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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

WAUCHULA, Fla. (AP) — A 33-year-old orangutan granted legal personhood by a judge in Argentina is settling into her new surroundings at the Center for Great Apes in central Florida.Patti Ragan, director of the center in Wauchula, Florida, says Sandra is "very sweet and inquisitive" and adjusting to her new home. She was born in Germany and spent 25 years 369

UPDATE: President Donald Trump's former national security adviser Michael Flynn will not be sentenced Tuesday. Original story: President Donald Trump's former national security adviser Michael Flynn said Tuesday in a federal court that "I was aware" that lying to the FBI is a crime.Flynn pleaded guilty a year ago to lying to federal investigators and is being sentenced by Judge Emmet Sullivan of the US District Court for the District of Columbia, who has had very strong words for the defendant."I want to be frank with you, this crime is very serious," Sullivan said. "Not only did you lie to the FBI, you lied to senior officials in the incoming administration.""All along, you were an unregistered agent of a foreign country while serving as the national security adviser to the President of the United States," Sullivan said. "That undermines everything this flag over here stands for. Arguably you sold your country out."Flynn has cooperated extensively with special counsel Robert Mueller's Russia investigation and at least one other Justice Department probe. It is also possible that Flynn "is continuing to cooperate with the government," prosecutor Brandon Van Grack said Tuesday.Flynn has given Mueller a key witness on some of the most scrutinized moments during the Trump campaign, transition and first month in the White House -- while also turning the former Army lieutenant general into a political cause backed by conservatives wary of Mueller's approach.Trump himself wished Flynn "good luck" in a Tuesday morning tweet, adding that it "will be interesting to see what he has to say."Despite Flynn's admissions that he lied about three things -- including policy requests he made to then-Russian Ambassador Sergey Kislyak during the transition -- Mueller's team has asked the judge to sentence Flynn to minimal or even no time.Three previous defendants in Mueller's probe -- Trump's former personal attorney Michael Cohen, the Dutch lawyer Alex van der Zwaan and former Trump campaign adviser George Papadopoulos -- pleaded guilty to the same crime of lying. Each received sentences that included prison time. But none of those men helped investigators as broadly, willingly or sincerely as Flynn, Mueller's team has said.Another defendant, former Trump campaign deputy Rick Gates, also pleaded guilty to a lying charge in Mueller's probe. He continues to cooperate with the investigation and has no set sentencing date.FBI's approachFlynn's sentencing has been shaded over the past three weeks by criticism of the FBI's actions when it first approached him in the White House on January 24, 2017.Flynn's defense team first raised the issue in a memo to Sullivan last week. The defense lawyers argued that Flynn should be spared jail time because he had lied under different circumstances than van der Zwaan and Papadopoulos, who had been warned they could be prosecuted for lying to the FBI.Flynn spoke to the FBI agents with no lawyer present and hadn't been warned of the potential legal consequences. He also did not involve the White House counsel's office, and the FBI did not involve the Justice Department in his interview.Flynn was so relaxed, investigators said, that they did not have the impression that he was lying during the interview, according to memos from the agents. Even so, the FBI knew that when Flynn said he hadn't asked for certain responses from Kislyak to the American sanctions against Russia or a United Nations Security Council resolution, he was lying.Tuesday, Sullivan asked Flynn's attorney Stephen Anthony if the former national security adviser was "entrapped by the FBI." Anthony said, "No, your Honor."Another FBI memo about the January 24, 2017, interview, released Monday night, further solidified that Flynn wrongly denied he had tried to influence the Russian government's reaction to sanctions and intentions at the UN.Flynn first met Kislyak in 2013 while director of the Defense Intelligence Agency, and he had developed the relationship with the Russian government since then. Court documents made public last year show that members of Trump's transition team knew about Flynn's requests to the ambassador a month before the inauguration.Flynn is also central to the potential obstruction of justice case surrounding Trump's interactions with former FBI Director James Comey. According to a memo Comey wrote in February 2017, the President asked him to drop the investigation into Flynn.Mueller's team has described on multiple occasions how Flynn misled members of the Trump administration about his contacts with Kislyak, which then prompted those public officials to share false information with the American public.Turkey projectAside from Flynn's conversations with the Russian, he admitted to lying about his lobbying work for the Turkish government as it sought to build American support for the extradition of a cleric and political opponent living in Pennsylvania.Flynn's two former business associates were indicted by the Justice Department on Monday for working on this project, which included Flynn authoring an op-ed in a Washington newspaper that sympathized with the current Turkish government and demonized the cleric. The op-ed published on Election Day 2016. The former business associates also accepted payments for the work through Flynn's company, the Flynn Intel Group, according to the charging document.One of the men, Flynn Intel Group co-founder Bijan Rafiekian, also known as Bijan Kian, appeared in a Virginia courtroom Tuesday and plead not guilty to charges of conspiracy and illegally acting as a foreign agent in the US.The other defendant in the case, a Dutch-Turkish businessman, is charged with the same two crimes plus lying to the FBI. The businessman, Kamil Ekim Alptekin, lives in Istanbul and has not appeared in US court. 5843

With Black Friday and Cyber Monday coming up, there's sure to be tons of great deals online, but many of those from third-party sellers are just too good to be true. 179

When a 12-year-old Michigan girl was asked by a man to get in his car, she responded by asking him what the password was, to which he couldn't provide and answer. The Macomb County Sheriff's Office says the stranger danger incident happened Wednesday around 7 a.m.The girl was walking to her school bus stop when she was approached by a newer model, black Chevy, four-door sedan. The windows of the vehicle were heavily tinted. Authorities say a male suspect in the vehicle asked the girl to "get in the car." She responded by asking what the password is. The suspect said he didn't know, so the 12-year-old ran away from the vehicle. The girl and her mother have set a password if the mother were to ever have someone pick the girl up at any location. After the girl ran away, the suspect eventually drove from the area. The girl then continued to the bus and told a school resource officer about the incident when she arrived at school.The girl was uninjured, and another student witnessed the incident and corroborated what the girl told police. The driver of the Chevy is described as a white male in his early 20s with dark hair. If you have information on this suspect, please contact the Macomb County Sheriff's Office at 586-469-7198. 1254