amastyleinsider

May 16, 2012

Questions From Users of the Manual

Filed under: frequently asked questions — amastyleinsider @ 11:31 am
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Q: Are arabic numerals used for measures of time:  years, months, weeks?

A: I’m assuming you are asking about using numerals vs words.  The short answer is yes; we use arabic numerals for years, months, and weeks.  But if you should also be curious about the use of  arabic vs roman numerals, see section 19.7.5; and for specific nomenclature conventions, see chapter 15.

Q: Do you have a style for citing tweets?

A: Our blog addressed this query on August 23, 2011.  Please take a look at this archived entry.

Q: How do you handle the word continued when it’s used after a title of a table that runs over onto a second page?

A: We don’t address this specifically in the manual, but if you look at one of the longest tables in the manual (the big SI conversion table in chapter 18) you will see that we used “(cont).”  Since then, however, in our own publications, we have switched to spelling the word out (“continued”) to better serve international readers (who may not recognize cont as a “familiar” abbreviation).

Q: If there is a “compound” acronym/abbreviation defined first in a manuscript (eg, chronic myeloid leukemia in chronic phase [CML-CP]) and, later in the same manuscript, just CML is required, should CML be redefined or did the first definition cover it?

A: Good question.  AMA Manual of Style authors agree that there is no need to expand a component of an already introduced compound abbreviation.  For instance, after introducing ST-elevation myocardial infarction (STEMI), there is no need to expand MI.  In your example, there is no need to treat CML as a new abbreviation.—Cheryl Iverson, MA

May 7, 2012

Citing Electronic Editions: or, Getting on the Same Page

Filed under: references — amastyleinsider @ 11:13 am
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Copyediting.com recently posted a tip on how to cite a book read on a Kindle or other similar e-reader,1 noting that with the lack of page numbers in such electronic editions this was a “peculiarity” that editors could use guidance on. They provided the guidance offered by the Chicago Manual of Style and the Publication Manual of the American Psychological Association. They noted that the AMA Manual of Style was “quiet on the subject.”

Not liking to remain quiet for long, Stacy Christiansen, our manual’s “Tweeter,” sent a tweet2 using the same example used in the Copyediting.com tip. To wit:

Barr C; senior editors at Yahoo. Shape your text for online reading. In: The Yahoo Style Guide. Kindle ed. New York, NY: St Martins Griffin; 2010.

Tweets don’t allow much space to delve into the finer points, such as how multiple specific citations in this book could be referenced in a single manuscript, which would also help readers who are not seeking the citation on a Kindle find the specific citation. Here is a little more information for a more specific citation, indicating not only the chapter name but also the paragraph number within the chapter:

Barr C; senior editors at Yahoo. Shape your text for online reading. In: The Yahoo Style Guide. Kindle ed. New York, NY: St Martins Griffin; 2010:¶1.

An article in the New York Times3 indicated that this question is of interest to more than manuscript editors—for example, to members of a book group, some of whom read the book under discussion in print and others of whom read it on an electronic reader, but all of whom want to be able to be “on the same page” when they are discussing the book. Furthermore, this desire has been taken seriously by Amazon, which markets the Kindle. The article noted that the Kindle “will now supplement its ‘location numbers’ with page numbers that correspond to physical books.”

Bravo, we might say. The author of the article, however, offers a different perspective by saying that the attempt to “incorporate cues to keep people grounded in what has come before [eg, the page number] or scrap convention completely” is a dilemma for designers of these new technologies. So, as we leap to the future, some of us still find it useful to keep one foot in the not-so-distant past. And there’s a word for that (also noted in the article): skeuomorphs. Long may we live and long may we leap (with glee but caution).—Cheryl Iverson, MA

1. Nichols W. Copyediting Tip of the Week: Citing electronic editions. Copyediting blog. Posted January 18, 2011. http://www.copyediting.com/copyediting-tip-week-citing-electronic-editions. Accessed May 7, 2012.

