Writing the Biomedical Writing the Biomedical

Manuscript:Manuscript:

Essentials of Good WritingEssentials of Good Writing

Christopher DantChristopher Dant

A Recognized ProblemA Recognized Problem

““There is no form of prose There is no form of prose

more difficult to more difficult to

understand and more understand and more

tedious to read than tedious to read than

the average scientific the average scientific

paper!”paper!”-Dr. Francis Crick,

1994The Astonishing Hypothesis

An Editor’s WarningAn Editor’s Warning

““Poor writing is likely to Poor writing is likely to annoyannoy reviewers and decrease the reviewers and decrease the author’s chance of author’s chance of publication recommendation”publication recommendation”

Bordage, G: Peer Reviewer, University of Illinois at Chicago: Bordage, G: Peer Reviewer, University of Illinois at Chicago: Academic Med 76(9), 2001Academic Med 76(9), 2001

An Author’s WarningAn Author’s Warning

““Some authors believe that they must impress Some authors believe that they must impress the reader (and the editor) with mastery and the reader (and the editor) with mastery and erudation of multisyllabic words in order for erudation of multisyllabic words in order for their work to be given attention.”their work to be given attention.”

““Say what you mean, mean what you say, and Say what you mean, mean what you say, and don’t use big words”don’t use big words”

David Pierson, MD. Repiratory Care 49(10): 2004.David Pierson, MD. Repiratory Care 49(10): 2004.

Methods are Critical: Methods are Critical: Editors’ ResponsesEditors’ Responses

How frequently do Editors encounter manuscript problems?

Seldom Occasionally Frequently

Poorly written, excessive jargon

Inadequate/inappropriate presentation

Poor description of design

Excessive zeal and self promotion

Rationale confused, contradictory

Essential data omitted, ignored

Boring

Important work of others ignored

Byrne DW, Publishing Medical Research Papers, Williams and Wilkins, 1998Byrne DW, Publishing Medical Research Papers, Williams and Wilkins, 1998

In 1953, Crick Writes:In 1953, Crick Writes: We wish to suggest a structure for the salt of deoxyribose We wish to suggest a structure for the salt of deoxyribose

nucleic acid (DNA). This structure has novel features, nucleic acid (DNA). This structure has novel features, which are of considerable biological interest.which are of considerable biological interest.

A structure for nucleic acid has already been proposed by A structure for nucleic acid has already been proposed by Pauling and CoreyPauling and Corey11. The model consists of three . The model consists of three intertwined chains, with the phosphates near the fibre intertwined chains, with the phosphates near the fibre axis, and the bases on the outside. In our opinion, this axis, and the bases on the outside. In our opinion, this structure is unsatisfactory for two reasons: structure is unsatisfactory for two reasons:

(1) We believe that the material which gives the x-ray (1) We believe that the material which gives the x-ray diagrams is the salt, not the free acid. Without the acidic diagrams is the salt, not the free acid. Without the acidic hydrogen atoms, it is not clear what forces would hold the hydrogen atoms, it is not clear what forces would hold the structure together, especially as the negatively charged structure together, especially as the negatively charged phosphates near the axis will repel each other.phosphates near the axis will repel each other.

(2) Some of the van der Waals distances appear to be too (2) Some of the van der Waals distances appear to be too small.small.

In 2005, an Author In 2005, an Author Writes:Writes:

In order to determine if the expertise in the In order to determine if the expertise in the attribution of emotion from basic facial attribution of emotion from basic facial expressions in high functioning individuals with expressions in high functioning individuals with autism spectrum disorder (ASD) is supported by autism spectrum disorder (ASD) is supported by the same reported brain regions of interest (ROI) the same reported brain regions of interest (ROI) as the regions supported by typically developing as the regions supported by typically developing individuals, the present study employed individuals, the present study employed functional MRI scanning technology acquired from functional MRI scanning technology acquired from 14 males and 32 females with the specified 14 males and 32 females with the specified disorder while performing emotion-matched and disorder while performing emotion-matched and emotional label linguistic and also control tasks. emotional label linguistic and also control tasks. The accuracy, response time, and average The accuracy, response time, and average activation was acquired and measured in the activation was acquired and measured in the amygdala and other important ROIs. amygdala and other important ROIs.

In 2005, an Editor In 2005, an Editor Rewrites:Rewrites:

In this study, our goal was to determine which brain In this study, our goal was to determine which brain regions were active during emotion-based tasks in regions were active during emotion-based tasks in children with autism spectrum disorder (ASD) children with autism spectrum disorder (ASD) compared with typically developing children. compared with typically developing children. Specifically, we used functional MRI in 14 boys and Specifically, we used functional MRI in 14 boys and 32 girls with ASD aged 6 to 11, and compared them 32 girls with ASD aged 6 to 11, and compared them with a cohort of typically developing boys and girls with a cohort of typically developing boys and girls while they reacted to basic facial expressions in the while they reacted to basic facial expressions in the MRI. The children performed a set of standardized MRI. The children performed a set of standardized emotion-matched and emotional-label linguistic and emotion-matched and emotional-label linguistic and control tasks. Their accuracy, response time, and control tasks. Their accuracy, response time, and average brain activation was acquired in the average brain activation was acquired in the amygdala and other important brain regions of amygdala and other important brain regions of interest (ROIs). Specifically, we found that…interest (ROIs). Specifically, we found that…

Why Does Grammar Why Does Grammar Matter?Matter?

Your paper must convey Your paper must convey clearly and accuratelyclearly and accurately your purpose, method, result, and conclusionyour purpose, method, result, and conclusion

Free of Free of ambiguity and misinterpretationambiguity and misinterpretation The scientific community is The scientific community is world-wideworld-wide If English is sloppy, ungrammatical, ambiguous in If English is sloppy, ungrammatical, ambiguous in

meaning, your meaning, your meaning is obscuredmeaning is obscured Peer reviewers and editors will Peer reviewers and editors will translate this to translate this to

your researchyour research Delayed or rejected publicationDelayed or rejected publication

Writing DeficienciesWriting Deficiencies

Wordiness and Wordiness and

redundanciesredundancies

Poor flow of ideasPoor flow of ideas

Poor syntax and grammarPoor syntax and grammar

Excessive abstractionExcessive abstraction

Unnecessary complexityUnnecessary complexity

Excessive compressionExcessive compression

Unnecessary qualificationUnnecessary qualification

Cut, condense, combineCut, condense, combine

Outline to catch logic Outline to catch logic

problemsproblems

Consult an editorConsult an editor

Be specific and descriptiveBe specific and descriptive

Keep it simple and directKeep it simple and direct

Do not overly compress Do not overly compress

writingwriting

Qualify statements as Qualify statements as

necessarynecessary

Most commonly cited by journal editorsMost commonly cited by journal editors

Writing Clarifies ThoughtWriting Clarifies Thought

Unclear writing means unclear Unclear writing means unclear thinking thinking

Simply writing ideas down for critical Simply writing ideas down for critical appraisal helps clarify the thoughtappraisal helps clarify the thought

Clear writing, then, will clarify: Clear writing, then, will clarify: the purposethe purpose the conclusionsthe conclusions the significancethe significance

Speaking it aloud clarifies the thoughtSpeaking it aloud clarifies the thought

Write Like We Talk?Write Like We Talk? In the elevator, Jane asks William about his recent study on In the elevator, Jane asks William about his recent study on

medical curriculum. ”What did you find in your study?”medical curriculum. ”What did you find in your study?”

