№ files_lp_3_process_9_36532
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Standardized conflict of interest and ethical compliance disclosure form required from authors submitting a manuscript, detailing financial relationships, institutional support, ethical approvals, and author certifications.
Document Type:
Author Disclosure Form
Issuing Organization:
International Committee of Medical Journal Editors (ICMJE)
Purpose:
Disclosure of Relationships and Conflicts of Interest
Related Journal:
Maltepe Tıp Dergisi
Scope:
Financial and Non-Financial Interests Related to Manuscript Submission
Time Frame:
Since Initial Planning of the Work and Past 36 Months
Sections Included:
Financial Support, Grants, Royalties, Consulting Fees, Honoraria, Expert Testimony, Travel Support, Patents, Advisory Roles, Stock Ownership, Other Interests
Additional Declarations:
Patient Consent, Ethics Committee Approval
Certification Requirement:
Author Confirmation of Complete and Unaltered Responses
Signatories:
Contributing Authors and Corresponding Author
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Note:
Year
Date:
Click or tap to enter a date
Author:
Click or tap here to enter text
Manuscript Title:
Click or tap here to enter text
US-based Author:
YES/NO
Manuscript Number:
Click or tap here to enter text
Journal:
Ophthalmology
Reference:
Van Gelder RN and Siegfried CJ, Ophthalmology, 2022; 129: 602-604
Disclosure Type:
Conflict of Interest
Time Frame:
Item #1 – since initial planning of the work; other items – past 36 months
Date:
3/19/2025
Your Name:
Daniela Seidel
Manuscript Title:
JBJS Associate Editor
Manuscript Number:
NA
Type of Document:
Disclosure Form
Purpose:
Declaration of relationships, activities, and interests
Time Frame:
Since initial planning of the work and past 36 months
Status:
All items marked as None
Note:
Year
Date:
7/13/2023
Author:
Ronald W. Lindsey, MD
Manuscript Title:
JBJS Deputy Editor
Manuscript Number:
Not provided
Document Type:
Conflict of Interest Disclosure Form
Organization:
International Committee of Medical Journal Editors (ICMJE)
Subject:
Disclosure of relationships/activities/interests related to manuscript content
Time Frame Item 1:
Since the initial planning of the work
Time Frame Items 2–13:
Past 36 months
Editorial Roles Disclosed:
Co-Editor, Texas Orthopaedic Journal; Co-Editor, Journal of Bone and Joint Surgery (JBJS) Case Connector
Patents Issued:
Tissue Integration Design for Seamless Implant Fixation; Mesh Bone Screw
Patents Pending:
Treatment of Subjects Undergoing Orthopaedic Surgery and Local Radiation Using Thrombin Derived Peptides
Advisory Role:
Member of the Advisory Board for the Max Biedermann Institute for Biomechanics at the University of Miami and the Mount Sinai Medical Center in Miami Beach, Florida
Certification Statement:
Author certified completion and accuracy of all responses
Note:
Year
Date:
6/26/23
Your Name:
Kimberly Templeton, MD
Note:
Manuscript Title
Year:
2023
Region / city:
Kansas
Subject:
Manuscript disclosure
Document type:
Disclosure form
Organization / institution:
University of Kansas Medical Center
Author:
Kimberly Templeton, MD
Target audience:
Authors of academic manuscripts
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Year:
2020
Region / City:
British Columbia
Topic:
Legal Practice, Ethics, Conflicts of Interest
Document Type:
Checklist
Institution:
Law Society of British Columbia
Author:
Law Society of British Columbia
Target Audience:
Law firms, legal professionals
Date of Approval:
2020
Date of Last Update:
2020
Document type:
Conflicts of interest declaration
Project:
Sussex Woods pilot – Landscape Drone Survey
Reference number:
PSS.SW.C18.25
Subject:
Procurement and grant conflict of interest disclosure
Contracting authority:
Natural England
Department:
Protected Sites Strategies project
Authorised individual:
Steve Walker
Job title:
Sussex Woods Protected Sites Strategies pilot co-ordinator (Senior Officer)
Country:
United Kingdom
Legal context:
United Kingdom procurement and grant processes
Date of declaration:
14.08.2025
Stage of process:
Procurement and grant lifecycle
Confidentiality requirement:
Yes
Intended signatories:
Individuals with access to procurement information
Year:
2021
Region / City:
Papua New Guinea, Hela and Southern Highlands provinces
Theme:
Climate change, Gender equality, Conflict prevention
Document Type:
Project proposal
Organ / Institution:
United Nations Development Programme (UNDP), International Organization for Migration (IOM)
Author:
UNDP, IOM
Target Audience:
Government agencies, civil society organizations, community leaders, women and youth groups
Duration:
18 months
Approval Date:
June 2021
Date of Revisions:
Not specified
Note:
Context description
Year:
2023
Region / City:
Global
Theme:
Protection of the natural environment in armed conflict
Document Type:
Model Pledge
Organization:
International Committee of the Red Cross (ICRC)
Author:
International Committee of the Red Cross (ICRC)
Target Audience:
States, National Societies, Observers
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2020
Region / City:
Ireland
Topic:
Validation and QA Approval Processes
Document Type:
Policy Guidelines
Organization:
Quality and Qualifications Ireland (QQI)
Author:
Quality and Qualifications Ireland (QQI)
Target Audience:
Independent evaluators, academic and educational professionals
Period of validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2026
Region / City:
Not specified
Theme:
Conflicts of interest, Personal interests, Qualification assessment
Document type:
Policy, Register
Organization:
Ofqual
Author:
Not specified
Target audience:
Organizations involved in qualification assessment and delivery
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Date:
13 March 2017
Place:
Strasbourg
Committee:
Committee of Experts on Terrorism (CODEXTER)
Document code:
CODEXTER (2017) 01
Type of document:
Discussion paper
Prepared by:
Secretariat of CODEXTER
Subject matter:
Interaction between international humanitarian law and domestic criminal law in terrorism cases
Legal frameworks referenced:
International humanitarian law, domestic criminal law, European Convention on Human Rights, Council of Europe counter-terrorism instruments
Geographical scope:
Europe and conflict-affected regions including Iraq, Syria, Yemen, Mali, Libya, Nigeria, Pakistan and Afghanistan
Target audience:
Member States of the Council of Europe
Policy context:
Prosecution of foreign terrorist fighters
Language:
English
Document Type:
Publishing guidelines
Subject:
Manuscript submission requirements
Sections Covered:
Author Contributions; Funding; Ethical Approval; Acknowledgments; Conflicts of Interest; Data Availability Statement
Intended Use:
Academic manuscript preparation
Related Process:
Journal publication
Includes Sample Text:
Yes
Guidance on Funding Disclosure:
Yes
Guidance on Ethical Statements:
Yes
Guidance on Conflict of Interest Disclosure:
Yes
Year:
2021
Region / City:
United Kingdom
Subject:
Anti-doping policies and regulations
Document type:
Declaration form
Organization / Institution:
UK Anti-Doping
Author:
UK Anti-Doping
Target audience:
Employees, Board and Committee members, National Trainers, and other associates of UKAD
Validity period:
Ongoing
Approval date:
Not specified
Amendment date:
Not specified
Organisation:
North East London NHS Foundation Trust (NELFT)
Type of document:
Policy
Subject:
Conflicts of interest, gifts and hospitality
Applicable legislation:
Bribery Act 2010
Effective date of legislation referenced:
1 July 2011
Scope:
Employees, bank/agency staff, Non-Executive Directors, agents and contracted parties acting as officers of the Trust
Related document:
NHS Constitution
Associated forms:
Gifts and Hospitality – Declaration Form; Conflicts of Interest – Declaration Form
Governance areas:
Quality Governance; Communications; Training; Monitoring and Review
Appendices:
Policy On a Page; Quick Guide to Declarations; Addendum
Year:
2023
Region / City:
Not specified
Subject:
Governance, Conflicts of Interest, Public Contributors
Document Type:
Guidelines
Organization:
ARC (Applied Research Collaboration)
Author:
Not specified
Target Audience:
Public Contributors to ARC governance
Effective Period:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified