Publisher Health

Signs of injury to the brain’s white matter called white matter hyperintensities, as seen on brain scans, may be tied more strongly to vascular risk factors, brain shrinkage, and other markers of dementia in former tackle football players than in those who did not play football, according to a study published in the December 20, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“Studies have shown that athletes exposed to repetitive head impacts can have increased white matter hyperintensity burden in their brains,” said study author Michael L. Alosco, PhD, of Boston University Chobanian & Avedisian School of Medicine. “White matter hyperintensities are easily seen on MRI as markers of injury of various causes. We know these markers are more common as people age and with medical conditions such as high blood pressure, but these results provide initial insight that they may be related to multiple aspects of brain damage from repetitive head impacts.”
Alosco said looking at white matter hyperintensities on brain scans may be a promising tool to study the long-term effects of repetitive head impacts. Repetitive head impacts have also been associated with chronic traumatic encephalopathy (CTE), a neurodegenerative disease that can result in dementia.
The study does not prove that repetitive head impacts and white matter hyperintensities cause other brain changes. It only shows an association.
The study involved 120 former professional football players and 60 former college football players with an average age of 57. They were compared to 60 men with an average age of 59 who had no symptoms, did not play football, and had no history of repetitive head impacts or concussion.
The participants had brain scans and lumbar punctures to look for biomarkers of neurodegenerative disease and white matter changes, along with other assessments.
In the former football players, a higher burden of white matter hyperintensities was associated with greater vascular risk factors; increased concentrations of p-tau proteins found in Alzheimer’s disease, CTE, and other neurodegenerative diseases; more brain shrinkage and a decrease in the integrity of the white matter pathways in the brain.

The relationship between white matter hyperintensities and stroke risk was more than 11 times stronger in former football players than in those who did not play football. For p-tau, the relationship was 2.5 times stronger in the football players. For a measure of white matter integrity, the relationship was nearly 4 times stronger in the former football players.
“While our research previously showed that former football players still have elevated white matter hyperintensity burden after controlling for sleep apnea, alcohol use and high cholesterol, it is still important to consider working on modifying these risk factors due to their effects on cognitive problems and other symptoms,” Alosco said.
A limitation of the study was that participants volunteered to take part, so they may not represent all former football players. In addition, since only elite football players were included, the results cannot be easily translated to other populations.
The study was supported by the National Institutes of Health and National Institute of Neurological Disorders and Stroke.

Nearly every organism on Earth follows a natural circadian rhythm that is coded by your cell’s clock genes, which do exactly as you suspect from the name: regulate your body’s rhythm on a 24-hour basis. Most cells in mammalian bodies have cilia of some sort, which are hair-like structures that perform a variety of functions such as movement for motile cilia and aiding in structure in function for non-motile, or primary, cilia. The primary cilia also act as a sensory organ for the cell, a function which has illuminated the primary cilia’s potential role in the healing process and how bodies heal at a different rate according to our circadian rhythm. In this research, the role of the primary cilia, biological clock and wound healing is explored.
Researchers published their results in EMBO Reports in November 2023.
The main findings concluded that clock proteins, which are proteins that regulate a 24-hour rhythm within a cell and are coded by clock genes, have much to do with the regulation of the primary cilia. The primary cilia act in accordance with the oscillations of the clock gene’s expression and can shorten or lengthen throughout the day. The length of the primary cilia can vary and is tied to the healing process of a wound. The shorter the length of the cilia, the shorter the wound-healing time appears to be. The research done in this study observes cells from mice over 72 hours and the rise and fall of the length of the cilia is observed to be in line with the rhythm of a 24-hour cyclical period.
“This suggests that the 24-hour cycle of primary cilia on fibroblasts may underlie in part the difference of wound healing speed between daytime and nighttime,” said Ryota Nakazato, researcher and author of the study. Fibroblasts are cells that contribute to forming connective tissue and are a major part of the healing process. The circadian rhythm in the primary cilia of these fibroblasts is more involved in wound healing during the day than at night.
The reason for this daytime-induced enhanced healing process appears to be from the relationship the 24-hour cycle has on the length of the primary cilium. During the day, the cilia are shorter and are more easily able to convert to a cell type that can invade the wound to begin the healing process. Primary cilia are possibly also involved in receiving and sending signals to the rest of the body which can also enhance wound repair. The cells with shorter primary cilia are more easily released from their “anchor” to start cellular migration to the wound site at an earlier time and might also more readily send out signals to increase the rate of wound repair than when the cilia length is longer.
“We expect that further analysis will clarify the role of primary cilia not only in wound healing, but also in various life phenomena that exhibit circadian rhythms, such as sleep/wakefulness, hormone secretion, and changes in body temperature,” Nakazato said.
Although there has been some headway made with the connection of these two seemingly unrelated subjects, there’s more work to be done to elucidate the mechanism by which circadian rhythm affects the body’s physiology, especially in immature or embryonic cells.