2. To cite an e-reader. http://twitter.com/AMAManual/status/32154562768928768. Posted January 31, 2011. Accessed May 7, 2012.

3. Brustein J. Why innovation doffs an old hat: Breakthroughs like the Kindle and the iPad retain cues to keep users grounded in what came before. New York Times. February 13, 2011;Week in Review:2.

April 25, 2012

The “Asterisk Solution,” or Group Authorship Is Still Authorship

Filed under: authorship,editing process — amastyleinsider @ 2:04 pm
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Authors may come alone or in pairs or trios. Or more. Today, more and more frequently, they come as part of a group. There is nothing wrong with group authorship—groups can accomplish great things. But if a group is named in the byline as sole author or in addition to individually named authors, all members of the group are still being presented as authors and all must meet authorship requirements.

This is a point of contention or difficulty for some authors (or some groups), who wish to have only the name of the group in the byline even if only a small number of the members of the group (eg, the Writing Committee) meet the standards of authorship set forth by the International Committee of Medical Journal Editors (ICMJE) and outlined on the authorship forms required by our journals.

What to do? The AMA Manual of Style lists an option to address both concerns: (1) authors who want only a group name to appear in the byline, even if all members of the group do not meet authorship criteria, and (2) journals that want to adhere to the criteria for authorship outlined by the ICMJE. Let’s call this the “asterisk solution.” An asterisk is placed after the group name in the byline, and this links to an asterisked footnote that indicates which members of the group met authorship criteria.

The asterisk solution often is a happy one for both authors and journal editors (and it allows readers to see who the true authors are). But sometimes even the asterisk is objected to. The editors of 3 ophthalmology journals (Archives of Ophthalmology, American Journal of Ophthalmology, and Ophthalmology) found strength in numbers. In August 2010, the 3 editors published a jointly written editorial in each of their journals, outlining the “asterisk solution” policy from the AMA Manual of Style and announcing that they planned to hold firm to this policy in their journals.

Being an author is a form of recognition and can add to one’s reputation. It also represents a responsibility. The asterisk solution bestows recognition and responsibility with a single character.—Cheryl Iverson, MA

April 16, 2012

Quiz Bowl: Publishing Terms

Filed under: quizzes — amastyleinsider @ 1:28 pm
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Imagine your first day of work as a new editor at a large association. Seasoned professionals are bandying around words such as blueline, bleed, and boilerplate. When they use the word dummy you think they’re talking about you. Before you pack your blue pencil and head for the door, take a deep breath and dive into this month’s AMA Manual of Style quiz on publishing terms at http://www.amamanualofstyle.com. Here is an example of what you can learn:

Which of the following terms means a drawing showing a conception of the finished product that includes sizing and positioning of the elements?
blueline
color proof
galley proof
layout

And the answer is (use your mouse to highlight the text box):

layout

According to the AMA Manual of Style, layout is “a drawing showing a conception of the finished product that includes sizing and positioning of the elements.” A blueline is “the proof sheet(s) of a book or magazine printed in blue ink that shows exactly how the pages will look when they are printed.” A color proof is “photomechanical or digital presentations of color.” A galley proof is “a proof of typeset text copy run 1 column wide before being made into a page.”

Feeling a little more armed to face that first day of work? If not, take the full Publishing Terms Quiz on the AMA Manual of Style website to master your knowledge of publishing terms.—Laura King, MA, ELS

April 10, 2012

Ambiguous, Equivocal

Filed under: usage — amastyleinsider @ 9:43 am
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These words often are taken to mean the same thing—which in some contexts they indeed do. When used to refer to test results or experimental findings, for example, both words are properly used to indicate uncertainty, ie, that the findings can be understood in more than one way.

However, a distinction comes to bear when one is referring to statements, either written or oral. Although both words also can properly be used when referring to a statement subject to more than one interpretation, accepted usage holds that ambiguous is the proper choice if the resulting uncertainty seems unintentional1(p39) and that equivocal is the way to go if the uncertainty seems to have been intentionally introduced to confuse or deceive.1(p423) The deceptive intent is key, and it is worth noting that whereas the verb equivocate is an accepted word, ambiguate is not.

