Health Sciences Writing Workshop

Frederick Reece

Director, English Language Center

Matthew Howell

Instructor, English Language Center

Clear writing is vital to science:

“Science moves forward in large measure because people make their findings public, challenge or confirm other people’s findings, have the occasional cat-fight over how to interpret what’s been found, and then build on that which turns out to be solid and reproducible.”

Dale Hammerschmidt, MD

Writing Exercise (First Draft)

Read Eating Brains: Cannibal Tribe Evolved Resistance to Fatal Disease.

Note the main ideas and most important information in the article.

Write a one paragraph summary / abstract of the article under the heading First Draft.

Style and Structure

Premises of Effective Communication:

You have information worth sharing. Your audience has an interest in this

information. Your audience has a use for this information. Your are trying to convey this information as

clearly as possible.

Style and Structure

If your information is not useful and interesting to your audience, then the style and structure of your writing don’t really matter.

Elegant style doesn’t compensate for irrelevant, inconsequential, or ambiguous information.

Confusing or counterintuitive structure makes reading, understanding, and retention significantly more difficult.

Style

The best style is: Invisible

Transparent

Efficient: A conduit for information, not an exhibition of “fancy” words and obscure phrases

Style

By writing in a style that is:

Clear Direct Precise Concise

You demonstrate respect for your reader.

Style

Good writing is clear:

What, exactly, do you want to say?

Use familiar words and phrases

The danger of the thesaurus: We all know what “fix” means, right?

Style

Synonyms for “fix” (noun): adhere, adjust, aim, align, alter,

arrange, attach, cement, cleave, cling, cohere, compose, concentrate, conform, coordinate, corrupt, debug, emasculate, fasten, focus, geld, glue, harmonize, mend, modify, neuter, order, overhaul, paste, regularize, repair, solution, spay, suborn, target, unite. . .

Style

. . . prepare, heat, make, ready

Let’s not forget “fix” can be a noun. . .

synonyms: dilemma, mess, box, corner, embarrassment, hole, plight, predicament, quandary, scrape, spot, hot water

(Furthermore, some synonyms of “fix” can be antonyms of each other . . . )

Style

Good writing is direct:

Explicit, not implied

Active voice, not passive voice, unless passive voice is clearly preferable.

Style

Implicit versus explicit: “Patients such as yourself with both diabetes and

heart disease are often at increased risk for myocardial infarction. As such, various lifestyle changes on your part will not only lower chances of morbidity, but have a positive effect on your overall sense of well-being.”

“In order to reduce chances of a heart attack and improve your quality of life, you need to adopt a low-fat, low carbohydrate diet and lose at least 5 kilos.”

Style

Passive Voice versus Active Voice

Passive voice = be verb + past participle

“It could be observed that the patient’s fever showed no sign of lessening after the first course of treatment.” (bad use of passive voice)

“There was no change in the patient’s fever after the first course of treatment.” (preferred use of active voice)

Style

And better yet:

“The patient’s fever remained unchanged.” (clearer and more direct)

Style

Positive use of passive voice:When the noun doing the action is unknown, or

when the action, or the noun receiving the action, is more important than the actor.

“Someone broke the photocopier.”(The focus is on “someone.”)

“The photocopier was broken.” (The focus is on the photocopier being broken, not on who did it.)

Style

Awkward Active Voice:

“In the early stages, severe, persistent headaches may indicate preeclampsia .” (unduly emphasizes the headaches, creates confusion regarding “in the early stages” . . . of severe headaches?)

Preferable Passive Voice: “In the early stages, preeclampsia may be

indicated by severe, persistent headaches.”

Style

Conclusion: Generally, choose active voice over passive voice, but use passive when the action, or the thing acted on is more important than the actor, or when the actor is unknown:

“Labor can be induced after 37 weeks” . . . rather than . . . “The physician may induce labor if the patient is past 37 weeks.”

Style

Good writing is precise.

Quantify when possible.

Specify when possible.

Divide information into separate sentences as needed to facilitate comprehension.

Style

“Since the earlier tuberculosis epidemics, New York has become much more effective in managing cases.” (vague)

“Since the 1992 tuberculosis epidemic, New York has increased the proportion of patients completing treatment to 90%, reducing acquired drug resistance by 90%, and documented a dramatic drop in the number of cases.” (quantified and specific, but still somewhat hard to follow)

Style

“Since the peak of the tuberculosis epidemic in 1992, New York City has increased the proportion of patients who complete treatment from 60% to more than 90% and reduced the rate of acquired drug resistance by more than 90%. A dramatic drop in cases has been documented, from 3811 in 1992 to 651 in 2012.”

(quantified and specific, but also properly divided into separate sentences)

Style

Good writing is concise.

Use the number of words necessary to convey relevant information, but no more.