These observations allow researchers to further explore the role the biological clock and its disturbances have in various health issues or disorders and can lead to the development of a field of study known as “circadian medicine.” The findings from more in-depth research on the physiology of circadian rhythm can aid those who struggle with jet lag, insomnia and other disorders or diseases that may stem from issues in regulating the body’s natural clock.
Ryota Nakazato, Faryal Ijaz and Koji Ikegami of the Department of Anatomy and Developmental Biology, Graduate School of Biomedical and Health Sciences at Hiroshima University with Koji Ikegami also from the Precursory Research for Embryonic Science and Technology and Yuki Matsuda of the Hiroshima University School of Medicine contributed to this research.
JSPS Grants-in-Aid, Japan Science and Technology Agency, the Natural Science Center for Basic Research and Development at Hiroshima University and the MEXT Project helped make this research possible.

Published4 hours agoShareclose panelShare pageCopy linkAbout sharingImage source, Nicki BainBy Angie BrownBBC Scotland, Edinburgh and East reporterAngus Bain has suffered debilitating epileptic fits every Christmas for the past 13 years. But this year the 17-year-old is hoping to have a seizure-free festive season, after undergoing life-changing laser brain surgery just 11 weeks ago.After years of enduring almost weekly attacks, they appear to have been virtually eliminated by the pioneering procedure. “I’ve never had such a long period not having a seizure, it’s an amazing relief. I’m so happy,” Angus told BBC Scotland News. “Christmas is a big occasion and now it will be even bigger this year.”Being able to have this surgery is amazing. I think it could change my life forever by making me able to do the things I haven’t been able to do.”Image source, Nicki BainAngus, who lives in Gateside, Fife, was diagnosed with epilepsy when he was four years old. His seizures are so severe they leave him wiped out for days afterwards. In October a piece of his brain that causes the attacks was removed by laser at the Royal Hospital for Children and Young People in Edinburgh. It will take a year before he can come off the strong medication he is on so his brain recovers from the surgery but it is hoped he will then be seizure-free.His mum, Nicki Bain, 48, said: “Our lives have been consumed with Angus’s epilepsy since he was four. He has been on lots of very heavy medication, had wires in his head, brain stimulation, so many tests and scans. “The build-up to him having a seizure would last a few days, then after the seizure it would take another couple of days for him to recover, so I don’t think he’s ever actually had a normal day.”He would say, ‘I just want to get rid of my epilepsy and get on with my life’.”Image source, Nicki BainAngus, a pupil at Strathallan School in Perthshire, said that, although it’s early days, he was daring to dream he could go skiing. It was previously deemed too dangerous for him to ride on a chairlift. “In the past it made me feel a bit annoyed and upset that it was holding me back and keeping me from doing sport especially rugby,” he said. “And I might also be able to become a singer now, I’d love to do that as a career and to be able to get my driver’s licence, something I’ve not been allowed to apply for as my seizures were too bad.”I wish I could go to parties with my friends. I see photos of all my friends together and I am jealous that I can’t go but they can.”But it’s just been too risky for me with all the seizures I have had.”Image source, Nicki BainThe pioneering new technology is MRI-guided Laser Interstitial Thermal Therapy (LITT) surgery – which can reach the centre of the brain.Edinburgh Children’s Hospital Charity said The Welch Trust bought the £140,000 equipment, which costs £15,000 a year to maintain.Nicki, from Gateside, said: “The process was absolutely mind-blowing and recovery was fast. You’d never know he’d had brain surgery. “It’s extraordinary that this surgery is now available in Scotland. It’s going to change so many lives. “For the past 13 years, Angus has had seizures at Christmas time. I can’t even put into words what it means to him, and all our family, for him to be seizure-free for Christmas this year.”He’s a remarkable boy who has shown so much resilience. His future is looking so bright, and we’re incredibly proud and excited for him.” Image source, Nicki BainDr Jothy Kandasamy, consultant neurosurgeon at the hospital, said: “For some patients, by replacing invasive neurosurgery with cutting-edge laser therapy, we not only dramatically reduce risks to these patients, but significantly reduce their recovery time too. “The laser surgery is a breakthrough for some patients and will give some patients with epilepsy a real chance to live a normal life.”The surgery has been life-changing not just for Angus, but for the entire family.”These experiences are what drive me. My patients motivate and inspire me to provide the highest level of neurosurgical care possible to change young people’s lives.”Image source, Nicki BainTo qualify for the laser surgery patients must go through months of scans and tests. They must also have continued having seizures despite being on anti-epilepsy medication.Roslyn Neely, chief executive officer of Edinburgh Children’s Hospital Charity, said: “We are encouraged by the life-changing impact that the laser surgery has had for Angus, and his whole family.”What an incredible difference this will make to his future, and that of others living with epilepsy who can now go on to have the surgery.”Angus said he now cannot wait for Christmas adding: “I feel like this is a happy ending because I have been through a lot.”Related Internet LinksEdinburgh Children’s Hospital CharityThe Welch TrustThe BBC is not responsible for the content of external sites.

Published24 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Jamie Niblock/BBCBy Charlotte RoseBBC Investigations, EssexAs a counsellor, Claire Jennings has always been there for other people. But she is one of hundreds of disabled people caught up in a contractual dispute between a county council and a firm that provides payroll services. And they all have the same question: “Where has our money gone?”Claire Jennings is registered blind and has scoliosis, a spinal condition that causes her “constant pain”.In April, she lost all hearing in her right ear, which has affected her balance. She is entitled to 29 hours of support every week, which includes help to get up, wash, dress and take medication, as well as preparing meals to make sure she does not eat food that could be out of date.”In the most recent budget we were told that disabled people should work,” she says.”I do work, but I can’t sit in front of my clients if I’m still in my pyjamas.” She says it is these little things that others might “take for granted” – but give Claire “dignity, and offer meaning to my life”.Image source, Science Photo LibraryClaire is one of about 1,500 disabled people in Essex who use “direct payments” to buy personal care, and whose budgets are held by an organisation that manages payroll services, like paying carers and sorting out tax or National Insurance. The payroll firm Purple, based in Chelmsford – and its predecessor Essex Paths – provided this service for nearly two decades, but the contract was terminated by Essex County Council in July, and a new firm, Penderels Trust, was appointed.Blind woman’s electricity cut off after £36,000 bill errorDisability benefits cost could rocket, report saysDisabled to get cost of living £150 from SeptemberClaire says that, at that time, she had almost £2,000 in her account because she had been advised by Purple to keep a “buffer” for emergencies.But since July, she has contacted both Purple and Essex County Council a number of times to find out where her money is and why it has not been paid to her, or transferred to the new provider. She says she was told her outstanding balance would be returned in August.Five months on, she has still not received a penny. The situation has left Claire extremely worried.”There’s no transparency, no communication about where it’s gone,” she says.She feels it is “unfair” that disabled people are caught in the middle of the dispute, likening the situation to a child of divorcing parents.”We are collateral damage to something I’ve got no comprehension of,” she says.Image source, Jamie Niblock/BBCThe BBC has spoken to a number of Purple service users who set up a Facebook group called “Unhappy Carers and Customers”.Their complaints include late payments to carers, incorrect payments to HMRC, poor communication, and a failure to provide up-to-date account statements.Among them is Mary Hunt, who looks after the personal budget of her daughter Laura.Laura is 41 and has Down’s syndrome, asthma and an underactive thyroid. She also struggles to regulate her body temperature. She lives in supported accommodation with 24-hour support staff in Chelmsford, and is also entitled to 25 hours of personal care every week.’Huge consequences’Mary says she had no problems with Purple up until 2017 when she says the service “deteriorated”. Since then, she says life has been “chaotic” and “stressful”.On one occasion last year, Laura’s account had gone into debit and Mary said she called “90 times in a week” to get hold of someone who could sort out the issue. Like others, she has had problems with carers and personal assistants being paid on time. One carer, to whom Laura had become attached, left the sector altogether because payments were so unreliable, she said.”To this day I have no idea how much was left in that Purple account,” she says.She says she tried to contact the new provider, Penderels Trust, but found that they were “inundated” with others in the same situation.By the end of July, Mary took the decision to take control of the budget herself.She says she holds Essex County Council responsible for failing to take action when she and others had made complaints about Purple for some years.”These pots of money keep families going, keep people safe, keep them secure,” she adds.”When you mess about with people’s lives like this, the consequences are huge.”Image source, Getty ImagesPurple told the BBC: “Our aim is to provide a high quality, individualised service. Every person deserves the support and tools to meet their day-to-day needs.”We are sorry to hear about the concerns raised by Claire and Mary. Their experience does not reflect what we strive to achieve. “Unfortunately, we are unable to comment publicly on the detailed points raised as we take confidentiality seriously.”A spokesperson for Essex County Council said the authority was “in the process of reconciling all funds that were held by the previous Direct Payment Support Service provider”.”This is taking some time due to the volume of information and accounts that need to be reconciled,” the spokesperson added. “However, all funds will be transferred with no detriment to any individual who receives a direct payment. All care commitments will continue to be met.”Follow East of England news on Facebook, Instagram and X. Got a story? Email eastinvestigationsteam@bbc.co.uk or WhatsApp 0800 169 1830More on this story’Determined’ boy, 2, raises thousands for charityPublished5 DecemberDisability benefits cost could rocket, report saysPublished18 SeptemberMillions to receive cost of living paymentPublished20 JuneFirms ‘lose trillions’ by ignoring disabled consumersPublished18 May 2021Related Internet LinksEssex County CouncilThe BBC is not responsible for the content of external sites.

