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Foot-and-mouth disease (FMD) affects cloven-hoofed livestock and causes devastating damages to the world's economies. Being endemic in developing countries, FMD has imposed a significant threat to the FMD-freedom status in developed countries. The globally-concerted effort to eradicate FMD at its source has faced a substantial challenge of having little knowledge about how FMD spreads in developing countries. So far, FMD virus transmission parameters have been estimated based on only a dozen actual outbreak data, mostly in Europe. Meanwhile, the fundamental north-south differences in livestock production, trading, and quarantine systems have questioned the applicability of these estimates to developing countries. In this light, we aim to narrow the knowledge gap by estimating the FMD virus transmission parameters in an endemic country, Vietnam, the world's fifth- largest pork producer. We use the spatial-dynamic kernel-based approach combined with daily FMD incursion data and FMD-host census data. The estimation also considers livestock composition and livestock quantity by species, which can influence FMD transmission. In line with existing literature, we find that cattle and buffaloes have a larger influence on disease spread than pigs, and FMD transmission depends on the herd size and the distance between susceptible and infected premises. However, our findings show FMD virus can spread over a much more ample space in our case compared with those in existing literature (25 km and 50 km versus 10 km), and the kernels have much fatter tails. This difference is likely due to the weakness in biosecurity systems, poor implementation of surveillance and quarantine measures, and bad husbandry practices such as swill feeding, which are prevalent in developing countries. Thus, our estimated kernels will be helpful for Vietnam in developing suitable biosecurity measures to contain and eradicate the FMD virus. They are also highly relevant for other countries with livestock farming practices and climate conditions similar to those in Vietnam., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Amid concerns about the pediatrician-scientist workforce, we hypothesized that declining numbers of pediatric subspecialists devote at least 25% of their professional time to research with fewer younger and female pediatricians engaged in research over the study period., Methods: Board-certified pediatricians enrolling online in the American Board of Pediatrics (ABP's) Maintenance of Certification (MOC) program October 2009 through 2016 were invited to complete a survey with questions about the allocation of their professional time. Responses from individuals in the 14 ABP-certified subspecialties were analyzed. The number and proportions of respondents devoting 25-49% and 50% or more of professional time to research were calculated over time. Age and gender were also examined., Results: We analyzed 21,367 responses over 8 years. A small number of pediatric subspecialists engaged in research with 5.2-6.7% devoting 25-49% and 5.6-8.4% at least 50% of their professional time to research across subspecialties. There was no discernable increase or decrease over time or pattern by age or gender., Conclusion: Less than 10% of pediatric medical subspecialists devote at least 50% of their professional time to research. Efforts to promote research among pediatric subspecialists have not increased the size of the population that reports engaging in research at this level.

Objective: Explore pediatric residents' experiences and confidence with quality improvement (QI)., Methods: Pediatric residents were surveyed nationally in July 2017 about their demographic characteristics, experiences with QI projects over the previous year, and confidence with QI skills. Descriptive statistics and distributions of each individual demographic and QI variable, as well as training program size, were calculated for each variable. QI question responses were compared to demographic characteristics of the respondents, and chi-square statistics were calculated., Results: In total, 11,137 out of 11,304 (98.5%) residents completed the survey. Half of residents had participated in a QI project over the previous academic year, and 78% of third-year residents reported having done so. However, few of these residents self-reported moderate or high confidence in their ability to design a QI project (28.9%), use QI tools (23.1%), use QI methodologies (24.0%), or use data to track changes in their personal practice over time (28.9%). Residents in small or medium programs were statistically more likely to rate their confidence in certain QI abilities higher than those in large programs., Conclusions: Although recent pediatric residents appear to be participating in QI activities during training, their self-perception of their QI skills development remains low. Residents in small and medium programs provide more favorable reports., (Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Although national bodies have proclaimed the importance of incorporating quality improvement (QI) into the daily fabric of clinical care, the actual proportion of practicing pediatricians who participate in QI activities on an annual basis is unknown. Correspondingly little is known about pediatrician motivations for, attitudes about, and support received for QI participation., Methods: Pediatric diplomates enrolling in the American Board of Pediatrics' Maintenance of Certification program during calendar year 2016 were provided with the opportunity to complete a brief survey. A portion of the survey was focused on issues related to participation in QI programs., Results: Survey responses were received from 8714 of the 11 890 diplomates who enrolled in Maintenance of Certification in 2016 (response rate: 73.3%). Overall, 86.6% of respondents reported participation in at least 1 QI project in the previous year. There was variation in previous-year