USSA/AVAA 2021 Academic Meeting Submissions
Fill out one form per submission using the contact information of the author who will receive all correspondence related to the submission acceptance and scheduling. Please use author contact information that will still be effective on October 8. All forms must be submitted by Friday, June 25, 2021 (11:59 p.m. CT). If you submitted an abstract to ANESTHESIOLOGY® 2021, a separate submission of your abstract to the USSA/AVAA annual meeting is explicitly permitted by ASA, USSA and AVAA.
Abstract title. Note: All abstract titles must be in English.
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Corresponding Author Name. This person will receive all communications related to the abstract submission.
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First Name
Middle Name
Last Name
Designation
Corresponding Author Email
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example@example.com
Corresponding Author Phone Number
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Area Code
Phone Number
Corresponding Author Institution Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please check the box if the Corresponding Author contact information is the same as the Presenting Author.
YES
Presenting Author Name
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First Name
Middle Name
Last Name
Designation
Presenting Author Email
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example@example.com
Presenting Author Phone Number
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-
Area Code
Phone Number
Presenting Author Institution Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list all additional authors (in order). Type n/a if there are no additional authors
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Please list all additional institutions involved (in order). Type n/a if there are no additional institutions
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All authors agree to an unbiased presentation:
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AGREE
DISAGREE
The Accreditation Council for Continuing Medical Education requires that ASA ensure that the following decisions were made free of the control of a commercial interest. (The ACCME defines a “commercial interest” as any proprietary entity producing health care goods or services, with the exemption of non-profit or government organizations and non-health care related companies.) a. Identification of CME needs; b. Determination of educational objectives; c. Selection and presentation of content; d. Selection of all persons and organizations that will be in a position to control the content of CME; e. Selection of educational methods; f. Evaluation of the activity USSA/AVAA must be able to show that everyone who is in a position to control the content of an educational activity has disclosed all financial relationships with any commercial interest to the provider. The ACCME defines “financial relationships” as financial relationships in any amount occurring within the past 24 months that create a conflict of interest. An individual must disclose to the learners any financial relationship(s). If there are no financial relationships, the learners must be informed that no relationships exist. An individual who refuses to disclose financial relationships will be disqualified from being a planning committee member, a teacher, or an author of CME, and cannot have control of, or responsibility for, the development, management, presentation or evaluation of the CME activity. USSA/AVAA will implement a mechanism to resolve all conflicts of interest before the educational activity takes place. Does the Planner/Presenter and/or an immediate family member (including the author’s spouse/partner) have a financial relationship as described above? Check box(es) below to enter the company name that corresponds with the relationship in the left hand column for your "Self" and/or for your "Spouse". If you have nothing to disclose, please check the box accordingly.
All authors comply with ACCME Standards:
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YES
NO
Check the items in the box that correspond with the relationship in the right hand column for the presenting author and/or for presenting author spouse. If you have nothing to disclose , please check the box accordingly.
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I Have Nothing to Disclose
Salary
Ownership
Royalties
Equity Position
Stock Options
Funded Research
Consulting Fees
Honoraria
Other Material Support
As the corresponding author for this submission, I will submit a conflict of disclosure form for all co-authors. The submission will not be considered final until all disclosure information is complete. At its discretion, ASA, USSA, or AVAA may request additional conflict of disclosure information. I Agree
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YES
NO
I understand that my abstract may be accepted for presentation. I understand that I will need to upload my presentations no later than September 22, 2021 according to the instructions that will be sent in late August. I Agree
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YES
NO
If my abstract is accepted, I will attend the Academic Meeting or a coauthor or colleague will attend in my place. As soon as it is known that there is a change in the presenting author, I will contact Sue Lentz at vaanesthesiologist@gmail.com regarding this change.
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YES
NO
I understand that I must contact the USSA/AVAA personnel with any requests to make changes to my submission after the June 25, 2021 deadline. Changes will be reviewed and accepted on a case-by-case basis. Typically, only minor changes, grammatical changes, or changes to authors will be made. DEADLINE FOR ALL CHANGES: Wednesday, June 30, 2021. I will contact Sue Lentz at vaanesthesiologist@gmail.com with all change requests. I Agree
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YES
NO
Should I have a scheduling conflict, I understand that abstracts cannot be rescheduled for a different day/time. A co-author may be appointed as the presenter if the primary author cannot present. I Agree
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YES
NO
If the USSA/AVAA Academic Meeting Abstract Review Committee withdraws my abstract for reasons including but not limited to irregularities or misconduct, I understand that I may not submit an abstract for the following year. I Agree
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YES
NO
I understand that abstracts submitted for 2021 will be administratively withdrawn if the presenting author or his/her designee failed to show for a scheduled presentation at the USSA/AVAA 2021 Academic Meeting. I Agree
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YES
NO
If I fail to appear for an USSA/AVAA 2021 Academic Meeting eAbstract, I understand that I will be considered in non- compliance and my abstract will be considered withdrawn and will be pulled from subsequent publications. I Agree
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YES
NO
USSA/AVAA Academic Meeting Policy on Scientific Abstracts: I understand that abstracts submitted for presentation at the USSA/AVAA Academic Meeting must not have been published prior to October 1, 2020 at any local, national or international meeting* or broadcasted or published, in print or digital format, including journals, newsletters, news media coverage and education products. Internal presentations to small groups within the authors’ institution are permitted. For inquiries regarding news releases on these abstracts, please contact Sue Lentz at vaanesthesiologist@gmail.com. I Agree