““Basically, we found that medical teachers of undergraduates Basically, we found that medical teachers of undergraduates tend not to let students look after the difficult patients.”tend not to let students look after the difficult patients.”

Later that evening, William sits down at his computer and Later that evening, William sits down at his computer and writes:writes:

““The study confirmed the hypothesis that clinical instructors The study confirmed the hypothesis that clinical instructors of undergraduate medical students would choose of undergraduate medical students would choose instructional techniques limiting active student instructional techniques limiting active student involvement in patient care activities when faced with involvement in patient care activities when faced with problematical situations.”problematical situations.”

Clear Writing EssentialsClear Writing Essentials

PRECISION

LOGIC

DIRECTNESS

BREVITY

CLEAR WRITINGCLEAR WRITING

Poor Medical WritingPoor Medical Writing Poor Poor

Grammar/PunctuatioGrammar/Punctuationn

Superfluous words, Superfluous words, phrases phrases

Misused words, Misused words, phrasesphrases

RepetitionRepetition

Unnecessary Complexity

Overuse of passive voice

Unnecessary Qualification

Poor flow of ideas

Omit Needless Words, Omit Needless Words, PhrasesPhrases

Vigorous writing is concise. Vigorous writing is concise.

A sentence should contain no unnecessary A sentence should contain no unnecessary words, a paragraph no unnecessary words, a paragraph no unnecessary sentences for the same reason that a sentences for the same reason that a drawing should have no unnecessary lines drawing should have no unnecessary lines and a machine no unnecessary parts.and a machine no unnecessary parts.

This requires not that the writer make all This requires not that the writer make all his sentences short or that he avoid all his sentences short or that he avoid all detail and treat his subjects only in detail and treat his subjects only in outline, but that every word tell.outline, but that every word tell.

Needless ModifiersNeedless Modifiers

Audible Audible to the earto the ear Tetrahedral Tetrahedral in shapein shape Small Small in sizein size Red Red in colorin color In In closeclose proximity proximity FinalFinal outcome outcome Important Important essentialsessentials Adequate Adequate enoughenough AdvanceAdvance planning planning Fewer Fewer in numberin number Add Add togethertogether EquallyEqually as well as as well as

Starts Starts outout Cools Cools offoff Surrounded Surrounded on all sizeson all sizes Consensus Consensus of opinion of opinion Entirely Entirely completecomplete Add Add togethertogether Absolutely Absolutely essentialessential SkinSkin rash rash Soft Soft in consistencyin consistency StillStill continues continues Estimated Estimated at aboutat about

Superfluous PhrasesSuperfluous Phrases

It is clear that…It is clear that… clearlyclearly

In the event that...In the event that... IfIf

At the present timeAt the present time now, currentlynow, currently

Due to the fact thatDue to the fact that sincesince

Subsequent [prior] toSubsequent [prior] to After (before)After (before)

Due to circumstances thatDue to circumstances that because or sincebecause or since

In a careful mannerIn a careful manner CarefullyCarefully

Have an effect (impact) onHave an effect (impact) on Affect (Affect (not not impact)impact)

Needless PhrasesNeedless Phrases It is interesting to It is interesting to

note… note…

It should be pointed It should be pointed out…out…

It is obvious that…It is obvious that…

Of course… Of course… oror It is clear It is clear that...that...

Needless to say…Needless to say…

Call your attention to Call your attention to the fact…the fact…

This is a subject that…This is a subject that…

In the event thatIn the event that

In the nature ofIn the nature of

The point I am trying to The point I am trying to make..make..

It may be argued It may be argued that…that…

In a very real senseIn a very real sense

For the most partFor the most part

In the case ofIn the case of

In regards to…In regards to…

Needless PhrasesNeedless Phrases In the event thatIn the event that

In the nature ofIn the nature of

The point I am trying to The point I am trying to make..make..

It may be argued It may be argued that…that…

In a very real senseIn a very real sense

For the most partFor the most part

In the case ofIn the case of

In regards to…In regards to…

O M I T

It is interesting to It is interesting to note… note…

It should be pointed It should be pointed out…out…

It is obvious that…It is obvious that…

Of course… Of course… oror It is clear It is clear that...that...

Needless to say…Needless to say…

Call your attention to Call your attention to the fact…the fact…

This is a subject that…This is a subject that…

Wordy PhrasesWordy Phrases in view of the foregoing circumstancesin view of the foregoing circumstances thereforetherefore are found to be in agreementare found to be in agreement agreeagree has the ability tohas the ability to cancan has the capability ofhas the capability of cancan (with) the passage of time(with) the passage of time (with) (with)

timetime at this point in timeat this point in time nownow due to the fact thatdue to the fact that becausebecause examined in comparison toexamined in comparison to compared tocompared to for the purpose offor the purpose of forfor by means ofby means of byby a small number ofa small number of fewfew a large number ofa large number of manymany

Word UsageWord Usage

Word Usage Word Usage

Fewer vs lessFewer vs less

FewerFewer used for number: used for number: FewerFewer interventions may mean less care… interventions may mean less care…

We evaluated We evaluated fewerfewer than 100 studies… than 100 studies…

LessLess used for mass or volume indicating used for mass or volume indicating degree or valuedegree or value

Less thanLess than 50 mg of drug was used… 50 mg of drug was used…

Word UsageWord Usage Case/patient/subject/control (subject)Case/patient/subject/control (subject) In research, In research, casecase is a particular instance of a disease, is a particular instance of a disease,

patientpatient is a person under medical care, is a person under medical care, subjectsubject is a person is a person with a characteristic or disorder under study (but not with a characteristic or disorder under study (but not treated), treated), control subjectcontrol subject is a person not sharing the same is a person not sharing the same characteristics as subjects under study.characteristics as subjects under study.

A A casecase of diabetes… of diabetes…

We report 14 cases of diabetes in patients..We report 14 cases of diabetes in patients.. In this study, we report on 14 diabetic patientsIn this study, we report on 14 diabetic patientsSubjects (Subjects (patientspatients)) were treated with… were treated with… But…But…It is too early to judge if this is the case or not…It is too early to judge if this is the case or not…It is too early to judge if this is so...It is too early to judge if this is so...

