Let the debate end: Grammy noms anybody's guess

NASHVILLE, Tenn. (AP) — It's a brutal year to be in the Grammy nominations handicapping game.

Sure, there are a few safe bets. Mumford & Sons and Frank Ocean are expected to take a share of nominations when they're announced Wednesday night on national television during "The Grammy Nominations Concert Live!" in Nashville.

And popular songs by Gotye, fun., Taylor Swift and Carly Rae Jepsen may land those artists on the list as well, though Jepsen harbors some doubt her omnipresent song "Call Me Maybe" will net a nod.

"I would be so shocked," the 27-year-old singer said last week. "But this year has taught me to look forward to surprises and just be ready for anything. So, cross your fingers for me."

Viral songs like Jepsen's seemed to be the theme of the year, and with no watershed albums during the nominating period for the 2013 Grammys like Adele's "21" or Kanye West's "My Beautiful Dark Twisted Fantasy," it's not clear who will turn out as this year's top nominee.

Thus the guessing game.

The Grammy nominations period ended Sept. 30 and three of the year's top four debuting albums — from Swift, One Direction and Jason Aldean — came after that date. Rihanna also released a new album after the period ended. All could have songs nominated, but a popular album is the quickest way to accumulate multiple nods.

Mumford & Sons slipped in just under the deadline. Introduced to much of their burgeoning fan base through a 2011 appearance on the Grammys, the British folk-rock band could return with a flourish after selling 600,000 copies of "Babel" in the first week of release and setting streaming records on Spotify.

And Ocean showed the kind of bravery that might be rewarded by The Recording Academy's voters when he announced in liner notes for his album "channel ORANGE" that he'd had a same-sex encounter, causing an industry-wide discussion of the issue.

Questions surround many of the other artists who might be considered sure bets, however. Gotye should be a lock in multiple categories, but his viral song "Somebody That I Used to Know," featuring Kimbra, wasn't submitted in the song of the year category because of a sample, eliminating one of its most viable prospects.

Others who might be considered possible top nominees like Drake and The Black Keys released their platinum-selling, hit-spawning albums late last year and they'll have to overcome short-term memory issues among voters.

Sean Garrett, a producer for artists like Usher and Beyonce with multiple Grammy nominations, said a lack of clear trends during the nominating period made it difficult to guess going into the show.

"It was sort of an iffy kind of year in my opinion," Garrett said in a phone interview. "I'm going to be honest: I think the politics kind of slowed the music down."

He expects pop stars like Jepsen, Bieber, Swift and Korean sensation PSY to take home nominations, but doesn't see an artist accumulating a high number of nominations. That could leave room for newer acts, including fun., one of his favorites.

"They have a very clever sound," Garrett said. "The lead singer (Nate Reuss) has an amazing, amazing voice. I feel like they just came with something that was a bit different. It was mainstream pop music and it had some edge to it. And there was great songwriting there."

Fun., with their anthemic hit "We Are Young," are among the night's performers, joining Maroon 5, Ne-Yo, Luke Bryan, The Who, Hunter Hayes and others.

"It just feels like we spent the last 12 years pulling back the arrow and this year we just let it go," fun. guitarist Jack Antonoff said. "This last year has been incredible and amazing and hard and I don't even know what it would have been like if we didn't have 10 or 12 years of experience because it still feels like we're learning everything for the first time."

The nominations show is being held outside Los Angeles for the first time in its five-year history. LL Cool J returns, co-hosting the show live on CBS at 10 p.m. EST from Bridgestone Arena with Swift.

It's the first official Grammy activity in Music City since 1973, when the late Johnny Cash kicked off the live broadcast. He'll figure into Wednesday night's as well when Dierks Bentley and The Band Perry pay tribute to the man in black.

"So we're going to do that as a tribute to Johnny, a tribute to Nashville, a tribute to country music, a tribute to being back here," longtime Grammy producer Ken Ehrlich said. "And I think it will be magical."

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AP Music Writer Mesfin Fekadu contributed to this report from New York City.

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http://grammy.com

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Longer tamoxifen use cuts breast cancer deaths

Breast cancer patients taking the drug tamoxifen can cut their chances of having the disease come back or kill them if they stay on the pills for 10 years instead of five years as doctors recommend now, a major study finds.