In writing, more is only better if it conveys more relevant, useful, and interesting information. Even then, respect the reader’s time and patience.

Style

Example:

“By undertaking a careful and detailed examination of all of current studies, we may easily conclude that many types of cancers do not respond equally well to radiation.”

“Current evidence indicates that some cancers are less responsive to radiation.”

Style: Grammar

Typical Sentence Structure: Subject + Verb + Object

“ I ate the pizza.”

“I gave the pizza to my kids.”

“I gave my kids the pizza.”

Direct Object: the noun receiving the action

Indirect Object: the noun receiving the direct object

“Doctor Uyar gave the patient novocaine.” (correct)

“Doctor Uyar gave novocaine to the patient.” (correct)

“Dr. Uyar administered the patient novocaine.” (incorrect)

“Dr. Uyar administered novocaine to the patient.” (correct)

Style: Grammar

Either construction may be used with some verbs such as:

Give, offer, bring, pay, promise, send, take, tell, hand, leave, sell, and a few others.

However, for most verbs, the indirect object must be proceeded by “to” or “for.”

Style: Grammar

Subject – Verb Agreement:

Singular subject + verb (s or es)

The car runs well.

Plural subject (s or es) + verb

The cars run well.

Simple, in this case . . .

Style: Grammar

But when the subject is separated by words or phrases from the verb:

One of the most common sites of metastasized tumors (is/are) within the marrow of the bone.

You must KNOW what the subject is.

Style: Grammar

Some grammatical errors in English can be overlooked, but not this one:

“I enjoy golf is quite relaxing.”

In English, a noun can NEVER be a subject and an object at the same time.

“I enjoy golf, which is quite relaxing.”

Style: Grammar

Why is there a comma after “golf”?

“I enjoy golf, which is quite relaxing.”

(non-restrictive clause; it provides extra information about the noun)

“Of the sports which I’ve tried, the one which is most relaxing is golf.” (restrictive clauses, necessary to identify the particular noun(s) I am talking about)

Style: Grammar

“The person who lives in the big house on the corner is a doctor.” (restrictive)

“My friend Steve, who lives in the big house on the corner, is a doctor.” (non-restrictive)

“The person”: Which person?

“My friend Steve”: We know which person.

Style: Grammar

Transitional words and phrases: Provide logical connections between

ideas and information. Establish continuity (smooth flow)

between clauses, and between paragraphs.

Logical relationships: addition, cause and effect, contrast, intensification, etc.

Style: Transitions

Style: Transitions

Lists of transitional (linking) words and phrases can be found in books and on the internet.

We will focus on some commonly misused transitional devices:

“Moreover”: indicates addition, similar to “additionally, furthermore, in addition.”

Style: Transitions

On the contrary: it does NOT indicate contrast in the way that “although,” “however, or “on the other hand” do.

On the contrary intensifies a previous point, typically expressed in the form of a negative statement.

“I’m not dying. On the contrary, I am in excellent health.”

Style: Transitions

It is INCORRECT to say:

“I feel fine. On the contrary, I am in excellent health.”

It is CORRECT to say:

“There is no evidence of coronary damage; on the contrary, his cardiogram showed no abnormalities of any kind.”

Style: Transitions

“On the contrary” is similar to “in fact,” or “as a matter of fact,” but it generally follows a negative statement.

“On the contrary” emphasizes or intensifies the previous statement.

Style: Transitions

“Despite” or “in spite of” both mean “even though __________ is the case,”

“Despite his chronic pain, the patient maintained an active lifestyle.”

Means . . .

“Even though his chronic pain existed, the patient maintained an active lifestyle.”

Style: Transitions

“Despite the fact that” or “in spite of the fact that” function like “even though,” “although,” etc.

“Despite the fact that he was in chronic pain, the patient maintained an active lifestyle.”

Means . . .

“Even though he had chronic pain, the patient maintained an active lifestyle.”

Style: Word Choice

Misused or overused words, by native Turkish speakers:

Aim

Perfect

Mention

Style: Word Choice

Aim (noun): goal, objective, ambition, aspiration, end, intention, object, purpose, focus

Aim (verb): attempt, intend, propose, try, target

Style: Word Choice

Perfect: flawless, that which could not be improved

upon, absolutely error-free

Perfect is not the same as excellent, wonderful, outstanding, fantastic.

“Perfect” typically does not describe anything that could even potentially be improved upon.

Style: Word Choice

Mention:

a brief, often incidental reference or statement; to refer to or speak about briefly or incidentally

Any essential or significant point, idea, or information communicated in any way is NOT “mentioned.” It is examined, discussed, argued, presented, etc.

Structure

The best structure is: Natural

• chronological• logically sectioned

Standardized An efficient conduit for information,

assisting the reader in comprehension and retention.