Misused Words, PhrasesMisused Words, Phrases Do not use Do not use impactimpact as a verb in place of as a verb in place of to affectto affect

The temperature The temperature impactsimpacts the growth rate of the bacterial the growth rate of the bacterial sample..sample..

The temperature The temperature affectsaffects the growth rate of the bacterial the growth rate of the bacterial samplesample

Do not use Do not use impactimpact as a noun in place of as a noun in place of effecteffect

The release of hydrocarbons has had a significant The release of hydrocarbons has had a significant impactimpact on the depth of the ozone layer...on the depth of the ozone layer...

The release of hydrocarbons has had a significant The release of hydrocarbons has had a significant effecteffect on on the depth of the ozone layer.the depth of the ozone layer.

Misused Words, PhrasesMisused Words, Phrases Because, sinceBecause, since Because preferred—since implies Because preferred—since implies

from the time of (since from the time of (since yesterday)yesterday)

AsAs Avoid because it means Avoid because it means whilewhile

ContinualContinual repeatedlyrepeatedly ContinuousContinuous without interruptionwithout interruption

For two weeks, the sperm whales For two weeks, the sperm whales continuallycontinually dived to dived to great depths in search of food.great depths in search of food.

The spectrum of refracted light is The spectrum of refracted light is continuouscontinuous..

Misused Words, PhrasesMisused Words, Phrases Abnormal/NormalAbnormal/Normal Not used for patients or tests per Not used for patients or tests per

sese Negative/PositiveNegative/Positive Apply to results, findingsApply to results, findings

The physical exam was normalThe physical exam was normalThe findings from the exam were normal (or positive, negative)The findings from the exam were normal (or positive, negative)

The throat culture was negativeThe throat culture was negativeThe throat culture was negative for beta-hemolytic streptococciThe throat culture was negative for beta-hemolytic streptococci

The electroencephalogram ( or any other test) was positiveThe electroencephalogram ( or any other test) was positiveThe electroencephalogram (test) showed abnormalities in… the The electroencephalogram (test) showed abnormalities in… the

temporal lobetemporal lobe

Misused Words, PhrasesMisused Words, Phrases Compare to vs. Compare withCompare to vs. Compare with

Compare toCompare to— to point out similarities between different — to point out similarities between different thingsthings

Compare withCompare with— (used more often in science)— to point out — (used more often in science)— to point out differences between similar thingsdifferences between similar things

Children with fragile X syndrome are often Children with fragile X syndrome are often compared tocompared to those those with autism because of similarities in behaviors…with autism because of similarities in behaviors…

Brain tumors are relatively rare Brain tumors are relatively rare compared withcompared with more common more common cancers, such as lung, breast, prostate, and colorectal.cancers, such as lung, breast, prostate, and colorectal.

Misused Words, PhrasesMisused Words, Phrases Prevalence vs. IncidencePrevalence vs. Incidence

IncidenceIncidence is a is a rate rate = number of NEW cases of a disease = number of NEW cases of a disease occurring in a population within a occurring in a population within a specified period of timespecified period of time, , normally 1 year.normally 1 year.

PrevalencePrevalence refers to the current number of people suffering refers to the current number of people suffering from an illness in a given year. This includes all those who may from an illness in a given year. This includes all those who may have been diagnosed in prior years, and newly diagnosed.have been diagnosed in prior years, and newly diagnosed.

The The incidenceincidence of a cancer is 20,000 per year with a of a cancer is 20,000 per year with a prevalenceprevalence of 80,000of 80,000 means means 20,000 new cases of cancer are diagnosed 20,000 new cases of cancer are diagnosed every year and there are 80,000 people with this illness, every year and there are 80,000 people with this illness, 60,000 of whom were diagnosed in previous years and are still 60,000 of whom were diagnosed in previous years and are still living with the disease.living with the disease.

Misused Words, PhrasesMisused Words, Phrases

RationalRational — adjective, meaning — adjective, meaning sane or sane or logicallogical

RationaleRationale — noun, meaning — noun, meaning justificationjustification

The patient appeared to be a The patient appeared to be a rationalrational human being.human being.

Their Their rationalerationale for the subject selection was for the subject selection was based on age of disease onset.based on age of disease onset.

Misused Words, PhrasesMisused Words, Phrases Parameter, VariableParameter, Variable

Parameter is a mathematical term meaning “measurable (numeric) Parameter is a mathematical term meaning “measurable (numeric) characteristic of a population”characteristic of a population”

The mean and the standard deviation were the The mean and the standard deviation were the parametersparameters of of the distribution…half-life of drug A is a pharmacokinetic parameter…the distribution…half-life of drug A is a pharmacokinetic parameter…

Parameter does not mean Parameter does not mean variable or measurementvariable or measurement —or limit, —or limit, boundary, or condition.boundary, or condition.Cigarette and alcohol use were the two Cigarette and alcohol use were the two parametersparameters measured ... measured ...

It is important that the patient be informed about the It is important that the patient be informed about the parametersparameters of of treatment...treatment...

……all are without meaning—use all are without meaning—use variable or measurevariable or measure or better, don’t or better, don’t label them.label them.

Misused Words, PhrasesMisused Words, Phrases Age, AgedAge, Aged

Aged Aged not not ageage designates a person’s age. Give precise age when designates a person’s age. Give precise age when possiblepossible

The patient, The patient, agedaged 70 years, had symptoms of dementia 70 years, had symptoms of dementia [The 70-year-old patient had…][The 70-year-old patient had…] Note compound adjectiveNote compound adjective

The program was designed for children The program was designed for children agedaged 5 through 8 years. 5 through 8 years.The The teenagedteenaged patients with tinnitus... (or better) The patients with patients with tinnitus... (or better) The patients with

tinnitus, aged 14, 16, and 17 years…tinnitus, aged 14, 16, and 17 years…

It is redundant to add It is redundant to add of ageof age after the years, since it is implied after the years, since it is implied in the adjectives in the adjectives younger younger and and olderolder

The patient group comprised women younger than 25 years The patient group comprised women younger than 25 years [of [of age].age].

Misused Words, PhrasesMisused Words, Phrases Assure, Ensure, InsureAssure, Ensure, Insure

AssureAssure means to provide positive information to a person means to provide positive information to a person and implies removal of doubt (British: insure)—set set the and implies removal of doubt (British: insure)—set set the mind at restmind at rest

The technician The technician assuredassured the subjects that their results would the subjects that their results would be confidentialbe confidential

EnsureEnsure means to make sure or certain means to make sure or certain The technician The technician ensuredensured that the patient’s test was positive that the patient’s test was positive

InsureInsure means making precautions beforehand; cover with means making precautions beforehand; cover with insurance; guarantee persons against riskinsurance; guarantee persons against risk

People should People should insureinsure their possessions... their possessions...

