How bacteria are changing your mood


Gut-Brain illustration

If anything makes us human it’s our minds, thoughts and emotions.

And yet a controversial new concept is emerging that claims gut bacteria are an invisible hand altering our brains.

Science is piecing together how the trillions of microbes that live on and in all of us – our microbiome – affect our physical health.

But even conditions including depression, autism and neurodegenerative disease are now being linked to these tiny creatures.

We’ve known for centuries that how we feel affects our gut – just think what happens before an exam or a job interview – but now it is being seen as a two-way street.

Groups of researchers believe they are on the cusp of a revolution that uses “mood microbes” or “psychobiotics” to improve mental health.

The study that ignited the whole concept took place at Kyushu University in Japan.

The researchers showed that “germ-free” mice – those that never came into contact with microbes – pumped out twice the amount of stress hormone when distressed than normal mice.

The animals were identical except for their microbes. It was a strong hint that the difference was a result of their micro-organisms.

“We all go back to that first paper for the first wave of neuroscientists considering microbes,” says Dr Jane Foster, a neuropsychiatrist at McMaster University in Canada.

“That really was very powerful for those of us who were studying depression and anxiety.”

It was the first hint of microbial medicine in mental health.

How could bacteria be altering the brain?

The brain is the most complex object in the known universe so how could it be reacting to bacteria in the gut?

  • One route is the vagus nerve, it’s an information superhighway connecting the brain and the gut.
  • Bacteria break down fibre in the diet into chemicals called short-chain fatty acids, which can have effects throughout the body.
  • The microbiome influences the immune system, which has also been implicated in brain disorders.
  • There is even emerging evidence that gut bugs could be using tiny strips of genetic code called microRNAs to alter how DNA works in nerve cells.

There is now a rich vein of research linking germ-free mice with changes in behaviour and even the structure of the brain.

But their completely sterile upbringing is nothing like the real world. We’re constantly coming into contact with microbes in our environment, none of us are germ-free.

At Cork University Hospital, Prof Ted Dinan is trying to uncover what happens to the microbiome in his depressed patients.

A good rule of thumb is a healthy microbiome is a diverse microbiome, containing a wide variety of different species living all over our bodies.

Prof Dinan says: “If you compare somebody who is clinically depressed with someone who is healthy, there is a narrowing in the diversity of the microbiota.

“I’m not suggesting it is the sole cause of depression, but I do believe for many individuals it does play a role in the genesis of depression.”

And he argues some lifestyles that weaken our gut bacteria, such as a diet low in fibre, can make us more vulnerable.

The microbiome

  • You’re more microbe than human – if you count all the cells in your body, only 43% are human
  • The rest is our microbiome and includes bacteria, viruses, fungi and single-celled archaea
  • The human genome – the full set of genetic instructions for a human being – is made up of 20,000 instructions called genes
  • But add all the genes in our microbiome together and the figure comes out at between two million and 20 million microbial genes
  • It’s known as the second genome and is linked to diseases including allergy, obesity, inflammatory bowel disease, Parkinson’s, whether cancer drugs work and even depression and autism

More than half your body is not human

Gut Instinct: Why I put my poo in the post

Does vaginal seeding boost health?

Why a faecal transplant could save your life

It’s an intriguing concept – that an imbalance in the gut microbiome could be involved in depression.

So scientists at the APC Microbiome centre, at University College Cork, started transplanting the microbiome from depressed patients to animals. It’s known in the biz as a trans-poo-sion.

It showed that if you transfer the bacteria, you transfer the behaviour too.

Prof John Cryan told the BBC: “We were very surprised that you could, by just taking microbiome samples, reproduce many of the features of a depressed individual in a rat.”

This included anhedonia – the way depression can lead to people losing interest in what they normally find pleasurable.

For the rats, that was sugary water they could not get enough of, yet “when they were given the microbiome from a depressed individual, they no longer cared”, says Prof Cryan.

Listen to The Second Genome on BBC Radio 4.

The next episode airs at 11:00 BST on Tuesday April 24, repeated 21:00 BST Monday April 30 and on the BBC iPlayer

Similar evidence – linking the microbiome, the gut and the brain – is emerging in Parkinson’s disease.

It is clearly a brain disorder. Patients lose control over their muscles as brain cells die and it leads to a characteristic tremor.

But Prof Sarkis Mazmanian, a medical microbiologist from Caltech, is building the case that gut bacteria are involved.

“Classical neuroscientists would find this as heresy to think you can understand events in the brain by researching the gut,” he says.

He has found “very powerful” differences between the microbiomes of people with Parkinson’s and those without the disease.

Studies in animals, genetically hardwired to develop Parkinson’s, show gut bacteria were necessary for the disease to emerge.

And when stool was transplanted from Parkinson’s patients to those mice, they developed “much worse” symptoms than using faeces sourced from a healthy individual.

Prof Mazmanian told the BBC: “The changes in the microbiome appear to be driving the motor symptoms, appear to be causal to the motor symptoms.

“We’re very excited about this because it allows us to target the microbiome as an avenue for new therapies.”

The evidence linking the microbiome and the brain is as fascinating as it is early.

But the pioneers of this field see an exciting prospect on the horizon – a whole new way of influencing our health and wellbeing.

If microbes do influence our brains then maybe we can change our microbes for the better.

Can altering the bacteria in Parkinson’s patients’ guts change the course of their disease?

