Questions From Users of the Manual

Q: How do you create a “thin space” in Word?

A: In Word, use the shortcut to the ¼ em space character under Insert/Symbol/Special Characters. The Unicode value for the ¼ em space is 2005, and it’s in the General Punctuation section of any Unicode font. The 1/6 em space is also used as a thin space; the Unicode value for that is 2006, and it’s also in the General Punctuation section of any Unicode font.

Q: Is it necessary to include http:// in a URL? What about www.? I like to avoid long strings for URLs and if it’s OK to shorten them, that’s what I’d like to do. 

A: The http:// in the URL is only necessary in text to ensure that the reader knows that the information provided is a website. If that information is clear from the context without http://, it is not necessary. To know whether www is necessary or not, you should try the URL without it. Some URLs require the www, while others will not work if www is added. To ensure that the URL is correct, you should check it on the Internet.

Q: Can you please tell me how many journals use the AMA Manual of Style?  Does a list of these journals exist?

A: I don’t have the data you request…and I’d certainly be interested myself. I can tell you that we’ve  sold  almost 30,000 copies of the print book, in addition to site licenses and individual subscriptions to the online book. Although this doesn’t answer your question precisely, the number of copies sold might be of some help.—Cheryl Iverson, MA

Questions From Users of the Manual

Q: How should columns with mixed units of measure indicate the unit of measure?

A: In a table with mixed units throughout, use a table footnote for the most common unit of measure, eg, “Unless otherwise indicated, data are expressed as number (percentage).” and specify in the stub or column head only those units that are different. In a table with mixed units in a single column, use the most common unit in the column head and only provide another unit in the table cell for those entries that have a different unit of measure.

Q: Because of the change from the 9th to the 10th edition in the way number and percentage are handled in running text (see page 832 in the 10th edition), should column headings in tables also be changed to read, for example, “No. of Girls (%)” rather than “No. (%) of Girls”?

A: No. The style “No. (%) of Girls” is still an acceptable table column head as here both “number” and “percentage” apply to “of girls,” whereas in the example on p 832, the percentage is given as more of an aside to the numerator and denominator and hence follows: “Death occurred in 6 of 200 patients (3%).”

Q: What recommendations do you have for the preferred typeface of a punctuation mark that follows copy set in something other than roman type?

A: Some specific recommendations are outlined below:

• If an entire sentence is set in a typeface other than roman (eg, italic, bold), any punctuation in that sentence would take the typeface of the rest of the sentence.

• If part of a sentence is set in a typeface other than roman, even if it’s the end of the sentence, the ending punctuation would be roman.

• For heads, sideheads, entries in a glossary, the punctuation would follow that of the preceding word (so, in Correct and Preferred Usage of Common Words and Phrases, the commas between the word pairs are boldface, like the words).

• For parentheses and brackets, unless the entire sentence is set in a typeface other than roman, the parentheses or brackets are roman (see the example with “[sic]” on p 358).—Cheryl Iverson, MA


Questions From Users of the Manual

Q: If there is a column for P values in a table and if a P value “straddles” rows (eg, provides the P value for men vs women), how should this be shown?

A: There are several options, with option 1 being preferred:

1. Center the P value between the items it compares (eg, between the values for men and women) and consider the use of a side brace.

2. If only 2 items are being compared, list the P value on the line giving the overall category (eg, Sex).

3. Use footnotes to indicate the P value for items being compared (eg, use a superscript “a” next to the value for men and the value for women and indicate the P value for this comparison in a footnote labeled “a”).

Q: If some of the confidence intervals given in a table column include negative values, how do you combine the minus sign and the hyphen that would normally be used in such a range in a table?

A: With ranges that include a minus sign, use to to express the range, rather than a hyphen. Carry this style throughout the entire table, even for those values that do not include a minus sign.—Cheryl Iverson, MA

Questions from Users of the Manual

Q: I’ve been searching the 10th edition to see where the list of footnote symbols from the previous edition is given and I cannot find it. Is that because the lowercase alphabet letters are now going to replace these symbols, as mentioned on page 91?

