Study: Drug coverage to vary under health law


WASHINGTON (AP) — A new study says basic prescription drug coverage could vary dramatically from state to state under President Barack Obama's health care overhaul.


That's because states get to set benefits for private health plans that will be offered starting in 2014 through new insurance exchanges.


The study out Tuesday from the market analysis firm Avalere Health found that some states will require coverage of virtually all FDA-approved drugs, while others will only require coverage of about half of medications.


Consumers will still have access to essential medications, but some may not have as much choice.


Connecticut, Virginia and Arizona will be among the states with the most generous coverage, while California, Minnesota and North Carolina will be among states with the most limited.


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Online:


Avalere Health: http://tinyurl.com/d3b3hfv


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Deal brings end to L.A., Long Beach ports strike









Clerical workers at the ports of Los Angeles and Long Beach will return to work Wednesday, ending a strike that crippled America's busiest shipping hub for more than a week.


Leaders of the 800-member International Longshore and Warehouse Union Local 63 Office Clerical Unit agreed to a tentative deal after marathon negotiations that ended late Tuesday. The deal will not become final until it is ratified by the full union membership.


It ends a grueling battle between both sides that threatened to damage the fragile U.S. economy. Since the strike began, 20 ships diverted to rival ports in Oakland, Ensenada and Panama, while other freighters docked offshore waiting for a resolution.





"This was at a critical juncture," said Jack O'Connell, an international trade economist. "The national economy is still trying to get on its feet and this strike would have been decidedly unhelpful. There are enough head winds out there already."


The deal came after Los Angeles Mayor Antonio Villaraigosa called in two federal mediators Tuesday morning to try and break the impasse. That pushed the unions into a quicker deal, fearing a loss of influence and negotiating power once the mediators took over.


For Villaraigosa, a former union leader before going into politics, the tentative agreement was seen as a victory. "Mission accomplished. This has been a long eight days, but it's a great day for everybody now that a deal has been reached," Villaraigosa said in announcing a deal.


The strike began Nov. 27 as the clerical workers' union voiced frustration about shipping line employers outsourcing jobs, an accusation the Harbor Employers Assn. has denied.


Though the union is small, it was backed by the 10,000 regional members of the ILWU, which honored the picket line and refused to work. By the end, the strike shut down 10 of the 14 cargo container terminals at the nation's busiest seaport complex.


The port employers had been pushing for mediation since last week. Clerical workers agreed only after Villaraigosa intervened.


Both union and harbor employers spent most of Tuesday huddled inside a community center near the port.


The mediators joined Villaraigosa there at about 8:30 p.m. as negotiators for the union were voting behind closed doors.


"When unions are weak, they badly want mediators, and when they are strong, they sometimes don't," said Nelson Lichtenstein, who directs the Center for the Study of Work, Labor and Democracy at UC Santa Barbara. "This was a sign that the union felt it was dealing from a position of strength."


The dispute wasn't about wages or benefits. It centered on the claim by the union that employers have steadily outsourced jobs through attrition.


The union says the employers have transferred work from higher-paid union members to lower-paid employees in other states and countries.


"Tonight is the end of a very long journey," said Steve Berry, lead negotiator for the Los Angeles and Long Beach Harbor Employers Assn.


Berry said there will be "no outsourcing under this contract."


Berry said the package included unspecified wage and pension increases. He also said there was added job security to the deal, that included a "no layoff" clause that would go into effect once ratified.


The contract will last for six years, and is retroactive to June 30, 2010. It will be set to expire on June 30, 2016.


Few other details of the agreement were revealed by either side or the mayor.


However, during the last few days, salary has been one major bargaining point.





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Pakistan’s Hazara Shiites Under Siege


Declan Walsh/The New York Times


Many members of the Hazara Shiite community killed by Sunni extremists are buried in a graveyard in Quetta, Pakistan.







QUETTA, Pakistan — Calligraphers linger at the gates of an ancient graveyard in this brooding city in western Pakistan, charged with a macabre and increasingly in-demand task: inscribing the tombstones of the latest victims of the sectarian death squads that openly roam these streets.




