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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_287"
                     title="COLUMN: Outliers: The Story of Success"
                     score="0.002"
                     href="http://www.medpagetoday.com/Columns/18148?impressionId=1265760417615"
                     
      &lt;p&gt;Popular author Malcolm Gladwell has become something of a fixture on the healthcare speaking circuit and it&apos;s easy to understand why. Taken collectively, his books go further than most in explaining the factors that influence and facilitate societal change.&lt;/p&gt;
&lt;p&gt;In his groundbreaking book, &lt;em&gt;The Tipping Point&lt;/em&gt;, Gladwell challenged  --  and eventually changed  --  the way we understand the world. He contends that one imaginative person applying a well-placed lever can move the world.&lt;/p&gt;
&lt;p&gt;His second book, &lt;em&gt;Blink&lt;/em&gt;, examined the power of intuition and its influence on our thinking. One concept that particularly struck me was the idea of &quot;thin slicing&quot;  --  filtering the few factors that matter from an overwhelming number of variables. In the context of medical malpractice, Gladwell advises readers to &quot;thin slice&quot; new physicians, trusting their intuition if they sense a physician is not listening to them.&lt;/p&gt;
&lt;p&gt;Gladwell has done it again! His newest book, &lt;em&gt;Outliers&lt;/em&gt;, is destined to transform the way we understand success.&lt;/p&gt;
&lt;p&gt;In &lt;em&gt;Outliers&lt;/em&gt;, Gladwell explains the extraordinary success of the Beatles and Bill Gates in the context of generation, family, culture, and class. The lives of these Outliers  --  people whose achievements fall outside normal experience  --  actually follow a peculiar and unexpected logic, suggesting that context and background matter a great deal.&lt;/p&gt;
&lt;p&gt;How does this apply to healthcare? The answer is in a chapter entitled, &quot;The Ethnic Theory of Plane Crashes.&quot;&lt;/p&gt;
&lt;p&gt;In the late 1990s, Korean Air was internationally admonished following a series of dramatic cockpit failures and subsequent crashes. Multiple investigations led to the same conclusion: poor cockpit communication, rooted in deep cultural barriers, led to circumstances that became deadly.&lt;/p&gt;
&lt;p&gt;The chapter discusses three important messages regarding communication: mitigation, crew resource management (CRM), and a concept known as the power distance index (PDI).&lt;/p&gt;
&lt;p&gt;Mitigation is a term used by linguists to describe an attempt to downplay or sugarcoat the meaning of what is being said. According to Gladwell, &quot;We mitigate when we&apos;re being polite, when we are ashamed or embarrassed, and when we are being deferential to authority.&quot;&lt;/p&gt;
&lt;p&gt;Although mitigation may be appropriate or even desirable in some situations, it can be disastrous in a cockpit on a stormy night, or an operating room or trauma bay. For the past 15 years, combating mitigation has been a major crusade in commercial aviation.&lt;/p&gt;
&lt;p&gt;Gladwell contends that the unprecedented decline in airline accidents in recent years is attributable, in part, to this war on mitigation.&lt;/p&gt;
&lt;p&gt;CRM training is designed to teach junior crew members how to communicate clearly and assertively in order to reduce dangerous mitigation. Airlines teach copilots how to challenge the pilot if he or she thinks something is going awry.&lt;/p&gt;
&lt;p&gt;For example, the copilot might begin with &quot;Captain, I&apos;m concerned about...,&quot; then proceed to &quot;Captain, I&apos;m uncomfortable with...,&quot; and if the Captain still doesn&apos;t respond, &quot;Captain, I believe this situation is unsafe.&quot;&lt;/p&gt;
&lt;p&gt;Today, CRM is also playing a major role in efforts to improve healthcare quality and safety.&lt;/p&gt;
&lt;p&gt;One staunch proponent is John Nance, a decorated Vietnam pilot, attorney, and author of &lt;em&gt;Why Hospitals Should Fly&lt;/em&gt;, a clever book depicting a fictional hospital wherein the tenets of CRM have been completely internalized by the administrative leadership, medical staff, and all front-line caretakers.&lt;/p&gt;
&lt;p&gt;The third key communication concept outlined in &lt;em&gt;Outliers&lt;/em&gt;, PDI, is one aspect of a model developed by Dutch psychologist, Geert Hofstede. It is rooted in cross-cultural psychology and concerns attitudes toward hierarchy, especially those relating to how much a particular culture values and respects authority.&lt;/p&gt;
