Recent replies to "JOURNAL CLUB: Cardiovascular Events during World Cup Soccer"

Reply from Linda Cooper

Linda Cooper — Tue, 29 Apr 2008 17:59:08 -0000

Maxine, I don’t know if I’ll be able to convince you of the merits of the Structured Abstract, but I’ll try!

I really like Structured Abstracts – from both the reader’s and author’s point of view because such abstracts are a logical way to tell a story about the research being reported. Furthermore, Structured Abstracts give authors a specific format to follow with pretty specific guidelines on what to include where. This helps keep methods in the Methods section, results in the Results section – and discussion out of the Results – for example.

If you object to the sub-headings (Introduction, Methods, Results, and Discussions), then they can be removed from the text before printing.

As a brief experiment, I’ve transformed an unstructured abstract into a structured one – so you can let me know which is more readable. (Kindly remember that this isn’t my area of expertise. The issue here is if the Structured Abstract leads to a clearer story of the findings.)

Here goes:

Original Unstructured Abstract

An Experiment of Nature: Brain Anatomy Parallels Cognition and Behavior in Williams Syndrome

Williams syndrome (WS) is a neurogenetic-neurodevelopmental disorder characterized by a highly variable and enigmatic profile of cognitive and behavioral features. Relative to overall intellect, affected individuals demonstrate disproportionately severe visual-spatial deficits and enhanced emotionality and face processing. In this study, high-resolution magnetic resonance imaging data were collected from 43 individuals with WS and 40 age- and gender-matched healthy controls. Given the distinct cognitive-behavioral dissociations associated with this disorder, we hypothesized that neuroanatomical integrity in WS would be diminished most in regions comprising the visual-spatial system and most “preserved” or even augmented in regions involved in emotion and face processing. Both volumetric analysis and voxel-based morphometry were used to provide convergent approaches for detecting the hypothesized WS neuroanatomical profile. After adjusting for overall brain volume, participants with WS showed reduced thalamic and occipital lobe gray matter volumes and reduced gray matter density in subcortical and cortical regions comprising the human visual-spatial system compared with controls. The WS group also showed disproportionate increases in volume and gray matter density in several areas known to participate in emotion and face processing, including the amygdala, orbital and medial prefrontal cortices, anterior cingulate, insular cortex, and superior temporal gyrus. These findings point to specific neuroanatomical correlates for the unique topography of cognitive and behavioral features associated with this disorder. (214 words)

Structured Abstract

Brain anatomy parallels cognition and behavior in people with Williams Syndrome

Introduction: People with Williams Syndrome, a developmental disorder of the nervous system, demonstrate a wide range of cognitive and behavioral abnormalities. Such individuals have severe visual-spatial deficits in combination with enhanced emotional reactions and an enhanced ability to recognize faces. We hypothesize that in affected individuals, the regions of the brain involved in processing visual and spatial information are diminished while those regions involved in emotion and face recognition are preserved or augmented.

Methods: We compared high-resolution magnetic resonance imaging data from 43 patients with Williams Syndrome to 40 age-and gender-matched healthy controls. Using volumetric analysis and voxel-based morphometry, we measured the neuroanatomical profile of patients with this condition and controls.

Results: In the regions of the brain that process visual and spatial information, those with Williams Syndrome had decreased gray matter volume and density, compared with controls. In regions of the brain that participate in emotion and face recognition, those with Williams Syndrome had increased gray matter volume and density, compared with controls.

Discussion: These findings reveal a correlation between the anatomical features of the brain and the cognitive and behavioral features associated with Williams Syndrome. (181 words)

Reply from Martin Fenner

Martin Fenner — Mon, 28 Apr 2008 19:45:26 -0000

The Cochrane review about technical editing I posted here last week also contains a section about structured abstracts. The authors identified 7 studies that looked at the readability of unstructured vs. structured abstracts. The studies suggest that structured abstracts are easier to read but longer. One of these studies can be found on PubMed Central: Quality of nonstructured and structured abstracts of original research articles in the British Medical Journal, the Canadian Medical Association Journal and the Journal of the American Medical Association.

I want to defend the statistics included in the abstract. They do not increase the readability, but they help with another problem that is common in clinical research papers. It used to be very difficult to summarize all papers about a specific problem in a systematic analysis because there was no standardized reporting. The CONSORT statement has improved this situation.

Reply from Maxine Clarke

Maxine Clarke — Mon, 28 Apr 2008 07:54:48 -0000

PS To address the far more vital point at issue here, watching football is not bad for stress levels so long as Liverpool or Carlisle win. If they don’t, then everyone’s stress levels go up, not just the watchers’ .

Reply from Maxine Clarke

Maxine Clarke — Mon, 28 Apr 2008 07:51:15 -0000

Martin—over the years we have regularly discussed whether to introduce structured abstracts at Nature, and so far we haven’t seen a compelling case, compared with a regular first paragraph written in the style shown in techicolour here. We have had various people fulminate at us for not publishing structured abstracts, to whom my usual response has been to challenge them to write a short article convincing Nature readers that they are a good thing (compared to what is there now). So far, nothing has made the cut, though we have certainly run Correspondence letters on the topic.