Deceptive intent might be inferred from the immediate context of surrounding statements. Often, however, intent is inferred from the larger context, ie, the history of the issue under discussion or the (perceived) character of the person making the statement. Given the latter means of inference, it is not surprising that the use of equivocal to refer to deceptive statements has been accepted since the late 1700s—about the time that the word also came to be commonly used to describe persons believed “[d]oubtful in character or reputation; liable to unfavorable comment or description; questionable; suspicious.”2(p527) Equivocal is still occasionally used when referring to such persons, but current usage, particularly in the social media, tends to favor terms somewhat more colorful.

Equivocal also can imply that a person has used ambiguous language in a qualifying way to avoid personal commitment to the statement made.1(p423) This meaning, however, although a bit more neutral than the meaning already noted, still hints at something less than savory. In short, although using ambiguous and equivocal interchangeably to describe a statement will be correct in some instances, writers tempted to use equivocal in place of ambiguous would do well to remember that the former has additional connotations often freighted with “nasty overtones.”3

Perhaps because clarity and certainty are seldom used for deceptive purposes, matters are less complicated in negative constructions: unambiguous and unequivocal both indicate that a test result or a statement has only one interpretation. However, because equivocal carries negative connotations, unequivocal is often used to emphasize a lack of deceptive intent.

As a side note, another word, unequivocable, has been used interchangeably with unequivocal since the early 1900s.2(p2166) How this monster came to be is a matter of some conjecture, but it likely arose either from innocent confusion over the proper spelling and pronunciation of equivocal or from a desire to use a loftier-sounding word (although it is difficult to imagine an instance in which unequivocal would not be lofty enough). In any case, unequivocable and its variants are often considered nonstandard.1(p1366)

The bottom line:

● Referring to test results or experimental findings having more than one interpretation? Ambiguous and equivocal are both correct, but it is worth noting that the latter can have negative overtones and is perhaps best avoided unless the reporting of results seems intentionally unclear.

● Referring to a statement having more than one interpretation? Remember that all equivocal statements are ambiguous, but not all ambiguous statements are equivocal. If the statement seems intentionally unclear with the goal of distancing or deceiving, use equivocal.

Unambiguous and unequivocal both indicate that something has only one interpretation, although when describing a statement unequivocal is sometimes used to emphasize an absence of deceptive intent.

Unequivocable, while found in some dictionaries, is often considered nonstandard and should probably be avoided.—Phil Sefton, ELS

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

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

3. Ambiguous, equivocal. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:38.

March 27, 2012

A Few Thoughts on Fewer and Less

Filed under: usage — amastyleinsider @ 12:30 pm
Tags: ,

All of the usual English-language usage books seem so sure that they give little more than a compound sentence to explain that fewer should be used when referencing things that can be counted and less when referencing quantity or things that can be measured.

The AMA Manual of Style1 points out that the 2 words “are not interchangeable.” Then explains the difference by advising readers to “[use] fewer for number (individual persons or things) and less for volume or mass (indicating degree or value).” It offers the following examples: “Fewer interventions may not always mean less care” and “The authors evaluated fewer than 100 studies yet still reported more support for the conventionally prescribed therapy.” The entry is followed by a note that provides 2 more examples including parenthetical explanations:

spent less than $1000 (not: spent fewer than $1000)

reported fewer data (not: reported less data)

The Associated Press Stylebook2 entry says, “In general, use fewer for individual items, less for bulk or quantity” and provides the following examples, or should I say commands:

Wrong: The trend is toward more machines and less people. (People in this sense refers to individuals.)

Wrong: She was fewer than 60 years old. (Years in this sense refers to a period of time, not individual years.)

Right: Fewer than 10 applicants called. (Individuals.)

Right: I had less than $50 in my pocket. (An amount.) but: I had fewer than 50 $1 bills in my pocket. (Individual items.)

