Policy on Systematic Manipulation, Paper Mills, and Submission Integrity

1. Purpose and Scope

The Archives of Pediatric Neurosurgery (APN) is committed to protecting the integrity, reliability, and transparency of the scholarly record.

This policy describes the measures used by APN to identify, assess, and respond to suspected:

• paper-mill activity;
• fabricated, falsified, or manipulated data;
• plagiarism or translated plagiarism;
• duplicate, redundant, or derivative publication;
• inappropriate image or video manipulation;
• authorship manipulation or the sale of authorship;
• undisclosed or inappropriate use of artificial intelligence;
• peer-review manipulation;
• citation manipulation;
• identity or affiliation misrepresentation; and
• coordinated or systematic manipulation of the submission and publication process.

This policy applies to all manuscripts submitted to APN, including:

• Original Articles;
• Review Articles;
• Clinical Case Reports;
• Technical Notes;
• How I Do It articles;
• Clinical Images;
• Clinical Videos;
• Editorials;
• Letters to the Editor;
• Historical Vignettes;
• Commentaries; and
• other invited or unsolicited contributions.

The policy applies before, during, and after publication.

2. Definition of Paper Mills and Systematic Manipulation

For the purposes of this policy, a paper mill is an individual, organization, or commercial service that produces, modifies, sells, or submits fraudulent or inauthentic manuscripts, data, images, videos, peer reviews, or authorship positions.

Systematic manipulation may include, but is not limited to:

• fabrication or falsification of clinical or research information;
• use of stock, duplicated, or manipulated images presented as original clinical material;
• submission of manuscripts based on invented patients, data, or procedures;
• sale, purchase, or inappropriate transfer of authorship;
• addition or removal of authors without a legitimate scholarly contribution;
• false representation of author identities or institutional affiliations;
• use of fabricated reviewer identities;
• use of false or compromised e-mail addresses during peer review;
• coordinated submission of formulaic or substantially similar manuscripts;
• use of irrelevant, inappropriate, manipulated, or fabricated references;
• manipulation intended to increase citations to specific authors, journals, institutions, or organizations;
• resubmission of previously rejected or published material without proper disclosure; and
• undisclosed automated production of manuscripts or manuscript sections.

The use of a professional language-editing service is not, by itself, considered paper-mill activity. However, such services must not produce, fabricate, alter, or misrepresent the scientific or clinical content of a manuscript.

3. General Principles

1. Indicators are assessed collectively. No manuscript will be classified as fraudulent solely because of an isolated characteristic, such as the use of a non-institutional e-mail address, language difficulties, similarity in a standard methods section, or compliance with a reporting guideline.

2. Automated tools do not make editorial decisions. Similarity-detection, image-screening, artificial intelligence detection, and other integrity tools may generate alerts, but all findings are evaluated by editors and, when appropriate, independent specialists.

3. Authors are given an opportunity to respond. When appropriate and when doing so will not compromise an investigation, the corresponding author and coauthors will be invited to explain concerns and provide supporting documentation.

4. Clinical confidentiality is protected. Any original clinical documentation requested by the journal must be appropriately de-identified and transmitted through a secure method determined by the Editorial Office.

5. Editorial decisions are evidence-based. Decisions are based on the manuscript, supporting documentation, author responses, peer-review reports, and relevant publication-ethics guidance.

6. Good-faith errors are distinguished from misconduct. APN distinguishes honest mistakes, inadequate reporting, and formatting problems from deliberate fabrication, falsification, plagiarism, or manipulation.

7. International and institutional diversity is respected. A lack of an institutional e-mail address or differences in institutional documentation are not, in isolation, considered evidence of misconduct. Alternative methods may be used to verify author identity and affiliation.

4. Submission-Integrity Screening

All submissions may undergo administrative, ethical, and integrity screening before or during peer review.

The screening may include:

• verification of compliance with the journal's Author Guidelines;
• verification of author names, affiliations, and contact information;
• assessment of ORCID records, where available or required;
• confirmation of the corresponding author's identity;
• plagiarism and similarity screening using Turnitin or another appropriate service;
• assessment of duplicate or redundant publication;
• assessment of the manuscript's internal consistency;
• review of references for accuracy and relevance;
• verification of ethical approval, exemption, waiver, or informed consent, as applicable;
• assessment of patient anonymity and confidentiality;
• evaluation of authorship and CRediT contribution statements;
• assessment of funding and conflict-of-interest disclosures;
• assessment of disclosed use of AI or AI-assisted tools;
• inspection of clinical images, figures, tables, and videos;
• verification of suggested reviewer identities and conflicts of interest; and
• comparison with other manuscripts when systematic or coordinated activity is suspected.

