‘est Coast party because a West Coast party doesn’t He lives in northern Michigan. The practice of meditation is finding followers in the Western world Sociocultural Designations. Capitalize names of languages, nationalities, ethnicities, political parties, religions, and religious denominations, Do not capitalize political doctrines (conservative, progressive). Do pi ‘bite or bl _ nace. + Pi ). Do not capitalize w : 1 black as a desi African American an Arab man, the Berbers the Catholic Church (but: a Methodist church, English language Ethiopian food the French Hispanic population Indian American community of Italian heritage Latina girls Native American Protestant Sanskrit Although she has bees a member of the ‘ Is zt ¢ Republican rye a time she was a Democrat. me ary for years, atone ‘This legislation endorses the principies of de ican for . t ip! smocracy in our republican form 37530.3 Proper Nouns f historical and spécia} ‘ERAS Events, Awards, and Legislation. Capitalize the names of events, historical periods, and awards Cbut not common nouns that may follow the names). Capitalize the official names of awards and specific parts of laws and bills 3 but follow the official name (as in the lowercase w in Americans with Disabiliti Act). Americans with Disabilities Act the Great Depression Medicare Nobel Prize Physician's Recognition Award Public Law 89-74 Civil War Civil War era Congressional Medal of Hono: Declaration of Helsinki qual Rights Amendment Purple Heart ‘pamily and Medical Leave Act of 1993 Special Olympics ‘Taste of Chicago “Title IX French Revolution Geneva Convention REESE Eponyms and Words Derived From Proper Nouns, With eponyms, capitalize the. proper name but pot the common nouns that follow it : Down syndrome Trendelenburg position ‘Rose-Waaler test Wada test per nouns are not capitalized. In general, Febster’s Collegiate Dictionary or Dorland’s Most common words derived from proy follow the current edition of Merriam Illustrated Medical Dictionary (for medical tesms). asabic numerals mendelian brussels sprouts parkinsonism candidiasis roman numerals darwinian schistosomiasis india ink Note JAMA and the Arcbives Journals do not capitalize anabie and roman when refetring to numerals italize trademasks and proprietary names of drugs and brand ducts andl equipment. Do not capitalize generic names OF Proprietary Names. Capi names of manufactured pro descriptive terms. lets of acetaminophen (Tylenol; Johason & ‘The patient had swallowed 46 tal Jersey) and was treated for acetaminophen Johnson, New Brunswick, New overdose. : All references to exact brand names must be verified and include the city and state ore Jomenclature, Equipment, Devices, and = country of the manufacturer. (See also 15.5, Nt Reagents) The trademafle and copyright symbols are not used in JAMA and 4 chives Journals style. Allah Ganesh the Holy Spirit Christmas Eid ul-Fitr Fourth of July Good Friday Kwanzaa Labor Day Tests, fests Theeracr and complete titles of tests and subscales of testsshould be capitalized. orl test not usually capitalized except when i is part of the offical name of the test. Always ve: ify exact names of any ‘sources, any tests with the author or with reference Official i Ola Names. Capitalize the official titles of organizations, businesses, confe ames , businesses, conferences, congress insutions and governmental agencies. Do not capitalize the conjunc- _ fons articles, of prepositions of 3 or fewer letters contained within these names, For stitutions, do not capitalize the unless it is part of the official title. God or Goddess (when used ina monotheistic sense) jal Names ‘Organisms. Capitalize the formal name of a genus when used in the singula, sethout 2 species name. Capitalize formal genus names but not 4 Mond ane = generic des apilne but not tr gence Shean, (eg, SrepIpcoced or derived adjectives (str reptococeal) (see also is, Microorganisms), Do not capitalize the name o scies, variety, 7 roorga 2 ine of a species, variety, 4 __bsperies Do capltlie phylum, cla, ore, 0 fanily (see 15.4 Nomenclatse, __ Organisms end Pathogens). For ciptalizaiion of virus names, see 15.143, N nen + dature, Organisms and Pathogens, Virus and Prion Nomenclature vee fonal plural Seasons, Deities, Holidays, Do not capital Hs . capitalize the names 0 the naies Of specific deities and manifestations ERSone Doane Jesus Christ Nature the goddess Athena Capitalize recognized holidays and calendar events. New Year's Eve Passover Ramadan ~ Rosh Hashanah ‘Thanksgiving Day Chics a E¢ i 80 Board of Education the International Subcommittee on the Communist Paty Viral Nomenclature Congress Knox College Council of Science Editors Northwestern Memorial Hospital the Federal Bureau of Investigation The Ohio State University Harvard University Quaker Oats Corporation Honse of Representatives Robert Wood johnson Foundation 37104 Designaters the Senate ‘Tufts University School of Medicine Sigma-Aldrich Comporation supreme Court (Note: capitalize Court only when refersing to the Supreme Court) the US Navy poards of health, the company, congressional government, the navy, US senators in abbreviated form, institu. We prefer lowercasing such ‘But: the board of trustees, the reports, a congresswoman, the federal themselves and their officers capitals for titles. and the Arcbives Journals Often when referring to tions and organizations use initial generic terms. For example, JAMA ignations: the American Medical Association the Board of Trustees the Council on Scientific Affairs the House of Delegates the president of the AMA. the association the board or the trustees the council the delegates the president in running text, a singular form that is capitalized 25 Part of the official name usually not capitalized in the plural. axtment of Pediatrics at the University of llinols, She is chair of the Dep urbana. Funding was received from the departments of pediatrics and neurology a the University of Blinois, Urbana. 