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When I write say The Lancet in text and italicise it with em (when I should be using cite) I don't mean anyone to put on a fancy voice when reading it but I do intend to emphasise it by making it stand out of the text at a glance, and also to conform with publishing convention. If we used the cite tag and specified it in the CSS as italic it would probably be better and take care of all book and journal/magazine titles, and the rest would probably be pure emphasis of words in text.
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