Specific Uses of Fonts and Styles - Editing, Proofreading, Tagging, and Display

AMA Manual of Style - Stacy L. Christiansen, Cheryl Iverson 2020

Specific Uses of Fonts and Styles
Editing, Proofreading, Tagging, and Display

21.9.1 Lowercase.

Lowercase (minuscule) letters are smaller than capital (or uppercase) letters and are differently configured (eg, a, A). The term lowercase originates from the earlier use of manually set wooden or metal characters that were kept by compositors in 2 cases; the lower case contained the smaller letters and the upper case contained the larger capital letters.9 Sentences are typically set with the initial letter of the first word of a sentence as a capital letter and all other letters lowercase.

In titles, the initial letter of each major word is set as a capital letter and all other letters are lowercase. Some publications use sentence-style lowercase for titles, with only the initial letter of the first word being a capital. For example, the JAMA Network journals use a mix of initial uppercase and lowercase letters for titles (see 10.2, Titles and Headings).

Use of Clinical Prediction Rules for Guiding Use of Computed Tomography in Adults With Head Trauma

Potential Mechanisms for Cancer Resistance in Elephants and Comparative Cellular Response to DNA Damage in Humans

Pharmacologic Management of Irritable Bowel Syndrome

The format recommended herein for bibliographic references follows sentence-style lowercase for journal article titles and mixed capitals and lowercase for book titles:

1.Chetty R, Stepner M, Abraham S, et al. The association between income and life expectancy in the United States, 2001-2014. JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226

2.National Academies of Sciences, Engineering, and Medicine. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press; 2017.

(See 3.9.1, English-Language Titles.)

The case of words (lowercase and uppercase) for titles, headings, and labels in tables and figures is addressed in 4.1.3, Table Components, and in 4.2.6, Components of Figures.

21.9.2 Capital (Uppercase).

Capital (majuscule) letters are larger than lowercase letters and are used as initial letters in the first word of sentences and for proper names. They are also often used as the initial letter of major words in titles, headings, and subheadings. (Caput is Latin for head.6) Use of all capital letters in large blocks of text should be avoided because legibility is decreased; other means of emphasis should be used if needed, such as bold type. For this reason, the JAMA Network journals use all-capital letters sparingly (eg, for sideheads in print/PDF abstracts).

A drop cap (a form of initial cap) is an oversized capital letter of the first word that begins a paragraph and drops through several lines of text. It may be used to draw the reader’s attention to the beginning of an article, chapter, or important section (see Figure 21.6-1 for an example). An initial cap may also be a raised cap when the capital letter is raised above the main line of text.

21.9.3 Boldface.

A general scheme of headings and side headings may call for the use of boldface type for first- and second-level headings and for first-level side headings in the text, although heading styles and formats vary among publications (see 2.8, Parts of a Manuscript, Headings, Subheadings, and Side Headings). For example, the JAMA Network journals use the following headings:


Boldface may also be used in text to call out references to figures or tables (usually only at first mention):

Demographic data for the participants in the study are given in Table 1.

21.9.4 Italics.

Italics is a form of roman type style that slants to the right. Italics have multiple uses. However, setting large blocks of body text in italics should be avoided because legibility is reduced. Use italics as follows:

■For level 4 heads (second-level sideheads)

■When terms are described as terms and letters as letters (see 8.6.7, Coined Words, Slang, and 8.7.5, Using Apostrophes to Form Plurals):

The page number is called the folio.

In his handwriting, the n’s look like u’s.

■For titles of books and journals, proceedings, symposia, plays, paintings, long poems, video games, musical compositions, movies, space vehicles, planes, and ships (see 10.2, Titles and Headings):

JAMA Psychiatry

USS Constitution

Verdi’s Requiem

Spirit of St Louis (plane)

Microbe Invader (video game)

■For legal cases (see 3.16, US Legal References), eg, Roe v Wade

■For epigraphs set at the beginning of a work

■For search terms (see 2.6, Keywords):

Search terms included both subject headings and keywords for aortic diseases, intramural hematoma, aortic dissection, penetrating ulcer, aortic ulcer, aortic syndrome, optimal medical therapy, open repair, endovascular treatment, stent graft, therapy, and diagnosis.

■For some non-English words and phrases (see 12.1.1, Use of Italics) that are not shown among English terms in the current edition of Merriam-Webster’s Collegiate Dictionary or in accepted medical dictionaries (eg, de Qi sensation). Italics are not used if words or phrases are considered to have become part of the English language (eg, café au lait, in vivo, in vitro, en bloc).

■For lowercase letters used in alphabetic enumerations of items or topics (the parentheses are set roman): (a), (b), (c), etc.

