romana english

Statement of interest

Name:
Manuscript Title:

1. Have you, in the past 5 years, accepted the following from an organisation that may in any way gain or lose financially from the results of your study or the conclusions of your review, editorial or letter, please answer yes or no:

- Reimbursement for attending a symposium? YES/NO*

- A fee for speaking? YES/NO*

- A fee for organising education? YES/NO*

- Funds for research? YES/NO*

Funds for a member of staff? YES/NO*

- Fees for consulting? YES/NO*

- Gifts exceeding 500 € per year? YES/NO*

2. Have you, in the past 5 years, been employed by an organisation that may in any way gain or lose financially from the results of your study or the conclusions of your review, editorial or letter? Please answer yes or no. YES/NO*

3. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially from the results of your study or the conclusions of your review, editorial or letter? Please answer yes or no. YES/NO*

4. Have you acted as an expert witness on the subject of your study, review, editorial or letter? Please answer yes or no. YES/NO*

5. Do you have any other competing financial interests? If so, please specify. YES/NO*

6. Are you or have you ever been in any relationship with or receipt of any benefit (financial or other) from the tobacco industry or corporate affiliates? Please answer yes or no. YES/NO*

7. Do you or your spouse knowingly hold any shares in the Tobacco industry? Please answer yes or no. YES/NO*

*Please delete as necessary

 

If you have answered "yes" to any of the above questions, the Pneumology considers that you or your institution may have a conflict of interest, which, in the spirit of openness, should be declared. Please draft a statement to publish with the article detailing these interests and add it to this form. This statement will be published along side your article in the event of acceptance.