Tougher than any fibre made by humans and extraordinarily good at transmitting vibrations to the predators that weave it, spider silk has been a source of inspiration for the development of everything from scaffolding for regenerating bones to bulletproof vests, remote sensors and noise reducers. Yet one of its most remarkable attributes, its resistance to decay, has received little attention. Some researchers speculate that spider silk keeps hungry bacteria at bay by being laced with antibiotics. But work by Wang Pi-Han and Tso I-Min at Tunghai University, in Taiwan, published in the Journal of Experimental Biology, suggests this is not the case. Rather, silk manages to avoid being eaten by locking the nutrients it contains behind an impenetrable barrier.
Spider silk is made of proteins that ought to be attractive to microbes. Moreover, because webs are often built in environments, like forests and bogs, that are rife with these bugs, there should be ample opportunities for bacteria to settle on the strands and feast. Remarkably, this does not seem to happen.
Dr Wang and Dr Tso were curious about how spiders manage this. They began their investigation by putting bacteria and spider silks together in laboratory conditions perfect for bacterial growth. They worked with silk strands collected from three species of spider that build their webs in different environments, and set these down on nutrient-rich plates. Each plate had one of four bacterial species growing on it. The team then used microscopes to monitor the behaviour of the bacteria over the course of 24 hours.
After repeating the experiment three times, they found that the bacteria never fed on the silks. They also found, however, that the strands were not immune to having bacteria grow over and around them—suggesting that those strands were not laced with antibiotics.
The two researchers then tried growing their bacteria directly on silk strands, by providing them with a range of nutrient supplements. Only one of these supplements, nitrogen, encouraged consumption of the silk. When the strands were lathered in a nitrogen-rich solution, bacteria ate them. Without nitrogen, they were held at bay. This is odd, because proteins (of which silk is made) are, themselves, rich in nitrogen.
That led Dr Wang and Dr Tso to conclude that the antibacterial properties of spider silk are caused not by any sort of antibiotic but, rather, the structure of the silk itself. Natural selection, it seems, has driven spider silk to store the proteins it is composed of behind a layer made impenetrable by its physical rather than its chemical structure.
What, exactly, that structure is the two researchers have yet to determine. Once it has been elucidated, though, the discovery should pave the way for artificial antibacterial materials that do not use antibiotics to keep the bugs away.
Ajournalist walks into Honest Burgers, a small chain of restaurants in Britain. Mindful of the carbon emissions that come from raising cows, he orders a plant-based burger. It tastes convincingly beefy, at least when encased in a brioche bun and loaded with vegan Gouda and chipotle “mayo”. He asks where this wondrous environmentally friendly virtueburger was made? Sheepishly, staff inform him that the patty—supplied by Beyond Meat, a California-based company—has been flown in from America.
To be fair, Beyond Meat has plans to begin production of its foods in the Netherlands. The company’s expansion is just one sign of a step-change in the demand for foods aiming to replace meat on people’s plates. A niche business is becoming mainstream. Startups and established food conglomerates are hungry for a share of a rapidly growing market for plant-based meats—foods that mimic the taste, texture and nutritional qualities of meat, without a single animal in sight.
At the moment, the market for meat substitutes is tiny. Euromonitor, a market-research firm, estimates that Americans spend $1.4bn a year on them, around 4% of what they spend on real meat. Europeans also chomp through about $1.5bn-worth of meatless meat a year, but this is 9-12% of what they spend on animal flesh.
Euromonitor expects the market for meat alternatives in both Europe and America to double by 2022. Analysts at Barclays, a bank, estimate that global sales of alternative meats could grow from 1% of the total market for meat to 10% over the next decade.
No bones about it
If so, the implications are vast. Until recently, the only way to make meat was for an animal to eat a plant and then be killed. Now, with better technology, it may be possible to create radically different, animal-free food chains. And boffins are constantly improving what bogus burgers taste like.
Demand for plant-based meat is driven by a combination of environmental, ethical and health concerns. Raising animals for meat, eggs and milk is one of the most resource-intensive processes in agriculture. According to the un’s Food and Agriculture Organisation, it generates 14.5% of global greenhouse-gas emissions. Globally, demand for meat from animals is shooting up as people in developing countries grow richer and can afford to feast on flesh. In rich countries, by contrast, an increasing number of people say they would like to eat fewer animals. They may even mean it.
Nearly two-fifths of Americans who described themselves as carnivores told a survey by Mintel in February that they wanted to add more plant-based foods to their diet. Some call themselves “flexitarians”: not wholly vegetarian or vegan, but anxious to reduce their meat consumption nonetheless. Young people are the most fervently flexible. Around a third of those under the age of 35 in Britain told a poll by Mintel in September 2018 that they wanted to cut the amount of meat they eat, compared with less than a fifth of older people.
Partly because of this, demand for meat substitutes has grown by 37% in America in the past two years and by 30% in western Europe. Beyond Meat and Impossible Foods, another plant-based food company in Silicon Valley, have entered the market. Impossible has raised $700m in private funds; its backers include Bill Gates. Since Beyond Meat went public in May its valuation has more than quintupled, to $8.4bn.
Many of these companies look to plant-based milks as a precedent. The market for these took off in the mid-2000s, recalls Matt Ball from the Good Food Institute (gfi), a non-profit group in Washington, dc, that monitors and promotes awareness of plant-based meat. That owes something to canny marketing. In 2002 Dean Foods bought Silk, a soya-milk brand, and insisted that it was placed next to cows’ milk on supermarket shelves. That made consumers think of it as just another variety of the white stuff you pour on cereal, rather than a weird product for people with allergies.
Plant-based milk—including almond, oat and hemp—now accounts for about 15% of retail milk sales in America and 8% in Britain. Over the past year nearly two-fifths of American households bought alternative milks. Often they do so alongside dairy products; in a poll by Ipsos-mori 38% of American consumers said that they guzzle plant-based milk, but only 12% did so exclusively. The others were flexitarian, drinking both moo juice and the nutty or beany variety. In Britain 20% of people surveyed by Mintel glugged such products, but only a third of those did so because of an allergy or intolerance. The rest said the new milks were healthier or more ethical.
