COHESION IN ACADEMIC TEXTS

Connectives and Referents

A good piece of writing is not just a set of random sentences. When writing a text, it is
important to have ideas flowing smoothly; otherwise, you will only have a collection of non-
sense sentences. Halliday and Hasan (1976) say that there are four types of links that can be
used to avoid this: reference, ellipsis and substitution, conjunction, and lexical cohesion. Next
we have a piece of writing about dental caries. Some of the elements that give cohesion to
ideas have been highlighted in blue.

 In dental caries process, acidogenic (acid-producing) oral plaque bacteria ferment

carbohydrates that are taken into the mouth, thereby producing organic acids. These
acids diffuse into the enamel dentin, or cementum, partially dissolving the mineral
components of the tooth, leading eventually to cavitation if the process continues. In
normal dental plaque, these acidogenic bacteria occupy less than 1% of the total flora.
As caries becomes progressive and more aggressive, the environment becomes more
acidic, and these aciduric bacteria survive at the expense of the other benign bacteria.
The most important aspect for the current discussion is that all acids produced by the
bacteria can readily dissolve tooth mineral. Two major groups of bacteria produce such
acids, namely, the mutans streptococci (including Streptococcus mutans and
Streptococcus sobrinus) and the lactobacilli species; yet there are undoubtedly other
acidogenic organisms involved in dental caries.

Ref: Abrams S. What Causes Dental Caries or Tooth Decay and Can it Be Reversed?

Now let’s take a look at some of the highlighted expressions:

 “These acids diffuse into the enamel dentin.” “These acids” refer to organic acids that
bacteria produce from carbohydrates (reference).
 “If the process continues”. Here, the expression “the process” replaces a statement
before: “the acids dissolve the mineral components of the tooth” (substitution). The
word “if” is a subordinating conjunction that gives a condition to the possible result of
the process: “leading eventually to cavitation” (conjunction).
 “The environment becomes more acidic.” This expression refers to the environment
inside the mouth, which is not mentioned explicitly (ellipsis) because the authors
assume that the reader knows what they mean.
 “Yet there are undoubtedly other acidogenic organisms involved in dental caries.”
Here, the word “yet” links the contrasting idea before: “there are two major groups of
bacteria that produce such acids” with the next idea: “other acidogenic organisms are
also involved in dental caries” (conjunction).
“Other acidogenic organisms” and “dental caries” are expressions that refer again, but
in a slightly different form, to “acidogenic oral plaque bacteria” and “dental caries
process” (lexical cohesion).

All this stuff may sound kind of complicated, and probably it is. But life can be made simpler if
we put together all those links in just two categories: referents and connectives.

1
Referents
It is very common in oral and written texts to find words or expressions (reference words) that
replace another word or expression (referent), which avoids repeating that word or expression
several times.
Referents usually appear first. However, there are cases in which they actually go after the
reference word.
Reference words are usually (but not always) pronouns. They may refer to a simple word, a
phrase, or a complex idea.

EXAMPLE 1
Egyptian bookkeepers associated with royal storehouses kept meticulous records (of the goods
stored in them), which were checked by an elaborate internal verification system. These early
accountants had good reason to be honest and accurate, because irregularities disclosed by
royal audits were punishable by fine, mutilation or death. Although such records were
important, ancient Egyptian accounting never progressed beyond simple list-making in its
thousands of years of existence. It is believed that besides illiteracy, the lack of coined money
prevented its development.

SOLUTION

• Them: royal storehouses.

• Which: records (of the goods stored in them).
• These early accountants: Egyptian bookkeepers associated with royal storehouses.
• Irregularities: (in) the meticulous records (kept by the Egyptian bookkeepers
associated with royal storehouses).
• Such records: the records (kept by the Egyptian bookkeepers associated with royal
storehouses).
• Its and its: ancient Egyptian accounting.
• It is believed: that besides illiteracy, the lack of coined money prevented its
development.*
* Illiteracy and the lack of coined money prevented the development of ancient Egyptian
accounting. This is what is believed.

