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1. Author: Name, Degrees (MD, PhD, etc)

      Title:
      Affiliation: (Department, Institution, City, State/Country)
      Email:
      Contribution: < We require an author’s role to be disclosed. If the paper has more than
       one author, then at least two authors must attest to the integrity of the original data and
       the analysis. Contributions by each author are printed in the Journal. Identified
       contributions include study design, conduct of the study, data collection, data analysis,
       and manuscript preparation, e.g., This author helped design the study and prepare the
       manuscript.>
      Attestation: < Attest to having approved the final manuscript, e.g., (Author Name)
       approved the final manuscript. Additionally, for research reports, brief reports, and
       technical communications involving more than one author, at least two authors must
       attest to having reviewed the original study data and data analysis e.g., (Author Name)
       attests to the integrity of the original data and the analysis reported in this manuscript.
       One author must also be designated as the archival author who is responsible for
       maintaining the study records, e.g., (Author Name) is the archival author.>
      Conflicts of Interest: <Relationships between each author and any company or
       organization with a potential or vested interest in the outcome of the study should be
       disclosed. If there are no conflicts of interest simply state “None”>

2. Author: Name, Degrees (MD, PhD, etc)

      Title:
      Affiliation: (Department, Institution, City, State/Country)
      Email:
      Contribution:
      Attestation:
      Conflicts of Interest:

3. Author: Name, Degrees (MD, PhD, etc)

      Title:
      Affiliation: (Department, Institution, City, State/Country)
      Email:
      Contribution:
      Attestation:
      Conflicts of Interest:

4. Author: Name, Degrees (MD, PhD, etc)

      Title:
      Affiliation: (Department, Institution, City, State/Country)



                                                 1
      Email:
      Contribution:
      Attestation:
      Conflicts of Interest:

Name of Department(s) and Institution(s):

Short Title:

Funding: <Please indicate if this work was funded by: National Institutes of Health (NIH),
Howard Hughes Medical Institute (HHMI), Medical Research Council (MRC), and/or Wellcome
Trust>

Corresponding Author:
Name
Department
Institution
Mailing address
Phone
Fax
Email

Did a Section Editor solicit this submission? Name:

IRB: <If conducting human research, please include the name and contact information for the
Institutional Review Board that approved your study. This is required for all human research.>




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posted:10/7/2012
language:Latin
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