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.

___

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

___

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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Japan inspecting tunnels after deadly collapse

TOKYO (AP) — Japanese officials ordered the immediate inspection of tunnels across the country Monday after nine people were killed when concrete ceiling slabs fell from the roof of a highway tunnel onto moving vehicles below.

Those killed in Sunday's accident were traveling in three vehicles in the 4.7-kilometer (3-mile) long Sasago Tunnel about 80 kilometers (50 miles) west of Tokyo. The tunnel, on a highway that links the capital to central Japan, opened in 1977 and is one of many in the mountainous country.

The transport ministry ordered that inspections be carried out immediately on 49 other tunnels around the country that are either on highways or roads managed by the central government and of similar construction.

Police and the highway operator Central Japan Expressway Co. were investigating why the concrete slabs in the Sasago Tunnel collapsed. An inspection of the tunnel's roof in September found nothing amiss, according to Satoshi Noguchi, a company official.

An estimated 270 concrete slabs, each weighing 1.4 metric tons (1.54 short tons), suspended from the arched roof of the tunnel fell over a stretch of about 110 meters (120 yards), Noguchi said.

The operator was exploring the possibility that bolts holding a metal piece suspending the panels above the road had become aged, he said. The panels, measuring about 5 meters (16 feet) by 1.2 meters (4 feet), and 8 centimeters (3 inches) thick, were installed when the tunnel was constructed in 1977.

Company President and CEO Takekazu Kaneko said that the company was inspecting other tunnels of similar structure, including a parallel tunnel for traffic going in the opposite direction. Both sections of the highway were shut down indefinitely.

Recovery work at the tunnel was suspended Monday while the roof was being reinforced to prevent more collapses, said Jun Goto, an official at the Fire and Disaster Management Agency

Yoshihiro Seto, an officer with the Yamanashi prefectural police, said they can't rule out that there are more bodies or survivors in the tunnel, but the possibility is low. Goto said they hope to resume recovery work on Tuesday.

Two people suffered injuries in the collapse.

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Nokia debunks rumor that it may be considering shift to Android

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Study shows growth in second screen users

NEW YORK (AP) — Television viewers were once called couch potatoes. Many are becoming more active while watching now, judging by the findings in a new report that illustrates the explosive growth in people who watch TV while connected to social media on smartphones and tablets.

The Nielsen company said that one in three people using Twitter in June sent messages at some point about the content of television shows, an increase of 27 percent from only five months earlier. And that was before the Olympics, which was probably the first big event to illustrate the extent of second screen usage.

"Twitter has become the second screen experience for television," said Deirdre Bannon, vice president of social media at Nielsen.

Social networking is becoming so pervasive that the study found nearly a third of people aged 18-to-24 reported using the sites while in the bathroom.

An estimated 41 percent of tablet owners and 38 percent of smartphone owners used their device while also watching television at least once a day, Nielsen said.

That percentage hasn't changed much; in fact, 40 percent of smartphone owners reported daily dual screen usage a year earlier, Nielsen said. The difference is that far more people own these devices and they are using them for a longer period of time. The company estimated that Americans spent a total of 157.5 billion minutes on mobile devices in July 2012, nearly doubling the 81.8 billion the same month a year earlier.

"There are big and interesting implications," Bannon said. "I think both television networks and advertisers are onto it."

The social media can provide networks with real-time feedback on what they are doing. The performance of moderators at presidential debates this fall was watched more closely than perhaps ever before, because people were instantly taking on Twitter to provide their own critiques.

It also makes for some conflicting information: Twitter buzzed with complaints last summer about NBC's policy of airing many Olympics events from London on tape delay, yet ratings for the prime-time Olympics telecast soared past expectations.

The increase in people watching television and commenting about it online would seem to run counter to another big trend this fall: more people recording programs and watching them at a later hour. Those contrary trends both increase the value of live event programming like awards shows or sporting events.

The Nielsen study also found that 35 percent of people who used tablets while watching TV looked up information online about the program they were watching. A quarter of tablet owners said they researched coupons or deals for products they saw advertised on television

As rapid as the use of social media while on television is growing in the United States, it already lags behind other countries. Nielsen said that 63 percent of people in the Middle East or Africa report using social media while on TV, and 52 percent of people in Latin America.

