![Page 1: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/1.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Matsumoto
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 2: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/2.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Matsumoto
Identifying Information Section 1.
1. Given Name (First Name)Morio
2. Surname (Last Name) Matsumoto
4. Are you the corresponding author? Yes No✔
3. Date29-February-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Matsumoto
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Matsumoto has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Abdel
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 5: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/5.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Abdel
Identifying Information Section 1.
1. Given Name (First Name)Matthew
2. Surname (Last Name) Abdel
4. Are you the corresponding author? Yes No✔
3. Date27-February-2020
Corresponding Author’s Name
Geoffrey F. Haft
5. Manuscript Title2019 Scoliosis Research Society Meeting Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH)
✔Award Number AR072597-01A1
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Stryker ✔ Paid consultant and royalties
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Abdel
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Abdel reports grants from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH), during the conduct of the study; personal fees from Stryker, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 7: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/7.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Dragsted
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 8: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/8.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Dragsted
Identifying Information Section 1.
1. Given Name (First Name)Casper
2. Surname (Last Name) Dragsted
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Lærke Ragborg Nielsen
5. Manuscript TitleScheuermann’s Kyphosis – A 39-year follow-up from diagnosis in non-operated patients
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
K2M ✔ Institutional research grants
Medtronic ✔ Institutional reseacrh grants
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Dragsted
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Dragsted reports grants from K2M, grants from Medtronic, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 10: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/10.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Parent
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 11: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/11.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Parent
Identifying Information Section 1.
1. Given Name (First Name)Stefan
2. Surname (Last Name) Parent
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Noelle Larson, MD
5. Manuscript Title2019 Scoliosis Research Society Meeting Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
EOS-imaging ✔ Royalties
Spinologics ✔ Co-founder of company
K2M ✔ Consulting
EOS-imaging ✔ Consulting
Medtronic ✔ Consulting
DePuy Synthes Spine ✔ Consulting
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Parent
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Academic Research chair in spine deformities of the CHU Sainte-Justine (DePuy)
✔
Endowments
DePuy Synthes Spine ✔
Canadian Institutes of Health Research
✔
Pediatric Orthopaedic Society of North America
✔
Scoliosis Research Society
✔
Medtronic ✔
EOS imaging ✔
Canadian Foundation for Innovation
✔
Setting Scoliosis Straight Foundation
✔
Natural Sciences and Engineering Council of Canada
✔
Fonds de recherche Québec - Santé
✔
Orthopaedic Research and Education Foundation
✔ ✔
DePuy Synthes ✔ Fellowship support
Medtronic ✔ Fellowship support
Orthopaediatrics ✔ Fellowship support, Speaker's bureau
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
4Parent
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Parent reports personal fees from EOS-imaging, personal fees from Spinologics, personal fees from K2M, personal fees from EOS-imaging, personal fees from Medtronic, personal fees from DePuy Synthes Spine, other from Academic Research chair in spine deformities of the CHU Sainte-Justine (DePuy), grants from DePuy Synthes Spine, grants from Canadian Institutes of Health Research, grants from Pediatric Orthopaedic Society of North America, grants from Scoliosis Research Society, grants from Medtronic, grants from EOS imaging, grants from Canadian Foundation for Innovation, grants from Setting Scoliosis Straight Foundation, grants from Natural Sciences and Engineering Council of Canada, grants from Fonds de recherche Québec - Santé, grants and other from Orthopaedic Research and Education Foundation , other from DePuy Synthes, other from Medtronic, other from Orthopaediatrics, from null, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1milbrandt
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2milbrandt
Identifying Information Section 1.
1. Given Name (First Name)todd
2. Surname (Last Name) milbrandt
4. Are you the corresponding author? Yes No✔
3. Date27-February-2020
Corresponding Author’s Name
Geoffrey F. Haft
5. Manuscript TitleSRS abstract
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3milbrandt
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):✔
No other relationships/conditions/circumstances that present a potential conflict of interest
Relationships not covered aboveSection 5.
Orthopediatrics-consultant Medtronic-consultant Zimmer-Consultant Viking Scientific-stockholder POSNA board member
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. milbrandt reports and Orthopediatrics-consultant Medtronic-consultant Zimmer-Consultant Viking Scientific-stockholder POSNA board member.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Shoji
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 24: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/24.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Shoji
Identifying Information Section 1.
1. Given Name (First Name)Hirokazu
2. Surname (Last Name) Shoji
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Kei Watanabe
5. Manuscript TitleHealth related quality of life in non-operated patients with adolescent idiopathic scoliosis in the middle years: Mean 25 years follow-up study.6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Shoji
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Shoji has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 26: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/26.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Watanabe
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Watanabe
Identifying Information Section 1.
1. Given Name (First Name)Kei
2. Surname (Last Name) Watanabe
4. Are you the corresponding author? Yes✔ No
3. Date07-March-2020
5. Manuscript TitleHealth related quality of life in non-operated patients with adolescent idiopathic scoliosis in the middle years: Mean 25 years follow-up study.6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Watanabe
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Watanabe has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 29: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/29.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Ohashi
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 30: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/30.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Ohashi
Identifying Information Section 1.
1. Given Name (First Name)Masayuki
2. Surname (Last Name) Ohashi
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Kei Watanabe
5. Manuscript TitleHealth related quality of life in non-operated patients with adolescent idiopathic scoliosis in the middle years: Mean 25 years follow-up study.6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 31: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/31.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Ohashi
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Ohashi has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 32: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/32.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Endo
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 33: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/33.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Endo
Identifying Information Section 1.
1. Given Name (First Name)Naoto
2. Surname (Last Name) Endo
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
5. Manuscript TitleHealth related quality of life in non-operated patients with adolescent idiopathic scoliosis in the middle years: Mean 25 years follow-up study.6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 34: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/34.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Endo
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Endo has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 35: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/35.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Smith
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 36: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/36.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Smith
Identifying Information Section 1.
1. Given Name (First Name)Brian
2. Surname (Last Name) Smith
4. Are you the corresponding author? Yes✔ No
3. Date12-February-2020
5. Manuscript TitleHumerus Ossification and Cobb Angle Correlates with Progression to Surgery in Scoliosis Patients
6. Manuscript Identifying Number (if you know it)JBJS-D-19-01318
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 37: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/37.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Smith
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Smith has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 38: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/38.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Mizouchi
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 39: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/39.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Mizouchi
Identifying Information Section 1.