2
EXAMPLE 2
In the reading below, reference words/expressions have been underlined. Identify the
corresponding referents for each one.
 When blood pressure falls, norepinephrine and angiotensin II (both of which constrict
the arteriole muscles) are secreted into the bloodstream. At the same time, the body
halts the secretion of NAP (a protein that causes arteriole muscles to relax and the
arterioles to dilate). These maneuvers cause the arterioles in the skin and nonessential
muscles to constrict, increasing their resistance to the incoming blood. This allows the
blood to flow to critical organs such as the brain. To visualize this, imagine a garden
hose that branches in two; if one branch constricts, the pressure in and flow through
the other one increase. It is the same with arterioles.
Ref: Insights into Shock. Sci. Am. February 2004.

SOLUTION
• Both of which: norepinephrine and angiotensin II.
• At the same time: when blood pressure falls.
• These maneuvers: norepinephrine and angiotensin II are secreted into the
bloodstream; and the body halts the secretion of NAP.
• Their resistance: the resistance of arterioles in the skin and nonessential muscles.
• This and this: the arterioles in the skin and nonessential muscles constrict, increasing
their resistance to the incoming blood.
• The other one: the other branch (in the garden hose).
• It: if one branch (one arteriole in this case) constricts, the pressure in and flow through
the other branch increase.

ACTIVITY 1
In the reading below, underline all the reference words/expressions and identify their
corresponding referents.
Language
Communication is the key ingredient of the nurse–patient relationship. Breaks in
communication can lead to misunderstanding, confusion, and error, all of which can lead to a
negative outcome. In the perioperative setting, it is imperative that patients have a full
understanding of what they will be experiencing. There can be numerous barriers to achieving
effective communication. These include, but are not limited to, language barriers, hearing
deficit, developmental issues, literacy level, and cultural barriers. The perioperative nurse must
assess each individual patient to determine which strategy would work best in each particular
situation.
There are some strategies to assist the nurse when faced with a culturally sensitive situation.
Invite the family members to choose where they would like to sit or stand. This allows them to
select a distance that is comfortable. Observe how the patient and family interact with others.
This will give clues as to what gestures are acceptable and appropriate, such as hand shaking
and eye contact. It is important for the nurse to avoid appearing rushed. If nonverbal cues are
used in response to questions, it is important to ask for clarification.
Ref: Language and Ethnicity Impact Perioperative Nursing Care. Nursing Clinics of North
America 41; 231-248 (2006)

ACTIVITY 2
In the reading below, underline all the reference words/expressions and identify their
corresponding referents.
Chance
In addition to genes and environment, another factor may affect ageing: chance. Isogenic
worms or mice do not all have the same lifespans, even in the same environment; this is why

3
populations show lifespan curves rather than sharp corners. It is possible that a stochastic
event — a metabolic insult or noise in the expression of a regulatory gene — flips an
epigenetic switch or sets in motion a chain of events that promotes ageing. One way to
investigate stochastic factors affecting lifespan would be to identify a marker that predicts,
early in life, the subsequent rate of ageing and then sort animals according to this marker,
learn how they differ, and make and test hypotheses. This might be possible: the rate of
decline in movement during early ageing predicts a worm’s lifespan, as does the AMP/ATP
ratio, which rises with age. Heat shock extends a worm’s lifespan, and individuals with the
strongest transcriptional response to heat shock live the longest. Because chance could
potentially have a large effect on lifespan, understanding how it may act is important.
Ref: The genetics of aging. Nature 464: 504-512 (2010)

Cataphora - Infinitive phrases and noun clauses

Until here we have given examples of anaphoric reference, in which a word, usually a pronoun
(reference word), is used to refer back to something else already mentioned in the text (the
referent). But we can also have the opposite situation (cataphoric reference). Take a look at
the four following sentences:
1. It is important to encourage the patient and family to ask questions.
2. It is helpful that the nurse can learn a few basic words in the patient's native language.
3. It is imperative that written instructions be given to the patient preoperatively.
4. It is also important to review the expectations of the patient and family members.

Cataphora is the use of a word or phrase, for example the pronoun “it”, that refers to
something that is mentioned later in the text. In the examples above, the referent appears
after the reference word (it) and corresponds to the underlined infinitive phrases (1 and 4) or
noun clauses (2 and 3).

Connectives
Connectives (also known as conjunctions) link words or ideas. In general, they join two ideas,
an idea with a set of words, or less commonly several ideas. They can even link paragraphs.
When we have two linked ideas, usually (but not all the times) they can be found just before
and after the connective, but sometimes the two ideas are actually after the connective. Let’s
see an example:

 Although most adults with obsessive-compulsive disorder recognize that what their
actions are senseless, some adults and most children may not realize that their
behavior is out of the ordinary.

