AHRQ Publishing and Communications Guidelines

Contents

Introduction
Requirements for Document Production and Publication
   Clearance
   Printing and Duplication
   Coordination With the AHRQ Web site
   Use of AHRQ Branding Design and Logos
   Proprietary Software
Disclaimers and Disclosures
   Disclaimers
     General Disclaimer
     Disclaimer for Multimedia Products
     Disclaimer of Conflicts of Interest
   Disclosures
     Funding Statement
     Public Domain Notice
     Statement on Accessibility
Copyright, Licensing Agreements, Trademarks, and Related Intellectual Property Requirements
   Statutory Basis of Copyright
   International Copyright
   Signing Copyright Forms—Duties of Federal Employees
   Reprinting Copyrighted Materials
     Fair Use
     Excerpting Content
     Tables, Graphs, and Figures
     Photographs
     Digital and Electronic Content
     Reprinting From the Internet
   Copyright of Grantees' Work
   Licensing Agreements
   Copyright Notices
     Additional Protections for Materials Published by HHS and its Agencies
   Documenting and Filing Permissions
   Trademarks and Trade Names
   Additional Information
Authorship and Credit
   Listing Authors With Their Affiliations
   Listing Credentials After an Author's Name
   Acknowledgments
Editorial Style, Usage, and Punctuation
   Resources
     Style Manuals
     Dictionaries
   Quick Tips on Usage and Style
     General Usage and Stylistic Considerations
     Statistical Usage
     Medical Usage
     Titles of Reports
     General Punctuation
     Bulleted Lists
     Hyphens
     Hyphenated Prefixes
     Compound Words
     Acronyms
     Abbreviations
     Numerals
     Capitalization
Citations, Reference List, Footnotes, and Bibliography
   Citation Style
   Rules for Citing Sources
   Citation Management Software
   Citing Journals
   Citing Database Reviews and Other Public Health Publications
   Citing Books
   Citing a Chapter in a Book or an Article in a Compendium
   Citing Scientific and Technical Reports From Government Agencies
   Citing Grant or Contract Reports
   Citing Dissertations and Theses
   Citing Conference Proceedings
   Citing a Publication With No Listed Author
   Citing Nonprint Data, Including Web Citations
   Footnotes
   Bibliographies
Type Specifications for Print or Web Manuscripts
   Front Matter
   Report Body
   Headings
   Tables and Figures
   Back Matter
Type Specifications for Desktop-Published Products
Samples for Print or Web Documents
   Sample Headings
   Inside Front Cover for a Final Report
   Title Page for a Final Report
   Back of Title Page
   Acknowledgments
   Contents
Submission of Documents to AHRQ
   General Procedures
   Procedure for Reports Submitted as Final Copy
   Procedure for Reports Submitted as Final Manuscript or Peer Review Copy
   Procedures for Print-Ready Products Submitted for Offset Printing
   Procedures for DVD
The Editorial and Production Processes at AHRQ
   Objectives of the Editorial Process
   Levels of Edit
   Checklist of Standard Editorial Procedures
   Production Editing Checklist
   Copyediting Checklist
   Substantive Editing Checklist
   The Publications Process
Additional Information

Appendixes 
Appendix 1-A. Copyright: Permission Forms and Licensing Agreement
Appendix 1-B. Trademarks
Appendix 1-C. AHRQ Grant Final Progress Reports

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Introduction

The Agency for Healthcare Research and Quality (AHRQ) has developed these publishing specifications to give staff, contractors, and grantees basic guidance and a format to follow for preparing reports and other products submitted to the Agency for publication (e.g., conference summaries, scientific and technical reports, fliers, booklets, and multimedia products and tools).

This section includes guidance on such matters as clearance, printing and duplication, and posting on the AHRQ Web site. It also provides guidance on legal requirements such as disclaimers, copyright permissions, and the use of trademarks and trade names. It provides a set of tips on editorial style and a description of the editorial process that occurs once a document is received at AHRQ’s Office of Communications (OC).

This section provides instructions for most reports and includes general, not exhaustive, specifications for other documents. AHRQ programs may have developed detailed style guidance tailored to their particular needs. Please contact your OC managing editor for additional guidance pertaining to your program and products.

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Requirements for Document Production and Publication

Clearance

Only certain publications require a U.S. Department of Health and Human Services (HHS) clearance using the Strategic Communications Plan (SCP). This is an internal HHS platform. The review is designed to ensure that the material for publication is in line with Federal Government and departmental priorities and policy. Products that require Office of the Assistant Secretary for Public Affairs (ASPA) review and submission of the SCP include products that are newsworthy, controversial, new information, or part of a public education campaign. If not, then the SCP can be filled out for internal review only.

All products are assigned to an OC managing editor who will work with you and your project staff to develop clearance paperwork. The OC managing editor is responsible for submitting the SCP for approval. The SCP form can be found on the Intranet.

Printing and Duplication

Contractors are not permitted to obtain printing services on behalf of the Federal Government. The OC editor manages printing through the Government Printing Office.

With OC approval, contractors are allowed to make a limited number of copies of AHRQ documents. Quantities are not to exceed 25,000 impressions (i.e., the total number of pages; for example, five copies of a 100-page document equals 500 impressions). An OC managing editor must review the document before it is copied and will assign a publication number for the document.

Select for specifications for delivering art files to OC for printing.

Coordination With the AHRQ Web Site

All print products that AHRQ publishes are posted on the Agency’s Web site and often include associated Web-based tools and products. Many products are Web-only; these must adhere to the same requirements that apply to printed products. It is critical that you review Section 2 of these guidelines to understand AHRQ’s Web policies.