The Elements of Style3 elliptically warns, “Less should not be misused for fewer” with the following explanation. “Less refers to quantity, fewer to number. ‘His troubles are less than mine’ means ‘His troubles are not so great as mine.’ ‘His troubles are fewer than mine’ means ‘His troubles are not so numerous as mine.’”

A Writer’s Reference,4 a college handbook, is equally economical: “Fewer refers to items that can be counted; less refers to items that cannot be counted” followed by its example for usage: “Fewer people are living in the city” and “Please put less sugar in my tea.” (I’d rather that you didn’t put any sugar in my tea.)

But if the rule were so easy as these commonly used English-language usage references suggest, why are people confused?

If anything is certain about language, it is that nothing is certain: a truism that often frustrates my composition students, who simply want the answer when no one true answer exists. In the case of fewer and less, Webster’s Dictionary of English Usage5 and Fowler’s Modern English Usage6 support my position by telling an entirely different story about how to use less and fewer, with Webster’s devoting 3 and a third columns to it and Fowler’s devoting about 3 columns over 2 entries.

The former launches the alternate-usage discussion with a metaphoric clearing of its throat to suggest, however, that the general usage rule cited in most English-language reference texts “has only one fault–it is not accurate for all usage” and offers a rule amendment for using less:

less refers to quantity or amount among things that are measured and to number among things that are counted.

In other words, less can be used in both cases. Webster’s punctuates its point by saying the amended rule has actually reflected common usage for say “the past thousand years or so.” The general rule became established and embraced by most language scholars, so Webster’s theorized, from a 1770 comment about less made by Robert Baker in Reflections on the English Language. He wrote:

The word [less] is most commonly used in speaking of a Number; where I should think Fewer would do better. No fewer than a Hundred appears to me not only more elegant than No less than a Hundred, but more strictly proper.

Thus, a modest preference has become, as Webster’s points out, “elevated to an absolute status.” That transformation, the entry laments, may be due to the reluctance of “many pedagogues … to share the often complicated facts about English with their students.” In fact, Webster’s points to the Oxford English Dictionary as showing that “less has been used as countables since the time of King Alfred the Great.”

Although Fowler’s trends toward the generally accepted usage rule, it recognizes that perhaps the “complicated facts about English” should in fact be elucidated. As a means of clarification, it uses parts of speech to explain the usage differences. It says that “few and its comparative adj. fewer are used with countable nouns, i.e. with nouns that have both a singular and a plural form (book/books)…; or with collective nouns (fewer people…)” but, “[l]ess which is a comparative of little, is properly used with uncountable or mass nouns: in other words less refers to quantity and is the opposite of more (less affection, less power, less misery).” Furthermore, Fowler’s acknowledges when less can be used “idiomatically with plural nouns … esp. distances (it is less than seventy miles to London)” and the like.

In its final example in the few entry, Fowler’s notes the “regrettable” trend of “the use of less with an unprotected plural noun.”(That’s an expression that’s new to me.) One of the example sentences of that violation is

There will be less 100% loans about.

Don’t we all know that?—Beverly Stewart, MSJ

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

2. Goldstein N, ed. The Associated Press Stylebook and Briefing on Media Law. New York, NY: Basic Books; 2007.

3. Strunk W, White EB. Elements of Style. 4th ed. New York, NY: Longman; 2000.

4. Hacker D. A Writer’s Reference. 6th ed. Boston, MA: Bedford/St Martin’s; 2009.

5. Webster’s Dictionary of English Usage. Springfield, MA: Merriam-Webster Inc; 1989.

6. Burchfield RW. Fowler’s Modern English Usage. 3rd rev ed. New York, NY: Oxford University Press; 2004.

March 19, 2012

Questions From Users of the Manual

Filed under: frequently asked questions — amastyleinsider @ 2:36 pm
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Q: A colleague and I both remember seeing in a style manual that an en dash should be used between 2 words of equal weight. However, we checked the AMA Manual of Style and saw that this was not a supported use of the en dash. Did this guideline appear in a former edition of the AMA Manual, or did we just pick this idea up from another source?