A: Yes, almost right. We have changed our policy on using superscript symbols for table footnotes and are now using superscript lowercase letters. There are more of them and they are not so “odd.” However, we are continuing to use the old “footnote symbols” for bottom-of-the-page footnotes (see p 43). We only show 2 here…the asterisk and the dagger…because it is not likely that more would be needed (this is the only type of bottom-of-page footnotes that we use in our journals), but if you were to require more, the “old” list would still apply.

Q: I haven’t been able to locate in the 10th edition the place where it says that the symbols “greater than” and “less than” should not be used in running text. (It’s at the top of p 256 in the ninth edition.)

A: You are correct. We neglected to include that this time, but the policy is the same. The examples on page 399 illustrate this, but having the specific statement would be good. It’s a bit like the policy we have of reserving the use of the hyphen for ranges to within parentheses and in tables (and, of course, in references, for the page ranges) and not using it in running text (P values are another exception). It all has to do with “elegance.”—Cheryl Iverson, MA

Questions From Users of the Manual

Q: I understand that the second printing of the AMA Manual of Style is now available and that many of the items in the list of Errata on the companion website ( are corrected therein. How can I tell if I have the first or the second printing? Does the second printing have a different ISBN?

A: Yes, the second printing was published in October 2007 and in it the majority of errata listed on the companion website are corrected. You can tell which printing you have by looking at the copyright page of the book (p iv). In the lower left corner of that page is a string of numbers, beginning, on the left, with 9. The number on the far right of that string will indicate the number of the printing. If the last number on the right is a 2, you have the second printing. The ISBN does not change with printings.

Q: Which is correct: “Qvar has similar systemic effects to those of fluticasone” or “Qvar has similar systemic effects as those of fluticasone”?

A: The correct idiomatic form is “similar…to” not “similar…as,” as with “identical…to” rather than “identical…as.” I suspect the use of “as” in this construction comes from a related idiom: “the same as.” You could also rephrase this to “Qvar and fluticasone have similar systemic effects.” or “Qvar has systemic effects similar to those of fluticasone.”

Q: Has the policy on SI units changed? If so, how?

A: Yes. These changes are addressed in detail in section 18.5.10. For laboratory values reported in JAMA Network Journals, factors for converting conventional units to SI units should be provided in the article. In text, the conversion factor should be given once, at first mention of the laboratory value, in parentheses following the conventional unit.

The blood glucose concentration of 126 mg/dL (to convert to millimoles per liter, multiply by 0.055) was used as a criterion for diagnosing diabetes.

For articles in which several laboratory values are reported in the text, the conversion factors may be provided in a paragraph at the end of the “Methods” section. In tables and figures, this information can be provided in the footnote or legend.

Q: Although the 10th edition recommends spelling out state names except in full addresses and the reference list (for location of publishers), I notice that you still show “DC” for District of Columbia. Is this an exception?

A: Yes.

Q: If a state’s full name is spelled out on first mention in running text, per the new style, what do you do when numerous cities in the same state are mentioned in an article? Should the state name be spelled out every time it is mentioned, every time a new city is mentioned, or should the 2-letter postal code be used after the first time the state name is spelled out in running text?

A: The answer will depend on the context. If the article is about cities in a particular state, you might not need to include the state name with the individual cities at all, as it will be clear what the state is, eg, “6 cities in Massachusetts.” If the state name is spelled out at the first mention of each new city, it shouldn’t need to be repeated, unless there are instances in the manuscript of a city that exists in more than 1 state (eg, Springfield, Massachusetts, and Springfield, Illinois).—Cheryl Iverson, MA

Questions From Users of the Manual

Q: Section 3.12.5 describes how to cite books with editors and translators but there is no example showing how to cite a book with both an editor and an editor in chief. Should only the editor in chief be cited if one is given for a book?