Similarity percentages are treated as screening indicators rather than automatic evidence of plagiarism. Editors examine the nature, location, source, and extent of the matched material before reaching a decision.

5. Potential Indicators of Systematic Manipulation

The following characteristics may prompt additional editorial examination. An individual indicator is not necessarily evidence of misconduct.

5.1 Manuscript and language indicators

• generic or formulaic text that is poorly connected to the reported patient, procedure, or study;
• repeated or unusual phrases found in unrelated publications;
• inconsistent descriptions of the same patient, procedure, treatment, or outcome;
• discrepancies between the title, abstract, methods, results, figures, videos, and conclusions;
• sudden changes in terminology or writing style;
• use of technically correct language that lacks clinical coherence;
• implausible clinical chronology;
• claims not supported by the information presented;
• manuscripts that appear to be translations or close paraphrases of previously published work without attribution; and
• manuscripts that substantially reproduce the structure, data, or conclusions of another article.

5.2 Data and clinical documentation indicators

• implausible or internally inconsistent clinical data;
• repeated numerical patterns that are not adequately explained;
• discrepancies between the reported methods and available results;
• identical or nearly identical data appearing in unrelated manuscripts;
• inability to explain how the data were collected;
• failure to provide reasonable supporting information when concerns are identified; and
• inconsistencies between the reported clinical timeline and the dates shown in images, examinations, or videos.

5.3 Image and video indicators

• duplicated images within the same manuscript or across publications;
• inappropriate image alteration, cloning, splicing, or removal of relevant information;
• images or video frames inconsistent with the described patient, anatomy, procedure, or diagnosis;
• reuse of previously published images without disclosure or permission;
• images that appear to be stock material or derived from a source unrelated to the reported case;
• inconsistencies between operative video, radiological findings, captions, voice-over, and accompanying text; and
• missing or altered metadata when such information is relevant to an integrity assessment.

Adjustments to brightness, contrast, color balance, or sharpness may be acceptable when applied to the entire image and when they do not obscure, eliminate, or misrepresent relevant information. Any substantive image processing must be disclosed.

5.4 Authorship and identity indicators

• unexplained addition, removal, or reordering of authors;
• authors unable to describe their contribution to the work;
• inconsistencies between author names, affiliations, ORCID records, and contact details;
• an e-mail address that cannot reasonably be connected to the corresponding author;
• use of false or unverifiable institutional affiliations;
• inability to establish direct contact with one or more authors;
• evidence that an authorship position has been offered, purchased, or sold; and
• submission by a third party without transparent disclosure and authorization from all authors.

5.5 Peer-review indicators

• fabricated reviewer names or identities;
• reviewer e-mail addresses that cannot be independently verified;
• reviewer accounts controlled by an author or unauthorized third party;
• repeated suggestion of the same reviewers across apparently unrelated submissions;
• unusually rapid, generic, or uniformly favorable reviewer reports;
• evidence of coordinated peer-review activity;
• undisclosed relationships between authors and reviewers; and
• attempts to influence the selection or recommendations of reviewers.

5.6 Citation indicators

• references unrelated to the subject of the manuscript;
• citations that do not support the associated claims;
• excessive citations to a particular author, journal, institution, or Editorial Board member without scholarly justification;
• references to articles that do not exist or contain incorrect bibliographic information;
• citation clusters that appear to have been inserted for non-scholarly purposes; and
• citations apparently generated by an AI tool without human verification.

6. Author Identity and Affiliation Verification

APN may verify author identity and affiliation through:

• ORCID;
• institutional webpages;
• recognized bibliographic databases;
• previous scholarly publications;
• direct communication through an institutional e-mail account;
• confirmation by an institution, department, or research office; and
• other reliable professional documentation.

Whenever possible, authors should use an institutional e-mail address. However, authors without access to an institutional address will not be automatically excluded. In such cases, the Editorial Office may request an alternative form of identity or affiliation verification.

All listed authors must:

• meet the journal's authorship requirements;
• approve the submitted version;
• agree to be accountable for their contributions;
• disclose relevant conflicts of interest;
• provide an accurate description of their contributions; and
• participate directly in any authorship or integrity verification requested by the journal.

7. Authorship Contributions and Changes

APN follows internationally recognized authorship principles, including those of the International Committee of Medical Journal Editors (ICMJE). Authors must provide a contribution statement, preferably using the CRediT Contributor Roles Taxonomy.

