February 24, 2015

Sincerely, The Comma

Filed under: punctuation — amastyleinsider @ 1:25 pm
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Please enjoy this clever (if lengthy) New Yorker piece on the incredible comma, serial and otherwise.

February 5, 2015

January 29, 2014

Quiz Bowl: Comma

Filed under: quizzes — amastyleinsider @ 1:37 pm
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“Let’s eat Grandpa.”

“Turkeys gobble Grandma.”

“She finds inspiration in cooking her grandchildren and her dog.”

As the saying goes, “Commas save lives!” Just the simple addition of commas to the above sentences and Grandpa, Grandma, the grandchildren, and even the family dog are all free to live another day.

“Let’s eat, Grandpa.”

“Turkeys gobble, Grandma.”

“She finds inspiration in cooking, her grandchildren, and her dog.”

In an effort to end the scourge of comma-related fatalities, this month’s Style Quiz addresses the use of the comma.

Edit the following sentence based on your understanding of section 8.2 of the AMA Manual of Style.

The investigators performed a double-blind placebo-controlled patient-initiated 2-armed parallel clinical trial.

Highlight the text box for the answer: The investigators performed a double-blind, placebo-controlled, patient-initiated, 2-armed, parallel clinical trial.

In a simple coordinate series of 3 or more terms, separate the elements by commas (§8.2.1, Comma, Series, pp 337-338 in print).

If, like us at the AMA Manual of Style, you are determined to play a role in ending the epidemic of flagrant and dangerous comma misuse, check out the full quiz at—Laura King, MA, ELS

January 9, 2014

Quiz Bowl: Forward Slash

Filed under: quizzes — amastyleinsider @ 9:56 am
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Thanks to an astute reader (gold star for Regina Scaringella) who noticed that our use of the forward slash in patient/physician relationship contradicted page 345 of the stylebook, we have revised this post. The following terms are correct: obstetrics/gynecology and patient-physician. (updated 2/3/14)

It should be easy, right? The use of the forward slash, that is. However, every time I encounter a forward slash in a manuscript, I know I’m headed for a fight. It’s me against the sinister solidus. Is it obstetrics/gynecology, obstetrics-gynecology, or obstetrics and gynecology? Is it male/female ratio, male-female ratio, or male to female ratio? I won’t let it defeat me! I shall tame the villainous virgule, and you can too. Below are 2 examples from this month’s Style Quiz that will help you fight the forward slash foe.

Edit the following sentences for appropriate usage of the forward slash based on your understanding of section 8.4 of the AMA Manual of Style.

The male/female ratio was 2/1.

Use your mouse to highlight the text box for the answer: The male to female ratio was 2:1.

Although a forward slash may be used to express a ratio (eg, the male/female ratio was 2/1), the preferred style is to use a colon to express ratios that involve numbers or abbreviations (the Apo B:Apo A-I ratio was 2:1) and the word to to express ratios that involve words (the male to female ratio) (§8.4.5, In Ratios, p 354 in print; see also §8.2.3, Colon, Numbers, p 342).

But what about that pesky relationship between obstetrics and gynecology? Maybe this will help.

The study examined academic performance in undergraduate obstetrics/gynecology clinical rotations. to achieve an effective patient/physician relationship was a top discussion priority at the annual meeting.

This example is correct as is. When 2 terms are of equal weight in an expression and and is implied between them to express this equivalence, the forward slash can be retained (§8.4.1, Used to Express Equivalence or Duality, pp 353-354 in print).

We hope these examples have helped arm you in the battle for mastery over the forward slash. If not, the full quiz (available to subscribers at provides more guidance on the formidable forward slash.—Laura King, MA, ELS

October 23, 2013

Questions From Users of the Manual

Filed under: frequently asked questions — amastyleinsider @ 9:48 am
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Q: How should columns with mixed units of measure indicate the unit of measure?

A: In a table with mixed units throughout, use a table footnote for the most common unit of measure, eg, “Unless otherwise indicated, data are expressed as number (percentage).” and specify in the stub or column head only those units that are different. In a table with mixed units in a single column, use the most common unit in the column head and only provide another unit in the table cell for those entries that have a different unit of measure.

Q: Because of the change from the 9th to the 10th edition in the way number and percentage are handled in running text (see page 832 in the 10th edition), should column headings in tables also be changed to read, for example, “No. of Girls (%)” rather than “No. (%) of Girls”?

