CDC says US flu season starts early, could be bad

NEW YORK (AP) — Flu season in the U.S. is off to its earliest start in nearly a decade — and it could be a bad one.

Health officials on Monday said suspected flu cases have jumped in five Southern states, and the primary strain circulating tends to make people sicker than other types. It is particularly hard on the elderly.

"It looks like it's shaping up to be a bad flu season, but only time will tell," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

The good news is that the nation seems fairly well prepared, Frieden said. More than a third of Americans have been vaccinated, and the vaccine formulated for this year is well-matched to the strains of the virus seen so far, CDC officials said.

Higher-than-normal reports of flu have come in from Alabama, Louisiana, Mississippi, Tennessee and Texas. An uptick like this usually doesn't happen until after Christmas. Flu-related hospitalizations are also rising earlier than usual, and there have already been two deaths in children.

Hospitals and urgent care centers in northern Alabama have been bustling. "Fortunately, the cases have been relatively mild," said Dr. Henry Wang, an emergency medicine physician at the University of Alabama at Birmingham.

Parts of Georgia have seen a boom in traffic, too. It's not clear why the flu is showing up so early, or how long it will stay.

"My advice is: Get the vaccine now," said Dr. James Steinberg, an Emory University infectious diseases specialist in Atlanta.

The last time a conventional flu season started this early was the winter of 2003-04, which proved to be one of the most lethal seasons in the past 35 years, with more than 48,000 deaths. The dominant type of flu back then was the same one seen this year.

One key difference between then and now: In 2003-04, the vaccine was poorly matched to the predominant flu strain. Also, there's more vaccine now, and vaccination rates have risen for the general public and for key groups such as pregnant women and health care workers.

An estimated 112 million Americans have been vaccinated so far, the CDC said. Flu vaccinations are recommended for everyone 6 months or older.

On average, about 24,000 Americans die each flu season, according to the CDC.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

A strain of swine flu that hit in 2009 caused a wave of cases in the spring and then again in the early fall. But that was considered a unique type of flu, distinct from the conventional strains that circulate every year.

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Online:

CDC: http://www.cdc.gov/flu/weekly

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Wall Street little changed before next "cliff" signal

NEW YORK (Reuters) - Stocks were little changed on Tuesday as the market awaited developments in negotiations in Washington to avert a "fiscal cliff" that could push the U.S. economy into recession.

Republicans in Congress proposed steep spending cuts to bring down the budget deficit on Monday but gave no ground on President Barack Obama's call to raise taxes on the wealthiest Americans, and the proposal was quickly dismissed by the White House.

The market has been subject to swings in reaction to the proposals floated so far by politicians. Still, many investors expect the two sides to come up with a deal before the year-end deadline, which could trigger a rally in equities.

"Investors everywhere are focused on what is happening here related to the fiscal cliff and the risk that nothing will happen," said Gail Dudack, Chief Investment Strategist, Dudack Research Group in New York.

"From what I have seen, there is a consensus that something will happen. Maybe if it is not ideal, something will happen."

Differences within the Republican Party over how to engage with the Democrats came to the fore on Tuesday as one senator opposed to raising taxes lashed out at House Speaker and fellow Republican John Boehner for proposing to increase revenue by closing some tax loopholes.

Despite the sudden moves in the market, a measure of investor anxiety has held surprisingly flat.

The CBOE volatility index <.vix>, a gauge of market anxiety, was at 17 but has not traded above 20 since July following its 2012 high near 28 hit in June. The VIX's 10-day Average True Range, an internal volatility measure, is at its lowest since early 2007.

Obama will meet with U.S. governors at the White House on Tuesday to talk about the fiscal cliff, a $600 billion package of tax hikes and federal spending cuts that would begin January 1.

The president is also expected to talk about the fiscal cliff during an interview scheduled for 12:30 p.m. (1730 GMT) on Bloomberg TV.

Coach became the latest company to advance the date of its next dividend payment. Expectations of higher taxes on dividends kicking in in 2013 have pushed many companies to pay special dividends this year or advance their next pay-back to investors. Shares of the upscale leather-goods maker shed 1.6 percent to $57.25.