1. Given Name (First Name)Tatsuki
2. Surname (Last Name) Mizouchi
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Kei Watanabe
5. Manuscript TitleHealth related quality of life in non-operated patients with adolescent idiopathic scoliosis in the middle years: Mean 25 years follow-up study.6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 40: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/40.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Mizouchi
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Mizouchi has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 41: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/41.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Hirano
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 42: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/42.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Hirano
Identifying Information Section 1.
1. Given Name (First Name)Toru
2. Surname (Last Name) Hirano
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Kei Watanabe
5. Manuscript TitleHealth related quality of life in non-operated patients with adolescent idiopathic scoliosis in the middle years: Mean 25 years follow-up study.6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 43: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/43.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Hirano
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Hirano has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 44: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/44.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Haft
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 45: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/45.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Haft
Identifying Information Section 1.
1. Given Name (First Name)Geoffrey
2. Surname (Last Name) Haft
4. Are you the corresponding author? Yes✔ No
3. Date01-March-2020
5. Manuscript TitleAre Serum Ion Levels Elevated in Pediatric Patients with Spinal Implants versus Controls? (SRS Abstract from 2019 SRS Montreal meeting)6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
T. Denny Sanford Pediatric Collaborative Research Fund
✔Competitive research grant awarded for metallosis project
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 46: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/46.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Haft
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Haft reports grants from T. Denny Sanford Pediatric Collaborative Research Fund, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 47: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/47.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Cooperman
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 48: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/48.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Cooperman
Identifying Information Section 1.
1. Given Name (First Name)Daniel
2. Surname (Last Name) Cooperman
4. Are you the corresponding author? Yes No✔
3. Date23-February-2020
Corresponding Author’s Name
Brian Smith
5. Manuscript TitleUsing Humerus Ossification and Cobb Angle to Predict Progression to Surgery in Scoliosis Patients
6. Manuscript Identifying Number (if you know it)JBJS-D-19-01318R1
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 49: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/49.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Cooperman
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Cooperman has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 50: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/50.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Cui
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 51: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/51.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Cui
Identifying Information Section 1.
1. Given Name (First Name)Jonathan
2. Surname (Last Name) Cui
4. Are you the corresponding author? Yes No✔
3. Date26-February-2020
Corresponding Author’s Name
Brian Smith
5. Manuscript TitleUsing Humerus Ossification and Cobb Angle to Predict Progression to Surgery in Scoliosis Patients
6. Manuscript Identifying Number (if you know it)JBJS-D-19-01318R1
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 52: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/52.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Cui
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Cui has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 53: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/53.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Li
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 54: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/54.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Li
Identifying Information Section 1.
1. Given Name (First Name)Don
2. Surname (Last Name) Li
4. Are you the corresponding author? Yes No✔
3. Date24-February-2020
Corresponding Author’s Name
Brian Smith
5. Manuscript TitleUsing Humerus Ossification and Cobb Angle to Predict Progression to Surgery in Scoliosis Patients
6. Manuscript Identifying Number (if you know it)JBJS-D-19-01318R1
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Pediatric Orthopedic Society of North America ✔ Start-Up Grand
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
National Institutes of Health ✔ F30 Fellowship Grant
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Li
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Li reports grants from Pediatric Orthopedic Society of North America, during the conduct of the study; grants from National Institutes of Health, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 56: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/56.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Dahl
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 57: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/57.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Dahl
Identifying Information Section 1.
1. Given Name (First Name)Benny
2. Surname (Last Name) Dahl
4. Are you the corresponding author? Yes No✔
3. Date01-March-2020
Corresponding Author’s Name
Lærke C. Ragborg
5. Manuscript TitleScheuermann Kyphosis –39 year follow up from diagnosis in non-operated patients
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Stryker ✔ Consultant
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Dahl
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Dahl reports personal fees from Stryker, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 59: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/59.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1DeVries
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 60: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/60.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2DeVries
Identifying Information Section 1.
1. Given Name (First Name)Stephen
2. Surname (Last Name) DeVries
4. Are you the corresponding author? Yes No✔
3. Date21-February-2020
Corresponding Author’s Name
Brian Smith
5. Manuscript TitleUsing Humerus Ossification and Cobb Angle to Predict Progression to Surgery in Scoliosis Patients
6. Manuscript Identifying Number (if you know it)JBJS-D-19-01318R1
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3DeVries
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. DeVries has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 62: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/62.jpg)
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Garg
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 65: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/65.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Garg
Identifying Information Section 1.
1. Given Name (First Name)Sumeet
2. Surname (Last Name) Garg
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Noelle Larson, MD
5. Manuscript Title2019 Scoliosis Research Society Meeting Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Medtronic ✔
Nuvasive ✔
ACI Clinical ✔
Pediatric Orthopaedic Society of North America ✔
Scoliosis Research Society ✔
Children's Hospital Colorado ✔
University of Colorado Department of Orthopedics
✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Garg
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Garg reports personal fees from Medtronic, personal fees from Nuvasive, personal fees from ACI Clinical, grants from Pediatric Orthopaedic Society of North America, grants from Scoliosis Research Society, grants from Children's Hospital Colorado , grants from University of Colorado Department of Orthopedics, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 67: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/67.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Ames
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 68: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/68.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Ames
Identifying Information Section 1.
1. Given Name (First Name)Robert
2. Surname (Last Name) Ames
4. Are you the corresponding author? Yes No✔
3. Date03-March-2020
Corresponding Author’s Name
Amer F. Samdani
5. Manuscript TitleProspective Follow-Up of Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results from an FDA IDE Study
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Zimmer Biomet ✔ Funded the FDA IDE study
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Ames
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Ames reports grants from Zimmer Biomet, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 70: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/70.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Betz
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Betz
Identifying Information Section 1.