For at least a year now, Sunni extremist gunmen have been methodically attacking members of the Hazara community, a Persian-speaking Shiite minority that emigrated here from Afghanistan more than a century ago. The killers strike with chilling abandon, apparently fearless of the law: shop owners are gunned down at their counters, students as they play cricket, pilgrims dragged from buses and executed on the roadside.


The latest victim, a mechanic named Hussain Ali, was killed Wednesday, shot inside his workshop. He joined the list of more than 100 Hazaras who have been killed this year, many in broad daylight. As often as not, the gunmen do not even bother to cover their faces.


The bloodshed is part of a wider surge in sectarian violence across Pakistan in which at least 375 Shiites have died this year — the worst toll since the 1990s, human rights workers say. But as their graveyard fills, Hazaras say the mystery lies not in the identity of their attackers, who are well known, but in a simpler question: why the Pakistani state cannot — or will not — protect them.


“After every killing, there are no arrests,” said Muzaffar Ali Changezi, a retired Hazara engineer. “So if the government is not supporting these killers, it must be at least protecting them. That’s the only way to explain how they operate so openly.”


The government, already battling Taliban insurgents, insists it is taking the threat seriously. During the recent Mourning of Muhurram, when Shiites parade through the streets over 10 days, the Interior Ministry imposed stringent security measures such as blocking cellphone signals for up to 12 hours — to try to prevent remote bomb detonations — and banning doubled-up motorcycle riding. Even so, Sunni bombers struck at least five times, killing at least 50 Shiites and wounding several hundred. The Pakistani Taliban claimed responsibility for the biggest attacks, highlighting an emerging link between that group and traditional sectarian militants that has worried many.


Yet the unchecked killings have also raised wider questions about Pakistani society: about the spread of a cancerous sectarian ideology in a public that even just a decade ago seemed more tolerant, and about what might be spurring the growing audacity of the killers, some of whom are believed to have links to the country’s security services.


The murders in Quetta, for instance, involve remarkably little mystery. By wide consensus, the gunmen are based in Mastung, a dusty agricultural village 18 miles to the south that is the bustling local hub of Lashkar-e-Jhangvi, the country’s most notorious sectarian militant group.


Like so many Pakistani groups that combine guns with zealotry, Lashkar-e-Jhangvi thrives in a wink-and-nod netherworld: it is officially banned, but its leader, Malik Ishaq, was released from jail last year amid showers of rose petals thrown by supporters. Now Mr. Malik lives openly in southern Punjab Province, protected by armed men who loiter outside his door, allowing him to deliver hate-laced statements to visitors. Shiites are “the greatest infidels on earth,” he told a Reuters reporter last month.


In Quetta, his followers are similarly unfettered. In targeting the Hazara — who, with their distinctive Central Asian features, are easy to pick out — Lashkar-e-Jhangvi militants block busy highways as they search vehicles for Hazaras and daub walls with hate slogans. “The face is the target,” said Major Nadir Ali, a senior Hazara leader and retired army officer. “They see the face, then they shoot.”


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Facebook voting begins on Instagram data-sharing, email privacy












SAN FRANCISCO (Reuters) – Facebook Inc opened the polls on Monday for its roughly 1 billion users to vote on a variety of changes to the social network‘s policies, including a proposal to scrap the user voting system that Facebook introduced in 2009.


Facebook also said it had “clarified” some of the proposed changes, specifying that a new policy allowing it to share user data with recently acquired photo-application Instagram will be carried out in compliance with applicable laws and that Facebook will seek user consent when necessary.












The proposed changes, which Facebook announced on November 21, generated roughly 89,000 user comments as well as concerns from some privacy-advocacy groups and a request for more information from the Data Protection Commission in Ireland, where Facebook’s European business has its headquarters.


“Based on your feedback and after consultation with our regulators, including the Irish Data Protection Commissioner‘s Office, we’ve further clarified some of our proposals,” said Elliot Schrage, Facebook Vice President of Communications, Public Policy and Marketing in a post on Facebook’s company blog on Monday.


Facebook is proposing to eliminate the 4-year-old system that allows users to vote on changes to its governance policies. The company says the voting system hasn’t functioned as intended and is no longer suited to its current situation as a large publicly traded company subject to oversight by various regulatory agencies.


Facebook said on Monday that it would incorporate user suggestions for creating new tools to “enhance communication” on privacy and governance matters.