The U.S. media survey is based on a representative sample of 1,998 adults in Nielsen's regular TV ratings panel, conducted online between July 19 and Aug. 8. Nielsen's global survey involved more than 28,000 people in 51 countries and was taken between March 23 and April 12, 2011.

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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.

___

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

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Pacific nations alarmed by tuna overfishing

MANILA, Philippines (AP) — Pacific island nations and environmentalists raised an alarm Sunday over destructive fishing methods and overfishing that they say are threatening bigeye tuna — the fish popular among sushi lovers worldwide.

Palau fisheries official Nanette Malsol, who leads a bloc of Pacific island nations, said at the start of a weeklong tuna fisheries conference in Manila that large countries should cut back on fishing, curb the use of destructive fishing methods and respect fishing bans to allow tuna stocks to be replenished in the Pacific, which produces more than 60 percent of the world's tuna catch.

The annual meeting of the Western and Central Pacific Fisheries Commission, which regulates commercial fishing in the vast expanse of waters from Indonesia to Hawaii, is to approve steps aimed at protecting the bigeye and other threatened tuna species, along with giant whale sharks. More than 600 delegates from about 40 Asian and Western countries, along with environmental activists, are attending.

Malsol said she expects heated debate. Proponents of the multibillion-dollar fishing industry have squared off with conservationists in the past over the best ways to protect the bigeye and other species without considerably setting back the lucrative business.

Bigeye and yellowfin tuna, which can grow to 8-9 feet (2.4-2.7 meters) long and weigh more than 450 pounds (200 kilograms), are not in immediate danger of being wiped out, but have been hit hard by overfishing. The fish are used mostly for steaks, and in the case of bigeye, sushi.

The fisheries business in the western and central Pacific region, estimated to be worth about $5 billion annually, has drawn increasing numbers of industrial fishing fleets, which have caused tuna stocks to fall since the 1960s.

"This week it's up to the big fishing nations to show the world what they are going to do to cut overfishing of bigeye tuna," Malsol said.

Repeated telephone calls and messages to industry officials seeking comment Sunday were not answered.

Many fleets are using so-called "fish aggregation devices" — various types of floats which are used to lure vast numbers of tuna. When schools of tuna have massed under the devices, fishing vessels alerted by sensors approach and scoop up their catch with giant nets.

Between 47,000 and 105,000 fish aggregation devices, made from bamboo, palm fronds, plastic or old nets, have been deployed worldwide to attract a wide variety of marine life. The method is used to catch nearly half of the world's tuna and has contributed to the overfishing of bigeye tuna across the Pacific Ocean, according to the U.S.-based Pew Environment Group.

Aside from tuna, sea turtles, sharks and juvenile fish have often been caught and killed.

"The deployment of tens of thousands of drifting fish aggregating devices in the world's oceans with little to no oversight is extremely worrisome," said Amanda Nickson of the Pew Environment Group.

"The fishing industry is not currently required to account for its use of FADs. It is being allowed to gamble with the health of the ocean, and it is time for governments to require full accountability and management of this proliferating and risky fishing gear," Nickson said.

Conservation efforts, however, have been tough to implement and have sparked disagreements.

Greepeace activists said they will submit evidence to the fisheries commission detailing violations of regional tuna fishing rules by Southeast Asian countries including allowing fishing vessels to operate on the high seas without permits and required observers onboard.

A decision by the fisheries commission to exempt the Philippines from purse seine fishing — an industrial technique in which a net is used to surround and capture schools of fish — in a large swath of the Pacific has sparked complaints from other nations.

The exemption was given to discourage Philippine fleets from fishing in territorial waters off the country's eastern coast, which are known spawning grounds for tuna that later spread out to the Pacific.

Philippine Agriculture Secretary Proceso Alcala asked the fishing commission to extend the exemption, which he said started last October and would end in February next year.

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Katzenberg, Spielberg attend Governors Awards

LOS ANGELES (AP) — Tom Hanks. Quincy Jones. Kristen Stewart. Warren Beatty. Quentin Tarantino. George Lucas. Steven Spielberg. Kirk Douglas. Amy Adams. Richard Gere.

