All manuscripts are submitted for external expert peer review. The journal uses a double-blind peer-review system, with two to three referees (members of the Editorial Committee and/or external consultants) independently evaluating all manuscripts. The referees will make Suggestions as to acceptance, revision or rejection of manuscripts. In certain cases, specialist peer reviewers (such as statisticians) will be used, for example, for review of study design features, conduct of the study, presentation of data, statistical analysis, or conclusions. In order to ensure unbiased review, submissions from editors, employees or members of the Editorial Board are handled by external reviewers blinded to the editors, employees or members of the Editorial Board. If the referees indicate that a manuscript should be revised, authors will be requested to revise the manuscript along the lines indicated by the referees. Occasionally, resubmitted manuscripts may undergo further peer review. Once revisions are completed and approved by the Managing Editor, the corresponding author is notified that an article has been accepted for publication. Rejected manuscripts will not be returned to authors. The average length of time from acceptance of manuscript to publication is 6 months.