Another proposal would loosen the restrictions on how members of the social network can contact other members using the Facebook email system. The company said it planned to replace the “Who can send you Facebook messages” setting with new filters for managing incoming messages.


Facebook’s potential information sharing with Instagram, a photo-sharing service for smartphone users that it bought in October, flows from proposed changes that would allow the company to share information between its own service and other businesses or affiliates it owns.


The change could open the door for Facebook to build unified profiles of its users that include people’s personal data from its social network and from Instagram, similar to recent moves by Google Inc.


Facebook said on Monday that the proposed change was “standard in the industry” and “promotes the efficient and effective use of the services Facebook and its affiliates,” such as allowing users in the U.S. to interact with users in Europe.


“This provision covers Instagram and allows us to store Instagram’s server logs and administrative records in a way that is more efficient than maintaining totally separate storage systems,” the company wrote in a separate post on its website Monday titled “explanation of changes”.


“Where additional consent of our users is required, we will obtain it,” Facebook said.


Facebook users have until December 10 to vote on the policies using a special third-party application provided by Facebook and Facebook said the results will be certified by an independent auditor.


The vote is only binding if at least 30 percent of users take part, and two prior votes never reached that threshold.


(Reporting By Alexei Oreskovic; editing by Andrew Hay)


Tech News Headlines – Yahoo! News


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Fossil fuel subsidies in focus at climate talks


DOHA, Qatar (AP) — Hassan al-Kubaisi considers it a gift from above that drivers in oil- and gas-rich Qatar only have to pay $1 per gallon at the pump.


"Thank God that our country is an oil producer and the price of gasoline is one of the lowest," al-Kubaisi said, filling up his Toyota Land Cruiser at a gas station in Doha. "God has given us a blessing."


To those looking for a global response to climate change, it's more like a curse.


Qatar — the host of U.N. climate talks that entered their final week Monday — is among dozens of countries that keep gas prices artificially low through subsidies that exceeded $500 billion globally last year. Renewable energy worldwide received six times less support — an imbalance that is just starting to earn attention in the divisive negotiations on curbing the carbon emissions blamed for heating the planet.


"We need to stop funding the problem, and start funding the solution," said Steve Kretzmann, of Oil Change International, an advocacy group for clean energy.


His group presented research Monday showing that in addition to the fuel subsidies in developing countries, rich nations in 2011 gave more than $58 billion in tax breaks and other production subsidies to the fossil fuel industry. The U.S. figure was $13 billion.


The Paris-based Organization for Economic Cooperation and Development has calculated that removing fossil fuel subsidies could reduce carbon emissions by more than 10 percent by 2050.


Yet the argument is just recently gaining traction in climate negotiations, which in two decades have failed to halt the rising temperatures that are melting Arctic ice, raising sea levels and shifting weather patterns with impacts on droughts and floods.


In Doha, the talks have been slowed by wrangling over financial aid to help poor countries cope with global warming and how to divide carbon emissions rights until 2020 when a new planned climate treaty is supposed to enter force. Calls are now intensifying to include fossil fuel subsidies as a key part of the discussion.


"I think it is manifestly clear ... that this is a massive missing piece of the climate change jigsaw puzzle," said Tim Groser, New Zealand's minister for climate change.


He is spearheading an initiative backed by Scandinavian countries and some developing countries to put fuel subsidies on the agenda in various forums, citing the U.N. talks as a "natural home" for the debate.


The G-20 called for their elimination in 2009, and the issue also came up at the U.N. earth summit in Rio de Janeiro earlier this year. Frustrated that not much has happened since, European Union climate commissioner Connie Hedegaard said Monday she planned to raise the issue with environment ministers on the sidelines of the talks in Doha.


Many developing countries are positive toward phasing out fossil fuel subsidies, not just to protect the climate but to balance budgets. Subsidies introduced as a form of welfare benefit decades ago have become an increasing burden to many countries as oil prices soar.


"We are reviewing the subsidy periodically in the context of the total economy for Qatar," the tiny Persian gulf country's energy minister, Mohammed bin Saleh al-Sada, told reporters Monday.


Qatar's National Development Strategy 2011-2016 states it more bluntly, saying fuel subsides are "at odds with the aspirations" and sustainability objectives of the wealthy emirate.


The problem is that getting rid of them comes with a heavy political price.