Children of the Quorn
Meatless meat has been around for a while. In 1901 John Harvey Kellogg, the inventor of the cornflake (which he hoped would make people less keen on sex), was granted a patent for protose, a “vegetable substitute for meat” made of wheat gluten and peanuts. For a long time, however, the market for pseudomeat was small, and the incentive for making it tasty was accordingly modest. This is perhaps why so many early veggie burgers had the taste and the texture of heavily salted woodchips.
Today’s alternative-meat makers are more ambitious. They aim to outcompete the conventional meat industry. Their scientists are designing plant-based meats that taste a lot like the real thing.
What makes meat taste like meat? The full sensory experience of eating a slab of meat starts when the constituent proteins, fats and sugars within it interact during cooking. Apply heat and the amino acids and sugars react. The meat goes brown and releases dozens of volatile molecules that give it its flavour and odour in a process known as the Maillard reaction. Afterwards, as the meat is eaten, the bite, texture, umami flavour and melting fats combine to give meat-eaters an experience that they know as “meaty”.
Each new entrant to the market has tried to recreate these sensations of meatiness as closely as possible. Their products are generally based around a source of plant protein such as soya, wheat or legumes, which are then combined with a range of fats, colours and flavourings. The soya-based burger from Impossible Foods, for example, also contains haem, an iron-rich molecule that exists in living things to help proteins carry oxygen. Haem gives beef its reddish colour. It helps to create a meaty aroma and flavour once the meat is cooked. In the Impossible Burger, the formulation uses leghaemoglobin. This occurs naturally in the roots of soya but is made for Impossible Foods using genetically modified yeast.
Beyond Meat’s burger is made from proteins that come from peas, mung beans and rice, and is laced with beetroot to give the patty a reddish hue and the ability to “bleed” when bitten. It also contains specks of coconut oil and cocoa butter that give the burger a marbling when cooked, akin to the fat in a beef burger.
Many plant-based food firms hope one day to make pseudomeats that even more closely resemble animal muscle itself. This is tricky. To get the texture of their plant-based burgers and nuggets right, manufacturers use a process called extrusion, in which the mixture of ingredients is pushed through a small hole to create meat-like fibres. However, real animal muscle tends to have more complex structure than anything extrusion can achieve.
Most of these companies argue that their products are healthier than animal meat. Some claims are more convincing than others. A plant-based burger tends to provide the same number of calories as a similar-sized slab of beef. Plant-based meats contain no cholesterol, have less fat and more fibre and vitamins. They also avoid the increased risk of colorectal cancer that, according to the World Health Organisation, is linked to eating a lot of processed red meat. However, they also tend to contain more salt and less protein.
A big difference between meat and plant-based products is that the latter are continually improving. Since they are designed from scratch, manufacturers can keep tweaking the recipes to make each bite yummier or more nutritious. Whereas meat firms constantly search for ways to raise animals more efficiently, pseudomeat makers adapt and refine the product itself. Like the software-writers of Silicon Valley, their recipes are never complete.
From the moment Impossible’s burger was released, the company began gathering feedback. Consumers told the company they wanted a burger with a better “bite” and they wanted to be able to grill it themselves without it falling apart. Impossible also wanted to reduce the amount of salt and saturated fat while adding more protein. The Impossible Burger “2.0”, released earlier this year, replaced wheat protein with soya, which had the added advantage of making the burger gluten-free. Future iterations are planned. Researchers want to make the burgers juicier, so they do not become dry when cooked beyond medium. “The cow is not going to taste better,” says David Lipman, the chief scientist at Impossible Foods. But plant-based meats will.
Atze Jan van der Goot at the Food Process Engineering Laboratory at Wageningen University has been working with a Dutch firm called the Vegetarian Butcher (a pioneer in the plant-meat industry). Their latest invention can create muscle-like structures and textures within slabs of plant-based meats using a device called a Couette cell. This consists of two concentric cylinders, one of which rotates around the other while the ingredients are sandwiched in between. By exerting force on the proteins in the mixture, the ingredients lengthen into fibres and wind around one another. The result is a gelatinous red slab of plant meat that contains long, thick, elastic muscle-like fibres which look and flake apart like pulled pork or beef. Dr van der Goot’s team has shown that when grilled, cuts from this “muscle” can sizzle, brown and give off aromas like a steak.
From an environmental perspective, the new meats are surely better. Rearing and slaughtering animals is an inefficient way to produce food, says Bruce Friedrich of the gfi. Most of the energy that goes into making a cow is used as it walks around, digests food and grows the non-edible bits of its body such as bones and hooves.
As yet, rigorous environmental assessments of plant-based meats are rare. But both Impossible Foods and Beyond Meat have commissioned independent researchers to carry out life-cycle analyses of their products. Their findings are encouraging. “The main message is very clear—the two plant-based burgers represent very large, often ten-fold, savings in the environmental burdens of food consumption,” says Ron Milo, a biologist who studies sustainability at the Weizmann Institute of Science in Israel. “These savings are true for greenhouse emissions, land use and water use.” (See chart.)
Such greenery appeals to the young, the urban and the wealthy. However, to make a difference to the planet, meatless meat needs to be on billions of plates, not just millions. Over the past two years both Beyond Meat and Impossible Foods have worked with chains such as Burger King, Dunkin’ and Kentucky Fried Chicken, making sure that their brands feature prominently on menus. The Impossible Burger is also served in the British Airways first-class lounge in New York; the Beyond Burger, in business class on some Virgin Atlantic flights. (Before they start feeling smug, passengers should bear in mind that eating plantburgers on a flight is not a meaningful way to offset the carbon emissions of a transatlantic journey.)
Selling alternative meat in restaurants allows customers to try it in a setting where they are less price-sensitive, says Justin Sherrard of Rabobank, a Dutch lender. A bigger test, he says, will be how these patties fare in supermarkets, where shoppers watch pennies.
