Submitted manuscripts are reviewed by the Editor-in-Chief. If deemed potentially suitable for LHR, the Editor-in-Chief—sometimes in conjuction with the Associate Editors and/or members of the Board of Editors—assigns the manuscript to reviewers. LHR uses a double-blind peer review system in which authors will not know the names of reviewers, and in which reviewers will not know the names of authors. The peer review process usually takes up to five months. Peer reviews are advisory and the Editor-in-Chief is the final arbiter of every article manuscript.

Once the peer review process is complete, the Editor-in-Chief informs the author about the decision. The Editor-in-Chief may:

• Accept the manuscript
• Reject the manuscript
• Reject the manuscript with the option to revise and resubmit
• Conditionally accept the manuscript, subject to light revisions and the production of a production copy in conformity with all LHR editorial guidelines; and the author's completion of the author publishing agreement
• Final accept the manuscript, which sends the piece into production