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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

Twenty people were killed and more than two dozen were injured in a mass shooting at an El Paso shopping center on Saturday, according to Texas and local authorities."Lives were taken who should still be with us today," Gov. Greg Abbott said at a news conference near the Walmart and an adjacent shopping mall.Twenty-six people were injured, according to El Paso Police Chief Greg Allen."The ages and genders of all these people injured and killed are numerous in the age groups," Allen said. "The situation, needless to say, is a horrific one."A 21-year-old white man from Allen, a suburb of Dallas more than 650 miles away, is in police custody, Allen said. Authorities are looking at potentially bringing capital murder charges against him.The case also has a "nexus to a potential hate crime," he said."Right now, we have a manifesto from this individual that indicates to some degree a nexus to a potential hate crime," Allen said.FBI El Paso Special Agent in Charge Emmerson Buie said more investigative work was needed before determining whether there was a possible hate crime.The dead included three Mexican nationals, according to a tweet from President Andrés Manuel López Obrador. Six Mexicans were injured, Foreign Affairs Secretary Marcelo Ebrard wrote on Twitter.CNN reported the suspect is 21-year-old Patrick Crusius of Allen, according to three sources.Two federal law enforcement sources and one state government source confirmed the suspect's identity. The federal sources said investigators are reviewing an online writing posted days before the shooting that may speak to a motive.The online posting was believed to be written by Crusius, the sources said, but that has not been confirmed.'This was a massacre'The first call of an active shooter went out at 10:39 a.m. local time, Allen said. The first officer arrived on scene six minutes later.El Paso Police Sgt. Robert Gomez previously told reporters police were initially given multiple possible locations for the shooting, at a Walmart and the Cielo Vista Mall next door."This is a large crime scene, a large area," Gomez said of the scene.Multiple agencies responded to the scene, including the FBI, the sheriff's department, the state Department of Public Safety and Border Patrol.The crime scene will "be in play for a long period," Allen said. "Unfortunately, the deceased will remain at the scene until the scene is processed properly for evidentiary purposes to be gathered for later prosecution."Officials from two local hospitals said they had received at least 23 people.Thirteen people were taken to University Medical Center of El Paso, spokesman Ryan Mielke told CNN, and one of them has died. Two children with non-life-threatening injuries were transferred to a children's medical facility, Mielke said.Eleven victims were transported to the Del Sol Medical Center, hospital spokesman Victor Guerrero said. Nine are in critical but stable condition, he said.At least two of the patients are in a "life-threatening predicament," according to Del Sol Medical Center Dr. Stephen Flaherty. He said the patients ranged in age from 25 to 82. Two are in stable condition, he said, and seven required emergency operations."This was a massacre," US Rep. Veronica Escobar, who represents the area, told CNN. Escobar has received conflicting reports on the numbers of casualties, she said, but added, "The numbers are shocking."Footage shows people lying on the ground outside WalmartWalmart issued a statement regarding the shooting, saying, "We're in shock over the tragic events at Cielo Vista Mall in El Paso. ... We're praying for the victims, the community & our associates, as well as the first responders."Inside the mall, crowds hid inside stores after hearing reports of an active shooter, according to 26-year-old Brandon Chavez, an employee at Forever 21.Chavez had just started his shift when he saw customers and staff members running to the stock room to take shelter."There were about 20 children and adults, plus employees, hiding, all cramped like sardines," he told CNN. "Most of us were desperate, some were on their phones. There were girls crying, people trying to talk to each other and women with babies in their arms."Store employees had closed the glass doors but he could see police officers walking around the mall and evacuating people from other stores.After police officers knocked on the store's doors, Chavez said his group had to leave the store, forming a line with their hands up and running.In a shaky Snapchat video aired by CNN, a woman holding the camera frantically runs with a small group of girls or women through a mall department store and into a parking lot.As the group hurries past racks of clothes and cases of merchandise, voices off camera shout, "Hands up!"Once in the parking lot, one member of the group asks, "What happened?""I don't know," the woman holding the camera responds. "I don't know."Another video, shot from outside the Walmart, showed people lying on the ground, some of them next to a table set up by the store's entrance."There's a man lying down at the stand that a school set up," the man holding the camera says in Spanish."Help!" a man screams in English."We need CPR," someone else says. "We need CPR."'Our community will heal,' mayor saysMayor Dee Margo said Saturday evening that his city would rise above this "senseless and evil act of violence.""We will be defined by the unity and compassion we showed in the wake of this tragedy," he said. "United, our community will heal."Nowhere was that spirit more on display than at blood donation centers. Donations were urgently needed, and authorities said if local residents wanted to help, they should make appointments.Frances Yepez, waiting in line at one blood donation center, said the center was at max capacity and dozens of people were waiting to make appointments for Sunday or Monday."It's easy to make a dollar, but it's harder to make a difference," she said. "So I get out there and do whatever I can do to help."She said the mood there was somber, and she could hear sniffling as the crowd of people learned updates over the television.President calls shootings 'an act of cowardice'President Donald Trump tweeted his "heartfelt thoughts and prayers.""Today's shooting in El Paso, Texas was not only tragic, it was an act of cowardice," the President wrote. "I know that I stand with everyone in this country to condemn today's hateful act. There are no reasons or excuses that will ever justify killing innocent people."Democratic presidential candidate Beto O'Rourke, who once represented the area in Congress, addressed the shooting while at a speaking event in Las Vegas."We know there is a lot of injury, a lot of suffering in El Paso right now," he said. "I am incredibly sad and it is very hard to think about this.""But I'll tell you, El Paso is the strongest place in the world," he added. "This community is going to come together."O'Rourke said he would be cutting short his trip to return to El Paso.The scene was unfolding in the same week two employees were fatally shot at 7124

Victoria's Secret parent company L Brands confirmed on Thursday that it will not air its fashion show this year after falling ratings and backlash to the event in recent years."We think it's important to evolve the marketing of Victoria's Secret," L Brands Chief Financial Officer Stuart Burgdoerfer said on a call with analysts Thursday.The first Victoria's Secret fashion show aired in 1995, but last year the show fell to its 441

Update: We are in contact with our hero. He’s wearing this beauty to Game 6. pic.twitter.com/CobFG9q8kC— Bud Light (@budlight) October 29, 2019 155

UPDATE: 9:15 p.m. ET: Singer R. Kelly was arrested on Friday after he turned himself over to authorities after he was charged earlier in the day with 10 counts of sexual abuse. He did not answer any questions as he walked through a sea of photographers and reporters with handcuffs behind his back. PREVIOUS STORY: Musician R. Kelly has been indicted on 10 counts of aggravated criminal sexual abuse -- a class 2 felony -- involving four alleged victims, Cook County State's Attorney Kim Foxx said Friday.His attorney, Steve Greenberg, tweeted that Kelly would turn himself into police between 11 p.m. CT and midnight.Kelly is scheduled to appear in court Saturday for a bail hearing. Arraignment is set for March 8.A warrant has been issued for Kelly's arrest, Chicago police say. The charges handed up in an indictment from a grand jury span from 1998 to 2010, Foxx said.If convicted, Kelly faces a maximum of seven years in prison for each count.Kelly has been 976