Misused Words, PhrasesMisused Words, Phrases Respectively and former/latterRespectively and former/latter

Both force the reader to stop and backtrackBoth force the reader to stop and backtrack ““The mean values for men and women were 50.9 and 48.4, The mean values for men and women were 50.9 and 48.4,

respectively”respectively” ““The mean value for men was 50.9 and for women was 48.4.”The mean value for men was 50.9 and for women was 48.4.” ““Men and women were given drug based on body weight; the Men and women were given drug based on body weight; the

former required adjustments based on age, and the latter …”former required adjustments based on age, and the latter …” ““Men and women were given drug based on body weight. Men Men and women were given drug based on body weight. Men

required adjustments based on their age, but women…”required adjustments based on their age, but women…”

And/orAnd/or AvoidAvoid Your meaning is usually conveyed by “or” alone. Your meaning is usually conveyed by “or” alone. If necessary add “or both” at the end of a phraseIf necessary add “or both” at the end of a phrase ““Subarachnoid hemorrhage can cause headaches or stiff back, or Subarachnoid hemorrhage can cause headaches or stiff back, or

both.”both.”

The SentenceThe Sentence

The SentenceThe Sentence

Subjects and Verbs

• Clarify subject

• Vigorous verbs

• Improve subject-verb relationship

Parallelism

Placement of Information in Sentence

Brevity and Conciseness

Write with Clear Write with Clear Subjects, Strong VerbsSubjects, Strong Verbs

The The physicianphysician noticednoticed the smell of acetonethe smell of acetone on his on his breath…breath…

SS VV OO

The smell of acetone on the patient’s breath was something the The smell of acetone on the patient’s breath was something the physician noticed… (Passive)physician noticed… (Passive)

Make the topic Make the topic your your subjectsubject and choose a strong and choose a strong actionaction verbverb::

ResearchersResearchers measuredmeasured the atomic mass of the element the atomic mass of the element ……

Patient heart ratesPatient heart rates increasedincreased during the procedure. during the procedure.

Subject-Verb Must AgreeSubject-Verb Must Agree

A A reviewreview of all patients with grade 3 of all patients with grade 3 tumors tumors waswas undertaken… undertaken…

The The patientpatient, together with her physician , together with her physician and family, and family, makesmakes the surgery decisions. the surgery decisions.

Subjects as Adjectives Subjects as Adjectives (Stacked Modifiers)(Stacked Modifiers)

A series of fixed duration sequential constant rate A series of fixed duration sequential constant rate infusions…infusions…(which adjective is qualifying which noun?)(which adjective is qualifying which noun?) -Fixed-duration sequential constant-rate infusions -Fixed-duration sequential constant-rate infusions -Sequential infusions of constant rate and fixed duration…-Sequential infusions of constant rate and fixed duration…

……mouse marrow-derived macrophage colony-stimulating mouse marrow-derived macrophage colony-stimulating factor (M-CSF) dependent monocytesfactor (M-CSF) dependent monocytes Monocytes, derived from mouse marrow, whose growth was Monocytes, derived from mouse marrow, whose growth was

dependent on macrophage-stimulating factor (M-CSF).dependent on macrophage-stimulating factor (M-CSF).

Another aspect of spinal fluid biochemical profile Another aspect of spinal fluid biochemical profile complexity.complexity. Another aspect of the biochemical complexity of spinal fluid.Another aspect of the biochemical complexity of spinal fluid.

Passive or Active?Passive or Active?

ActiveActive ““We studied the behavior of We studied the behavior of

children…”children…”

PassivePassive ““The behavior of children was The behavior of children was

studied…”studied…”

Passive Voice Breeds Passive Voice Breeds Weak ConstructionsWeak Constructions

In the present study, it was decided to..In the present study, it was decided to.. Measurements were taken… It was necessary to …Measurements were taken… It was necessary to … In this study, we decided … We measured … We had In this study, we decided … We measured … We had

to…to…

In the present study, In the present study, an increase in sugar consumption an increase in sugar consumption was observedwas observed both in female and male children 1-2 hours both in female and male children 1-2 hours after drug A after drug A was takenwas taken. However, there was no significant . However, there was no significant sugar consumption increasesugar consumption increase 3 hours after taking drug A. 3 hours after taking drug A. (39 words)(39 words)

[We observed that] girls and boys [We observed that] girls and boys ateate more sugar 1 to 2 more sugar 1 to 2 hours after hours after takingtaking drug A; within 3 hours, sugar intake drug A; within 3 hours, sugar intake decreaseddecreased (23 words) (23 words)

Passive VoicePassive Voice

Too much passive voiceToo much passive voice is monotonousis monotonous shows a lack of convictionshows a lack of conviction requires more wordsrequires more words extends reading timeextends reading time may be ambiguousmay be ambiguous

A new process for determining white matter tract A new process for determining white matter tract direction from DTI imaging direction from DTI imaging waswas studied. The MRI studied. The MRI derivation from DTI derivation from DTI waswas determined. An algorhythm determined. An algorhythm to determine tract direction and density to determine tract direction and density isis proposed. proposed.

Active Voice Breeds Strong Active Voice Breeds Strong ConstructionsConstructions

The feedthrough The feedthrough was composedwas composed ofof a a sapphire optical filter, sapphire optical filter, which was which was pressedpressed against the pyrotechnic that against the pyrotechnic that was used for was used for the confinement ofthe confinement of the the charge.charge.

The feedthrough The feedthrough containedcontained a sapphire a sapphire optical filter, which optical filter, which pressedpressed against the against the pyrotechnic and pyrotechnic and confinedconfined the charge. the charge.

Active vs. Passive in Active vs. Passive in ManuscriptManuscript

ActiveActive is shorter, clearer, more is shorter, clearer, more emphaticemphatic AbstractAbstract IntroductionIntroduction DiscussionDiscussion

PassivePassive is appropriate for is appropriate for MethodsMethods ResultsResults

Present/Past Tense in Present/Past Tense in ManuscriptManuscript

Present TensePresent Tense Describing established knowledge or previously Describing established knowledge or previously

published results—“Lesions of internal capsule cause…”published results—“Lesions of internal capsule cause…” For presentation—“Figure 1 shows that…”For presentation—“Figure 1 shows that…”

Past TensePast Tense When describing methods and results in current paper— When describing methods and results in current paper—

“we used”“we used” For attribution—“Smith reported that…”For attribution—“Smith reported that…”

Avoid Present (Past) Perfect TenseAvoid Present (Past) Perfect Tense ““Smith has (had) reported that”Smith has (had) reported that”

Choose Strong VerbsChoose Strong Verbs Strong Verbs:Strong Verbs:

Prepare, study, think, teachPrepare, study, think, teach Not Not weakweak verbs: verbs:

Am, was, been ,were, isAm, was, been ,were, is

The reason we understood that one-man rule is The reason we understood that one-man rule is undesirable undesirable waswas our experience with the hospital our experience with the hospital expansion system.expansion system.

