PNF
12/20/11
UNIVERSITY OF PITTSBURGH, SCHOOLS OF THE HEALTH SCIENCES
RESEARCH PUBLICATION NOTIFICATION FORM
INSTRUCTIONS: For full-length manuscripts accepted for publication in peer-reviewed journals or submitted to online journals; to be completed by
First Listed U.P. Faculty Author or the Senior Author (if that author is at U.P.) and submitted to Department Chair with three copies of the manuscript.
Please fill in the information requested or place an X in the appropriate box. You must complete, sign and date this form. This form is also available at
www.health.pitt.edu.
SECTION I - MANUSCRIPT INFORMATION PNF CODE:_______________ (FOR INTERNAL USE ONLY)
Name of First Listed U.P. Faculty Author: First: Mid Init: Last:
Telephone: ( ) Facsimile: ( ) Email:
School/Department/Division/Center/Institute:
Title of Manuscript:
Name(s) of Co-author(s) and Affiliation (List as they appear on manuscript):
Manuscript Accepted for Publication in [Journal] (Volume, Year , Page if known):
Manuscript Submitted for Online Publication in [Journal], [Date Submitted]:
SECTION II – MANUSCRIPT CONTENT
1. Does this research involve Human Subjects1? Yes No
If "Yes", provide IRB Protocol Number:
IRB Protocol Title:
2. Does this research involve animals? Yes No
If "Yes", provide IACUC Protocol Number:
IACUC Protocol Title:
3. Does this manuscript describe an invention or discovery that is patentable 2? Yes No
4. Has an Invention Report been filed with the University Office of Technology Management? Yes No
5. Is this research newsworthy? (to describe to the press, School’s Board of Visitors, University Board of Trustees) Yes No
6. Keywords:
SECTION III – FUNDING SOURCE(S)
1. Funding source(s) and grant numbers (where applicable) that supported the activities reported in this manuscript:
1. Int Ext Source* Grant#
2. Int Ext Source* Grant#
3. Int Ext Source* Grant#
4. Int Ext Source* Grant#
5. Int Ext Source* Grant#
*Internal: Departmental funds, endowments, CMRF, etc.
______________________________________________________________________________________________________________
FIRST LISTED U.P. FACULTY AUTHOR (Signature) Date: _____________
This information is being collected to ensure that the breadth of research being performed by investigators at the University of Pittsburgh, Health Sciences is adequately
recognized. Further, the information in section II of this form will help to ensure that appropriate protocols are being followed and will prov ide valuable statistics that
are required for a number of university, state, and Federal reports on sponsored research. Your cooperation is appreciated.
1
The DHHS Federal Policy regulations define HUMAN SUBJECT as “a living individual about whom an investigator conducting research obtains data through (1)
intervention or interaction with an individual, or (2) identifiable private information.”
2
Examples of patentable inventions and discoveries include novel processes, devices, therapeutics, diagnostics, research tools, combinations of other technologies, or
reagents (e.g., cDNAs).