The Dow Jones industrial average <.dji> rose 27.92 points, or 0.22 percent, to 12,993.52. The S&P 500 <.spx> edged up 0.44 points, or 0.03 percent, to 1,409.90. The Nasdaq Composite <.ixic> fell 4.44 points, or 0.15 percent, to 2,997.76.

Darden Restaurants Inc plunged 10.1 percent to $47.14 as the worst performer on the S&P 500 after warning its latest quarter would miss expectations after unsuccessful promotions led to a decline in sales at its Olive Garden, Red Lobster and LongHorn Steakhouse chains.

In contrast, Big Lots Inc jumped 8 percent to $30.28 after the close-out retailer posted a smaller-than-expected loss and boosted its full-year adjusted earnings forecast.

Toll Brothers shares advanced 0.3 percent to $32.53 after the largest U.S. luxury homebuilder reported a higher quarterly profit and said new orders rose sharply.

MetroPCS Communications shares dropped 6.5 percent to $10.07 after Sprint Nextel appeared unlikely to make a counter-offer for the wireless service provider.

Shares of Pep Boys-Manny Moe and Jack slumped 12.5 percent at $9.34 a day after the release of the auto parts retailer's results.

(Reporting by Chuck Mikolajczak; Editing by Kenneth Barry)

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Israel says will stick with settlement plan despite European pressure

JERUSALEM (Reuters) - Israel rejected concerted criticism from Europe on Monday over Prime Minister Benjamin Netanyahu's decision to expand settlement building after the United Nations' de facto recognition of Palestinian statehood.

Britain, France, Spain, Sweden and Denmark summoned the Israeli ambassadors in their capitals to hear appeals for Netanyahu to reverse course and deep disapproval of the plan to erect 3,000 more homes in the occupied West Bank and East Jerusalem.

An official in Netanyahu's office said Israel would not bend. "Israel will continue to stand by its vital interests, even in the face of international pressure, and there will be no change in the decision that was made," the official said.

Angered by the U.N. General Assembly's upgrading on Thursday of the Palestinians' status in the world body from "observer entity" to "non-member state", Israel said the next day it would build the new dwellings for settlers.

Such projects, on land Israel captured in a 1967 war, have routinely drawn world condemnation. Approximately 500,000 Israelis and 2.5 million Palestinians live in the two areas.

In a shift that raised the alarm among Palestinians and in world capitals, Netanyahu's pro-settler government also ordered "preliminary zoning and planning work" for thousands of housing units in areas including the "E1" zone east of Jerusalem.

Such construction in the barren hills of E1 has never been put into motion in the face of opposition from Israel's main ally, the United States. Building in the area could bisect the West Bank, cut off Palestinians from Jerusalem and further dim their hopes for a contiguous state.

The settlement plan, U.N. Secretary-General Ban Ki-moon said, would deal "an almost fatal blow" to a two-state solution to the Israeli-Palestinian conflict.

"We don't want to shift into sanctions mode," French President Francois Hollande told a news conference with Italian Prime Minister Mario Monti. "We are more focused on persuading."

Britain made clear it would not back such Israeli retaliation over the U.N. vote, which Palestinians sought after peace talks collapsed in 2010 over settlement building.

"We deplore the recent Israeli decision to build 3,000 new housing units and unfreeze development in the E1 block," a Foreign Office spokesman said. "We have called on the Israeli government to reverse the decision."

But a spokesman for British Prime Minister David Cameron played down what diplomatic sources said was the possibility of recalling Britain's ambassador in Tel Aviv, saying: "We are not proposing to do anything further at this stage".

France expressed "serious concerns" to the Israeli ambassador, reminding him that settlement building in occupied territories was illegal and an "obstacle" to reviving peace talks with the Palestinians.

A French Foreign Ministry official, responding to reports Paris might bring its Tel Aviv envoy home, said: "There are other ways in which we can express our disapproval."

Ahead of a Netanyahu visit this week, Germany, considered Israel's closest ally in Europe, urged it to refrain from expanding settlements, and Russia said it viewed the Israeli moves with serious concern.