1. Given Name (First Name)Randal
2. Surname (Last Name) Betz
4. Are you the corresponding author? Yes No✔
3. Date03-March-2020
Corresponding Author’s Name
Amer F Samdani
5. Manuscript TitleProspective Follow-Up of Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results from an FDA IDE Study
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Zimmer Biomet ✔ Funded the FDA IDE study
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Abyrx ✔ Stock options
ApiFix ✔ ✔ Consulting, stock options
DePuy Synthes Spine✔
Royalties, speakers bureau, consulting
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Betz
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Electrocore ✔ Stock options
Globus Medical✔
Royalties, speakers bureau, consulting
Medovex ✔ Stock options
Orthobond ✔ Stock options
SpineGuard ✔ ✔ Royalties, consulting, stock options
Thieme Medical Publishers ✔ Royalties
Wishbone Medical ✔ ✔ Consulting, stock options
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Patent? Pending? Issued? Licensed? Royalties? Licensee? Comments
Methods and Techniques for Spinal Surgery [Vertebral Body Tethering]
✔ ✔Shriners Hospitals for Children
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ICMJE Form for Disclosure of Potential Conflicts of Interest
4Betz
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):✔
No other relationships/conditions/circumstances that present a potential conflict of interest
Relationships not covered aboveSection 5.
Son Randal Betz, Jr. is an employee of DePuy Synthes Spine
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Betz reports grants from Zimmer Biomet, during the conduct of the study; other from Abyrx, personal fees and other from ApiFix, personal fees from DePuy Synthes Spine, other from Electrocore, personal fees from Globus Medical, other from Medovex, other from Orthobond, personal fees and other from SpineGuard, personal fees from Thieme Medical Publishers, personal fees and other from Wishbone Medical, outside the submitted work; In addition, Dr. Betz has a patent Methods and Techniques for Spinal Surgery [Vertebral Body Tethering] licensed to Shriners Hospitals for Children and Son Randal Betz, Jr. is an employee of DePuy Synthes Spine.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 74: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/74.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Hwang
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 75: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/75.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Hwang
Identifying Information Section 1.
1. Given Name (First Name)Steven
2. Surname (Last Name) Hwang
4. Are you the corresponding author? Yes No✔
3. Date03-March-2020
Corresponding Author’s Name
Amer F. Samdani
5. Manuscript TitleProspective Follow-Up of Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results from an FDA IDE Study
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Zimmer Biomet ✔ Funded the FDA IDE study
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Zimmer Biomet ✔ Speakers bureau
NuVasive ✔ Consulting, speakers bureau
Auctus ✔ ✔ Consulting, stock options
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Hwang
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Hwang reports grants from Zimmer Biomet, during the conduct of the study; personal fees from Zimmer Biomet, personal fees from NuVasive, personal fees and other from Auctus, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 77: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/77.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Shetty
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 78: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/78.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Shetty
Identifying Information Section 1.
1. Given Name (First Name)Ajoy Prasad
2. Surname (Last Name) Shetty
4. Are you the corresponding author? Yes✔ No
3. Date07-March-2020
5. Manuscript Title The Analgesic Effect of Dexmedetomidine in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Double Blinded Prospective Randomized Study6. Manuscript Identifying Number (if you know it)Do Not know
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
GANGA ORTHOPAEDIC RESEARCH AND EDUCATION FOUNDATION
✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 79: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/79.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Shetty
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Shetty reports grants from GANGA ORTHOPAEDIC RESEARCH AND EDUCATION FOUNDATION , during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 80: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/80.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Crawford
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 81: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/81.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Crawford
Identifying Information Section 1.
1. Given Name (First Name)Charles
2. Surname (Last Name) Crawford
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Noelle Larson, MD
5. Manuscript Title2019 Scoliosis Research Society Meeting Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Alphatec ✔
Depuy-Synthes ✔
Medtronic ✔
Nuvasive ✔
OREF ✔
ISSG ✔
Pfizer ✔
Intellirod ✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Crawford
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
TSRH ✔
Alan L. & Jacqueline B. Stuart Spine Research ✔
Cerapedics, Inc. ✔
SRS ✔
Medtronic ✔
NIH ✔
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Crawford reports personal fees from Alphatec, personal fees from Depuy-Synthes, personal fees from Medtronic, personal fees from Nuvasive, grants from OREF, grants from ISSG, grants from Pfizer, grants from Intellirod, grants from TSRH, grants from Alan L. & Jacqueline B. Stuart Spine Research, grants from Cerapedics, Inc., grants from SRS, grants from Medtronic, grants from NIH, outside the submitted work; .
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ICMJE Form for Disclosure of Potential Conflicts of Interest
4Crawford
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 84: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/84.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Kanna P
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 85: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/85.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Kanna P
Identifying Information Section 1.
1. Given Name (First Name)Rishi Mugesh
2. Surname (Last Name) Kanna P
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Ajoy Prasad Shetty
5. Manuscript Title The Analgesic Effect of Dexmedetomidine in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Double Blinded Prospective Randomized Study6. Manuscript Identifying Number (if you know it)Do Not know
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
GANGA ORTHOPAEDIC RESEARCH AND EDUCATION FOUNDATION
✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 86: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/86.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Kanna P
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Kanna P reports grants from GANGA ORTHOPAEDIC RESEARCH AND EDUCATION FOUNDATION , during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 87: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/87.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Rajasekaran
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 88: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/88.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Rajasekaran
Identifying Information Section 1.
1. Given Name (First Name)Shanmuganathan
2. Surname (Last Name) Rajasekaran
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Ajoy Prasad Shetty
5. Manuscript Title The Analgesic Effect of Dexmedetomidine in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Double Blinded Prospective Randomized Study6. Manuscript Identifying Number (if you know it)Do Not know
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
GANGA ORTHOPAEDIC RESEARCH AND EDUCATION FOUNDATION
✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 89: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/89.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Rajasekaran
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Shanmuganathan reports grants from GANGA ORTHOPAEDIC RESEARCH AND EDUCATION FOUNDATION , during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 90: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/90.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Takeda
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 91: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/91.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Takeda
Identifying Information Section 1.
1. Given Name (First Name)Kazuki
2. Surname (Last Name) Takeda
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Shiro Ikegawa, and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Japan Orthopaedics and Traumatology Foundation
✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 92: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/92.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Takeda
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Takeda reports grants from Japan Orthopaedics and Traumatology Foundation, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 93: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/93.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Watanabe
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 94: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/94.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Watanabe
Identifying Information Section 1.