3.3, Manuscript Preparation, Footnotes to Title Pade, Author Affiliations, for Jes in an affiliation footnote) (See 2, f department ttl example of capitalization o! a SPSER Titles an son's name \d Degrees of Persons. Capitalize a pers pur not when it follows the name aum ted the meeting, ¢ Chair Lawrence Mandelb: .d committee chair Lawrence Mandelbaum was name .s when abbreviated but not when written Commilttes At the meeting, Capitalize academic degree out. Irene Briggs, MA trone Briggs received her master's degree from the University of Pennsylvania cific designations within a particular article, wi ERE Designators. When used as spet without numerals, capitalize Table, Tables, Figure, and Figures. somunarized in Table 2 as sen in the Table the middie third of the basilar artery (Figure 2) use the following des- ‘on’ title when it precedes the per 10.6 Acronyms and Initialisens ‘Do not capitalize the following words, even when used sign: inless ing words, even wh pr z ised as specific designators, unle: axis month, case notes chapter page chromosome paragraph column part control patient cay phase ~ edition schedule experiment section factor series fraction stage grade step grant stub group type 8 lead. volume level wave method week . But: Step (diet, Schedule 1 dru , Sche 1g, and Axis T of th Manual of Mental Disorders, Fourth Baton. Dlaanestc an act ‘Types and Sections of Arti ticles, General tern section within an article should be set lowercase used torefer @ a ype ofanicle ora an, His letter to the editor was published in the December issue. ‘The methods sections of articles are often inadequate. However, when referring to a specific type of article, or a section within a specifi > S ng LO a SI Qf arti " wi icle, or a section a article, capitalize the first letter in the words of the category or section " . name. Tlie Letters to the Editor section of Archives of Neurology a favorite of mine, See the “Methods” sectior sel ion for a full description of each of the groups in the Acronyms and Initiali: Ac s isms. Do not capil: initialism is derived (see 14.0, boven ‘he words from which an acronym or ith or prostate specific antigen (PSA) enzyme-linked immunosorbent assay (ELISA) Exception: When the words that form the actonym or initialism are - : A i initialism are proper names, se capitals as described in 10.3.9, Proper Nouns, Official Names: ‘National Institute of Mental Health (NIMH) 37910.8 "Intercanped” Compounds When there has been 2 “stretch” to create a study name or the name of a writing grou that maxes sense, is easy to say, and somehow relates to the name of the group, where the first letters of the major words do not match the acronym, do rot nusual capitalization to indicate how the study name was derived. Expanded stug or group-authorship names use normal JAMA and the Arcbives Journals capital Correct and Preferred Usage tion style Evaluation of Platelet I1b/Iila Inhibitor for Stenting (EPISTENT) a il arect and Proferred Usa as Enhanced Suppression of the Piatelet Ub/Ilia Receptor With Integrin’ 3 | Comect and Pafered Usage of dneromy ‘Therapy (ESPRIT) 17 i m2 Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY) : FP fedundant, Expendable, and incomparable Clock Referents Words and Phrases ane to Prevent Recurrent Events (CURE) h2.1 Redundant Words 1522 Expendable Words and Circumlocution Clopidogrel in Unstable Angis Laboratory Values 783 Fab AntPlatelet ‘Therapy in Unstable Refractory Angina (CAPTURE), | = 1023 Incomparable Words ne : Atcles Capitalized Computer Terms. Use initial capitals with computer commands; fun ns format tions, or features. 11.10 a 7 Inclusive Language Please do not press the Back button on your browser until we have finished 9 Jargon 1.10.1 Sex/Gender Q 11402 Race/Ethnich processing your request. ins ites age - i 11.104 Disabilities Enter one of more search terms and click Go. [age and Sex Referents T1405 ~ Senvel Ostentation tems in the History folder will be deleted after 90 days. . The word e-mail takes a lowercase letter in JAMA and Archives Jousnals style exte when it starts a sentence, ey : What would become of us if the deleatur did not Please send e-mail messages to my work address. exist, sighed the proofreader. José Saramago" ‘E-mail submissions are preferred ERESEEE “Intercapped” Compounds. JAMA and the Archives Journals capitalize trade Ie rot infrequently are compelled to refuse names according to the spelling of the legal trademarks, even if they begin with ublication fo an article which contains valuable lowercase letter and contain a capitalized letter. : Sacts, but which is weighed down with so many imperfections as to discourage one—as does the porcupine—from closer investigation. She sold her collection of vintage hats on eBay. JAMA Correct and Preferred Usage of Common Words and Phrases. The second pote Font a 1904 editorial in JAMA, certainly holds true today, but of course, editors ‘e # manuscripts that are poorly written but are of good science, although cy may fee] less confident about a paper's content if the presentation is sl Also, authors whose fist language is not that of the journal should stil be pees consideration. In particular, editors should not lose the author's voice, especial rin informal usage, Stil, scientific writing should be as precise as possible to avoid misinterpretation, This section provides a selection of correct and preferred terms. A note about the entries: Al-terms Cand i ni ne aout pairs of terms) are in alphabetical (not California). Avoid starting a sentence with one of erable to reword the sentence so that it letter, while retaining the preferred spelling of the trade name. these trade names, it is almost always pf begins with a word that takes an initial capi ACKNOWLEDGMENT Principal author: Brenda Gregoline, ELS abr ; iti i Shnormal, normal; negative, positive: Examinations and laboratory tests and studies not