In this case we have two opposite ideas (separated by a comma), one positive and one
negative that seem to contradict each other. The first idea says that “most adults with
obsessive-compulsive disorder recognize that what their actions are senseless” while the
second one says that “some adults and most children (with obsessive-compulsive disorder)
may not realize that their behavior is out of the ordinary”. The only way to join them is using a
contrastive connective, in this case “although”.
When working with connectives, the readers don’t need to be worried about which one is the
main idea, and which one is the subordinate idea; the really important task they have to do is
to identify, and understand, the ideas that are affected by the connective. It is also important
to know the type of connective. Appendix IV includes a comprehensive list of connectives,
their classification, and additional information (in Spanish) about this topic.

4
Types of Connectives
There are many types of connectives, but they can be classified in four broad categories:
Illustrating connectives (they give, emphasize, exemplify, explain, or add information), cause
and effect connectives, comparing/contrasting connectives, and time/order connectives
(used to arrange, list or sequence things or ideas). Next are some examples of each category:

Illustrating connectives
These connectives help us to improve our understanding of the topic (that) the reading is
dealing with. Example:

 Sheep are expected to be highly valuable for research in cystic fibrosis, because their
lungs resemble those of humans. Moreover, because sheep live for years, scientists
can evaluate their long-term responses to treatments.
First idea: sheep have lungs that are similar to human lungs, so they could be of high value to
investigate cystic fibrosis.
Moreover (illustrating connective)
Second idea: researchers can analyze, for many years, how they respond to treatments. This is
because sheep live for a long time.

Cause-effect
These connectives link two related ideas. In these cases one of the ideas is the result or the
consequence of the other one. One thing leads to another. Example:

 Because many key drugs for treating heart disease are now off-patent and thus
relatively inexpensive, important reductions could theoretically be achieved worldwide
in deaths caused by these maladies.

First idea (cause):

Numerous drugs that are used in the treatment of heart diseases are not protected by patents
anymore, so they are available now at lower prices.
Because (cause-effect connective)
Second idea (effect):
Reducing deaths associated to heart diseases, all over the world, is now possible: more
patients could be treated.

Comparison/Contrast
These connectives are used to highlight similarities (comparison) or differences (contrast)
between two things. Example:

 When the 2004 tsunami hit, no one had a set game plan for orchestrating a recovery
effort that involved more than five countries. Likewise, no global architecture exists to
deal with other health threats that cross national boundaries.

First idea: In 2004 there were no contingency plans for a tsunami, nobody knew what to do.
Likewise (comparative connective)
Second idea: Even now, there are no worldwide plans to ameliorate possible health menaces
or dangers that can simultaneously affect several countries.
In this case, the connective highlights the similarity between the two mentioned situations.
Now, let’s examine a contrastive connective:

5
  Although temperature is important in the transmission dynamics of malaria, many
other variables are of equal or greater importance.

First idea: environmental temperature is an important factor to be taken into account in

malaria transmission.
Although (contrastive connective)
Second idea: other equally (or even more) important than environmental temperature need to
be taken into account too.

Time/order
These connectives are used to organize (in time or space) things or ideas. They also allow
hierarchize related elements (to establish ranks among them). Example:

 In September 1982, a young girl died in Chicago after taking extra strength Tylenol
capsules contaminated with cyanide. On the next day, three more deaths were
reported due to Tylenol. The company (J&J) immediately alerted consumers across
the US, via the media, not to consume any type of Tylenol product. Then, in 1986, J&J
faced another problem when a woman died after taking a cyanide-laced Tylenol
capsule. The company quickly offered to replace all capsules with caplets, tablets in
the form of capsules. Finally, J&J decided to permanently discontinue capsule
products.

Here we have seven ideas that flow in a time sequence linked by six time connectives, just as
they happened. Let’s see:
In 1982, a young lady took some painkiller pills that had been contaminated with cyanide.
After
The young lady died.
On the next day
Three more persons died, for the same reason.
Immediately
The manufacturer warns its clients about not taking its painkillers anymore.
Then
In 1986, another woman died, for the same reason.
Quickly
The manufacturer replaces all the painkiller capsules with other pills called caplets (capsule-
shaped tablets).
Finally
The manufacturer stopped manufacturing capsuled products.