These and other famous folks came to the film academy's Governors Awards Saturday to honor filmmakers whose names may not be as well known, but whose contributions to the industry have affected movie-lovers everywhere.

Documentarian D.A. Pennebaker helped make the medium mainstream with his direct-cinema approach. George Stevens, Jr., founded the American Film Institute and established the Kennedy Center Honors. Hal Needham developed new ways of performing and directing death-defying movie stunts. DreamWorks Animation chief Jeffrey Katzenberg raised hundreds of millions of dollars for charity.

Octogenarians Pennebaker, Stevens and Needham received honorary Oscars for their distinguished careers and Katzenberg was recognized with the Jean Hersholt Humanitarian Award at the Academy of Motion Picture Arts and Sciences' Governors Awards ceremony, held at the Ray Dolby Ballroom at Hollywood and Highland Center.

The film academy has long awarded honorary Oscars, but established a new tradition four years ago of presenting those statuettes at a private dinner party where there are no time limits on speeches. Portions of the untelevised event may be included in the Feb. 24 Academy Awards telecast.

Stars mingled in the ballroom and dined on filet mignon and banana cream pie before academy president Hawk Koch urged them to "finish the deals, make the deals" so the program could begin.

Each honoree was introduced by a pair of stars and a short film of their work.

Michael Moore and Sen. Al Franken introduced Pennebaker. Moore called him an inspiration and the inventor of the modern documentary. Pennebaker ditched the tripod and carried his camera on his shoulder, and "all filmmaking changed," Moore said, "nonfiction and fiction."

The 87-year-old Pennebaker seemed to thank every colleague from his six-decade career during a nearly 20-minute speech that prompted his family to signal him to finish and inspired a joke from Will Smith later in the evening.

"Before I get started, D.A. Pennebaker has a couple more people he wanted to thank," Smith cracked.

Sidney Poitier and Annette Bening introduced Stevens, speaking of his commitment to honoring, preserving and furthering the art of film. In accepting his Oscar, Stevens thanked his late father for encouraging him to consider film a timeless art and "for opening the door for me to a creative life."

Needham "pushed the boundaries of what could be done in action," Tarantino said as he introduced the stuntman and director, adding, "I've ripped off many shots from you."

Al Ruddy, Oscar-winning producer of "The Godfather," described Needham as "one of the good guys" and "a gift to any producer." Ruddy told a story about making 1982's "Megaforce," which Needham directed. The stuntman helped design a rocket for the film's action sequences, and when brought it to the Goldwyn lot to demonstrate it, he accidentally launched it into a new soundstage and burnt the whole thing down. Later, while filming another stunt, Needham crashed a motorcycle and got a concussion, but he was back on set shooting the next morning.

The 81-year-old Needham called himself "the luckiest man alive": He grew up a sharecropper's son with eight years' education and went on to work with Billy Wilder, Jimmy Stewart and John Wayne. Now he's getting an Academy Award.

"My mom's looking down on tonight with a big smile on her face," he said, choking up and dabbing at his eyes with a handkerchief.

He closed by thanking "the entire Hollywood community for allowing me to be a part of it."

Tom Hanks and Will Smith introduced Katzenberg by joking about his persistent calls for charitable donations. The DreamWorks executive has raised more than $230 million as chairman of the Motion Picture and Television Fund foundation.

"Jeffrey has no problem asking for way too much money," Smith said.

"Mostly, all I did was pick up the phone and ask you," Katzenberg said as he accepted his award. "It's you who did it. You who gave of your time, your talent, your money, your hearts. Because that's what you do. That is what Hollywood does."

___

AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .

___

Online:

www.oscars.org

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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.

___

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

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'Cliff' talks: Geithner invites GOP counteroffer

WASHINGTON (AP) -- President Barack Obama is ready to entertain Republican proposals for spending cuts, but GOP lawmakers must first commit to higher tax rates on the rich and specify what additional spending cuts they want in a deal to avoid the looming "fiscal cliff," Treasury Secretary Timothy Geithner said.

