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Parliament OKs exit of Iraqi leader amid unrest

BAGHDAD — The Iraqi Parliament approved the resignation of Prime Minister Adel Abdul Mahdi on Sunday, setting the stage for a new political crisis as the ruling class scrambled to address protesters' grievances.

The looming showdown in Parliament comes as protesters have clashed with security forces in Baghdad and other cities as part of an effort to topple a system that they say favors an ossified elite. The protesters have called for a new election law and an end to the power-sharing arrangement that divides government spoils among Iraq's political heavyweights.

The two-month-old movement has posed the most serious challenge to Iraq's political order since the U.S.-led invasion in 2003. More than 430 demonstrators have been killed in the unrest, a human rights official said Sunday on the condition of anonymity.

Abdul Mahdi announced his plans to resign on Friday after violence erupted overnight across several cities and security forces killed at least 45 demonstrators over a 24-hour period.


Trump won't participate in impeachment hearings

WASHINGTON — The White House said Sunday that it would not participate in impeachment hearings Wednesday before the House Judiciary Committee.

Democrats prepared to approve their report Tuesday making the case for President Donald Trump's removal from office. The Democratic majority on the House Intelligence Committee says its report will speak for itself in laying out possible charges of bribery or "high crimes and misdemeanors," the constitutional standard for impeachment. After receiving the report, the Judiciary Committee would prepare actual charges. — AP

South Dakota plane crash killed 9 in extended family

Nine members of an extended Idaho family, ranging in age from 7 to 81, died when their plane crashed in a South Dakota field as they were heading home after a hunting trip.

Travis Garza, president of the wellness company Kyani, said in a Facebook post Sunday that the crash near Chamberlain on Saturday afternoon had killed its two founders and seven other relatives. Three family members were hospitalized.

Twelve people were aboard the single-engine Pilatus PC-12 bound for Idaho Falls when it crashed after takeoff, officials said. — AP


Mexico makes arrests in killings of American family

MEXICO CITY — Mexican authorities on Sunday arrested several people suspected of involvement in the killing of nine members of the LeBaron family, Americans whose deaths last month drew attention to rising violence in the country.

The federal Attorney General's Office said in a communique that "various individuals believed to be involved" in the killings outside the town of La Mora in the northern state of Sonora were arrested in a joint operation early Sunday.

Mexican President Andrés Manuel López Obrador faces mounting pressure to rein in the country's violence. In the latest eruption, authorities said at least 19 people were killed over the weekend in a gunbattle between the Cartel of the Northeast and security forces in the town of Villa Union near the Texas border. — The Washington Post

Malta's leader to resign in wake of journalist's killing

VALLETTA, Malta — Maltese Prime Minister Joseph Muscat told the nation Sunday night that he would resign in January, after an investigation into the 2017 car bombing that killed an anti-corruption journalist raised questions about the role of his former chief of staff. Hours earlier, nearly 20,000 Maltese had protested in the capital, Valletta, demanding that he step down. — AP


San Diego zoo welcomes southern white rhino calf

SAN DIEGO — San Diego Zoo Safari Park has a new baby: a white rhino conceived through artificial insemination.

The park said the female southern white rhino was born Nov. 21. The calf is walking, nursing well and bonding with her mother, an 11-year-old named Amani.

She's the 100th southern white rhino to be born at the park and the second conceived through artificial insemination. — AP

Woman gives baby born at airport an apt middle name

CHARLOTTE, N.C. — A woman who gave birth at an airport in North Carolina has given the baby a name tied to where she was born.

News outlets reported that Nereida Araujo went into labor Wednesday on a flight from Tampa, Florida, to Charlotte, North Carolina. Medics helped deliver the baby on the plane once it landed.

Araujo said she named her newborn daughter Lizyana Sky Taylor. — AP

High-tech rivals imperil symbol of medicine, the stethoscope

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."