The results could change treatment, especially for younger women. The findings are a surprise because earlier research suggested that taking the hormone-blocking drug for longer than five years didn't help and might even be harmful.

In the new study, researchers found that women who took tamoxifen for 10 years lowered their risk of a recurrence by 25 percent and of dying of breast cancer by 29 percent compared to those who took the pills for just five years.

In absolute terms, continuing on tamoxifen kept three additional women out of every 100 from dying of breast cancer within five to 14 years from when their disease was diagnosed. When added to the benefit from the first five years of use, a decade of tamoxifen can cut breast cancer mortality in half during the second decade after diagnosis, researchers estimate.

Some women balk at taking a preventive drug for so long, but for those at high risk of a recurrence, "this will be a convincer that they should continue," said Dr. Peter Ravdin, director of the breast cancer program at the UT Health Science Center in San Antonio.

He reviewed results of the study, which was being presented Wednesday at a breast cancer conference in San Antonio and published by the British medical journal Lancet.

About 50,000 of the roughly 230,000 new cases of breast cancer in the United States each year occur in women before menopause. Most breast cancers are fueled by estrogen, and hormone blockers are known to cut the risk of recurrence in such cases.

Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors — sold as Arimidex, Femara, Aromasin and in generic form — do the job with less risk of causing uterine cancer and other problems.

But the newer drugs don't work well before menopause. Even some women past menopause choose tamoxifen over the newer drugs, which cost more and have different side effects such as joint pain, bone loss and sexual problems.

The new study aimed to see whether over a very long time, longer treatment with tamoxifen could help.

Dr. Christina Davies of the University of Oxford in England and other researchers assigned 6,846 women who already had taken tamoxifen for five years to either stay on it or take dummy pills for another five years.

Researchers saw little difference in the groups five to nine years after diagnosis. But beyond that time, 15 percent of women who had stopped taking tamoxifen after five years had died of breast cancer versus 12 percent of those who took it for 10 years. Cancer had returned in 25 percent of women on the shorter treatment versus 21 percent of those treated longer.

Tamoxifen had some troubling side effects: Longer use nearly doubled the risk of endometrial cancer. But it rarely proved fatal, and there was no increased risk among premenopausal women in the study — the very group tamoxifen helps most.

"Overall the benefits of extended tamoxifen seemed to outweigh the risks substantially," Dr. Trevor Powles of the Cancer Centre London wrote in an editorial published with the study.

The study was sponsored by cancer research organizations in Britain and Europe, the United States Army, and AstraZeneca PLC, which makes Nolvadex, a brand of tamoxifen, which also is sold as a generic for 10 to 50 cents a day. Brand-name versions of the newer hormone blockers, aromatase inhibitors, are $300 or more per month, but generics are available for much less.

The results pose a quandary for breast cancer patients past menopause and those who become menopausal because of their treatment — the vast majority of cases. Previous studies found that starting on one of the newer hormone blockers led to fewer relapses than initial treatment with tamoxifen did.

Another study found that switching to one of the new drugs after five years of tamoxifen cut the risk of breast cancer recurrence nearly in half — more than what was seen in the new study of 10 years of tamoxifen.

"For postmenopausal women, the data still remain much stronger at this point for a switch to an aromatase inhibitor," said that study's leader, Dr. Paul Goss of Massachusetts General Hospital. He has been a paid speaker for a company that makes one of those drugs.

Women in his study have not been followed long enough to see whether switching cuts deaths from breast cancer, as 10 years of tamoxifen did. Results are expected in about a year.

The cancer conference is sponsored by the American Association for Cancer Research, Baylor College of Medicine and the UT Health Science Center.

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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NASA lost in space, expert panel says

WASHINGTON (AP) -- NASA is adrift without a coherent vision for where it should be going, an independent panel of space, science and engineering experts says.

But the report by the National Academy of Sciences doesn't blame the space agency. It faults the president, Congress and the nation for not giving NASA clear direction. At the same time, the report said NASA is doing little to further the stated goal of the White House to send astronauts to a nearby asteroid.

