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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Asian tourists flock to South Coast Plaza

It's Day 3 of his four-day visit, and, of course, Yuki Izuka — for the third time — is back at South Coast Plaza.

Sporting black slacks, leather tote, a pinstripe jacket and crisp tie, the pharmacist from Gunma, Japan, heads straight for the most glittering of shops: Tiffany.

He's on a mission to find a ring for his wife. "It is very expensive — but even more expensive in my home," he says. "Better if I can get something here."

Skipping tariffs and taxes, foreign shoppers flush with cash fill their Southern California trips with shopping sprees at places like South Coast Plaza, and increasingly, employees at the luxury shopping center are taking extraordinary steps to host them, trained to fulfill the tiniest of needs.

South Coast Plaza has become a destination for overseas Asians, who bundle trips to Disneyland with carefully plotted excursions to the retail mecca, stocking up on snug blue jeans, watches, luggage, purses and flashy sunglasses selling for $500 a pair.

"We could have seen it in American Vogue and we're here to get it," said Izuka, looking magazine model-sleek as he and his buddies walk past an Italian cafe and ride an escalator toward the center's Jewel Court, a cluster of high-end jewelry boutiques where foreigners pay cash for $100,000 necklaces or other sparkling baubles.

"I like to buy whatever I can because the prices are so low," says Lucas Xu, comparing the costs to those in China, his homeland.

"And every store has an Asian assistant," said Xu, an economics major in Colorado who has flown in with friends for a shopping excursion. "Wow."

"It's not just about selling somebody something. It's about making them feel important," says South Coast Plaza veteran Werner Escher.

In a sense, Escher is the director of foreign affairs at the center, though technically his title is director of domestic and international markets. He's been on the job more than four decades and travels to China at least once a year to firm up connections with influence makers. He partners with Disneyland and the Nixon Presidential Library & Museum, ready to whisk dignitaries from Beijing and Shanghai to the shopping center, even providing them chauffeurs and guides.

Under his direction, the staff is tightly focused on the foreign traveler.

There's a language-assistance program, with mall and store employees speaking more than 40 languages and dialects. Maps and directions are printed in Korean, Japanese, Spanish and Chinese, among others. Center executives carry business cards featuring Asian characters.

South Coast Plaza is now the first shopping center in the nation to accept UnionPay, China's leading credit card. Center reps also hand out VIP Passport booklets with exclusive offers for travelers. One afternoon, Escher shows it to Shelley Chen, who is from Guangzhou, an economic hub on China's southern coast. He bows and shakes her hand as she's on her way to look for a Gucci purse, having just graduated from law school.

"I like the famous names here," she says of the retailers. "My friends said I must come here."

Scott Hung, a sales director for a semiconductor company in Taiwan, wants to take home gifts for his twin boys. His boss is familiar with South Coast Plaza "and suggested me to go to this place," he said, asking about shops that carry children's goods and that have iPhone docking stations.

Visitors who are overseas celebrities get preferred treatment.

When Yang Mi, one of China's leading actresses, who boasts 22 million followers on Sina Weibo — similar to Twitter — came to South Coast, center officials entertained the actress and her entourage in a plush VIP Access Suite near Saks Fifth Avenue. They hosted the Chinese press corps, which swarmed in to interview and photograph her.

"For her to be here is major," Escher says. "It fills out the playlist of the people we want to attract."

Not to miss a beat, the center — which bills itself as a "shopping resort" — served as a ping-pong tournament venue to the top players in the U.S. and China. The cast of "Raise the Red Lantern," a production of the National Ballet of China, also descended on South Coast, accompanied by diplomats.

That's apart from outreach directed at the local Asian clientele, highlighting the lunar new year and the autumn moon festival. Managers at anchor stores like Macy's scramble to hire Chinese-speaking staff. And shopping at South Coast means visitors might avoid three taxes for luxury items imported to China: customs tariffs, value-added tax and consumption tax. Trade missions between Southern California and China can include a stop at one of the most upscale malls in America.

