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,Punctuation, and Sentence
tructurear anne a a,
Mana er and Senior Medical Writer
Scientific Publications
Texas Heart Institute at
.Houston, Texas
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Writing good paragraphs
Word choice
Punctuation
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This is a very well written BRP proposal to develop anovel cardiac replacement device (from the Overall
"The manuscript effectively conveys the authors' data andconclusions. I have no changes to recommend and
(Reviewer, J Thorac Cardiovas Surg, on "A SingleNucleotide Polymorphism )
The manuscript is well written. . . . I have no concernsw any aspec o s manuscr p . ev ewer, oracCardiovasc Surg, on Transcutaneous Near-InfraredSpectroscopy Detects Preliminary ExperimentalResults
Dr. J Michael Duncan and his associate have presented awell written case report of a patient with thrombus (Reviewer,Ann Thorac Surg)
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SENTENCE
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SENTENCE STRUCTURE
Place the message in the powerful
places: subject, verb, and completer
Topic = the subject (noun)
Action = the verb
Object = the completer (noun)
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u v w u
-tion, -ment, -ence, -al
Measurement
Assessment
Occurrence
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SENTENCE STRUCTURE Place the message in the subject, verb,
Of the religious groups, their animal fat
Americans.
RevisionSeventh-Day Adventists consume less animal
fat than other Americans.
The patient showed no change in symptoms.
Revision
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The patients symptoms did not change.
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immediately by the verb
therapy in patients undergoing coronary
thrombolysis was emphasized by theresults of the ISIS-2 trial.
Revision
The ISIS-2 trial showed the importance of
concomitant antiplatelet therapy
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SENTENCE STRUCTURE
OLD TO NEW
Remember the 2 most important positions:
beginning and end
ace o , prev ous y s a e n orma on
that links backward in the topic position
.
Place new information that you want to
em hasize in the com leter ie the stress
position (end of clauses and sentences)
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SENTENCE STRUCTURE
OLD TO NEW
The hypothesis that the extent of myocardialinjury reflects the degree of imbalance
e ween myocar a oxygen supp y an
oxygen requirements from Braunwald,
, .
in the 1970s as a result of observations in
ex erimental animals and atients.
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Revision
As a result of their observations, Braunwald andassociates hypothesized that the extent of myocardial
degree of imbalance between myocardial oxygen
supply and oxygen requirements. This hypothesisgained widespread acceptance in the 1970s.
The hypothesis that the extent of myocardial injury reflects the degree of imbalance
,
Maroko, et al. gained widespread acceptance in the 1970s as a result of
observations.
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ACTIVE VS. PASSIVE VOICE
Which is better?
We found that
It was found that
Active voice: sub ect erforms the action
Passive voice: subject is acted upon
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ACTIVE VOICE
More vigorous than passive voice Ex resses confidence in our research
Trend in scientific writing toward active voice
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WHEN DO YOU USE PASSIVEVOICE?
When the recipient of the action is moreimportant:
The patient was injected with the test drug.
When it does not matter who erformedthe action or when who performed the
action is not important:
The patient was transported to the hospital by
ambulance.
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The subject and verb must agree in number
Singular subject (no s)/singular verb (s) Plural subject (s)/plural verb (no s)
Ignore intervening phrases
The factor that affected study results was Treat collective nouns as singular, unless the
individual members are emphasized
The team responds to emergency calls.
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- Compound subjects (joined by and) require plural
verbs:
The patient with the Jarvik 2000 and the patient with theHeartMate II run 2 miles per day.
ompoun su ec s o ne y or or nor can e
singular or plural, depending upon the nearest element:
Neither the hos ital nor the h sicians were res onsible.Neither the physicians nor the hospital was responsible.
Indefinite pronouns (some, any, none, all, and most) can
,
Some of the values are correct.
Most of the manuscript was written by 1 author.
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To study the mechanisms involved in the
ene c a e ec s o y ra az ne on
ventricular function in patients who have,
assessment of ventricular function was
insufficiency, functional class I or II, at rest
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REVISED SENTENCE:
IDEAS SEPARATED
We assessed the mechanisms involved in the beneficial
effects of hydralazine on ventricular function in patients
.
assessment, we performed radionuclide studies of
ventricular function in 15 atients at rest and durintreadmill exercise. All patients had pure aortic
insufficiency and were in functional class I or II.