The OC managing editor will coordinate coding, loading, and posting of Web documents through AHRQ’s Web team, and with AHRQ’s program team for third-level domain Web sites.

Use of AHRQ Branding Design and Logos

AHRQ branding design elements must be included on all AHRQ products and communication materials, whether produced in-house or by a contractor. An OC managing editor can answer any questions on use of the AHRQ logo and branding design.

• Samples of AHRQ design elements/logos are provided in Section 7 of these guidelines.
• Grantees may not include HHS or AHRQ logos on their products.
• Products prepared under contract to AHRQ must include the HHS/AHRQ logos and may not contain contractor logos. Acknowledgment of the contractor's role is usually given in the front matter.
• The HHS/AHRQ logo is only to be used on official, AHRQ-sponsored products.

Proprietary Software

Files should not be prepared in a manner that requires users to purchase a specific software program to access the information.

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Disclaimers and Disclosures

Disclaimers

A disclaimer is used for reports developed under a contract or grant, to indicate the limitations of AHRQ’s responsibility for the content of the report, and any necessary cautions about its intended use. The disclaimer may be adapted to suit the needs of the individual project. It should be placed on the inside front cover of printed reports, and on the page following the title page of Web-only documents.

Examples of disclaimers for reports produced for AHRQ under contract are shown on the following pages.

General Disclaimer

A general disclaimer follows:

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

Disclaimer for Multimedia Products

The following is a sample disclaimer for multimedia products (e.g., DVDs, Webinars, PowerPoint presentations) developed under contracts or grants and disseminated by AHRQ:

The (name of organization) and AHRQ have made a good faith effort to take all reasonable measures to ensure that this product is accurate, up to date, and free of error in accord with clinical standards accepted at the time of publication. Any practice described in this product must be applied by health care practitioners in accordance with professional judgment and standards of care in regard to the unique circumstances that may apply in each situation they encounter. The (name of organization) and AHRQ are not responsible for any adverse consequences arising from independent application by individual professionals of the content of this product to particular patient circumstances encountered in their practices.

Disclaimer of Conflicts of Interest

The following disclaimer may be used to show that there are no affiliations or financial involvements that conflict with the material presented in a report:

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

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Disclosures

Funding Statement

For materials developed under an AHRQ contract that may or may not be published (final reports and contract deliverables) and for grantee journal articles, a funding statement is required:

This project was funded under contract/grant number XXXX from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the U.S. Department of Health and Human Services.

Public Domain Notice

This notice tells the reader whether the material is copyrighted or in the public domain. (Public domain applies to use in the United States only. Permission is needed for use in other countries). It should appear immediately following the disclaimer, either on the inside front cover (for printed reports) or on the page following the title page (for Web-only documents).

When a publication is entirely in the public domain, use the following notice:

This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated. Note: "…under the Social Security Act [42 USC 1320b-10 (a)(2)(B)], reprinting or distribution of AHRQ or other HHS materials for a fee is prohibited without prior specific, written authorization."

When the entire publication is in the public domain, except for short copyrighted quoted passages or reproduced tables or figures that require permission to reproduce, use the following notice:

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Note: "…under the Social Security Act [42 USC 1320b-10 (a)(2)(B)], reprinting or distribution of AHRQ or other HHS materials for a fee is prohibited without prior specific, written authorization."

When the entire document is copyrighted—as in special pre-approved situations where AHRQ grants a contractor permission to retain copyright to a product—use the copyright notice. A special copyright notice appears on the United States Preventive Services Task Force (USPSTF) Web site, whose Recommendation Statements are not in the public domain (see page 1-8).

Use a simpler public domain statement on fliers or pamphlets. For example:

This material may be reprinted without further permission.

For all notices, include at the end:

Public domain applies to use in the United States only. Permission is needed for use in other countries.

Statement on Accessibility

Section 508 of the Rehabilitation Act of 1973 requires Federal agencies to make all electronic and information technology accessible to persons with disabilities. If your document contains figures or complex tables, they must be readable by assistive devices for the visually disabled, or else provide a text description of their content.

If the managing editor decides that meeting these requirements would entail an undue burden in a particular situation, you will be asked to add this disclaimer statement to your report, usually on the page following the title page:

Persons using assistive technology may not be able to fully access information in this report. For assistance contact AHRQ at https://info.ahrq.gov/ [or other appropriate contact designated by the managing editor].

For further information on accessibility, go to Appendix 2-C.

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Copyright, Licensing Agreements, Trademarks, and Related Intellectual Property Requirements

This subsection outlines the key copyright principles that AHRQ staff, grantees, and contractors need to understand as they develop print and Web-based documents. It provides links to sites that provide authoritative information on these issues. Sample forms for obtaining permissions and implementing licensing agreements are provided in Appendix 1-A.

Statutory Basis of Copyright

U.S. Code, Title 17—Copyrights. The statute states that articles, books, photographs, and other copyrightable materials (such as software) belong to the authors upon creation or to the persons or institutions to which they have assigned the copyright.

International Copyright

Copyright protection in a particular country depends on the laws of that country. However, most countries offer copyright protection to foreign works according to international copyright treaties and conventions. If you are seeking foreign protection for a product, consult International Copyright Relations of the United States (PDF File, 833 KB) a publication of the U.S. Copyright Office, which lists the major bilateral and multinational agreements and countries that are parties to specific agreements.