&lt;p&gt;In cultures with low PDI, power holders try to underplay their power. In cultures with high PDI, the leader&apos;s authority is unassailable.&lt;/p&gt;
&lt;p&gt;Gladwell relates the impact of Hofstede&apos;s findings on aviation industry research. Their battle over mitigated speech and teamwork was actually an attempt to reduce power distance in the cockpit! He notes that Hofstede&apos;s work &quot;suggested something that had not occurred to anyone in the aviation world; that the task of convincing first officers to assert themselves was going to depend ... on their culture&apos;s power distance rating.&quot;&lt;/p&gt;
&lt;p&gt;So, what does PDI have to do with healthcare? I think that lowering the PDI  --  by means as simple as introducing one another and referring to one another by first names  --  can be helpful in improving communication on patient rounds, the intensive care unit, and elsewhere in the hospital setting.&lt;/p&gt;
&lt;p&gt;Surely, this may be provocative and threatening to the status quo. It might not work everywhere, but solid ethnographic research has concluded that when things go awry in a cockpit it is much easier to address a captain by his first name than by his title.&lt;/p&gt;
&lt;p&gt;I am not suggesting that we must suddenly become buddies on rounds, but knowing who is who and taking a moment to recognize everyone&apos;s role on the team would go a long way to improving communication  --  and, perhaps, clinical outcomes.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;Gladwell&apos;s books, and their provocative messages regarding how we think, challenge many of the tightly held, seemingly scientific aspects of our clinical decision-making at the bedside.&lt;/p&gt;
&lt;p&gt;But irrespective of varying reactions to &lt;em&gt;Outliers&lt;/em&gt;, I believe it would enhance our individual and collective ability to improve communication if we knew a little bit more about CRM and PDI.&lt;/p&gt;
&lt;p&gt;Maybe &lt;em&gt;Outliers&lt;/em&gt; and &lt;em&gt;Why Hospitals Should Fly&lt;/em&gt; should be required reading for every medical student and house officer as a part of the training experience.&lt;/p&gt;
&lt;p&gt;Could the way we address one another have an impact on clinical outcomes? If this is the case  --  and I believe it is  --  we should learn how to communicate appropriately in a simulated training environment so that it becomes routine in the hurly burly of everyday work.&lt;/p&gt;
&lt;p&gt;Gladwell asks why it is so difficult to acknowledge the fact that each of us comes from a culture with its own distinctive mix of strengths and weaknesses, tendencies, and predispositions. &quot;Who we are cannot be separated from where we are from  --  and when we ignore that fact, planes crash.&quot;&lt;/p&gt;
&lt;p&gt;And patients die.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Want More on Health Policy?&lt;/strong&gt; &lt;a href=&quot;http://nashhealthpolicy.blogspot.com/&quot; mce_href=&quot;http://nashhealthpolicy.blogspot.com/&quot; target=&quot;_blank&quot;&gt;Read David Nash&apos;s blog&lt;/a&gt;.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_1104"
                     title="Progress Slow in Reducing Foodborne Disease"
                     score="-0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/tb/13673?impressionId=1265760417615"
                     
      LITTLE FALLS, N.J., April 9 -- Rates of infection with various foodborne pathogens have been almost static since 2004, according to preliminary data from the CDC.
              &lt;br&gt;&lt;br&gt;The stagnation highlights the need to find new approaches to improving the safety of the U.S. food supply, according to Duc Vugia, M.D., of the California Department of Public Health, and colleagues.
              &lt;br&gt;&lt;br&gt;&quot;The lack of recent progress points to gaps in the current food safety system and the need to continue to develop and evaluate food safety practices as food moves from the farm to the table,&quot; they wrote in the April 10 issue of CDC&apos;s &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.
              &lt;br&gt;&lt;br&gt;The preliminary 2008 data came from the CDC&apos;s FoodNet (Foodborne Diseases Active Surveillance Network), which was set up in 1996 to collect information on laboratory-confirmed cases of foodborne illness from 10 states and other areas representing about 46 percent of the population.