The hospital expansion project The hospital expansion project taught ustaught us that that one-man rule is undesirable.one-man rule is undesirable.

Strong vs. Weak VerbsStrong vs. Weak Verbs WEAK verb phrasesWEAK verb phrases Made the arrangement forMade the arrangement for Made the decisionMade the decision Performed the Performed the

development ofdevelopment of Made the measurement ofMade the measurement of

STRONG verb (active)STRONG verb (active) ArrangedArranged DecidedDecided DevelopedDeveloped MeasuredMeasured

The human immune system is responsible not only for the identification of foreign molecules, but also for the actions leading to their immobilization, neutralization, and destruction.

The inhibitionThe inhibition of the reaction of the reaction was was carried outcarried out byby……

An increaseAn increase in heart rate in heart rate occurredoccurred

The human immune system not only identifies foreign molecules, but also immobilizes, neutralizes, and destroys those molecules.

The reaction wasThe reaction was inhibitedinhibited by…. by….

Heart rateHeart rate increasedincreased

More…Nouns From VerbsMore…Nouns From Verbs The development ofThe development of memory systems has been of memory systems has been of

interest...interest... How memory How memory developsdevelops has been of interest… has been of interest…

Our results indicate that Our results indicate that the interpretation ofthe interpretation of this this data should be taken with caution.data should be taken with caution.

Our results indicate that data should be Our results indicate that data should be interpretedinterpreted cautiously. cautiously.

In this patient, In this patient, the infusion ofthe infusion of glucose followed a glucose followed a timed course of every 2 hourstimed course of every 2 hours

In this patient, glucose was In this patient, glucose was infusedinfused every 2 hours. every 2 hours.

How To Spot Bad How To Spot Bad SentencesSentences

AvoidAvoid “There were”…. “there existed”…. “There were”…. “there existed”…. “were present”“were present”

““There were 10 patients with temporal lobe There were 10 patients with temporal lobe seizures.”seizures.”

““Temporal lobe seizures existed in 10 patients.”Temporal lobe seizures existed in 10 patients.”““Temporal lobe seizures were present in 10 Temporal lobe seizures were present in 10

patients.”patients.”

““Ten patients reported temporal lobe seizures.”Ten patients reported temporal lobe seizures.”

Passive Writing Not Passive Writing Not ForcefulForceful

A new process for eliminating nitrogen oxides A new process for eliminating nitrogen oxides from diesel exhaust engines from diesel exhaust engines isis presented. Flow presented. Flow tube experiments to test this process tube experiments to test this process areare discussed. A chemical reaction scheme to discussed. A chemical reaction scheme to account for this process account for this process isis proposed. proposed.

In this paper,In this paper, we present we present a new process for a new process for eliminating nitrogen oxide from the exhaust of eliminating nitrogen oxide from the exhaust of diesel engines. To test this process,diesel engines. To test this process, we studied we studied this process in flow tubes. To explain the process,this process in flow tubes. To explain the process, we developed (proposed) we developed (proposed) a scheme of chemical a scheme of chemical reactions.reactions.

Passive Sometimes OK Passive Sometimes OK

When the actor is unknown, unimportant, or receiver of action When the actor is unknown, unimportant, or receiver of action should be emphasized, use passive. should be emphasized, use passive.

The 45-year-old man had been shot in the abdomen and was The 45-year-old man had been shot in the abdomen and was brought to the emergency department.brought to the emergency department.

Proponents of this theory are not believed…Proponents of this theory are not believed… Readers of this work have little esteem for proponents of this Readers of this work have little esteem for proponents of this

theory…theory…

Sometimes the passive is more natural. Particularly, in Methods Sometimes the passive is more natural. Particularly, in Methods section, use passive. section, use passive.

The value of “x” was found to be…The value of “x” was found to be… Subjects were scanned using a novel fMRI method…Subjects were scanned using a novel fMRI method… Patients were excluded from the study…Patients were excluded from the study… Measurements of optical refraction were summarized...Measurements of optical refraction were summarized...

Subject-Verb PositionSubject-Verb Position

Information is easier to interpret if Information is easier to interpret if you place it where readers expect you place it where readers expect it to be.it to be.

Readers expect a Readers expect a verbverb soon after soon after the the subjectsubject…everything that …everything that comes between them gets little comes between them gets little attention!attention!

Subject-Verb PositionSubject-Verb Position

The emergence of virulent The emergence of virulent Plasmodium falciparumPlasmodium falciparum in in Africa within the past 6,000 Africa within the past 6,000 years as a result of a cascade years as a result of a cascade of changes in human behavior of changes in human behavior and mosquito transmission has and mosquito transmission has recently been hypothesized.recently been hypothesized.

Subject-Verb PositionSubject-Verb Position

The emergenceThe emergence of virulent of virulent Plasmodium falciparumPlasmodium falciparum in in Africa within the past 6,000 Africa within the past 6,000 years as a result of a cascade years as a result of a cascade of changes in human behavior of changes in human behavior and mosquito transmission and mosquito transmission has has recently been hypothesized.recently been hypothesized.

Subject-Verb PositionSubject-Verb Position According to a recent hypothesis, virulentAccording to a recent hypothesis, virulent

Plasmodium falciparumPlasmodium falciparum emergedemerged in Africa in Africa within the past 6,000 years as a result of a within the past 6,000 years as a result of a cascade ofcascade of (because of cascading) changes in (because of cascading) changes in human behavior and mosquito transmission.human behavior and mosquito transmission.

SubjectSubject verbverb easy to follow easy to follow Sentence end (stress position) contains Sentence end (stress position) contains the the

important information.important information. Less importantLess important information does not obscure information does not obscure

the messagethe message

ParagraphsParagraphs

Good Paragraphs Use…Good Paragraphs Use… Topic sentences—introduce concept to support Topic sentences—introduce concept to support

ideasideas

Consistent terms throughoutConsistent terms throughout

Transitions—related one idea to the nextTransitions—related one idea to the next

Consistent order of terms, ideas.Consistent order of terms, ideas.

Parallel formParallel form

Logical flow of ideasLogical flow of ideas

Short form: not long—6 sentences or less. Can Short form: not long—6 sentences or less. Can be 1be 1

Use Topic SentencesUse Topic Sentences Use a Use a topic sentencetopic sentence to announce the paragraph’s to announce the paragraph’s

topic.topic.

