Editorial policies

Editorial independence

Peer review

• Editorial screening

  Screening establishes whether the manuscript is within scope, whether the required ethics, consent, registration and data statements are present, and whether the reporting is complete enough for a reviewer to assess. A manuscript may be declined at this stage without external review.

• Reviewer selection

  Reviewers are selected for subject expertise relevant to the manuscript and are asked to decline where they hold a competing interest or where the manuscript falls outside their expertise. Author-suggested reviewers may be considered; the choice remains the editor’s.

• Double-blind handling

  Where double-blind review is requested, editors must ensure that author-identifying information is not shared with reviewers, and reviewers must not attempt to identify the authors. Authors prepare the anonymized file as described in the instructions for authors.

• Confidentiality

  A submitted manuscript is a confidential document. Editors and reviewers may not disclose its existence or contents, may not use its data or ideas before publication, and may not share it with a third party without the editor’s agreement.

• Reviewer use of AI tools

  Reviewers must obtain journal permission before using AI to assist with a review. Any permitted use must be disclosed, and confidential manuscript content must not be uploaded where confidentiality cannot be assured.

• Decisions

  The handling editor issues the decision with the reviewers’ comments. A request for revision states what must be addressed, and a revised manuscript is assessed against those points, with further review where the changes are substantial.

What is expected of each side of the process is set out in full for editors and for reviewers.

Competing interests, funding and recusal

Authors

Every manuscript carries a competing-interests statement and a funding statement naming each funder and award number, together with the funder’s role in the design, conduct, analysis, reporting and decision to publish. Where there is nothing to declare, the statement says so.

Financial interests

Employment, consultancy, honoraria, paid expert testimony, patents and patent applications, equity, and payments or equipment from a company whose product is studied are all declared, including those of an immediate family member.

Non-financial interests

Personal, professional, institutional, political and intellectual relationships that could be seen to bear on the work are declared on the same terms.

Reviewers

A reviewer discloses a competing interest when the invitation arrives and declines the assignment where the conflict requires it, rather than qualifying the review.

Editors

An editor discloses a conflict as soon as it arises and declines an assignment where the conflict requires it. Ethical concerns, authorship disputes and integrity questions are escalated to the editorial office for formal review rather than resolved by the handling editor alone.

Authorship and contribution

• Contributor statement

  A statement describing what each author did is required at submission and is published with the article.

• Acknowledgments

  People who contributed without meeting the authorship criteria — technical help, statistical advice, writing assistance, departmental support — are named in the acknowledgments with their permission, and the nature of the contribution is stated.

• Changes after submission

  Adding, removing or reordering authors after submission requires the written agreement of every author, including the one being added or removed, and a reason. The editorial office records the agreement before the change is made.

• Generative AI tools

  Generative AI tools cannot be authors. Authors remain responsible for accuracy, attribution, confidentiality and originality, and must disclose permitted use that affected text, code, images or analysis. Confidential manuscript, participant or peer-review material must not be uploaded to an unauthorized AI service.

• Corresponding author

  One author is responsible for correspondence through review, production and after publication, and for passing the journal’s communications to the co-authors.

Research ethics, consent and patient privacy

• Human-subject research

  Studies involving human participants, their tissue or their identifiable data require approval from a research ethics committee or institutional review board, or a documented exemption. The manuscript names the approving body and the approval or exemption reference, and states that the work conformed to the Declaration of Helsinki.

• Informed consent

  Participants give informed consent to take part and to have the work published. Where consent was waived, the manuscript states which body granted the waiver and on what grounds.

• Patient privacy in case reports and images

  A patient described in a case report or series, or shown in a clinical photograph, endoscopic image, radiograph or operative video, must give written consent to publication, and the manuscript must state that the consent was obtained. Identifying details that are not essential to the clinical point are removed. Masking the eyes is not de-identification: a facial photograph, an unusual lesion, a date, an institution and a rare diagnosis together can identify a person.

• Clinical-trial registration

  Interventional clinical trials must be registered in an accepted public trial registry at or before the first participant provides consent for enrollment. The registry name, registration number, and registration date must be reported in the manuscript.

• Animal research

  Work involving vertebrates or regulated invertebrates requires institutional animal-care approval, named in the manuscript with the protocol number, and reporting that follows the ARRIVE guidelines. Housing, anesthesia, analgesia and the method of euthanasia are described.

• Devices, drugs and off-label use

  Where a device or a drug was used outside its approved indication, the manuscript says so, names the regulatory status, and reports the safety monitoring that applied.

Data, statistics and reporting

• What the statement says

  Where the data supporting the findings are held, under what conditions they can be obtained, and any identifier they carry. Where clinical data cannot be shared because sharing would risk identifying participants or would breach the terms of consent, the statement says so and describes the route by which a qualified researcher may apply.

• Datasets and code

  Deposited datasets, analysis code and materials are cited with their own identifiers, in the reference list as well as in the statement, so that they can be credited and found.

• Reporting guidelines

  Manuscripts follow the reporting guideline appropriate to the design — CONSORT for randomized trials, STROBE for observational studies, PRISMA for systematic reviews, CARE for case reports, STARD for diagnostic-accuracy studies, ARRIVE for animal research — and submit the completed checklist where one exists.

• Statistical reporting

  The analysis plan, the software and version used, the handling of missing data, and the effect estimates with their confidence intervals are reported. Where a sample size was calculated, the calculation and its assumptions are given; where it was not, the manuscript says so and discusses what that means for the conclusion.

• Claims and their limits

  Conclusions must be proportionate to the evidence, including when results are negative or inconclusive. A single case does not establish efficacy, causality or prevalence, and clinical efficacy is not inferred from preclinical or bench results alone.

Originality and integrity of the submission

• Originality and simultaneous submission

  A manuscript submitted to JOA must not be under consideration elsewhere, and its substantive content must not have been published before. Submitting the same work to more than one journal at a time is a breach of this policy.

• Similarity screening

  Submissions are screened with Crossref Similarity Check, powered by iThenticate. A similarity report is read by an editor rather than applied as a threshold: matched text may be a method sentence, a scale name or a quotation, or it may be plagiarism, and only reading the matches distinguishes them.

• Redundant and duplicate publication

  Republishing the same data, cohort or analysis without disclosure is redundant publication. Where a manuscript overlaps an earlier publication by the same authors — a shared cohort, an interim analysis, a translated version — the overlap is disclosed in the cover letter and the earlier work is cited.

• Preprints and prior presentation

  Posting a preprint is permitted and is not prior publication. Disclose the preprint in the cover letter, cite it in the references, and note any conference presentation of the same work.

• Image integrity

  Figures must represent what was observed. Adjustments to brightness, contrast or color are applied to the whole image and disclosed in the legend; selective enhancement, erasure, duplication or splicing of a lane, a field or a region is not permitted, and a spliced gel or a composite image must show the divisions. Original unprocessed images may be requested at any stage.

• Permissions for reused material

  Written permission is obtained for any figure, table, image or extended quotation reproduced from another source, and the source is credited in the legend.

Corrections, retractions and expressions of concern

• Correction

  Published when an error affects the meaning, the data, the analysis, the attribution or the metadata of an article that otherwise stands. The notice states what was wrong and what is correct.

• Retraction

  Published when the findings are unreliable, whether through error or misconduct, or where the work was published in breach of research ethics or of this journal’s publishing policies, including redundant publication. The article stays online, marked as retracted, and the notice states the reason. Retraction records that the findings should not be relied on; it is not in itself a finding of misconduct against a named person.

• Expression of concern

  Published where there is well-founded concern about a published article and an investigation is either unresolved or unlikely to be conclusive. It states what is in question and remains until the matter is resolved by a correction, a retraction or a withdrawal of the concern.

• Raising a concern

  Concerns about a published article can be sent to the editorial office with the article’s DOI or title and the specific evidence. The journal follows the Committee on Publication Ethics flowcharts: the corresponding author and, where necessary, the authors’ institution are given the opportunity to respond before a notice is published.

Published notices appear in the archive alongside the articles they concern, and in the issue in which they were published.

Appeals, complaints and allegations of misconduct

• Appealing a decision

  An author who believes a decision rests on a misunderstanding may appeal by writing to the editorial office with the manuscript reference and a point-by-point response to the reviewers and the editor. An appeal is considered by an editor who was not responsible for the decision. A disagreement with the editorial judgment, without new argument or evidence, is not a ground for appeal, and a decision on appeal is final.

• Complaints about the process

  Complaints about how a manuscript was handled — delay, conduct, a failure to follow these policies — are sent to the editorial office and are handled separately from the scientific decision.

• Allegations of misconduct

  Allegations of fabrication, falsification, plagiarism, undisclosed competing interests, authorship abuse or breach of research ethics are investigated whether they concern a submitted or a published manuscript. The journal does not conduct institutional investigations: where the evidence warrants it, the matter is referred to the authors’ institution or funder, and the journal acts on the outcome. Where the concern is substantiated, the manuscript is rejected or the article is corrected, subjected to an expression of concern, or retracted.

• Confidentiality of a complaint

  The identity of a person raising a concern in good faith is not disclosed to the authors without their agreement, and the substance is discussed only with those who need to assess it.

Publishing terms

License

Articles are published under the Creative Commons Attribution 4.0 International license, with copyright retained by the authors. The copyright and license page states what that permits.

Article processing charge

Charged after acceptance only, and independent of the editorial decision. The amount, what it covers and how it is invoiced are on the article processing charges page.

Withdrawal of a submitted manuscript

An author who wishes to withdraw a manuscript after submission follows the withdrawal policy in full, including the requirement to receive written confirmation before the work is submitted elsewhere. Read the withdrawal policy.

Preservation

The journal’s preservation and deposit arrangements, and the identifiers each article carries, are set out on the indexing page.

Advertising and sponsorship

No advertiser, sponsor or commercial partner has any part in the assessment of a manuscript, in the selection of reviewers, or in the decision to publish.