in themselves abnormal, normal, negative, or positive, These adjectives apply 380 wes141 Corre: 382 and Preferred Usage of Common Words and Phrases to observations, results, of findings (see also 20.0, Study Design and Statistics). ay “void the use of “normal” and “abnosmal” to describe persons’ health status, 7 Results of cultures and tests for microorganisms and specific reactions may be negative or positive. Other tests focus on 2 pattem of activity rather tha single feature, and hence a range of normal and abnorinal results is possible. tests include electroencephalograms and electrocardiograms and modes of isha, such as isotopic scans, radiographic studies, and tomography. Incorrect; The physical examination was normal. Correct: Findings from the physical examination were normal. Incorrect The throat culture was negative. Correct Incorrect ‘The electroencephaldgram was positive Correct: ‘The electroencephalogram showed abnormalities in the . temporal regions. Incorrect which were previously negative, are now positive. Correct: Setologie test results for Treponema pallidsim hemagghitination, which were previously negative, are now positive, ‘also correct; Serologic tests for Treponema pallidum hemagglutination, the results of which were previously negative, showed. a titer of 1:80, See also 11.8, Laboratory Values. Exceptions; HIV-positive men seronegative women negative node Abort means to stop a process prematurely. In pregnancy, abOrHa abort, terminate: means the. premature expulsion—spontaneous (miscarriage) or induced the uterus of the products of conception. A pregnancy may be aborted, not a fete awoman, The synonym fermiricle—to bring to an ending or halt —may also Deus accident, Injury: According to the National Center for Injury Prevention and Conta the US Centers for Disease Control and Prevention, accident should not be used! sefer to injuries from any cause. Although acctdent implies a random act that unpredictable and unavoidable, epidemiologic studies and injury control progia indicate that injuries may be predictable and therefore preventable, The preferred: tesms refer either to the external cause (eg, injury from falls, injury from motor vehi i crashes, gunshot injury) or to the intentionality (‘unintentional injury” for init resulting from acts that were not intended to cause harm and “violence” for any 4¢4 which harm was intended).>* a In addition, accident (and accidental) is considered by the public health co#t munity to be imprecise. The injury-causing event can be described as noted abo swith other terms, such as crash, shooting, drowning, collision, poisoning, ox tf cation, Note: Do not change accident i is integral to the terminology being u example, an established injury ch ant Repo rem, international Classification of Diseases) acute, chronic: These terms are most often preferred for descriptions of sy and chronic to describe patients, parts of the body, treatment, of medication Avoid: chronic dialysis chronic heroin users - acute administration of epinephrine chronic diagnosis chronic care chronic aspirin therapy Preferred: long-term dialysis (also: maintenance dialysis (query author) Jong-tenn heroin users immediate administration of epinephrine long-standing diagnosis of a chronic di long-term care [see note below! ase long-term aspirin therapy chronic obstructive pulmonary disease acute renal failure chronic arthritis acute nephritis Also: acute, severe cystitis acute, mild prusitus Exception: Acute abdomen is a specific medical condition. . Anote on short- and long-term patient care: According to Kane and Kane, “acute core pastas Prefered to short-term care hospital. Long-term care has come to in- ke both an acute consponent (sometimes called subacute care or postacute care), sehen atesivel y provides the care formerly offered in hospitals, and the moze tradi. sonal conic component, which includes both medical and social services. As the implies, subacute care has a shorter time frame and serves patients who are expected to recuperate ot die, while the more chronic forn ides. sustain’ a ir on ore uP m provides more sustained adapt, adopt: To aday adopt: spt means to raodify to Bt a particular cin articular circumstance or requin ment. To adapt means to take and use as one's own. “us As evidence-based medicine contimies to evolve and to adapt, it is useful 10 tefine the discussion of.what it is aad what it is not Australia became the first nation to fe ist nation to formally adopt evidence-based as a key feature of its health system. meses 383 11.4 Correct and Preferred Usage of Common Words arid Phrases sect, for ification system (eg, Fatal Accident Reporting Sys- I s mptoms, conditions, or diseases; they refer to duration, not severity. Avoid the use of cecaueV1.1 Correct and F 384 ee referred Usage of Common Words and Phrases ect and Preferred Usage of Common Words ard! Phrases adherence, compliance: Although these terms are often used as synonyms, There ag aeferences, adherence can be defined as the extent ro which a patients Dehavior (gg ample, taking medication, Following a diet, socifying habits, or attending dives Goindides with medical or health advice, Use of the terra adherence is intended : Routine screening of sexually active teenaged girls during regular ph onjudgmental, a statement of fact rather than of blame of the prescriber, patient wisi i an effective way to detect Chiampdta machomats susp trcaiment.