Version: 08/03/16

Author Disclosure Form

Manuscript title / ______
Corresponding author / ______
Affiliation / ______
Tel. / ______
E-mail / ______
Co-authors / ______
______
Corresponding author signature / ______

Please note we do not release or sell our data to third parties.

To reduce errors in the way that names appear when they are abbreviated, please fill in the following table for all authors:

First name(s) / Surname/Family name / Name as it should appear in abbreviated form
E.g., Laura Elizabeth / Dormer / Dormer LE

Future Science Group websites

You may be aware that Future Science Group also runs a number of community websites; free-of-charge resources open to all healthcare professionals. Sites include:

  • 3DMedNet (
  • BioanalysisZone (
  • Neurology Central (
  • Oncology Central (
  • EpigenomicsNet (
  • MedChemNet (
  • RegMedNet (

Benefits include:

  • Easy access to freepeer-reviewed articles, from impact factored Medline journals
  • Fast access to the latest news and features
  • Information you can trust, selected by experts
  • Exciting multimedia content, including webinars and video interviews

If you would like access to any of the above, please tick the box next to the sites you are interested in above. Should your co-authors (or colleagues) be interested in the above, please ask them to contact us, or visit the relevant website above to register for free.

(NB. Authors requesting access will receive a separate email from the Digital Editor with a username, password and further details).

Please check the boxes below as appropriate

  1. Authorship

(Sections a & b should be completed)

a)I certify that I am the corresponding author for this manuscript. The manuscript is submitted with the knowledge and on behalf of the listed co-authors.

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b)I certify that each co-author listed above participated sufficiently in the work to take responsibility for the content, and that all those who qualify are listed. Authorship credit should be based on (a) substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (b) drafting the work or revising it critically for important intellectual content; AND (c) final approval of the version to be published; AND (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Conditions (a), (b), (c) and (d) must all be met.

  1. Contributors

(Sections a & b should be completed)

a) I certify that no individuals other than the listed co-authors contributed to this publication.

OR

I certify that individuals in addition to the listed co-authors contributed to this publication, but do not fulfil all four authorship conditions (a–d) listed above. These individuals are listed below and acknowledged in the manuscript. Types of contributors include, but are not limited to: statisticians, medical writers and research personnel.

Name / Affiliation / Email / Contribution

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b) I certify that no funded writing assistance was utilised in the production of this manuscript.

OR

I certify that funded writing assistance was utilised in the production of this manuscript, and any sources of funding for such assistance are clearly identified in the manuscript.

  1. Author responsibility

I certify that the manuscript represents valid work and that neither this manuscript nor one with substantially similar content under my authorship has been published or is being considered for publication elsewhere.

  1. Author disclosures

(Sections a & b should be completed)

a)I certify that financial and/or material support was received for this research and/or the creation of this work, the sources and extent of involvement of which are clearly identified in the manuscript.

OR

I certify that no financial and/or material support was received for this research or the creation of this work.

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b)I certify that one or more of the authors have financial and/or nonfinancial relationships with an organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript, which have been disclosed in the manuscript.

Authors should disclose relationships in which they (or a close family member): are employed, are a contractor, provide services, or have otherwise collaborated in commercial or scientific pursuits – even in the absence of direct monetary remuneration. Stock holdings and issued or pending patents of an author or family member should also be disclosed. A 36-month disclosure window should be used.

OR

I certify that none of the authors have any relevant financial and/or nonfinancial relationships to disclose as defined in the point above.

Details of all relevant financial/material support and financial and/or nonfinancial relationships (or the lack of) must be declared in the ‘Disclosure’ section of the manuscript for all authors.

  1. Ethical conduct of research (for original research authors only)

For studies involving data relating to human or animal experimental investigations, appropriate institutional review board approval has been obtained and is described within the article (for those investigators who do not have formal ethics review committees, the principles outlined in the Declaration of Helsinki have been followed).

For investigations involving human subjects, informed consent has been obtained from the participants involved and an explanation of how this was obtained is included in the manuscript.

Version: 08/03/16

Author Disclosure Form

  1. Copyright status of figures and tables

Please complete the following table to indicate the copyright status of the figures and tables included in your manuscript. Each figure and table should be listed and the appropriate box checked. Where permission has already been granted, please attach the relevant licence agreement.

Figure/table number / Original
(prepared for current manuscript and not previously published) / Adapted from a previously published manuscript
(NB. for copyright purposes, adaptation is defined as addition of new information that was not previously included in the original) / Previously published in an Open Access format / Previously published by STM publisher* / Previously published by non-STM publisher*

*A list of STM signatory publishers is available at

If you have any queries, please contact the Editorial Office by e-mail or telephone (+44 [0]20 8371 6090).