Authorship may not be offered, sold, purchased, transferred, or granted solely because of:

• administrative authority;
• departmental leadership;
• financial support;
• provision of general supervision;
• language editing;
• payment for manuscript preparation; or
• facilitation of submission or acceptance.

7.1 Changes in authorship

Any request to add, remove, or reorder authors after submission must:

1. be justified in writing;
2. explain the reason for the change;
3. include an updated contribution statement;
4. be approved directly by all listed and affected authors; and
5. be accepted by the Editor-in-Chief.

The journal may suspend the editorial process while an authorship request is assessed.

Unexplained, repeated, late, or extensive changes in authorship may lead to additional identity verification, rejection of the manuscript, notification of the authors' institutions, or investigation under this policy.

Authorship changes after acceptance are not normally permitted except when a legitimate reason is documented and confirmed by all authors.

8. Clinical Case Reports

Clinical Case Reports must follow the CARE reporting guideline, as listed by the EQUATOR Network.

Authors must provide:

• an accurate account of the clinical history;
• relevant examination and investigation findings;
• a clear clinical timeline;
• details of treatment or intervention;
• appropriate follow-up and outcomes;
• an evidence-based discussion;
• a clearly identified clinical or educational lesson;
• written informed consent for publication from the patient or legal guardian; and
• ethical approval, exemption, or waiver when required by applicable institutional or national rules.

Compliance with the CARE structure does not make an article inappropriately formulaic. Standardized reporting guidelines are intended to improve completeness, reproducibility, and transparency.

Nevertheless, editors and reviewers will assess whether the reported case is authentic, internally consistent, clinically plausible, original, and adequately supported.

When concerns arise, APN may request appropriately de-identified supporting documentation, including:

• original radiological or photographic files;
• relevant examination or laboratory reports;
• operative documentation;
• pathology documentation;
• follow-up information;
• ethics committee documentation; and
• confirmation of informed consent.

Authors must not submit documents containing unnecessary direct patient identifiers.

9. Technical Notes and How I Do It Articles

Technical Notes and How I Do It articles must describe an authentic surgical or technical experience and must not be based solely on generic descriptions obtainable from textbooks, previous publications, or AI-generated content.

These manuscripts are assessed for:

• originality or meaningful technical contribution;
• appropriate patient selection;
• relevant surgical anatomy;
• clarity and reproducibility of the technique;
• indications and contraindications;
• limitations;
• possible complications and their avoidance;
• clinical follow-up and outcomes, when applicable;
• consistency among the text, images, illustrations, and videos;
• balanced discussion of alternative techniques; and
• accurate representation of the authors' direct experience.

The journal may request original, appropriately de-identified documentation when necessary to confirm the authenticity of the procedure or clinical experience.

Commercial products, instruments, and devices must be described objectively. Promotional or advertising content is not acceptable. Relevant financial relationships must be disclosed.

10. Clinical Images and Clinical Videos

Clinical Images and Clinical Videos must present authentic, clinically relevant, and educational material.

Authors are responsible for:

• obtaining written patient or legal guardian consent;
• removing direct patient identifiers;
• avoiding recognizable facial features unless essential and specifically authorized;
• ensuring that all images and videos correspond to the reported patient or procedure;
• disclosing any relevant editing or processing;
• obtaining permission for any third-party material;
• verifying consistency between visual material and the accompanying text; and
• ensuring that the material does not contain inappropriate or unnecessary patient information.

APN may request:

• original image files;
• original unedited video;
• relevant metadata;
• appropriately de-identified DICOM files, when applicable and legally permissible;
• confirmation of patient consent;
• clarification of image or video processing; and
• supporting clinical or operative documentation.

Failure to provide requested original files or a satisfactory explanation may result in suspension of review or rejection.

11. Similarity, Plagiarism, and Derivative Publications

APN screens submitted manuscripts using Turnitin or another appropriate similarity-detection service.

The similarity score alone does not determine whether plagiarism has occurred. Editors assess:

• the source of the matched material;
• the amount and location of overlap;
• whether quotation and attribution are appropriate;
• whether the overlap concerns standard terminology or original scholarly content;
• whether the manuscript duplicates the structure, reasoning, data, or conclusions of another work;
• whether the overlap may represent translated plagiarism; and
• whether the authors have disclosed related publications or preprints.