A: No, I don’t believe we have ever recommended an en dash between 2 words of equal weight. It is the hyphen that we recommend between 2 words of equal weight. See the middle of page 346 of the 10th edition, with the examples of “blue-gray eyes” and “blue-black lesions.” We recommend use of the en dash when the items on either side are not of equal weight (eg, one element consists of 2 words or a hyphenated word or a compound). There are examples at the bottom of page 352 and the top of page 353.

Q: Is it appropriate to abbreviate echocardiography as ECHO or echo in documents that describe the use of echocardiography during the treatment of various types of cancer?

A: We would be unlikely to abbreviate echocardiography (or any related term, such as echocardiogram) to ECHO or echo. We would spell this term out. Only in cases in which there are serious space constraints would we consider abbreviating this term (eg, in a large table), and then we would recommend expanding the abbreviation in a table footnote.

Q: Do you use Web site or website? Traditionally it has always been “Web site,” but in the past few years I have noticed a change to the more informal “website” in many publications. What is your recommendation?

A: On the home page of the AMA Manual, in the navigation bar, there’s a listing for “Updates.” If you take a look there, you’ll see that a relatively recent update (January 18, 2012) indicates that, as of that date, we began to prefer website to Web site.  Check “Updates” periodically to see if there are other, newer updates on material in the manual.

Q: I have a style question I cannot find addressed in your manual. On a manuscript I plan to submit to a journal, the corresponding author has moved since the manuscript was written and this author wants to indicate both her current and her former affiliation. Can you advise on how to phrase this information?

A: The answer to your question is in section 2.3.3 of the manual. See the relevant excerpt below:

The affiliation listed, including departmental affiliation if appropriate, should reflect the author’s institutional affiliation at the time the work was done. If the author has since moved, the current affiliation also should be provided.

Author Affiliations: Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Dr Lloyd is now with the Department of Emergency Medicine, St Luke’s Hospital, Milwaukee, Wisconsin.

Cheryl Iverson, MA

March 12, 2012

Illicit, Elicit, Solicit

Filed under: usage — amastyleinsider @ 2:24 pm
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“I am the offspring of illicit love.”1(p814)

“Only suffering… can elicit the perfumes of the soul.”1(p503)

“Henry had been soliciting the pope for some time, in order to obtain a divorce from Catherine of Aragon, his queen.”1(p1822)

Illicit, elicit, solicit. The above examples make it abundantly clear that these words have distinctly different denotations; yet they are often confused or misused, even by careful writers. In medical contexts, it is especially important to preserve the distinctions between them.

Illicit, denoting simply “not permitted; unlawful”2(p618) (and sometimes used colloquially to indicate naughty, unseemly, or immoral), has limited use in medical writing. For example, written materials might convey the risks associated with use of illicit drugs, discuss illicit relationships between researchers and industry, or report on the illicit trade in human body parts. Beyond such instances, however, the word does not often come into play.

Elicit, however, is another story. Denoting “to call forth or draw out (as information or a response)” or “to draw forth or bring out (something latent or potential),”2(p404) the word occurs frequently in medical contexts. It might be used in both senses regarding a patient–physician encounter: for example, a physician evaluating a patient’s pain will ask questions to elicit information about the characteristics of the pain (eg, location, nature, duration, exacerbating factors). From the patient’s perspective, that is the easy part, and patients might well wish this were the end of the matter; however, having thus elicited mere information about the patient’s pain, the physician then embarks on maneuvers expressly designed to elicit the real thing. In written materials covering the basic sciences and their clinical applications, elicit is perhaps most frequently used in the second sense noted above. For example,a writer might report that a new vaccine elicits a given immune response, describe pathological mechanisms that elicit organ damage, or present a theory of how a treatment might elicit changes in gene expression.