Hoping to mimic the success of plant-based milks, Beyond Meat insisted that its products were placed in the same refrigerated aisles in supermarkets as its animal-based competitors—a condition that Whole Foods, a supermarket chain, acceded to in America in 2016. Sainsbury’s, a British supermarket, now stocks plant-based meat in the meat aisle.
Price, however, is still a problem. According to analysts at Bernstein, a research firm, a Beyond Burger retails at $11.50 per pound in supermarkets, compared with $7-9 for posh meat patties. On September 20th Impossible Burgers made their debut in America’s supermarkets, retailing for around $12 per pound. But competition should lower those prices. Consumers’ appetite for plant-based meat is bound to attract new entrants with cheaper offerings.
For its part, Beyond Meat hopes that as it ramps up production, prices will fall. Peas, the main source of protein used in its burgers, are in plentiful supply worldwide, thanks to an import ban in India last year. But getting them from the field to the plate has been tricky. The protein is extracted by firms such as Puris or Roquette and then transformed into burgers by Beyond Meat. Bottlenecks in the pea-protein supply last year delayed the firm’s launch in Europe. Limited production capacity prompted it to fly patties to Europe from its only plant in America (hence your correspondent’s peripatetic patty at Honest Burger in London). Only more recently has production capacity risen to meet demand. Beyond Meat’s new Dutch plant will help. Puris has teamed up with Cargill, one of the big four grain traders, to expand capacity. Roquette is investing €500m to do the same.
Smaller firms that specialise in ingredients for plant-based food have started to spring up, and more established ones, such as Ingredion, are moving into this space too. Its researchers are investigating whether other crops, such as yellow peas and fava beans, can make good meatless meat. They are also hoping to breed new varieties of soya and wheat. Earlier this year Motif Ingredients, a startup created by Gingko Bioworks, a biotech firm in Boston, raised $90m to develop specialised ingredients for plant-based products. Jon McIntyre, Motif’s boss, aims to make flavourings and other additives (to improve texture or bite, say) by inserting specific dna sequences into the genomes of yeast. Fermenting that yeast will then produce their desired products. Both companies hope that their products will help even the smallest firms to create their own plant-based meats from scratch.
Plant-based-meat firms are ramping up their research and development departments. Producing Impossible’s burger has involved countless experiments and prototypes, since 2011, to identify which proteins could best bind the patty together or to understand the ratios of the various ingredients needed to produce a meaty flavour. Mr Lipman, the chief scientist, boasts that his company’s offices contain the tools of a modern biotech lab. All this costs money.
Big food producers are getting involved. Kraft, an American firm, funds an incubator that invests in “disruptive” food brands. Unilever, a big conglomerate, bought the Vegetarian Butcher last year for an undisclosed amount. When it comes to r&d, Niko Koffeman, one of the founders of the Vegetarian Butcher, says that Unilever will invest as much as is needed to make the company the “world’s biggest butcher”.
None of these developments has escaped the attention of traditional meatpackers. Tyson Foods, a large meat processor based in Arkansas, was an early investor in Beyond Meat. In June it joined the fray more directly, launching a range of plant-based “chicken” nuggets and “blended” burgers, made with both plants and animal meat, which it claims are healthier than the traditional kind.
The impossibilities are endless
Other firms are trying to woo customers by making animal husbandry greener. Danish Crown, Europe’s largest pork producer, has said it wants to halve its emissions by 2030 by using energy and water more efficiently, and using greener packaging. More investors are demanding transparency on how meat is sourced, says Aarti Ramachandran of the fairr Initiative, a group that tells investors they might lose money if they back environmentally dodgy meat producers.
Other meat makers are lobbying for protection. Terrified of the prospect of meat grown from stem cells in labs, the beef industry in America has been urging legislatures to restrict the use of the word “meat” to that which comes from an animal carcass. At least nine American states—including Arkansas, Missouri and Mississippi—have now agreed. The National Cattlemen’s Beef Association is also asking the Food and Drug Administration, the federal regulator, to outlaw what it sees as misleading labelling of plant-based meat. In April the European Parliament’s agriculture committee recommended the introduction of a ban on plant-based meat producers using such terms as “burgers” and “sausages”, although the proposal has not yet been debated or voted upon by the full parliament. The European Court of Justice ruled that many plant-based alternatives could not be labelled “milk” in 2017, but this did not noticeably affect demand.
The fight over labels is a sign that meat producers are on the defensive, says Mr Friedrich of the gfi. “The meat industry attempting to define meat as something that comes from a slaughtered animal is every bit as absurd as trying to say that your phone is not a phone because it doesn’t plug into a wall any more,” he claims.
When plant-based meat becomes common, language will no doubt adapt. The word “meat” may one day simply evoke the sensory experience that comes from eating a particular blend of fats, amino acids, minerals and water. Whether that is made by slaughtering animals or by some other means depends on the ingenuity of the new meat makers. ■
Last Tuesday, at the funeral for the Supreme Court Justice John Paul Stevens, Ruth Bader Ginsburg delivered a eulogy. She concluded, “Justice Stevens much appreciated the writings of the literary genius known by the name William Shakespeare, so I will end with a line from the Bard fitting the prince of a man Justice Stevens was: ‘Take him for all in all, we shall not look upon his like again.’ ” Ginsburg’s wording was careful—it had to be, lest she mischaracterize her colleague’s views. Stevens didn’t appreciate the writings of Shakespeare; he appreciated the writings of the individual known asShakespeare. Ginsburg’s “Hamlet” quote? Stevens, known for his dissenting opinions (Bush v. Gore, Citizens United v. F.E.C.), believed that it was probably written not by Shakespeare, the commoner from Stratford-upon-Avon, but by Edward de Vere, the seventeenth Earl of Oxford.
A quick recap of the Oxfordian theory, which was proposed in 1920, by a schoolteacher named J. Thomas Looney: Shakespeare was the front man for de Vere, an aristocrat who could not publish under his own name. (Writers were looked down on—sometimes they were even tortured or killed.) This explains why there were no books in Shakespeare’s Stratford house and why no letters written by Shakespeare survive. (Some Oxfordians think that Shakespeare was illiterate.) This explains why there is no evidence that Stratford citizens recognized Shakespeare as a writer during his lifetime. And it explains why the plays are so good, so complicated, so familiar with the concerns of nobility and the geography of Italy. (Shakespeare isn’t known to have ever left England.)