© NoncompHiance connotes a stigmatzing image of rule, enforcer, s aed contol dominance and submission; and deviance fom expected social fe Whether a patient chooses to adhere to @ therapeutic regimen may depend on sig aspecis of his or her experience with the disease and the medical encounter itself? : Influenza vaccination is not recommended f yamended for infants a mouths, younger than 6 atematve, form: The 75-year-old patient had symptoms of cognitive lecline. © Note: iB some expressions regarding age, itis redundant to add of age after the num- | ber of months or years, since itis implied in the adjectives younger and older ‘Although incompletely characterized and understood, the association be: tween poor adherence 1o drag therapy and vieologic failure with resistant see also 11.2.1, Redundant, Expendable, and Incomparable Words and Ph: S . ASCs, = Redundant Words, has been clearly established in HIV infection : Possible exception: A patient with a severe mental illness may be required to ¢o: " aggravate, irritate; When an existing condition is made worse, more seriox with court-ordered therapy. sae tis aggravated Cals, exacerbated), nol trated. irated indents reaction, don, often excessive (eg, inflammation), to a stimulus. adverse effect, adverse event, adverse reaction, side effect: Side effect is a secondan : consequence of therapy (usually drug-based) that is implemented to cozrect a mi although, though: Alibough and though may be considered condition. The term is often used incorrectly when adverse effec, adverse eve rer atoug) is preferable as a complete conjunction, aterchangeabie, How ane oorse reaction is intended, Since a side effect can be ether benefical or ha || [ixtamevon isan “abbreviation” and thus may be less appropriate for forma pr is specific terminology should be used. : : priate for formal prose. ‘A secent study examined the incidence of serious and fatal adverse drug, reactions —any harmful, unintended, or undesiced effect of a drug—in hos pitalized patients : “Asside effect of therapy with inydroch{orothiazide is improved bone mineral = density Although the analysis was done correctly, the fundamental terms of the investigation were 100 nasrow to be interesting Basal cell carcinoma of the skin and melanoma are the subjects of an ex- tensive lirerature, Squamous cell carcinoma, though, remains largely ‘enge affect, effect: Affect (a-fekD, asa verb, means to have an jnffuence 09 fect (ie peed ane sane as. a verb, means to bring about or to cause The 2 words cannot be used :iftee = he between: Among usually pertains to general collective relations and always in a group ol bore te 2. Benueen perains othe selation between ¥ enty and Lor _ffoning a relationship th cach ofthe thers bot peace ay exis aang them, The patients shared the library books among themselves. changeably Ingesting massive doses of ascorbic acid may affect his recovery [influence the recovery in some wayl. ag a his recovery [produce = Ingesting massive doses of ascorbic acid may effect ’ Between ve the recovery]. twee you and me, we are certain to find the common factor among those we have examined, Affect Ca-Fekt), as a noun, refers to immediate expressions of emotion (in conteas snood, which refers to sustained emotional states). Aiject is often used as path analog, analogue: Use arialog when referring to items rela mputers or ele 7 og whe 1g to it > ted to con 1 Devchiatric diagnostic terminology. Effect (ek), as a noun, means result, seg “tronic & quipment. Use analogue when “something similar to something else” is a | Meant or when referring to chemical comp: 5 rhe’patient’s general lack of affect was consicered io be an effect of recent analogue scale). compounds. Use viswal analog scale (not visual trauma, oe abe, likely: When apt refers to volition or a habitual tendency, it should not be __(edofan inanimate object. This restriction does not apply when apt means “suited e pose.” Liable connotes the possibility of risk oF dis 3 ; b is lisadvantage to the ‘tkely merely implies probability aid thus is more inclusive than pt omens age, aged, school-age, school-aged, teenage, teenaged: The adjectival form aged, fhe noun age, should be used to designate a person's age, Similary, school-aged teonaged ace preferred to school-age and teenage. However, @ prec age! oF renge should be given whenever possible. See also 11.5, Age and Sex Refere Correct: A child is apt to ery when frustrated. the patient, aged 75 years, had symptoms of cognitive decline Incorrect: A polyethylene catheter is less apt to kink than one made of vinyi. 38511.4 Correct and Prefered Usage of Common Wards and Phrases 11.4 Correct and Preferred Usage of Common Words and Phrases - By mandating that every relevant paper sly stave titutional oi configuration p 7 Comect ‘The team must decide on the most apt config review board approved the study protocol, journal editors can assure incision is made, “a it the research itself was ct ically." ihe Bet ne eiving immunosuppressant drugs are liable to readers that the research itself was conducted ethically. Correct: Patieny fangal infections. attenuate, attenuation: In computed tomographic (CT) imaging, attenuation refers to acquire fang: hh if ie ip overloaded. the absorption of x-rays by the patient's body. The appearance of the patient's tissues Correct, The computer system is likely to crash # on the CT scan is dependent on the amount of x-rays absorbed (ie, attenuated) ; by that tissue. Low attenuation (or hypoattenuation) refers to areas of blackness om | the CT’scan. High aenuation (or byperattenuation) refers toareas of whitenesson the scan. i pt: blished study, report, or essay—that ‘cle, manuscript, paper, typescript: An unpul ; ‘ Se deoument Welt ey be referred to as a manuscript, paper, ot iypescript. When: published, it is an article Calso, a study) ‘the amhors thank Frank J. Kobles, PhD, for statistical review of the manu. because: see as, because, since script. because of, caused by, due to, owing to: These phrases are not synonymous, but the ih manuscript preparation. Nancy MacClean assisted wi differences are subtie. Due to and caused by'are adjectival phtases; owing to and a because of, adverbial phrases. The use of dite to in both situations can sometimes a aller a sentence’s meaning. “The content of this article does not necessarily reflect the views or policies of the US Department of Heaith and Human Services. ‘The