RETALIATION

Israeli Finance Minister Yuval Steinitz said Israel could not have remained indifferent to the Palestinians' unilateral move at the United Nations.

"I want to tell you that those same Europeans and Americans who are now telling us 'naughty, naughty' over our response, understand full-well that we have to respond, and they themselves warned the Palestinian Authority," he said.

Palestinian chief negotiator Saeb Erekat said building in E1 "destroys the two-state solution, (establishing) East Jerusalem as the capital of Palestine and practically ends the peace process and any opportunity to talk about negotiations in the future".

The United States, one of the eight countries to vote alongside Israel against the Palestinian resolution at the General Assembly, has said the settlement plan was counterproductive to the resumption of direct peace talks.

Washington used the same argument in opposing the Palestinian initiative at the United Nations.

In Europe, only the Czech Republic voted against the status upgrade while many countries, including France, backed it. Netanyahu plans to visit Prague this week to express his thanks.

In the Gaza Strip, Sami Abu Zuhri, spokesman for the governing Hamas Islamist movement, called Israeli settlement "an insult to the international community, which should bear responsibility for Israeli violations and attacks on Palestinians".

In another blow to the Palestinian Authority, which exercises limited self-rule in the West Bank, Israel announced on Sunday it was withholding Palestinian tax revenues this month worth about $100 million, arguing the Palestinians owed $200 million to Israeli companies.

"These are not steps towards peace, these are steps towards the extension of the conflict," Spanish Foreign Minister Jose Manuel Garcia-Margallo said.

Only three weeks ago, Netanyahu won strong European and U.S. support for a Gaza offensive that Israel said was aimed at curbing persistent cross-border rocket fire.

Favored by opinion polls to win a January 22 national election, he brushed off the condemnation and complaints at home that he is deepening Israel's diplomatic isolation.

Netanyahu told his cabinet on Sunday that his government "will carry on building in Jerusalem and in all the places on the map of Israel's strategic interests".

But while his housing minister has said the government would soon invite bids from contractors to build 1,000 homes for Israelis in East Jerusalem and more than 1,000 in West Bank settlement blocs, the E1 plan is still in its planning stages.

"No one will build until it is clear what will be done there," the minister, Ariel Attias, said on Sunday.

Israel froze much of its activities in E1 under pressure from former U.S. President George W. Bush, and the area has been under the scrutiny of his successor, Barack Obama.

Most world powers consider Israel's settlements to be illegal. Israel cites historical and Biblical links to the West Bank and Jerusalem and regards all of the holy city as its capital, a claim that is not recognized internationally.

(Additional reporting by Crispian Balmer, Dan Williams, Nidal al-Mughrabi in Gaza, Jihan Abdalla in Ramallah, Steve Gutterman in Moscow, Gareth Jones in Berlin, John Irish and Elizabeth Pineau in Paris and Tim Castle in London; writing by Jeffrey Heller; editing by Philippa Fletcher)

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West Point Hosts First Same-Sex Marriages

By Julia Haskins

12/03/2012 at 12:35 PM EST

Brenda "Sue" Fulton and Penelope Gnesin

Jeff Sheng/Outserve-SLDN/AP

West Point Military Academy has made history by hosting the institution's first same-sex marriages. 

The 210-year-old Academy hosted the nuptials of Brenda "Sue" Fulton, a 53-year-old West Point graduate, and Penelope Gnesin, 52, at the Academy's Cadet Chapel on Dec. 1. "It was such a sacred, joyous day," Fulton told CNN. 

The chapel was the first place Fulton heard the Cadet Prayer – which includes the line, "make us to choose the harder right instead of the easier wrong" – and it resonated with her.

"As both Penny and I worked to support LGBT military people, those principles were always in front of us," Fulton said. "To be able to celebrate this with so many of our straight and gay military folks, bi and trans, was really overwhelming."

Prior to Fulton and Gnesin's ceremony, Army 1st Lt Ellen Schick and Shannon Simpson wed in West Point's original Old Cadet Chapel on Nov. 24. 

