CHICAGO (AP) — 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 long-standing 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 past decade, though, the tech sector 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 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 a 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 amplify the sounds.
When the stethoscope is pressed against the body, sound waves make the diaphragm — the flatmetal 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 $200, compared with at least a few thousand dollars for some of the hightech 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," he said, "if I don't have it around my shoulders, it's as though I was feeling almost naked."
JOHANNESBURG — From a one-story house with mustard-colored walls off a bustling road in Mauritius, Olivier Bancoult is defying the U.K. by plotting a return to the tiny tropical island where he was born.
A 55-year-old native of the remote Chagos Islands in the Indian Ocean, Bancoult heads a group of mostly elderly women who, like him, were expelled shortly after Britain bought the archipelago from its then-colony Mauritius in 1965. His campaign has taken him to London and the United Nations and secured him a meeting with Pope Francis.
As a young boy, Bancoult and the other roughly 2,000 inhabitants of Chagos were deported to the U.K., Mauritius and Seychelles. The new owners then gassed the residents' pets, closed the coconut plantations and allowed the U.S. to build a military base on the biggest island of Diego Garcia. With the exception of the air force base seen as crucial for U.S. operations in the Middle East and Afghanistan, the U.K. has kept the islands free of inhabitants by declaring an area the size of France a protected marine reserve in 2010. Only a few people are allowed to visit briefly each year, and they can't stay overnight.
"My mother died here (in Mauritius), without ever having been back to her home," Bancoult said in an interview. "I won't let that happen to me."
At a time when politicians in Britain are evoking its imperial past as the U.K. prepares to quit the European Union, the country is under international pressure to give up its last African colony, a sign of its diminished global importance when only 80 years ago it held sway over almost a quarter of the world's population.
"What Britain is facing today is having to confront its colonial past, whether it's Chagos or Northern Ireland," said Philippe Sands, a London-based lawyer who serves as Counsel for Mauritius. "It's the story of its empire coming back to haunt it."
In February, the International Court of Justice ruled the 1965 excision of the Chagos Archipelago from Mauritius unlawful because it wasn't based on the free will of the people concerned. In an advisory opinion, the court stated that the U.K. has an obligation to end its administration of the archipelago "as rapidly as possible."
Then, in May, the U.N. General Assembly affirmed the ruling by an overwhelming majority, with 116 member states voting in favor of a resolution setting a six-month deadline for the U.K. to withdraw. Only six members rejected the proposal — the U.S., Hungary, Israel and Australia among them. The deadline was Nov. 22.
"A U.N. General Assembly resolution doesn't mean you have to comply, but obviously it's very embarrassing for them," said David Brewster, a senior research fellow at the National Security College in Canberra, Australia. "That's what happens when you alienate your allies."
At the end of his September visit to Mauritius, Pope Francis chided the U.K., saying it needs to respect the wishes of international institutions.
But things are unlikely to change overnight.
The U.K. argues it can't give up the Chagos Islands for security reasons. It doesn't recognize Mauritius's claim over what it calls the British Indian Ocean Island Territory, or BIOT, a spokesperson for the U.K.'s Foreign & Commonwealth Office said in an email.
"The joint U.K.-U.S. defense facility on the British Indian Ocean Territory helps to keep people in Britain and around the world safe from terrorism, organized crime and piracy," the spokesperson said. "The status of BIOT as a U.K. territory is essential to the value of the joint facility and our shared interests — an arrangement that cannot be replicated."
Labour leader Jeremy Corbyn has repeatedly said the U.K. should respect the international court's opinion, cooperate with Mauritius and ensure that the people of Chagos can return home.
Mauritian Prime Minister Pravind Jugnauth, who won an election last week, has vowed to pursue the decolonization process with "unflinching determination." But he's also tried to allay concerns about the future of Diego Garcia, saying he has no objections to the base and is ready to enter into a long-term arrangement with the U.S.
Today, the Mauritius government is redrawing its national maps and has set money aside to help the Chagossians prepare for an eventual return. The post office even issued special stamps to celebrate the court ruling.
Still, organizing and funding the relocation of as many as 9,000 people to an archipelago that's more than 1,100 miles away and has no schools, hospitals or any other public services will cost significantly more than the $1.4 million the government has set aside.