1. Given Name (First Name)Kota
2. Surname (Last Name) Watanabe
4. Are you the corresponding author? Yes✔ No
3. Date28-February-2020
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 95: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/95.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Watanabe
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Watanabe has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 96: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/96.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Matsumoto
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 97: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/97.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Matsumoto
Identifying Information Section 1.
1. Given Name (First Name)Morio
2. Surname (Last Name) Matsumoto
4. Are you the corresponding author? Yes No✔
3. Date29-February-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No
![Page 98: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/98.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Matsumoto
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 99: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/99.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Mathew
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Mathew
Identifying Information Section 1.
1. Given Name (First Name)Smitha
2. Surname (Last Name) Mathew
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Geoffrey F. Haft
5. Manuscript TitleAre Serum Ion Levels Elevated in Pediatric Patients with Metal Implants?
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 101: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/101.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Mathew
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Mathew has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 102: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/102.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1van Wijnen
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 103: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/103.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2van Wijnen
Identifying Information Section 1.
1. Given Name (First Name)Andre
2. Surname (Last Name) van Wijnen
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Geoff Haft
5. Manuscript TitleAre Serum Ion Levels Elevated in Pediatric Patients with Metal Implants?
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 104: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/104.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3van Wijnen
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. van Wijnen has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 105: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/105.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Blakemore
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 106: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/106.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Blakemore
Identifying Information Section 1.
1. Given Name (First Name)Laurel
2. Surname (Last Name) Blakemore
4. Are you the corresponding author? Yes No✔
3. Date02-March-2020
Corresponding Author’s Name
Noelle Larson, MD
5. Manuscript Title Prospective Randomized Controlled Trial of Implant Density in AIS: Results of the Minimize Implants Maximize Outcomes Study6. Manuscript Identifying Number (if you know it)paper #78
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Stryker Spine ✔
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Blakemore
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Blakemore reports personal fees from Stryker Spine, from null, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 108: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/108.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Chan
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 109: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/109.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Chan
Identifying Information Section 1.
1. Given Name (First Name)Chris Yin Wei
2. Surname (Last Name) Chan
4. Are you the corresponding author? Yes No✔
3. Date02-March-2020
Corresponding Author’s Name
Mohd Shahnaz Hasan
5. Manuscript TitleTranexamic Acid In Pediatric Scoliosis Surgery (TRIPSS): A Prospective Randomized Trial Comparing High Dose And Low Dose Tranexamic Acid In Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion Surgery6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 110: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/110.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Chan
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Chan has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 111: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/111.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Ng
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 112: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/112.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Ng
Identifying Information Section 1.
1. Given Name (First Name)Ching Choe
2. Surname (Last Name) Ng
4. Are you the corresponding author? Yes No✔
3. Date02-March-2020
Corresponding Author’s Name
Mohd Shahnaz Hasan
5. Manuscript TitleTranexamic Acid In Pediatric Scoliosis Surgery (TRIPSS): A Prospective Randomized Trial Comparing High Dose And Low Dose Tranexamic Acid In Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion Surgery6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 113: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/113.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Ng
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Ng has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 114: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/114.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Chiu
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 115: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/115.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Chiu
Identifying Information Section 1.
1. Given Name (First Name)Chee Kidd
2. Surname (Last Name) Chiu
4. Are you the corresponding author? Yes No✔
3. Date02-March-2020
Corresponding Author’s Name
Mohd Shahnaz Hasan
5. Manuscript TitleTranexamic Acid In Pediatric Scoliosis Surgery (TRIPSS): A Prospective Randomized Trial Comparing High Dose And Low Dose Tranexamic Acid In Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion Surgery6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Chiu
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Chiu has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 117: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/117.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Polly
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Polly
Identifying Information Section 1.
1. Given Name (First Name)David
2. Surname (Last Name) Polly
4. Are you the corresponding author? Yes No✔
3. Date26-March-2020
Corresponding Author’s Name
A. Noelle Larson
5. Manuscript TitleMinimize implants maximize outcomes
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
OREF ✔
SRS ✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
SI-Bone ✔ Consultant
Medtronic ✔ Royalties to institution
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Polly
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Globus ✔ Royalties to institution
Springer ✔ Textbook royalties
Medtronic ✔ Research grant to institution
Mizuho OSI ✔ Research grant to institution
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Polly reports grants from OREF, grants from SRS, during the conduct of the study; personal fees from SI-Bone, other from Medtronic, other from Globus, personal fees from Springer, grants from Medtronic, grants from Mizuho OSI, outside the submitted work; .
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ICMJE Form for Disclosure of Potential Conflicts of Interest
4Polly
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 121: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/121.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Akman
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 122: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/122.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Akman
Identifying Information Section 1.
1. Given Name (First Name)Yunus Emre
2. Surname (Last Name) Akman
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Sinan Kahraman
5. Manuscript TitleClinical, Radiological and HRQoL Outcomes after Selective Thoracic Fusion with Minimum 15 Years Follow-up
6. Manuscript Identifying Number (if you know it)Paper #84
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 123: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/123.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Akman
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Akman has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 124: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/124.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Enercan
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 125: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/125.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Enercan
Identifying Information Section 1.
1. Given Name (First Name)Meric
2. Surname (Last Name) Enercan
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Sinan Kahraman
5. Manuscript TitleClinical, Radiological and HRQoL Outcomes after Selective Thoracic Fusion with Minimum 15 Years Follow-up
6. Manuscript Identifying Number (if you know it) Paper #84
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 126: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/126.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Enercan
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Enercan has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 127: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/127.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Hamzaoglu
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Hamzaoglu
Identifying Information Section 1.
1. Given Name (First Name)Azmi
2. Surname (Last Name) Hamzaoglu
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Sinan Kahraman
5. Manuscript TitleClinical, Radiological and HRQoL Outcomes after Selective Thoracic Fusion with Minimum 15 Years Follow-up
6. Manuscript Identifying Number (if you know it)Paper #84
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Medtronic ✔
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Hamzaoglu
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Hamzaoglu reports non-financial support from Medtronic, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 130: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/130.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Kahraman
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 131: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/131.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Kahraman
Identifying Information Section 1.