Published41 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Aurelia FosterHealth reporterPeople who cannot burp suffer embarrassment, anxiety and depression because of the condition, on top of physical pain, researchers say.Retrograde cricopharyngeus dysfunction (R-CPD) causes abdominal bloating, “socially awkward” gurgling noises from the chest and neck, and flatulence.The research was carried out by a group of Texan university academics.They said many doctors are “unfamiliar” with the disease, leaving patients “underserved”.They added that more research into, and more awareness of, R-CPD were needed. The group added there is a need to investigate “the severity that this syndrome has on a patient’s daily life, including its mental and social implications”, because it can negatively affect sufferers’ quality of life,.R-CPD, also known as “no burp syndrome”, occurs when the cricopharyngeal muscle in the throat is unbale to relax to allow gas to pass upwards.Botox allows man to burp again after 20 years’Tormenting people’Yakubu Karagama, an ear, nose and throat consultant at London’s Guy’s and St Thomas’ Hospital, said the condition had been “tormenting people for a long time”. “When you eat something or drink, you have this pain. Some patients have to lie down so that the gas will come up, and some people have to stick their finger in their mouth to force themselves to be sick, so that the gas will come out with it.”Mr Karagama told the BBC that since 2016 he had been treating people with this condition with Botox injections, which work by relaxing the cricopharyngeus muscle.He said the treatment had been “life-changing” for “almost every single patient” on whom he had operated.However, it is currently available as a private treatment only because there is little awareness of the condition among the health profession, Mr Karagama said.”You can imagine if I said to you ‘I can’t burp’. This is the problem. Most people would laugh at it.”People don’t understand the physiology of burping,” he said.Mr Karagama said it was not known how many people have the condition, but he believed it was common.”A lot of people don’t even know that the symptoms they’re having is because of this condition. The majority of the patients that have presented to my clinic said that they’ve had this all their life.” He said funding was needed to undertake clinical research into the condition, which he said people were suffering with “unnecessarily”.An NHS England spokesperson said: “While the clinical evidence of this condition is extremely limited due to the small number of people who have come forward with it, NHS staff enact clinical advice from NICE [the National Institute for Health and Clinical Excellence], which sets out the care and services suitable for patients with a specific condition or need.”This study, based on their survey of 199 people unable to burp, concluded there was “very limited awareness” of the condition among health professionals, and improved understanding of the disease could increase diagnosis and treatment rates.This would lead to an improved quality of life for patients, the authors said.Researchers found half of people with symptoms of R-CPD discussed them with their primary care provider, but that 90% of those said they did not receive adequate help.The study notes a general “prevalence of psychiatric symptoms” in people with disorders which are difficult to diagnose.”Therefore, it is paramount to explore the mental health implications of this condition,” the authors say.R-CPD was only recently officially given a name by a US academic 2019 when the first scientific paper on it was published.More on this storyBotox allows man to burp again after 20 yearsPublished30 September 2021Related Internet LinksClinical Research Institute – Texas Tech University Health Sciences CenterSchool of Medicine – Texas Tech University Health Sciences CenterThe BBC is not responsible for the content of external sites.

Published20 December 2023Shareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesThe latest Covid booster campaign is under way across the UK and those who qualify are urged to get jabbed as soon as possible. No Covid restrictions are in place across the UK, but guidance recommends people who catch the virus “should try to stay at home”.What are the Covid symptoms?Many of the symptoms are similar to those for colds and flu and include: high temperature, fever or chillscontinuous coughloss of, or change in, your normal sense of taste or smellshortness of breathfeeling tired or exhaustedaching bodyheadachesore throatblocked or runny noseloss of appetitediarrhoeafeeling sick or being sickMost people feel better within a few days or weeks – but for some, it can be more serious. Those concerned their or their child’s symptoms are worsening should request an urgent GP appointment or help from NHS 111. WHO charts rapid spread of new JN.1 Covid variant Why Covid is still flooring some peopleWhat about long Covid?Between 2% and 20% of people catching Covid go on to have longer-term symptoms, “long Covid”, research suggests.In March, the Office for National Statistics (ONS) estimated 1.9 million people in the UK (2.9% of the population) still had symptoms more than four weeks after their initial infection. There is no simple test for long Covid, and people report a variety of symptoms, including: extreme tirednessshortness of breathmuscle aches memory and concentration problems (“brain fog”)Some people have developed long Covid after an initial mild infection. What are the symptoms of long Covid?Get NHS help with Covid recoveryWhere can you get a Covid test?Routine Covid testing is not recommended, and most people can’t get free tests via the NHS. You may still be able to get free NHS tests if you:have a health condition that makes you eligible for treatment if you test positivework in healthcare or a hospiceYou can buy a test for about £2 from High Street and online chemists, but cannot report these test results to the NHS.Do you have to isolate after testing positive?People are largely advised to treat Covid like any other respiratory disease. You no longer have to self-isolate after testing positive.Image source, Getty ImagesHowever, the government recommends trying to stay home for five days – or three for under-18s, as younger people tend to be infectious for a shorter period. People at higher risk of becoming seriously ill with Covid who have been told they are entitled to treatments if they catch it must report their test result so the NHS can contact them about their options.How to look after yourself if you get CovidHow long are you contagious?Some people are infectious for about five days but others may be contagious for up to 10. Those who have a high temperature or still feel unwell after five days are advised to stay home if they can until they:feel well enough for your normal activitiesno longer have a high temperatureCan you go to work with Covid?You don’t have to tell your employer you have Covid. However, you are asked to avoid contact with others for five days, which means you should work from home if you can, especially if you have a high temperature. The specific schemes offering financial support to those isolating during the pandemic have ended. But you may be entitled to Statutory Sick Pay – worth £109.40 a week.Image source, ThinkstockCan children go to school with Covid?Under-18s who test positive for Covid are advised to stay at home for three days. NHS guidance says if a child has mild symptoms such as a runny nose, sore throat or mild cough – and they feel well enough – they can go to school or childcare. Who can have a Covid jab?In the UK, you can only have the Covid vaccine via the NHS if you meet certain criteria.For most people, vaccinations are now available only as part of a seasonal rollout. You cannot currently buy them privately. The 2023 autumn booster campaign is targeting:residents in care homes for older adultsover-65speople aged six months to 64 years in a clinical risk groupfront-line health and social-care workers12-64-year-olds who are household contacts of people with weakened immune systems16-64-year-olds who are carers or work in care homes for older adultspregnant womenThe NHS has been contacting eligible people. You can no longer book a Covid jab online or by calling NHS 119 – but you may be able to with a local NHS vaccination service or you can find a walk-in site.This round of seasonal Covid jabs will be available until 31 January.Moderna told BBC News it hoped its Covid jab would be on sale in the UK from 2024. Pfizer is also exploring options for private provision. Who can get another Covid jab this autumn?How long after having Covid can you have a jab?If you have Covid, or think you might, NHS advice is to delay vaccination until you feel better.It also recommends waiting if you have a high temperature or feel otherwise unwell with any illness.But there is no need to wait if you have recently recovered from Covid and feel well.The vaccines do not infect people with Covid and cannot cause positive test results.

Published18 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesA sub-variant of the Omicron mutation of the Covid virus has been classified as a “variant of interest”, by the World Health Organization, because of “its rapidly increasing spread”.JN.1 has been found in many countries around the world, including India, China and the United States. The risk to the public is currently low and current vaccines continue to offer protection, the WHO says.But it warns Covid and other infections could rise this winter.Respiratory viruses such as flu, respiratory syncytial virus (RSV) and childhood pneumonia are also on the rise in the northern hemisphere.Indian state says ‘don’t panic’ as Covid cases riseWhy Covid is still flooring some peopleNobel Prize goes to scientists behind mRNA Covid vaccines’The virus which causes Covid is constantly changing over time and sometimes this leads to new variants developing.Omicron has been the globally dominant variant for some time.The WHO says it is continuously monitoring the spread of Omicron sub-variant JN.1 and will issue updates as needed. It is currently tracking a number of Covid variants of interest – but none is thought to be concerning.Winter surgeJN.1 is spreading fast in all regions, probably because it has an additional mutation in the spike protein to the BA.2.86 variant from which it descended.”It is anticipated that this variant may cause an increase in Sars-Cov-2 [coronavirus] cases amid a surge of infections of other viral and bacterial infections, especially in countries entering the winter season,” the WHO’s risk assessment says.Evidence on how capable JN.1 is of defeating the immunity offered by vaccines is limited, the WHO says.There are no reports of people becoming more ill with this variant than previous ones.But more studies are needed, the WHO says, as the number of countries reporting data on people admitted to hospital with Covid has dramatically reduced.To prevent infections and severe disease, the WHO advises:wear a mask in crowded, enclosed areascover up coughs and sneezesclean your hands regularly stay up to date with Covid and flu vaccinations, especially if vulnerablestay home if ill get tested if you have symptomsMore on this storyWhy Covid is still flooring some peoplePublished3 days agoNobel Prize winners: ‘I thought it was an anti-vaxxer prank’Published2 OctoberCovid boosters for over-65s as hospital cases risePublished18 SeptemberAround the BBCUK Covid public inquiry – BBC Sounds, Radio 4Related Internet LinksTracking SARS-CoV-2 variants- World Health OrganizationThe BBC is not responsible for the content of external sites.