A: No. The style “No. (%) of Girls” is still an acceptable table column head as here both “number” and “percentage” apply to “of girls,” whereas in the example on p 832, the percentage is given as more of an aside to the numerator and denominator and hence follows: “Death occurred in 6 of 200 patients (3%).”

Q: What recommendations do you have for the preferred typeface of a punctuation mark that follows copy set in something other than roman type?

A: Some specific recommendations are outlined below:

• If an entire sentence is set in a typeface other than roman (eg, italic, bold), any punctuation in that sentence would take the typeface of the rest of the sentence.

• If part of a sentence is set in a typeface other than roman, even if it’s the end of the sentence, the ending punctuation would be roman.

• For heads, sideheads, entries in a glossary, the punctuation would follow that of the preceding word (so, in Correct and Preferred Usage of Common Words and Phrases, the commas between the word pairs are boldface, like the words).

• For parentheses and brackets, unless the entire sentence is set in a typeface other than roman, the parentheses or brackets are roman (see the example with “[sic]” on p 358).—Cheryl Iverson, MA


June 4, 2013

Questions From Users of the Manual

Filed under: punctuation — amastyleinsider @ 1:31 pm
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Q: I can’t find anywhere in the AMA Manual of Style guidance on having back-to-back sets of parentheses in running text. Here is an example:

 The mean duration of surgery for the computerized-navigation group was 52.6 minutes longer than that of the control group, resulting in a statistically significant difference (P < .05) (Table 1).

I would prefer to see something like this:

The mean duration of surgery for the computerized-navigation group was 52.6 minutes longer than that of the control group, resulting in a statistically significant difference (P < .05; Table 1).

But does the manual have a preference?

A: Short answer: The style manual does not include anything about a pref on use of back-to-back parens, so this is something to think about including in the Punctuation chapter for the 11th edition. (Also, as you’ll see from the few examples below, because we don’t have a policy on this, it has not been handled consistently in our publications.)

Longer answer: Although our first response to your specific example was that we liked the avoidance of back-to-back parens and would favor (as you do) the inclusion of both items in a single set of parens, or would find either version OK, on further thought we decided that this answer was too easy and that often both sets of parens should be retained. Reasons: (1) Although in the example provided it makes sense to combine and use the semicolon, in more complicated sentences it might not be the best choice. (2) Table and Figure citations might be easier to find if not combined with other info.

Below are a few examples from The JAMA Network Journals that might illustrate where combining the information in parens might not be as desirable as keeping the parenthetical items separate.

A significantly higher incidence of SSHL was noted in the HIV group compared with the control group, with an incidence rate ratio (IRR) of 2.17 (95% CI, 1.07-4.40), particularly for the male participants, who had an IRR of 2.23 (1.06-4.69) (Table 2).

Here, keeping the table citation separate makes it clear that the table citation relates to BOTH values given in the sentence, not just the second one. Note that in our journals the first citation of a table or figure is set in different type (here, heavy boldface) to make it stand out.

In this example, where info was combined, it would probably have been better to also have kept the table citation separate as it applied to both bits of info in the sentence:

Mean mandible defect lengths were similar for patients undergoing FFF and LSBF reconstruction (7.8 and 7.7 cm, respectively); STFFs were used to reconstruct significantly shorter defects (mean, 6.0 cm, P<.001, Table 1).

And in this example, which does not include a table or figure citation, similar logic would also probably have made retention of back-to-back parens a better choice since the hazard ratio and P value apply to both, not just the second “n”:

Significantly more patients (n=174) withdrew from the placebo group compared with the chelation group (n=115; hazard ratio, 0.66; P=.001).

Splitting or lumping parentheses should depend more on content than strictly on style.—Cheryl Iverson, MA

July 18, 2012

Is It an Either/Or or a 50-50 Proposition?

Filed under: punctuation — amastyleinsider @ 2:26 pm
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The usual suspects stand 7½ inches high in a stack next to my computer. They moderate my dogma against what I think lazy or muddled use of punctuation or language by nicely telling me that I am wrong or, worse, that I have become woefully out of date.

No, I don’t wear a string of pearls, hang my reading glasses around my neck, stuff a tissue in the sleeve of my cardigan sweater, or wear my hair swept up in a bun, though my gray strands have thickened to streaks that I fear will dominate my hair soon enough. But I do become cranky about usage trends that render the language imprecise.

