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Conditions For Publication Form

THE ANNALS OF THORACIC SURGERY
3440 Market Street
Suite 306
Philadelphia, PA 19104-3325
Phone: 215-349-5542
Fax: 215-614-0416
e-mail: ats{at}uphs.upenn.edu
website: http://www.atseditorialoffice.org

ATS#: _______________________________________________

Authors:______________________________________________________________________________________________________
_____________________________________________________________________________________________________________

Manuscript Title:_______________________________________________________________________________________________
_____________________________________________________________________________________________________________

This form MUST be completed, signed by ALL authors, and returned to the Editorial Office before your manuscript can be accepted for publication. This form with signatures may be returned by fax to 215-614-0416.

Individual Conflict of Interest Disclosure Statement: Each author must indicate that for the past 12 months either (a) no financial conflict of interest exists with any commercial entity or competitor whose products are featured, described, reviewed, evaluated or compared in the manuscript, except for funding supporting the study as disclosed under “Acknowledgments” (see below) or (b) a potential conflict of interest exists with one or more commercial entities or a competitor whose products are featured, described, reviewed, evaluated or compared in the manuscript through the existence of one or more of the following relationships: (1) the author is a full- or part-time employee of a company; (2) the author and/or immediate family members (siblings, parents, children) has an existing or optional equity interest in a company and/or owns or partly owns patents licensed to a company; (3) the author has an ongoing retainer relationship (consultant, speaker, etc) with a company for which he/she receives financial remuneration; or (4) the author has received financial compensation for this publication. Financial compensation includes any amount of cash, securities, gifts, services, or items of value. If "Yes" is checked, a box on the title page of the published article will read: "Dr. X discloses that he/she has a financial relationship with company Y."

Acknowledgment of Sources of Funding for This Study: Grants, financial support and technical or other assistance are acknowledged at the end of the text before references. All sources of financial support for this project must be acknowledged.

Scientific Responsibility Statement: Each author must sign this form to certify that he or she has participated sufficiently in the work to take responsibility for a meaningful share of the content of the manuscript (as specified in the signature area below).

Freedom of Investigation Statement: "Freedom of investigation" is defined as freedom from outside interests in controlling the design of the study, acquisition of data, collection, analysis, and interpretation of data, and having freedom to fully disclose all results. Each author must indicate whether or not he or she has had full “freedom of investigation” before, during, and after this study. Except for New Technology articles, this statement is signed on the “Conditions for Publication Form” (below) and does not appear in the published manuscript.

Undisclosed Authors: The corresponding author is responsible for identifying names, addresses and affiliations of all undisclosed writers who have contributed to this submitted manuscript.

Exclusive Publication Statement: Each author must sign this form to certify that none of the material in this manuscript has been published previously in either print or electronic form, and that none of this material is currently under consideration for publication elsewhere. This includes symposia, transactions, books, articles published by invitation, posting in electronic format, and preliminary publications of any kind except an abstract of 400 words or fewer.

Copyright Transfer Agreement: Each author must sign this form to certify that, if the manuscript is accepted for publication in The Annals, copyright (including the right to obtain copyright registration, whether separately or as part of a journal issue or otherwise) in and to the above article, including original artwork, transfers throughout the world and for the full term and all extensions and renewals thereof to:

THE SOCIETY OF THORACIC SURGEONS (STS)

This transfer includes the right to adapt the article for use in conjunction with computer systems and programs, including reproductions or publication in machine-readable form and incorporation in retrieval systems.

Rights of authors: The STS hereby licenses the following rights back to the author(s):

  1. Patent and trademark rights to any process or procedure described in the article.
  2. The right to photocopy or make single electronic copies of the article for their own personal use, including for their own classroom use, or for the personal use of colleagues, provided the copies are not offered for sale and are not distributed in a systematic way outside of their employing institution (e.g., via an e-mail list or public file server). Posting of the article on a secure network (not accessible to the public) within the author's institution is permitted.
  3. The right, subsequent to publication, to use the article or any part thereof free of charge in a printed compilation of works of their own, such as collected writings or lecture notes.

Note: All copies, paper or electronic, or other use of the information must include an indication of the STS copyright and a full citation of the journal source. Please refer requests for all uses above, including the authorization of third parties to reproduce or otherwise use all or part of the article (including figures and tables), to Elsevier’s Global Rights Department, PO Box 800, Oxford OX5 1DX, United Kingdom; Tel: (+44) 1865 843830 (UK) or (+1) 215 239 3804 (US); Fax: (+44) 1865 853333; Email: healthpermissions{at}elsevier.com. Or submit request online at http://www.elsevier.com/permissions.

Authorship: If copyright is held by the employer, the employer or an authorized representative of the employer must sign in addition to the author(s).
          If the author is a U.S. Government employee and this work was done in that capacity, the copyright transfer applies only to the extent allowed by U.S. law and the author should sign this form. Please confirm by checking the appropriate space in the signature area at the end of this form. Any other author who is not a U.S. Government employee should also sign the Conditions for Publication Form.