Signing Copyright Forms—Duties of Federal Employees

Employees of the Federal Government who submit articles to journals for publication must not assign copyright to the journal. Work done by Federal employees is not protected by the Copyright Act, and copyright ownership cannot be transferred. The following statement should be used if a Federal employment option is not provided on the journal’s copyright form:

I was an employee of the U.S. Federal Government when this work was completed and prepared for publication. Therefore, it is not protected under the Copyright Act, and copyright ownership cannot be transferred.

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Reprinting Copyrighted Materials

Fair Use

A common issue for government employees, grantees, and contractors is the use of material from copyrighted publications in reports or documents to be published by AHRQ. The ability to directly quote short passages of text relevant to a particular point is protected under the Fair Use doctrine. Short passages (typically several paragraphs or less) can be quoted without permission, but the copyrighted sources must be indicated in the text or by a footnote or endnote. The ideas from a copyrighted publication can be summarized in your own words, but the author(s) of the original idea should be referenced.

Excerpting Content

Copyright must be taken into account when reproducing material written by others, including tables and figures that were first published in copyrighted publications, photographs and illustrations, software applications, and multimedia content. To use any of these materials, the AHRQ-associated author needs written permission from the copyright holder to reproduce the item. A copy of the permission must accompany any document delivered to AHRQ.

In some cases, the copyright holder, often a journal or book publisher, may charge a fee to use the material. At a minimum, copyright holders will require the reprinted item to run with a statement, such as "Reprinted with permission from J Reason. Human Error. New York: Cambridge University Press, 1990, p.175."

Tables, Graphs, and Figures

If you create a diagram, graph, or a new table using only part of the data from a copyrighted source, you may be able to cite the item without asking for permission to reprint. If changes are minor and you are using most of the original content, request permission from the source to adapt the material. The changes have to be significant so that the item is sufficiently different than its source to be considered a distinct product. Once permission to adapt the material is received, the item would appear with a statement along the lines of, "Adapted from Donabedian A. Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment. Volume I. Ann Arbor, MI: Health Administration Press, 1980."

Photographs

Permission is needed to reproduce photographs that are under copyright protection. An exception to this is if the photo is in the public domain (for example, if it was taken specifically for the Federal Government’s use or if it is old enough to be out of copyright). With regard to photographs under copyright protection, you first must determine who owns the rights to the image. Sometimes, the photographer, not the publisher, retains the copyright. The credit line under the picture in a book or journal/magazine/newspaper article should state who the copyright owner is, if it is not held by the publisher. For AHRQ publications, photographs should be accompanied by a notice, for example, "Copyright [or ©] 1956, Time-Life Books." If the photographer’s name is known, it should be part of the credit line as well (e.g., "Photograph by Ansel Adams, copyright 1967 by National Geographic."). A sample permission form for the use of photographs is provided in Appendix 1-A.

Digital and Electronic Content

Digital or electronic content is subject to the same protections as print products with some additional provisions specific to online resources. Consult with AHRQ on licensing and permission considerations for the development of electronic databases or Web-based tools.

Reprinting From the Internet

Special care is needed when excerpting or reprinting material from Web sites. Current copyright law suggests that posted material is considered to be under copyright by the author immediately upon its creation, even if no copyright notice is given. Ask permission to reprint posted messages if an email address is given for the author; otherwise, cite the Web site and the date of posting, if indicated.

For both text and graphics, the original source should be consulted to ensure the accuracy of quoted or copied material found on a Web site other than that of the original writer or publisher. Text may have been misquoted, and photographs and other graphics may have been altered.

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Copyright of Grantees' Work

Grantees may copyright their work, such as tools and products; however, the Federal Government has the right to use the work for its own purposes, as long as it does not distribute the products outside the Agency.

Licensing Agreements

In general, contractors may not copyright products they create on behalf of AHRQ because contract deliverables are the property of the Federal Government.

However, contract project officers may, in certain circumstances, elect to allow contractors to share rights to the materials by negotiating a licensing agreement after AHRQ receives the deliverable. In these situations, the contractor retains the copyright and the Federal Government has the license to disseminate the products. The Federal Government must indicate who holds the copyright for the tools and products. The licensing agreement can be in the form of a letter. (Go to a sample form in Appendix 1-A.)

When the Agency distributes the material, it will include a disclaimer and copyright notice in the packaging. For further information contact the OC managing editor assigned to the project..

Copyright Notices

A notice should be provided of the existence of copyrighted material, as follows:

• When an entire print or electronic document is copyrighted, the notice should be placed on the back of the title page or in another appropriate location in the front matter. (Refer to the Public Domain Notice section above.)
• When copyrighted material pertains only to particular photographs, tables, illustrations, or other graphic materials, an abbreviated copyright notice should be placed directly under the copyrighted item.
• For DVDs and other electronic media, the notice should be included in the sleeve or wallet.

A sample copyright notice follows for use in situations where AHRQ has concluded a licensing agreement for the use of a copyrighted product:

"The (description of item), (title of product), is the intellectual property of (name of organization). The Agency for Healthcare Research and Quality (AHRQ) has a nonexclusive, royalty-free, worldwide license to use and disseminate the work and to authorize others to use it in their delivery of health care or for quality improvement and educational purposes. The author/owner hereby assures health care professionals, physicians, nurses, and hospital systems that use of the (description of item), distributed by or through AHRQ, in their practices is permitted. Each user is granted a royalty-free, non-exclusive, non-transferable license to use the product in accordance with the guidance contained in the work.

The product may not be changed in any way by any user. The product and its contents may be used and incorporated into other (training/educational/specify) programs on the condition that no fee is charged by the reproducer of the product or its contents for its use. The product may not be sold for profit or incorporated in any profit-making venture without the expressed written permission of (name of author/owner organization/copyright holder)."