When Jordan raised fuel prices last month, angry crowds poured into the streets, torching police cars, government offices and private banks in the most sustained protests to hit the country since the start of the Arab unrest. One person was killed and 75 others were injured in the violence.


Nigeria, Indonesia, India and Sudan have also seen violent protests this year as governments tried to bring fuel prices closer to market rates.


Iran has used a phased approach to lift fuel subsidies over the past several years, but its pump prices remain among the cheapest in the world.


"People perceive it as something that the government is taking away from them," said Kretzmann. "The trick is we need to do it in a way that doesn't harm the poor."


The International Energy Agency found in 2010 that fuel subsidies are not an effective measure against poverty because only 8 percent of such subsidies reached the bottom 20 percent of income earners.


The IEA, which only looked at consumption subsidies, this year said they "remain most prevalent in the Middle East and North Africa, where momentum toward their reform appears to have been lost."


In the U.S., environmental groups say fossil fuel subsidies include tax breaks, the foreign tax credit and the credit for production of nonconventional fuels.


Industry groups, like the Independent Petroleum Association of America, are against removing such support, saying that would harm smaller companies, rather than the big oil giants.


In Doha, Mohammed Adow, a climate activist with Christian Aid, called all fuel subsidies "reckless and dangerous," but described removing subsidies on the production side as "low-hanging fruit" for governments if they are serious about dealing with climate change.


"It's going to oil and coal companies that don't need it in the first place," he said.


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Associated Press writers Abdullah Rebhy in Doha, Qatar, and Brian Murphy in Dubai, United Arab Emirates, contributed to this report


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Karl Ritter can be reached at www.twitter.com/karl_ritter


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Chino Hills seeks to close home used by pregnant Chinese women









A Chino Hills residence allegedly housing women from China who want to give birth to U.S.-citizen children is on the verge of being shut down by the city after complaints about traffic and a sewage spill.


The home is on a hilltop at the end of a long driveway on Woodglen Drive, an area zoned for single family houses. City officials have issued a cease and desist order, alleging that the site is being used as a hotel in a rural residential zone. They plan to take the property owner to court.


"Who the customer base is, is not our concern," said city spokeswoman Denise Cattern. "Our concern is that it's a hotel."








A website that city officials believe is associated with the business describes a full range of services, from shopping trips for pregnant women to assistance obtaining American passports for newborns.


A 30-day stay at the Chino Hills facility, along with a month of prenatal care, costs $10,500 to $11,500, according to the Chinese-language website, www.asiamchild.com.


Asiam Child is based in Shanghai, with branches in Anhui province and Nanjing, the website says.


The property owner, Hai Yong Wu, did not return a call seeking comment. A man who left the hotel in a black BMW on Monday afternoon would not speak to reporters.


So-called birth tourism appears to be an active but largely under-the-radar industry in Southern California. One local Chinese phone book has five pages of listings for birthing centers, where women from China and Taiwan stay for a month or so before going home with their U.S.-citizen babies. When the children get older, they may return here to study, perhaps paving the way for the rest of the family to immigrate more easily.


In San Gabriel last year, code enforcement officials shut down a facility where about 10 mothers and seven newborns were staying.


Federal immigration officials say there is no law prohibiting pregnant women from entering the U.S. But obtaining a visa through fraud would be a crime, said Virginia Kice, a spokeswoman for U.S. Immigration and Customs Enforcement.


Chino Hills officials have notified federal authorities about the residence. Kice said she could not confirm whether ICE is investigating.


Neighbors report seeing groups of pregnant women walking along the quiet cul de sac. Cars from the residence sometimes drive down the street at unsafe speeds, they said.


In addition to the single-family zoning violation, the city has cited the owner for allegedly constructing additional rooms without a permit. A sewage spill estimated at 2,000 gallons also prompted a cease and desist order.


"It would be nice to have my neighborhood back. It was a quiet little street," said neighbor Sonya Valez.


On Saturday, a group called Not in Chino Hills staged a street-corner protest against the site.


"They go back," said Rossana Mitchell, a co-founder of the group. "They don't pay taxes, they don't assimilate."


cindy.chang@latimes.com





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Young and Educated in France Find Employment Elusive


Colin Delfosse for The New York Times


Justine Forriez, 23, holds a master’s degree in health administration. But after an apprenticeship, she is living on state aid and working at off-the-books jobs.







LILLE, France — Justine Forriez wakes up early to go onto the computer to look for a job. She calls university friends and contacts; she goes to the unemployment office every week, though mostly for the companionship, and has taken a course in job hunting. She has met with 10 different recruiters since May and sent out 200 résumés.




Ms. Forriez is not poor or disadvantaged, and she holds a master’s degree in health administration. But after a two-year apprenticeship, she is living on state aid and working at off-the-books jobs like baby-sitting and tending bar. She cares for a dog for $6.50 a day. She paints watercolors in her spare time to keep herself from going crazy.


“I don’t feel at ease when I’m home,” she said. “You find yourself with no work, no project.” With the extra $45 for dog sitting, she said, “I can go to the grocery store.”


Ms. Forriez, 23, is part of a growing problem in France and other low-growth countries of Europe — the young and educated unemployed, who go from one internship to another, one short-term contract to another, but who cannot find a permanent job that gets them on the path to the taxpaying, property-owning French ideal that seemed the norm for decades.


This is a “floating generation,” made worse by the euro crisis, and its plight is widely seen as a failure of the system: an elitist educational tradition that does not integrate graduates into the work force, a rigid labor market that is hard to enter, and a tax system that makes it expensive for companies to hire full-time employees and both difficult and expensive to lay them off.


The result, analysts and officials agree, is a new and growing sector of educated unemployed, whose lives are delayed and whose inability to find good jobs damages tax receipts, pension programs and the property market. There are no separate figures kept for them, but when added to the large number of unemployed young people who have little education or training, there is a growing sense that France and other countries in Western Europe risk losing a generation, further damaging prospects for sustainable economic growth.


Louise Charlet, 25, has a master’s degree in management. She worked as an apprentice at the Kiabi clothing company for more than two years, but was not given a permanent job; she’s also worked for three months at a hotel here. She prowls the Internet for job offers, goes to the unemployment office and lives with her unemployed boyfriend in a neat, tiny apartment. “You see,” she said, pointing to the computer, “there’s only one job offer today, and it’s a temporary contract.”


The crisis makes companies doubly reluctant to hire, she said. “In our parents’ generation, you had a job for life; now we constantly have to change jobs, change companies, change regions.”


Yasmine Askri, 26, majored in human resources, and after a year of unemployment, she got a business school degree. She was promised a fixed contract after an internship, but it never came. She left the Lille area for Paris to find a job, and spent another year on unemployment, finally finding an interim job for 18 months at GDF Suez. But that contract ended in June. Again unemployed, she has sent out nearly 400 résumés, she said, but has had only three interviews.


“It’s a disaster for everyone,” said Jean Pisani-Ferry, who runs the economic research center Bruegel in Brussels. “They can’t get credit, and they’re treated awfully by employers. And then there are all those young people in jobs that don’t match their skills.” The labor market, he said, is “deeply dysfunctional.”


Throughout the European Union, unemployment among those aged 15 to 24 is soaring — 22 percent in France, 51 percent in Spain, 36 percent in Italy. But those are only percentages among those looking for work. There is another category: those who are “not in employment, education or training,” or NEETs, as the Organization for Economic Cooperation and Development calls them. And according to a study by the European Union’s research agency, Eurofound, there are as many as 14 million out-of-work and disengaged young Europeans, costing member states an estimated 153 billion euros, or about $200 billion, a year in welfare benefits and lost production — 1.2 percent of the bloc’s gross domestic product.


Maïa de la Baume and Stefania Rousselle contributed reporting from Paris and Lille.



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U.S. election, iPhone 5, Kardashian top Yahoo! 2012 searches












LOS ANGELES (Reuters) – The U.S. presidential election became the most-searched item and Kim Kardashian was the most-searched person on Yahoo! in a year when online searches were dominated by big news stories and pop culture obsessions, the search engine company said on Monday.


The search term “election” topped the list of searches, led not only by extensive media coverage but also widening conversation on online social media platforms.












The term “political polls” was No. 8 of the top 10 Yahoo! searches of the year.