There is talk of psychiatrists prescribing mood microbes or psychobiotics – effectively a probiotic cocktail of healthy bacteria – to boost our mental health.

Dr Kirsten Tillisch, at University of California, Los Angeles, told me: “If we change the bacteria can we change the way we respond?

But she says we need far bigger studies that really probe what species, and even sub-species, of bacteria may be exerting an effect on the brain and what products they are making in the gut.

Dr Tillisch said: “There’s clearly connections here, I think our enthusiasm and our excitement is there because we haven’t had great treatments.

“It’s very exciting to think there’s a whole new pathway that we can study and we can look and we can help people, maybe even prevent disease.”

And that’s the powerful idea here.

The microbiome – our second genome – is opening up an entirely new way of doing medicine and its role is being investigated in nearly every disease you can imagine including allergies, cancer and obesity.

I’ve been struck by how malleable the second genome is and how that is in such start contrast to our own DNA.

The food we eat, the pets we have, the drugs we take, how we’re born… all alter our microbial inhabitants.

And if we’re doing that unwittingly, imagine the potential of being able to change our microbiome for the better.

Prof Cryan said: “I predict in the next five years when you go to your doctor for your cholesterol testing etc, you’ll also get your microbiome assessed.

“The microbiome is the fundamental future of personalised medicine.”

Follow James on Twitter.

Illustrations: Katie Horwich

Welsh language row over Anglesey school closures plan


A child writingImage copyright
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Image caption

The council has said it wants schools of the correct size and in the correct locations led by inspiring head teachers

Proposals to close rural schools are being rushed through before new rules come into force that will give them more protection, a Welsh language group has claimed.

The closures of Ysgol Corn Hir, Ysgol Bodffordd and Ysgol Henblas in the Llangefni area are being considered by Anglesey council’s scrutiny committee.

Cymdeithas yr Iaith said the council’s plans were based on “tired” arguments.

The council said it wanted high standards and denied it was in a hurry.

A report being considered by the committee on Monday highlights the cost per pupil and a backlog of maintenance at all three schools.

It also references lower than expected standards at Ysgol Henblas and Ysgol Bodffordd.

The report recommends either building a new school to replace all three or building a school to replace Ysgol Bodffordd and Ysgol Corn Hir and maintaining Ysgol Henblas either in its current form or as a multi-site school.

  • ‘Quiet crisis’ over school funding warning from heads
  • Smaller class size fund pays for 80 new teachers

The committee will consider the options and make a recommendation on the future of the schools.

However, the Welsh language group pointed to changes to the School Organisation Code that will mean rural schools will be officially designated and listed, making closures the last resort.

Authorities will have to assess the likely impact of a school’s closure on children’s education, the wider community and travel arrangements, and explain why closure is the “most appropriate” course of action.

A consultation closed in September 2017 and plans are currently being reviewed.

Referring to this, Cymdeithas yr Iaith made an appeal to Education Secretary Kirsty Williams.

It said: “We wish to draw your attention to the fact that education officers in Ynys Môn (Anglesey) are attempting to rush through a proposal to close the schools at Bodffordd and Henblas… before your new code comes into force.

“They are using the same tired old generic arguments which would result in the closure of practically every rural school on your list if dogmatically adhered to.”

‘Committed’

In response, an Anglesey council spokesman said: “We are aware of the possible changes to the School Organisation Code and act on the content.

“As part of this, community, language and equality impact assessments will be completed.

“The county council is committed to consulting on plans to ensure the best use of resources provide a sufficient number of places and to promote education of the highest standard in the Llangefni area and indeed in all parts of the island.”

The Welsh Government said: “We are in the process of analysing consultation responses and expect the code to come into force in the autumn.

“In the meantime we expect local authorities to act in the spirit of the proposed changes by ensuring any case for closure is strong and that alternatives to closure are appropriately explored.”

Eat: Build a Beautiful Savory Tart Out of Your Leftovers


Early in the morning, Natasha Pickowicz ducked into the walk-in refrigerator, the one all the way at the end of the dishwashing station in Café Altro Paradiso’s kitchen, and studied the family shelf. As usual, the tidy nook was stacked with plastic containers of odds and ends, leftover prep from the night before, set aside for staff meal. A pint of blanched broccolini stems here, a lump of blue-cheese butter there. But where anyone else might have seen a random muddle of junk, Natasha Pickowicz saw tarts — big, beautiful tarts that would feed the whole kitchen before noon.

She gathered a few pint containers: ham and red-onion scraps, spare confit leeks and yesterday’s mashed potatoes, tatters of provolone and raw cauliflower debris. She reached for fluttery maitakes, a sticky paste of caramelized onions and a handful of cold, slightly sad-looking boiled potatoes with their skins still on. Pickowicz set everything on the counter, just across from a cook smashing raw beef for carpaccio. “It’s really satisfying to find a purpose for all these things,” she said, already seeing how the bits and pieces would come together on cold discs of pie dough.

Pickowicz is a pastry chef, known for desserts like her glamorous fruit crostatas and the pastries she makes at both Altro Paradiso and Flora Bar in New York. She started baking savory tarts at an old job when there was an excess of squash one summer, and now she builds a few out of whatever’s on hand each morning, working quickly among the tasks on her to-do list so that she can set out a late breakfast for herself and the cooks. Her approach is spontaneous but deliberate, which is to say, the scraps are random, but there’s nothing random about the way that Pickowicz composes them. “I’m always thinking critically about how they’ll cook,” she said. “I’m thinking about creating layers, so when you bite into it, you’re transitioning from tender dough through body and structure.” I wasn’t sure exactly what she meant, until I watched her make four tarts.

For one, she layered mashed potatoes and cauliflower over dabs of caramelized onion. After it came out of the oven and cooled, she covered it in parsley leaves and lemon zest and draped over those thin, soft pieces of ham. She arranged the leeks over smudged mascarpone and lemon zest, keeping it simple. For the third, she broke the potatoes apart with her hands, creating rough, jagged edges that would go golden as they roasted on the pastry — which she coated first with smears of ricotta and an oily condiment of preserved lemon. The maitakes, after they were roasted with red-onion pieces and caramelized onion for the very last tart, would be covered with crisp, dressed leaves of pink radicchio del Veneto.

Photo


Credit
Gentl and Hyers for The New York Times. Food stylist: Michelle Gatton. Prop stylist: Amy Wilson.

Repurposing leftovers, making something entirely whole and new from fragments, isn’t only about economy and efficiency in the kitchen. There’s joy in limiting yourself to what you already have, in finding a use for every scrap and stretching a little into a lot. At home, I made Pickowicz’s pastry dough, with its giant flecks of butter, using as little ice water as possible to bring the crumbs together, and tucking some extra dough into the freezer for another day’s tart. It was only technically spring in New York, so I didn’t have much to work with. Some ricotta, some small boiled potatoes and a single shallot. I asked myself, what would Natasha do?

I smeared ricotta all over the cold dough, grated lemon zest over the top and cracked a little bit of black pepper. Then I broke the potatoes up into big pieces with my hands, mixed in the sliced shallot and dressed it all with olive oil and salt. That went on top of the ricotta. I filled a few gaps with torn up provolone, using the last few slices in the fridge. And when the tart came out of the oven, when it had cooled down to room temperature, I seasoned it again and covered it in dressed radicchio leaves, which wouldn’t have been quite enough to make a meal on their own. It was a delicious and inexact emulation, a spontaneous salad tart, and somehow it was big enough to feed six.

Recipe: Potato-and-Radicchio Tart | Tart Crust

Continue reading the main story

The Healing Edge: ‘Whole Again’: A Vet Maimed by an I.E.D. Receives a Transplanted Penis


“That injury, I felt like it banished me from a relationship,” he said in an interview last week. “Like, that’s it, you’re done, you’re by yourself for the rest of your life. I struggled with even viewing myself as a man for a long time.”

But now, four weeks after the surgery, he said, “I feel whole again.”

He asked that his name not be published, because of the stigma associated with genital injuries. Except for his immediate family and a few close friends, he has told no one about the nature of his wounds, he said.

Dr. W.P. Andrew Lee, the chairman of plastic and reconstructive surgery at Johns Hopkins, said the goal of this type of transplant is “to restore a person’s sense of identity and manhood.”

Photo

The patient chose not to be identified because of the stigma associated with genital injury.

Credit
Andrew Mangum for The New York Times

For most men, that means regaining the ability to urinate while standing up and to have sex. Dr. Lee thinks transplantation can make both possible, though healing and nerve regeneration will take time. Urination is expected first, within a few months. Nerves grow from the recipient into the transplant at the rate of about an inch a month.

“We’re hopeful we can restore sexual function in terms of spontaneous erection and orgasm,” Dr. Lee said.

Although the scrotum was transplanted, the donor’s testes had been removed for ethical reasons: Keeping them might enable the recipient to father children that belonged genetically to the organ donor, something not considered acceptable by medical guidelines.

Because the recipient’s own reproductive tissue was destroyed, he will not be able to have biological children. He takes testosterone to compensate for the loss of his testes, and is being treated with another drug, Cialis, to encourage erectile function.

How many men might need this type of transplant is not known. Data from the Defense Department show that more than 1,300 men sustained so-called genitourinary injuries in Iraq and Afghanistan, and that 31 percent of those injuries involved the penis.

About 20 percent of the penile injuries were considered severe — but how many might warrant a transplant is not clear. Women in the military have also suffered genitourinary and reproductive injuries, but they are less common.

Teams at Johns Hopkins and at the Massachusetts General Hospital are both evaluating more candidates for the surgery — some hurt in the military, others affected by accidents or illness. But it can take a long time to find a matching donor — the Johns Hopkins patient waited more than a year on the transplant list — so no rush of operations is expected.

The Department of Defense has funded some of the research, but Johns Hopkins is paying for the first operation, which Dr. Lee estimated would cost from $300,000 to $400,000. The surgeons — nine plastic and reconstructive surgeons, and two urologists — worked for free.

Dr. Lee said he hoped for grants from the Pentagon to help pay for future operations, and also for insurance coverage, which is not available now for this type of transplant.

Photo


Credit
Johns Hopkins Medicine

After the explosion that injured the soldier, he remained conscious, he remembered, but knew he was sinking into shock. He passed out on the medevac helicopter. His next memory was waking up in the United States, relieved to be alive.

Soon, the gravity of the damage hit. A military doctor told him it was permanent and irreparable.