Structure

IMRAD

The “IMRAD” structure is not an arbitrary publication format but rather a direct reflection of the process of scientific discovery.

–International Committee of Medical Journal Editors (over 1000 journals)

Structure

The IMRaD article1.Title page 2.Abstract 3.Main Text I –Introduction—Why did you do it? M –Methods—How did you do it? R –Results—What did you find? D –Discussion—What might it mean?

Why is it important? 4.Acknowledgements 5.References

facilitatesmodularreading

Structure

Describe experiments done to answer the question.

Describe results found that answer the question.

Start with study answer and end addressing broader implications.

Why did you study this problem?

What might it mean?

How did you do it?

What did you find?Start broad and narrow to a specific question.

Structure of an IMRaD article

Study question

Study answer

Discus

sion

Introduction

Methods

Results

Structure

IMRaD: Introduction

Purpose To interest your audience To describe why the study was performed

Content overview Provide sufficient baseline knowledge for readers to

understand your study (but don’t overdo it). Explain how your study differs from previous

publications. State the study question.

Structure

General knowns/problems

Specific knowns

Gaps in research

Questions and approach

Start with general background information.

Move to specific details about what is known and unknown.

State the study question and describe the experimental approach.

KEEP IT SHORT (500 words)

Introduction: content overview

Structure

Link the unknown to the study purpose: Unknowns or what is inadequate

about previous research Study question/purpose

Signal the study question to the reader: “The purpose of this study was to…” “To determine whether…” “In this study, we examined whether...”

How to end the Introduction?

Describe how this study is different from previous studies.

Structure

IMRaD: Methods

Purpose To allow readers to interpret your results and evaluate

your conclusions To enable readers to replicate your findings

Content overview Include materials and methods, but not results. Provide enough experimental details and references

to enable a trained scientist to evaluate or repeat your work.

Identify where you obtained reagents and equipment (manufacturer, city, state).

Structure

Methods: Overall structure

Arrange experimental details as protocols described in separate subsections.

Technical step-by-step procedure Explain the purpose of the protocol

Use a chronological order Begin with the study design and end with any

statistical analyses.

Structure

Common problems in the Methods

No explanation of the purpose of a method A purpose statement allows readers to jump

back and forth between results and their corresponding methods.

“To detect serum levels of protein X, we…”

No explanation of the purpose of a technique “We excluded patients who were febrile because

[the test] is known to give false positives in the presence of an active infection.”

Structure

IMRaD: Results Purpose

To report the results of your experiments and answer the research question posed in the Introduction

To point the reader to the data shown in the figures and tables

Content overview Report the results of the experiments described in the

Methods section. Report what happened during the study.

Structure

Results: Overall structure Most to least important

Give the main or most important findings first. Best for studies with a single main experiment or

focused study design

Chronological sometimes necessary Report results in the order in which the experiments

were done. Best for studies in which critical preliminary work is

performed prior to the main experiment or when the results of one experiment determine the next

Structure

Common problem in the Results Lack of meaningful descriptions of data

Report “raw” data in tables and figures (when possible).

Summarize and interpret the data that is presented in the tables and figures.

Mean tumor size was 2 cm in mice treated with X and 4.2 cm in untreated mice.

Mean tumor size in mice decreased from 4.2 to 2 cm after treatment with X.

Mean tumor size in mice decreased by half after treatment with X (Figure 1).

Just data

Direction of change

Direction and proportion of change

Structure

IMRaD: Discussion Purpose

To provide an answer to your study question To show how your study advances knowledge To highlight the implications of your findings

Content overview Provide an answer to the study question. Compare and contrast your findings with existing

knowledge. Discuss the limitations of your study. Draw conclusions that follow from your findings.

Structure

Answer

Literature review

Limitations

Conclusions and Implications

Structure of the Discussion

Answer the study question (cite your key findings and other supporting results as needed)

Interpret your findings in the context of existing knowledge and limitations of your study.

End with general conclusions and implications.

Structure

Discussion: First paragraph

Provide answer to the question posed in the Introduction.

Do not begin the Discussion with a second Introduction or detailed repetition of results.

Support your answer with your results and data.

Support your answer with other’s results. Cite appropriate references.

Structure

Discussion: First paragraph

Start with the study answer.

You can briefly restate the study question or context. “The question addressed by the present study was whether

X is a cause of Y. The main finding of this study is that…”

“Previous studies suggest that X is a common symptom of Y disease. Our results show that X is only common in a subset of…”

Structure

Discussion: Middle paragraphs

Difficult section to write Outline main points to improve flow

Organize from most to least important or according to the science.

Discuss possible explanations of your findings. Discuss your findings in the context of existing

knowledge. Discuss limitations and assumptions of the study.

Structure

Discussion: Last paragraph Provide a one-paragraph concluding summary.