To study the mechanisms involved in the beneficial effects of hydralazine on ventricularfunction in patients who have chronic aortic insufficiency, a radionuclide assessment of
ventricular function was performed in 15 patients with pure aortic insufficiency, functional
class I or II, at rest and during simple treadmill exercise.
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There had been ma or chan es in our resentation
related to the data accumulated as a consequence ofexhaustive study of the results of treatment in cancers of
, , .
Revision
, ,
to, by, at, through, from, with, away, etc.)
We changed our presentation after exhaustively studying
the results of treated cancers of the head and neck,breast, and gynecological tract.
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Her ob was to teach the basic
fundamentals of pharmacology. The cells were red in color.
The beakers were filled to capacity.
,combine together, completely empty, eliminatealtogether, fellow colleagues, fewer in number,
, , ,shape, very unique, younger than 50 years ofage, prior history
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needless to say
it may be said that
it was demonstrated
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due to the fact that (because)
an increased number of (more)
the majority of (most)
as e resu o ecause
at this point in time (now)
in regard to (about)
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,
was demonstrated that the echocardiogramcorrectly predicted a large vegetation (15 mm)
attached to the right coronary cusp but failed to
detect three 4- to 5-mm lesions found during theme a surgery was e ng per orme on e
remaining two cusps, whereas in another patient,
on all 3 cusps, and herein we will describe these
three cases.
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HOW WOULD YOU REVISE
THE EXAMPLE
Long, wordy sentences are difficult to
rea un ess ey are very we wr en
Aim for 25-30 words per sentence, orless
Include onl 1 idea er sentence
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In one atient who had numerous ve etations the
echocardiogram correctly detected a large vegetation (15mm) attached to the right coronary cusp but failed to detect
- -
2 cusps. However, in another patient, the echocardiogram
correctly detected lesions on all 3 cusps. This reportdescribes these cases.In one patient who had numerous vegetations, it was demonstrated that the
echocardiogram correctly predicted a large vegetation (15 mm) attached to the
r g coronary cusp u a e o e ec ree - o -mm es ons oun ur ng
the time that surgery was being performed on the remaining two cusps,
whereas in another patient, the echocardiogram correctly predicted lesions on
all 3 cus s, and herein we will describe these three cases.
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WHAT CHANGED?
Three sentences instead of one
Periods broke up ideas
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ACTION INAPPROPRIATELY IN
SUBJECT n ncrease n ear ra e occurre .
Revision Heart rate increased.
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PLACED IN SUBJECT
Measurements of blood pH were made .
Revision Blood pH was measured with a
radiometer capillary electrode.
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PLACED IN OBJECT
X drug caused a decrease in heart rate.
Revision
en pa en s were g ven rug, e r
heart rate decreased.
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INDICATE RELATIONSHIPS
Transitions are im ortant for lo ical flow of
sentences and paragraphs
Use transitions to indicate how sentencesand paragraphs are related
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the sentence
sentence that connects it to the previous
Transitional sentences: sentences used
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EXTERNAL TRANSITIONS
For conclusions: therefore, thus
In a sequence: first, second, then
To contrast: however, in contrast
Others: for exam le in addition
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INTERNAL TRANSITIONS
Individual residues in the repeated-sequenceblocks had diver ed. Althou h the individual
residues diverged, the patterns of amino
acids were identical.
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EXTERNAL AND INTERNAL
TRANSITIONS
B widenin our focus to the entire trachea we
were able to see that most ganglion cell bodies(72%) were located in the neural plexuses, and
along the longitudinal nerve trunks.
Furthermore, we were able to see that most ofthe ganglia contained only 1-4 ganglion cellbodies. Thus, ganglia along the longitudinal
-bodies, as previously reported, are not typicalof most tracheal ganglia.
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TRANSITIONAL SENTENCES
(With an External and Internal
End of a paragraph:
evidence to support Duncan and Levys
.