“That was crushing, but when he walked away I thought, he hasn’t been a doctor long enough, he doesn’t know what he’s talking about,” the patient said. “You got all this technology, how can you tell me this is permanent? There’s got to be something.”

He felt isolated, even in the hospital among other wounded soldiers.

“There were times you’d be hanging out and guys would be talking about getting hurt, and that’s one of the first things when they get blown up, to check down there, and they would say things like, ‘If I lost mine I’d just kill myself,’” he said. “And I’m sitting there. They didn’t know, and I know they didn’t mean any offense, but it kind of hits you in the gut.”

He struggled with thoughts of suicide, he said: “When I would actually think about killing myself, I would think, ‘Am I really just gonna kill myself over a penis?’”

He learned to walk with prosthetic legs, left the hospital and lived on his own in an apartment. But he had trouble connecting with other people, and even when he no longer needed OxyContin for physical pain he kept taking it to numb his emotions.

He managed to wean himself off it. He saw a therapist. He earned a college degree and began making plans to attend medical school.

But relationships or even dating felt out of the question. If he got close to someone, he would have to disclose his wounds, and the thought filled him with anxiety.

“It is a lonely injury,” he said.

In 2012, he began consulting Dr. Richard J. Redett, the director of pediatric plastic and reconstructive surgery at Johns Hopkins, about a procedure to create a penis from his own tissue, possibly the skin on the inside of the forearm.

That operation makes urination possible, but requires an implant to achieve an erection. The procedure was appealing, but Dr. Redett also mentioned a future possibility that seemed much more promising: a transplant.

Photo

Hospitalized since the operation a month ago, the patient may be ready to go home in the next week or so.

Credit
Andrew Mangum for The New York Times

“Basically, if you do a transplant, you’re going to have the real thing again,” the patient said.

He decided to wait.

He passed an exhaustive screening process. Certain nerves and blood vessels have to be intact, along with the urethra, the tube that carries urine out of the body.

Candidates also have to qualify psychologically — to be able to understand the risks and benefits and stick to their anti-rejection medicine, as well as have a family or other support network.

Families of organ donors are asked specifically for permission to use the penis, and past requests have been made for research purposes. Carisa M. Cooney, a clinical research manager in plastic and reconstructive surgery at Johns Hopkins, said that when families hear that the goal is to help wounded veterans, many consent.

In this case, the donor’s family sent the soldier a message via New England Donor Services: “We are all very proud that our loved one was able to help a young man that served this country. We are so thankful to say that our loved one would be proud and honored to know he provided such a special gift to you. As a family, we are very supportive of all the men and women who serve our country and grateful for the job you did for this nation. Please know that this is truly a heartfelt statement, as we have several veterans in the family. We hope you can return to better health very soon and we continue to wish you a speedy recovery.”

The donor was from another state, and three surgeons from Johns Hopkins — Dr. Redett, Dr. Damon Cooney and Dr. Gerald Brandacher — flew there by private jet to operate on him, an exacting procedure to remove precisely the tissue that would be needed.

They had to coordinate with teams from other institutions who were collecting other organs, and at times there were 25 people in the operating room, Dr. Brandacher said. Part of his role was to remove nine vertebrae from the donor, to provide stem cells that the Johns Hopkins team would infuse into the recipient to help prevent rejection and minimize the amount of anti-rejection medicine needed.

The patient said that before the surgery, he wondered if he would accept the new body parts, mentally and emotionally.

“What tripped me out at first is sometimes I would get a thought like, ‘Am I going to be able to see it as my own?’” he said. “That thought would creep in. But once I had it done, that’s the only way I see it. It’s mine.”

Looking ahead, he sketched out his hopes.

“Definitely, to do well in school, to go to medical school and follow my career as a doctor, find my niche in the field and just excel at it. Maybe settle down and maybe eventually find someone, and get into a relationship, maybe. Just that normal stuff.”

Continue reading the main story

Spotify tests filter to block swearing in songs


DrakeImage copyright
PA

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Drake is among the artists whose explicit songs are riding high in the Spotify charts

Spotify, the UK’s biggest music streaming service, has started testing a way of filtering out songs which have explicit lyrics.

The feature has been introduced on its iPhone and iPad apps – six years after being requested on its online forums.

But some users have told BBC Radio 5 live: that the feature does not have enough controls.

Rivals such as Apple Music already have password-protected parental controls to skip explicit tracks.

‘Awkward moments’

Since 2011, streaming music providers have been expected to display the word “explicit” next to tracks that record companies believe are unsuitable for children.

Currently more than a third of the Top 50 songs in Spotify’s UK chart contain explicit lyrics.

Mother Nicola Ford set up an online petition calling for the filter after she was caught out listening at home.

She said: “I’d had quite a few awkward moments, where the kids had been listening to songs on the radio, and suddenly our home filled [with swear words] when they played the same songs on Spotify.

“I set up a petition online and found that lots of people were petitioning for the same thing, so I got a lot of interest.”

Image copyright
Getty Images

Image caption

Daniel Ek co-founded Swedish streaming company Spotify in 2006

The new setting, which was first introduced at the start of April, greys out explicit songs and prevents them from playing, but it doesn’t replace them with clean versions.

Nicola says this does not go far enough.

“The kids want to listen to the song that they’ve heard, so they will try and sneak the song in.

“If they are going to try to listen to the song, I’d like them to get the clean versions.”

‘Beta version’

Others have complained that the setting. which is only available to Premium users, does not have a Pin code and can be changed by anyone with access to the device.

“It would be useful for the account holder, the parent, to control the setting,” says Nicola.

“All these companies need to try really hard to help us manage what goes on in our homes, Spotify included. I think they could have shown interest a lot earlier.”

Spotify describes the explicit content filter as a “beta version” and says it is currently being tested for “some users”.

In a statement it said: “We are always testing new products and experiences at Spotify, but have no further news to share on a product launch at this time.”

London Marathon: MasterChef semi-finalist Matt Campbell dies


Matt CampbellImage copyright
Twitter

Image caption

Matt Campbell on the right was running his second marathon in two weeks

A MasterChef semi-finalist has died after collapsing during the London Marathon, it has been confirmed.

Matt Campbell, 29, collapsed at the 22.5 mile mark and died later in hospital.

He appeared on the BBC’s MasterChef: The Professionals in December 2017, and had been running the race – the hottest on record – for his father who died 18 months ago.

His social media posts said that it was his second marathon in a fortnight.

The Kendal chef was running the race for The Brathay Trust in honour of his father Martin.

Donations to his sponsorship fund have risen to more than £53,000 – far exceeding his original target of £2,500.

Read more on this and other Cumbria stories

On 8 April Mr Campbell completed the ASICS Greater Manchester Marathon.

Helen Hokin, who was Mr Campbell’s PR consultant, said: “He was a lovely, kind-hearted and down-to-earth man. I believe he was poised to become the next great innovator in British food.

“He was in the middle of a roadshow tour and he had such a way with inspiring young chefs. This is so sad.”

Mr Campbell began his career working in Michelin-starred restaurants after finishing second in the BBC’s Young Chef of the Year aged 20 in 2009.

According to his website he left the UK for the French Alps and worked in private villas and “award-winning luxury” ski chalets.

He returned to the UK, last year and entered MasterChef: The Professionals where he reached the semi-finals.

Image copyright
Masterchef

Image caption

Matt Campbell was a semi-finalist on BBC’s MasterChef: the Professionals in 2017

A spokeswoman for MasterChef said: “We are shocked and saddened to hear the news about Matt Campbell, one of our talented contestants from last year.

“It was a privilege to have him on the show. He will always be remembered for producing some of the most innovative and groundbreaking food that we saw on the series.

“From the whole MasterChef team, our sincere condolences and thoughts are with his family and friends.”

Michelin-starred chef, and MasterChef: The Professionals judge Marcus Wareing, has also paid tribute:

According to his Justgiving page, he only completed his first ever marathon with his late father Martin and brother Josh in 2016.

Speaking of his father he said: “The past year and a half have been the toughest of my life but his spirit and energy live on in me.

“He was the most inspirational man in my life and was the one who said: ‘go on, why don’t you give it a go? I know you can do it’ and entered me into my first marathon.”

Food journalist Jay Rayner has tweeted his condolences:

Godfrey Owen, chief executive of the Brathay Trust paid tribute to Mr Campbell.

“He was a real creative chef and one of the things he was very keen on doing was sharing that knowledge with young chefs who wanted to get involved in the industry.

“He was such a great athlete and also a wonderful supporter of Brathay.”

How the new royal baby has already followed George, Charlotte's footsteps


When Prince William and Princess Kate’s newborn made his debut outside a London hospital, he did so in a shawl steeped in royal history.

The baby, whose name has not yet been announced, was swaddled in a shawl made by G.H. Hurt & Son, a Nottingham, England-based maker of lace knitwear that was founded in 1912.

PHOTO: Prince William and Catherine Duchess of Cambridge leave the hospital with their newborn baby boy at the Lindo Wing, St Marys Hospital, London, April 23, 2018.Tim Rooke/REX via Shutterstock
Prince William and Catherine Duchess of Cambridge leave the hospital with their newborn baby boy at the Lindo Wing, St Mary’s Hospital, London, April 23, 2018.

The company has a “long-standing connection with The Royal Family,” Kensington Palace said in a statement.

The newborn’s father, Prince William, and siblings, Prince George, 4, and Princess Charlotte, who turns 3 next week, all had shawls made by G.H. Hurt & Son when they were babies, according to Kensington Palace.

PHOTO: Prince William and Catherine Duchess of Cambridge leave the hospital with their newborn baby boy at the Lindo Wing, St Marys Hospital, London, April 23, 2018.Hannah Mckay/Reuters
Prince William and Catherine Duchess of Cambridge leave the hospital with their newborn baby boy at the Lindo Wing, St Mary’s Hospital, London, April 23, 2018.

The style of shawl seen on William and Kate’s third child was not revealed by Kensington Palace.

PHOTO: Prince William and Catherine Duchess of Cambridge leave the hospital with their newborn baby boy at the Lindo Wing, St Marys Hospital, London, April 23, 2018.John Stillwell/AP
Prince William and Catherine Duchess of Cambridge leave the hospital with their newborn baby boy at the Lindo Wing, St Mary’s Hospital, London, April 23, 2018.

The company has a collection of around one dozen baby shawls on its website, ranging in price from $50 to as much as $170.

George wore a shawl by G.H. Hurt & Son when he made his debut outside St. Mary’s Hospital after his birth in July 2013.