Many patients with a chronic wound have other Many patients with a chronic wound have other diagnoses that require medical attentiondiagnoses that require medical attention. Frequently . Frequently encountered are vascular insufficiency, metabolic encountered are vascular insufficiency, metabolic disturbance…A disturbance…A treatment plantreatment plan for chronic wounds is for chronic wounds is not adequate until such problems are addressed…not adequate until such problems are addressed…

Treatment plansTreatment plans are generally divided by physiologic are generally divided by physiologic systemsystem. Those dealing with the cardiovascular . Those dealing with the cardiovascular system…system…

Topic Sentences ClearTopic Sentences ClearThe incidence and demography of Anorexia nervosa have been The incidence and demography of Anorexia nervosa have been

extensively characterized (1-21).extensively characterized (1-21). Anorexia nervosa occurs in Anorexia nervosa occurs in roughly 1% of adolescent and young adult females (1-3). Most roughly 1% of adolescent and young adult females (1-3). Most cases (90%) are female (4-8), and the majority are Caucasian and cases (90%) are female (4-8), and the majority are Caucasian and come from middle-class or higher socioeconomic groups (9-14). come from middle-class or higher socioeconomic groups (9-14). Anorexia nervosa is more prevalent in industrialized countries that Anorexia nervosa is more prevalent in industrialized countries that share a western view that thinness is ideal (15, 16). It develops share a western view that thinness is ideal (15, 16). It develops most frequently during adolescence; mean age of onset is 17 years most frequently during adolescence; mean age of onset is 17 years with bimodal peaks at ages 14 and 18 (17-19). The prevalence of with bimodal peaks at ages 14 and 18 (17-19). The prevalence of anorexia nervosa has remained constant over the past few anorexia nervosa has remained constant over the past few decades; one notable change is the higher incidence in women decades; one notable change is the higher incidence in women over age 30, although this still represents a minority of cases over age 30, although this still represents a minority of cases (20,21). (20,21).

Persons with anorexia nervosa frequently manifest symptoms of Persons with anorexia nervosa frequently manifest symptoms of depressiondepression Among these symptoms are depressed mood, loss of Among these symptoms are depressed mood, loss of interest, social withdrawal, insomnia, difficulty in concentrating) interest, social withdrawal, insomnia, difficulty in concentrating) and anxiety. Depression….and anxiety. Depression….

Use Consistent TermsUse Consistent Terms Drug B has shown to Drug B has shown to decrease synaptic decrease synaptic

transmission of serotonin.transmission of serotonin. This This reduction in reduction in neurotransmitter negative feedbackneurotransmitter negative feedback is a is a result of the drug’s action on presynaptic result of the drug’s action on presynaptic vesicles in the dendrite.vesicles in the dendrite.

Drug B Drug B decreases the synaptic transmission decreases the synaptic transmission of serotoninof serotonin from presnaptic vesicles from from presnaptic vesicles from the dendrites of neurons. This the dendrites of neurons. This decrease in decrease in serotoninserotonin is produced by drug B’s inhibitory is produced by drug B’s inhibitory action of K+ ions in the presynaptic vesicles.action of K+ ions in the presynaptic vesicles.

Logical TransitionsLogical Transitions This question is discussed in more detail in the following paragraphs..This question is discussed in more detail in the following paragraphs..

Thus, many educators believe that if medical students work under Thus, many educators believe that if medical students work under difficult conditions during clinical rotations, they will be better difficult conditions during clinical rotations, they will be better prepared for the prepared for the unpredictable demands of practice.unpredictable demands of practice.

The unpredictable demandsThe unpredictable demands of emergency medicine and critical of emergency medicine and critical care…care…

Because of this, However, Meanwhile, Next, More Because of this, However, Meanwhile, Next, More specifically, specifically,

Three hypotheses have been suggested for this. Three hypotheses have been suggested for this. FirstFirst, … A , … A secondsecond hypothesis… hypothesis… ThirdThird,,

Use paragraph headings.Use paragraph headings.

Start with a good outlineStart with a good outline

Transitions: Paragraph Transitions: Paragraph CoherenceCoherence

Use a clear point carried through, Use a clear point carried through, notnot like this: like this: Tetracyclines have been in use since 1948. Their side effects, Tetracyclines have been in use since 1948. Their side effects,

however, are still a problem. Photosensitivity and tooth however, are still a problem. Photosensitivity and tooth discoloration as well as overgrowth of nonsusceptible discoloration as well as overgrowth of nonsusceptible organisms in the gut must be considered when drugs are organisms in the gut must be considered when drugs are prescribed. It has been found that such drugs as gentamycin prescribed. It has been found that such drugs as gentamycin are useful in eliminating most gram-negative organisms. are useful in eliminating most gram-negative organisms. Tetracyclines are derived from Streptomyces and Tetracyclines are derived from Streptomyces and semisynthetic derivatives...semisynthetic derivatives...

Paragraph development: general to specific, Paragraph development: general to specific, important points first, problem (as a question), important points first, problem (as a question), reasons for argument.reasons for argument.

Use Consistent OrderUse Consistent Order In describing several ideas or items, keep them in In describing several ideas or items, keep them in

the same order throughout the paper.the same order throughout the paper.

To study the effects of drug A on decreased estrogen To study the effects of drug A on decreased estrogen production, we measured anterior pituitary leuteinizing production, we measured anterior pituitary leuteinizing hormone, follicle-stimulating hormone, adrenal cortisol, and hormone, follicle-stimulating hormone, adrenal cortisol, and posterior pituitary oxytocin in premenopausal women. The posterior pituitary oxytocin in premenopausal women. The effect of drug A on oxytocin… Whereas cortisol decreased…effect of drug A on oxytocin… Whereas cortisol decreased…

To study the effects of drug A on decreased estrogen To study the effects of drug A on decreased estrogen production, we measured anterior pituitary leuteinizing production, we measured anterior pituitary leuteinizing hormone, follicle-stimulating hormone, adrenal cortisol, and hormone, follicle-stimulating hormone, adrenal cortisol, and posterior pituitary oxytocin in premenopausal women. posterior pituitary oxytocin in premenopausal women. Leuteinizing hormone decreased in response to drug A, but Leuteinizing hormone decreased in response to drug A, but follicle stimulating hormone..follicle stimulating hormone..

Use Parallel FormUse Parallel Form Use the same ideas, words: the differences will be Use the same ideas, words: the differences will be

clear.clear.

To determine whether cholinergic or adrenergic nerves mediate To determine whether cholinergic or adrenergic nerves mediate release of glucocorticoids from the adrenal gland, we did experiments release of glucocorticoids from the adrenal gland, we did experiments on glands excised from white rats. To on glands excised from white rats. To induce release of hormoneinduce release of hormone, we , we stimulated the tissue both electrically and pharmacologically. To stimulated the tissue both electrically and pharmacologically. To inhibit inhibit the hormonethe hormone, we added an inhibitor to the bathing solution., we added an inhibitor to the bathing solution.

To determine whether cholinergic or adrenergic nerves mediate To determine whether cholinergic or adrenergic nerves mediate release of glucocorticoids from the adrenal gland, we excised whole release of glucocorticoids from the adrenal gland, we excised whole adrenal glands from white rats to study them in vitro. adrenal glands from white rats to study them in vitro. We induced We induced secretion of hormonesecretion of hormone by stimulating the tissue both electrically and by stimulating the tissue both electrically and pharmacologically. pharmacologically. We inhibited secretion of hormoneWe inhibited secretion of hormone by adding the by adding the inhibitor B to the bathing solution.inhibitor B to the bathing solution.