In contrast, we reviewed several studies that
su orted the alternate h othesis ro osed b
Bjornson et al . . .
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WRITING A GOOD
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GOOD PARAGRAPHS
Tell a story
With organized ideas
ideas
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GOOD PARAGRAPHS
Include
A to ic sentence
Supporting sentences with transitions
A concluding sentence with transition
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Gives an overview of all the other
States either the general topic or the
Is placed first
(or summary) sentence at the end
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A paragraph should have supportingsentences that
Say something specific about the topic
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EXAMPLE: PARAGRAPH STRUCTURE
There are 3 different theories regarding the slow relaxation ofcatch muscles of molluscs. (topic sentence) One theory holdsthat catch is due to some unusual property of myosin in these
muscles that produces a slow rate of detachment.12 (states firsttheory) In this theory, paramyosin would have no special roleeyon a o prov ng e sca o ng on w c e myos n s
positioned. (detail for previous sentence) The second theory
holds that the tension is developed by actin-myosin interaction. s a es secontheory) Because the thick filaments are of limited length,interaction would have to occur through fusion of thick
14. ,which I subscribe, pictures a structural change in theparamyosin core affecting the rate of breaking of myosin-catch
15
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CONTINUITY IN PARAGRAPHS
ont nu ty: t e smoot ow o eas rom
sentence to sentence (and from paragraph to
What is the point of each sentence?
What does each sentence contribute to the
story?
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Keep a consistent order
Put parallel ideas in parallel form
Signal the subtopics of a paragraph,
ie, first, second, finally
Use transitions to indicate relationshipsbetween ideas
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Key terms: words or phrases that name importantideas dealt with in a manuscript
Repeating key terms exactly from sentence to
providing continuity (ie, if you start with a term
like restenosis, use restenosis throughout) Use category terms plus this or these toavoid too much repetition
details from a previous sentence, ie,quantitative cell-based bioassay becomes
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Di italis increases the contractilit of the
mammalian heart. This change in inotropicstate is a result of changes in calcium fluxroug e musc e ce mem rane.
Revision
mammalian heart. This increasedcontractilit results from chan es in
calcium flux through the muscle cellmembrane.
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sentence, explain them in supportingsentences in the same order
Supporting sentences should include all
sentence and not add anything not
mentioned in the to ic sentence
Avoid interrupting the sequence ofex lanations with other information
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. , ,
shape of ganglion cell bodies in the trachealneural plexus, we examined individual cell
bodies in their entirety at 100-400x with a
compound light microscope. B. For the
assessmen o s r u on, rs eac gang on
cell body was classified C. For the
ganglion cell body, the major and minor axes ofthe cell bod were measured
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POINT OF VIEW
Sentences with the same topics should have
the same subject
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CONSISTENT?
A. Propranolol had variable effects on the-
flow. B. In the cerebrum, the increase in blood
flow caused by hypoxemia was not significantlyaltered by propranolol. C. However, in other
organs, such as the gut and the kidneys, and in
e per p era c rcu a on, proprano o cause a
more severe decrease in blood flow than did
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KEEP A CONSISTENT
POINT OF VIEW
Revision
Propranolol had variable effects on the
ypoxem a- n uce c anges n reg ona oo
flow. In the cerebrum, propranolol did not
caused by hypoxemia. However, in other
organs, such as the gut and the kidneys, and in
the peripheral circulation, propranolol caused amore severe decrease in blood flow than did
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P T PARALLEL IDEA INPARALLEL FORM
Parallel sentences have the sameatterns. Parallel form is effective forpresenting similar or contrasting
informationWe were able to see that most ganglion cellbodies (72%) are located ... and only a small
longitudinal nerve trunks. Furthermore, wewere able to see ...
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PUT PARALLEL IDEAS IN PARALLEL FORM
But, do not use parallel form for nonparallel ideas
To determine whether cholinergic or adrenergic nerves
mediate secretion of fluids from tracheal submucosal
glands, we did experiments on glands excised fromferrets. To induce secretion, we stimulated the tissue both
electrically and pharmacologically. To inhibit secretion, we
added X to the bathing solution.