A: No, I would not exclude other editors’ names if an editor in chief is given. You could extrapolate from the example in section 3.12.5 that shows how to cite an editor and a consulting editor. In that example, repeated below, just replace “consulting ed” by “ed in chief.”

Klaassen CD. Principles of toxicology and treatment of poisoning. In: Hardman JG, Limbird LE, eds. Gilman AG, consulting ed. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill Book Co; 2001:67-80.

Q: When you cite an online reference that will require a password to access the reference, should you include in the reference citation some indication that access is restricted?

A: We wrestled with this question when preparing the current edition and decided against it because different users would have different access rights.

Q: When citing the same work 2 or more times in a manuscript, do you continue to use the same superscript reference number, or do you use a different superscript reference number and relist the work multiple times in the reference list?

A: It is our style to give a reference one number and to refer to it by that number every time it’s cited. This policy is not stated specifically in the manual and perhaps in the next edition it should be. In the current edition, page 44 discusses the situation in which an author might want to cite different (and specific) page numbers from the same reference. The style used is based on the assumption that a reference number “sticks” throughout a manuscript.

Q: Your manual (pp 22 and 183 in print) advises that clinical trials should be registered and that the URL of the registry and the identifying number should be published as a part of the manuscript. Is this still true if the clinical trial has been terminated?

A: Yes, the identifier should be given even if the clinical trial has been terminated. Anyone who chooses to go to the URL provided will be able to read about the trial and will also see there that it has been terminated.—Cheryl Iverson, MA

Questions From Users of the Manual

Q: Would you hyphenate “white coat hypertension”?

A: We would follow the latest edition of Webster’s New Collegiate Dictionary. The 11th edition recommends inclusion of a hyphen: white-coat hypertension.

Q: If 2 footnote symbols appear next to each other in a table, should any punctuation be introduced between them?

A: Yes. As with the policy for citation of a reference citation and a footnote symbol side by side (see page 95 in the print), add a comma. So, you might have superscript a,b; or superscript a,c-e.

Q: I would like to know how to cite your 10th edition in the style recommended by the 10th edition.

A: Glad to oblige:

Iverson C, Christiansen S, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007.

Q: Section 3.10 advises beginning the subtitle of a journal article cited in a reference list with a lowercase letter. Is this true even if the title ends with a question mark?

A: Yes. Here is an example, edited to style:

Mayer AP, Files JA, Ko MG, Blair JE. Do socialized gender differences have a role in mentoring? academic advancement of women in medicine. Mayo Clin Proc. 2008;83(2):204-207.

The same policy would apply if the title were to end with an exclamation point, although those are rare in scholarly article titles!—Cheryl Iverson, MA

Questions From Users of the Manual

Q: I have sometimes seen myalgia written in its plural form, myalgias. I would no sooner write myalgias than I would write bone losses.  What is your opinion on this?

A: I took a look at both Webster’s 11th and Dorland’s, our principal dictionaries, and both of them define myalgia as “pain in a muscle or muscles.” I think that this is indication that the singular covers both one and many. So, in short, I am in agreement with your reasoning and would use the singular. I also consulted the author of our Correct and Preferred Usage chapter, and she agrees–she feels the plural form is more “jargon-y.”

Q: In the sentence below, would you change frequently occurring to common?

Constipation is a frequently occurring symptom that can result from dehydration, use of certain medications, prolonged bed rest, lack of physical activity, or mechanical changes resulting from cancer or anticancer therapies.

A:  My instinct is that these 2 are not identical. The notion of “frequently occurring” could apply to frequency in a single individual, I think, whereas “common” signifies that it is something that may be experienced by many people (without any regard to its frequency). Roxanne Young, the author of our Correct and Preferred Usage chapter, concurs. You did not say why you were thinking of making the change, but the opinion from The JAMA Network Journals is that we would retain the distinction, however subtle, between frequently occurring and common.

