The e-Journal of Neonatology Research

Your open access, online source for everything in neonatology

Author Full Disclosure Form

without comments


Paste form below into a new word file, fill out, then attach form to email with subtitle of “author disclosure form” to (or print faxed version, fill out and fax to  504-988-2950, attention Phillip Gordon – click here for PDF)

AUTHOR FULL DISCLOSURE FORM for e-Journal of Neonatology Research

 Question: Does this submission include human patients? (if yes, please read Statement 1 and respond to the query beneath, if no, proceed to Statement 2) 

YES  /  NO  (delete the incorrect answer)

Statement 1:

Patients have a right to privacy that should not be infringed without informed consent. Identifying information, including patients’ names, initials, or hospital numbers, should not be published in written descriptions, photographs, and pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives written informed consent for publication. Informed consent for this purpose requires that a patient who is identifiable be shown the manuscript to be published. Authors should identify Individuals who provide writing assistance and disclose the funding source for this assistance.

Identifying details should be omitted if they are not essential. Complete anonymity is difficult to achieve, however, and informed consent should be obtained if there is any doubt. For example, masking the eye region in photographs of patients is inadequate protection of anonymity. If identifying characteristics are altered to protect anonymity, such as in genetic pedigrees, authors should provide assurance that alterations do not distort scientific meaning and editors should so note.

The requirement for informed consent should be included in the journal’s instructions for authors. When informed consent has been obtained it should be indicated in the published article.

      – International Committee of Medical Journal Editors (“Uniform Requirements for Manuscripts Submitted to Biomedical Journals”) — February 2006

Question 1A. Does your submission conform to this statement?

YES  /  NO /  N/A  (delete the incorrect answers)

Question 1B. Does this submission include animal research?

YES  /  NO  (delete the incorrect answer)

(if you answered yes to either question A or B, read statement 2 and answer the query below, otherwise, skip to statement 3).

Statement 2:

When reporting experiments on human subjects, authors should indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). If doubt exists whether the research was conducted in accordance with the Helsinki Declaration, the authors must explain the rationale for their approach, and demonstrate that the institutional review body explicitly approved the doubtful aspects of the study. When reporting experiments on animals, authors should be asked to indicate whether the institutional and national guide for the care and use of laboratory animals was followed.

      – International Committee of Medical Journal Editors (“Uniform Requirements for Manuscripts Submitted to Biomedical Journals”) — February 2006

Question 2: Does your submission conform to this statement?

YES  /  NO  (delete the incorrect answer)

Statement 3:

Public trust in the peer review process and the credibility of published articles depend in part on how well conflict of interest is handled during writing, peer review, and editorial decision making. Conflict of interest exists when an author (or the author’s institution), reviewer, or editor has financial or personal relationships that inappropriately influence (bias) his or her actions (such relationships are also known as dual commitments, competing interests, or competing loyalties). These relationships vary from those with negligible potential to those with great potential to influence judgment, and not all relationships represent true conflict of interest. The potential for conflict of interest can exist whether or not an individual believes that the relationship affects his or her scientific judgment. Financial relationships (such as employment, consultancies, stock ownership, honoraria, paid expert testimony) are the most easily identifiable conflicts of interest and the most likely to undermine the credibility of the journal, the authors, and of science itself. However, conflicts can occur for other reasons, such as personal relationships, academic competition, and intellectual passion.

      – International Committee of Medical Journal Editors (“Uniform Requirements for Manuscripts Submitted to Biomedical Journals”) — February 2006

Question 3: Do any of the authors on the submission have conflicts of interest, dual commitments, competing loyalties / interests?

YES  /  NO  (delete the incorrect answer), if the answer is yes, please explain in more detail.

Statement 4: randomized controlled trials involving humans must be pre-registerd at prior to the initiation of the study in order to be eligible for publication in this e-journal, consistent with the editor consensus statement published in 2001 at requiring preregistration of all randomized controlled human trials in order to be considered for publication in participating editors journals.

Question 4: Does your submission include any primary or seconday data from a human randomized controlled trial that was not preregistered at prior to patient enrollment?

YES  /  NO  (delete the incorrect answer)

Contact Author Information

Who is the contact author:

what is their email address:

what is their phone number:

what is their birth date:

Do they certify that all of the above information is accurate?

YES  /  NO  (delete the incorrect answer),

Written by Dr Phillip Gordon

March 17th, 2011 at 11:58 pm

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