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Where the Mississippi River nears its end, sits a city that nearly faced its own end.“It’s a different kind of place,” said Louisiana native Hosea LaFleur.Nearly 15 years after Hurricane Katrina, New Orleans remains a city where the past never strays too far from the present. The storm is still felt by every homeowner here on their homeowners’ insurance bills.After the storm, insurance companies no longer wanted to offer homeowners insurance in parts of Louisiana that were vulnerable to hurricanes. They thought it was a money-loser.So, the state created Citizens Insurance. Initially controversial, it was funded by all the property owners in the state, including people who didn’t live anywhere near the damaged areas.“That certainly was a hard sell for those folks,” said Louisiana Insurance Commissioner Jim Donelon.Louisiana’s Citizens Insurance eventually helped stabilize the insurance market after Katrina and attracted more than 30 new insurance companies to the state. The number of homeowners on Citizens has also since plummeted, from 174,000 in 2008 to about 38,000 today, representing about 0.4 percent of the market there.“The policyholders are contributing fees, as well as the companies writing business contribute fees,” said Joey O’Connor, owner of the O’Connor Insurance Group and president of the Independent Insurance Agents and Brokers of Louisiana.Hosea LaFleur’s coastal home is on Citizens Insurance.“Just fell in love with it,” he said of the home. “Fell in love with the people, the things, the atmosphere.”It’s been hit by hurricanes twice: first Katrina in 2005 and then Gustav, three years later.“Knocked our walls down, everything down,” LaFleur said.Despite the repeated rebuilding, he wouldn’t dream of giving it up.“It's home to us,” LaFleur said. “We love it. We love everything about it.”Robert Allen is an adjunct professor at the School of Professional Advancement at Tulane University. His courses specialize in risk management and threat assessments. “That's going to start adding up,” he said, of rebuilding in vulnerable natural disaster areas. “Who foots the bill at the end of the day? You do. I do. Everybody else does.”Last year, the U.S. experienced 14 separate billion-dollar natural disasters: two hurricanes, two winter storms, eight severe storms, wildfires and a drought.From California wildfires to Midwest floods to coastal hurricanes, Allen said that as some insurance companies pull back from covering some areas, taxpayers will need to figure out if they want to keep footing the rebuilding bill.“At the end of the day is going to come down to money,” he said. “I mean, how much money is being put into that and at what point again do you decide this is enough?”Allen said one idea that’s been floated is to create a federal natural disaster insurance program, similar to the national flood insurance program. Taxpayers everywhere would be responsible for keeping it solvent.“There was talk or there is some kind of undertones about doing that with all hazards threats -- like doing that with the fires and just underwriting some of this stuff,” Allen said.It’s a challenge that taxpayers will have to confront, if they chose to rebuild areas hit over and over again by nature’s fury. 3259

While foot traffic at traditional indoor malls have seen a decline in the last decade, outlet malls are on the rise. According to the National Real Estate Investor, 6.8 million square feet of outlet store space has opened in the United States since 2015. On Wednesday, the Federal Trade Commission issued tips on shopping at outlet stores. One tip some might not realize is that often outlet stores sell items that are of lesser quality than at normal stores. According to the FTC, many outlets sell items not available in regular stores. While these items come at a discount, they might not be the same quality. "For example, a jacket might not be fully lined, the stripes on a shirt may not match up at the seams, a t-shirt may be made of a lighter-weight fabric, and shoes might be made with synthetic materials rather than real leather," the FTC said in its consumer tips. "If top quality is important, you may want to shop elsewhere. But if it’s the brand, style, or look that’s key, you may be in the right place."The Canadian Broadcasting Corporation shows the difference between items found at outlets versus items found in regular retailers. There are other opportunities to save money at outlets."Some outlet centers also offer shopper club memberships," the FTC said. "If you join, you’ll get information about sales, events, exclusive offers from merchants, and other perks. With some clubs, you can earn gift cards and other rewards at various 'spend levels.' Just be sure to read the fine print before you get to the checkout." 1554

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

WESLEY CHAPEL, Fla. — Three women have been arrested after they led police on a pursuit through Pasco County and it all started after someone reported seeing the women naked at a Pasco County rest area off of I-75 on Wednesday. On Wednesday, April 10, 2019, at approximately 11:15 a.m., an FHP trooper was dispatched to the suspicious persons call at the northbound I-75 rest area just south of State Road 54. When the trooper arrived on scene, she found three black females completely naked. The women told the trooper they had showered and were "air drying."Troopers say the girls told them they had been at a relatives house in Lutz and got into an arugment. They had no where else to shower, so they bought soap and water and bathed themselves on the grass outside the rest stop building. The girls got dressed before speaking to troopers.As the trooper was attempting to gather their information, the three women ran and got into a white 2009 Nissan Sentra and traveled southbound into the northbound rest area entrance before turning back around and heading northbound before traveling north on I-75 toward State Road 52. The trooper initiated a pursuit, but the pursuit was canceled due to the pursuit not fitting FHP criteria, according to FHP. RECOMMENDED: 1277

Vice President Mike Pence's press secretary Alyssa Farah is expected to become the next Pentagon spokeswoman, CNN has learned.Farah worked in Pence's office for nearly two years after being poached from her post as the spokesperson for the House Freedom Caucus. She is expected to start next month.The White House did not immediately respond to a request for comment. The Washington Post 400