■For genus and species names of some microorganisms, plants, and animals when used in the singular and the names of a variety or subspecies. Plurals, adjectival forms, and taxa above genus (eg, class, order, family) are not italicized (see 14.14, Organisms and Pathogens):



Staphylococcus aureus



Streptococcus (But: organisms, streptococcal, streptococci)

■For portions of restriction enzyme terms (see 14.6.1, Nucleic Acids and Amino Acids):



■For gene symbols but not gene names (see 14.6.2, Human Gene Nomenclature; 14.6.3, Oncogenes and Tumor Suppressor Genes; and 14.6.5, Nonhuman Genetic Terms):



■For chemical prefixes (N-, cis-, trans-, p-, etc) (see 14.4.4, Chemical Names, and 15.10, Molecular Medicine)

■For mathematical expressions, such as lines, variables, unknown quantities, and constants (see 20.0, Mathematical Composition). Numerals or abbreviations for trigonometric functions and differentials are not italicized:

sin x = a/b

■For some statistical terms (see 19.6, Statistical Symbols and Abbreviations):

P value


t test

■For the abbreviation for acceleration due to gravity, g, to distinguish it from g for gram (see 13.11, Clinical, Technical, and Other Common Terms)

■For the term sic (see also Insertions in Quotations in 8.5.2, Brackets)

■In formal resolutions, for Resolved

■Sparingly, for emphasis

21.9.5 Small Caps.

In this typeface style, all the letters take the shape of a capital letter. However, in the place of lowercase letters, smaller capital letters are used. The small caps generally, but not always, align with the same x-height as the regular roman face, in the same typeface. Use small capital letters as follows:

■AM and PM in time (see 17.5.3, Time)

■BC, BCE, CE, and AD (see 13.3, Days of the Week, Months, Eras)

■Some prefixes in chemical formulas (L for levo-, D for dextro-) (see 14.4.4, Chemical Names, and 14.10, Molecular Medicine)

21.9.6 Color.

Although not technically a font type, color is another option to add emphasis, create hierarchy, and organize elements in a publication. Colored type on a white background does not have the same contrast as black type, so the white spaces around the letters can lose their clarity.5 To compensate, the typeface should be larger or bolder. At typical body text sizes, color is not particularly effective. Letter forms do not cover much surface area, so colored text is difficult to notice unless it is highly contrasting.8 Some journals use different colors of text or shading to indicate hyperlinks to other content. However, in scientific publications (whether print or digital), colored text should be used sparingly.

Principal Author: Stacy L. Christiansen, MA


Thank you to the following for their review and guidance: Karen Adams-Taylor, JAMA Network; David Antos, JAMA Network; Erin Kato, JAMA Network; Trevor Lane, MA, DPhil, Edanz Group, Fukuoka, Japan; Chris Meyer, JAMA Network; and Monica Mungle, JAMA Network.


1.Chicago Manual of Style. 17th ed. University of Chicago Press; 2017.

2.NLM Journal Archiving and Interchange Tag Suite. Updated September 13, 2012. Accessed July 22, 2018. https://dtd.nlm.nih.gov/

3.Council of Science Editors. Scientific Style and Format: The CSE Manual for Authors, Editors, and Publishers. 8th ed. University of Chicago Press/Council of Science Editors; 2014.

4.Extensible markup language (XML). W3C (World Wide Web Consortium). Updated October 11, 2016. Accessed July 22, 2018. https://www.w3.org/XML/

5.Felici J. The Complete Manual of Typography. 2nd ed. Peachpit; 2012.

6.Wheildon C. Type & Layout: Are You Communicating or Just Making Pretty Shapes? Worsley Press; 2005.

7.Bringhurst R. The Elements of Typographic Style, Version 4.0. Hartley & Marks; 2013.

8.Butterick M. Butterick’s Practical Typography. 2019. Accessed August 12, 2019. https://practicaltypography.com

9.Haley A. Lowercase letters. Fonts.com website. Accessed January 2, 2016. https://www.fonts.com/content/learning/fontology/level-1/type-anatomy/lowercase-letters

Additional Resources and General References

Ambrose G, Harris P. The Fundamentals of Typography. 2nd ed. AVA Publishing; 2011.

Craig J, Scala IK. Designing With Type: The Essential Guide to Typography. 5th ed. Watson-Guptill Publishers; 2006.

Kasdorf WE, ed. The Columbia Guide to Digital Publishing. Columbia University Press; 2003.

Lynch PJ, Horton S. Web Style Guide: Basic Design Principles for Creating Web Sites. 3rd ed. Yale University; 2009.

National Center for Biotechnology Information, National Library of Medicine. Journal Publishing Tag Library, NISO JATS Version 1.2 (ANSI/NISO Z39.96-2019). May 2019. Accessed August 12, 2019. https://jats.nlm.nih.gov/publishing/tag-library/1.2/