A longtime moderate, the Democratic congressman now says he had been “convinced through propaganda” that calls for universal health care were “a nonsensical leftist notion.”As he mounts a long-shot primary challenge to President Biden, Representative Dean Phillips says he has had an epiphany about American health care policy.Gone is his yearslong skepticism about adopting a national single-payer health care system. Now Mr. Phillips, a moderate Democrat from Minnesota, is embracing the “Medicare for all” proposal championed in two presidential campaigns by Senator Bernie Sanders — whose former top aide is now advising Mr. Phillips’s campaign.Mr. Phillips said in an interview on Tuesday that he would join as a co-sponsor to a House proposal that would expand Medicare by creating a national health insurance program available to all Americans, a shift that comes seven weeks into a presidential campaign that has yet to show significant progress in public polling.“I was a good example of someone who had been convinced through propaganda that it was a nonsensical leftist notion,” Mr. Phillips said. “It’s not. It really isn’t. And that’s I think that’s part of my migration, if you will, a migration of understanding and due diligence and intellectual curiosity and most importantly, listening to people.”Embracing the House bill is a low-stakes maneuver. With Republicans in control of the chamber, there is little chance it will come to a vote. Even when Representative Nancy Pelosi of California was speaker, Democrats never held a vote on proposals for Medicare for all that were championed by their progressive caucus — largely because President Biden didn’t support such a move, and centrist Democrats believed it was a bridge too far.Mr. Phillips — who spoke in the interview by videoconference, from an onscreen profile identifying him as “Generic Democrat” in a sly nod to the party’s best performer in polls — argued that his recent evolution on health care was not an effort to outflank Mr. Biden from the left.Instead, he said, he has become convinced that expanding Medicare, the government-run insurance program for older people, to cover all Americans would end up saving the federal government money and should attract support not just from progressives but also from conservatives — including backers of former President Donald J. Trump.“This is not a Hail Mary, by any stretch,” Mr. Phillips said. “It’s not an olive branch to progressives. You know what it really is? It’s an invitation to Trumpers.”Mr. Biden’s campaign spokesman, Kevin Munoz, declined to comment about Mr. Phillips.Mr. Phillips, a businessman who grew wealthy helping to run his family’s liquor distilling empire and later helped build a gelato behemoth, is a former board chairman of Allina Health, one of Minnesota’s largest health care systems. He said his beliefs began to change about 10 years ago, when his daughter Pia, then 13, received a diagnosis of Hodgkin’s lymphoma, and he saw “the gaps between the haves and the have-nots.”In July 2020, as a first-term congressman, he embraced a “state public option” that would allow Americans to buy into Medicaid. More recently, he said, he has been consulting with Representative Pramila Jayapal of Washington, the chair of the Congressional Progressive Caucus, who is a lead sponsor of the House Medicare for all bill, backed by more than half of House Democrats.Mr. Biden has moved the Democratic conversation about health care away from the idea of a single-payer plan, focusing instead on narrower issues like lowering drug costs and improving maternal health.“This is not a serious proposal in today’s environment,” Leslie Dach, the chair of the health advocacy group Protect Our Care and a former Obama administration official, said of Mr. Phillips’s switch. “We’re living in an era where it takes all of our energy to protect what we have from Republicans in Congress.” Mr. Phillips has not gained much traction. A poll last month from CNN and the University of New Hampshire found that he had support from about 10 percent of likely Democratic primary voters in New Hampshire, the only state where he has a campaign apparatus. Mr. Biden’s name will not be on the ballot there, but the same CNN poll found that 65 percent of voters said they would write in his name.Mr. Phillips said he hoped to do well in New Hampshire before moving on to Michigan, where Mr. Biden’s approval ratings in recent polls have taken a hit from Black and Arab American voters who disapprove of his support for Israel in its war against Hamas.But Mr. Phillips offered little in the way of daylight between himself and Mr. Biden on that conflict, which has left Democratic voters fiercely divided. The congressman said that he would not call for an immediate cease-fire and that he did not consider Israel “an apartheid state,” as many on the left argue.Yet Mr. Phillips contended that Democrats were so disenchanted with Mr. Biden that when presented with another option, they would take it. “The good news is that 66 percent of the country does not yet hate me,” Mr. Phillips said, in a dig at the president’s dismal approval ratings. “America has already made up its mind about President Biden and Vice President Harris.”