ancle by Casrozza and Silke adesses the therapeutic oPHons fora 69-year-old woman with disease of the left main coronary artery | Survivors of child abuse tend to enter abusive relationships due to intra psychic conflicts, Meaning: Survivors of child abuse tend to enter abusive relationships when “for the reason that" i since: As, because, and since can all be used when “fort : that are caused by intrapsychic conflicts, : as, Because, fas should be avoided when it could be con meant. However, in this construction, steued to mean wile. Because due to is adjectival, “intrapsychic conflicts” descfibes the relationships Caused by could be substituted for due to, and the meaning would be retained. That She could not answer her page as she was examining a Ambiguous: are could be inserted before dive to without changing the sentence’s meaning It oa as she was examining @ Survivors of child abuse tend to enter abusive relationships owing to intta- 1p Better: She could not answer her Peas as psyehic conflicts ic critically ill patient [comma use ; . i | Preferred: She could not answer her page because she was examin Meaning Because of intrapsychic conflicts, survivors of child abuse tt a critically ill patient, tend to enter abusive relationships. “from the: Because owing to is used adverbially, “intrapsychic conflicts” characterizes the en- similarly, since should be avoided when it could be construed to mean “from the trance into abusive relationships. Because of could be substituted for owing to, and time of" or “from the time that, the meaning would be retained. However, if that are is inserted before owing to, the She had not been able to answer her page since she Ambiguous: sentence’s meaning changes. ; vas in the.clinie Glue #8 usage: The phrase “coughs due to coids” is a good example of correct Preferred: She had not been able to answer her page because she Usage of due to. If “because of” sounds right, use it or “owing to.” If “caused by” is i itor" - oa or “that rest - ‘was in the clinic. intended, use it or “due to” (or possibly “attributable to” or “that result from”), Jationship: Association is a connection between two variables nie between: sce among, between see not i ct. See : ane does not necessarily cause the other. Relationsbip implies cause and effect. Set 20.9, Study Design and Statistics, Glossary of Statistical Terms biopsy: Biopsy refers to the removal and examination (usually mictoscopically) of issue or ceils from the living body. Use of biepsy as a verb was previously considered t,be incorrect. However, such use has become common and acceptable. assure, ensure, insure; These verbs are used syaonsmously in any cons there are distinctions. Assure means to provide postive information ro a DeSCE A persons and implies the removal of doubt and suspense Cosswe he suds wa pants that their test sesuits will be held in complete cont < : =, sue mest make sure or certain @nsure the statistical power of the study ake precaution beforehand Gnsure his life. i ; ee ‘orks! families that theie policies ensured "aoe woe permanent) burial. Acceptable: ‘The lung mass was biopsied. A biopsy-of the hing mass was performed Lesions believed to be malignant were biopsied Observations are made of the biopsy specimen, not on the biopsy itself. ‘The insurance company that workers with few assets would get a decent (ie, 387 386114 Coreact d Preierran Usage af Common Word 414 Correct and! Preferred Usage of Common Words and Phreses g8 0 ron Words a Many patients in the United medical care} States have type 2 di i abetes fonly persons under Incorrect: Biopsy was normal. s fonly persons under Correct The results of the biopsy were normal a case is evaluated, documented, and reponed. A patient is examined, undergoes iesting, and is treated. A research participant is recruited, selected, sometimes sub- jected to experimental conditions, and observed. (See diagnose, evaluate, examine, identify; and follow, follow up, observe.) | Note: In general, patients should not be referred to as clients or consumers. author’s name and affiliation are concealed from the reviewer. The equivaleg However, persons enrolled in substance abuse treatment programs, for example, or masking (ot masked assessment) is preferred by some investigators and jou | © persons undergoing treatment ata dialysis center are sometimes referred to as clients. particularly those in ophthalmology. See also 20.9, Study Design and Statistics ¢ Client may also be used by social workers or psychologists and in some research : settings where patient or participant is inappropriate. Conswmer—one who con- sumes goods or services—has worked its way into the medical fexicon and may be | appropriate in certain discussions, For instance, in the following example, patient - would not fit the contest: i blinding, masking: The statistical term blinding (or blinded review or asses the evaluation or categorization of an outcome in which the person asses outcome is unaware of the treatment assignment; blinding is used to avoig) The term és also used to refer to peer review, usually to represent cases in wh sary of Statistical Terms. breastfeed, nurse: When referring to human lactation, use breastfeeding. Thiste more specific than nursing and prevents any confusion with the profes nursing, cadaver, donor: When describing the source of human organs and tissues. transplantation, avoid cadaver (or dead body), Correct usage is deceased don recovered from deceased organ and tisswe donors), 4 ‘When referring to a deceased person whose body is to be used for anat dissection, cadaver is correct (cadaveric as adjective) z catatonic, manic, psychotic, schizophrenic: These adjectives refer to severe psychiatric . can, may: Referring to oné meaning of cam and may, Bemstein’ in The Careful iq _ disorders. tt is inappropriate to trivialize the disorders by using these terms to de stated: “Whatever the interchangeability of these words in