TenseTense Use Use PRESENTPRESENT tense tense

When describing established knowledge or previously When describing established knowledge or previously published resultspublished results

Lesions of the midbrain cause…Lesions of the midbrain cause… For presentation of figures and tablesFor presentation of figures and tablesTable 1 illustrates… Table 5 shows …Table 1 illustrates… Table 5 shows … Use in Use in Abstract, Introduction, DiscussionAbstract, Introduction, Discussion

Use Use PASTPAST tense tense When describing When describing Methods and ResultsMethods and ResultsWe used… We found …We used… We found … For attributionFor attributionSmith reported…Smith reported…

TenseTense Do Do notnot use the use the PERFECTPERFECT tenses: tenses:

Smith has reported the presence of … Smith has reported the presence of … Present perfectPresent perfect

Jones had described the action of drug A… Jones had described the action of drug A… Past Past perfectperfect

Use Use FUTUREFUTURE tense only for pointing out the tense only for pointing out the need for further studies:need for further studies:

In the next series of studies, we will examine this In the next series of studies, we will examine this population in series with …population in series with …

Styles to AvoidStyles to Avoid Respectively and former/latterRespectively and former/latter

Both force the reader to stop and backtrack:Both force the reader to stop and backtrack:The mean values for men and women were 50.9 and 48.4, The mean values for men and women were 50.9 and 48.4,

respectivelyrespectivelyThe mean value for men was 50.9 and for women was 48.4.The mean value for men was 50.9 and for women was 48.4.Men and women were given drug based on body weight; the former Men and women were given drug based on body weight; the former

required adjustments based on age, and the latter …required adjustments based on age, and the latter …Men and women were given drug based on body weight. Men Men and women were given drug based on body weight. Men

required adjustments based on their age, but women…required adjustments based on their age, but women…

And/orAnd/orYour meaning is usually conveyed by “or” alone. Your meaning is usually conveyed by “or” alone. If necessary add “or both” at the end of a phraseIf necessary add “or both” at the end of a phraseSubarachnoid hemorrhage can cause headaches or stiff back, or Subarachnoid hemorrhage can cause headaches or stiff back, or

both.both.

Avoid Phrases with Avoid Phrases with “There”“There”

AvoidAvoid there werethere were…. …. there existedthere existed…. …. were presentwere present

There wereThere were 10 patients with temporal lobe seizures. 10 patients with temporal lobe seizures.Temporal lobe seizures Temporal lobe seizures existedexisted in 10 patients. in 10 patients.Temporal lobe seizures Temporal lobe seizures were presentwere present in 10 patients. in 10 patients.

Ten patients reported temporal lobe seizures.Ten patients reported temporal lobe seizures.

Delete on SightDelete on Sight Arguably Arguably ConfusingConfusing Needless to sayNeedless to say Just say itJust say it RecentRecent Undefined: last week, last year?Undefined: last week, last year? SignificantSignificant Meaningless unless statisticalMeaningless unless statistical It…that It…that constructionsconstructions

It is a fact thatIt is a fact thatIt is apparent thatIt is apparent thatIt is of interest to noteIt is of interest to noteIt is often the caseIt is often the caseIt is recognized thatIt is recognized thatIt is shown thatIt is shown that

Avoid RepetitionAvoid Repetition Do not disclose results in introductionDo not disclose results in introduction Do not repeat the Introduction in DiscussionDo not repeat the Introduction in Discussion In textIn text

Do not repeat figure legends, table titles, or contents of the tables Do not repeat figure legends, table titles, or contents of the tables themselvesthemselves

Use tables sparinglyUse tables sparingly Presenting a few facts in text takes less space than a tablePresenting a few facts in text takes less space than a table Do not use tables for presenting simple listsDo not use tables for presenting simple lists

Abbreviations, definitions, symbols in figures and tables Abbreviations, definitions, symbols in figures and tables must be explained in legends and footnotesmust be explained in legends and footnotes

Never refer a reader back to text for such informationNever refer a reader back to text for such information

Redundancies and JargonRedundancies and Jargon The trend seems to suggest that perhaps The trend seems to suggest that perhaps

A affects B.A affects B.

The trend seems to suggest thatThe trend seems to suggest that perhaps perhaps A affects B.A affects B.

A may affect B.A may affect B. A affects B in some instances…(which A affects B in some instances…(which

ones?)ones?)

Redundancies and JargonRedundancies and Jargon In the present paper, the authors show In the present paper, the authors show

that A affected B at 37°C.that A affected B at 37°C.

In the present paper, the authors In the present paper, the authors We show We show that A affected B at 37°C.that A affected B at 37°C.

Redundancies and JargonRedundancies and Jargon In the second part of the paper, it is shown In the second part of the paper, it is shown

that A affected B at 37°C only in the that A affected B at 37°C only in the presence of exceedingly small presence of exceedingly small concentrations of protease.concentrations of protease.

In the second part of the paper, it is shown In the second part of the paper, it is shown thatthat A affected B at 37°C only in the A affected B at 37°C only in the presence of presence of exceedinglyexceedingly small small concentrations of protease.concentrations of protease.

Redundancies and JargonRedundancies and Jargon The paper concludes with a summary of the The paper concludes with a summary of the

evidence indicating that A may be, under evidence indicating that A may be, under carefully limited circumstances, an effective carefully limited circumstances, an effective agent against infections caused by gram-agent against infections caused by gram-negative organisms.negative organisms.

The paper concludes with a summary of the The paper concludes with a summary of the evidence indicating thatevidence indicating that Under some Under some conditions, A may beconditions, A may be, under carefully limited , under carefully limited circumstances,circumstances, anan effective effective agentagent against against infections caused by gram-negative infections caused by gram-negative organisms.organisms.

Avoid Long References to Figs, Avoid Long References to Figs, TablesTables

Transfected cells had a diffuse GFP signal throughout the cell… (Fig 4a-h)…However, the colchicine did not …. (Figure 4i)…A 250 bp product was observed in RT-PCR, the expected size for a pliced produce (Fig 5, lane 8)…

Eliminate Vague Eliminate Vague Adjectives/AdverbsAdjectives/Adverbs

Very, exceedingly, clearly, large, smallVery, exceedingly, clearly, large, small, etc, etc Vague and don’t have meaningVague and don’t have meaning

The magnitude of change was very largeThe magnitude of change was very large

The change was 10-fold larger than…The change was 10-fold larger than…

Figure 1Figure 1 clearly shows…clearly shows…

Figure 1 shows…Figure 1 shows…

OnlyOnly leads the reader leads the reader

The subjects receiving drug A had only a 4% incidence of …The subjects receiving drug A had only a 4% incidence of …

The subjects receiving drug A had a 4% incidence compared with The subjects receiving drug A had a 4% incidence compared with a 10% incidence in subjects receiving drug Ba 10% incidence in subjects receiving drug B

Summary: Summary:

Advice from a Leading Advice from a Leading

Medical Journal EditorMedical Journal Editor

Brevity is BeautifulBrevity is Beautiful

Brevity usually delivers the message more

clearly, gives the journal more pages for other

authors, impresses reviewers, and warms the

hearts of editors (who are fond of three-word

sentences).