              &lt;p&gt; 
              &lt;p&gt;Last year, there were a total of 18,499 laboratory-confirmed infections. &lt;em&gt;Salmonella&lt;/em&gt; led the way with 7,444 cases, followed by &lt;em&gt;Campylobacter&lt;/em&gt; (5,825), &lt;em&gt;Shigella&lt;/em&gt; (3,029), &lt;em&gt;Cryptosporidium&lt;/em&gt; (1,036), Shiga toxin-producing &lt;em&gt;Escherichia&lt;/em&gt; &lt;em&gt;coli&lt;/em&gt; (STEC) O157 (513), STEC non-O157 (205), &lt;em&gt;Yersinia&lt;/em&gt; (164), &lt;em&gt;Listeria&lt;/em&gt; (135), &lt;em&gt;Vibrio&lt;/em&gt; (131), and &lt;em&gt;Cyclospora&lt;/em&gt; (17).
              &lt;p&gt; 
              &lt;p&gt;For most pathogens, the incidence was highest among children under four. However, most hospitalizations and deaths occurred in people 50 and older.
              &lt;p&gt; 
              &lt;p&gt;The 2008 incidence of infections caused by &lt;em&gt;Campylobacter&lt;/em&gt;, &lt;em&gt;Cryptosporidium&lt;/em&gt;, &lt;em&gt;Listeria&lt;/em&gt;, STEC O157, &lt;em&gt;Salmonella&lt;/em&gt;, &lt;em&gt;Shigella&lt;/em&gt;, &lt;em&gt;Vibrio&lt;/em&gt;, and &lt;em&gt;Yersinia&lt;/em&gt; was not significantly different than the previous three years.
              &lt;p&gt; 
              &lt;p&gt;None of the Healthy People 2010 targets for reduced rates of infection was reached.
              &lt;p&gt; 
              &lt;p&gt;Although rates of infection caused by &lt;em&gt;Listeria&lt;/em&gt;, STEC O157, &lt;em&gt;Shigella&lt;/em&gt;, and &lt;em&gt;Yersinia&lt;/em&gt; dropped overall from 1996 to 2004, there were no such reductions in those caused by &lt;em&gt;Cryptosporidium&lt;/em&gt; and &lt;em&gt;Salmonella&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The leveling of infection rates after 2004 indicates the need for changes to strengthen the safety of an increasingly complex food supply system, according to David Acheson, M.D., FDA&apos;s associate commissioner for foods, who discussed the findings on a conference call with reporters.
              &lt;p&gt; 
              &lt;p&gt;&quot;The system needs to be modernized to address . . . the globalization of the food supply and the rapid distribution chains,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;The FDA, he said, has been integrating its efforts more with state health departments. The agency also has been hiring more scientists and inspectors, increasing domestic and foreign inspections.
              &lt;p&gt; 
              &lt;p&gt;In addition, rapid response teams have been set up in six states -- Florida, California, North Carolina, Minnesota, Michigan, and Massachusetts -- to more quickly respond to outbreaks of foodborne disease, according to Dr. Acheson.
              &lt;p&gt; 
              &lt;p&gt;He reiterated the need for a traceability system to track food from its origin to store shelves, or vice versa. This is been an issue in two major recalls over the six months involving salmonella-tainted peanuts and pistachios.
              &lt;p&gt; 
              &lt;p&gt;The &lt;em&gt;MMWR&lt;/em&gt; editors cited some of the studies limitations. They included the possibility that changing laboratory practices could affect reporting, FoodNet&apos;s ability to track only illnesses caused by pathogens routinely identified in laboratories, and the possibility that differences in healthcare utilization could explain age differences in incidence.
              &lt;p&gt; 
              &lt;p&gt;In addition, they said, because the results came from 10 states, they might not generalize to the entire U.S. population.
             
    </recommendedItem>
    <recommendedItem id="20090101_19_1949"
                     title="Strep B Screening Guidelines Quickly Adopted"
                     score="-0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/tb/14759?impressionId=1265760417615"
                     
      TORONTO, June 17 -- National guidelines for streptococcus B screening in pregnant women, issued in 2002, were rapidly adopted, researchers said.