PHOTO:Prince William, Duke of Cambridge and Catherine, Duchess of Cambridge, depart The Lindo Wing with their newborn son, Prince George, at St Marys Hospital on July 23, 2013 in London.Oli Scarff/Getty Images
PHOTO:Prince William, Duke of Cambridge and Catherine, Duchess of Cambridge, depart The Lindo Wing with their newborn son, Prince George, at St Mary’s Hospital on July 23, 2013 in London.

The company said in a statement at the time that George wore its Super-fine Merino Wool Christening Shawl, which retails now for around $75.

Charlotte was also wrapped in a shawl made by the company when she left St. Mary’s Hospital with William and Kate in May 2015.

PHOTO: Catherine, Duchess of Cambridge and Prince William, Duke of Cambridge depart the Lindo Wing with their newborn daughter, Princess Charlotte, at St Marys Hospital on May 2, 2015 in London.Chris Jackson/Getty Images
Catherine, Duchess of Cambridge and Prince William, Duke of Cambridge depart the Lindo Wing with their newborn daughter, Princess Charlotte, at St Mary’s Hospital on May 2, 2015 in London.

The princess wore a G.H. Hurt & Son Elegant Soft Wool Baby Shawl, which now retails for around $100, according to the company.

VIDEO: Princess Kate delivers a boy: What to expect nextPlay
Princess Kate delivers a boy: What to expect next

10 dead after van hits pedestrians, driver in custody: Police


Ten people were killed and 15 others injured after a white van rammed pedestrians in Toronto today, police said.

The driver is under arrest, Toronto police told ABC News. The suspect was identified as Alek Minassian, 25, sources told ABC News.

The attack started at Yonge Street and Finch Avenue, police said. The suspect drove south for nearly 1 1/2 miles, hitting more people at Yonge Street and Sheppard Avenue. The van finally stopped on Poyntz Avenue, just off Yonge Street.

Witness Ali Shaker saw the Ryder van jump the sidewalk and said people walking were “crumbled up,” he told CTV News.

“He’s just hitting people one by one, going down,” Shaker said. “It was a nightmare.”

Another witness Phil Zullo told CTV News he saw “shoes and hats flown everywhere.”

PHOTO: According to eyewitnesses, a white van hit pedestrians in Toronto, Canada, April 23, 2018, CTV reported.CTV
According to eyewitnesses, a white van hit pedestrians in Toronto, Canada, April 23, 2018, CTV reported.

Visibly frightened by what he saw, Shaker could barely recount the horror he witnessed. He said he was driving when the incident occurred.

“I’m so shaky — I can’t believe this is happening,” he said. “This is so unbelievable.”

Shaker said that he assumed at first that the driver was experiencing some kind of medical emergency and even attempted to try to stop the driver from causing more carnage.

“I thought he had a heart attack or something so I was trying to chase him on the way, almost trying to catch up,” he told CTV News, adding that the driver was moving fast.

“He hit every everybody on the sidewalk; anybody in his way he would hit,” Shaker added. “The bus stop — all shattered. There was a lady in there I saw and I stopped and I looked and I went after and all I see is just crumbling one by one.”

Another witness said he stopped outside of a building for a smoke break and saw a middle-aged man get struck as he was crossing the street.

“As I lit up my cigarette I saw a man walking in the middle of the intersection and a van plowed right into him,” the witness, who went by Steve, told CTV News. “I saw the guy go flying. … It was just clear as day, just saw the guy get hit by the van and pieces of the van fell off.”

A van with a damaged front-end sits idle on a sidewalk after the driver drove down a sidewalk crashing into a number of pedestrians in Toronto, Monday, April 23, 2018. The van apparently jumped a curb Monday in a busy intersection in Toronto and struThe Associated Press
A van with a damaged front-end sits idle on a sidewalk after the driver drove down a sidewalk crashing into a number of pedestrians in Toronto, Monday, April 23, 2018. The van apparently jumped a curb Monday in a busy intersection in Toronto and stru

Afterward, Steve said he rushed into the middle of the street to tend to the injured man “to make sure no other cars struck him.”

The victim, he said, was around 50, was unconscious “and could barely move.”

Steve added that the van kept driving and hit others, leaving behind pools of blood.

“I saw three or four [people] on the ground around me,” he said. “Other people were getting CPR.”

He’s convinced that stopping for the cigarette break saved him, Steve said.

“I had just stopped to light the cigarette and if I hadn’t done that I would have been killed as well,” he said. “I would have been right there with that guy.”

Sunnybrook Health Sciences Centre said it had received seven patients from the scene.

PHOTO: Police arrive on the scene where a white van struck pedestrians, April 23, 2018, in Toronto, Canada.CTV via AP
Police arrive on the scene where a white van struck pedestrians, April 23, 2018, in Toronto, Canada.

Images from the scene show multiple people on the ground.

Video showed the moment police confronted the suspect. In the video, a police officer draws his firearm and faces off against the suspect, who appears to be pointing an object.

Canadian Prime Minister Justin Trudeau said that while he’s “just learning about the situation in Toronto, our hearts go out to any affected. We’re going to obviously have more to learn and more to say in the coming hours.”

Toronto’s Mayor John Tory his “thoughts are with those affected by this incident.”

He appeared before reporters this afternoon to announce the death toll and said the beautiful weather meant multiple people were out on the street.

“There were a lot of pedestrians out … enjoying the sunny afternoon,” the mayor said.