Even accomplished writers sometimes confuse the homophones illicit and elicit. However, these terms are easily distinguished from each other: illicit is always an adjective, whereas elicit is—in current usage—always a verb. (It also can help to remember that illicit denotes illegal; for the temperance-minded, the illicit distillation of spirits might also come to mind.)

Troublesome as homophones can be, however, sometimes near-homophones can be more so, especially when they are similar in meaning. For example, elicit and solicit—the latter most frequently used in medical contexts in the sense of “to approach with a request or plea”2(p1187)—are often used interchangeably, with solicit perhaps more frequently used in place of elicit.3 However, such use obscures an important distinction. The Oxford Dictionary of American Usage and Style perhaps explains this distinction most succinctly: “To solicit a response is to request it. To elicit a response is to get it.”3 Thus, in the patient–physician encounter alluded to above, the physician solicits information regarding the patient’s pain and then performs a physical examination to elicit and evaluate actual pain. The Oxford resource also points out an ambiguity that can arise when elicit and solicit are confused: “‘Sentient representatives expect the core group to solicit [read elicit?] response from about 4,000 people.’”3 In other words, will the group solicit responses from 4000 persons, or will the group approach a larger number of persons to try and elicit 4000 responses, knowing that some persons approached might not reply? In medical contexts, the distinction has obvious implications for reports of survey studies and possibly for discussions of power calculations in reports of clinical trials.

Three quick tips:

* Looking for an adjective to describe something as immoral, forbidden, or illegal? Illicit (think illicit = illegal) might be the ticket.

* Looking for a verb to convey the requesting of information? Consider solicit.

* Looking for a verb to convey the obtaining of information or the drawing forth of a response or change? Consider elicit (think elicit = get).—Phil Sefton, ELS

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

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

3. Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000:309.

February 28, 2012

Quiz Bowl: SI vs Conventional Units

Filed under: quizzes — amastyleinsider @ 1:51 pm
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Welcome back, quiz bowl participants. Our very first quiz bowl, which appeared on this site on May 5, 2011, dealt with format, style, and punctuation of units of measure. Now we’re back to delve even further into the intriguing and ever-changing world of units of measure style. The following is a sample of one of the questions that appears in this month’s AMA Manual of Style quiz on SI vs conventional units (http://www.amamanualofstyle.com/). Answer the question based on your understanding of section 18.5 of the AMA Manual of Style.

The mean 2-dimensional area of the largest metastasis was 7.2 sq in.

So, what do you think? This one isn’t really too hard. Here’s the answer (use your mouse to highlight the text box):

The mean 2-dimensional area of the largest metastasis was 46.8 cm2.

Measurements of length, area, volume, and mass are reported in metric units rather than English units. To convert square inches to square centimeters, multiply by 6.5 (§18.5.1, Length, Area, Volume, Mass, pp 794-795 in print).

Let’s try a more challenging question.

Admission laboratory tests revealed the following: serum creatinine, 0.9 mg/dL; serum urea nitrogen, 11 mg/dL; serum albumin, 39 g/L; and prothrombin time, 11.5 seconds.

Yes, this one is definitely harder. Here’s the answer:

Admission laboratory tests revealed the following: serum creatinine, 0.9 mg/dL (to convert to micromoles per liter, multiply by 88.4); serum urea nitrogen, 11 mg/dL (to convert to millimoles per liter, multiply by 0.357); serum albumin, 3.9 g/dL (to convert to grams per liter, multiply by 10); and prothrombin time, 11.5 seconds.

For laboratory values, factors for converting conventional units to SI units should be provided in the article. In text, the conversion factor should be given once, at first mention of the laboratory value, in parentheses following the conventional unit (§18.5.10, Laboratory Values, pp 797-816 in print). Although the AMA Manual of Style recommends writing out units of measure when no numbers are reported (eg, micromoles per liter), some journals may prefer to use abbreviations when listing SI conversion factors (eg, mmol/L).

