Peer review is fundamental to the scientific publication process and the dissemination of knowledge and information. Peer reviewers are experts chosen by editors to provide written assessment of the strengths and weaknesses of written research, with the aim of improving the reporting of research and identifying the most appropriate and highest quality material for the publication. Regular reviewers should be required to meet minimum standards (as determined and promulgated) regarding their background in original research, publication of articles, formal training, and previous critical appraisal of manuscripts.

Peer reviewers should be experts in the specific topic addressed in the articles they review, and should be selected for their objectivity and scientific knowledge. Individuals who do not have such expertise should not be reviewers, and there is no role for review of articles by individuals who have a major competing interest in the subject of the article.

Reviewers will be expected to be professional, honest, courteous, prompt, and constructive. The desired major elements of a high-quality review should be as follows:

• The reviewer should have identified and commented on major strengths and weaknesses of study design and methodology
• The reviewer should comment accurately and constructively upon the quality of the author's interpretation of the data, including acknowledgment of its limitations.
• The reviewer should comment on major strengths and weaknesses of the manuscript as a written communication, independent of the design, methodology, results, and interpretation of the study.
• The reviewer should comment on any ethical concerns raised by the study, or any possible evidence of low standards of scientific conduct.
• The reviewer should provide the author with useful suggestions for improvement of the manuscript.
• The reviewer's comments to the author should be constructive and professional
• The review should provide the editor the proper context and perspective to make a decision on acceptance (and/or revision) of the manuscript.

All reviewers should be informed of the publication's expectations and editors should make an effort to educate them and suggest educational materials (such as articles on how to peer review): The editors should routinely assess all reviews for quality; they may also edit reviews before sending them to authors, or simply not send them if they feel they are not constructive or appropriate. Ratings of review quality and other performance characteristics of reviewers should be periodically assessed to assure optimal performance, and must contribute to decisions on reappointment or ongoing review requests. Individual performance data may be introduced for reviewers and it must be kept confidential. The submitted manuscript is a privileged communication; reviewers must treat it as confidential. It should not be retained or copied. Also, reviewers must not share the manuscript with any colleagues without the explicit permission of the editor. Reviewers and editors must not make any personal or professional use of the data, arguments, or interpretations (other than those directly involved in its peer review) prior to publication unless they have the authors' specific permission or are writing an editorial or commentary to accompany the article.

If reviewers suspect misconduct, they should notify the editor in confidence, and should not share their concerns with other parties unless officially notified to do so.

High-quality review is important, but equally important is that readers be able to readily determine which contents of the journal are peer reviewed. The journal should describe which types of articles are peer reviewed, and by whom (ie, only by editorial board members, by outside expert reviewers, or both). Editors should strongly consider having a statistician review reports of original research that are being considered for publication, if this feasible, since studies have shown that typical

Editors should publish annual/proceedings audits of acceptance rates, publication intervals, percentage of submissions sent out for external peer review, and other performance data.