Revision To determine whether cholinergic or adrenergic nerves
mediate secretion of fluids from tracheal submucosal
lands we did ex eriments on lands excised from
ferrets. We induced secretion by stimulating the tissueboth electrically and pharmacologically. We inhibited
secretion b addin X to the bathin solution.
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MISTAKES IN WRITING
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Com arative terms hi her reater lower less
increase, or decrease) use than, not compared to
Ex erimental rabbits had a 28% reater
decrease in alveolar phospholipid as compared
to control rabbits during normal ventilation.
Revision
Alveolar phospholipid decreased 28% more in
rabbits.
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UNLIKE THINGS
These results are similar to previouss u es.
Revision These results are similar to the results
.
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, Compare 1 thing or person with another to
examine similarities or differences in detail
(usually in science, with is correct)
treated with X drug with those in patientstreated with Y drug.
Compare 1 thing or person to another onlywhen describing a single striking similarity ordissimilarit
We compared heart transplant patients tocoronary bypass patients in terms of rates of
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MISPLACED AND DANGLING
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MISPLACED AND DANGLING
MODIFIERS
Dangling modifier: a word or phrase that is not attached to any word in the sentence or is
attached to the wrong word
, .
Revision
The surgical team decided to bypass the artery because it was totally occluded.
Blood flow was allowed to return to baseline before roceedin with the next occlusion.
Revision
Blood flow was allowed to return to baseline before the next occlusion was begun.
,
directions.Revision
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,
noticeably in all directions.
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IN TITLES
Isolation of Antigens From MonkeysUsin Com lement-fixation Techni ues
Revision
Isolation of Antigens From Monkeys by
Using Complement-fixation Techniques
Use of Complement-fixation Techniques
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KEEP PRONOUN
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KEEP PRONOUN
ANTECEDENTS CLEAR
n an ece en s e wor a pronoun re ers o.
If the antecedent is unclear, the reader may notbe able to understand the sentence
Tyson et al. abruptly occluded the venae
cavae before anal zin the heart beats. As aresult of this, the volume of the right heartrapidly decreased.
Clarify the antecedent with a category termAs a result of this rocedure or occlusion
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CASE OF PERSONAL PRONOUNS
ronouns rep ace nouns
Subject case: I, he, she, we, who, whoever, they
them
Give the award to whomever you prefer.
(Objective case: the object of you prefer)
Give the award to whoever will benefit most.
Whom did you consult?
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CASE OF PERSONAL PRONOUNS
When using personal pronouns in
questions, you can choose the correct
pronoun by answering the question
Who would be the best reviewer for this
paper
She would be the best reviewer. (Not her)
To whom should I give the award?I should give it to him. (Not he)
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PARALLEL STRUCTURE
Parallel ideas are ideas that are equal in logicand importance. Parallel ideas should be written
in parallel form, either as a pair or in series
and to improve survival.
than renal blood flow.
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E. coli than the group with Pseudomonas.
Cardiac output was less in the group
.Pseudomonas.
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NONPARALLEL ELEMENTS
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NONPARALLEL ELEMENTS
IN A SERIES .
cysteine HCL, 50 mg of methionine, andhas a final volume of 115 mL.
Revision
e mo ca on con a ns . mg o
cysteine HCL and 50 of methionine; its
.
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WORD CHOICE
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LABORATORY VALUES
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LABORATORY VALUES
Be Precise
Hemoglobin level
Prothrombin time
Pulse rate
Total serum cholesterol value Creatinine level or clearance
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USE PRECISE WORDS
The bilirubin has been elevated for severalhours.
Revision
e ru n eve as een e eva e or
hours.
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, ,
serotonin was associated with an increase
in microvascular pressure.
Revision
er sero on n n us on, m crovascu ar
pressure increased 10% in isolated,
.
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,
females (except when male and femaleare used as adjectives, e.g., male donor,male children; when children and adultsare mixed, females, aged 12 to 25)
se e , no exp re
Use humanely euthanized (AMA style:
studies, not sacrificed
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or unusual use- -
questionnaires specifically designed for
we utilized one designed for patients
with con estive heart failure.