Heather—agree totally on the hype. But for a paper to qualify as truly “good” in my opinion, there has to be that crucial message to the reader: “this is what the landscape was like before you read my paper, and this is what it is like as a result of you having spared your valuable time to read it”. The peer-review and editing process will excise any hype that might have been present in the original submission. Too many papers leave the reader none the wiser as to how the advance has changed anything, althoug most of them allow the reader to understand the new result in its own little universe. What a general reader needs is a link from that small, closed universe to the bigger picture of the field. Personally, I don’t think this applies just to “general” journals like Nature, Science or PNAS, but to any report wherever it is published.

Reply from Bob O'Hara

Bob O'Hara — Mon, 28 Apr 2008 05:58:08 -0000

I like the structured abstract for studies like clinical trials or epidemiological studies like this one, where the interest is mainly in the results, and the methodology is standard (i.e. it can be summarised in one piece of jargon). It wouldn’t work so well for papers about modelling, or the weird sort of data we have to deal with in field biology.

I agree with Maxine and Richard that having all the statistics in teh absrtact is distracting (as is having a cat leap up in fromt of teh cmpute. OK, he’s in my lap now).

So, 1-1, and we’re in to extra time. I guess we should all read the paper itself now.

Reply from Richard Grant

Richard Grant — Mon, 28 Apr 2008 00:21:20 -0000

Personal opinion, as always: I thought the abstract was terrible. I detest the structured abstract favoured of medical journals, and p values have no place there.

Reply from Martin Fenner

Martin Fenner — Sun, 27 Apr 2008 21:19:13 -0000

Heather, you are of course right about the dangers of (spectator) baseball. The American League Championship Boston Red Sox vs. New York Yankees 2004 certainly produced a few heart attacks. And you can get hit by a baseball if you go to the ballpark (more details in this Japanese research paper). Maybe all that is part of the excitement.

And as you live in France, you can probably explain the lower myocardial infarction mortality in French men the day France won the 1998 World Cup of football. The French paper is also interesting as it allows to compare how the data are graphically displayed. I believe that good figures and tables are also part of a well-written paper.

Reply from Heather Etchevers

Heather Etchevers — Sun, 27 Apr 2008 20:10:21 -0000

@Martin: I am sure a similar study with baseball fans would come up with similar results. Try (spectator) golf.

Maxine wrote: I see this a lot in papers: one reads a good description of the problem and the result, but not enough about where the new result is going to lead, or how it changes what we knew before the study being reported.

How something changes what was known before the study is, I agree, helpful to see spelled out. But I would find speculation about where the new result might lead a little annoying, unless it is an explicit new hypothesis that not only the authors but the audience can tackle.

Not to wear out the sports metaphor.

Reply from Martin Fenner

Martin Fenner — Sun, 27 Apr 2008 16:55:06 -0000

Maxine, part of the reason I picked this paper is the structured abstract. They are becoming very common in medical journals, and I think that the format works in most of these cases. As the abstract follows the standard IMRAD (introduction, material and methods, results and discussion) format, this could be applied to other subject areas.

Nature and Science are of course notable exceptions and I wonder whether structuring a paper in the IMRAD format (with subheading for introduction, materials and methods, etc.) really helps with readibility or is just a convention.

And I agree that some numbers in the abstract are not helpful. The dates do not convey any important information. The numbers for relative risk and confidence intervals probably belong into the abstract.

As for the discussion and conclusions, it is obvious to me what should be done. Germans should stop being football fans and start watching sports that are less exciting, e.g. baseball or cricket. Or have the team loose in the first round, that’s just what happened the last two European Championships.

But seriously, I agree that the discussion could have been more imaginative. The study design was very clever, but the findings don’t really surprise anybody. Or maybe the authors have secretly set up an intervention study for Euro 2008?

Reply from Maxine Clarke

Maxine Clarke — Sun, 27 Apr 2008 14:59:40 -0000

I am at home (it is Sunday) so I cannot access the full text from your link or an internet search, Martin. I’ll be able to when I am in the office.

So, just to comment on the abstract. For me, the jury is still out on structured abstracts. An argument can be presented in a logical manner in a short abstract without the need for subheadings—for a medical study or other formalised study I can see the usefulness of a standard number of headings, and I know that text-mining processes are helped by them, so they are probably the way forward. However, as a human reader, I don’t find the subheadings particularly aid my comprehension in this example.

I agree that the language is very clear, one can easily grasp the problem, how they addressed it, their result and that they think something should be done. So full marks for all of that.

I don’t give them marks for all the numbers and symbols in the abstract. Purely as a reader, they are a distraction. Give me words any day. (I understand that the numbers are there for other reasons than pure accessibility of the abstract to the individual, nonspecialist reader such as myself.)

The other downside to me, a very common one, is that the authors don’t say what they think should be done, or to put it another way, where their research leaves the field. What is the next step as a result of their work? As you imply, the “intervention” could be that the people stop going to watch football matches. On a more realistic note, can’t the authors give us more of a hint after that great lead-up? Are they recommending a drug? Or a stress-reduction exercise—yoga before the match, type of thing?

I see this a lot in papers: one reads a good description of the problem and the result, but not enough about where the new result is going to lead, or how it changes what we knew before the study being reported.

I hope I don’t sound too negative, as this paper’s abstract certainly fulfils the main purpose of explaining to the reader why the problem is important and what the researchers found out. I am intrigued by what you write about the figure and will take a look at that when I am somewhere with access to the NEJM.