Stevens began expressing his doubts about the Bard of Avon in November of 1987, at a moot-court hearing on the topic “Who Wrote Shakespeare?” Stevens and Justices William Brennan and Harry Blackmun listened to arguments in support of the Stratford man and arguments in support of de Vere. Stevens said, of the Stratford argument, “I have lingering concerns about some of the gaps in the evidence: the absence of eulogies at the time in 1616 when Shakespeare died.” He added, “You can’t help but have these gnawing doubts that this author may, perhaps, have been someone else.” A few years later, in a law-review article, he doubled down, citing the theory that “Shakespeare is a pseudonym for an exceptionally well-educated person of noble birth who was close to the English throne.” Edward de Vere.
“The article was him coming out as an Oxfordian,” Tom Regnier, a former president of the Shakespeare Oxford Fellowship, said. The organization, which has about four hundred members—including the Shakespearean actors Derek Jacobi and Mark Rylance, who are honorary trustees—is dedicated to researching the authorship question and evangelizing about de Vere. In 2009, the group gave Stevens its highest honor: naming him Oxfordian of the Year.
Alex McNeil, the Oxfordian who was tasked with notifying Stevens, didn’t know how to contact a Supreme Court Justice, so he mailed a letter to the Court. Several weeks later, he received a response from Stevens’s secretary: “Be here on November 12th at 2pm.” (“They don’t ask, ‘Is such-and-such date good for you?’ ” McNeil said.) Regnier, McNeil, and two other Oxfordians—all attorneys—arrived at Stevens’s chambers to present him with a plaque. They chatted about the authorship question. Michael Pisapia, one of the Oxfordians who joined, said that Stevens made it clear that he was an anti-Stratfordian, but that he shied away from endorsing a definitive theory of authorship.
“He said, ‘Of course it’s not the guy from Stratford,’ ” Pisapia recalled. “But when we asked about the other candidates he’d say things like ‘Oh, I don’t bite.’ ‘What about Bacon?’ ‘No, I don’t bite.’ ‘O.K., so what about Oxford?’ He said, ‘Well, you certainly couldn’t convict anyone else of it.’ ”
But the award was not rebuffed. “He accepted it with both hands, literally,” Pisapia said. The Oxfordians understood Stevens’s reluctance to commit. “Let’s say some piece of evidence comes out and proves that it was Queen Elizabeth I,” Pisapia said. “His whole career as a jurist would have a shadow over it. Like, ‘Wow, he sure missed that one.’ ” (Although the reputation of Hugh Trevor-Roper, the historian, never quite recovered after he authenticated the Hitler diaries, Whoopi Goldberg’s career didn’t suffer when she raised doubts about the moon landing on “The View.”)
The late Justice Antonin Scalia was openly Oxfordian. Scalia told the Wall Street Journal, in 2009, that his wife “thinks we Oxfordians . . . can’t believe that a commoner could have done something like this, you know, it’s an aristocratic tendency.” (Scalia was never named Oxfordian of the Year.)
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McNeil said, “We’re often accused of snobbery by the other side, but we’re not saying that someone from a small town, a four-day trip away from London, couldn’t have done this. It’s that he couldn’t have done this without leaving any evidence behind. And, for lawyers, it’s the evidentiary question that sticks out the most.”
The Oxfordians are busy planning their annual conference, which will be held this fall at the Mark Twain House, in Hartford, Connecticut. (Twain was skeptical of the Stratford man, and his last book, “Is Shakespeare Dead?,” addresses the authorship question.) “We’ll do something to honor Stevens,” Regnier said.
Pisapia credits Stevens, as well as the 2011 film “Anonymous,” with bringing the Oxfordian theory into the mainstream. “Thirty years ago, if you talked about the authorship question, you were lumped in with the flat-earthers, with the people who were going to stake out Area 51,” he said. “The Stevens thing wasn’t so groundbreaking to the rest of the world—it wasn’t like Beyoncé having twins—but it made it more acceptable to talk about.” ♦
The first study to test the gene-editing technology CRISPR inside the human body is about to get underway in the United States, according to news reports.
The study plans to use CRISPR to treat an inherited eye disorder that causes blindness, according to the Associated Press.
People with this condition have a mutation in a gene that affects the function of the retina, the light-sensitive cells at the back of the eye that are essential for normal vision. The condition is a form of Leber congenital amaurosis, one of the most common causes of childhood blindness that affects about 2 to 3 newborns out of every 100,000, according to the National Institutes of Health.
The treatment will correct the mutation using CRISPR, a tool that allows researchers to precisely edit DNA in a specific spot, the AP reported.
Researchers will use an injection to deliver the treatment directly to the light-sensitive cells, according to a statement from Editas Medicine, the company that is conducting the study along with Allergan.
The trial will enroll a total of 18 patients, both children (ages 3 and up) and adults.
The new study is different from the controversial research of a Chinese scientist who used CRISPR to edit the genomes of twin babies last year. In that case, the Chinese scientist edited the DNA of embryos, and these gene alterations could be passed down to the next generation, the AP reported. In the new study, the DNA edits made in the children and adults cannot be passed down to their offspring, the AP said.
We recently told you about a study that looked at how may more trees could grow on Earth and how much carbon they could absorb from the atmosphere. The answer: The planet has room for about 2.5 billion acres of forest, and all those trees could suck up an additional 200 gigatons of carbon. While that wouldn’t solve climate change, it would be a huge help.
That kind of reforestation would be a monumental global undertaking, but every single tree still counts. They all sequester carbon.
So, if you plant a tree, what kind should it be?
Peter Del Tredici, senior research scientist emeritus at the Arnold Arboretum at Harvard University said that, for trees to sequester a lot of carbon, they need to live long and healthy lives. “You want a tree that is going to survive in your climate with the minimum amount of maintenance,” he said.