              &lt;p&gt; 
              &lt;p&gt;In 2003 and 2004, 85% of women were screened before delivery, compared with just 48.1% in 1998 and 1999, according to Stephanie Schrag, DPhil, of the CDC, and colleagues.
              &lt;p&gt; 
              &lt;p&gt;The proportion of infants exposed to antibiotics in the delivery period also rose -- to 31.7% from 26.8% -- the researchers reported in the June 18 issue of the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The guidelines call for pregnant women to be screened for strep B colonization before delivery, followed by antibiotic prophylaxis in women positive for the bacteria.
              &lt;p&gt; 
              &lt;p&gt;The goal of the guidelines was to prevent early-onset strep B disease in infants -- a leading infectious cause of illness and death in the first week of life.
              &lt;p&gt; 
              &lt;p&gt;The adoption of the guidelines coincided with an observed 27% drop in the incidence of the disease, the researchers noted. In this study, the incidence of the disease was 0.32 per 1,000 births, they found.
              &lt;p&gt; 
              &lt;p&gt;But the researchers said there are opportunities to reduce the incidence still further, by better management of preterm deliveries and improved delivery of culture results.
              &lt;p&gt; 
              &lt;p&gt;The findings come from an analysis of data from the CDC&apos;s Active Bacterial Core surveillance, a 10-state, population-based system that monitors invasive strep B disease.
              &lt;p&gt; 
              &lt;p&gt;The researchers studied 254 births in which the infant had strep B disease and 7,437 births in which the infant did not.
              &lt;p&gt; 
              &lt;p&gt;They found:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;87.0% of women positive for strep B and who delivered at term received antibiotic prophylaxis, while antibiotics were only given in 63.4% of women with unknown colonization status who delivered early
                &lt;li&gt;incidence of disease was higher in preterm babies than in those delivered at term -- 0.73 cases per 1,000 live births compared with 0.26
                &lt;li&gt;Most cases of strep B disease -- 189 of 254, or 74.4% -- occurred in full-term infants
                &lt;li&gt;Among mothers who delivered at term, missed screening accounted for 34 cases of disease, or 13.4% of the total
                &lt;li&gt;61.4% of the full-term infants who had disease were born to mothers who had tested negative before delivery
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;The authors noted that &quot;in the case of any highly implemented prevention strategy, remaining cases of disease will often be the result of prevention failures; given the performance of the antenatal screening test for group B streptococcus as a predictor of intrapartum colonization status, some false negative results are expected to occur.&quot;
              &lt;p&gt; 
              &lt;p&gt;Mothers who delivered early were less likely to be screened than mothers who delivered at term, with a relative risk of 0.56 and a 95% confidence interval from 0.51 to 0.62.
              &lt;p&gt; 
              &lt;p&gt;In a univariate analysis, delivery at less than 34 weeks&apos; gestation was the only factor significantly associated with not being screened before delivery. The relative risk was 1.5, with a 95% confidence interval from 1.2 to 1.8.
              &lt;p&gt; 
              &lt;p&gt;Overall, however, lack of screening contributed only a small proportion of strep B disease, with only 18.0% of the cases occurring among infants of unscreened women.
              &lt;p&gt; 
              &lt;p&gt;Penicillin or ampicillin were the most common agents used for prophylaxis (employed in 76.7% of women for whom it was deemed necessary). Among those with a penicillin allergy, clindamycin was most commonly used.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The researchers reported no external support for the study. 