Example
Identify and tell the two ideas linked by each connective in this paragraph:
If current trends continue, by 2020 global rates of infectious diseases, such as diarrhea,
pneumonia and tuberculosis will decline relative to chronic diseases. Mental illness,
particularly depression, will increase, occupying second place on the list of contributors to the
world's burden of disease. Heart disease will hold first place, and, surprisingly, vehicular
accidents will climb to third--being especially numerous in countries that lack (or poorly
enforce) licensing, registration and inspection requirements. At the same time, rates of
obesity, tobacco-related disease and industrial accidents will continue to ascend.
Ref: Public Health in Transition. Scientific American, Sep. 2005, Vol. 293 Issue 3, p92.

Solution
First idea: by 2020 global rates of infectious diseases will decline.

6
If
Second idea: Current trends continue (this condition must be fufilled).
Third idea: Mental illness, particularly depression, will increase, and will become second place
on the list of contributors to the world's burden of disease.
Fourth idea: Heart disease will become first place (on the same list).
And
Fifth idea: Vehicular accidents will become third (on the list of contributors to the world's
burden of disease) especially in countries that don’t have strict licensing, registration and
inspection requirements.
At the same time
Sixth idea: Obesity rates, smoking-related illnesses and industrial accidents will continue to
climb.
Observe that there’s another connective included in the first idea, which links two sets of
words:
Infectious diseases.
Such as
Diarrhea, pneumonia and tuberculosis.

ACTIVITY 3
REFERENTS AND CONNECTIVES
Look for reference words and connectives in this reading, and identify the referents or the two
linked ideas. Then, identify the steps in the process to make cheese.
CHEESEMAKING BASICS
All cheese starts with milk. Once the milk is collected, it is put into a huge container and
warmed. First, the milk must separate into curds (solid) and whey (liquid). To start this process,
the lactose, or milk sugar, needs to become lactic acid. After warming the milk, cheese makers
add a starter culture that contains one or more types of bacteria, including Streptococcus
thermophilus and Lactobacillus helveticus. These bacteria are also known as lactic acid bacteria
(LAB) because they produce lactic acid as they metabolize. Once the acidity level in the milk
rises, the casein (one of the proteins in milk; whey is the other) can curdle. This requires the
addition of rennet, which is a group of enzymes extracted from the stomach lining of a young
cow, sheep or goat. In the stomach, rennet allows the animal to digest its mother's milk. When
added to milk, it makes the casein turn into curds.
After settling for up to two hours, the curdled milk has the appearance and texture of custard
or pudding. The temperature of the cheese at this point depends on the type of cheese being
made. Generally, higher temperatures produce firmer cheeses. Next, the curd is cut using a
tool called a harp, which releases the whey. The size of the curds will determine the type of
cheese -- soft cheeses come from large curds, while harder ones come from very fine curd. The
whey is drained and used as an additive in processed foods and in animal feed.
Ref: How Stuff Works: Making Cheese.

ANSWER KEY
ACTIVITY 1
In the reading below, underline all the reference words/expressions and identify their
corresponding referents.
Language
Communication is the key ingredient of the nurse–patient relationship. Breaks in
communication can lead to misunderstanding, confusion, and error, all of which can lead to a
negative outcome. In the perioperative setting, it is imperative that patients have a full
understanding of what they will be experiencing. There can be numerous barriers to achieving

7
effective communication. These include, but are not limited to, language barriers, hearing
deficit, developmental issues, literacy level, and cultural barriers. The perioperative nurse must
assess each individual patient to determine which strategy would work best in each particular
situation.
There are some strategies to assist the nurse when faced with a culturally sensitive situation.
Invite the family members to choose where they would like to sit or stand. This allows them to
select a distance that is comfortable. Observe how the patient and family interact with others.
This will give clues as to what gestures are acceptable and appropriate, such as hand shaking
and eye contact. It is important for the nurse to avoid appearing rushed. If nonverbal cues are
used in response to questions, it is important to ask for clarification.
SOLUTION
All of which: misunderstanding, confusion, and error.
It: that patients have a full understanding of what they will be experiencing (that’s what is
imperative)
They: patients
These: barriers (to achieving effective communication).
They: family members.
This: invite the family members to choose where they would like to sit or stand.
This: observe how the patient and family interact with others.
It: the nurse must avoid appearing rushed (this is important).
It: to ask for clarification (this is important).