spoken or infort scribe normal variations of individual or group behavior, for Which suitable descrip- \ lish, the writer who is attentive to the proprieties will preserve the vaditio © tors are available. For example, in common trivial uses of these terms, contradictory 1 tinction: can for ability or power to do something, may for permission 10 dai can usually be substituted for schizophrenic; strange, disorganized, or senseless for ‘A second meaning of may refers to likelihood or possibility: : psychotic (depending on the context); overactive for manic; and. motionless for I catatonic, Note: It is dehumanizing to refer to a patient as ‘a schizophrenic.” Use “the | patient with schizophrenia” or “the schizophrenic patient.” See also 1.10.4, Inclu- Hi sive Language, Disabilities. \ | ‘The Internet has become an important mass medium for consumers seeking, health information and health care services online. case-fatality rate, fatality: mortality, mortality rate: See 20.9, Study Design and Sta- tistics, Glossary of Statistical Terms. Dehydration may have contributed to the early onset of shock. ‘The lesion may or may not resolve without treatment, case, client, consumer, participant, patient, subject: In clinical research, a particular instance of a disease. A patient is « particular person under medical ‘caused by: see because of, caused by, due to, owing to f research participant (preferred to subject; see below) is a person with a p : characteristic o behavior, or a person who undergoes an intervention as scientific investigation, uswally a case-control study or randomized controlled: control participant is a person wha does not have at Jeast some of the characte uncer study, or does not receive the intervention, but provides a basis of comp -with the case patient (see 20.0, Stucly Design and Statistics). In case-control stu is appropriate to refer to cases, patients in the case group, or case patie controls, participants in the control group, ot control patients. Some consider subject (as in study subjecé) to be impersonal, even derogates if the person in the study were in a subservient role, Similarly, the use of: dehumanizing when referring to a specific person. For example : cesarean delivery, cesarean section: According to the American College of Obstetri- cians and Gynecologists, the preferred tems are cesarean delivery (or cesarean birth) or abdominal delivery (to differentiate it from vaginal delivery). Cesarean Section is incorrect, as are the spellings Caesarean and caesarean. chief complaint, chief concern: Chief complaint has been traditionally used by phy- sicians when taking a patient's history. However, chief concern may be a better description because complaint may be construed as pejorative and confrontational, chronic: see acute, chronic dlassic, classical: In most scientific writing, the adjective classic generally means authentic, authoritative, or typical (the classic symptoms of myocardial infarction include angina, dyspnea, nauseaand diaphoresis). In contrast, classical refers to the humanities or the fine or historical arts (the elements of classical architecture can be applied in radically different architectural contexts than those for which they were developed), Avoid: A 63-year-old case of type 2 diabetes Preferred: 63-year-old man with type 2 diabetes. Note: Make the distinction between person and patient: ‘Many persons in the United States have type 2 diabetes [persons with 1 diabetes regardless of care] 388 389)390 7.1 Correct and Preferred Usage of Common Words and Phrases The patient with emphysema coughed continually. His labored breathing was eased by a continuous flow of oxygen through a terms: nasal cannula, Classical lissencephaly may be caused by mutations of genes in chromeso, bands 17p13.3 and Xq22.3-423. “The classical and alternative pathways of complement components are: scribed in 15.8, Nomenclature, Immunology, Complerneat contrast, contrast agent, contrast material, contvast medium: Distinguish between ee blackness and whiteness on an image) and contrast material {on co ras agent, contrast medium) (ie, a substance 2 certain sue. aS ce aconit anc cee ee on seaes inistered to enhance certain struc- ‘The authors suggest how to present results of data analysis under each g 3, statistical paradigms: classical frequentist, .informationtheoreit A suspension of barium injected into the intestine was used as the contrast s the contrast Bayesian. agent for radiological examination. criterion standard, gold standard: See 20.9, Study Design and Statistics, Glossary of Sta- client: see case, client, consumer, participant, patient, subject tistical Terms. pending on context, these terms can be used to descr he health fields of medicine, nursing, psychology describe, 2 (as well as occupational and physical therapy FS case, cient conunen eevicpenn cases are described: only cases are reported. (See Veterinary medicine, for example), as distinguished from those specializing in aluate, examine, Wnty ent Sublet management, treatment dlagnose, oratory science, research, policy, theory, or writing and editing. When refering ig : ° particular type of clinician or practitioner, its preferable to use the more descrip term (eg, physician, nurse, dentist, optometrist), The plural forms of clinician practitioner may be appropriate t0 refer to a group of such professionals from Older Terms ferent fields. See also provider. z Preferred Terms eS juvenile diabetes, juvenile-onset type 1 diabetes mellitus compare to, compare with: One thing or person is usually compared with anc diabetes, insulin- siroke vicuim person with AIDS, person who has Similarly, Asian persons may wish to be described according to their country or had a stroke dian, Japanese, Sei Lankan. Note that Asian crippled, lame, deformed physically disabled the deaf deaf persons, deaf adults, deaf culture geographic area of origin, eg, Chinese, In ‘and Asian American (Chinese and Chinese American, Do not use Oriental or Orfentals, 8 Note, Avoid using “non” Cg, “white and nonwhite participants"), which is @ ponspecifie “convenience” grouping and label, Such a “catewory” may Pe oversim- plified and misleading, even incossect, Occasionally, however, one sees these cat- Gagotizations used for comparison in data apalysis. In such cases, the author should be queried, Multiractal and people of color are sometimes used in part 10 address the heterogeneous ethnic background of many people and so on) are not equivalent or community or interchangeable. confined (bound) 10 a wheelchair uses 2 wheelchair wed ens that my be inappropriate and insensitive (blind to the truth, deaf ‘or similar reasons, some publications. avbid the t. | when referring to a study’s methodology. Som die Hind He Some mamas use ean pases many mes, an hanging or ample ‘AIDS patients” to “persons with AIDS” at every occurrence may result in awkward and stilted text. In such cases, the adjectival form may be used. EREIERE Age. Discrimination based on age (young of old) is ageism. Because the term elderly connotes 2 stereotype, avoid using it as a noun, When referring to the entire PoP IEE Sexual Orientation. Sexual orientation should be indicated in a manuscript only Litton of elderly persons, use of the elderly may be appropriate (as in the impact of prescription drug costs on the elderly, for example). Otherwise, terms suchas older when scientifically relevant. The term sexual preference should be avoided be ‘persons, older people, elderly patients, gertatric patients, older adults, older patients, implies a voluntary choice of sexual orientation not supported by the sentfe nd older, ot ihe older poprslation are preferred. | literature. In some contexts, reference to specific sexual havior mon uh have sex with meri) may be more relevant than sexual orientation. mene ‘aging adults, persons O5 years av "Note: In studies that involve human beings, age should always be given spe- cifically. Researchers in geriatrics may-use defined terms for older age BrOUDS, © ‘The nouns lesbians and gay men ave preferred to the broader term homosexuals when referring to specific groups of women and men, respectively. Avoid using gay ly defined as 60 or 65 t0 70 oF so years) and old-old (60 yea and : 2 or gays as a noun, Heterosexual and homosexual may 5 gr gms #8 a now sexual may be used as adjectives (eg, A member of a heterosexual or homosex: jomosexual couple may be referred to as spo companion, partner, or life partner. Same-sex couple este 5 ne le and same: fe companion, be on iple and same-sex marriage are young-old (usual olden), See also 11.5, Age and Sex Referents. “Adiultism is a form of ageism in which children and adolescents are discounted? Disabilities Act Chitp:/fwww.usdoj fividual has any physical or psycho- civity, such as walking, learning, ity, SoS NB; learning; ACKNOWLEDGMENTS Principal author: Roxanne K. Young, ELS the blind, schizophicenies, epileptics). Instead, put the person first, Avoid describing Special , thank contributing F persons as victims of with other emotional serms that suggest helplessness (afflicted = Dinckx, MD, Dn Oho Mary Sols, MP. Contrbating Esitor, J John Hh anid, sufering from, sricket witb, maimed). Avoid eupemistie descriptors such 28 verity of Mnesota, Ton Lakes and Diane Beimeat Lang, BS Radiologie Socio : . s; ath Lang, BS, Radiological Society physically challenged ot special: of North America, Oak Brooks, Illinois. bilities. Accoyding to the Americans with “gov/crt/ada/), “a disability exists when an ind logical illness that substantially Limits’ a major life a breathing, working, or participating in community activities. ‘Avoid labeling Cand thus equating) people with their disabilities or diseases (©f, a714.10 Inclusive Language ang REFERENCES 4, Saramago J. The History of the Siege of Lisbon. Pontieto G, tans-ed. New York, Ny: Haxcourt Brace; 1997. 2. Why are scientists poor writers [Queries and Minor Notes? JANES, 1904;427:477. 3, Revised Framework of External Cause of Injury ( Code) Groupings for Presenting Injury Mostality and Mosbidity Data, hipi/fwrww cde gov/ncipe/whatsnew/matrixt Intm. Accessed Febmtary 18, 2005 2 sicher D. Injury: an overlooked globat health concer [From the Surgeon General], JAMA, 2000;284(8):950. 5. Kane RL, Kane RA. Long-term care. JAMA, 1995;273(21}:1690-1691. 6 MeDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to ‘medication prescriptions: scientific review, JAMA. 2002;288(22):2868-2879. 5. Chren M. Doctor's orders: rethinking compliance in dermatology [editorial}. Arch Dermatol, 2002;138(3):393-394 8, Altobelli L, reporter. Ethics in medical research [annual meeting report]. Sci Favor. 2005;28(5):153. 9, Bernstein IM. The Carefial Writer: A Modera Guide to English Usage. New York, NY: Free Press; 1998. 10, The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, Report of the Expest Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2003;26(suppl 1):85-820. Li. Publications Department, American College of Obstetricians and. Gynecologists. Publications Guidelines, Washington, DC: American College of Obstetricians and Gynecologists; 1997:22-23. 42, Pinn VW. Sex and gender factors in medical studies: implications for health and clinical practice. JAMA. 2003;289(4):397-400. 13. Roth M, “Glycated hemoglobin,” not “glycosylated hemoglobin.” Clit. Chem. 1983,29CL1):1991, 14, Allen CJ. Surgeries. Arch Surg, 1996;131(2):128. : 15. Schur NW. British English A to Zed. New York, NY: Facts on File Publications; 1987, 16. Flanagin A. Re: Violence and nursing letter. J Professional Nurs. 2000;16(40:252 47, Words and phrases. In: Fishbein M. Medical Writing: The Technic and the Art. Chi- cago, IL: American Medical Association; 1938:46. 48. Morrison T, Nobel Prize in Literature Lecture, December 7, 1999, In: Allen S, ed, Nobel Lectures, Literature 1991-1995, Singapore: World Scientific Publishing Co; 1997. hitp:/nobelprize.org/iterature/laureates/ 1993 /morrison-lecture heml, Accessed Feb~ ruary 27, 2006. 