Concierge Stepheny Southa came to the aid of a pregnant guest recently. Speaking in Mandarin, the woman told her: "You're my size. I need to buy some clothes that I can wear after having the baby."

Southa said she went with the expectant mother to try on multiple outfits for her.

"We have the ability to satisfy someone who comes from a long distance," Southa says.

Robert Sun, founder of the American Chinese CEO Society, says he has taken guests from China's Shandong province to South Coast for dinner and to buy presents.

"They fall in love because of the large number of brand names. No other place can compare," he recalls. Foreign visitors are familiar with Beverly Hills and Rodeo Drive, Sun added, "but now they see South Coast as the best shopping. When somebody has a good experience buying, like, a bag, they go and tell their friends."

If there's one thing missing from the experience for shoppers from China, it's a Chinese restaurant. And shoppers have pointed that out, said Escher, who's been scouting candidates when he travels overseas. Officials hope to make an announcement by the lunar new year in February, an event they anticipate will be covered prominently by the ethnic media.

"Shopping," Escher says, "is the No. 1 activity when people travel."

anh.do@latimes.com

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Dire Scene as Rebels Prepare to Leave Goma,Congo

NAIROBI, Kenya — Lootings. Assassinations. A spreading sense of lawlessness.

That was the alarming picture that emerged on Friday from Goma, a rebel-held city in the eastern Democratic Republic of Congo, despite vows by the rebels to withdraw peacefully.

Human rights groups said that the M23 rebels who captured Goma last week were now going on an assassination campaign as they prepared to leave, creating a vortex of crime and confusion.

“I think it will be extremely chaotic over the next few days,” said Ida Sawyer, a researcher for Human Rights Watch.

Residents in Goma reported that the rebels were piling cases of ammunition and other looted supplies onto trucks, with some of it heading toward neighboring Rwanda, while a new letter to a United Nations Security Council committee said that the Rwandan Army had crossed the border into Congo and had helped the fighters capture Goma in the first place.

Rwandan troops “openly entered into Goma through one of the two official border crossings,” said the letter, which was written by Steve Hege, the coordinator of a United Nations investigative panel, and was leaked by a third party.

The panel has accused Rwanda — with help from Uganda — of creating, equipping and commanding the rebels. In his letter, Mr. Hege contended that once the rebels and Rwandan soldiers chased the Congolese Army out of Goma, “these troops together took control over the entire city, marching through downtown dressed in a combination of R.D.F. and new M23 uniforms,” using R.D.F. to signify the Rwanda Defense Force.

Rwanda has strenuously denied any covert involvement in this round of conflict. But it has sent thousands of soldiers across the border to overthrow the Congolese government at least twice in the past, justifying such actions by blaming Congo for insecurity across the region.

Some of Rwanda’s staunchest allies, including the United States, have recently cut aid to Rwanda amid the allegations of meddling in Congo. On Friday, the BBC reported that the British government had suspended more than $33 million in aid, which Rwanda desperately needs to keep its government running.

Congo and Rwanda seem to be heading into yet another turbulent, acrimonious phase, with tensions growing by the day. It began this spring when more than 1,000 former rebels who had been integrated into the Congolese Army mutinied. The rebels named themselves the M23 after March 23, 2009, the date of a failed peace deal between the two sides.

Most of the rebel commanders were Tutsi, the same minority ethnic group that dominates politics and the economy in Rwanda, and many of them had fought in the Rwandan Army.

The rebels indicated this week that they would abide by a regional agreement signed last weekend to leave Goma. “And we are continuing with that plan,” Bertrand Bisimwa, an M23 spokesman, said Friday.

He said the rebels had begun withdrawing from Goma and planned to station all troops about 12 miles outside the city, as the agreement demanded.

But another rebel spokesman contradicted him, telling The Associated Press that the rebels would not be able to leave Goma for “logistical reasons” until Sunday.

Aid workers in Goma said on Friday that they could not see any sign of a rebel pullout.

“I’m not seeing big movements of soldiers,” said Richard Nunn, a coordinator for Oxfam. “I still see some rebel soldiers in town. It’s very difficult to say what’s going on right now.”