"The ball really is with them now," Geithner, one of the president's chief negotiators with Capitol Hill, said during appearances on five Sunday talk shows. He acknowledged that Republicans are "having a tough time trying to figure out what they can do, what they can get support from their members for." The White House "might need to give them a little more time to figure out where they go next."

Geithner presented congressional leaders Thursday with Obama's postelection blueprint for averting the combination of hundreds of billions in tax increases and spending cuts that will take effect beginning in January if Washington doesn't act to stop it.

But House Speaker John Boehner, R-Ohio, dismissed the plan as "not serious," merely a Democratic wish list that couldn't pass his chamber.

As outlined by administration officials, the plan calls for nearly $1.6 trillion in new tax revenue over the next decade, while making $600 billion in spending cuts, including $350 billion from Medicare and other health programs. But it also contains $200 billion in new spending on jobless benefits, public works and aid for struggling homeowners — and would make it virtually impossible for Congress to block Obama's ability to raise the debt ceiling.

"I was just flabbergasted," Boehner said, describing his meeting with Geithner. "I looked at him and I said, 'You can't be serious?" The speaker, noting the short time between the Nov. 6 election and the new year, said time has been lost so far "with this nonsense."

With the George W. Bush-era tax cuts expiring and across-the-board spending cuts hitting in under a month, Boehner said, "I would say we're nowhere, period." He said "there's clearly a chance" of going over the cliff.

But Geithner, also in interviews that were taped Friday, offered a somewhat rosier view. "I think we're far apart still, but I think we're moving closer together," he said.

He called the back-and-forth "normal political theater," voicing confidence a bargain can be struck in time, and said all that's blocking it is GOP acceptance of higher tax rates on the wealthy.

"It's welcome that they're recognizing that revenues are going to have to go up. But they haven't told us anything about how far rates should go up ... (and) who should pay higher taxes?" Geithner said.

He said so far, GOP proposals demonstrate "political math, not real math."

Republican leaders have said they accept higher tax revenue overall, but only through what they call tax reform — closing loopholes and limiting deductions — and only coupled with tough measures to curb the explosive growth of Medicare, Medicaid and Social Security.

But Geithner insisted that there's "no path to an agreement (without) Republicans acknowledging that rates have to go up for the wealthiest Americans." He also said the administration would only discuss changes to Social Security "in a separate process," not in talks on the fiscal cliff.

As to spending, Geithner said if Republicans don't think Obama's cutting enough spending, they should make a counter-proposal. "They might want to do some different things. But they have to tell us what those things are," he said.

Republicans have also rejected Obama's debt ceiling proposal. Geithner noted it was Senate Minority Leader Mitch McConnell who first suggested it, as a temporary measure in the summer 2011 deficit deal. The administration would make it permanent. "It was a very smart way by a senator with impeccable Republican credentials to ... lift this ... periodic threat of default," Geithner said. "And that's an essential thing for us."

Geithner voiced sympathy for Republicans leaders, saying they're caught between the voters' endorsement of higher taxes on the rich and a House GOP caucus that thinks all tax increases are job-killers.

"They really are in a difficult position," he said. "And they're going to have to figure out their politics of what they do next."

In the past week, Obama has held a series of campaign-style appearances — including one in a swing district in Pennsylvania — urging lawmakers to accept a Senate-passed measure extending tax cuts for all but the top 2 percent of wage-earners. He'll continue the effort when he meets with governors on Tuesday and speaks to the Business Roundtable on Wednesday.

GOP leaders contend letting top-end tax cuts run out would hit small businesses and cost jobs.

Still, Sen. Lamar Alexander, R-Tenn., said Republicans will "hold our nose and raise some revenues" if the result is a deal that reins in runaway debt. But he said the onus is on Obama to knuckle down to talks.

"I'm ready for the president to get off the campaign trail, and get in the White House and get a result," Alexander told reporters in Nashville on Saturday. "Right now he's got the presidential limousine headed toward the fiscal cliff with his foot on the accelerator."

Geithner appeared on CBS' "Face the Nation," NBC's "Meet the Press," CNN's "State of the Union," ABC's "This Week," and "Fox News Sunday." Boehner was on Fox, too.

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Associated Press Writer Erik Schelzig in Nashville contributed to this report.

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