To have a meaningful effect, he said, a tree must live at least 10 to 20 years. “It takes that long for a tree to build up enough foliage so that it can have a substantial impact on the environment,” Dr. Del Tredici said.
With that in mind, oaks can be great in the Northeast, while ficus trees might work better in Southern California. In the Northwest, just about everything does well. Nonnative, noninvasive species like the ginkgo tree are good options, too.
Getting your tree to reach its full potential requires plenty of soil volume and ample room to grow, Dr. Del Tredici said. He discouraged fast-growing trees like poplars because they have a shorter life span. Medium-growth trees like pin oak are better from a carbon perspective.
Considering how climate change might shift conditions like temperature and water availability over time is also really important, said Emily Nobel Maxwell, the cities program director for The Nature Conservancy in New York.
Careful placement of a tree can bring additional climate benefits, she added, which could possibly be even more significant than carbon sequestration.
“There are ways to locate tees to maximize energy efficiency benefits,” Ms. Maxwell said. A tree that casts shade on your house in the summer or helps insulate in the winter can lower utility bills and, quite likely, carbon emissions. “You can strategically plant.”
The Arbor Day Foundation has a plenty of tools — like a best-tree finder and a hardiness zone look-up — to help identify the right tree for the right place. The Department of Agriculture’s I-Tree lets you design your optimal tree placement. Another useful exercise is simply to walk around an arboretum or botanical garden to get a sense of what you like. A nursery can be a great resource as well.
But both Dr. Del Tredici and Ms. Maxwell pointed out that putting the tree in the ground is only the first step in a decades-long process. “As important as planting a tree,” Ms. Maxwell said, “is taking care of a tree.”
More than 1 in 10 patients are harmed in the course of their medical care, and half of those injuries are preventable. Among the preventable errors, 12 percent led to a patient’s permanent disability or death, according to the report published Wednesday in The BMJ, a medical journal.
The study, which included information on more than 300,000 patients from 70 earlier reports, highlights how serious the problem is, said the study’s lead author, Maria Panagioti, a senior lecturer at the University of Manchester.
“We need strategies in place to detect and correct the key causes of patient harm in health care,” Panagioti said in an email. “Our study finds that most harm relates to medication, and this is one core area that preventative strategies could focus on.”
While the study was international in scope, the findings would be applicable to the U.S., Panagioti said.
The new findings come two decades after a jarring report from the Institute of Medicine concluded that medical errors resulted in the deaths of as many as 98,000 Americans each year.
“It’s a reminder that 20 years into our realization about the problems with patient safety, the rate of preventable harm caused by health care continues to be unacceptably high, causing a huge burden of unnecessary patient suffering and even death,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, who was not involved in the new research.
“This is one of the largest studies ever conducted on the frequency and severity of patient harm,” Wu said. “And it provides evidence that these harms occur in all medical care settings. It’s a problem that needs our attention.”
For the new study, Panagioti and her colleagues combed through the medical literature looking for studies that examined medical errors and patient harms. They settled on 70 studies that contained information on 337,025 mostly adult patients, 28,150 of whom experienced harmful incidents, of which 15,419 were preventable.
While 49 percent of the harms reported in the study were “mild,” 36 percent were considered to be “moderate,” and 12 percent “severe.”
Incidents relating to drugs and other therapies accounted for 49 percent of the harms, and injuries related to surgical procedures accounted for 23 percent. Health care infections and problems arising from diagnoses each accounted for 16 percent of the harms.
There’s no “silver bullet” for reducing medical errors, experts say. It requires a combination of patient and staff engagement, consistent management focus and, sometimes, technology, said Tami Minnier, chief quality officer of UPMC, Pittsburgh.
In 2005, UPMC established “Condition H” — for Help — so patients and families could call for a rapid response team to the bedside for any care concerns, including communication breakdowns, Minnier told NBC News. “While infrequently used, we believe that Condition H has averted significant patient harm over the years,” she said.
Other hospitals have made changes in hopes of diminishing the numbers of errors and harms, said Dr. Karl Bilimoria, director of surgical outcomes and quality improvement at Northwestern University’s Feinberg School of Medicine.
“For example, registries have been created to measure harms of various kinds and to allow hospitals to compare themselves to other institutions,” Bilimoria said.
When possible, patients and their families can protect against medical errors by becoming their own advocates.
“The more people observing and participating in the patient’s medical care the better,” Bilimoria said. “I would encourage patients to ask physicians to explain things and make sure all have a common understanding.”
Don’t be intimidated by busy doctors or other medical staff, advised Minnier.
“There are some basic things to keep track of,” she said. For example, “make sure they are washing their hands to prevent infections and are using the right protective equipment.”
If you’re not comfortable with what’s happening, “make them pause so you can ask questions,” Minnier said. “Checklists have become very popular. One of the important purposes of checklists is that they force people to pause and think about what is happening.”
President Trump’s approval ratings are under water in national polls. His position for re-election, on the other hand, might not be quite so bleak.
His advantage in the Electoral College, relative to the national popular vote, may be even larger than it was in 2016, according to an Upshot analysis of election results and polling data.
That persistent edge leaves him closer to re-election than one would think based on national polls, and it might blunt any electoral cost of actions like his recent tweets attacking four minority congresswomen.
For now, the mostly white working-class Rust Belt states, decisive in the 2016 election, remain at the center of the electoral map, based on our estimates. The Democrats have few obviously promising alternative paths to win without these battleground states. The president’s approval ratings remain higher in the Sun Belt battlegrounds than in the Rust Belt, despite Democratic hopes of a breakthrough.
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The president’s views on immigration and trade play relatively well in the Northern battlegrounds, including among the pivotal Obama-Trump voters.
There are signs that some of these voters have soured on his presidency, based on recent polling. There is also reason to think that white working-class voters who supported Mr. Trump were relatively likely to stay home in last November’s midterm elections.
A strategy rooted in racial polarization could at once energize parts of the president’s base and rebuild support among wavering white working-class voters. Many of these voters backed Mr. Trump in the first place in part because of his views on hot-button issues, including on immigration and race.