My problem is the slash or virgule. It seems to pop up everywhere, from a syllabus for a graduate class to a book assigned in another class. On the syllabus, the assessment subsection head includes “Exam/Term Paper and Class Participation.” Good, I thought, I will be able to pick whether to take the exam or write a paper. But no, as I read on I see there is no choice. The exam is to be written as an essay. Should that expression then be considered a compound modifier of a compound word and expressed with an en dash instead of a slash—“examination–term paper”? The book, on the other hand, discusses a collaborative “Harvard/MIT” study. Clearly, this should have been a hyphen rather than a slash.

But most frequently, I find excessive use of the virgule in the medical research articles I edit. Its prevalence in these articles always surprises me because by nature the virgule is ambiguous while science writing aims at precision—to the point of putting readers to sleep: no active verbs, few identifiable subjects, only statements that remain within the bounds of the data, and no causation, just associations.

So am I justified in being annoyed at what I consider an over-reliance on the slash? As a reader, I favor words and punctuation that make ideas clear. And while I am scrupulous about taking out an and/or construction, as is the mandate of our style manual, by stretching “red and/or white” to “red, white, or both,” I consider my irritation justified when confronted with extending its use to what was submitted in a table footnote for an article I recently edited:

            Rescue was defined as any pharmacological/electrical/surgical intervention for the termination/prevention of AF [atrial fibrillation]/flutter…

I dutifully changed it:

            Rescue was defined as any pharmacological, electrical, or surgical intervention for the termination or prevention of AF [atrial fibrillation] or flutter…

Although I was correct in determining that the slashes suggested an alternative, I could have guessed they meant a series.

Before checking the books, I confirm that the symbol of the virgule, which comes from the Latin virgula, “a little bough, twig; a rod, staff,”1 is defined as a slash in Merriam-Webster’s Collegiate Dictionary.2 Clearly, it looks like what it means, a visual mnemonic perhaps? My understanding of the punctuation mark is that the virgule can mean and or it can mean or, or as my poet-husband suggests, it classically means and/or.

So now to the stack. First up, the AMA Manual of Style,3 which in the introductory paragraph of the Forward Slash (Virgule, Solidus) section says that the virgule “is used to represent per, and, or or and to divide material (eg, numerators and denominator in fractions; month, day, and year in dates [only in tables and figures]; lines of poetry).” Then comes the first major discussion under the section, which says that the slash expresses equivalency “[w]hen 2 terms are of equal weight in an expression and and is implied” and provides the following example:

The diagnosis and initial treatment/diagnostic planning were recorded.

With this definition in mind, how do my above examples stand up to the test? MIT would probably not quibble with being viewed as equivalent to Harvard, but I still think in this case they are functioning, in their capacity as the generators of a study, as a compound modifier and should be hyphenated, even though and is implied. I think the same goes for my “exam/essay” example because and is not implied. They are a single concept as the major assessment for the class. And for my table footnote, while they represent equivalent interventions, the word and is not implied, but the expression “termination/prevention” could have been left alone as equivalent ideas. However, I think changing “AF/flutter” to “AF or flutter” was correct because I don’t think the experience is equivalent. (However, I am told by one of our medical editors that AF/flutter is so constructed because a patient’s heart rhythms may vacillate between the 2 states so that treatment and outcome are similar, thereby, demonstrating another example of the virgule serving as a visual reality.)

Fowler’s Modern English Usage4 and The Elements of Style5 are silent on the matter. The Associated Press Stylebook6 allows its use only to describe “phrases such as 24/7 or 9/11” and advises writers and editors to “otherwise confine its use to special situations, as with fractions or denoting the ends of a line in quoted poetry.”

The Chicago Manual of Style7 says, “A slash most commonly signifies alternatives. In certain contexts it is a convenient (if somewhat) informal shorthand for or. It is also used for alternative spellings or names. Where one or more of the terms separated by slashes is an open compound, a space before and after the slash can be helpful.” Although coming at it from the alternative angle rather than equivalent angle, I think my editing still stands. Nevertheless, I think the Chicago Manual captures the spirit of the slash in response to the speed brought on by the age of the Internet and people like my boss, who said, “I like it. It’s fast.”

As for me, the confusion of meaning slows me down. I vote for words.—Beverly Stewart, MSJ

1. University of Notre Dame. Latin dictionary and grammar aid Web page. Accessed July 16, 2012.

2. Virgule. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA; Merriam-Webster Inc; 2003:1397.

3. 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.