That's why there are "extra-parliamentarian groups in Mauritius that question the government's ability to administer the Chagos Archipelago," political analyst Catherine Boudet said by phone from the capital, Port Louis.
Bancoult is confident that the returning residents can make a decent living, mainly from tourism and fishing. And he's planning to charter a boat for their return when the day comes.
"There are already people living there who weren't born there," he said, referring to the foreign employees at the military base. "We'll bring our birth certificate to show that we have a right to live there, too."
Omahans have no shortage of fun, trendy districts in which to shop, live, dine and luxuriate.
Now Ralston wants a piece of the pie.
In the years since construction of the Ralston Arena in 2012, city leaders have been trying to figure out how to draw people from the arena and the area near 72nd and Q Streets into the city’s downtown, which resides southwest of there, along 77th Street.
Born of that desire came the Hinge project, a blueprint for transforming the area into an inviting entrance to the city while completing a major redevelopment of the downtown.
When the idea was first included in the city’s comprehensive plan in 2014, officials spoke of adding a lake, a park and mixed-use buildings that could house apartments, condos, restaurants, stores or bars. They talked of getting private developers on board who could create a vibrant, walkable space.
The Ralston City Council in November approved a master plan for the project — what Mayor Don Groesser called the “50,000-foot view” of what Ralston could look like years down the line.
The master plan, at 108 pages, is comprehensive. It addresses housing needs and the kinds of businesses Ralston is lacking. It lays out a vision for how the area between 72nd Street and the downtown could be built.
If the Hinge ultimately adheres to the master plan, it would create more than 460 new housing units, 1,000 new residents and about 160,000 square feet of retail and commercial space, according to city documents. By comparison, the Nebraska Crossing Outlets has about 400,000 square feet of retail space.
The master plan does not lay out a timeline for the project.
It’s too early for the project to have a set price tag, but Groesser said planners have tossed out $40 million to $50 million for the entire project, much of which would come from the private sector.
The biggest city expense would most likely be for the many green spaces sprinkled through the project’s conceptual designs. Those could cost upward of $5 million — another rough estimate, Groesser said.
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One such imagined green space, in the plan called Gateway Park, would act as a natural welcome mat into the city. In the designs, planners have placed it off 72nd Street between Main and Burlington Streets.
Other amenities included in the designs, from 72nd all the way into downtown, include a small grocery store, pedestrian plazas, a food truck park and aesthetic street designs.
But Ralston doesn’t want to bite off more than it can chew.
When the Hinge was first being discussed, the city considered starting the redevelopment effort farther east, closer to 72nd Street and away from downtown. But that proved to be a challenge, partly because a handful of businesses closer to 72nd had no interest in selling their properties, Groesser said.
Instead, the city is starting closer to home, focusing first on the downtown area itself. As of early December, the city was in negotiations to sell a city-owned parking lot along Park Drive that was appraised at $100,000, according to Dave Forrest, Ralston's outgoing city administrator.
The parking lot could one day be developed into an apartment complex.
A study by engineering company HDR is underway to examine Ralston’s main downtown plaza, which meets at the intersection of five streets. The three-month study is expected to provide options for how the city could rework the heart of its downtown space.
City officials believe that if they can spur redevelopment downtown and slowly work east, they’ll prove to business owners, developers and other stakeholders that the project is working, Groesser said.
Then the city would use downtown redevelopment as a catalyst to keep the momentum going east toward 72nd Street and the Ralston Arena.
“I think if it really starts moving, the development community within Omaha will help us figure out how to make the thing happen,” Groesser said.
The timeline of the project is unclear. The HDR study on the five-point intersection could be done by February. The downtown apartments could break ground in April.
“Everything else is pretty much (up) in the air,” Groesser said.
The plan acknowledges that Ralston will face challenges in seeing its vast vision come together. Omaha’s other districts — Aksarben, Benson, etc. — benefit from being established. And those pockets have access to more young people than the Ralston area.
But Groesser said Ralston doesn’t need to be a carbon copy of other communities. As the project progresses, it can cater to the needs of Ralston.
City leaders stress that nothing in the master plan is final. As the city moves forward, new ideas and different designs could emerge and previous plans could be scrapped.