“The 2012 elections dominated the online searches, which is amazing because if something is in the news, it’s already accessible … people were really saturated by it, but even so, that was a key word that people typed throughout the year,” Vera Chan, Yahoo!’s web trend analyst, said in a conference call.


Chan said only two other news stories have topped the list in the past decade, those being the death of Michael Jackson in 2009 and the BP oil spill in 2010.


“iPhone 5″ came in at No. 2, which Chan said was interesting “in a post-Steve Jobs era” because while Apple Inc’s iPhone has featured regularly in the top searches since the first generation emerged in 2007, this was the first time a specific model had appeared high on the list.


Reality star Kim Kardashian was the most-searched person on the website, coming in at No. 3 and leading six famous women in the top 10.


Chan said Kardashian’s “notoriety has kept her at the top,” citing her ongoing divorce saga with ex-husband Kris Humphries, her high-profile relationship with rapper Kanye West and her E! channel reality shows.


Sports Illustrated cover model Kate Upton, British royal Kate Middleton, late singer Whitney Houston, troubled former child star Lindsay Lohan and pop star and former “American Idol” judge Jennifer Lopez all featured in the top 10 after being in the news prominently throughout the year.


Middleton, who was followed eagerly by fans and critics in her first year as a royal married to Britain’s Prince William and being a staple at the London Olympics and the Queen’s Diamond Jubilee, also garnered the most-searched scandal of the year when a French magazine published photos of her topless.


“olympics” came in at No. 7 on the list, as many turned to online media to watch and keep tabs on the global sporting event held in London during the summer.


On Yahoo!’s separate list of top-searched obsessions, pop culture dominated this year, with “The Hunger Games,” reality star Honey Boo Boo, erotic novel “Fifty Shades of Grey,” British boy band One Direction, Carly Rae Jepsen’s hit song “Call Me Maybe” and Korean rapper Psy’s “Gangnam Style” featuring in the top 10.


Yahoo! Inc compiles its annual search lists based on aggregated visitor activity on the network and billions of consumer searches.


(Editing by Eric Walsh)


Internet News Headlines – Yahoo! News


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Kellan Lutz, Hugh Jackman Take Bites and Swipes & More Casting News















12/02/2012 at 07:00 PM EST







Kellan Lutz (left) and Hugh Jackman


Christopher Polk/Getty, Han Myung-Gu/WireImage


It's comeback time. Whether seeking revenge or reprising beloved roles, a fresh crop of movies shows that the best characters always come back for more.

Twilight's Kellan Lutz feasts on others as a vampire, but this time, he's utilizing his own body for powers, Zimbio reports.

The actor will star in Tatua as a tattooed assassin whose weapons are extracted from the ink on his body. The process is a strain on the hit man, but he must put that aside when his son is kidnapped by a dangerous foe.

Hugh Jackman is set to reprise his role as Wolverine in
X-Men: Days of Future Past, the Hollywood Reporter. Ian McKellen (Magneto) and Patrick Stewart (Professor Xavier), will also be joining Jennifer Lawrence, James McAvoy, Michael Fassbender and Nicholas Hoult.

Charlize Theron will star in an adaptation of the final installment of a South Korean revenge trilogy, the Hollywood Reporter also says. The original movie revolves around a woman wrongfully imprisoned for 13 years who then sets out to seek her long-awaited revenge. Writer William Monahan says the English-language remake will be "very American – and very unexpected."

The made-for-TV Disney channel movie Life-Size is getting a sequel, Variety reports. Tyra Banks will reprise her role as Eve, the doll who comes to life, and also executive produce the movie. No word yet on whether Lindsay Lohan, who played Eve's owner, will be making a return.

Also coming soon:

Beyoncé won't be slowing down after her Super Bowl performance in February. Just a couple weeks later, she'll introduce her still untitled, feature-length documentary on HBO, Deadline reports. The documentary airs Feb. 16.

Bridesmaids' Rose Byrne will be going through the motions as a newlywed in I Give it a Year, Zimbio reports. As if being newly married wasn't tough enough, the "too perfect" ex Anna Faris will be shaking up an already teetering balance.

Cate Blanchett will be stirring up her wicked ways as the evil stepmother in a live-action adaptation of Disney's Cinderella, also according to Zimbio.

And George Clooney is sticking to his winning formula by joining forces with his Argo team to produce an untitled crime drama, Variety reports.

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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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