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This document is a disclosure form for authors to report their financial and non-financial relationships, activities, and interests related to the content of a manuscript submitted for publication.
Note:
Year
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Date:
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Author:
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Manuscript Title:
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US-based Author:
YES/NO
Manuscript Number:
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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
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
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:
2023
Region / City:
Queensland, Australia
Topic:
Child Protection, Kinship Care
Document Type:
Guidelines
Organization:
Department of Families, Seniors, Disability Services and Child Safety
Author:
Unknown
Target Audience:
Kinship carer applicants, assessors, Child Safety officers
Period of validity:
Not specified
Date of approval:
Not specified
Date of amendments:
Not specified
Year:
2017
Region / City:
NATO Europe
Topic:
Military frequency spectrum allocation
Document Type:
Agreement
Author:
NATO
Target Audience:
NATO Member Nations, Civil and Military Authorities
Period of Validity:
Not specified
Date of Approval:
Not specified
Date of Amendments:
Not specified
Year:
2023
Region / City:
United States
Theme:
Invention Disclosure, Patent Process
Document Type:
Form
Organization:
NIST
Author:
NIST Technology Partnerships Office
Target Audience:
NIST employees, inventors, researchers
Effective Period:
Until submission
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2009
Region / City:
Queensland
Topic:
Criminal History Disclosure, Guide, Hearing, and Assistance Dogs
Document Type:
Legal Guide
Organization / Institution:
Guide, Hearing and Assistance Dogs Team
Author:
Not specified
Target Audience:
People applying for approval as guide, hearing, or assistance dog trainers or employee trainers
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
Not specified
Region / City:
Not specified
Topic:
Author disclosure, conflicts of interest
Document type:
Author disclosure form
Organization / Institution:
Rheumatology
Author:
Not specified
Target audience:
Authors of manuscripts submitted to Rheumatology
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Note:
Year
Subject:
Use of Free and Open Source Software (FOSS) in Non-Production Materials
Document Type:
Approval Document
Authority / Organization:
Daimler Truck AG
Target Audience:
Contractors, Software Developers
Year:
2021
Region / City:
Hauz Khas, New Delhi
Theme:
Patent Application
Document Type:
Form
Organization:
IIT Delhi
Author:
FITT
Target Audience:
IIT Delhi faculty, staff, visiting faculty, and students
Period of validity:
Not specified
Approval Date:
Not specified
Date of Modification:
Not specified
Year:
2026
Region / City:
Oregon
Subject:
Conflict of Interest Disclosure
Document Type:
Form
Institution:
Oregon Department of Transportation
Author:
Oregon Department of Transportation
Target Audience:
Firms under contract with the Agency
Period of Validity:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Document type:
Institutional review form
Organization:
University of New England Institutional Review Board
Jurisdiction:
United States
Scope:
International human subjects research
Applicable research formats:
In-person research; Online-only research
Intended submitter:
Principal Investigator
Regulatory framework:
U.S. federal human subjects research regulations
Review body:
Institutional Review Board
Contact information:
[email protected]
Version date field:
Yes
IRB number field:
Yes
Target audience:
Faculty, staff, and student researchers
Geographic focus:
Research conducted outside the United States
Compliance topics:
Ethics approval, informed consent, data protection, export control regulations
Year:
2019
Region / City:
Fort Eustis, Virginia
Topic:
Foreign Disclosure Operations
Document Type:
Pamphlet
Organization / Institution:
United States Army Training and Doctrine Command (TRADOC)
Author:
United States Army
Target Audience:
TRADOC personnel and foreign disclosure officers
Period of Validity:
Indefinite
Approval Date:
10 July 2019
Date of Changes:
Not specified
Year:
2023
Region / City:
Ireland
Topic:
Statistical Disclosure Control
Document Type:
Best Practice Guide
Organization / Institution:
Central Statistics Office (CSO)
Authors:
Timothy Linehan, Karina Dineen
Target Audience:
Researchers, Data Custodians, CSO Staff
Period of Validity:
Ongoing
Approval Date:
2023
Date of Revisions:
Not specified
Year:
2023
Region / City:
Portsmouth, NH
Subject:
Healthcare Technology, EHR, Transparency
Document Type:
Letter
Organization / Institution:
Altea Healthcare
Author:
Michael Mai
Target Audience:
Drummond Group
Period of Validity:
Indefinite
Approval Date:
07/21/2023
Date of Changes:
Not specified
Note:
Year
Subject:
Non-conformance Reporting and Disclosure
Document Type:
Instructional Form
Organization / Institution:
Lockheed Martin Aeronautics
Author:
Lockheed Martin
Target Audience:
Suppliers, LM Business Units