Please prepare your manuscript according to our instructions in How to Prepare Your New Manuscript and How to Determine Your Article Type .

All text, references, figure legends, and tables should be in one double-spaced electronic document. You may either include figures in the text file or upload your figures separately. We prefer the former, but this may not work well for complicated graphics, which should be sent separately. Either insert all the figures or send each figure as a separate file.

Format your documents for U.S. letter (8 1/2 x 11 in or 21.8 x 28.2cm). Do not format for A4 letter, as it will not print properly.

For figures, it is permissible to send low-resolution images for peer review, although we may ask for high-resolution files at a later stage.

For Original Articles, there is normally a limit of 5 figures and tables (total) per manuscript. Additional figures and tables may be considered as supplements for Web-only publication.

REQUIRED FORMS

You do not need to send a separate cover letter file with your online submission. Instead, we offer a text box in which you can type your information, or you can cut and paste from a previously written letter. This box can also be left blank, if you wish.

Any change in authorship after submission must be approved in writing by all authors.

Authors of original research articles are not required to submit a formal Financial Disclosure Form at the time of submission. We will request it later, if necessary. However, we do request that you note major conflicts of interest in your cover letter or in the Source of Funding text box.

All authors of review articles are required to submit our Disclosure Form for Review Articles and Editorials.

PREFERRED FILE FORMATS

Our preferred file type for new manuscript submissions is Adobe Acrobat portable document format (.pdf) with all figures inserted in the same document. We will also accept Word (.doc), WordPerfect (.wpd), text (.txt) documents, and .rtf file format.

Acceptable formats for pictures, photos, and figures are PDF, DOC, PPT, JPG, GIF, TIF.

Please be aware that we will convert all submissions to PDF for peer review.

SAVING FILES IN PDF FORMAT

Most graphics programs will allow you to "save as" to Acrobat format. To save a Word or WordPerfect document as a PDF, you will need a PDF writer such as Adobe Acrobat, Adobe PDFWriter, or Acrobat Distiller. To check whether you have one, look at your list of printers. If a PDF writer appears, you are all set. Open the file and print to the PDFWriter.

SUBMITTING YOUR MANUSCRIPT

When you click on Submit a New Manuscript , a new browser window will open. You will need to complete the following steps:

• Title; type of manuscript; contact information for the corresponding author
• Information on the other authors; group name (if applicable); funding information
• Word count, Figure count, etc; Abstract (if applicable); cover letter (you may copy [Ctrl-C] and paste [Ctrl-V] from a word-processing program); Suggested reviewers (optional); Other Information (optional)
• Review your title page and your cover letter
• Upload your files

Once a manuscript assistant has checked the files and logged the manuscript into our database, you will receive an acknowledgment with your permanent six-digit manuscript number. Please use this manuscript number in all future communications with us and when using our manuscript tracking system, PaperTRAIL. If you do not receive this e-mail acknowlegment within two business days after submitting your manuscript, please contact us.

ON RESUBMISSIONS AND REVISIONS

The Journal differentiates between (a) manuscripts that have been rejected and (b) manuscripts that will undergo further consideration after requested changes have been made.

Resubmission: If you have received a letter of rejection and wish the editors to reconsider their decision, you are "resubmitting." Your file will be considered a new submission, and you will receive a new six-digit manuscript number. Please upload a letter with specific responses to the reviewers' comments.

Revision: If the editors have asked you to make specific changes to your manuscript and return it for further consideration, you are sending a "revision." You can use your previous six-digit manuscript number to simplify the online submissions process.

CONFLICT OF INTEREST

Authors of research articles should disclose at the time of revision any financial arrangement they may have with a company whose product is pertinent to the submitted manuscript or with a company making a competing product. Such information will be held in confidence while the paper is under review and will not influence the editorial decision, but if the article is accepted for publication, a disclosure statement will appear with the article.

Because the essence of reviews and editorials is selection and interpretation of the literature, the Journal expects that authors of such articles will not have any significant financial interest in a company (or its competitor) that makes a product discussed in the article.

REVIEW AND ACTION

Manuscripts are examined by members of the editorial staff, and two thirds are sent to outside reviewers. We encourage authors to suggest the names of possible reviewers, but we reserve the right of final selection. Rejected paper manuscripts and illustrations will not be returned. Communications about manuscripts will be sent after the review and editorial decision-making process is complete; for potentially acceptable manuscripts, the period between the receipt of all reviews and an editorial decision is usually longer. For information about the status of a submitted manuscript, see PaperTRAIL . Further information about the review process used by the Journal may be found in Tracking the Peer Review Process .

COPYRIGHT

The Massachusetts Medical Society is the owner of all copyright to any work published by the Society. Authors agree to execute copyright transfer forms as requested with respect to their contributions accepted by the Society. The Society and its licensees have the right to use, reproduce, transmit, derive works from, publish, and distribute the contribution, in the Journal or otherwise, in any form or medium. Authors may not use or authorize the use of the contribution without the Society's written consent, except as may be allowed by U.S. fair-use law.