For any other purpose, use is best
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DATA, CRITERIA, MEDIA
Data is the plural of datum
Media is the plural of medium
Data, criteria, and media all take PLURAL
. .
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,
Prior to vs before ,
read everything I could find on the topic.
Following vs after
w u y,
Phineas Gages behavior changed
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All heat-stable materials utilized in the
isolation and assay of solutions weres er ze pr or o use.
Revision
All heat-stable materials used in the
isolation and assa of solutions were
sterilized before use.
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v
equalna
unanimous
unique
original
expert
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,
was placed on a Harvard ventilator.
The trachea was intubated, and the lamb
was ven a e w connec e o a arvarventilator.
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ABBREVIATIONS
Avoid nonstandard abbreviations; they make
, n v ro ce - ase oassays
PK, pharmacokinetic
TK, toxicokinetic
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MAKE SENSE TOGETHER
The appearance of nondialyzable35
S in.
Revision
The appearance of nondialyzable 35S in
the luminal bath was noted. OR, the
amoun was measure .
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incubated.
The tissue was minced, and the samples
were ncu a e .
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WORDS CARELESSLY
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,se or symp oms, con ons, seases
(they refer to duration, not severity), but not, ,
Long-term treatment
ong- erm mar uana users
Acute renal failure
Acute studies
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, Affect, verbto act on
How smoking affects health is still a matter of
concern to physicians. ,
We studied the effect of epinephrine on glucosekinetics in dogs.
Effect, verbto bring about, to cause
He hoped to effect a change in the system. (Used
Affect, nounemotional state or expressionThe schizophrenic patient had blunted affect.
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, , Can: abilit to do somethin
Homogeneous cell lines of short duration
can be achieved with cloning techniques.
May: possibility or permission
This mechanism ma also be the cause ofthe ozone effect.
Might: smaller possibility
Our findings might one day lead to a bettertreatment.
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,
Com rise: to be com osed of or sim l
include: e u e e eve
highly toxic ingredients.
The quack medication is composed of
several highly toxic ingredients.
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Dose: uantit to be administered at onetime, or the total quantity administered
Dosage: a regimen; the regulatedadministration of individual doses, usually
The atient received an initial dose of 50 m
and, thereafter, a dosage of 25 mg 3 times aday for 6 days.
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substitute caused by
loss of funding.
a loss of funding.
orrec : e a se resu was ue o an
error in the statistical analyses.
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,
separate or related, of a condition or a disease
unknowns.
The cause of his heart failure was acute
m ocardial infarction.
Other abused -ology words: pathology,morphology, histology, symptomatology
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EXAMINE EVALUATE
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EXAMINE, EVALUATE
Patients are examined
Conditions or diseases are evaluated
Not: We evaluated the patient for signs of
heart disease.
But: We examined the patient for signs ofheart disease.
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, , Show: indicate somethin b evidence
The data show that clotting times vary widely.
Reveal: make known something previouslyun nown
Differential staining revealed 3 types of cells.
experiments
By dropping objects from the Leaning Tower of
Pisa, Galileo demonstrated that bodies of
different masses fall with equal velocities and
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LEARN A FEWPUNCTUATION RULES
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-
abbreviations or numerals
IQs
During the 1970s
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H henate 2 words that come before a nounand work together to modify that noun. Do not
hyphenate 2-word modifiers that come after the
Risk-reward ratio (BUT: ratio of risk to reward)
- .The study was double blind.)
Each 96-well micro late assa consisted 8
or 9 samples.
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Hyphenate compound numbers from 21 to99 and fractions used as adjectives, but not
fractions used as nouns Thirty-six patients were examined.
A two-thirds majority was needed.
Three fourths of the questionnaires were
returned.
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joined by hyphens:, , , , , , , ,
infra, inter, intra, micro, mid, non, over, pre,
, , , , , , , ,trans, tri, ultra, un, under
- -
Check journal style
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When two or more hyphenated compoundshave a common base, omit the base in all
but the last compound. In unhyphenated ,
base
Preoperative and postoperative treatment
-
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as units:
open heart surgery
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even when used in a compound modifier
The electrically actuated pump
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are not important to sentence meaning
Do not set off restrictive clauses; restrictive
c auses eg n w t t at
The numbness, which had been apparent for days,.