Alone, the president’s relative advantage in the Electoral College does not necessarily make him a favorite to win. His approval rating is well beneath 50 percent in states worth more than 270 electoral votes, including in the Northern battleground states that decided the 2016 election.
And just because racial polarization could work to the president’s advantage in general doesn’t mean that his particular tactics will prove effective. The president’s campaign rally on Wednesday night seemed, for a time, to go too far even for him: on Thursday he disavowed the “send her back” chants that supporters directed toward a congresswoman who immigrated to the United States as a refugee. (By Friday, he was declining to condemn the chants.)
But Mr. Trump’s approval rating has been stable even after seemingly big missteps. And if it improves by a modest amount — not unusual for incumbents with a strong economy — he could have a distinct chance to win re-election while losing the popular vote by more than he did in 2016, when he lost it by 2.1 percentage points.
The president’s relative advantage in the Electoral College could grow even further in a high-turnout election, which could pad Democratic margins nationwide while doing little to help them in the Northern battleground states.
It is even possible that Mr. Trump could win while losing the national vote by as much as five percentage points.
The state of the Electoral College, 2018
The best available evidence on the president’s standing by state comes from the large 2018 election surveys. Their quality is generally high, and unlike most surveys, they have been adjusted to match actual election results, ironing out many potential biases of pre-election polls. Although these surveys are nearly nine months old, the stability of the president’s overall approval ratings means, for our purposes, that they remain a decent measure of the distribution of his support.
Taken together, the president’s approval rating among midterm voters stood at about 45.5 percent, excluding the voters who did not express an opinion (for comparability, measures of the president’s approval will exclude voters without an opinion).
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By state, the president’s approval rating was beneath 50 percent in states worth 310 electoral votes: the states carried by Hillary Clinton, along with Michigan, Pennsylvania, Wisconsin, Iowa, Arizona and North Carolina. This is not exactly good news for the president, but not as bad as it typically would be given an approval rating of 45.5 percent. John McCain, for instance, lost states worth 365 electoral votes in 2008 while winning 45.7 percent of the vote.
The most important measure of the president’s strength in the Electoral College, relative to the national vote, is the difference between the national vote and the “tipping-point state” — the state most likely to push a candidate over the Electoral College threshold.
Wisconsin was the tipping-point state in 2016, and it seems to hold that distinction now, at least based on the president’s approval rating among 2018 midterm voters.
Over all, the president’s approval rating was 47.1 percent in Wisconsin, above his 45.5 percent nationwide. This implies that the president’s advantage in the Electoral College, at least by his approval rating, is fairly similar to what it was in 2016.
A closer look at the underlying evidence suggests there’s reason to think the president’s ratings could be higher than estimated in the state. The estimates are based on four measures of the president’s standing, and there is one outlier: the Votecast survey, which places the president’s net approval rating at minus 13, or 43.6 percent approval. The other three are in close agreement, placing the president’s rating between 47 percent and 48 percent.
There is an additional piece of evidence, unique to Wisconsin, that’s consistent with a stronger position for the president: the Marquette University poll, which gave Mr. Trump a minus 5 net approval among likely voters in its final poll before the midterms. Over the longer run, the president has averaged a minus 5 net approval among registered voters (not midterm voters) in Marquette polls since October.
In other words, most measures suggest that the president’s rating is higher than 47.1 percent in Wisconsin. If you excluded the Votecast data and added the final Marquette poll, the president’s approval rating would rise to 47.6 percent — or a net 4.2 points higher than his nationwide approval.
It is important to emphasize that it is impossible to nail down the president’s standing in Wisconsin, or any state, with precision. But Wisconsin is the pivotal state in this analysis, and a one-point difference there could potentially be decisive.
One reason that such a small swing in Wisconsin could be so important is that the Democrats do not have an obviously promising alternative if Wisconsin drifts to the right.
In 2016, Florida was that obviously promising alternative: It voted for Mr. Trump by 1.2 percentage points, compared with his 0.8-point victory in Wisconsin.
But all of the measures indicate that Florida has shifted to the right of the nation since 2016, at least among 2018 midterm voters. The president’s approval rating in Florida was essentially even — and by our measure, slightly positive. Republicans narrowly won the Florida fights for Senate and governor, and also the statewide U.S. House vote.
The next tier of Democratic opportunities doesn’t provide an easy backstop to Democratic weakness in Wisconsin either. There’s Arizona, where Democrats had a good midterm cycle, but where the president’s approval rating is plainly stronger than it is nationwide or in Wisconsin. The same is true of Iowa or North Carolina, though the president’s standing in those states is somewhat more uncertain in the absence of an exit poll or a high-profile statewide result.
In the end, these states, particularly Arizona, could prove to be a better opportunity for Democrats than Wisconsin. But at least based on this evidence, it would probably be more a reflection of Democratic weakness in Wisconsin than strength elsewhere.
Milwaukee and Miami-Dade
In both Wisconsin and Florida, the president’s resilience seems grounded in two regions: the Milwaukee area and Miami-Dade County.
The president’s average approval rating in the Milwaukee media market stands at 48 percent — virtually unchanged from what it was in 2016, in a compilation of Marquette University polls since October. His approval has declined in the rest of the state, according to both the Marquette data and the exit polls, which also showed the president holding firm in the Milwaukee area. A similar pattern has showed up in statewide election results, where Republicans have tended to run strongly in the area.
The president’s approval rating in Miami-Dade may even be better than his standing there in 2016, based on three Times/Siena surveys of two districts there, Florida’s 26th and 27th. These polls were also highly accurate, coming within a point of the election results. On average, the president’s approval rating stood at 45.7 percent among the likely electorate in the two districts— well above his 40.8 percent share of the major-party vote there in the 2016 presidential election.
At first glance, these regions might seem to have little in common. But in terms of politics, their idiosyncrasies have played out in similar ways.
Both are regions where the Republicans do better than demographics would lead you to expect. Milwaukee is one of the last Northern metropolitan areas where Republicans still rule the suburbs; Miami-Dade is one of the few places where Republicans win Hispanics, in this case Cuban voters.