Additional Protections for Materials Published by HHS and its Agencies

In addition to copyright protections for some AHRQ products, reprinting of AHRQ (and other HHS or HHS Agency) publications without permission for commercial purposes is also prohibited under a section of the Social Security Act (42 United States Code  1320b-10). Although originally written to prohibit commercial use of Social Security and Medicare logos for commercial purposes, another paragraph in the subsection describing “Prohibited Acts” covers all HHS publications bearing a Departmental or Agency logo:

2(B) No person may, for a fee, reproduce, reprint, or distribute any item consisting of a form, application, or other publication of the Department of Health and Human Services unless such person has obtained specific, written authorization for such activity in accordance with regulations which the Secretary shall prescribe.

Violators of this section of the Social Security Act can be fined up to $5,000 per printed or electronic copy sold without permission—and even more for commercial use or audio-video materials.

If a staff member, grantee, or contractor finds a commercial publisher or bookseller reprinting AHRQ-funded reports and selling them for a profit, please alert the AHRQ Office of Communications. If the use was not with permission, the Office of  Communications will contact the Office of the General Counsel to take appropriate action.

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Documenting and Filing Permissions

AHRQ requires authors to provide to the OC managing editor a copy of the written permission they received to use copyrighted material; also, to give credit to the copyrighted source in a footnote. Example:

Source: World Health Organization, 1990. Used with permission.

The complete citation for the source of the copyrighted material should be included in the reference list. If a table or figure is compiled from data from a number of sources, each source should be listed in a footnote at the bottom of the item, and the complete citation should be included in the reference list. Indication should be given if the table or figure has been adapted.

Samples of copyright permission forms are provided in Appendix 1-A.

Trademarks and Trade Names

• Registered trademarks must be reflected in print or Web copy by using the ™ or ® symbols. Use the symbols on first mention in each chapter and in major headings.
• Trade or brand names of drugs or products must be avoided. For a trademarked or a brand name of a drug, use the generic name whenever possible. Use the Physicians' Desk Reference® to determine the drug's generic name.
• Any constraints on using the materials must be specified.
• For information about trademarks, go to Appendix 1-B.

Additional Information

Additional information on copyright and the use of copyrighted materials can be obtained from the U.S. Copyright Office, which has links to copyright management organizations, such as the Copyright Clearance Center. The Copyright Clearance Center helps businesses and academic institutions pay fees for uses of copyright material that do not fall under the Fair Use protections. The AHRQ Information Resources staff collaborates with  the Copyright Clearance Center.

AHRQ staff authors, project officers, and contractors should work with managing editors in AHRQ’s Office of Communications to help them decide what permissions are needed for their project.

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Authorship and Credit

Listing Authors With Their Affiliations

A separate list of authors with their affiliations may also be provided in the front matter of a scientific or technical report.

Listing Credentials After an Author's Name

The professional credentials listed after an author’s name help establish a publication’s credibility. They should be relevant to the topic, the intended audience, and the author’s contribution to the publication. Editors should be guided by the author’s preferences.

Credentials should be listed in the following order:

• Academic and professional degrees, with the higher-ranked degree first.
• Licenses or other State-issued designations.
• Professional certifications.
• Honors, including fellowships in honorary societies.

As a general rule, no more than three credentials should be given.

Acknowledgments

Acknowledgments are optional. Short acknowledgments can be included in the front matter; longer lists of acknowledgments may warrant an appendix. Acknowledgments should describe briefly the specific substantive contribution an individual or organization made. They should call attention to special efforts, and should avoid suggesting that individuals are being thanked for performing their paid duties. Do not include AHRQ staff. The acknowledgments may recognize contractor affiliation, but no outside logo may be used. For example:

We thank John Doe, Ph.D., Professor of Environmental Health Sciences at the XXX School of Public Health, and Jane Roe, M.D., M.Sc., Associate Professor of Medicine at the XXX School of Medicine, for their valuable advice on this document.

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Editorial Style, Usage, and Punctuation

Resources

Style Manuals

• Government Printing Office style. AHRQ follows the U.S. Government Printing Office (GPO) Style Manual.
• AMA Manual of Style. For issues of scientific and medical usage not addressed by GPO, we ask you to refer to the American Medical Association Manual of Style.
• Publication Manual of the American Psychological Association. Refer to this manual for social science terminology and usage.
• Associated Press Stylebook. Refer to this manual for materials such as press releases intended for publication in newspapers, magazines, and other journalistic outlets.

Dictionaries

• Standard English usage. We suggest Webster's Third New International Dictionary.
• Medical usage. We suggest Dorland's Illustrated Medical Dictionary.

Quick Tips on Usage and Style

The following sections list helpful tips from GPO, along with AHRQ style preferences.

General Usage and Stylistic Considerations

• Data. The word "data" takes a plural verb. "Datum" is the singular form of data.
• Sex versus gender. "Sex" refers to male or female physical characteristics. "Gender" distinguishes masculine and feminine social roles.
• People versus persons. "People"—not persons—is the plural of "person." Exception: do not correct this in article or book titles in reference lists.
• Comparisons. Say "compared with" not "compared to."
• Use. Not utilize.
• Subjects without content. Avoid beginning sentences with "it" or "this" when "it" or "this" has no referent.
• Prevention. Say "preventive," not "preventative."