APN does not accept:

• plagiarism;
• self-plagiarism that results in redundant or duplicate publication;
• translated plagiarism;
• salami slicing intended to produce multiple minimally different publications;
• derivative case reports that do not provide a distinct clinical lesson;
• minimally modified technical reports that do not make an original scholarly contribution; or
• simultaneous submission to another journal.

Authors must disclose all closely related manuscripts, preprints, conference publications, abstracts, or previous reports and provide copies when requested.

12. Use of Artificial Intelligence and AI-Assisted Tools

The use of generative AI or AI-assisted tools must comply with APN's authorship and disclosure policies.

AI tools:

• cannot be listed as authors;
• cannot assume responsibility for the accuracy or integrity of a manuscript;
• cannot provide informed consent;
• cannot be accountable for conflicts of interest; and
• cannot replace human verification of facts, references, clinical details, images, or conclusions.

Authors remain fully responsible for all submitted content, including material generated or edited using AI-assisted tools.

Any substantive use of AI must be transparently disclosed, including:

• the name and version of the tool, when available;
• the purpose for which it was used;
• the sections or materials affected; and
• confirmation that the authors reviewed and verified the output.

AI tools must not be used to:

• fabricate or alter clinical data;
• create false patients or procedures;
• generate or manipulate images presented as authentic clinical material;
• produce false citations;
• conceal plagiarism;
• impersonate authors or reviewers; or
• generate fraudulent peer-review reports.

Routine spelling, grammar, and language-correction tools may be treated differently from generative AI, provided they do not alter the scientific or clinical meaning.

Undisclosed or inappropriate AI use may result in rejection or other action under this policy.

13. Reviewer Identity and Peer-Review Integrity

APN uses a double-anonymized peer-review model for peer-reviewed article types.

Reviewer suggestions submitted by authors are treated only as recommendations. APN is not required to invite any suggested reviewer.

The journal may verify reviewer identity using:

• institutional affiliations;
• institutional e-mail addresses;
• ORCID;
• publication records;
• bibliographic databases;
• institutional webpages; and
• previous verified reviewing activity.

At least one reviewer should be selected independently of author recommendations. Editors and reviewers must disclose relevant conflicts of interest.

The following are prohibited:

• authors creating or controlling reviewer accounts;
• use of fabricated reviewer identities;
• submission of false contact information;
• third parties providing reviews without editorial authorization;
• reviewers delegating a review without permission;
• reviewers uploading confidential manuscripts to public generative AI systems; and
• coordinated efforts to influence an editorial decision.

Suspected peer-review manipulation may result in immediate suspension of the review process and investigation.

14. Requests for Supporting Information

When an integrity concern is identified, APN may request information reasonably necessary to assess the submission, including:

• original or unprocessed images and videos;
• de-identified source data;
• data dictionaries or analytic outputs;
• ethics committee approval, exemption, or waiver;
• patient or legal guardian consent confirmation;
• clinical timeline clarification;
• authorship contribution details;
• institutional affiliation confirmation;
• funding documentation;
• information regarding professional editing or third-party submission assistance;
• disclosure of AI-assisted tools; and
• copies of related manuscripts or publications.

Requests will be proportionate to the concern identified.

To protect confidentiality, authors should not send direct patient identifiers unless specifically requested through a secure and legally appropriate process. APN may provide instructions for secure transmission or institutional verification.

Failure to respond, an inadequate response, or failure to provide reasonably requested information may result in rejection or further investigation. However, inability to provide a particular document will be evaluated in context and will not automatically be considered proof of misconduct.

15. Editorial Assessment and Investigation Procedure

When possible manipulation or misconduct is suspected, APN may take the following steps:

1. document the concern and preserve relevant records;
2. suspend peer review, acceptance, or publication while the matter is assessed;
3. conduct an additional editorial or technical review;
4. request an explanation and supporting information from the corresponding author;
5. contact all coauthors directly;
6. consult independent subject-matter, statistical, image, video, or research-integrity experts;
7. compare the submission with related manuscripts or publications;
8. verify identities, affiliations, ethical documentation, or reviewer information;
9. contact the authors' institution, research-integrity office, ethics committee, funder, or another journal when necessary and appropriate; and
10. make a decision in accordance with APN policies and relevant COPE guidance.

The journal is not responsible for determining legal guilt or formally adjudicating research misconduct. Institutions normally have primary responsibility for conducting formal investigations involving their researchers. However, APN has an independent responsibility to protect its editorial process and the scholarly record.

