Abshire, MD; et al. Rubino, MD; Frank L. Barbara P. Research Letter. Bates, BSc; Savannah K. Bindman, MD. Cohn, MD; Barbara E. A Piece of My Mind. Ghanem, MD, PhD. Niknam, BS; Jose R. Zubizarreta, PhD.
Lam, MD; Meghan R. Kuehn, MSJ. Biotech Innovations. Poetry and Medicine. Number references in the order they appear in the text; do not alphabetize. In text, tables, and legends, identify references with superscript arabic numerals. When listing references, follow AMA style and abbreviate names of journals according to the journals list in PubMed. For more examples of electronic references, click here. Such description should include appropriate references to the original literature, particularly for uncommon statistical methods.
For more advanced or novel methods, provide a brief explanation of the methods and appropriate use in the text and consider providing a detailed description in an online supplement.
In the reporting of results, when possible, quantify findings and present them with appropriate indicators of measurement error or uncertainty, such as confidence intervals see Reporting Standards and Data Presentation. Avoid relying solely on statistical hypothesis testing, such as the use of P values, which fails to convey important quantitative information.
For observational studies, provide the numbers of observations. For randomized trials, provide the numbers randomized. Report losses to observation or follow up see Missing Data.
For multivariable models, report all variables included in models, and report model diagnostics and overall fit of the model when available see Statistical Procedures. Define statistical terms, abbreviations, and symbols, if included. Avoid nontechnical uses of technical terms in statistics, such as correlation, normal, predictor, random, sample, significant, trend.
Do not use inappropriate hedge terms such as marginal significance or trend toward significance for results that are not statistically significant. Causal language including use of terms such as effect and efficacy should be used only for randomized clinical trials.
For all other study designs including meta-analyses of randomized clinical trials , methods and results should be described in terms of association or correlation and should avoid cause-and-effect wording.
For observational studies that use an established population, a power calculation is not generally required when the sample size is fixed. However, if the sample size was determined by the researchers, through any type of sampling or matching, then there should be some justification for the number sampled.
In any case, describe power and sample size calculations at the beginning of the Statistical Methods section, following the general description of the study population. It is generally not necessary to provide a detailed description of the methods used to generate summary statistics, but the tests should be briefly noted in the Methods section eg, ANOVA or Fisher exact test. Identify regression models with more than 1 independent variable as multivariable and regression models with more than 1 dependent variable as multivariate.
Report all variables included in models, as well as any mathematical transformations of those variables. Provide the scientific rationale clinical, statistical, or otherwise for including variables in regression models. Failure to account for such correlation will result in incorrect estimates of uncertainty eg, confidence intervals. Describe how the model accounted for correlation. For example, for an analysis based on generalized estimating equations, identify the assumed correlation structure and whether robust or, sandwich variance estimators were used.
Or, for an analysis based on mixed-effects models, identify the assumed structure for the random effects, such as the level of random intercepts and whether any random slopes were included. Fixed-effects estimation should be described as conditional likelihood.
Avoid the term fixed effects for describing covariates. Report losses to observation, such as dropouts from a clinical trial or those lost to follow-up or unavailable in an observational study. If some participants are excluded from analyses because of missing or incomplete data, provide a supplementary table that compares the observed characteristics between participants with complete and incomplete data.
Consider multiple imputation methods to impute missing data and include an assessment of whether data were missing at random. Approaches based on "last observation carried forward" should not be used. Comparisons arrived at during the course of the analysis or after the study was completed should be identified as post hoc.
For analyses of more than 1 primary outcome, corrections for multiple testing should generally be used. For secondary outcomes, address multiple comparisons or consider such analyses as exploratory and interpret them as hypothesis-generating. The reporting of all outcomes should match that included in study protocols. For randomized clinical trials, protocols with complete statistical analysis plans should be cited in the Methods section and submitted as online supplementary content see Reporting Clinical Trials.
Randomized clinical trials should be primarily analyzed according to the intention-to-treat approach. Deviations from strict intention-to-treat analysis should be described as "modified intention-to-treat," with the modifications clearly described.
At the end of the Methods section, briefly describe the statistical tests used for the analysis. State any a priori levels of significance and whether hypothesis tests were 1- or 2-sided. Also include the statistical software used to perform the analysis, including the version and manufacturer, along with any extension packages eg, the svy suite of commands in Stata or the survival package in R. Do not describe software commands eg, SAS proc mixed was used to fit a linear mixed-effects model.