1. Given Name (First Name)Sinan
2. Surname (Last Name) Kahraman
4. Are you the corresponding author? Yes✔ No
3. Date28-February-2020
5. Manuscript TitleClinical, Radiological and HRQoL Outcomes after Selective Thoracic Fusion with Minimum 15 Years Follow-up
6. Manuscript Identifying Number (if you know it)Paper #84
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Kahraman
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Kahraman has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 133: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/133.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Karadereler
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 134: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/134.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Karadereler
Identifying Information Section 1.
1. Given Name (First Name)Selhan
2. Surname (Last Name) Karadereler
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Sinan Kahraman
5. Manuscript TitleClinical, Radiological and HRQoL Outcomes after Selective Thoracic Fusion with Minimum 15 Years Follow-up
6. Manuscript Identifying Number (if you know it)Paper#84
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 135: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/135.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Karadereler
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Karadereler has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 136: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/136.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Mutlu
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 137: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/137.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Mutlu
Identifying Information Section 1.
1. Given Name (First Name)Ayhan
2. Surname (Last Name) Mutlu
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Sinan Kahraman
5. Manuscript TitleClinical, Radiological and HRQoL Outcomes after Selective Thoracic Fusion with Minimum 15 Years Follow-up
6. Manuscript Identifying Number (if you know it)Paper #84
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 138: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/138.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Mutlu
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Mutlu has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 139: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/139.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Ozturk
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 140: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/140.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Ozturk
Identifying Information Section 1.
1. Given Name (First Name)Huseyin
2. Surname (Last Name) Ozturk
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Sinan Kahraman
5. Manuscript Title
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 141: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/141.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Ozturk
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Ozturk has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 142: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/142.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Ulusoy
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 143: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/143.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Ulusoy
Identifying Information Section 1.
1. Given Name (First Name)Levent Onur
2. Surname (Last Name) Ulusoy
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Sinan Kahraman
5. Manuscript TitleClinical, Radiological and HRQoL Outcomes after Selective Thoracic Fusion with Minimum 15 Years Follow-up
6. Manuscript Identifying Number (if you know it)Paper #84
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 144: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/144.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Ulusoy
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Ulusoy has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 145: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/145.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Naduvanahalli Vivekanandaswamy
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 146: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/146.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Naduvanahalli Vivekanandaswamy
Identifying Information Section 1.
1. Given Name (First Name)Ankith
2. Surname (Last Name) Naduvanahalli Vivekanandaswamy
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Ajoy Prasad Shetty
5. Manuscript TitleThe Analgesic Effect of Dexmedetomidine in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis-A Double Blinded Prospective Randomized Study6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 147: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/147.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Naduvanahalli Vivekanandaswamy
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Naduvanahalli Vivekanandaswamy has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 148: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/148.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Hasan
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 149: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/149.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Hasan
Identifying Information Section 1.
1. Given Name (First Name)Mohd Shahnaz
2. Surname (Last Name) Hasan
4. Are you the corresponding author? Yes✔ No
3. Date02-March-2020
5. Manuscript TitleTranexamic Acid In Pediatric Scoliosis Surgery (TRIPSS): A Prospective Randomized Trial Comparing High Dose And Low Dose Tranexamic Acid In Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion Surgery6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 150: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/150.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Hasan
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Hasan has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 151: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/151.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Hasegawa
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 152: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/152.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Hasegawa
Identifying Information Section 1.
1. Given Name (First Name)Kazuhiro
2. Surname (Last Name) Hasegawa
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Kei Watanabe
5. Manuscript TitleHealth related quality of life in non-operated patients with adolescent idiopathic scoliosis in the middle years: Mean 25 years follow-up study. 6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 153: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/153.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Hasegawa
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Hasegawa has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 154: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/154.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Labelle
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 155: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/155.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Labelle
Identifying Information Section 1.
1. Given Name (First Name)Hubert
2. Surname (Last Name) Labelle
4. Are you the corresponding author? Yes No✔
3. Date01-April-2020
Corresponding Author’s Name
Noelle Larson
5. Manuscript TitleProspective Randomized Controlled Trial of Implant Density in AIS: Results of the Minimize Implants Maximize Outcomes Trial6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
ORS ✔
SRS ✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Spinologics Inc. ✔ Stock ownership
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Labelle
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Labelle reports grants from ORS, grants from SRS, during the conduct of the study; other from Spinologics Inc., outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Sanders
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Sanders
Identifying Information Section 1.
1. Given Name (First Name)James
2. Surname (Last Name) Sanders
4. Are you the corresponding author? Yes No✔
3. Date07-March-2019
Corresponding Author’s Name
Noelle Larson, MD
5. Manuscript TitleSRS Abstract
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Patent? Pending? Issued? Licensed? Royalties? Licensee? Comments
Shape memory spinal instrumentation
✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Sanders
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Sanders reports In addition, Dr. Sanders has a patent Shape memory spinal instrumentation issued.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Kwan
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 161: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/161.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Kwan
Identifying Information Section 1.
1. Given Name (First Name)Mun Keong
2. Surname (Last Name) Kwan
4. Are you the corresponding author? Yes No✔
3. Date02-March-2020
Corresponding Author’s Name
Mohd Shahnaz Hasan
5. Manuscript TitleTranexamic Acid In Pediatric Scoliosis Surgery (TRIPSS): A Prospective Randomized Trial Comparing High Dose And Low Dose Tranexamic Acid In Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion Surgery6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Kwan
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Kwan has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Pelletier
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Pelletier
Identifying Information Section 1.
1. Given Name (First Name)Glenn
2. Surname (Last Name) Pelletier
4. Are you the corresponding author? Yes No✔
3. Date09-March-2020
Corresponding Author’s Name
Amer Samdani
5. Manuscript TitleProspective Follow-Up of Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results from an FDA IDE study
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Pelletier
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Pelletier has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 166: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/166.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Samdani
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 167: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/167.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Samdani
Identifying Information Section 1.
