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Two centuries after its invention, the stethoscope — the very symbol of the medical profession — is facing an uncertain prognosis.It is threatened by hand-held devices that are also pressed against the chest but rely on ultrasound technology, artificial intelligence and smartphone apps instead of doctors’ ears to help detect leaks, murmurs, abnormal rhythms and other problems in the heart, lungs and elsewhere. Some of these instruments can yield images of the beating heart or create electrocardiogram graphs.Dr. Eric Topol, a world-renowned cardiologist, considers the stethoscope obsolete, nothing more than a pair of “rubber tubes.”It “was OK for 200 years,” Topol said. But “we need to go beyond that. We can do better.”In a longstanding tradition, nearly every U.S. medical school presents incoming students with a white coat and stethoscope to launch their careers. It’s more than symbolic — stethoscope skills are still taught, and proficiency is required for doctors to get their licenses.Over the last decade, though, the tech industry has downsized ultrasound scanners into devices resembling TV remotes. It has also created digital stethoscopes that can be paired with smartphones to create moving pictures and readouts.Proponents say these devices are nearly as easy to use as stethoscopes and allow doctors to watch the body in motion and actually see things such as leaky valves. “There’s no reason you would listen to sounds when you can see everything,” Topol said.At many medical schools, it’s the newer devices that really get students’ hearts pumping.“Wow!” ″Whoa!” ″This is awesome,” Indiana University medical students exclaimed in a recent class as they learned how to use a hand-held ultrasound device on a classmate, watching images of his lub-dubbing heart on a tablet screen.The Butterfly iQ device, made by based by Guilford, Connecticut-based Butterfly Network Inc., went on the market last year. An update will include artificial intelligence to help users position the probe and interpret the images.Students at the Indianapolis-based medical school, one of the nation’s largest, learn stethoscope skills but also get training in hand-held ultrasound in a program launched there last year by Dr. Paul Wallach, an executive associate dean. He created a similar program five years ago at the Medical College of Georgia and predicts that within the next decade, hand-held ultrasound devices will become part of the routine physical exam, just like the reflex hammer.The devices advance “our ability to take peek under the skin into the body,” he said. But Wallach added that, unlike some of his colleagues, he isn’t ready to declare the stethoscope dead. He envisions the next generation of physicians wearing “a stethoscope around the neck and an ultrasound in the pocket.”Modern-day stethoscopes bear little resemblance to the first stethoscope, invented in the early 1800s by Frenchman Rene Laennec, but they work essentially the same way.Laennec’s creation was a hollow tube of wood, almost a foot long, that made it easier to hear heart and lung sounds than pressing an ear against the chest. Rubber tubes, earpieces and the often cold metal attachment that is placed against the chest came later, helping to amplify the sounds.When the stethoscope is pressed against the body, sound waves make the diaphragm — the flat metal disc part of the device — and the bell-shaped underside vibrate. That channels the sound waves up through the tubes to the ears. Conventional stethoscopes typically cost under 0, compared with at least a few thousand dollars for some of the high-tech devices.But picking up and interpreting body sounds is subjective and requires a sensitive ear — and a trained one.With medical advances and competing devices over the past few decades, “the old stethoscope is kind of falling on hard times in terms of rigorous training,” said Dr. James Thomas, a cardiologist at Northwestern Medicine in Chicago. “Some recent studies have shown that graduates in internal medicine and emergency medicine may miss as many of half of murmurs using a stethoscope.”Northwestern is involved in testing new technology created by Eko, a Berkeley, California-based maker of smart stethoscopes. To improve detection of heart murmurs, Eko is developing artificial intelligence algorithms for its devices, using recordings of thousands of heartbeats. The devices produce a screen message telling the doctor whether the heart sounds are normal or if murmurs are present.Dennis Callinan, a retired Chicago city employee with heart disease, is among the study participants. At age 70, he has had plenty of stethoscope exams but said he feels no nostalgia for the devices.“If they can get a better reading using the new technology, great,” Callinan said.Chicago pediatrician Dr. Dave Drelicharz has been in practice for just over a decade and knows the allure of newer devices. But until the price comes down, the old stalwart “is still your best tool,” Drelicharz said. Once you learn to use the stethoscope, he said, it “becomes second nature.”“During my work hours in my office, if I don’t have it around my shoulders,” he said, “it’s as though I was feeling almost naked.” 5223

Vice President Mike Pence canceled a previously scheduled event in New Hampshire on Tuesday to return to the White House, two White House officials told CNN, though the reason for scrapping the event was not immediately clear.The vice president's spokeswoman said Pence never left the Washington area and that the event will be rescheduled."Something came up that required the @VP to remain in Washington, DC. It's no cause for alarm. He looks forward to rescheduling the trip to New Hampshire very soon," Alyssa Farah wrote in a tweet.An official close to the vice president told CNN that there was no emergency, saying, "the VP was called back to the White House but no cause for alarm."Pence was scheduled to travel to Manchester, New Hampshire, to participate in a roundtable discussion with patients at the Granite Recovery Center headquarters and deliver remarks on the opioid crisis and illegal drug flow into the state. 939

U.S. stock indexes retreated from their record highs after a government report showed that hiring was a touch weaker than expected last month. Employers added 145,000 jobs, short of the 160,000 economists had forecast. But the number was solid enough to cement Wall Street's view that the job market is holding up and can continue allowing households to spend, preserving the largest part of the economy. The bond market rallied after the report showed workers’ wages aren’t rising much, which lessens the threat of inflation. The yield on the 10-year Treasury note fell to 1.82% from 1.85%. The Dow Jones topped 29,000 for the first time ever, but retreated to close at 28,823.77 on Friday. 703

U.S. officials sought to determine Sunday whether extremist groups had infiltrated police brutality protests across the country and deliberately tipped largely peaceful demonstrations toward violence — and if foreign adversaries were behind a burgeoning disinformation campaign on social media.As demonstrations spread from Minneapolis to the White House, New York City and overseas, federal law enforcement officials insisted far-left groups were stoking violence. Meanwhile, experts who track extremist groups also reported seeing evidence of the far-right at work.Investigators were also tracking online interference and looking into whether foreign agents were behind the effort. Officials have seen a surge of social media accounts with fewer than 200 followers created in the last month, a textbook sign of a disinformation effort.The accounts have posted graphic images of the protests, material on police brutality and material on the coronavirus pandemic that appeared designed to inflame tensions across the political divide, according to three administration officials. The officials spoke on condition of anonymity to discuss investigations.The investigations are an attempt to identify the network of forces behind some of the most widespread 1268

We don’t want your 500 extra cops in the subway Andrew Cuomo—and your crackdown on people of color for at best minor offenses must stop!Videographer is admittedly swearing a lot, but appreciate people getting each other’s backs! #NoNewCops https://t.co/CeBXDaJLgF— Cynthia Nixon (@CynthiaNixon) November 9, 2019 324