Good English WorksGood English Works

There is no bias against non-English-speaking authors; half of our articles come from countries where English is not the primary language.

Lack of clarity is a different matter and is a major determinant of priority scores.

If yours is the greatest work of the year (and we understand it), we can rewrite, punctuate, and put it into the journal style. If it is just near-great and in competition with other near-greats, it may fail.

READ the Instructions to READ the Instructions to AuthorsAuthors

We do not summarily reject the 50% of submissions that don’t conform to our instructions, but a paper in the style of another journal give the wrong impression.

It is analogous to giving wilting flowers to your loved one; the motive may be pure, but the recipient ponders where the flowers may have come from and what route they may have traveled.

ExamplesExamples A girl 3 months of age presented herself because A girl 3 months of age presented herself because

of a tumor mass protruding from the vulva.of a tumor mass protruding from the vulva. An infant 3 months old [A 3-month-old infant] An infant 3 months old [A 3-month-old infant]

was brought to the hospital because of a tumor was brought to the hospital because of a tumor protruding from the vulva.protruding from the vulva.

The present studies suggest the possibility that The present studies suggest the possibility that this medication may cause nausea in some this medication may cause nausea in some cases.cases.

Our studies suggest that this medication causes Our studies suggest that this medication causes nausea in some patients (or) Our studies show nausea in some patients (or) Our studies show this medication may cause nausea in patients.this medication may cause nausea in patients.

ExamplesExamples The primary route of lithium elimination from the The primary route of lithium elimination from the

body is through renal lithium excretion.body is through renal lithium excretion. Lithium is eliminated (excreted) from the body Lithium is eliminated (excreted) from the body

primarily through the kidneys.primarily through the kidneys.

In these patients, water consumption increase was In these patients, water consumption increase was observed after drug A was given; the patients on observed after drug A was given; the patients on drug B were observed to have no change in water drug B were observed to have no change in water consumption throughout the study.consumption throughout the study.

Patients who took drug A drank more water [how Patients who took drug A drank more water [how much?], whereas patients who took drug B drank much?], whereas patients who took drug B drank normally (or had no change in water intake).normally (or had no change in water intake).

ExampleExample To study the mechanisms involved in the beneficial effects of To study the mechanisms involved in the beneficial effects of

hydralazine on ventricular function in patients who have chronic hydralazine on ventricular function in patients who have chronic aortic insufficiency, a radionuclide assessment of ventricular aortic insufficiency, a radionuclide assessment of ventricular function was performed in 15 patients with pure aortic function was performed in 15 patients with pure aortic insufficiency, functional capacity I or II, at rest and during supine insufficiency, functional capacity I or II, at rest and during supine exercise. (1 sentence)exercise. (1 sentence)

We We assessedassessed the mechanisms involved in the beneficial effects the mechanisms involved in the beneficial effects of hydralazine on ventricular function in patients with chronic of hydralazine on ventricular function in patients with chronic insufficiency. For this insufficiency. For this assessmentassessment, we used radionuclides to , we used radionuclides to measure ventricular function in 15 measure ventricular function in 15 patientspatients at rest and during at rest and during supine exercise. All supine exercise. All patientspatients were diagnosed with pure aortic were diagnosed with pure aortic insufficiency and were rated functional capacity I or II. insufficiency and were rated functional capacity I or II.

(3 sentences with transitions)(3 sentences with transitions)

ExampleExample The advantages of epidural opiates in the The advantages of epidural opiates in the

relief of postoperative pain have been relief of postoperative pain have been repeatedly emphasized. There remains, repeatedly emphasized. There remains, however, considerable uncertainty as to however, considerable uncertainty as to the consistency and equality of analgesia the consistency and equality of analgesia provided by this technique.provided by this technique.

The advantages of epidural opiates for the The advantages of epidural opiates for the relief of post-operative pain are well relief of post-operative pain are well known, although their analgesic known, although their analgesic consistency and quality are less certain.consistency and quality are less certain.

ExampleExample In summary, then, foam filled endotracheal cuffs In summary, then, foam filled endotracheal cuffs

would appear to offer a preferable alternative to would appear to offer a preferable alternative to low pressure high volume cuffs in terms of low pressure high volume cuffs in terms of protecting the airway and this efficacy is achieved protecting the airway and this efficacy is achieved in the context of cuff to tracheal wall pressures that in the context of cuff to tracheal wall pressures that are both predictable and acceptable.are both predictable and acceptable.

In summary, foam-filled endotracheal cuffs protect In summary, foam-filled endotracheal cuffs protect the airway better than cuffs with low pressure and the airway better than cuffs with low pressure and high volume. The pressure between the foam-filled high volume. The pressure between the foam-filled cuff and the tracheal wall is predictable and cuff and the tracheal wall is predictable and acceptable.acceptable.

ExamplesExamples

Recent research suggests that these two Recent research suggests that these two disorders may not be as distinct as disorders may not be as distinct as previously was thought and the degree of previously was thought and the degree of overlap may be considerable. overlap may be considerable.

Recent research suggests that these two Recent research suggests that these two disorders may overlap considerably.disorders may overlap considerably.

ExamplesExamples

The study of Barrett et al. (1997) is The study of Barrett et al. (1997) is considered to be methodologically sound. considered to be methodologically sound. In that study, 1,000 bacteria were In that study, 1,000 bacteria were transformed with the novel gene. transformed with the novel gene.

In a methodologically sound study by In a methodologically sound study by Barret et al. (1997), 1,000 bacteria were Barret et al. (1997), 1,000 bacteria were transformed with the novel gene.transformed with the novel gene.

ExampleExample Baby walkers are devices that provide preambulatory Baby walkers are devices that provide preambulatory

infants with postural support in addition to offering infants with postural support in addition to offering them the opportunity to experience bipedal locomotion. them the opportunity to experience bipedal locomotion. They are intended to simulate the infant’s independent They are intended to simulate the infant’s independent locomotion and by so doing, it is argued, encourage locomotion and by so doing, it is argued, encourage and even accelerate the early acquisition of this skill.and even accelerate the early acquisition of this skill.

Baby walkers are devices that allow babies who are still Baby walkers are devices that allow babies who are still at the crawling stage to stand up and practice walking. at the crawling stage to stand up and practice walking. Some researchers believe that such devices encourage Some researchers believe that such devices encourage and even speed up a baby’s ability to walk and even speed up a baby’s ability to walk independently.independently.