49. Meriam-Webstor’s Collegiate Dictionary. 1th ed. Springfield, MA: Merriam-Webster Ine; 2008. 20, Maggio R. Tatbing About People: A Guide to Fair and Accurate Language. Phoents, AZ: Oryx Press; 1997. 21, Orentlicher D. Retioning and the Americans with Disabilities Act. JAMA 1994;271(4):308-314. 4 ADDITIONAL READINGS Burchard EG, Ziv E, Coyle Niet al. The importance of race and ethnic background in biomedical eesearch and clinical practice. NV Engl J Med. 2003;348(12):1170-1175. fal Ovientation Cooper RS, Kaufmy 1166-1170. Indigenous: to capitalize or not. World Association of Medical Editors Web site itps// www. wame-org/indigenous him. Published September 2-18, 2003. Accessed Apri 24, 2006. IS, Ward R, Race andl genomics, W Fgh) Med. 200%.349 12). Kaplan JB, Bennett T, Use of race and ethnicity in biomedical publication, JAMA 2003;28%20):2709-2716. Leonardi M, Bickenbuch J, Ustun TB, Kostanjsek N, Chatterji §; the MHADIE Consortiam. The definition of disability: what is in a name? Lancet. 2006;368(9543)1219-1221 Office of Management and Budget, the Executive Office of the President, Standards for the Classification of Federal Data on Race and Ethnicity. http://www.whitehouse gov/omb: /fedseg/race-ethnicity.htmal, Accessed April 24, 2006. (Outram SM, Ellison ETH, Improving the use of race and ethnicity in genetic research: a survey of instructions to authors in genetics journals. Sef Falitor. 2006;29(3):78-80. Race and ethnicity: how do we deseribe people? World Association of Medical Editors Web ste tp /fworw.wame.org/describe-him, Published January 13, 2006. Accessed April 24, “ i Risch N. Dissecting racial and ethnic differences. N Engl J Med. 2006;354(4):408-411 Rivara FP, Finberg L. Use of the terms race and ethnicity, Arch Fe n ct “ediatr Adolesc Me 2001;155(2):119. ue Schwartz RS, Racial profiling in medical research. N Engl J Med. 2001;344(18):1392-1393, Winker MA. Measuring race and ethnicity: why and how? j4M4. 2004;292(13):1612-1614, ag |Non-English Words, Phrases, and Accent Marks Rt 22 . Non-English Words, Phrases, and Titles Accent Marks (Diacritics) fau1 Use of Italics 42.12. Translation of Titles 42.43 Capitalization and Punctuation Non-English Words, Phrases, and Titles Use of Italics. Some words and phrases derived from other languages bave become part of standard English usage. Those that have not should be italicized (see 22.0, Typography), and usually a definition should be given. Consult standard medical dictionaries and the most recent edition of Merriam-Webster's Collegiate Dictionary for guidance. A public health investigation revealed that the source of lead exposure was bai ge fen (clamshell powder), 1 of the 36 ingredients of the Chinese herbal medicine, In Vitro Susceptibility Testing of Antifungal Agents Medical information and advice abound on the Internet, but remember: Caveat lector. Lorenz Bohler, the son of a carpenter, eventually became the preceptor traumatologiae totus mundi (weacher of traumatology in the whole world), Non-English street addresses, names of buildings, and names of organizations should not be italicized. Correspondence: W. Wayand, MD, Allgemeines 6ffentliches Krankenhaus der Stadt Linz, Krankenhausstrasse 9, 4020 Linz, Austria, ‘The Brazilian College of Surgeons (Colégio Brasileiro de Cirurgides) was founded on July 30, 1929. Translation of Titles. Non-English titles mentioned in text may be translated or not, at the’ author's discretion. If the original title is used, an English translation should be given parenthetically, except in cases in which the work is considered well known. Both the English translation of the title (if given) and the non-English title should be italicized for books, journals, plays, works of att, television and radio programs, long poems, films, and musical compositions. Stendahl’s Le rouge et le noir (The Red and the Black) is required reading for all third-year students 42442.2 Accent Macks (Dizerities) 12.2 Accent Marks (Diacrities) Tratamiento de la bipertension (Treatment of Hypertension) : dot marie xy masterpiece De Humant Corporis Fabrica grave Bibliotheque Andreas Vesalius’ 16th-centui surgence of anatomy as - 3 y - macron gigndskein (On the Structure of the Elana Body) marked the re a discipline. t ring Angstrom sthe pues for talcizing and transtating non-English-language journal aticic dies are, slash Kobeats slightly diffesent (see 3.9.2, References, Tisles, ‘Non-English-Language Titles) s : wn : tilde mafana vumlaut Henoch-Schéniein purpura Capitalization and Punctuation, Non-English words should be capitalized and non- English phrases punctuated according to that language's standard of correctness, wedge Viapte Follow language dictionaries and The Chicago Manual of Style, . : some languages are not supported by commonly used word-processing programs sacritic), when added to a letter, and Web browsers. Page proofs including words in such languages should be re- ‘viewed thoroughly by a person familiar with the language, and some letters or entire (EERE Accent Marks (Diacrities). An accent mark (ai indicates a phonetic value different from that of the unmarked letter, English words’. jvords and phrases may need to be rendered online using images rather than HTMI, nce spelled with accent marks (eg, cooperate, preeminend now aue writer and trinted without them, Consult the most recent edition of ‘Merriam-Webster’s College bout whethera word should retain its accent. Ia. | _ ACKNOWLEDGMENT Principal author: Brencla Gregoline, ELS iate Dictionary to resolve questions at general, English words in common usage should bespelied without diacritical marks. "Accent marks should always be retained in the following instances: ® Proper names ‘Dr Bonneman is a Pew Scholar in the Biomedical Sciences.

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