If analysis code is included, it should be placed in the online supplementary content. If P values are reported, follow standard conventions for decimal places: for P values less than.
For secondary and subgroup analyses, there should be a description of how the potential for type I error due to multiple comparisons was handled, for example, by adjustment of the significance threshold. In the absence of some approach, these analyses should generally be described and interpreted as exploratory, as should all post hoc analyses.
For randomized trials using parallel-group design, there is no validity in conducting hypothesis tests regarding the distribution of baseline covariates between groups; by definition, these differences are due to chance. Because of this, tables of baseline participant characteristics should not include P values or statements of statistical comparisons among randomized groups.
Instead, report clinically meaningful imbalances between groups, along with potential adjustments for those imbalances in multivariable models. Restrict tables and figures to those needed to explain and support the argument of the article and to report all outcomes identified in the Methods section.
Number each table and figure and provide a descriptive title for each. Every table and figure should have an in-text citation. Verify that data are consistently reported across text, tables, figures, and supplementary material. Frequency data should be reported as "No. Whenever possible, proportions and percentages should be accompanied by the actual numerator and denominator from which they were derived.
This is particularly important when the sample size is less than Tables that include results from multivariable regression models should focus on the primary results.
Provide the unadjusted and adjusted results for the primary exposure s or comparison s of interest. If a more detailed description of the model is required, consider providing the additional unadjusted and adjusted results in supplementary tables. Do not duplicate data in figures and tables. For all primary outcomes noted in the Methods section, exact values with measures of uncertainty should be reported in the text or in a table and in the Abstract, and not only represented graphically in figures.
Bar graphs should be used to present frequency data only ie, numbers and rates. Avoid stacked bar charts and consider alternative formats eg, tables or splitting bar segments into side-by-side bars except for comparisons of distributions of ordinal data. Actual values not log-transformed values of relative data for example, odds ratios, hazard ratios should be plotted on log scales.
For survival plots, include the number at risk for each group included in the analysis at intervals along the x-axis scale.
For any figures in which color is used, be sure that colors are distinguishable. All symbols, indicators, line styles, and colors in statistical graphs should be defined in a key or in the figure legend. Axes in statistical graphs must have labels. Units of measure must be provided for continuous data. Note: All figures are re-created by journal graphics experts according to reporting standards using the JAMA Network style guide and color palette.
Use the table menu in the software program used to prepare the text. Avoid using tabs, spaces, and hard returns to set up the table; such tables will have to be retyped, creating delays and opportunities for error. Tables should be single-spaced and in a or point font do not shrink the point size to fit the table onto the page.
Do not draw extra lines or rules—the table grid will display the outlines of each cell. Each piece of data needs to be contained in its own cell. Do not try to align cells with hard returns or tabs; alignment will be imposed in the production system if the paper is accepted. Although individual empty cells are acceptable in a table, be sure there are no empty columns.
To show an indent, add 2 spaces. For additional detail on requirements for data presentation in tables, see Statistical Methods and Data Presentation. Place each row of data in a separate row of cells, and note that No. In a table, provide a footnote with the conversion factor to SI units. To present data that span more than 1 row, merge the cells vertically. For example, in Table 2 the final column presents the P value for overall age comparisons.
The table should be constructed such that the primary comparison reads horizontally. For example, see Table 3 incorrect and Table 4 correct. If a table must be continued, repeat the title and column headings on the second page, followed by " continued. Footnotes to tables may apply to the entire table, portions eg, a column , or an individual entry. The order of the footnotes is determined by the placement in the table of the item to which the footnote refers. When both a footnote letter and reference number follow data in a table, set the superscript reference number first followed by a comma and the superscript letter.
Use superscript letters a, b, c to mark each footnote and be sure each footnote in the table has a corresponding note and vice versa. Number all figures graphs, charts, photographs, and illustrations in the order of their citation in the text. The number of figures should be limited.
Avoid complex composite or multipart figures unless justified. For initial manuscript submissions, figures must be of sufficient quality and may be embedded at the end of the file for editorial assessment and peer review. If a revision is requested and before a manuscript is accepted, authors will be asked to provide figures that meet the requirements described in Figure File Requirements for Publication.