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YES
NO
You are required to acknowledge the statement below. Failure to comply with the following may result in withdrawal of your abstract from the current year or disqualification from submitting in future years. I agree to the following: USSA/AVAA 2021 Academic Annual Meeting Scientific Abstract Embargo Policy: Embargo policies have been adopted from the ASA annual meeting guidance in that all scientific abstracts accepted for presentation are embargoed (may not be published or publicized) until the date and time of presentation. If you submitted an abstract to ANESTHESIOLOGY® 2021, a separate submission of your abstract to the USSA/AVAA annual meeting is explicitly permitted by ASA, USSA and AVAA. I Agree
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YES
NO
By submitting an abstract on this USSA/AVAA website, you represent that you own or otherwise have the rights to the written summaries of research or observations ("Abstract") you provided to the USSA/AVAA on this site. USSA/AVAA acknowledges and agrees that as between USSA/AVAA and you, you own all right, title and interest of any nature, throughout the world, in and to the Abstract, including any copyright registration or applications for copyright registrations relating thereto anywhere in the world. You grant to USSA/AVAA a non-exclusive, perpetual, sub-licensable, worldwide, right and license(or sublicense, as the case may be) to use, copy, modify, reproduce, publicly display, publicly perform, transmit, distribute or otherwise make available the Abstract in any form or format, including without limitation, through the Internet on various websites of USSA/AVAA and USSA/AVAA’s licensees or USSA/AVAA’s affiliates, intranets, and any other technologies whether now known or developed in the future; and to permit end-users to copy, display and print it for their own personal or business use (but not for resale by any such end- user). USSA/AVAA will not edit or modify the content of the Abstract, but may modify the format to fit the look and feel of the media on which it is displayed or distributed. You agree that USSA/AVAA may delete your Abstract from the USSA/AVAA Database at any time without prior notice and without refund of any fees to you. THIS WEB SITE AND THE MATERIALS ARE PROVIDED ON AN AS-IS BASIS WITHOUT ANY WARRANTY OF ANY KIND, EITHER EXPRESSOR IMPLIED. TO THE FULLEST EXTENT PERMITTED BY LAW, USSA/AVAA AND USSA/AVAA’S AFFILIATES AND USSA/AVAA’S SUPPLIERS DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY WARRANTY OF MERCHANTABILITY, NON-INFRINGEMENT OR FITNESS FOR A PARTICULAR PURPOSE. In no event shall USSA/AVAA or any of USSA/AVAA's affiliates or USSA/AVAA’s suppliers be liable for any damages whatsoever (including, but not limited to, direct, indirect, incidental, consequential, punitive or exemplary damages, or any damages for loss of profits, use, data, good will or other intangibles) arising from or in any way relating to these terms of use, the materials, or any information, goods or services obtained from or referred to in the materials, whether based on warranty, contract, tort (including, but not limited to, negligence), or any other legal theory, and whether or not advised of the possibility of such damages. Some states do not allow the exclusion of implied warranties or the exclusion or limitation of incidental or consequential damages, so such limitations or exclusions may not apply to you. These Terms are governed by the internal laws of the State of Illinois. You agree that any action arising out of or in any way relating to these Terms may be brought only in a court of competent jurisdiction in the State of Illinois, and you hereby consent to the jurisdiction, venue and convenience of such courts. Any waiver of any provision of these Terms will be effective only if it is in writing signed by the USSA/AVAA. No waiver of any provision of these Terms shall be deemed a further or continuing waiver of such provision or any other provision. If any provision of these Terms is found to be invalid, void or unenforceable by any court having competent jurisdiction, the remainder of these Terms shall remain in full force and effect. I Agree
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YES
NO
HUMAN STUDIES: If human subjects and/or their medical records were used, please indicate your answer to the following statement: I have satisfied the requirements of my institution or organization regarding the use of human subjects in research.
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YES
NO
N/A
ANIMAL STUDIES: If animal studies have been used in the reported experiments, please indicate your answer to the following statement: I have satisfied the requirements of my institution or organization regarding the use of animal subjects in research.
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YES
NO
N/A
Internal Review Board (IRB) or Institutional Animal Care and Use Committee (IACUC) Approval: Please note: Failure to have IRB or IACUC approval will lead to automatic rejection of the abstract.
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YES
NO
N/A
I understand that USSA/AVAA will not accept author additions after the June 25, 2021 deadline. Please ensure that all your co-authors have been added at the time of submission, before June 25, 2021 11:59 PM CT. No exceptions will be made to this policy. Grammatical changes and changes to the author order will be accepted on a case-by-case basis on or before Wednesday, June 30, 2021.
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YES
NO
I understand that as the corresponding author my email address may be shared with the moderator(s) of the session if my submission is accepted. Moderators may contact presenters prior to the conference regarding their presentation.
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YES
NO
Please select the topic/track your eAbstract would fall under.
Medically Challenging Case
Ambulatory Anesthesia
Cardiac Anesthesia
Critical Care Medicine
Fundamentals of Anesthesiology
Geriatric Anesthesia
Neuroanesthesia
Obstetric Anesthesia
Pain Medicine
Pediatric Anesthesia
Perioperative Medicine
Professional Issues
Regional and Acute Pain
Please list any keywords relevant to your eAbstract.
Please enter ONLY the eAbstract summary in the box below: The summary should be a two to three-line summary/description of your abstract that may only appear on the USSA/AVAA Annual Academic Meeting website. The material will not be considered in the grading or acceptance process for abstracts. NOTE: The size limit is 800 characters which will also include the authors and institution.
Abstracts can be uploaded below. Limit the body of the abstract to 3400 characters. Please include abstract title, authors, institutions in the file. Tables and figures can be included. Only the body of the abstract count towards the character limit.
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By signing and dating the fields below you acknowledge that you agree to the information above and have answered it to the best of your ability.
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Thank you for completing the USSA/AVAA eAbstract form.
Submissions are due by Friday, June 25, 2021
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