Statistical Usage

• p-values. We prefer lower case regular (p<0.05).
• Confidence intervals. Use 95% CI, 3.0 to 6.1. This format makes it clear that the interval is a range; it also prevents confusion between negative signs and hyphens.
• Probabilities. When comparing probabilities, be precise. Use "[however many times] as likely" rather than "more likely," "less likely," or "very likely." (Example: Say the odds of getting cancer = 5.7/1000 for women and 17/1000 for men. This means that men are about 3 times as likely to get cancer as women.)
• Comparisons. To achieve precision and enable the reader to imagine the importance of your results, report them in comparative terms to describe the magnitude of effect (units, relative risks, absolute terms), when applicable. For example, if the risk of cancer in men is 3/1000 and the risk in women is 6/1000, then the relative risk for women is 2 (twice the risk in men). Use all three terms to provide a full description.
• Significance. Ensure that terms such as "inconclusive," "inadequate," "insufficient," "inconsistent," and "significance" are used consistently and correctly. "Statistical significance has a precise meaning.
• Equivalence. Use the technical terms "equivalent," "noninferior," and "superior" appropriately.

Medical Usage

• Medical language should be precise. In this example—"as shown on mammography or other imaging"—the techniques are doing the showing and not the images produced by them. A more accurate description would be: "as shown on a mammogram or other radiographic image."
• Cancer is a general term referring to both carcinomas and sarcomas.
• Taxonomic terms are always italicized (e.g., Clostridium difficile or C. difficile). Note that the term is spelled out at first usage.
• Patients and study subjects should be described with humane language:
  • Diabetic patients or patients with diabetes, rather than diabetics.
  • The treatment failed to alleviate the patient's symptoms, rather than the patient failed treatment.
  • The patient reported chest pain, rather than the patient complained of chest pain.

Titles of Reports

Titles of reports should be brief yet informative. The following tips should help achieve this goal:

• If possible, keep the title to a maximum of 10 words. A short subtitle is optional.
• In general, do not use acronyms in titles. However, if spelling out a term would make the title too long or incomprehensible, or if the acronym is so familiar to the audience that the spelled-out term would be awkward, use the acronym rather than the spelled-out term. Never use both spelled-out term and acronym in a title. (For the purposes of this rule, headings are treated like text, not like titles.)

General Punctuation

• Spacing at end of sentences. Use a single space after the period at the end of a sentence.
• Serial comma. For elements in a series, use a comma before the conjunctions "and," "or," and "nor" (e.g., dog, cat, and bird).
• Et al. Use a comma before "et al." in a reference list (more information is under References).
• Em dash. Use an em dash (—), with no spaces before or after, to separate phrases or clauses from the rest of a sentence.
• En dash. Use an en dash (–) for compound terms when one element of a compound is itself a multi-word element (e.g., New York–New Jersey bridge), and for numeral ranges (e.g., 10–20 or 1999–2000) within the body of the text. (In a reference lists, use hyphens for ranges of pages.)

Bulleted Lists

For a simple list consisting only of words or phrases, do not use periods at the end of the items:

The store has three locations:

• Silver Spring
• Wheaton
• Rockville

If the list contains full sentences, include periods at the end of each item:

The man noticed three things in the waiting room:

• The clock was slow.
• The plants needed to be watered.
• The magazines were dated 1985.

If one item in a list requires a period, all items get periods:

The researchers were very interested in three topics:

• Health care quality.
• Grants.
• The National Healthcare Disparities Report. The Agency for Healthcare Research and Quality publishes this report annually.

Hyphens

• Hyphenate descriptive words when they modify a noun (e.g., lipid-modifying treatment, patient-centered communication, core-needle biopsy).
• Hyphenate the following words only when they are used as modifiers (e.g., long-term care).
  • In-depth analysis.
  • Long-term care.
  • Short-term memory.
  • Up-to-date statistics.
• Do not hyphenate adverbs when they are used descriptively with an adjective (e.g., developmentally based models, clinically relevant dose).
• Use hyphens for ranges of pages in reference lists. (Use en-dashes for numeral ranges within the body of text.)

Hyphenated Prefixes

Prefixes are not hyphenated in AHRQ style, unless the compound produces an unreadable or ambiguous word, or the original word is a proper noun, for example:

• Anti (e.g., anticoagulant; but anti-inflammatory, anti-AIDS).
• Co (e.g., codirector, but co-occurrence).
• Non (e.g., nonopioid, but non-Hispanic).
• Post (e.g., postsurgical, postmarketing; but post-test, post-Darwinian).
• Pre (e.g., preterm).
• Re (e.g., rebiopsy; but re-creation vs. recreation).

Compound Words

• The following appear as one word:
  • Database.
  • Dataset.
  • Decisionmakers.
  • Decisionmaking.
  • Email.
  • Followup (one word if used as a noun, but two words if used as a verb, such as "the doctor will follow up with you in a few days").
  • Online.
  • Policymakers.
  • Policymaking.
• Words beginning with "anti," "non," or "co" are used as compounds unless the compounding produces an unreadable or ambiguous word. (e.g., prefer anti-inflammatory. Refer to the section under Hyphens.)
• Do not compound the following:
  • Use "health care" as two words, except in the Agency's name or if it is used as one word in official titles.
  • Quality of life, except when used as an adjective (quality-of-life outcomes).
  • Web site, Web conference.

Acronyms

• Define all acronyms in the text at the first mention in each chapter or major report section (i.e., in the text or headings but not the title).
• The first usage should be followed by the acronym in parentheses—for example, angiotensin-converting enzyme inhibitors (ACEIs).
  • Exception: do not define HIV/AIDS.
• After first usage, use the acronym consistently.
• Use acronyms judiciously. If a term is used only a handful of times in a document, an acronym may not be necessary.
• Avoid using "the" before the acronyms AHRQ, FDA, and NIH.
• List all acronyms and abbreviations at the bottom of figures and tables.