The gunshots rang out at 8:13 a.m., echoing across the high school football field and middle school garden. They continued for 49 minutes without interruption: an AR-15-style rifle, with .223-caliber bullets, ripping at 94 decibels through a community that did not even pause to wonder if a disaster was unfolding at the schools.Listen to This ArticleOpen this article in the New York Times Audio app on iOS.It was just a typical morning in Cranston, R.I., where more than 2,000 children attend school within 500 yards of a police shooting range. There, local police officers sharpen their gun skills, sometimes until 8:30 at night.Some days they shoot Glock pistols, like the weapons used in the mass shootings at Virginia Tech, the Charleston church and Thousand Oaks, Calif. Other days, they use AR-15-style semiautomatic rifles, similar to the ones used in the killings in Newtown, Conn.; Las Vegas; Parkland, Fla.; Buffalo and Uvalde, Texas.Many parents have tried in vain to have the range moved to a more remote area or enclosed to block out the upsetting sounds. They have written letters in support of a bill in the state legislature that would prohibit outdoor shooting ranges within a mile of schools. But the police opposed the legislation, and the bill is now being “held for further study.”“This facility is necessary to train and qualify all department members with the weapons they carry to fulfill the mission of protecting the public,” said Col. Michael Winquist, the chief of police.Sherry IzziExcessive noise — even generally — is disruptive to the health and well-being of children, research shows, and medical experts say the sound of gunfire, which could elicit a fight-or-flight response, may be even worse.But while many students say they recall being deeply disturbed by the gunfire at first — freezing, diving under desks — they now exhibit what public health experts say could be a potentially more dangerous reaction: desensitization.“I remember thinking, ‘We shouldn’t be getting used to this,’” said Valentina Pasquariello, who graduated in June. “But it was at the point where you have to get used to it — you don’t have a choice.”Sara Johnson, a professor of pediatrics at Johns Hopkins University School of Medicine, who has studied how firearms and other chronic stressors affect child development, said the students are “doing mental gymnastics to feel safe in that type of environment, and make peace with it.” Though the situation in Cranston is unique, Dr. Johnson and others said it is reflective of a country where the threat of gun violence has encroached upon the everyday lives of schoolchildren.“Whether or not you go to school across from a gun range,” Dr. Johnson said, “you’re being asked to accommodate the challenges of growing up in an environment that has guns baked in.”Morning: Psychology ClassCarmen Carline, whose two daughters, ages 17 and 10, attend Cranston, R.I., schools near the shooting range.Maansi Srivastava/The New York TimesMaranda Carline, 17. “Nobody has that healthy kind of fear that drives you to find safety — that’s what I’m afraid of,” said her mother, Carmen.Maansi Srivastava/The New York TimesOne morning last month, the first blasts of the day came as Maranda Carline, 17, a high school junior, was in first-period psychology class, snacking on Skittles and learning about how childhood trauma can affect a person’s long-term development. The sound of 50 rounds barraged Miranda again as she walked outside to her next class at 9:01 a.m.; another 50 came at 10:56 a.m., as she rushed to finish an essay on prohibition for her history midterm.Maranda has long memorized the steps from active shooter training, as rote as solving an algebra equation: Barricade the door. Hide in the corner. If necessary, wield scissors and throw trash bins, or chairs, or whatever else you can find.But her mother, Carmen Carline, was not confident Maranda would follow these steps in a real-life situation, for the simple reason that she wouldn’t know it was real. “When a gunman shows up at my kid’s school, and they hear the bullets, and nobody even looks up — nobody has that healthy kind of fear that drives you to find safety — that’s what I’m afraid of,” she said, breaking down in tears.Asked whether she found the gunfire distracting, Miranda paused, then said: “It’s kind of reassuring, I guess, because it means that there are police close by,”Her mother interjected: “That’s how they sell it to the kids.”Midday: Lunch BlockSherry IzziBetween the blasts that day, Cranston, a city of about 80,000, embodied the euphony of a New England autumn: leaves tumbling across driveways, basketballs drumming the pavement of cul-de-sacs; engines humming in a Dunkin’ drive-through line. Decades ago, residents said, the gunfire from the range was sporadic and quieter, like popcorn popping in the distance, as local officers learned to use handguns. But police departments grew, and so did the number of federal agencies and other groups using the range. So, too, did the types of weapons — and with them, the noise.During the Covid pandemic, adults who had commuted to jobs stayed home all day and could not believe what they heard. By 2021, the range became a source of tension. A petition for “peace and quiet” circulated.In September 2022, residents went to the City Council with stories: the new art teacher crouching down and calling for a lockdown; visiting athletes at a track invitational “hitting the turf”; one resident stepping on a spent 9-millimeter casing in front of the high school.A homework assignment for Camryn Carline, Maranda’s younger sister.Maansi Srivastava/The New York TimesWestern Hills Middle School, which is across the street from the Cranston Police Academy and its gun range.Maansi Srivastava/The New York TimesOne council member, Jessica Marino, said tradition should take precedence: “I do believe the range is in the right location, because it has been there for a long time,” she said.Another council member at the time, Matthew Reilly, an alum of the middle and high schools, said: “It was never a traumatic situation. Me and my friends, and I can only speak from personal experience, it never really affected us.”The police department’s training academy applied for $1.6 million through the American Rescue Plan to enclose the range, but the grant was denied.The department said it reduced the number of outside groups using the range — ending agreements with the airport police and federal agencies like the F.B.I. — and had replaced sound-absorbing panels and added berms and shrubbery to dampen the noise.