1. Given Name (First Name)Amer
2. Surname (Last Name) Samdani
4. Are you the corresponding author? Yes✔ No
3. Date27-February-2020
5. Manuscript TitleProspective Follow-Up of Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results from an FDA IDE StudyProspective Follow-Up of Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results from an FDA IDE StudyProspective Follow Up of Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results From An FDA IDE Study6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Zimmer Biomet ✔ Funded the FDA IDE study
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Zimmer Biomet ✔ Royalties, consulting
Depuy Synthes ✔ Consulting
Stryker ✔ Consulting
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Samdani
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
NuVasive ✔ Royalties, consulting
Globus ✔ Consulting
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Patent? Pending? Issued? Licensed? Royalties? Licensee? Comments
Technique of Vertebral Body Tethering
✔ ✔Shriners Hospitals for Children
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Samdani reports grants from Zimmer Biomet, during the conduct of the study; other from Zimmer Biomet, other from Depuy Synthes, other from Stryker, other from NuVasive, other from Globus, outside the submitted work; In addition, Dr. Samdani has a patent Technique of vertebral body tethering licensed to Shriners Hospitals for Children.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
4Samdani
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Shah
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 171: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/171.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Shah
Identifying Information Section 1.
1. Given Name (First Name)Suken
2. Surname (Last Name) Shah
4. Are you the corresponding author? Yes No✔
3. Date08-March-2020
Corresponding Author’s Name
Noelle Larson
5. Manuscript TitleProspective Randomized Controlled Trial of Implant Density in AIS: Results of the Minimize Implants, Maximize Outcomes Study6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Setting Scoliosis Straight Foundaton ✔
DePuy Synthes Spine ✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
DePuy Synthes Spine ✔
Stryker / K2M ✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Shah
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Globus Medical ✔
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Shah reports grants from Setting Scoliosis Straight Foundaton, grants from DePuy Synthes Spine, during the conduct of the study; personal fees from DePuy Synthes Spine, personal fees from Stryker / K2M, personal fees from Globus Medical, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 173: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/173.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Larson
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 174: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/174.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Larson
Identifying Information Section 1.
1. Given Name (First Name)A. Noelle
2. Surname (Last Name) Larson
4. Are you the corresponding author? Yes No✔
3. Date27-February-2020
Corresponding Author’s Name
Geoffrey F. Haft
5. Manuscript Title2019 Scoliosis Research Society Meeting Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
SRS, OREF ✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Medtronic, Zimmer, Globus✔
honorarium directed to Mayo research
![Page 175: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/175.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Larson
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Larson reports grants from SRS, OREF, during the conduct of the study; other from Medtronic, Zimmer, Globus, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 176: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/176.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Larson
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 177: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/177.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Larson
Identifying Information Section 1.
1. Given Name (First Name)A. Noelle
2. Surname (Last Name) Larson
4. Are you the corresponding author? Yes✔ No
3. Date27-February-2020
5. Manuscript Title2019 Scoliosis Research Society Meeting Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
SRS, OREF ✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Medtronic, Zimmer, Globus✔
honorarium directed to Mayo research
![Page 178: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/178.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Larson
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Larson reports grants from SRS, OREF, during the conduct of the study; other from Medtronic, Zimmer, Globus, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 179: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/179.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Sucato
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 180: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/180.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Sucato
Identifying Information Section 1.
1. Given Name (First Name)Daniel
2. Surname (Last Name) Sucato
4. Are you the corresponding author? Yes No✔
3. Date06-March-2020
Corresponding Author’s Name
Noelle Larson
5. Manuscript Title2019 Scoliosis Research Society Meeting Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Globus ✔ Royalties
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 181: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/181.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Sucato
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Sucato reports other from Globus, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 182: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/182.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Sanli
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Sanli
Identifying Information Section 1.
1. Given Name (First Name)Tunay
2. Surname (Last Name) Sanli
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Sinan Kahraman
5. Manuscript TitleClinical, Radiological and HRQoL Outcomes after Selective Thoracic Fusion with Minimum 15 Years Follow-up
6. Manuscript Identifying Number (if you know it)Paper #84
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Sanli
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Sanli has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Weinstein
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Weinstein
Identifying Information Section 1.
1. Given Name (First Name)Stuart
2. Surname (Last Name) Weinstein
4. Are you the corresponding author? Yes No✔
3. Date25-March-2020
Corresponding Author’s Name
dolan
5. Manuscript TitleSRS submission
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Weinstein
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Weinstein has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 188: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/188.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Yunus
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 189: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/189.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Yunus
Identifying Information Section 1.
1. Given Name (First Name)Siti Nadzrah
2. Surname (Last Name) Yunus
4. Are you the corresponding author? Yes No✔
3. Date02-March-2020
Corresponding Author’s Name
Mohd Shahnaz Hasan
5. Manuscript TitleTranexamic Acid In Pediatric Scoliosis Surgery (TRIPSS): A Prospective Randomized Trial Comparing High Dose And Low Dose Tranexamic Acid In Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion Surgery6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Yunus
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Yunus has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 191: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/191.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Aubin
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Aubin
Identifying Information Section 1.
1. Given Name (First Name)Carl-Eric
2. Surname (Last Name) Aubin
4. Are you the corresponding author? Yes No✔
3. Date06-March-2020
Corresponding Author’s Name
Noelle Larson
5. Manuscript Title2019 Scoliosis Research Society Meeting Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Natural Sciences and Engineering Research Council of Canada ✔
Industrial Reseach Chair with Medtronic of Canada (outside the scope of the study)
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Aubin
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Aubin reports grants from Natural Sciences and Engineering Research Council of Canada, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 194: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/194.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Fletcher
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Fletcher
Identifying Information Section 1.
1. Given Name (First Name)Nicholas
2. Surname (Last Name) Fletcher
4. Are you the corresponding author? Yes✔ No
3. Date28-February-2020
5. Manuscript TitleProspective Randomized Controlled Trial of Implant Density in AIS: Results of the Minimize Implants Maximize Outcomes Study6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Orthopaediatrics ✔
Medtronic ✔
Nuvasive ✔
Zimmer/Biomet ✔
Harrison Foundation ✔
![Page 196: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/196.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Fletcher
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Fletcher reports personal fees from Orthopaediatrics, personal fees from Medtronic, personal fees from Nuvasive, personal fees from Zimmer/Biomet, grants from Harrison Foundation, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Erickson
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 198: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/198.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Erickson
Identifying Information Section 1.