Panel member Bob Crippen, a retired NASA manager and astronaut who piloted the first space shuttle mission, said he has never seen the space agency so adrift. He said that includes the decade between the end of the Apollo moon landings and the beginning of the space shuttle program.

"I think people (at NASA) want to be focused a little more and know where they are going," Crippen told The Associated Press.

President Barack Obama in 2010 told the space agency to plan to send astronauts to an asteroid by 2025 as a training ground for an eventual Mars landing. But the 80-page report from the national academy and its authors say that there is little support for that idea within NASA and the international space community. Also, NASA hasn't allocated much money for it. Nor has it done much to locate an asteroid target. The agency's vague strategic plan avoids mention of an asteroid mission.

Crippen said an asteroid mission just doesn't make sense, technically or politically.

"I hate to use the word credible, but people don't buy it," said academy panel member Marcia Smith, president of Space and Technology Policy Group. "They don't feel that the asteroid mission is the right one."

NASA chief spokesman David Weaver said in an emailed statement that the agency has clear and challenging goals.

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Powerful typhoon kills at least 74 in Philippines

MANILA, Philippines (AP) — At least 43 villagers and soldiers drowned in a southern Philippine town Tuesday when torrents of water dumped by a powerful typhoon cascaded down a mountain, engulfing emergency shelters and an army truck, officials said. The deaths raised the toll from one of the strongest storms to hit the country this year to at least 74.

Gov. Arturo Uy said rain from Typhoon Bopha accumulated atop a mountain and then burst down on Andap village in New Bataan town in hard-hit Compostela Valley province. The victims included villagers who had fled from their homes to a school and village hall, which were then swamped by the flash flood. An army truck carrying soldiers and villagers was washed away, according to Uy and army officials.

"They thought that they were already secure in a safe area, but they didn't know the torrents of water would go their way," Uy told DZBB radio.

He said the confirmed death toll in the town was likely to rise because several other bodies could not immediately be retrieved from floodwaters strewn with huge logs and debris.

Bopha slammed into Davao Oriental province region at dawn, its ferocious winds ripping roofs from homes and its 500-kilometer (310-mile) -wide rain band flooding low-lying farmland.

The storm, packing winds of 140 kilometers (87 miles) per hour and gusts of up to 170 kph (106 mph), toppled trees, triggered landslides and sent flash floods surging across the region's mountains and valleys.

Two entire provinces lost power and more than 100 domestic flights were canceled. About 60,000 people fled to emergency shelters.

Twenty-three people drowned or were pinned by fallen trees or collapsed houses in Davao Oriental province's coastal town of Cateel, which had the most deaths after New Bataan, Davao Oriental Gov. Corazon Malanyaon told the ABS-CBN TV network, citing police reports.

Some towns in the province were so battered that no roofs remained on buildings, Malanyaon said.

The other deaths included three children who were buried by a wall of mud and boulders that plunged down a mountain in Marapat village, also in Compostela Valley. Their bodies were wrapped in blankets by their grieving relatives and placed on a stage in a basketball court.

"The only thing we could do was to save ourselves. It was too late for us to rescue them," said Valentin Pabilana, who survived the landslide.

In Davao Oriental, a poor agricultural and gold-mining province about 1,000 kilometers (620 miles) southeast of Manila, an elderly woman was killed when her house was struck by a falling tree, said Benito Ramos, who heads the government's disaster-response agency.

The other victims either drowned or were hit by trees, he said, adding that the death toll was expected to rise.

While some 20 typhoons and storms normally lash the archipelago nation annually, the southern provinces battered by Bopha are unaccustomed to fierce typhoons, which normally hit the northern and central Philippines.

A rare storm last December killed more than 1,200 people and left many more homeless and traumatized, including in Cagayan de Oro city, where church bells pealed relentlessly on Tuesday to warn residents to scramble to safety as a major river started to swell.

Officials were taking no chances this year, and President Benigno Aquino III appealed on national TV on Monday for people in Bopha's path to move to safety and take storm warnings seriously.

In Compostela Valley, authorities halted mining operations and ordered villagers to evacuate to prevent a repeat of deadly losses from landslides and the collapse of mine tunnels in previous storms.