“These are our last efforts,” the department’s second-in-command, Maj. Todd Patalano, wrote to the mayor and the chief of police in a February 2023 email obtained by The Times. “At this point, we will not be making any further accommodations.”Afternoon: Football PracticeAntonella Pasquariello. “You start to wonder if you’re the crazy one for worrying,” she said.Maansi Srivastava/The New York TimesMeshanticut State Park, where Ms. Pasquariello strolls around a lake and onto school grounds, just to scan the premises for her peace of mind.Maansi Srivastava/The New York TimesFor Antonella Pasquariello, a mother of three, one memory of school pickup time plays like a slow-motion movie in her head: She pulled up in her car, rolled down her window and watched as “cute little kids are strolling out of the school, not flinching, as the sound of artillery whacked up against the building.”She glanced at the bus lines and tennis courts to “make sure bodies weren’t falling.”Haunted by the experience, she wrote to the superintendent asking why the shooting couldn’t be banned during school hours. She was referred to the mayor, who replied that it would “take time and financing.”Ms. Pasquariello was leashing her goldendoodle, Cleo, for a walk when shooting resumed at 12:03 p.m. She listened for sirens: No sirens, no school shooting, she said. They cracked again at 2:47 p.m., as the junior varsity Falcons took to the football field for practice, and then at 3:21 p.m., as elementary school children climbed off their buses.When Ms. Pasquariello’s youngest son, August, got home from school, she asked him about the gunshots. He said he didn’t hear any.Evening: Bedtime RoutineJose GiustiAt dusk, Jose Giusti watched his 6-year-old, Gianna, practice cartwheels under a cacophony of bullets.Mr. Giusti works for the city of Providence’s licensing department, which enforces noise ordinances. He and his wife, Alyssa, know that, in research studies, children living in noisy environments have higher blood pressure, increased levels of cortisol, and hyperactivity. So far, Gianna seems OK.At bedtime, Gianna shuffled around in her cheetah pajamas and unicorn earphones. Then her parents put her to sleep with a white noise machine to block out the sound of the gunfire.Audio produced by

Published3 hours agoShareclose panelShare pageCopy linkAbout sharingBy Sonia Kataria & Rob SissonsBBC NewsA junior doctor says he could be forced to quit the profession if an agreement is not found to end a pay dispute.Dr Mohammed Hussain, who works at Leicester Royal Infirmary, is joining colleagues from across the country in three days of strike action.Medics are asking for a 35% pay rise, which the British Medical Association (BMA) says makes “perfect sense”.The government says it is “completely unaffordable” and has urged the BMA to “come back to the negotiating table”.NHS bosses are warning patients of disruption as junior doctors start a 72-hour walkout on Wednesday.Dr Hussain, from Derby, told the BBC medics had put in years of studying and training before sacrificing time with their families to work 60-hour weeks.”It’s frustrating we’ve had to strike in the first place,” he said.Housing ladder struggleThe 28-year-old says the job is satisfying and helping patients through “rough times” is “definitely worth it”.”But in terms of me, personally, I’m really struggling,” he said. “Sometimes I wake up and I don’t want to get out of bed because you don’t know how bad it could be.”In the hospital, it’s hit and miss. It’s long hours and you don’t know what shift you’re heading into. “You don’t know if somebody’s quit, or if somebody’s sick and you have to deal with the rota gap or if you’re going to be working a shift of two doctors instead of your own.”Dr Hussain, who lives at home with his parents with his family, said he was struggling to get on the housing ladder as his take home pay was just over £2,000 a month.”When I started medical school, the quality of life as a doctor would have would been very different,” he said.”Almost seven years since day one, it’s almost unrecognisable as to how a doctor is living.”Image source, PA MediaHe said it was a “daily battle” not to quit the job he describes as “hectic” and return to marketing. “The corporate life wouldn’t be as morally pleasing and I probably wouldn’t be positively helping people as much, but I would have my own house,” he said.”With the poor salary and not being competitive in the international market, a lot of my colleagues are leaving and leaving gaps in the rotas – gaps that never get filled.”Health Secretary Victoria Atkins said: “I want to assure patients that we have taken significant contingency measures to reduce the disruption these strikes will cause.”But we know that despite these measures and the hard work of NHS staff, these strikes can cause significant disruption to patients and add extra pressure on the NHS.”We have consistently acted reasonably, and that approach has led to offers being put to members of the consultant and specialist doctor unions.”My door remains open should the BMA Junior Doctors Committee cancel these disruptive strikes and come back to the negotiating table as we were making good progress.”Follow BBC East Midlands on Facebook, on X, or on Instagram. Send your story ideas to eastmidsnews@bbc.co.uk.More on this storyWhy are doctors demanding the biggest pay rise?Published18 MayEast Midlands junior doctors join national strikePublished13 MarchPhysios speak of pay fears as they embark on strikePublished26 JanuaryRelated Internet LinksBritish Medical AssociationNHSThe BBC is not responsible for the content of external sites.