Both areas were, or still are, represented by major establishment figures in Republican politics: Scott Walker, Paul Ryan, Jeb Bush and Marco Rubio. Many fought hard against Mr. Trump in the primary. These areas were some of Mr. Trump’s weakest of the primary season — he won 22 percent in the primaries in Miami-Dade and in Waukesha, Wis.
Hillary Clinton improved over Barack Obama in both areas in 2016.The president’s apparent resilience or recovery in these regions contrasts with what has happened elsewhere in the country. But it is possible that the real anomaly was his weakness in 2016, which was perhaps in part because of the president’s hostility to his prominent skeptics in these areas. The Republican establishment is now unified, if belatedly, behind the president; perhaps these voters have unified behind him as well.
The consequences of higher turnout
Many assume that the huge turnout expected in 2020 will benefit Democrats, but it’s not so straightforward. It could conceivably work to the advantage of either party, and either way, higher turnout could widen the gap between the Electoral College and the popular vote.
That’s because the major Democratic opportunity — to mobilize nonwhite and young voters on the periphery of politics — would disproportionately help Democrats in diverse, often noncompetitive states.
The major Republican opportunity — to mobilize less educated white voters, particularly those who voted in 2016 but sat out 2018 — would disproportionately help them in white, working-class areas overrepresented in the Northern battleground states.
If everyone who was eligible to vote turned up at the polls, the gap between the Sun Belt and Rust Belt would close. Texas, astonishingly, would emerge as the tipping-point state. Wisconsin and Pennsylvania, by contrast, would barely budge.
Of course, a full-turnout election is not going to happen. In recent months, analysts have speculated about a 70 percent turnout among eligible voters, up from 60 percent in 2016.
In this kind of high-turnout presidential election, by our estimates, the tipping-point state would drift to the right as people who voted in 2016 but not in 2018 return to the electorate and nudge states like Pennsylvania and Wisconsin toward the president. At the same time, the Sun Belt would drift left. Arizona could overtake Wisconsin as the tipping-point state. But even in this hypothetical high-turnout election, the president’s approval rating in Arizona would be higher than it was in 2018 in Wisconsin. It becomes harder for the Democrats to win the presidency.
In such an election, the tipping-point state could have a net approval rating that is five points higher than the president’s national net approval rating, potentially allowing the president to win re-election while losing the popular vote by a wide margin.
2018 isn’t destiny
This analysis mainly covers the opportunities available to both parties; we can’t know which side will take better advantage of them. And it’s important to emphasize that the kind of slight difference in measuring Wisconsin is beyond our ability to discern with great confidence, even using high-quality, calibrated data.
All of this is based on the president’s approval rating — well ahead of the election. Most presidents manage to improve their approval rating between this point and the election, particularly with a strong economy. But unforeseen events could also hurt his approval rating; it is even imaginable that the president could go too far on immigration for some of his more moderate supporters.
If the president’s ratings improve, the crucial question will be where. The answer is likely to be influenced by the contrast he can draw with his still-undetermined opponent.
Democrats could nominate a candidate who tries to win the presidency by mobilizing a new, diverse coalition with relative strength in Sun Belt states, while making little or no effort to secure the support of the white working-class voters with reservations about the president.
The Democrats could certainly win in the Sun Belt states, even in Texas. Perhaps this kind of Democrat could generate such a favorable turnout that it helps the party even in relatively white states.
But it’s also a strategy that would tend to increase the risk of a wide gap between the Electoral College and the national vote. It’s also hard to see how it would be the easier way forward for Democrats, at least as long as the president’s approval rating in the Rust Belt remains so much lower than in the Sun Belt states.
Of course, the campaign season has barely begun. The election could wind up being a simple referendum on the president, and his approval ratings suggest he could lose, perhaps even decisively. But his relative advantage in the Electoral College could ensure his political survival.
Nate Cohn is a domestic correspondent for The Upshot. He covers elections, polling and demographics. Before joining The Times in 2013, he worked as a staff writer for The New Republic. @Nate_Cohn
Boris Johnson holds his first cabinet meeting in Downing Street, 25 July 2019. Photograph: Reuters
Another day, another horror. The new cabinet has met for the first time. Oh, and Boris Johnson has made his Commons debut as prime minister. Horrors plural, then. We’re living in a Hammerfilm, my friends, but one looped over and over, where the protagonist enunciates only using vowel sounds and stuttering, and the plot is him wreaking revenge on a nation because he once lost a game of fives and has never gotten over it.
Here is all the action from the day. I am so, so sorry.
Photograph: Aaron Chown/PAI swear to God this looks like the most awful dinner party of all time. This looks like a dinner party one would be personally offended to be invited to. The Guido Fawkes Twitter account described it as a “fantasy cabinet”, which pretty much tells you everything.
I’m not saying this is a good practice – because it isn’t – but you know how schools scheme to get all their lowest achieving students kicked out so that their table position isn’t affected? This would be the lot that you’d round up and drive off the premises without even opening the gates. This is a cabinet thicker than the bubbling tar on today’s roasting roads. This is a cabinet thiccer than Nicki Minaj.
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I hope Sajid Javid AKA Spock wearing a swimming cap is proud of himself. I hope the working-class, state-school boy is proud that he’s now chancellor of an administration pledging to make things easier for the wealthiest and most comfortable in society. I hope he thinks about his choices in life. I hope he’s thinking about them right now.
Photograph: Parliament liveMichael Gove here, who judging by the redness of his face is either defecting to Labour or has been sitting in the garden in the searing heat. Be your sunburnt best. Cute though, that he and James Cleverly are holding hands, if only so that their affair can be uncovered and Sarah Vine can write her “most personal and explosive column yet”, which she writes literally every single week.
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I can just imagine lots of heartrending pieces about her teen son, but not about the time the couple left him in a hotel room, a bit like when David Cameron left his daughter in a pub. That’s the thing about Tories: their kids are like their morals, in that they’re disposable.
Anyway, I’m not saying the past three years haven’t been bad for all of us, but specifically bad for me, who had the indignity of being nominated for a prestigious Press Award, losing, and watching Vine win in a different category. It felt a bit like being punched in the face by excruciating prose.