Need some more practice? Subscribe to the AMA Manual of Style online and take the full quiz. If you’re new to the site, check out some of our other quizzes as well.—Laura King, MA, ELS

February 21, 2012

Incidence

Filed under: statistics,usage — amastyleinsider @ 9:55 am
Tags: , ,

In medical contexts, incidence is most often used in its epidemiologic sense, ie, the number of new cases of a disease occurring over a defined period among persons at risk for that disease. When thus used, incidence may be expressed as a percentage (new cases divided by number of persons at risk during the period) or as a rate (number of new cases divided by number of person-years at risk).

Reporting several incidence values in the same sentence can nearly always be accomplished using the singular form (eg, “the incidence of nonfatal myocardial infarction during follow-up was 10% at 6 months, 19% at 12 months, and 26% at 18 months” or “the incidence of clinical stroke decreased significantly, from 7.6 to 5.3 per 1000 person-years in men and from 6.2 to 5.1 per 1000 person-years in women). However, in rare instances, sentence construction may necessitate the use of the plural, which of course is… what, exactly? The understandable urge to simply add an “s” at the end of the word to form the plural results in incidences — a form not found in most dictionaries and a clunker of a word if ever there was one. Writers wishing for a more mellifluous plural sometimes use incidence rates, a valid term but one perhaps best reserved for reporting incidence values expressed as actual rates rather than simple percentages. Moreover, incidences is sometimes used when reporting values either as percentages or as rates, in the latter case missing a valuable opportunity to emphasize that rates rather than percentages are being reported.

Thus, it is perhaps best to use incidences, awkward as it may be, when reporting multiple incidence values as percentages and incidence rates when reporting such values as rates, eg, “at first follow-up, the incidences of falls resulting from frailty, neuromuscular disorders, or improper use of mobility devices were 15% (95% CI, 10%-20%), 12% (95% CI, 7%-17%), and 12% (5%-19%), respectively” or “the incidence rates for falls resulting from frailty, neuromuscular disorders, or improper use of mobility devices were 5.1, 6.3, and 4.6 per person-year, respectively.” Incidentally, these 2 examples report occurrences (falls) rather than diseases or conditions, and so represent 2 instances reporting the incidence of incidents.

To further muddy the waters, incidence is sometimes confused with prevalence, defined as the proportion of persons with a disease at any given time (ie, total number of cases divided by total population). Thus, whereas incidence describes how commonly cases are diagnosed, prevalence describes how widespread the disease already is; on a more personal level, incidence describes one’s risk of developing the disease, whereas prevalence describes the likelihood that one already has it. The confusion between the terms is perhaps attributable to the occasional use of prevalence in place of incidence in the study of rare, chronic diseases for which few newly diagnosed cases are available; however, this circumstance is unusual, and incidence and prevalence should always be distinguished from one another and used appropriately. (See also §20.9, Glossary of Statistical Terms, in the AMA Manual of Style, p 872 in print.)

Whereas prevalence is often used in general contexts to indicate predominance or general acceptance, the circumstances calling for the use of incidence in general contexts are quite few and become fewer still when one takes into account that incidence is often used when incidents (the simple plural of incident) or instance (again denoting an occurrence) would be the better choice. Perhaps incidents or instances was intended but never made it to the page — as is so often the case with homophones and near-homophones, even the careful writer who usually would not confuse incidence, incidents, and instance might one day look back over a hastily typed passage only to see that a wayward incidence has crept in; if the passage is hastily edited to boot, the error might well go unnoticed until the passage is in print and a discerning reader takes pains to point it out in a letter or e-mail. The plural form, incidences, has virtually no use outside of the epidemiologic discussed above, although it has been used to subtly disorienting effect by translators rendering the Kafkaesque works of Russian writer Daniil Kharms (1904-1942) into English, most notably when rendering the 1-word title of Incidences, Kharms’ 1934 collection of absurdist critiques on life in the Soviet Union under Stalin. However, writers who are not political dissidents aiming for absurdist effect — presumably all medical writers — would do well to proofread carefully and often. — Phil Sefton, ELS

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