participation in a QI project by practice affiliation categories, ranging from 79.9% for nonacademic generalists to 92.4% for academic specialists. The extrinsic requirement for QI to maintain board certification was the dominant motivator among all respondents (50.7%), followed by 2 intrinsic factors: identify gaps in practice and implement change (40.3%) and opportunity to collaborate with others (36.9%)., Conclusions: Although the results are encouraging, despite almost 2 decades of national attention to the quality of health care and efforts to embed continual QI in health care delivery activities, ∼1 in 5 nonacademic pediatricians and 1 in 10 academic pediatricians did not report participating in any QI activities in the previous year., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Leslie is employed by the American Board of Pediatrics; the other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Objectives: To determine, among pediatric residents, the timing and stability of decisions to pursue fellowship training and select a specific subspecialty, which can be used to inform strategies to better match the distribution of pediatric subspecialist with the needs of children., Study Design: A longitudinal survey administered with the General Pediatrics In-training Exam to pediatric residents in the US and Canada, 2010-2014. The study included residents who responded in each of their first 3 years of residency and indicated plans to enter fellowship or matriculated, 2013-2016, into 1 of the 14 medical subspecialty fellowships for which the American Board of Pediatrics grants a certificate. Descriptive and χ 2 statistics were calculated., Results: Of the 7580 residents who completed 3 annual surveys (response rate 99%) 4963 (65.5%) indicated plans to pursue fellowship training and 2843 (37.5%) matriculated into fellowship. Residents who did not enter fellowship were in smaller residency programs and programs with less interest in fellowship among interns. Most residents who matriculated into fellowship (68.4%) planned to do so as interns and maintained that plan throughout residency. In contrast, 22.7% had selected a specific subspecialty as interns. Fellowship decisions were made later in residency by female residents, American Medical Graduates, and residents in programs where <50% of interns planned to pursue fellowship training. Timing and stability of decisions varied across subspecialty fields., Conclusions: Understanding the timing of pediatric medical subspecialty fellowship decisions could be used to shape medical education and, ultimately, the pediatric workforce., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To assess the part-time workforce and average hours worked per week among pediatric subspecialists in the 15 medical subspecialties certified by the American Board of Pediatrics., Study Design: We examined data from pediatric subspecialists who enrolled in Maintenance of Certification with the American Board of Pediatrics from 2009 to 2015. Data were collected via an online survey. Providers indicated whether they worked full time or part time and estimated the average number of hours worked per week in clinical, research, education, and administrative tasks, excluding time on call. We calculated and compared the range of hours worked by those in full- and part-time positions overall, by demographic characteristics, and by subspecialty., Results: Overall, 9.6% of subspecialists worked part time. There was significant variation in part-time employment rates between subspecialties, ranging from 3.8% among critical care pediatricians to 22.9% among developmental-behavioral pediatricians. Women, American medical graduates, and physicians older than 70 years of age reported higher rates of part-time employment than men, international medical graduates, and younger physicians. There was marked variation in the number of hours worked across subspecialties. Most, but not all, full-time subspecialists reported working at least 40 hours per week. More than one-half of physicians working part time in hematology and oncology, pulmonology, and transplant hepatology reported working at least 40 hours per week., Conclusions: There are unique patterns of part-time employment and hours worked per week among pediatric medical subspecialists that make simple head counts inadequate to determine the effective workforce. Our findings are limited to the 15 American Board of Pediatrics-certified medical subspecialties., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Concerns exist regarding the adequacy of the pediatric subspecialty workforce in the United States. Data on practice patterns and job characteristics are necessary to help develop policies to ensure availability., Methods: We performed survey data analysis of all pediatric subspecialists enrolled in Maintenance of Certification in 2013 and 2014, assessing demographic information, characteristics of current positions, plans for retirement, and satisfaction with allocation of professional and clinical responsibilities. Four logistic regression models examined the independent association of demographic variables collected along with variables of practice ownership and academic appointment with the outcome variables of pediatric subspecialists reporting match of desired with current actual professional duties, match of desired with current actual clinical responsibilities, current part-time employment, and expected age of retirement <65 years of age., Results: Data from 5100 subspecialists were analyzed (response rate 87.2%). Most (83%; N = 4251) reported their current allocation of professional time was what they desired in their current position; similarly, 93% ( N = 4755) reported likewise for clinical responsibilities. Differences by gender and years in subspecialty were evident, with women much more likely to work part time than men (odds ratio 6.22); those >20 years in practice were less likely to retire before the age of 65 compared with