When the editorial office receives a manuscript, it is reviewed for appropriateness and may be rejected without review if it is clearly of inadequate quality, falls beyond the journal’s scope, or omits significant sections.

Every essay deemed appropriate for consideration is subject to examination by outside specialists, not just members of the Editorial Board. After receiving at least two reports with recommendations from external reviewers, the Editor-in-Chief decides whether to publish the work.

Although authors are welcome to recommend qualified reviewers, the editorial office and the editor-in-chief retain the authority to choose other reviewers. Since writers are in the best position to determine who is an expert in the topic, they are asked to recommend reviewers. Furthermore, other papers on the same subject can benefit from the reviewers that have been mentioned. Thus, acquiring these names might assist the editorial office in making sure that the right individuals are contacted to examine every content.

To prevent bias, the journal employs double-blind peer review, in which neither the authors nor the reviewers are aware of one another’s identities.

The Editor-in-Chief will decide whether to (1) accept, (2) make minor revisions, (3) make substantial revisions, or (4) reject after receiving at least two reviews. The writers will be informed of the rationale for the decision.

The Editor-in-Chief has the discretion to reject an article if the authors do not make satisfactory revisions after receiving reviewer reports, regardless of whether the adjustment is minor or large.

Depending on the degree of change required, articles that have been revised will either be sent out for additional review or the Editor-in-Chief will decide what to do.

Because it can be challenging to locate qualified reviewers and there may be delays in getting reviewer reports, the time needed to examine and make a judgment varies greatly. The editorial office and editor-in-chief try their best to reduce the amount of time between submission and the initial decision. Although it cannot guarantee it, the journal strives to make a first judgment (after review) in 40–60 days.

It should be noted that the Editor-in-Chief decides whether to publish anything that does not include original research (such as editorials or letters to the editor) and that these pieces are not subject to external scrutiny.