ABC News
PHOTO: Toronto Van Attack

Ralph Goodale, the country’s minister of public safety and emergency preparedness, called the incident an attack but said he didn’t want to speculate when asked if the terrorism was to blame.

“We cannot come to any firm conclusions at this stage,” he said.

Secretary of Homeland Security Kirstjen Nielsen is in Toronto as part of the G-7 Security Ministerial, which is set to conclude on Tuesday. A senior State Department official told ABC News that the U.S. delegation is safe.

PHOTO: A tarp lays on top of a body on Yonge St. at Finch Ave. after a van plowed into pedestrians, April 23, 2018, in Toronto, Canada.Cole Burston/Getty Images
A tarp lays on top of a body on Yonge St. at Finch Ave. after a van plowed into pedestrians, April 23, 2018, in Toronto, Canada.

The White House released its first comment on the attack late Monday night, saying, “The United States stands with the Canadian people in the aftermath of today’s tragic event in Toronto, where a van drove into a crowd of people killing several and injuring many more.”

“Our thoughts and prayers go out to the families of those affected, and we wish a full recovery to those injured,” the statement reads. “The United States Government pledges to provide any support Canada may need.”

Ryder, the brand of rental truck involved in the incident, said in a statement it was saddened by “this tragic event” and extended its “deepest sympathies” to those impacted.

The company also stated that it is “cooperating fully with authorities.”

ABC News’ Pierre Thomas, Malka Abramoff and M.L. Nestel contributed to this report.

Fiction: When the Aftermath of a Shooting Is as Devastating as the Crime


Juska, the author of several other novels, including “The Blessings” (2014), neatly lays the groundwork for a character who would be liable to miss flagrant warning signs. When Maggie’s husband of 17 years left her for another woman, he accused Maggie of having been blind to his misery. Her teenage daughter, Anna, has a history of anxiety and disordered eating, and in the book’s sections told from Anna’s point of view, we learn that Maggie is only dimly aware of her daughter’s continued struggles. Yet as the story moves through its many layers, Maggie’s initial response to Nathan becomes problematic in a different way. As she tells her students, “Remember, fact and truth are two different things.” Nathan’s essay is disturbing — especially in hindsight — but where do you draw the line? Nearly all personal writing betrays an element of sadness, shyness or emptiness. And when living behind screens becomes the norm, aren’t even the most successful and well adjusted among us a little bit awkward and isolated?

In keeping with a novel about a writing instructor, Juska’s prose is clean and straightforward. She strikes a cozy tone that is the literary opposite of toxic masculinity. In the opening pages, we learn that Maggie lives in a home with “high beamed ceilings, the soft pile of logs by the wood stove, the sun-bleached pillows piled in the window seat.” We are also introduced to the loose-shingled red barn that “looks romantic from a distance,” and serves as the repository for Maggie’s students’ old essays. The pace can drag, and no novel needs so many descriptions of the color and cast of the sky. But in our age of political rancor and tweet storms befitting our state of emergency, there is something radical about a take on the gun problem that concerns itself more with raising questions than ire.

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Darkness suffuses “How to Be Safe,” Tom McAllister’s heady and unsettling exploration of America’s gun violence epidemic. A mass shooting hits the Rust Belt town of Seldom Falls, Pa., once a leading producer of elevator parts and now a pocket of the nation where opportunity has dried up and “guns were gifts you got for 13-year-old boys.” The book’s primary narrator is Anna Crawford, who was recently suspended from her job as a teacher at the school for her negative attitude and unstable behavior. When news of the shooting breaks, she is briefly considered a suspect, and neighbors and friends are all too willing to buy into the idea of Anna as villain. “Reports cited anonymous sources talking about everything I’d ever done wrong — shoplifting, taking too many smoke breaks at work, knocking over a neighbor’s mailbox after an argument. An ex shared nude photos of me, because, he said, anyone who could kill kids had lost her right to privacy.” Anna is quickly cleared of the crime, but people still avoid her. Even her online therapist blocks her.

While those surrounding Anna go through the motions of healing, she does not grant herself forgiveness. She is steadfast in her sadness, perhaps the one thing she has claim to. Staggering about town, often half-drunk by midafternoon, she serves as a docent to tragedy and all that follows: the media swarms, the rallies, the memorials, the political infighting, the blip of a presidential visit, the hashtags. In a sadly Delphic feat, McAllister imagines a Friday morning student reflection program called “Never Again.”

Yet this is far more than a ripped-from-the-headlines story. McAllister, the author of the melancholic novel “The Young Widower’s Handbook” (2017), delivers here a portrait of a nation vibrating with failure and humiliation. Anna’s history with abusive men long predates the shooting, which partly explains her willingness to serve as sponge for a fresh cycle of misogynistic vitriol. She contends with jeers and emailed threats, only to empathize with her abusers. One of the book’s greatest successes is its exploration of the overlapping forces and impulses behind our nation’s sexual-harassment and firearms crises. Anna visits a confession booth that has popped up on her town’s main street. “I said I was lazy and unfocused and I understood why I was unlovable, but I still wished it weren’t so. Then I said sometimes at night I think maybe I’m actually the one who did the shooting.”