ACTIVITY 2
In the reading below, underline all the reference words/expressions and identify their
corresponding referents.
Chance
In addition to genes and environment, another factor may affect ageing: chance. Isogenic
worms or mice do not all have the same lifespans, even in the same environment; this is why
populations show lifespan curves rather than sharp corners. It is possible that a stochastic
event — a metabolic insult or noise in the expression of a regulatory gene — flips an
epigenetic switch or sets in motion a chain of events that promotes ageing. One way to
investigate stochastic factors affecting lifespan would be to identify a marker that predicts,
early in life, the subsequent rate of ageing and then sort animals according to this marker,
learn how they differ, and make and test hypotheses. This might be possible: the rate of
decline in movement during early ageing predicts a worm’s lifespan, as does the AMP/ATP
ratio, which rises with age. Heat shock extends a worm’s lifespan, and individuals with the
strongest transcriptional response to heat shock live the longest. Because chance could
potentially have a large effect on lifespan, understanding how it may act is important.
SOLUTION
Another factor: a factor in addition to genes and environment.
The same environment: the environment where isogenic worms or mice live.
This: Isogenic worms or mice do not all have the same lifespans, even in the same
environment.
It: that a stochastic event flips an epigenetic switch or sets in motion a chain of events that
promotes ageing (this fact is possible).
This marker: a marker that predicts, early in life, the subsequent rate of ageing.
This: to learn how they (the animals) differ, and make and test hypotheses.
Does: as the AMP/ATP ratio predicts a worm’s lifespan.
Which: the AMP/ATP ratio.
It: chance.

8
ACTIVITY 3
REFERENTS AND CONNECTIVES
Look for reference words and connectives in this reading, and identify the referents or the two
linked ideas. Then, identify the steps in the process to make cheese.
CHEESEMAKING BASICS
All cheese starts with milk. Once the milk is collected, it is put into a huge container and
warmed. First, the milk must separate into curds (solid) and whey (liquid). To start this
process, the lactose, or milk sugar, needs to become lactic acid. After warming the milk,
cheese makers add a starter culture that contains one or more types of bacteria, including
Streptococcus thermophilus and Lactobacillus helveticus. These bacteria are also known as
lactic acid bacteria (LAB) because they produce lactic acid as they metabolize. Once the acidity
level in the milk rises, the casein (one of the proteins in milk; whey is the other) can curdle.
This requires the addition of rennet, which is a group of enzymes extracted from the stomach
lining of a young cow, sheep or goat. In the stomach, rennet allows the animal to digest its
mother's milk. When added to milk, it makes the casein turn into curds.
After settling for up to two hours, the curdled milk has the appearance and texture of custard
or pudding. The temperature of the cheese at this point depends on the type of cheese being
made. Generally, higher temperatures produce firmer cheeses. Next, the curd is cut using a
tool called a harp, which releases the whey. The size of the curds will determine the type of
cheese -- soft cheeses come from large curds, while harder ones come from very fine curd.
The whey is drained and used as an additive in processed foods and in animal feed.
SOLUTION (CONNECTIVES)
Here we have a process description to make cheese. The connectives once, first, after, once
(again), after (again), next; give information about the sequence of this process. The
connectives also, because, when, while; are used to give some additional information. The
steps in the process are:
1. The milk is collected.
2. Put the milk into a huge container.
3. Warm the milk.
4. The milk must separate into curds and whey.
5. Add a starter culture that contains one or more types of bacteria.
6. The acidity level in the milk rises.
7. Add renet.
8. The casein turns into curds.
9. Settle for two hours, until the curdled milk has the appearance and texture
of custard or pudding.
10. Cut the curd using a tool called a harp.
11. The whey is released and drained.

SOLUTION (REFERENCE WORDS)

This process: The milk must separate into curds (solid) and whey (liquid).
These bacteria: Streptococcus thermophilus and Lactobacillus helveticus.
They: Streptococcus thermophilus and Lactobacillus helveticus. (The same bacteria.)
This: The casein (one of the proteins in milk; whey is the other) can curdle.
This point: After settling for up to two hours.
Which: a tool called a harp.
Ones: cheeses.

Luis A. Saldarriaga B.
Profesor de Inglés (English ESP) - Universidad del Valle (2002 - 2014).
Cali, julio 09 de 2014.