Bopha, a Cambodian word for flower or a girl, is the 16th weather disturbance to hit the Philippines this year. Forecasters say at least one more storm may strike the country before Christmas.

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Associated Press writer Teresa Cerojano contributed to this report.

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Fleetwood Mac readies tour and new music

NEW YORK (AP) — Fleetwood Mac is heading back on the road, and that means the top-selling group will release new music — sort of.

On its 34-city North American tour, which kicks off April 4 in Columbus, Ohio, the band will perform two new songs, and it could mean a new album will follow. Or not.

Stevie Nicks recently sang on tracks that Lindsey Buckingham, Mick Fleetwood and John McVie worked on, calling the sessions "great." But Nicks also says she's not sure where the band fits in today's music industry.

"Whether or not we're gonna do any more (songs), we don't know because we're so completely bummed out with the state of the music industry and the fact that nobody even wants a full record," she said. "Everybody wants two songs, so we're going to give them two songs."

Nicks said depending on the response to the new tracks — which Buckingham calls "the most Fleetwood Mac-y stuff ... in a long time" — more material could come next.

"Maybe we'll get an EP out of it or something," Buckingham said.

Nicks will continue to record solo albums, though. The group is celebrating the 35th anniversary of the best-selling "Rumours" album, which has moved some 20 million units in the United States. She knows that's not possible again, despite the success of Adele's "21," which has sold 10 million units in America in less than two years.

"This is Adele's 'Rumours,'" Nicks said. "She had a baby, she's going to take a year off to take care of her baby — that's why I never had any kids. She's going to go back and start writing again, you never know what the next record's going to be. Is it going to sell 10 million records? You don't know," she said.

Buckingham said he initially wanted to record a new album, but Nicks "wasn't too into that." But the guitarist and singer knows that new music isn't a priority for the band's fans.

"It wouldn't matter if they didn't hear anything new. In a way there's a freedom to that — it becomes not what you got, but what you do with what you got. Part of the challenge of this tour is figuring out a presentation that has some twists and turns to it without having a full album," he said.

Fleetwood Mac, which was formed in 1967, last released an album in 2003, though they hit the road in 2009. Nicks and Buckingham — who originally joined the band in 1974 as a couple — both released solo albums and toured last year. Buckingham had suggested that Fleetwood Mac tour last year, but says getting everyone to agree was tough.

"If you look at Fleetwood Mac as a group, you can make the case of saying we're a bunch of individuals who don't necessarily belong in the same group together, but it's the synergy of that that makes us so good. But it also makes the politics a little more tenuous," he said. "You can say that not only can it be a political minefield, someone's always causing trouble, right? I caused trouble for years so I can't point any fingers."

The tour also includes cities such as New York, Chicago, Boston, Las Vegas and Los Angeles, and will end June 12 in Detroit.

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Online:

http://www.fleetwoodmac.com/

You can follow Music Writer Mesfin Fekadu on Twitter at twitter.com/MusicMesfin

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Tapping citizen-scientists for a novel gut check

WASHINGTON (AP) — The bacterial zoo inside your gut could look very different if you're a vegetarian or an Atkins dieter, a couch potato or an athlete, fat or thin.

Now for a fee — $69 and up — and a stool sample, the curious can find out just what's living in their intestines and take part in one of the hottest new fields in science.

Wait a minute: How many average Joes really want to pay for the privilege of mailing such, er, intimate samples to scientists?

A lot, hope the researchers running two novel citizen-science projects.

One, the American Gut Project, aims to enroll 10,000 people — and a bunch of their dogs and cats too — from around the country. The other, uBiome, separately aims to enroll nearly 2,000 people from anywhere in the world.

"We're finally enabling people to realize the power and value of bacteria in our lives," said microbiologist Jack Gilbert of the University of Chicago and Argonne National Laboratory. He's one of a team of well-known scientists involved with the American Gut Project.

Don't be squeamish: Yes, we share our bodies with trillions of microbes, living communities called microbiomes. Many of the bugs, especially those in the intestinal tract, play indispensable roles in keeping us healthy, from good digestion to a robust immune system.

But which combinations of bacteria seem to keep us healthy? Which ones might encourage problems like obesity, diabetes or irritable bowel syndrome?

And do diet and lifestyle affect those microbes in ways that we might control someday?