Warranties: The author(s) warrant that the article is the author's original work and has not been published before. The author(s) warrant that the article contains no libelous or other unlawful statements, and does not infringe on the rights of others. If excerpts from copyrighted works are included, the author(s) has (have) obtained written permission from the copyright owners and will credit the sources in the article.

Preprints: The author(s) warrant(s) that if a prior version of this work (normally a preprint) has been posted to an electronic server, such version was accessible to only a small group of individuals and the author(s) will cause its prompt removal from such server.


I agree with the preceding conditions and provide the appropriate signatures and information
below accordingly:
Corresponding Author's Name:___________________________________________________________
Signature:______________________________________________ Date:___________________________________
Author's employer's signature, if appropriate: _______________________________________________
U.S. Government employee: Yes ___ No ___
Conflict of interest: Yes ___ No ___
          If yes, with which entity: ____________________________________________
Did you have freedom of investigation in all aspects of this work?: Yes ___ No ___
Undisclosed writers have contributed to this paper: Yes ___ No ___
          If yes, provide the writer’s full name, address and affiliation in separate correspondence.
My contribution to this study included (check applicable items): ___study design; ___development of methodology; ___collection of data; ___analysis and/or interpretation of data; ___writing (not revising) all sections of the manuscript; ___supervision; ___other, please specify____________________________________________

Author's Name:________________________________________________________________________
Signature:______________________________________________ Date:___________________________________
Author's employer's signature, if appropriate: _______________________________________________
U.S. Government employee: Yes ___ No ___
Conflict of interest: Yes ___ No ___
          If yes, with which entity: ____________________________________________
Did you have freedom of investigation in all aspects of this work?: Yes ___ No ___
My contribution to this study included (check applicable items): ___study design; ___development of methodology; ___collection of data; ___analysis and/or interpretation of data; ___writing (not revising) all sections of the manuscript; ___supervision; ___other, please specify____________________________________________

Author's Name:________________________________________________________________________
Signature:______________________________________________ Date:___________________________________
Author's employer's signature, if appropriate: _______________________________________________
U.S. Government employee: Yes ___ No ___
Conflict of interest: Yes ___ No ___
          If yes, with which entity: ____________________________________________
Did you have freedom of investigation in all aspects of this work?: Yes ___ No ___
My contribution to this study included (check applicable items): ___study design; ___development of methodology; ___collection of data; ___analysis and/or interpretation of data; ___writing (not revising) all sections of the manuscript; ___supervision; ___other, please specify____________________________________________

Author's Name:________________________________________________________________________
Signature:______________________________________________ Date:___________________________________
Author's employer's signature, if appropriate: _______________________________________________
U.S. Government employee: Yes ___ No ___
Conflict of interest: Yes ___ No ___
          If yes, with which entity: ____________________________________________
Did you have freedom of investigation in all aspects of this work?: Yes ___ No ___
My contribution to this study included (check applicable items): ___study design; ___development of methodology; ___collection of data; ___analysis and/or interpretation of data; ___writing (not revising) all sections of the manuscript; ___supervision; ___other, please specify____________________________________________

Author's Name:________________________________________________________________________
Signature:______________________________________________ Date:___________________________________
Author's employer's signature, if appropriate: _______________________________________________
U.S. Government employee: Yes ___ No ___
Conflict of interest: Yes ___ No ___
          If yes, with which entity: ____________________________________________
Did you have freedom of investigation in all aspects of this work?: Yes ___ No ___
My contribution to this study included (check applicable items): ___study design; ___development of methodology; ___collection of data; ___analysis and/or interpretation of data; ___writing (not revising) all sections of the manuscript; ___supervision; ___other, please specify____________________________________________

Author's Name:________________________________________________________________________
Signature:______________________________________________ Date:___________________________________
Author's employer's signature, if appropriate: _______________________________________________
U.S. Government employee: Yes ___ No ___
Conflict of interest: Yes ___ No ___
          If yes, with which entity: ____________________________________________
Did you have freedom of investigation in all aspects of this work?: Yes ___ No ___
My contribution to this study included (check applicable items): ___study design; ___development of methodology; ___collection of data; ___analysis and/or interpretation of data; ___writing (not revising) all sections of the manuscript; ___supervision; ___other, please specify____________________________________________

Author's Name:________________________________________________________________________
Signature:______________________________________________ Date:___________________________________
Author's employer's signature, if appropriate: _______________________________________________
U.S. Government employee: Yes ___ No ___
Conflict of interest: Yes ___ No ___
          If yes, with which entity: ____________________________________________
Did you have freedom of investigation in all aspects of this work?: Yes ___ No ___
My contribution to this study included (check applicable items): ___study design; ___development of methodology; ___collection of data; ___analysis and/or interpretation of data; ___writing (not revising) all sections of the manuscript; ___supervision; ___other, please specify____________________________________________

If there are additional authors on the article, please photocopy this form and attach additional sheets as need be with appropriate information and signatures affixed.


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