16. Possible Editorial Actions

Depending on the stage of publication and the nature of the concern, APN may:

• request clarification or correction;
• request original files or additional documentation;
• require authorship or disclosure corrections;
• return the manuscript for revision;
• obtain additional peer review;
• suspend consideration of the manuscript;
• reject the manuscript;
• withdraw an acceptance decision before publication;
• reject other related submissions when their integrity is also in question;
• restrict future submissions for a defined period in serious or repeated cases;
• notify authors' institutions, ethics committees, or funders;
• notify another journal or publisher when related submissions are involved;
• publish a correction;
• publish an expression of concern;
• retract an article;
• correct the authorship record; and
• notify indexing and preservation services of a post-publication action.

Editorial action will be proportionate to the evidence, the seriousness of the concern, its effect on the reliability of the work, and the authors' response.

17. Post-Publication Concerns

APN will consider credible concerns raised after publication, regardless of the identity or status of the person raising them.

Concerns should include, whenever possible:

• the title and DOI of the article;
• a clear description of the issue;
• the location of the potentially problematic material;
• supporting evidence or relevant comparison material; and
• the name and contact details of the person raising the concern.

Anonymous concerns may be considered if they contain sufficient specific and verifiable information.

After receiving a concern, APN may:

• conduct an initial assessment;
• contact the authors;
• request original data or documentation;
• consult independent experts;
• contact the authors' institution;
• publish a correction or expression of concern;
• retract the article when the findings are unreliable or serious misconduct is established; or
• take no further action when the concern is not substantiated.

Corrections, expressions of concern, and retractions will be clearly identified, linked to the original article, and issued in accordance with COPE guidance.

18. Confidentiality and Protection of Participants

APN will handle integrity concerns as confidentially as reasonably possible.

Information may be shared with:

• editors directly involved in the assessment;
• independent experts;
• the authors;
• relevant institutional officials;
• ethics committees;
• research-integrity offices;
• funders;
• publishers or journals involved in related submissions; and
• legal or regulatory authorities when required by law.

Clinical information and source documentation must be handled in accordance with applicable privacy, data-protection, and research-ethics requirements.

Individuals who raise concerns in good faith will not be subject to retaliation by the journal. Deliberately false, malicious, harassing, or unsupported accusations may be disregarded.

19. Appeals

Authors may appeal an editorial decision arising from this policy by submitting a written request to the APN Editorial Office.

An appeal must:

• clearly identify the manuscript or published article;
• explain the grounds for the appeal;
• respond to the specific integrity concerns;
• include relevant supporting documentation; and
• be submitted within the period specified in the editorial decision.

Appeals are assessed by the Editor-in-Chief, Co-Editor-in-Chief, or another editor or independent expert who was not directly responsible for the original decision whenever practicable.

An appeal does not guarantee reconsideration, external review, or reversal of the decision.

20. Responsibilities of Editors and Reviewers

Editors and reviewers must report suspected manipulation or misconduct confidentially to the Editor-in-Chief or Editorial Office.

They must not:

• directly accuse authors outside the confidential editorial process;
• conduct public investigations;
• contact patients;
• contact the media;
• disclose manuscript content;
• use manuscript information for personal advantage;
• upload confidential manuscripts, images, videos, or data to public AI platforms; or
• retain or distribute manuscript materials after completing the review.

Editors with a conflict of interest must recuse themselves from the assessment.

21. Education and Continuous Improvement

APN recognizes that paper-mill methods and other forms of publication manipulation continue to evolve.

The journal will periodically review and update its procedures based on:

• COPE guidance;
• ICMJE recommendations;
• EQUATOR Network reporting guidelines;
• the joint COPE/DOAJ/OASPA/WAME Principles of Transparency and Best Practice in Scholarly Publishing;
• developments from the STM Integrity Hub;
• new tools for manuscript, image, video, citation, and identity screening; and
• experience arising from the journal's editorial process.

Editorial Board members and reviewers may receive updated guidance on recognizing and responding to research-integrity concerns.

22. Reporting a Concern

Concerns regarding a submitted or published article should be sent confidentially to:

The communication should include the manuscript identification number or published article DOI, a description of the concern, and any supporting information.

23. References and Related Standards

This policy is informed by the following standards and resources:

• Committee on Publication Ethics — COPE Guidelines
• COPE — Paper Mills
• COPE — Retraction Guidelines
• International Committee of Medical Journal Editors — ICMJE Recommendations
• EQUATOR Network — CARE Guidelines
• CRediT — Contributor Roles Taxonomy
• Principles of Transparency and Best Practice in Scholarly Publishing
• STM Integrity Hub