The numbness that caused the patients death wasattributed to drug therapy.
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, , ,
equivalents: namely, that is, and for
The use of standardized scores, eg, Z
,comparisons.
AMA Style: no periods
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coordinating conjunctions (and, but, for,
or nor et so . This sentence construction
is called a compound sentence
No sub rou of res onders could beidentified, and differences between centers
were so great that no real comparison was
possible.
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Placed around interru tin words and hrases that are
not important to meaning (nonrestrictive)
-
has been developed and validated
At 16 and 32 ng/mL, however, 4 of the 5 curves had
at least 1 predicted concentration that deviated
Sams sister Sarah had 12 children. Johns twin
s s er, ue, a c ren.
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Edwards rhinoplasty was scheduled forAugust 19, 1985, at the Mayo linic.
Exce tion: month and ear without the date.
December 1941 was a time to fear.
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citation of references and footnote symbols
(American style)
Ill lend you my stethoscope, she replied.
., .,reported the studies simultaneously.
. ,
MD,1
Mike Wilson, MD,2
and Denton A.Coole , MD3
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After introductor clauses or hrases
If the infection recurs, another course of
zithromycin should be given. er ems n a ser es
The doctor, the nurse, and the therapist saw
. Between a series of modifiers
The randomized, double-blind, placebo-controlled trial
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SEMICOLONS
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SEMICOLONS
Separate independent clauses The conditions of 52% of the patients
improved greatly; 4% of the patients
were os o o ow-up.
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conjunctive adverb (eg, furthermore, then,
however, thus, hence, indeed, yet) or acoordinating conjunction if one of the clauses
has internal punctuation. Use a comma after
e con unc ve a ver The patients fever had subsided; however,
.
This consideration is important in any
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, , .
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Sometimes used to se arate list itemswhen one or more of the items has
internal punctuation The study had three goals: first, to
examine medication compliance in our
pa en s; secon , o e erm ne e re a veinfluence of clinical effectiveness and
and third, to test a psychosocialintervention desi ned to im rove
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medication compliance.
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Punctuate material inside ( ) appropriately
hours (much longer than I would have liked)
and did not resolve the question.
After what seemed an eternity (It took 2
hours!), the discussion on parentheses
ended.
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SCIENTIFIC or REGULATORY
WRITING
Use only one graphic element at a time
MAKES THE BRAIN WORK HARDER
HAS RECEIVED
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Place outside commas and eriods inside
colons and semicolons
Place other punctuation inside quotationmarks only when part of quoted material
Why bother to do autopsies at all if the result is
Do not do the autopsy if the result is invariably
edema and congestion of the viscera.
If the result is edema and congestion of the
viscera, do not do the autopsy.
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Pl d i d d l d
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Place around coined words, slan , andwords or phrases used ironically or
facetiously Avoid overuse: We have found that the
majority of children with chronic SVT
eve op car omyopat y.
With quotation marks, the sentence implies
t at t e c ren not ave c ron c
or cardiomyopathy
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hyphenated compound when both parts
together constitute a single word, even in atitle
Long-term goals
Follow-up studies
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CAPITALIZATION
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Do not capitalize words from which
ELISA, enzyme-linked immunosorbent
LOQ, limit of quantitation
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This is a very well written BRP proposal to develop anovel cardiac replacement device (from the Overall
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novel cardiac replacement device (from the Overall
"The manuscript effectively conveys the authors' data and
conclusions. I have no changes to recommend and(Reviewer, J Thorac Cardiovas Surg, on "A SingleNucleotide Polymorphism )
The manuscript is well written. . . . I have no concerns
w any aspec o s manuscr p . ev ewer, oracCardiovasc Surg, on Transcutaneous Near-InfraredSpectroscopy Detects Preliminary ExperimentalResults
Dr. J Michael Duncan and his associate have presented a
well written case report of a patient with thrombus (Reviewer,Ann Thorac Surg)
2009
Thank You!
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Thank You!Marianne Mall ia, ELS
832.355.6776
mmallia heart.thi.tmc.edu
2009