Abbreviations

• Spell out standard medical abbreviations—such as SAMe (S-adenosyl methionine), HbA_1c (hemoglobin A_1c), MRSA (methicillin-resistant Staphylococcus aureus)—at first usage. In general, place the spelled-out version first, followed by the abbreviation in parentheses. (There may be exceptions, when the abbreviation is the focal point of the sentence.)
• Spell out "United States" when used as a proper noun. Use the abbreviation "U.S." when used as an adjective.
• Spell out these standard abbreviations when they are in text and abbreviate them when they are within parentheses:
  • Et cetera (etc.).
  • For example (e.g.).
  • That is (i.e.).
  • Versus (vs.).
• Be careful to distinguish between e.g. (an example from a larger class) and i.e. (an explanation of the term that has been described in the preceding phrase).
• Spell out "percent" in text, but use % in tables, figures, charts, graphs, and parentheses.

Numerals

• Use numerals for time, measurement, and money (e.g., 2-year followup, 4 weeks, 4 percent, 10 cm, $5 million) and for the number 10 and greater. Write out everything else (six cats, nine oranges, three-ply, fivefold).
• Use numerals for ordinal numbers beginning with 10th (in text and footnotes).
• Numerals are also preferred in charts and in parentheses; for example (n=3 studies).

Capitalization

• Avoid long strings of capitalization, bold, and italics in text.
• Capitalize the following in text as well as headings:
  • The titles and subtitles of the report.
  • The words Federal, State, Nation, and Federal Government. However, do not capitalize nationwide, statewide, local, or federally.
  • Capitalize the Web in "Web site" and "Web conference." Also capitalize Webcast, Weblog, and Webinar, as one word.
  • Capitalize offices and officers related to AHRQ programs when used as titles: e.g., John Doe, Project Officer; Mary Roe, Task Order Officer.
• In titles and headings, capitalize the following:
  • Prepositions with four or more letters (With, From, Between).
  • All 4-letter demonstrative pronouns (This, That).
  • All 2- and 3-letter verbal forms (To [in an infinitive], Am, Be, Is, Was, Has, Have).
  • Each word in a hyphenated term with initial caps (Off-Label Use of Drugs).
    • Exception: Evidence-based Practice Centers.
• Do not capitalize in text:
  • The words "syndrome" and "disease" (e.g., Prader-Willi syndrome, Paget disease).
  • Medical conditions (e.g., type 2 diabetes).

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Citations, Reference List, Footnotes, and Bibliography

Citation Style

For citations and reference lists, AHRQ uses its own modification of the Vancouver Style^®, which is similar to PubMed. A detailed explanation follows of how sources should be cited.

Rules for Citing Sources

For the in-text citations:

• Assign each source a number, in the order in which it is referred to in the text. When the same source is cited a second time, it retains its number.
• Provide a source or attribution for all statements of fact. For example, "Only two studies^1,2 showed a positive outcome for this treatment approach."

For the reference list:

• Format all references in AHRQ style; do not use the reference style of the source material.
• Cite in the reference list every reference used in the text.
• Ensure that every reference in the reference list is cited in the text.
• List only the first three authors, followed by a comma, then et al.
• Separate inclusive page numbers by a hyphen.
• To facilitate retrieval, add a document identifier if one is available, such as a PMID number for journal articles indexed by PubMed, an NTIS number for government reports, or a digital object identifier (DOI) for Web documents.

Cross-check to ensure that every reference used in the reference list is cited in the text and vice versa.

Citation Management Software

The use of reference management software, such as Procite^®, EndNote^®, or Reference Manager^®, is recommended.

Citing Journals

• Author name(s) followed by initials (no periods). List up to three authors and then add a comma followed by "et al." Period at the end of the author list.
• Full title of article, including subtitles, followed by a period. Sentence capitalization.
• Title of journal, abbreviated in Index Medicus style, followed by a period. However, do not italicize the journal title. (This is a deviation from Index Medicus style.)
• Year (month optional), followed by a semicolon, no space after.
• Volume, issue (optional, in parentheses), and page numbers; no spaces. Use a hyphen for a range of numbers.
• Add the PubMed identification (PMID) number to the end of each reference found in PubMed. This unique identifier can be obtained simply by searching for the reference in PubMed. Having it makes future retrieval easier.

Example: standard journal citation:

Ouchida K, LoFaso VM, Capello CF, et al. Fast forward rounds: an effective method for teaching medical students to transition patients safely across care settings. J Am Geriatr Soc 2009 May;57:910-7. PMID: 19368582.

Example with more than three authors:

Lesselroth B, Adams S, Felder R, et al. Using consumer-based kiosk technology to improve and standardize medication reconciliation in a specialty care setting. Jt Comm J Qual Patient Saf 2009 May;35(5):264-71. PMID: 19480380.

Note: The issue number is optional.

Example of a policy statement in a journal, where a committee is the author:

American Academy of Pediatrics, Medical Home Initiatives for Children With Special Health Care Needs Project Advisory Committee. The medical home [policy statement]. Pediatrics 2002 July;110(1):184-6. PMID: 12093969.

Note: The issue number is optional.