1. Given Name (First Name)Mark
2. Surname (Last Name) Erickson
4. Are you the corresponding author? Yes No✔
3. Date11-March-2020
Corresponding Author’s Name
Paul Sponseller, MD
5. Manuscript TitleScoliosis Research Society Annual Meeting 2019 Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Green Sun Medical ✔ Unpaid Consultant
Medtronic ✔ consultant
Nuvasive ✔ consultant
POSNA ✔ BOD
![Page 199: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/199.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Erickson
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Erickson reports other from Green Sun Medical, personal fees from Medtronic, personal fees from Nuvasive, other from POSNA, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 200: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/200.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Grauers
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 201: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/201.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Grauers
Identifying Information Section 1.
1. Given Name (First Name)Anna
2. Surname (Last Name) Grauers
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Swedish Research Council ✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 202: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/202.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Grauers
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Grauers reports grants from Swedish Research Council, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 203: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/203.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Otomo
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Otomo
Identifying Information Section 1.
1. Given Name (First Name)Nao
2. Surname (Last Name) Otomo
4. Are you the corresponding author? Yes No✔
3. Date29-February-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Japan Orthopaedics and Traumatology Foundation
✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 205: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/205.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Otomo
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Otomo reports grants from Japan Orthopaedics and Traumatology Foundation, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 206: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/206.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Ogura
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 207: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/207.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Ogura
Identifying Information Section 1.
1. Given Name (First Name)Yoji
2. Surname (Last Name) Ogura
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 208: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/208.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Ogura
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Ogura has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 209: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/209.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Gerdhem
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 210: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/210.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Gerdhem
Identifying Information Section 1.
1. Given Name (First Name)Paul
2. Surname (Last Name) Gerdhem
4. Are you the corresponding author? Yes No✔
3. Date01-March-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Swedish Research Council ✔
Scoliosis Research Society ✔
Stockholm County Council ✔
Karolinska Institutet ✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
![Page 211: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/211.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Gerdhem
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Gerdhem reports grants from Swedish Research Council, grants from Scoliosis Research Society, grants from Stockholm County Council, grants from Karolinska Institutet, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 212: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/212.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Ikegawa
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 213: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/213.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Ikegawa
Identifying Information Section 1.
1. Given Name (First Name)Shiro
2. Surname (Last Name) Ikegawa
4. Are you the corresponding author? Yes✔ No
3. Date03-March-2020
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Japan Agency for Medical Research and Development (AMED)
✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 214: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/214.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Ikegawa
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Ikegawa reports grants from Japan Agency for Medical Research and Development (AMED), during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 215: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/215.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Fan
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 216: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/216.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Fan
Identifying Information Section 1.
1. Given Name (First Name)Yan-Hui
2. Surname (Last Name) Fan
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 217: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/217.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Fan
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Fan has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 218: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/218.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Qiu
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 219: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/219.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Qiu
Identifying Information Section 1.
1. Given Name (First Name)Yong
2. Surname (Last Name) Qiu
4. Are you the corresponding author? Yes No✔
3. Date24-January-1960
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Hong Kong Health and Medical Research Fund
✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 220: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/220.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Qiu
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Qiu reports grants from Hong Kong Health and Medical Research Fund, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 221: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/221.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Qiu
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Qiu
Identifying Information Section 1.
1. Given Name (First Name)Yong
2. Surname (Last Name) Qiu
4. Are you the corresponding author? Yes No✔
3. Date24-January-1960
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 223: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/223.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Qiu
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Qiu has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 224: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/224.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Song
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 225: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/225.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Song
Identifying Information Section 1.
1. Given Name (First Name)You-Qiang Song
2. Surname (Last Name) Song
4. Are you the corresponding author? Yes No✔
3. Date07-March-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Hong Kong Health and Medical Research Fund
✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 226: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/226.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Song
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Song reports grants from Hong Kong Health and Medical Research Fund, during the conduct of the study; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 227: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/227.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Takahashi
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 228: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/228.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Takahashi
Identifying Information Section 1.
1. Given Name (First Name)Yohei
2. Surname (Last Name) Takahashi
4. Are you the corresponding author? Yes No✔
3. Date02-March-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 229: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/229.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Takahashi
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Takahashi has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 230: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/230.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Brearley
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 231: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/231.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Brearley
Identifying Information Section 1.
1. Given Name (First Name)Ann
2. Surname (Last Name) Brearley
4. Are you the corresponding author? Yes No✔
3. Date27-February-2020
Corresponding Author’s Name
A. Noelle Larson
5. Manuscript TitleProspective Randomized Controlled Trial of Implant Density in AIS: Results of the Minimize Implants Maximize Outcomes Trial6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 232: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/232.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Brearley
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Brearley has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 233: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/233.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Kere
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 234: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/234.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Kere
Identifying Information Section 1.
1. Given Name (First Name)Juha
2. Surname (Last Name) Kere
4. Are you the corresponding author? Yes No✔
3. Date08-March-2020
Corresponding Author’s Name
Shiro Ikegawa and Kota Watanabe
5. Manuscript TitleA multi-ethnic meta-analysis defined the association of rs12946942 with progression of adolescent idiopathic scoliosis
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 235: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/235.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Kere
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Kere has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 236: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/236.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Kahan
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Kahan
Identifying Information Section 1.
1. Given Name (First Name)Joseph
2. Surname (Last Name) Kahan
4. Are you the corresponding author? Yes No✔
3. Date20-February-2020
Corresponding Author’s Name
Brian Smith
5. Manuscript TitleUsing Humerus Ossification and Cobb Angle to Predict Progression to Surgery in Scoliosis Patients
6. Manuscript Identifying Number (if you know it)JBJS-D-19-01318R1
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Kahan
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Kahan has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Gehrchen
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Gehrchen
Identifying Information Section 1.