              &lt;p&gt;No potential conflicts were disclosed.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
    <recommendedItem id="20090101_19_3337"
                     title="CDC: H1N1 Flu Still Hits the Young Hardest"
                     score="-0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/16535?impressionId=1265760417615"
                     
      &lt;p&gt;ATLANTA  --  The pandemic H1N1 influenza virus continues to disproportionately attack the young, the CDC warned today.&lt;/p&gt;
&lt;p&gt;Children and adults under age 25 have accounted for 53% of hospitalizations for laboratory-confirmed H1N1 and 23.6% of related deaths since Sept. 1, the agency reported at a press briefing.&lt;/p&gt;
&lt;p&gt;Seniors, on the other hand, have accounted for just 7% of H1N1-confirmed hospitalizations and 11.6% of deaths from the virus based on data from 27 and 28 states, respectively.&lt;/p&gt;
&lt;p&gt;&quot;This is really, really different than what we see with seasonal flu,&quot; said Anne Schuchat, MD, director of the CDC&apos;s National Center for Immunization and Respiratory Diseases, who led the briefing.&lt;/p&gt;
&lt;p&gt;Seasonal flu typically causes 60% of its hospitalizations and 90% of fatalities in those 65 and older, she noted. &quot;It&apos;s almost completely reversed here,&quot; a pattern that matches what was seen in the spring.&lt;/p&gt;
&lt;p&gt;Schuchat reemphasized that physicians shouldn&apos;t take &quot;No&quot; as the answer when using the influenza rapid diagnostic test.&lt;/p&gt;
&lt;p&gt;&quot;You can&apos;t really rely on that. The accuracy of the rapid tests when they show up a negative is not that good,&quot; she said.&lt;/p&gt;
&lt;p&gt;Physicians should trust their clinical judgment in administering antivirals early to severely ill patients with flu-like symptoms or those with known risk factors for more severe disease, including pregnancy and asthma  --  without waiting for laboratory results or trusting a negative rapid result, Schuchat said.&lt;/p&gt;
&lt;p&gt;Pregnancy, in particular, has been a risk factor for which the CDC said it has met resistance in its recommendation to treat with antivirals.&lt;/p&gt;
&lt;p&gt;&quot;Completely healthy pregnant women have been coming down with horrible, horrible illnesses [with the pandemic H1N1, including the need for] intensive care unit courses, and, tragically, more deaths that we&apos;ve been hearing about recently,&quot; Schuchat said.&lt;/p&gt;
&lt;p&gt;Deaths in the young population were also more common in children with neurologic conditions, such a cerebral palsy and muscular dystrophy, although there have been some otherwise healthy children who have had the same grave outcome.&lt;/p&gt;
&lt;p&gt;One reason behind the &quot;overwhelmingly serious complications&quot; seen in some healthy young people is that the virus can cause pneumonia if the infection spreads to the lower respiratory tract, which is difficult to treat even with antivirals, Schuchat said.&lt;/p&gt;
&lt;p&gt;Another problem seen in some of the cases is that bacteria, particularly staph, can creep in after the influenza has weakened the immune system and cause serious pneumonia, she added.&lt;/p&gt;
&lt;p&gt;Already this fall, 292 deaths have been reported by the 28 states reporting laboratory-confirmed H1N1 cases to the CDC. Schuchat said the number of cases likely reflected under-reporting, but that the ages of affected patients was probably a good reflection of practice.&lt;/p&gt;
&lt;p&gt;The age breakdown was: &lt;ul&gt; &lt;li&gt;3.1% ages 4 and under&lt;/li&gt; &lt;li&gt;13.7% ages 5 to 18&lt;/li&gt; &lt;li&gt;6.8% ages 19 to 24&lt;/li&gt; &lt;li&gt;32.5% ages 25 to 49&lt;/li&gt; &lt;li&gt;32.2% ages 50 to 64&lt;/li&gt; &lt;li&gt;11.6% ages 65 and older&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Over the same Sept. 1 to Oct. 10 period, there were 4,958 laboratory-confirmed H1N1-related hospitalizations reported to the CDC by 27 states.&lt;/p&gt;
&lt;p&gt;The ages of those hospitalized were: &lt;ul&gt; &lt;li&gt;19% ages 4 and younger&lt;/li&gt; &lt;li&gt;25.3% ages 5 to 18&lt;/li&gt; &lt;li&gt;8.7% ages 19 to 24&lt;/li&gt; &lt;li&gt;24% ages 25 to 49&lt;/li&gt; &lt;li&gt;15% ages 50 to 64&lt;/li&gt; &lt;li&gt;7.2% ages 65 and older&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;These statistics support the CDC&apos;s recommendations targeting younger populations for vaccination efforts, Schuchat said.&lt;/p&gt;