"Ellen is very proud to serve her country and wanted a military wedding," Simpson told OutServe Magazine. "We felt that we should be allowed the same opportunity to marry on a military post as any heterosexual military couple."

The marriages come after two major victories for the LGBT community. In 2011, New York legalized same-sex marriage and the military's "Don't Ask, Don't Tell" policy was repealed.

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Explainer: Why was pregnant duchess hospitalized?

LONDON (AP) — While morning sickness in pregnant women is common, the problem the Duchess of Cambridge has been hospitalized with is not.

In a statement Monday, palace officials said she was hospitalized with hyperemesis gravidarum, a potentially dangerous type of morning sickness where vomiting is so severe no food or liquid can be kept down. Palace officials said the duchess was expected to remain hospitalized for several days and would require a period of rest afterwards.

"It's not unusual for pregnant women to get morning sickness, but when it gets to the point where you're dehydrated, losing weight or vomiting so much you begin to build up (toxic) products in your blood, that's a concern," said Dr. Kecia Gaither, director of maternal fetal medicine at Brookdale University and Medical Center in New York.

The condition is thought to affect about one in 50 pregnant women and tends to be more common in young women, women who are pregnant for the first time, those expecting multiple babies and in non-smokers. Gaither said that fewer than one percent of women with the condition need to be hospitalized.

Doctors aren't sure what causes it but suspect it could be linked to hormonal changes or nutritional problems.

Women admitted to the hospital with hyperemesis gravidarum are usually treated with nutritional supplements and given fluids intravenously to treat dehydration. Dr. Dagni Rajasingam, a spokeswoman for the Royal College of Obstetricians and Gynaecologists, said most women hospitalized with the condition are discharged within several days.

"It depends on how well the woman is keeping fluids down," she said.

If the problem is recognized and treated early, doctors say there are no long-term effects for either the mother or the child. Left untreated, the mother could be at risk of developing neurological problems — including seizures — or risk delivering the baby early.

Gaither said the condition usually subsides by the second trimester.

"The rest of the pregnancy could be entirely uneventful," she said, adding that pregnant women treated for the condition are usually advised to avoid fatty foods that could aggravate the problem.

Gaither said the duchess would probably be able to meet her usual royal obligations by her second trimester.

"She should be able to meet all her public obligations soon," she said, advising her to take her vitamins and ensure there are no other underlying health problems. "She should just be looking forward to having a healthy little plump person."

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Wall Street turns flat as U.S. factory data offsets China

NEW YORK (Reuters) - Stocks barely budged on Monday, with the S&P 500 and Nasdaq trimming early gains as disappointing U.S. factory numbers dented optimism spurred by positive data on China's economy.

Output by China's factories grew in November for the first time in more than a year, data showed. But that encouraging signal about the health of the world's second-largest economy was offset by a surprising contraction in U.S. manufacturing, which fell in November to its lowest level in more than three years, according to the Institute for Supply Management.

The market's reaction to the ISM data was somewhat muted, however, as concerns about budget dealings in Washington on the "fiscal cliff" remain the primary focus of investors. Political haggling continues over how to deal with large automatic spending cuts and tax hikes scheduled to kick in next year that could tip the U.S. economy back into recession.

"At this point, all you can say about the data is they are discounting it," said Paul Mendelsohn, chief investment strategist at Windham Financial Services in Charlotte, Vermont.

"So barring some catastrophe here in terms of the fiscal cliff, we look pretty stable."

Among other factors serving to offset the ISM report were two developments in the euro zone: Spain formally requested the disbursement of more than $50 billion of European funds to recapitalize its crippled banking sector, while Greece said it would spend 10 billion euros ($13 billion) to buy back bonds in a bid to reduce its ballooning debt.

The PHLX Europe sector index <.xex> advanced 0.6 percent.

"The general feeling underneath here is things are improving - Europe appears to be improving, at least politically getting their act together," Mendelsohn said.