1. Given Name (First Name)Martin
2. Surname (Last Name) Gehrchen
4. Are you the corresponding author? Yes No✔
3. Date28-February-2020
Corresponding Author’s Name
Lærke Ragborg
5. Manuscript TitleScheuermann’s Kyphosis – A 39-year follow-up from diagnosis in non-operated patients
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Medtronic ✔ Institutional grants
K2M ✔ Institutional grans
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Gehrchen
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Gehrchen reports grants from Medtronic, grants from K2M, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 242: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/242.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Oetgen
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Oetgen
Identifying Information Section 1.
1. Given Name (First Name)Matthew
2. Surname (Last Name) Oetgen
4. Are you the corresponding author? Yes No✔
3. Date27-February-2020
Corresponding Author’s Name
Noelle Larson
5. Manuscript Title
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Oetgen
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Oetgen has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 245: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/245.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Pahys
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 246: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/246.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Pahys
Identifying Information Section 1.
1. Given Name (First Name)Joshua
2. Surname (Last Name) Pahys
4. Are you the corresponding author? Yes No✔
3. Date27-February-2020
Corresponding Author’s Name
Amer Samdani
5. Manuscript TitleProspective follow-up of anterior vertebral body tethering (AVBT) for idiopathic scoliosis: interim results from an FDA IDE study6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Zimmer Biomet ✔ Funded the FDA IDE study
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
NuVasive ✔ Consultant
DePuy Synthes ✔ Consultant
Zimmer Biomet ✔ Consultant
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Pahys
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Pahys reports grants from Zimmer Biomet, during the conduct of the study; personal fees from NuVasive, personal fees from DePuy Synthes, personal fees from Zimmer Biomet, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 248: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/248.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Petit
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
2Petit
Identifying Information Section 1.
1. Given Name (First Name)Logan
2. Surname (Last Name) Petit
4. Are you the corresponding author? Yes No✔
3. Date26-February-2020
Corresponding Author’s Name
Brian Smith
5. Manuscript TitleUsing Humerus Ossification and Cobb Angle to Predict Progression to Surgery in Scoliosis Patients
6. Manuscript Identifying Number (if you know it)JBJS-D-19-01318R1
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Petit
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Petit has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
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ICMJE Form for Disclosure of Potential Conflicts of Interest
1Richards
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 252: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/252.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Richards
Identifying Information Section 1.
1. Given Name (First Name)Benjamin Stephens
2. Surname (Last Name) Richards
4. Are you the corresponding author? Yes No✔
3. Date09-March-2020
Corresponding Author’s Name
Noelle Larson
5. Manuscript Title2019 Scoliosis Research Society Abstracts MIMO
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes✔ No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row. Excess rows can be removed by pressing the "X" button.
Name of Institution/Company Grant? Personal
Fees?Non-Financial
Support?Other? Comments
SRS ✔
OREF ✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Richards
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Richards reports grants from SRS , grants from OREF, during the conduct of the study.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 254: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/254.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Sponseller
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 255: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/255.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Sponseller
Identifying Information Section 1.
1. Given Name (First Name)Paul
2. Surname (Last Name) Sponseller
4. Are you the corresponding author? Yes✔ No
3. Date25-March-2020
5. Manuscript TitleSRS Abstracts
6. Manuscript Identifying Number (if you know it)
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes✔ No
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
If yes, please fill out the appropriate information below.
Name of Entity Grant? Personal
Fees?Non-Financial
Support?Other? Comments
Johnson and Johnson ✔ ✔
Globus ✔
Orthopediatrics ✔
Deputy Editor for The Journal of Bone & Joint Surgery
✔
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ICMJE Form for Disclosure of Potential Conflicts of Interest
3Sponseller
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Sponseller reports grants and personal fees from Johnson and Johnson, personal fees from Globus, personal fees from Orthopediatrics, other from Deputy Editor for The Journal of Bone & Joint Surgery, outside the submitted work; .
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.
![Page 257: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/257.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
1Talty
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.
Identifying information.
The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of the work itself, from the initial conception and planning to the present. The requested information is about resources that you received, either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the work without receiving any financial support from any third party -- that is, the work was supported by funds from the same institution that pays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check "Yes".
Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entity that could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor (EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from the entity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could be perceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could be perceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.
Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.
Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.
Definitions.
Instructions
1.
2.
3.
4.
5.
Other: Anything not covered under the previous three boxes Pending: The patent has been filed but not issued Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether earning royalties or not
Royalties: Funds are coming in to you or your institution due to your patent
Entity: government agency, foundation, commercial sponsor, academic institution, etc. Grant: A grant from an entity, generally [but not always] paid to your organization
Personal Fees: Monies paid to you for services rendered, generally honoraria, royalties, or fees for consulting , lectures, speakers bureaus, expert testimony, employment, or other affiliations Non-Financial Support: Examples include drugs/equipment supplied by the entity, travel paid by the entity, writing assistance, administrative support, etc.
![Page 258: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/258.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
2Talty
Identifying Information Section 1.
1. Given Name (First Name)Ronan
2. Surname (Last Name) Talty
4. Are you the corresponding author? Yes No✔
3. Date20-February-2020
Corresponding Author’s Name
Brian Smith
5. Manuscript TitleUsing Humerus Ossification and Cobb Angle to Predict Progression to Surgery in Scoliosis Patients
6. Manuscript Identifying Number (if you know it)JBJS-D-19-01318R1
The Work Under Consideration for PublicationSection 2.
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.)?Are there any relevant conflicts of interest? Yes No✔
Relevant financial activities outside the submitted work.Section 3.
Are there any relevant conflicts of interest? Yes No✔
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Intellectual Property -- Patents & CopyrightsSection 4.
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? Yes No✔
![Page 259: ICMJE Form for Disclosure of Potential Conflicts of …...any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,](https://reader035.vdocuments.us/reader035/viewer/2022071103/5fdcae86fbea8724777ba3e1/html5/thumbnails/259.jpg)
ICMJE Form for Disclosure of Potential Conflicts of Interest
3Talty
Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):
No other relationships/conditions/circumstances that present a potential conflict of interest ✔
Relationships not covered aboveSection 5.
At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements. On occasion, journals may ask authors to disclose further information about reported relationships.
Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box below.
Disclosure StatementSection 6.
Dr. Talty has nothing to disclose.
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.