Answering those questions will require studying vast numbers of people. Getting started with a grassroots movement makes sense, said National Institutes of Health microbiologist Lita Proctor, who isn't involved with the new projects but is watching closely.

After all, there was much interest in the taxpayer-funded Human Microbiome Project, which last summer provided the first glimpse of what makes up a healthy bacterial community in a few hundred volunteers.

Proctor, who coordinated that project, had worried "there would be a real ick factor. That has not been the case," she said. Many people "want to engage in improving their health."

Scott Jackisch, a computer consultant in Oakland, Calif., ran across American Gut while exploring the science behind different diets, and signed up last week. He's read with fascination earlier microbiome research: "Most of the genetic matter in what we consider ourselves is not human, and that's crazy. I wanted to learn about that."

Testing a single stool sample costs $99 in that project, but he picked a three-sample deal for $260 to compare his own bacterial makeup after eating various foods.

"I want to be extra, extra well," said Jackisch, 42. Differing gut microbes may be the reason "there's no one magic bullet of diet that people can eat and be healthy."

It's clear that people's gut bacteria can change over time. What this new research could accomplish is a first look at how different diets may play a role, said American Gut lead researcher Rob Knight of the University of Colorado, Boulder.

One challenge is making sure participants don't expect that a map of their gut bacteria can predict their future health, or suggest lifestyle changes, anytime soon.

"I understand I'm not going to be able to say, 'Oh, my gosh, I'll be susceptible to this,'" said Bradley Heinz, 26, a financial consultant in San Francisco. He is paying uBiome $119 to analyze both his gut and mouth microbiomes; just the gut is $69.

"The more people that participate, the more information comes out and the more that everybody benefits," he added.

Participants can sign up for either project via the social fundraising site Indiegogo.com over the next month. They also can send scrapings from the skin, mouth and other sites, to analyze that bacteria. Sign up enough family members or body sites, or be tracked over time, and the price can rise into the thousands. American Gut researchers plan some free testing for those who can't afford the fees, to try to increase the experiment's diversity.

Don't forget the pets: "We sleep with them, play with them, they often eat our food," said American Gut co-founder Jeff Leach, an anthropologist. What bacteria we have in common is the next logical question.

Already, American Gut researchers are preparing to compare what they find in the typical U.S. gut with a few hundred people in rural Namibia, who eat what's described as hunter-gatherer fare. Also, Leach will spend three months living in Namibia next year, and is storing his own stool samples for before-and-after comparison.

But diet isn't the only factor. Your bacterial makeup starts at birth: Babies absorb different microbes when they're born vaginally than when they're born by C-section, a possible explanation for why cesareans raise the risk for certain infections. Taking antibiotics, especially in early childhood, can alter this teeming inner world, and it's not clear if there are lasting consequences.

Then there's your environment, such as the infections spread in hospitals. In February, a new University of Chicago hospital building opens and Gilbert will test the surfaces, the patients and their health workers to see how quickly bad bugs can move in and identify which bacteria are protective.

Whatever the findings, all the research marks "a huge teachable moment" about how we interact with microbes, Leach said.

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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Online:

www.indiegogo.com/americangut

www.indiegogo.com/ubiome

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GOP senator: Boehner’s budget proposal ‘will destroy American jobs’

South Carolina Republican Sen. Jim DeMint (Win McNamee/Getty Images)

WASHINGTON—South Carolina Republican Sen. Jim DeMint just gave Democrats a shiny new talking point.

The tea party-backed senator on Tuesday slammed House Republican leaders for the fiscal cliff proposal they offered earlier this week.

"Speaker [John] Boehner's $800 billion tax hike will destroy American jobs and allow politicians in Washington to spend even more, while not reducing our $16 trillion debt by a single penny," DeMint said in a statement. "This isn't rocket science. Everyone knows that when you take money out of the economy, it destroys jobs, and everyone knows that when you give politicians more money, they spend it. This is why Republicans must oppose tax increases and insist on real spending reductions that shrink the size of government and allow Americans to keep more of their hard-earned money."