The Dow Jones industrial average <.dji> shed 10.45 points, or 0.08 percent, to 13,015.13. The Standard & Poor's 500 Index <.spx> inched up just 0.62 of a point, or 0.04 pct to 1,417.80. The Nasdaq Composite Index <.ixic> added 3.68 points, or 0.12 percent, to 3,013.92.

The S&P 500 briefly moved above its 50-day moving average at about 1,420, a level that the index has been below since October 22, and now serving as a key resistance point for equities.

U.S. Treasury Secretary Timothy Geithner pushed Republicans on Sunday to offer specific ideas to cut the deficit and predicted that they would agree to raise tax rates on the rich to obtain a year-end deal to avoid the fiscal cliff.

Dell shares rose 5.8 percent to $10.19 as one of the biggest percentage gainers in both the S&P 500 and Nasdaq 100 <.ndx> after Goldman Sachs upgraded its view on the stock to "buy" from "sell."

Singapore Airlines said it was in talks with interested parties to sell its 49 percent stake in British carrier Virgin Atlantic, with sources saying that Delta Air Lines was among the potential suitors. Delta shares fell 1.8 percent to $9.82.

(Reporting by Chuck Mikolajczak; Editing by Kenneth Barry and Jan Paschal)

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Islamist protest shuts down Egypt's top court

CAIRO (Reuters) - Protests by Islamists allied to President Mohamed Mursi forced Egypt's highest court to adjourn its work indefinitely on Sunday, intensifying a conflict between some of the country's top judges and the head of state.

The Supreme Constitutional Court said it would not convene until its judges could operate without "psychological and material pressure", saying protesters had stopped the judges from reaching the building.

Several hundred Mursi supporters had protested outside the court through the night ahead of a session expected to examine the legality of parliament's upper house and the assembly that drafted a new constitution, both of them Islamist-controlled.

The cases have cast a legal shadow over Mursi's efforts to chart a way out of a crisis ignited by a November 22 decree that temporarily expanded his powers and led to nationwide protests.

The court's decision to suspend its activities appeared unlikely to have any immediate impact on Mursi's drive to get the new constitution passed in a national referendum on December 15.

Three people have been killed and hundreds wounded in protests and counter-demonstrations over Mursi's decree.

At least 200,000 of Mursi's supporters attended a rally at Cairo University on Saturday. His opponents are staging an open-ended sit-in in Cairo's Tahrir Square, the cradle of the uprising that toppled Hosni Mubarak in February 2011.

Mursi and the Muslim Brotherhood, which propelled him to power in a June election, hope to end the crisis by pushing through the new constitution hastily adopted by the drafting assembly on Friday. The next day the assembly handed the text to Mursi, who called the referendum and urged Egyptians to vote.

"The Muslim Brotherhood is determined to go ahead with its own plans regardless of everybody else. There is no compromise on the horizon," said Hassan Nafaa, a professor of political science at Cairo University.

Outside the Supreme Constitutional Court, Muslim Brotherhood supporters rallied behind the referendum date. "Yes to the constitution", declared a banner held aloft by one protester. Chants demanded the "purging of the judiciary".

The interior minister told the head of the court that the building was accessible and the protests were peaceful, according a statement from the ministry.

The protest reflected the deep suspicion harbored by Egypt's Islamists towards a court they see as a vestige of the Mubarak era. The same court ruled in June to dissolve the Muslim Brotherhood-led lower house of parliament.

Since then, several legal cases have challenged the legitimacy of the upper house of parliament and the 100-member constituent assembly that wrote the constitution.

Those against the upper house have focused on the legality of the law by which it was elected, while the constitutional assembly has faced a raft of court cases alleging that the way it was picked was illegal.

STOCK MARKET RALLIES

Mursi believes that securing approval for the new constitution in a popular referendum will bury all arguments on the legality of the constituent assembly, as well as controversy over the text it worked through the night to finish on Friday.

It will also override the November 22 decree that prompted statements of concern from Western governments and a rebellion by sections of the judiciary that saw it as a threat to their role. The decree shielded Mursi from judicial oversight.

Judges supervise voting in Egypt, so Mursi now needs them to oversee the referendum. Vice President Mahmoud Mekky said on Sunday he was confident the judges would perform that role, though Mursi's critics in the judiciary may call for a boycott.