&lt;p&gt;She noted that although the distribution of H1N1 vaccine still seems to be smaller than demand in most areas, the number of doses available for states to order rose from 9.8 million last week to 12.8 million, and the number actually ordered by the states roughly doubled.&lt;/p&gt;
&lt;p&gt;&quot;It probably feels like a slow start for a lot of people,&quot; Schuchat said. &quot;But we&apos;re still really at the beginning [of the flu season]. We&apos;re in it for the long haul.&quot;&lt;/p&gt;
&lt;p&gt;Based on the 1957/1958 pandemic flu, a second wave of infection might be expected in the spring, she noted. &quot;At CDC, we&apos;re planning a long response.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_4150"
                     title="H1N1 Testing, Positive Results on the Decline (CME/CE)"
                     score="-0.006"
                     href="http://www.medpagetoday.com/Pulmonology/URIstheFlu/tb/17614?impressionId=1265760417615"
                     
      &lt;p&gt;The end of the so-called second wave of pandemic H1N1 influenza may be in sight as testing rates  --  and the number of positive tests for the virus  --  show evidence of decline across the country, a report affirmed.&lt;/p&gt;
&lt;p&gt;From their peak in late October, diagnostic H1N1 testing rates dropped 75% by Dec. 9, back down to volumes seen in August, when the current wave of illness began, according to Quest Diagnostics.&lt;/p&gt;
&lt;p&gt;These findings reinforce surveillance findings from other sources, commented Anthony Fiore, MD, MPH, a medical epidemiologist with the CDC in Atlanta.&lt;/p&gt;
&lt;p&gt;&quot;Honestly, in a lot of areas of the country I don&apos;t know that people need us to tell them that rates are declining,&quot; Fiore told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;They clearly are in most parts of the country.&quot;&lt;/p&gt;
&lt;p&gt;Quest Diagnostics  --  one of the largest companies involved in H1N1 testing  --  said positive H1N1 tests dropped 60% or more in every region but one during the two weeks from Nov. 25 to Dec. 9 compared with the prior two weeks.&lt;/p&gt;
&lt;p&gt;The area comprising Colorado, Montana, Utah, North and South Dakota, and Wyoming saw only a 38% drop in test positivity.&lt;/p&gt;
&lt;p&gt;And, pandemic H1N1 is still plenty active, particularly in New England, Fiore noted.&lt;/p&gt;
&lt;p&gt;&quot;But this is very typical of influenza, and happens every season,&quot; he said in an interview, &quot;where you have very different pictures in different parts of the country at different times of the winter season.&quot;&lt;/p&gt;
&lt;p&gt;Nationally, Quest Diagnostics found falling rates of H1N1 in test specimens as well.&lt;/p&gt;
&lt;p&gt;The company&apos;s analysis was based on testing volume at five of the company&apos;s laboratories that perform diagnostic H1N1 testing. The company also markets two emergency use-authorized H1N1 test kits to other laboratories, but these weren&apos;t included in the report.&lt;/p&gt;
&lt;p&gt;In the two weeks from Nov. 25 to Dec. 9, only 21% of specimens tested positive for the pandemic influenza virus, compared with 44% throughout the earlier part of November.&lt;/p&gt;
&lt;p&gt;Altogether, about half of H1N1 tests performed since May 11  --  soon after the virus started circulating in the U.S.  --  have been positive for the virus, the report said.&lt;/p&gt;
&lt;p&gt;While H1N1 positivity rates dropped across age groups, children ages 5 to 14 years continue to have the highest proportion of positive results, at close to 40%.&lt;/p&gt;
&lt;p&gt;Though the H1N1 wave appears to be drawing to a close, seasonal influenza is expected to &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/17598&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/17598&quot; target=&quot;_blank&quot;&gt;pick up as usual &lt;/a&gt;through the end of the month and begin to peak in the first months of the new year, Fiore said.&lt;/p&gt;
&lt;p&gt;But experts are divided over how widespread and virulent the seasonal flu will be this year: some believe it has already been &quot;crowded out&quot; by H1N1. Nor is there consensus on whether there&apos;s a third wave of H1N1 on the horizon for the spring, or how bad it will be.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was done entirely through Quest Diagnostics, which makes H1N1 laboratory testing kits and performs diagnostic H1N1 testing.&lt;/p&gt;&lt;p&gt;Fiore reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>