Graphs, charts, some illustrations, titles, legends, keys, and other elements related to figures in accepted manuscripts will be re-created and edited according to JAMA Network style and standards prior to publication. Online-only figures will not be edited or re-created see Online-Only Supplements and Multimedia. Preparation of scientific images clinical images, radiographic images, micrographs, gels, etc for publication must preserve the integrity of the image data.
Digital adjustments of brightness, contrast, or color applied uniformly to an entire image are permissible as long as these adjustments do not selectively highlight, misrepresent, obscure, or eliminate specific elements in the original figure, including the background. Selective adjustments applied to individual elements in an image are not permissible. Individual elements may not be moved within an image field, deleted, or inserted from another image.
Cropping may be used for efficient image display or to deidentify patients but must not misrepresent or alter interpretation of the image by selectively eliminating relevant visual information.
When inappropriate image adjustments are detected by the journal staff, authors will be asked for an explanation and will be requested to submit the image as originally captured prior to any adjustment, cropping, or labeling.
Authors may be asked to resubmit the image prepared in accordance with the above standards. Each figure for the main article may be uploaded as a separate file or appended to the end of the manuscript with the figure titles and legends. Note: If a revision is requested and before acceptance, authors must upload each figure for the main article as a separate file and follow the instructions in Figure File Requirements for Publication. See the Table of Figure Requirements for additional guidance for specific types of figures for suggested resolution and file formats.
In general each figure should be no larger than 1 MB. Each figure for the main article must be uploaded as a separate file. See the Table of Figure Requirements for additional guidance and file formats for specific types of figures. Files created by vector programs are best for accurately plotting and maintaining data points. JAMA Network journals are unable to use file formats native to statistical software applications to prepare figures for publication; most statistical software programs allow users to save or export files in digital vector formats.
Images created digitally by digital camera or electronically created illustrations must meet the minimum resolution requirements at the time of creation. Electronically increasing the resolution of an image after creation causes a breakdown of detail and will result in an unacceptable poor-quality image.
Each component of a composite image must be uploaded separately at submission and individually meet the minimum resolution requirement. Digital cameras capture images in RGB. Do not change any color settings once the file is on the computer. Black-and-white photographs eg, radiographs, ultrasound images, CT and MRI scans, and electron micrographs can be submitted in either RGB or grayscale modes. At the end of the manuscript, include a title for each figure.
The figure title should be a brief descriptive phrase, preferably no longer than 10 to 15 words. A figure legend caption can be used for a brief explanation of the figure or markers if needed and expansion of abbreviations. For photomicrographs, include the type of specimen, original magnification or a scale bar, and stain in the legend.
For gross pathology specimens, label any rulers with unit of measure. Digitally enhanced images must be clearly identified in the figure legends as enhanced or manipulated, eg, computed tomographic scans, magnetic resonance images, photographs, photomicrographs, x-ray films. Photographs, clinical images, photomicrographs, gel electrophoresis, and other types that include labels, arrows, or other markers must be submitted in 2 versions: one version with the markers and one without. Provide an explanation for all labels, arrows, or other markers in the figure legend.
The Figure field in the File Description tab of the manuscript submission system allows for uploading of 2 versions of the same figure. Refer to Categories of Articles because there may be a limit on the number of figures by article type. For images featuring patients or other identifiable persons, it is not acceptable to use black bars across the eyes in an attempt to deidentify. Cropping may be acceptable as long as the condition under discussion is clearly visible and necessary anatomic landmarks display.
Bar graphs are typically vertical but when categories have long titles or there are many of them, they may run horizontally. If the data plotted are a percentage or rate, error bars may be used to show statistical variability. Acceptable File Formats for Initial Submission:. Acceptable File Formats for Revision and Publication:. To demonstrate the relationship between 2 or more quantitative variables, such as changes over time. The dependent variable appears on the vertical axis y and the independent variable on the horizontal axis x ; the axes should be continuous, not broken.
To show participant recruitment and follow-up or inclusions and exclusions such as in a systematic review. To display the proportion or percentage of individuals represented on the y-axis remaining free of or experiencing a specific outcome over time represented on the x-axis.
The number of individuals followed up for each time interval number at risk should be shown underneath the x-axis. Each element should be described the ends of the boxes, the middle line, and the whiskers. Data points that fall beyond the whiskers are typically shown as circles. Provide indicators of both directions of results at the top of the plot on either side of the vertical line eg, favors intervention. Typically, proportionally sized boxes represent the weight of each study and a diamond shows the overall effect at the bottom of the plot.