McAllister is a writer of poetic inclinations, and his prose occasionally trips over itself with Werner Herzog-esque beats meant to impart resonance to a story that doesn’t need it. In a section where Anna’s ex-boyfriend Robbie makes her bacon and eggs, we learn: “Eggs are chickens that haven’t been born yet. You eat them and then inside you they are born and your body is filled with birds.” On the whole, though, the writing sears — and reminds us of literature’s power to fill a void that no amount of inhaling the vapors of Twitter will satisfy. “What I envisioned was this: No memorial at all. No stone. No American flags every three feet. No ribbons. No priests and no Bible. No symbolic floral arrangements to represent vitality or youth or rebirth. No poet reading a poem about rising from the ashes. No obelisks, for God’s sake. Just dig a huge hole and fill it with guns.”

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Books of The Times: Rachel Kushner’s ‘The Mars Room’ Offers Big Ideas in Close Quarters


“The Mars Room” is the follow-up to Kushner’s “The Flamethrowers” (2013), one of this decade’s indelible novels. That novel has a sense of escape, of IMAX Western vistas. Its protagonist, Reno, is a young woman who races a Valera motorcycle on the Bonneville Salt Flats.

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Rachel Kushner

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Chloe Aftel

“The Mars Room,” on the other hand, is all about constriction. Like Alfred Hitchcock in many of his best films, Kushner works here in close quarters. This novel shifts from the strip club to a more claustrophobic venue: a women’s prison in California’s Central Valley where Romy is sent — she gets two consecutive life sentences — after killing a sicko who stalked her.

This novel has many angles, many tempers. We witness Romy’s anarchic, drug-addled, near-orphaned childhood in San Francisco. Kushner offers a great, subversive portrait of that city. This section reads a bit like a left coast retelling of Jim Carroll’s classic about teenage life on Manhattan’s mean streets, “The Basketball Diaries.”

Romy’s San Francisco “was not about rainbow flags or Beat poetry or steep crooked streets but fog and Irish bars and liquor stores all the way to the Great Highway, where a sea of broken glass glittered along the endless parking strip of Ocean Beach.”

Like Reno, Romy knows cars. Before she is sent away she only slightly improbably drives a 1963 Chevrolet Impala, as magnificent a thing as God ever deposited onto four wheels.

Before long, heartbreak is piled upon heartbreak. When she’s imprisoned, Romy is a single mother with a young son named Jackson. Her mother cares for the boy until she dies in a car crash. After that, Romy has no idea what happens to him, nor do we. She’s lost her parental rights; Jackson vanishes into foster care.

Other characters are folded into the mix. Chief among them is Gordon, a stalled young academic who teaches in Romy’s prison. He brings her books; he begins to have feelings for her. Also there’s Doc, an imprisoned cop who went rogue. The scenes of his nasty past life are so pulsing you start to think that Kushner has a hard-boiled, Charles Willeford-type thriller in her.

Kushner’s portrait of life inside the women’s prison is grainy and persuasive. It’s all here: the lice treatments, the smuggling of contraband in rectums and vaginas, the knifings, the cliques, the boredom, the heinous food. About a grim hunk of Thanksgiving Day meat, one inmate comments, “People say it’s emu.”

Kushner smuggles her share of humor into these scenes. Like Denis Johnson in “Jesus’ Son,” a book this novel references, she is on the lookout for bent moments of comic grace.

In one scene, the inmates decide to throw a party and begin to surreptitiously save their meds in order to crush them into a punch. Romy gives this tipple a name: “a short island iced tea.” Another of this novel’s memorable characters, a butch lesbian named Conan, goes on a woozy riff about how cows are righteous because they dress in nothing but leather.

If these prison scenes have a flaw, it’s that Kushner has clearly done so much research that it weighs her down a bit. It’s as if she feels compelled to report everything she’s learned.

“The Mars Room” is a major novel, a sustained performance, one that broods on several exigent ideas. The sense of constriction I mentioned above plays out in many ways. Nearly every character has had radically limited options from birth.

Romy had academic promise as a kid but threw away her chance to go to college. After high school she waits tables in an IHOP. When she goes to Walmart to buy shoes for the job, she can’t help but deliver a profound, class-based riff on the type of shoes sold there, made for dead-end jobs and just a step above the footwear issued in institutions like prison. They’re nearly training shoes, she thinks, for incarceration.

There have always been echoes of laconic but resonant writers like Robert Stone and Don DeLillo in Kushner’s prose. In “The Mars Room,” she dwells as well on Dostoyevskian notions of evil. There are so many types; so few are recognized.

“There were stark acts of it: beating a person to death,” Gordon, the academic, thinks. “And there were more abstract forms, depriving people of jobs, safe housing, adequate schools.” In “Naked Lunch,” William S. Burroughs put this idea in slightly different words: “The face of ‘evil’ is always the face of total need.”

There’s an extended and winning juxtaposition, in “The Mars Room,” of the writing of two men who sought escape from society’s constraints: Henry David Thoreau and Theodore J. Kaczynski, the Unabomber.

Kushner quotes Kaczynski at some length, and the idea is floated that these men are not so different as it might seem. Kushner makes one want to learn about Kaczynski all over again.

“The Mars Room” moves cautiously and slowly. It prowls rather than races. It is like a muscle car oozing down the side roads of your mind. There are times when you might wish it had more velocity, more torque, yet there are reasons it corners cautiously.

Like someone wary after a bad accident, Romy says, “I did not see any doom in the road.”

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