Peer-review is the system used to assess the quality of a manuscript before it is published. Independent researchers in the relevant research area assess submitted manuscripts for originality, validity and significance to help editors determine whether the manuscript should be published in their journal.

In cases where the journal is unable to find sufficient peer reviewers, the services of a publishing partner, Research Square, may be used to identify suitable reviewers and provide reports to avoid further delays for authors. Reviewers recruited by Research Square are paid a small honorarium for completing the review within a specified timeframe. Honoraria are paid regardless of the reviewer recommendation. With Research Square, a double-blind peer review system is in operation.

In cases where reports have been obtained by Research Square, the peer review reports will be unsigned unless the reviewer opts in to sign the report.