“We have a beautiful downtown,” Groesser said. “I think we have an opportunity to let it develop like it wants to develop.”
Correction: A previous version of this story incorrectly stated that the City of Ralston had sold a city-owned downtown parking lot. As of Dec. 2, the city was still in negotiations to sell the property.
DAVID CITY, Neb. — They’re calling it a “Christmas miracle,” courtesy of the folks at Hallmark, in this eastern Nebraska farm town.
David City, population 2,900, sure needed a shot in the arm.
One of the town’s biggest employers, Fargo Assembly, announced that it was closing this fall, subtracting about 190 jobs.
Traffic had declined on Nebraska Highway 15 through town after three years of construction projects, hurting local businesses.
An annual Christmas kickoff event had faded away after the spark plug behind the event, a local flower store owner, died.
Then, almost out of the blue, the Hallmark company announced that it was coming to town, with plans to transform the town square into a “winter wonderland” as part of a company effort to pump up communities that have seen some setbacks.
David City was picked because of its bad fortune, but also because it was the hometown of the greeting card company’s late founder, Joyce C. Hall.
The result? Close to 5,000 people crowded into town for “Christmas Comes Early to David City” on Oct. 30 to see the donated new decorations. As a Hallmark Channel video crew filmed, Santa Claus arrived in a Model T Ford, local choirs sang carols and kids signed letters to Santa. Santa even took a side trip to a local nursing home.
“The impact has been huge,” said Kelcie Keeling, executive director of the Butler County Chamber of Commerce. “It was the perfect gift that we just really needed. It gave us that morale boost that was lacking.”
Now, David City is planning a series of extra Christmas events beginning Wednesday to capitalize on the Hallmark decorations and a steady stream of calls from potential visitors.
Hallmark, whose cable TV channel features wall-to-wall Christmas movies this time of year, launched a “Hometown Christmas” initiative this year. The company staged a star-studded “Christmas Con” event in New Jersey and built 15 new homes in an Alabama town ravaged by a tornado.
The “Christmas Comes Early to David City” event was part of the initiative, designed to create “Hallmark-worthy holiday moments” in selected small towns, according to a company press release.
It sure worked in David City, according to Anthony Hruska, the pharmacist/owner of David City Discount Pharmacy.
“It was exactly what you’d think a ‘Hallmark moment’ would be,” Hruska said of the Oct. 30 event. “You could hardly move in our store. And everyone was in a festive mood.”
“People are still coming to town,” he added.
Bobbi Schmid, owner of the Northside Cafe and service station, said a committee of local business owners got only about a month’s warning to line up choirs, install new Christmas lights downtown and arrange for everything from portable restrooms to selfie stations for photographs.
About the time exhaustion would set in, Schmid said someone else would volunteer to help out, lending a forklift or offering to drive shuttle buses.
“You couldn’t believe the generosity of people,” she said. “It was truly a community event.”
That isn’t always the case in David City, which has two high schools, a public school and Aquinas Catholic that compete for attention. In the past, local flower shop owner Jolene Fichtl had organized a Christmas kickoff event, complete with horse-drawn carriage rides around the town square.
But after Fichtl died in 2016, that event faded away. Attempts at launching other communitywide celebrations in town haven’t taken off.
Schmid said that during the past three years, truckers and other potential customers detoured around David City because of construction work on Highway 15 and renovation of the town square. Downtown businesses literally had to greet customers through the back door, she said. But the Hallmark event, Schmid said, is bringing back traffic and the curious.
A series of “Christmas on the Bricks” nights in David City have been hurriedly scheduled to showcase the new look inspired by Hallmark. The set of Candy Cane Lane used in a seven-minute video produced from the Oct. 30 event was initially supposed to be going back to Hallmark, but Keeling said it has now been donated to the community.
The set will be open for viewing one night a week from 6 to 8 p.m. at the Ford/Goodyear Building, 312 Fifth St. in David City, beginning Wednesday. The Candy Cane Lane set also will be open on Dec. 11 and 18. There will be horse-drawn carriage rides, and businesses are being encouraged to stay open late on those Wednesday nights.
A tour of local homes decorated for Christmas is also scheduled for Dec. 14.
“It was a Christmas miracle that we definitely needed,” Keeling said.