Republican House leaders on Monday sent a letter to the White House with a plan to avoid a series of automatic tax increases and spending cuts set to begin on Jan. 1, 2013. With a 10-year price tag of about $2.2 trillion, the Republican proposal would raise federal revenue by closing loopholes and capping deductions within the tax code and making changes to entitlement programs. The letter was signed by seven House leaders, including Budget Committee Chairman Paul Ryan of Wisconsin and Ways and Means Committee Chairman Dave Camp of Michigan.

Democrats dismissed it quickly, calling for a bill that would increase taxes on households earning more than $250,000 per year and more federal spending on infrastructure, which were not included in the Republican plan.

DeMint's comment may be a bit of a sideshow—he's not directly involved in the negotiations and he represents just a single vote in Congress—but it's representative of how conservatives feel about the Republican proposal, and it offers ample ammunition to President Barack Obama and Democrats in the fiscal cliff media relations war.

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Gunman severely wounds Swedish woman in Pakistan

LAHORE, Pakistan (AP) — Pakistani police say a gunman on a motorcycle has shot and critically wounded a Swedish woman in the eastern city of Lahore.

Police officer Malik Awais says the woman, Bargetta Emmi, was getting out of her car in front of her home when she was shot in the neck by an unknown assailant Monday. Her servants reported the incident to police.

Awais says Emmi was director of FGA Church (Full Gospel Assemblies of Pakistan).

The Swedish Embassy in Islamabad confirmed a Swedish woman was shot and has severe injuries but provided no other details.

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Palace says Duchess of Cambridge expecting a baby

LONDON (AP) — Get the nursery ready: Prince William and his wife Catherine are expecting their first child.

St. James's Palace announced the pregnancy Monday, saying that the Duchess of Cambridge — formerly known as Kate Middleton — has a severe form of morning sickness and is currently in a London hospital. William is at his wife's side.

The palace said that since the pregnancy is in its "very early stages," the 30-year-old duchess is expected to stay in the hospital for several days and will require a period of rest afterward.

William is second in line to the throne after his father, Prince Charles, so the couple's first child would normally become monarch in due course.

In recent days, Middleton has kept up royal appearances — recently playing field hockey with schoolchildren at her former school.

The confirmation of her pregnancy caps a jam-packed year of highs and lows for the young royals, who were married in a lavish ceremony at Westminster Abbey last year.

They have traveled the world extensively as part of Queen Elizabeth II's diamond jubilee celebrations and weathered the embarrassment of a nude photos scandal, after a tabloid snapper published topless images of the duchess.

Joe Little, managing editor of Majesty magazine, said the news bookended a year that saw the royal family riding high in popular esteem after celebrations of Queen Elizabeth II's 60 years on the throne.

"We're riding on a royal high at the moment at the end of the diamond jubilee year," he said. "People enjoyed the royal romance last year and now there's this. It's just a good news story amid all the doom and gloom."

Speculation about when William and his bride would start a family has been rife since their wedding.

William's mother — the late Princess Diana — got pregnant just four months after her wedding in 1981. Like Kate, Diana reportedly suffered from morning sickness for months and complained of constant media attention.

"The whole world is watching my stomach", Diana once said.

American tabloid speculation of the pregnancy has been rampant for months. One newspaper even cited anonymous sources talking about Kate's hormone levels. Others have focused on the first signs of the royal bump.

News of the pregnancy drew congratulations from across the U.K. establishment.

The palace said the royal family was "delighted" by the news, while Prime Minister David Cameron wrote on Twitter that the royals "will make wonderful parents."

Not only are the attractive young couple popular — with William's easy common touch reminding many of his mother, the late Princess Diana — but their child is expected to play an important role in British national life for decades to come.

Whether boy or girl, the child will be next in line behind William in the line of succession to the throne, Cabinet Office officials have said.

Leaders of Britain and the 15 former colonies that have the monarch as their head of state agreed in 2011 to new rules which give females equal status with males in the order of succession.

Although none of the nations had legislated to make the change as of September 2012, the British Cabinet Office confirmed that this is now the de-facto rule.

On the couple's tour of Malaysia, Singapore, the Solomon Islands and Tuvalu in September, William reportedly said he hoped he and Kate would have two children.

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Associated Press writers Jill Lawless and Paisley Dodds contributed to this report.

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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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