Example of an article where individuals are writing as participants in a program (the CERT at U. of Penn.). Because this journal may be unfamiliar, spelling out the institution’s name may help the reader recognize the source:

Strom BL, Schinnar R; Center for Education and Research on Therapeutics, University of Pennsylvania. Evaluating health information technology's clinical effects. Leonard Davis Institute of Health Economics (LDI). LDI Issue Brief 2011 Feb;16(4):1-4. PMID: 21365962.

Note: In the example above, a semicolon is used to separate the individual authors from the institutional author.

Example of an article in a journal supplement, with a related discussion:

Hadley J. Sicker and poorer—the consequences of being uninsured: a review of the research on the relationship between health insurance, medical care use, health, work, and income. Med Care Res Rev 2003;60(2 Suppl):3S-75S; discussion 76W-112S. PMID: 12800687.

Example of an editorial in a journal:

Alberts ME. Immunization [editorial]. Iowa Med 1989 Oct;79(10):489-93. PMID: 2807831.

Example of a magazine article without a by-line:

"Teach back" technique improves patient safety. Patient Education Management 2007 April;44-5.

Citing Database Reviews and Other Public Health Publications

Use standard PubMed formats for the following kinds of documents, but do not italicize the journal titles:

• Database Reviews:
  

  Somaraju UR, Tadepalli K. Hematopoietic stem cell transplantation for Gaucher disease. Cochrane Database Syst Rev 2008;(1):CD006974.

• Other Public Health Publications:
  

  Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults: United States, 1999. MMWR Morb Mortal Wkly Rep 2001;50:120-5. PMID: 11393491.

Citing Books

• Author name(s) followed by initials (no periods after initials). Comma between each author. After three authors, use a comma followed by "et al."
• Title. Use title capitalization for the title of a work as a whole; sentence capitalization for titles of parts—chapters, articles in a series, etc.
• City of publication (followed by a colon), publisher (followed by a semicolon), and date. For the State, (used only when location of city is not clear), use the two-letter U.S. Postal Service abbreviation.
• Use a period to separate each of the three major elements above (author, title, and publication information).

Examples: books with an individual author:

Perrin PG, Smith GH. The Perrin-Smith Handbook of Current English. Chicago: Scott, Foresman; 1962.

Arthur J. Lean Six Sigma Demystified: A Self Teaching Guide. New York: McGraw Hill; 2007.

Example: book with an institutional author:

Beth Israel Hospital. Obstetrical Decision Making. Philadelphia: B.C. Decker; 1987.

Example where both the city and State are needed:

Dennis P. Lean Production Simplified: A Plain-Language Guide to the World's Most Powerful Production System. University Park, IL: Productivity Press; 2002.

Citing a Chapter in a Book or an Article in a Compendium

Note: The parts are in sentence case capitalization; the whole is in title case capitalization.

Examples: chapter in a book:

Cassidy JT, Pefty RE. Basic concepts of drug therapy. In: Textbook of Pediatric Rheumatology. 2nd ed. New York: Churchill-Livingston; 1990:chapter 3.

Pesce MA. Laboratory testing in infants and children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders Elsevier; 2007:chapter 714.

Note: Inclusive page numbers are preferred; the chapter is a less desirable alternative.

Examples: volumes in a series:

Rombeau JL, Caldwell MD, eds. Parenteral Nutrition. In: Clinical Nutrition, vol. 2. Philadelphia: Saunders; 1986.

Note: The designation ed./eds. is abbreviated.

Merritt CRB. Breast imaging techniques. In: Putnam CE and Ravin CE, eds. Textbook of Diagnostic Imaging, vol.3. Philadelphia: Saunders; 1988:2118-20.

Example of a reference with specific page numbers:

Anthony D, Chetty VK, Kartha A., et al. Re-engineering the hospital discharge: an example of a multifaceted process evaluation. In: Henriksen K, Battles JB, Marks ES, et al., eds. Advances in Patient Safety: from Research to Implementation, vol. 2. Rockville, MD: Agency for Healthcare Research and Quality; 2005:379-94.

A volume in an AHRQ series posted on the Web:

Shojania K, McDonald K, Wachter R, et al. Care coordination. In: Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, vol. 7. AHRQ Publication No. 04(07)-0051-7. Rockville, MD: Agency for Healthcare Research and Quality; 2007. www.ahrq.gov/clinic/tpcaregaptp.htm. Accessed November 5, 2010.

Citing Scientific and Technical Reports From Government Agencies

• Author name(s). Use "et al." after three authors. Insert a comma before "et al."
• Title of the article and/or individual publication within a series. Title capitalization for full-length reports.
• Name of the series.
• Publication or acquisition number.
• City (and state if necessary) of publication, followed by a colon.
• Agency or organization responsible for the series, followed by a semicolon.
• Date of publication.
• DOI number, if available.
• Statement of online availability, if applicable.

Examples: Reports with individual or institutional authors:

Cohen S. Sample design of the 1997 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 11. AHRQ Publication No. 01–0001. Rockville (MD): Agency for Healthcare Research and Quality; 2000.

National High Blood Pressure Education Program Working Group. Working Group Report on High Blood Pressure in Pregnancy. NHBPEP Publication No. 00–3029.Washington, DC: National Heart, Lung, and Blood Institute; 2000.

Example: Citation with DOI number:

Schiraldi GR. Post-traumatic stress disorder sourcebook: a guide to healing, recovery, and growth [Internet]. New York: McGraw-Hill 2000 [cited 2006 Nov 6]. 446 p. Available from: http://books.mcgraw-hill.com/getbook.php?isbn=0071393722&template=#toc doi:10.1036/073732658

Example: AHRQ compilations for which there are no authors:

Methods Guide for Effectiveness and Comparative Effectiveness Reviews. AHRQ Publication No. 10(11)-EHC063-EF. Rockville, MD: Agency for Healthcare Research and Quality; March 2011. Chapters available at http://www.effectivehealthcare.ahrq.gov.