Restate the answer to your study question.

Discuss important implications of your study. •Applications

•Recommendations

•Theoretical implications

•Speculations

•Future directions

Provide a clear payoff to the reader.

Style and Structure: Summary

Good writing is transparent. It appears to be effortless, but is the result of careful preparation and attention. It is:

Clear Direct Precise Concise Structured

Style and Structure: Summary

Proper grammar Appropriate transitional devices Appropriate word choices Logical and chronological structure . . .

All contribute to the quality of your writing.

Style Exercises

For each pair of sentences below, select the one that better conveys the information.

“After reviewing the relevant data, it can be concluded that many patients taking anti-inflammatory medications have an increased likelihood of experiencing gastro-intestinal problems such as internal hemorrhage.”

“The data indicate that long-term use of anti-inflammatory drugs increases the likelihood of bowel perforation or hemorrhage.”

Of the two sentences above, which one is better, and why?

Style Exercises: Answer

After reviewing the relevant data, it can be concluded that many patients taking anti-inflammatory medications experience an increased likelihood of undergoing gastro-intestinal problems such as internal hemorrhage. (Worse)

The data indicate that long-term use of anti-inflammatory drugs increases the likelihood of bowel perforation or hemorrhage. (Better)

Style Exercises

Which of the sentences below uses passive voice, and which active voice?

“Lungs may be damaged by exposure to airborne solvents.”

“Exposure to airborne solvents may cause lung damage.”

What does each sentence focus on? Which sentence is better, and why?

Style Exercises

Which of the sentences below uses passive voice, and which active voice?

“A physician should administer heparin to patients with venous thrombo-embolism.”

“Heparin should be administered to patients with venous thrombo-embolism.”

What does each sentence focus on? Which sentence is better, and why?

Style Exercises

Which sentence below is incorrect, and why?

“The paramedic administered cardiac massage to the accident victim.”

“The paramedic administered the accident victim cardiac massage.”

“The paramedic gave the accident victim cardiac massage.”

“The paramedic gave cardiac massage to the accident victim.”

Style Exercises

Which verb in the sentence below is correct, and why?

“The results of a four-year study conducted by the Mayo Clinic (indicate/indicates) that caffeine consumption has no causal relationship with coronary illness.”

Style Exercises

Which sentence below is correctly punctuated, and why?

“The physician administered a drug, which dilates the blood vessels.”

“The physician administered hydralizine, which dilates the blood vessels.”

Style Exercises

Which sentence below is correct, and why?

I exercise often; however, my blood pressure is still high.

I exercise often; on the contrary, my blood pressure is still high.

Style Exercises

Which sentence below is correct, and why?

There is no reason to suspect metastasis; on the contrary, the tumor is highly localized.

There is no reason to suspect metastasis; on the other hand, the tumor is highly localized.

Style Exercises

Which sentence below is correct, and why?

“He is a perfect student; he only missed two questions on his board exams.”

“He is an outstanding student; he only missed two questions on his board exams.”

Style Exercises

Which sentence below is correct, and why?

“This morning, I have mentioned several characteristics of good writing.”

“This morning, I have discussed several characteristics of good writing.”

Writing Exercise (Revised Draft)

Exchange your first draft with someone next to you.

Check the writing for errors in style and structure.

Return the draft to its author.

Making an Abstract

The following are the purposes of an abstract.

Background info about the study/Why this study was done What was done, and how Most important findings and conclusions Recommendations for future research

Take the passage you wrote previously, and using the above criteria, rewrite your summary to function as the abstract of a paper.

Model Abstract

Compare your abstract with the following model.

Mammalian prions, which are transmissible agents which cause lethal neurodegenerative diseases, such as Kuru and Creutzfeldt-Jakob disease (CJD) are composed of assemblies of misfolded cellular prion protein (PrP). A novel PrP variant, V127, was under positive evolutionary selection during the epidemic of kuru-an acquired prion disease epidemic of the Fore population in Papua New Guinea-and appeared to provide strong protection against disease in the heterozygous state. Here we have investigated the protective role of variant V127 and its interaction with the common, worldwide M129V PrP polymorphism. We demonstrate that mice gentically engineered to Express V127 and injected with infectious prions are completely resistant to both kuru and classical Creutzfeldt-Jakob disease (CJD) prions (which are closely similar) but can be infected with variant CJD prions, (a human prion strain resulting from exposure to bovine spongiform encephalopathy prions to which the Fore were not exposed.) Notably, mice expressing 2 copies of V127 were completely resistant to all prion strains. Further study in transgenic mice expressing different ratios of variants of PrP would assist in identifying the mechansim by which V127 resists prion conversion and propagation.

Health Sciences Writing Workshop

Thank you for your attention.

Any Questions?