Photograph: Chris J Ratcliffe/Getty ImagesWhat this is is when you bump into a colleague that you hate leaving the office at the same time, and have to exchange a polite hello. You’re both going the same way, but under no circumstances can you bear to spend another second in their company. So you are Amber Rudd, and you lie to Jacob Rees-Mogg that you forgot something and will have to pop back to your desk.
A vision of a future that could have been, had Johnson not avoided criminal prosecution over his £350m Vote Leave bus. I would recommend this clip of Ian Hislop on Have I Got News for You, talking about that particular case: “At the moment we’re just at the preliminary stage about whether when he was a public official he was telling lies and therefore abusing his office. It’s very similar to putting the Pope on trial and saying are you a Catholic? I would like him to have a fair trial, with a desirable result with him being imprisoned forever.” But now he lives in No 10. Truly; this country.
Photograph: Tolga Akmen/AFP/Getty ImagesThis is actually a really nice photo of Nicki Morgan, isn’t it? It looks like the picture from a Chelsea flower show brochure. Or the promotional material showing off the communal gardens of a new development of flats. And by “communal” I mean only for the private owners and not the affordable tenancy holders, who are allowed to play with nearby drainpipes and I guess maybe the odd bollard. But really they should stay indoors, curtains closed.
Photograph: Frank Augstein/APThis is how Priti Patel should always be photographed, to portray the fact that she is Voldemort in a boxy jacket. A Priti name with an ugly ideology. A woman whose hobbies and interests on her Tinder profile are listed as: building Lego models of immigration dentention centres; cosy nights in chatting about reinstating the death penalty; and working holidays to Israel. As home secretary, Patel will be attending Cobra meetings, which is appropriate, cos she’s a snake.
Photograph: Jeff J Mitchell/Getty ImagesDominic Raab here, looking as he will always look, which is a man cast as the latest Bond villain, before having to drop out because of his gross in-real-life behaviour. So here he is, having made the switch to horror. The endless, endless horror.
A girl walks inside a cluster of UAE flags. Photograph: Kamran Jebreili/AP
When I learned of Alia Abdulnoor’s death and the conditions of her detention, I was both saddened and outraged. Unjustly detained in the United Arab Emirates (UAE), Alia was denied her dignity along with a fair trial.
The list of rights denied to her is long. After being arrested and detained by state security forces in 2015, she was held incommunicado for months without charge. Deprived of contact with her family, she suffered degrading conditions that may have contributed to the deterioration of her health. She was, her family say, forced to sign a confession without being allowed to read it.
On 5 February 2017, Alia received a 10-year jail sentence for abetting al-Qaida-led terrorism, promoting its ideology and extending financial assistance to its members.
In a statement, the UAE public prosecution office claimed that Alia had received state-funded cancer treatment back in 2008, and suggested that: “During her incarceration, her cancer relapsed. The prison authorities shifted her to the jail hospital, but she refused treatment. Not only did she refuse the world-class treatment prescribed for her by the doctors, she also went on hunger strikes on occasions. She received the same level of medical attention and treatment given to all citizens and residents in the country.”
This is the UAE’s explanation of events, which I and other human rights experts reject as a shameful distortion of the truth.
Many believe her arrest was linked to her support of Syrian people after the outbreak of the uprising, specifically her fundraising that sent money to Syrian women and children. The authorities depicted this as support for terrorists abroad. While the UAE’s anti-terror laws supposedly exist to protect people, in Alia’s case – as with many others – they have become a tool of injustice, discrimination and abuse for political purposes. While the laws are there to protect the country, they were used against an individual endorsing other people’s rights.
Any statement extorted using torture cannot and should not be accepted as evidence by justice mechanisms. Tortureis prohibited by international law, as are the numerous human rights breaches that occur in UAE, an issue that is of growing concern to the UN Office of the High Commissioner for Human Rights.
Alia’s case serves as a reminder of how human rights are viewed in the UAE. Hospitalised when it was too late, she received only palliative care. Not only did the denial of medical treatment and the refusal to release her violate international standards, it breached the UAE’s own legislation. Emirati law provides for the compassionate release of prisoners on health grounds and for unimpeded access of family members to terminal detainees. Knowing all this they even rejected calls from UN human rights experts for Alia’s release.
Authorities also ignored and dismissed repeated calls from her doctor, lawyers and the international community for her release. Alia should have been allowed to spend her last days surrounded by her family. The pain she suffered was entirely unnecessary. There is no doubt in my mind that the UAE bears responsibility for her death.
As a symbol of the cruelty of the UAE state security apparatus, its own justice system fails to recognise and deal with breaches of its own laws. Torture, denial of access to basic rights, isolation and other abuses have been reported by detainees throughout the country. Anti-terrorism laws and national security concerns are regularly cited when convicting activists.
The Emirati president, Sheikh Khalifa bin Zayed. Photograph: AFP/Getty Images
Sheikh Khalifa bin Zayed declared 2019 as the UAE’s “year of tolerance”, but if this is their interpretation of “tolerance”, we should all be terrified of what happens when intolerance is shown. Or was the labelling of 2019 simply a public relations exercise to lay the foundations for the hosting of the 2020 World Expo in Dubai?
This year alone there have been many cases of the UAE showing intolerance to any kind of differing opinion. The 26-year-old British football fan Ali Issa Ahmad was arrested and allegedly tortured for wearing a Qatar T-shirt. UAE authorities dispute this, saying his injuries were self-inflicted to gain publicity. British woman Laleh Shahravesh was detained in Dubai under controversial cybercrime laws for historical social media posts about her ex-husband’s wife.
In calling for true commitment to put an end to the human rights violations by the authorities in the UAE, we also urge them to investigate the ongoing cases and to hold accountable those responsible for Alia’s death. It would be a true show of force if other countries that believe in human rights and dignity were to withdraw their support for the Dubai Expo in 2020, which otherwise presents another opportunity for the repressive regime to paint a facade over its continued breach of international human rights laws.
Like so many others, Alia’s case awaits justice and should not be forgotten – instead it should inspire action to prevent such an appalling story happening again.