Industrial and Systems Engineering and Health Care: Critical Areas of Research. Final Report. AHRQ Publication No. 10-0079. Rockville, MD: Agency for Healthcare Research and Quality; May 2010.

Citing Grant or Contract Reports

• Author name(s).
• Full title of the report. Title capitalization.
• Status of the report, if given (final, draft, preliminary).
• Grantee or contractor.
• Grant or contract number.
• Publication or acquisition number.
• City of publication.
• Agency for which the report was prepared.
• Date (year with first three letters of month).

Example: grant or contract report:

Schachter H, Resiman J, Tran K, et al. Health Effects of Omega-3 Fatty Acids on Asthma. Evidence Report/Technology Assessment No. 91. Prepared by University of Ottawa Evidence-based Practice Center under Contract No. 290–01–0021. AHRQ Publication No. 04–E013–2. Rockville, MD: Agency for Healthcare Research and Quality; July 2004.

Example: series of case studies published under contract to AHRQ [from Julius]:

Schneider K, Nichols L, Stevens C, et al. Success Stories from the AHRQ-Funded Health IT Portfolio (2009). Prepared by John Snow, Inc., under Contract No. HHSA 2902009000181. AHRQ Publication No. 10-0095-3-EF. Rockville, MD: Agency for Healthcare Research and Quality; November 2010.

Citing Dissertations and Theses

• Author name.
• Full title of the report. Title capitalization.
• Publication type.
• Location and name of institution.
• Date of publication.

Example: dissertation:

Youssef NM. School Adjustment of Children With Congenital Heart Disease [dissertation]. Pittsburgh: University of Pittsburgh; 1988.

Example: thesis

Devins GM. Helplessness, Depression, and Mood in End-Stage Renal Disease [master's thesis]. Montreal, Quebec: McGill University; 1981.

Citing Conference Proceedings

• Editor names(s).
• Title of publication. Title capitalization.
• Title of conference. Title capitalization.
• Dates and place of conference.
• City of publication, publisher, and date of publication.

Example: conference proceedings:

Vivian VL, ed. Child abuse and neglect: a medical community response. First AMA National Conference on Child Abuse and Neglect; 1984 Mar 30–31; Chicago. Chicago: American Medical Association; 1985.

In addition, papers presented at meetings should begin with:

• Author name(s).
• Full title of paper. Sentence capitalization.

Example: conference paper:

Harley NH. Comparing radon daughter dosimetric and risk models. In: Gammage RB, Kaye SV, editors. Indoor Air and Human Health. Proceedings of the 7th Life Sciences Symposium; 1984 Oct 29–31; Knoxville, TN. Chelsea (MN): Lewis Publishers; 1985:69-78.

Example: conference abstract:

Lunin LF. Organizing for information interaction in a radiology department [abstract]. In: Petrarca AE, ed. Information Interaction. Proceedings of the 45th ASIS Annual Meeting; 1982 Oct 17–21; Columbus, OH. White Plains (NY): Knowledge Industry Publications, Inc.; 1982:179-80.

Citing a Publication With No Listed Author

When no author is listed for a reference, list the reference alphabetically by title (excluding "A," "An," or "The" if it is the first word). For government documents, the publishing agency often will be listed as the report author.

Citing Nonprint Data, Including Web Citations

When nonprint data are used, give the following information as applicable and available:

• Author name(s) followed by initials (no periods). Comma between each author. After three authors, use a comma followed by "et al."
• Title. Use title capitalization for the title of a work as a whole; sentence capitalization for titles of parts—chapters, articles in a series, and so forth.
• Type of medium (CD, DVD, and so forth).
• Source of data.
• Availability information (for example, Web URL).
• Date accessed, if a Web product.

Example: Web citation:

Hsiao C-J, Beatty PC, Hing ES, et al. Electronic Medical Record/Electronic Health Record Use by Office-based Physicians: United States, 2008 and Preliminary 2009. Centers for Disease Control and Prevention, National Center for Health Statistics. www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.pdf. Accessed January 7, 2010.

Example: part of database:

Sestini P, Renzoni E, Robinson S, et al. Short-acting beta 2 agonists for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2002(4):CD001495.

Example: Web site:

Use the following simplified format:

www.ahrq.gov/consumers. Accessed January 16, 2009.

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Footnotes

Footnotes should not be confused with references. The reference list at the end of a report is a list of sources cited in the report. Footnotes, on the other hand, are used primarily to provide an explanation that, if included in the text, would interrupt its flow. The following rules apply:

• Use footnotes sparingly.
• Use superscript letters rather than numbers.
• Tables and figures are likely to need footnotes, and may also include citations to the reference list. Cite the source by letter in the body of the table, provide an abbreviated reference at the foot of the table, and list the source(s) in the reference list.
• Provide an alphabetical list of all acronyms and abbreviations at the foot of the table.

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Bibliographies

A bibliography should be distinguished from a reference list. A reference list documents the sources of specific statements in the text of a literature review or report. A bibliography can serve various broader purposes: to document the sources used in developing a paper or report, whether or not they were discussed specifically in the text; to evaluate the opinions of others who have written on a topic; or to provide suggestions for further reading.

The structure of a bibliography will depend upon its purpose. Most often, it is arranged alphabetically by its first element: either by author, or in the case of a document without an author, by title.

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