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

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

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

7. The Chicago Manual of Style. 16th ed. Chicago, IL: University of Chicago Press; 2010.

June 27, 2012

Questions From Users of the Manual

Filed under: frequently asked questions — amastyleinsider @ 1:38 pm
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Q: We do not find anything in the manual on how to treat “24/7.” Would you recommend spelling it out?

A: You are right. We don’t address this. But Webster’s 11th does. Both “24-7” and “24/7” are offered as equal variants. I think the latter is more common and would prefer that, without spelling it out.

Q: I understand that human genes are set all caps and italic, with the protein products set all caps and roman. But what to do with proto-oncogenes? Do the examples in section 15.6.2 indicate that, if the c- prefix is used, the lowercase (retroviral) form of the 3-letter oncogene is always used, regardless of whether we’re dealing with humans or mice? I am often presented with c-KIT, c-Kit, and c-kit in one document and would appreciate a clear explanation.

A: For oncogenes, it would always be c-kit and then, based on page 633 of the style manual, KIT for the human gene homologue and Kit for the mouse gene homologue.

Q: To follow your reference style, if “et al” is used, is a period used after “al”? And should the reference number be set as a superscript?

A: To answer your second question first, yes, the reference number should be set as a superscript if you follow the style set forth in the AMA Manual. And unless “et al” ends the sentence, “al” would not be followed by a period (even though it is an abbreviation).—Cheryl Iverson, MA

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

October 7, 2011

Quiz Bowl: To Capitalize or Not to Capitalize

Filed under: quizzes — amastyleinsider @ 9:12 am
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Flipping through the table of contents of the most recent issues of JAMA and the Archives journals, I realize how challenging it can be to correctly capitalize article titles and subtitles. Do hyphenated compounds use initial capital letters on both terms? Are words of 2 letters or fewer capitalized? How do you capitalize genus and species names? Much like Hamlet’s “To Be or Not to Be” conundrum, I am often found muttering to myself “To Capitalize or Not to Capitalize.”

This month in the Archives of Internal Medicine, an article on hip fracture and increased short-term but not long-term mortality in healthy older women appears. But how should this be capitalized as a title? Is it “Hip Fracture and Increased Short-Term But Not Long-Term Mortality in Healthy Older Women,” “Hip Fracture and Increased Short-term But Not Long-term Mortality in Healthy Older Women,” or “Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women”?

This month’s JAMA contains an article on the need for critical reappraisal of intra-aortic balloon counterpulsation. But is it the “Need for Critical Reappraisal of Intra-Aortic Balloon Counterpulsation” or the “Need for Critical Reappraisal of Intra-aortic Balloon Counterpulsation”?

Finally, in the Archives of Otolaryngology–Head & Neck Surgery, an article on leiomyosarcoma of the head and neck: a population-based analysis is published. But did the authors perform “A Population-Based Study” or “A Population-based Study”?

Capitalizing titles can provide editors with a sea of troubles, which is why we have chosen the topic for this month’s quiz. Test your ability to correctly capitalize the title in the following example. For further explanation of the correct answer, refer to section 10.2 (pp 372-374 in print). Then check out this month’s quiz (which subscribers can find at for more titles and subtitles to capitalize.

tolcapone in patients with parkinson disease: a randomized, double-blind, placebo-controlled trial

Okay, back to the original question—to capitalize or not to capitalize? How did you handle this title and subtitle? Did you know that double-blind and placebo-controlled are treated differently? Here’s the answer (use your mouse to highlight the text box):

Tolcapone in Patients With Parkinson Disease: A Randomized, Double-blind, Placebo-Controlled Trial

The A should be capitalized because it is the first word of the subtitle (§10.2, Titles and Headings, p 372 in print). Double-blind is a hyphenated compound considered a single word (ie, it can be found as a single entry in Webster’s); therefore, blind should not be capitalized. Placebo and controlled are 2 separate terms operating together as a temporary compound; therefore, both parts of the hyphenated compound should be capitalized (§10.2.2, Hyphenated Compounds, pp 373-374 in print).

For the record, those titles I mentioned earlier should be capitalized as follows:

Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women
Need for Critical Reappraisal of Intra-aortic Balloon Counterpulsation
Leiomyosarcoma of the Head and Neck: A Population-Based Analysis

If you want more examples to help you solve the puzzle surrounding correct capitalization of titles and subtitles, take the Capitalization of Titles and Subtitles Quiz on the AMA Manual of Style online.—Laura King, MA, ELS

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