Q: The author instructions in a journal to which I am about to submit a paper refers to the “standard abbreviations within the AMA 10th edition (see pages 502-525).” I notice that a small number of these abbreviations are followed by an asterisk, indicating that they do not require expansion at first mention. Are these the only “standard abbreviations” to which the guidelines might refer? Does the AMA Manual of Style contain other lists that include such “asterisked” items?

A:  The list on pages 502-525 (in section 14.11 for those who use the online manual and don’t find page numbers helpful), does indeed contain a few items that have an asterisk to indicate that they do not need to be expanded at first mention. [NOTE:  As of July 27, 2011, an asterisk was also added after CI (confidence interval). See this in the online Updates.] The page numbers 502 through 525 also include the list in 14.12 , Units of Measure. There are many other little lists of abbreviations throughout the manual, but these lists, in the Abbreviations chapter, are the ones most likely to be intended by the instructions for authors you cite.—Cheryl Iverson, MA

Questions From Users of the Manual

Q: I have a question about biologic vs biological and physiologic and physiological. How do I know which version to use?

A: It may have been “hidden,” but the tricky “-ic/-ical” question is addressed in the manual on  page 396 (section 11.1). This section specifically addresses biologic/biological and physiologic/physiological, 2 pairs of words where the different endings may have a different meaning.

Q: In section 8.3.1, why do you show a hyphen in “The rash was a treatment-related adverse event.” but not in “The adverse event was treatement related.”?

A: The policy of hyphenating a compound when it  precedes the noun it modifies but not when it follows comes up in many examples in the Hyphens section of the manual. The rationale for this policy is based on easier comprehension. Much may precede and modify a noun. The use of hyphenation (as in “treatment-related adverse event”) helps make the relationships of the words that precede the noun clearer and easier for a reader to understand. In the case in which this word string follows the noun, the hyphenation is not required for easier understanding (“The adverse event was treatment related.”) You see this same logic in so many places:

It was a 5-cm distance.

The distance was 5 cm.

He was a well-known author.

The author was well known.

Q: Would it be acceptable to use as a way to shorten URLs in references in a scientific article’s reference list?

A: Using to shorten URLs in the reference list for a scientific article is probably not consistent with best practices. We do use in our style manual tweets, to save space, but the reference list of a scientific article is a different matter. Use of the full URL allows readers to know the original domain name (like We are also not sure how permanently stable a shortened link would be.

NOTE:  The person who inquired noted:  “Regarding shortened URLs and transparency, there is one bright spot for people citing US government publications. The government created its own vanity domain,”—Cheryl Iverson, MA


Questions From Users of the Manual

Q: Does the change of footnote symbols from asterisk, dagger, etc (9th edition) to superscript lowercase letters (10th edition) apply not only to tables but also to the title page?

A: No, this change does not apply to the title page. Typically, the only footnotes used on the title page would be the “death dagger” (see section 2.3.2) and the asterisk at the end of the byline if the byline is the name of the group, not all members of which qualify for authorship (see p 15, bottom).

Q: In your information on databases, the link you provide for HUGO no longer links. Do you have the new URL?

A: Yes, since publication of the 10th edition of the manual, the URL for HUGO has changed. The new URL is We have included this in a new batch of errata posted on the companion website in January 2008 and it will be corrected in the third printing.

Q: In medical writing, is it preferred to spell naive with or without the umlaut over the i?

A: We would follow the latest edition of Webster’s New Collegiate Dictionary. The 11th edition shows that both spellings are equally correct but, in such cases, to maintain uniformity among all the articles in our family of journals, we arbitrarily select the first spelling given: naive. Also, in the 10th edition of our manual (p 422), it indicates that “in general, English words in common usage should be spelled without the diacritical marks.”—Cheryl L. Iverson, MA