While the Islamists' critics, including representatives of the Christian minority, have accused the Brotherhood of trying to hijack the constitution, investors appear to have seen Mursi's moves as a harbinger of stability. They were also relieved that Saturday's mass Islamist protest went off calmly.

The main stock market index, which lost a tenth of its value in response to Mursi's November 22 decree, rallied more than 2 percent when the market opened on Sunday.

"The events that took place through the weekend, from the approval of the final draft of the constitution and the president calling a referendum, gave some confidence to investors that political stability is on track," said Mohamed Radwan of Pharos Securities, an Egyptian brokerage.

But the political opposition, made up of leftist, liberal and socialist parties, have been infuriated by what they see as the Brotherhood's attempt to ram through a constitution that does not enjoy national consensus.

Mursi's opponents warn of deeper polarization ahead.

"LET EVERYONE HAVE THEIR SAY"

Leading opposition figure Mohamed ElBaradei said on Twitter that the "struggle will continue" over a draft constitution that "undermines basic freedoms".

Liberal figures, including former Arab League chief Amr Moussa, pulled out of the constituent assembly last month, as did Christian representatives.

The draft constitution contains Islamist-flavored language which opponents say could be used to whittle away human rights and stifle criticism. It forbids blasphemy and "insults to any person", does not explicitly uphold women's rights and demands respect for "religion, traditions and family values".

The New York-based Human Rights Watch said it protected some rights while undermining others.

The text limits presidents to two four-year terms, requires parliamentary approval for their choice of prime minister, and introduces some civilian oversight of the military - although not enough for critics. Mubarak ruled for three decades.

Mursi described it as a constitution that fulfilled the goals of the January 25, 2011 revolution that ended Mubarak's rule. "Let everyone - those who agree and those who disagree - go to the referendum to have their say," he said.

The Islamists are gambling that they will be able to secure a "yes" vote by mobilizing their core support base and many other Egyptians keen for an end to two years of turmoil that has taken a heavy toll on the economy.

Nafaa of Cairo University said the constitution would likely be approved by a slim majority. "But in this case, how can you run a country with a disputed constitution - a constitution not adopted by consensus?" he asked.

(Writing by Tom Perry; Editing by Alistair Lyon)

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Verizon may soon launch Samsung Galaxy Camera with 4G LTE

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Larry Hagman, Boy Meets World Re-Boot Get Top Reactions This Week

12/02/2012 at 12:25 PM EST

Danielle Fishel and Ben Savage; Larry Hagman

Everett, Hulton Archive/Getty

It was a post-Thanksgiving week of delightful highs and solemn lows. From the passing of favorite actors to confusion over the recent Two and a Half Men drama, this week's stories left you experiencing a whirlwind of emotions on PEOPLE.com.

As always, you've been reacting in droves, telling us what you love, what makes you mad and what leaves you to LOL.

Check out the stories with top reactions on the site this week, and keep clicking on the emoticons at the bottom of every story to tell us what you think!

Nostalgic readers loved the promise of a Boy Meets World spinoff getting the green light. Fans of the original show were thrilled to see that Ben Savage and Danielle Fishel will film for the Girl Meets World pilot.

The entertainment world lost some beloved members this week. Larry Hagman, best known as J.R. Ewing on Dallas, lost his battle with throat cancer at 81. Deborah Raffin of 7th Heaven also succumbed to leukemia at 59.

Celebrities are often ridiculed for giving their children bizarre names, but the Jameson family may have outdone them all by naming their baby girl "Hashtag". You agreed: Leave social media terms to the Internet.

Readers weren't sure what to make of Angus T. Jones's shocking rant about his show, Two and a Half Men. By calling the CBS sitcom "filth," and urging viewers to stop watching, Jones is said to be remaining with the program.

News of Demi Moore's new beau had readers snickering. But Moore, who is no stranger to dating younger men, seems to have no issue with dating 26-year-old art dealer Vito Schnabel.

Check back next week for another must-read roundup, and see what readers are reacting to every day here.

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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