To display quantitative data other than counts or frequencies on a single scaled axis according to categories on a baseline horizontal or vertical. Point estimates are represented by discrete data markers, preferably with error bars in both directions to designate variability. To show individual data points plotted according to coordinate values with continuous, quantitative x- and y-axis scales.
A curve that is generated mathematically may be fitted to the data to summarize the relationship among the variables. To explain physiological mechanisms, describe clinical maneuvers and surgical techniques, or provide orientation to medical imaging. To display clinical findings, experimental results, or clinical procedures, including medical imaging, photomicrographs, clinical photographs, and photographs of biopsy specimens.
Legends for photomicrographs should include details about the type of stain used and magnification. Authors may submit supporting material to accompany their article for online-only publication when there is insufficient space to include the material in the print article. This material should be important to the understanding and interpretation of the report and should not repeat material in the print article.
The amount of online-only material should be limited and justified. Online-only material should be original and not previously published. Online-only material will undergo editorial and peer review with the main manuscript. If the manuscript is accepted for publication and if the online-only material is deemed appropriate for publication by the editors, it will be posted online at the time of publication of the article as additional material provided by the authors.
This material will not be edited or formatted; thus, authors are responsible for the accuracy and presentation of all such material. Online-only material should be submitted in a single Word document with pages numbered consecutively.
Each element included in the online-only material should be cited in the text of the main manuscript eg, eTable in the Supplement and numbered in order of citation in the text eg, eTable 1, eTable 2, eFigure 1, eFigure 2, eMethods. The first page of the online-only document should list the number and title of each element included in the document. Online-only text should be set in Times New Roman font, 10 point in size, and single-spaced. The main heading of the online-only text should be in 12 point and boldface; subheadings should be in 10 point and boldface.
All references cited within the online-only document must be included in a separate reference section, including those that also were cited in the main manuscript. They should be formatted just as in the main manuscript and numbered and cited consecutively in the online-only material. Online-only tables should be inserted in the document and numbered consecutively according to the order of citation as eTable 1, eTable 2, etc.
The text and data in online tables should be Arial font, 10 point in size, and single-spaced. The table title should be set in Arial font, 12 point, and bold. Headings within tables should be set in 10 point and bold. Table footnotes should be set in 8 point and single-spaced. See also instructions for Tables above.
If a table runs on to subsequent pages, repeat the column headers at the top of each page. Wide tables may be presented using a landscape orientation. Online-only figures should be inserted in the document and numbered consecutively according to the order of citation as eFigure 1, eFigure 2, etc. Figure titles should be set in Arial font, 12 point, bold, and single-spaced. Text within figures should be set as Arial font, 10 point.
Figure legends should be set in 8 point and single-spaced. Graphs and diagrams should be exported directly out of the software application used to create them in a vector file format, such as. Image file formats such as. Photographs, including all radiological images, should be prepared as. Photographs should be inserted in the document with the "Link to File" button turned off. Wide figures may be presented using a landscape orientation. For editorial and review of an initial submission, submit videos according to the following specifications:.
For each video, provide an in-text citation eg, Video 1. At the end of the manuscript file, include a title a brief phrase, preferably no longer than 10 to 15 words and a caption that includes the file format and a brief explanation for each video.
The same title and caption must be entered in the designated fields in the manuscript submission system when uploading each video. If multiple video files are submitted, number them in the order in which they should be viewed.
This cohort study examines whether mammographic density is associated with an increased risk of contralateral breast cancer or ipsilateral breast tumor recurrence among women.
This cross-sectional study uses data from the Veterans Affairs Surgical Quality Improvement Project to examine changes in the autonomy of resident physicians in the operating room over the past 15 years. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. January , Vol , No. Fleisher, MD. Abstract Full Text. JAMA Surg. Polcz, MD, MS. Original Investigation.
Importance: In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability. Objective: To test the hypothesis that a long-term structured physical activity program is more effective than a health education program also referred to as a successful aging program in reducing the risk of major mobility disability.
Design, setting, and participants: The Lifestyle Interventions and Independence for Elders LIFE study was a multicenter, randomized trial that enrolled participants between February and December , who participated for an average of 2.
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