those <10 years in practice (odds ratio 0.33)., Conclusions: This study is the largest to date of practicing pediatric subspecialists. Variation in work patterns found between genders, with time in practice, and between subspecialties suggests that future research should focus on these issues., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Rabies is an invariably fatal, but preventable zoonotic disease. Despite a national programme for its prevention and control, the number of rabies associated deaths in Vietnam has increased in recent years. A cross-sectional survey was undertaken in 2012 to assess and compare the knowledge, awareness and practices of 189 public health workers (PHW) and animal health workers (AHW) attending a joint training course for professionals from provinces in northern Vietnam with the highest number of deaths from rabies. Questionnaires facilitating self-evaluation were provided, and total knowledge scores were calculated (maximum 38 points) and categorized into: 'high' (>30 points), 'moderate' (21-30) and 'low' (<21). The response rate was 100%, and among the 189 participants, 56% were PHW compared to 44% who were AHW. Although most respondents knew rabies could be transmitted through the bite of an animal, most commonly a dog, and that rabies is a preventable disease, significant differences between groups were identified. Major areas included poor knowledge of common rabies reservoirs, wound management and guidance on post-exposure prophylaxis. Overall, the total mean knowledge scores for PHW was significantly higher (P = 0.011) compared to those for AHW, but both scores fell within the 'moderate' knowledge range. However, proportionately more PHW than AHW achieved 'high' knowledge scores (P = 0.0098). To our knowledge this is the first published study to simultaneously assess the knowledge and awareness of animal health and public health professionals attending joint training activities aimed at strengthening rabies prevention and control. To ensure effective prevention and control of rabies requires that AHW and PHW not only coordinate and collaborate, but have a common knowledge and understanding of rabies prevention and control measures. This study provides important baseline data in a relatively unexplored area of research that can focus future interventions and research., (© 2016 Blackwell Verlag GmbH.)

Background and Objectives: A near vacuum exists for credible information regarding specialty-specific demography, including gender, years since training completion, current employer, academic affiliation, and hours worked in specific tasks. Understanding the current status and changes to the medical workforce and its work patterns is essential to assessing whether the supply and distribution meets the needs of patients, institutions, society, and educational programs., Methods: A self-administered electronic survey sent to all pediatricians at the time of their enrollment in the Maintenance of Certification program in 2013-2014. The survey focused on exploring trends associated with career choice, career paths, time spent in professional activities, and current practice characteristics. Logistic regression and χ(2) analyses were conducted., Results: The response rate was 87.2% (N = 15 351). Of those who completed the survey, 9253 (64%) self-identified as general pediatricians. An increased likelihood of working part-time was seen among women (odds ratio [OR]: 12.21), those without an academic appointment (OR: 1.32), and those not working in a private/independent practice (OR: 1.15). Overall, 89% (n = 8214) of respondents stated that their current allocation of professional time was approximately what they wanted. Those more likely to be involved in quality improvement in the past year did not work in independent/private practices (OR: 1.78) and worked full-time (OR: 1.16)., Conclusions: Understanding the current nature of the pediatric workforce is a first step in providing data to guide future workforce planning and the training experiences required to maintain and shape the workforce to meet the current and future needs of children., (Copyright © 2016 by the American Academy of Pediatrics.)

Objectives: The issues of importance in selecting a first job for new pediatric subspecialists, and their ability to find positions that match their professional and clinical goals, are unknown. The objectives were to (1) describe current employment patterns, practice characteristics, factors influencing choice of first position, and future work goals of new pediatric subspecialists; and (2) examine the relationship of these variables with the actual professional time allocation and clinical responsibilities compared with the desired first job., Methods: The authors surveyed 3010 individuals sitting for ≥1 of the 14 subspecialty certification exams. The main outcomes were (1) most important factors in choosing employment; (2) ability to gain employment in positions that matched their goals; and (3) variation in employment characteristics among men versus women, time since completion of training, and part-time versus full-time status., Results: Response rate was 97%. Lifestyle/spousal or family considerations was the factor identified as most important in the choice of first position after fellowship training for half of respondents (50%; n = 1277). There was a median of 75% of actual time spent in direct and/or consultative inpatient or outpatient care, with 5% in medical education, 5% in administration, and 5% in research. A majority (74%; n = 1825) reported this proportion to be approximately what they wanted. Most respondents (89%; n = 2194) reported that their allocation of patient care responsibilities (ie, inpatient versus outpatient) was approximately what they wanted., Conclusion: A large majority of pediatric subspecialists found initial positions matching their goals for professional responsibilities and clinical care., (Copyright © 2016 by the American Academy of Pediatrics.)