Other residents reported an increase in carjackings and break-ins, saying that Goma was becoming virtually lawless at night. Many people fear that a vacuum could open up when the rebels leave, and that the Congolese Army could be even worse.

When Congolese troops hastily retreated from Goma last week, Mr. Nunn said, “there was a lot of rape, a lot of insecurity, a lot of extortion and some killings.”

“It was a mess, and people are worried about the same kind of thing happening when they come back,” he added.

The deal struck last weekend calls for one battalion of government troops to return to Goma’s streets and for a mixed force of rebels, government troops and a yet-to-be-named “neutral force” to guard the airport, from which millions of dollars in minerals is exported every month.

The rebels have clearly infiltrated the police in Goma, with officers who speak the principal Rwandan language strutting around the city last week in uniforms so freshly sewn that loose threads still hung off them. Congolese officers who had been disarmed said that only Tutsi officers were allowed to carry guns.

Most analysts believe that the rebels will officially withdraw from Goma soon, after cleaning out everything of value (there were reports that they robbed the central bank this week). Because the Congolese government is so weak and its army is in such disarray, the rebels are expected to extract a new deal that will give them top positions in the army and an even firmer grip on a large and lucrative swath of eastern Congo.

Residents said that at least 10 people in Goma had been assassinated in the past 10 days, with many more disappearances. After one magistrate was struck in the face with a machete and nearly killed last week, United Nations peacekeepers evacuated more than 20 other magistrates.

“We’ve confirmed several cases of targeted killings by the M23 in and around Goma,” said Ms. Sawyer, the Human Rights Watch researcher. She said the victims included “those who refused to join the M23 or act as informants, individuals deemed uncooperative during looting incidents, and other suspected ‘enemies.’ ”

The rebels have denied any wrongdoing.

Mr. Bisimwa, the rebel spokesman, said that he had heard the same accusations but that no one had offered proof.

“Where are the facts?” he asked.

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Dennis Quaid Files for Divorce, Seeks Joint Custody

By Mike Fleeman

11/30/2012 at 09:20 PM EST

Kimberly Buffington-Quaid and Dennis Quaid

Casey Rodgers/NBC/AP

Dennis Quaid is ready to end his marriage for good.

After his wife of eight years, Kimberly Buffington-Quaid, sought legal separation in October, the Vegas star filed Friday for divorce in Los Angeles Superior Court.

The actor requests joint physical and legal custody of their 4-year-old twins, Thomas and Zoe, and offers to pay spousal support, according to the petition.

This will be the third divorce for Quaid, 58, who was previously married to Meg Ryan and P.J. Soles.

Kimberly, a former real estate agent, initially filed for divorce in March. She
put the divorce on hold a month later, pulling the papers so they could work on their marriage, before then filing for separation.

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New Georgia Government Starts Punishing Members of Old

Justyna Mielnikiewicz for The New York Times

Georgians in the office of Archil Kbilashvili, the nation’s new prosecutor, to file complaints.

TBILISI, Georgia — These days, when the Georgian prosecutor’s office opens, people are lined up, clutching plastic bags full of documents. One after another, they are presenting their case that President Mikheil Saakashvili’s government stripped them of something: a state job, a piece of land, an apartment. Most of them want to see someone punished.

The promise that officials would be punished helped propel the billionaire Bidzina Ivanishvili to victory in October parliamentary elections, dislodging the group of politicians who had controlled Georgia for nine years. Mr. Saakashvili conceded the loss and agreed to enter the opposition, and for the first time in Georgia’s post-Soviet history, power changed hands legally.

About two months later, the Georgian experiment — to many in the West, a last hope for building democracy in inhospitable post-Soviet terrain — hangs in the balance.

Mr. Ivanishvili has embarked on the project of prosecuting former officials more swiftly than anyone expected, saying he cannot ignore the public’s demand for justice. But numerous cases are targeting political rivals, since Mr. Saakashvili remains president until next October. The authorities have already charged 23 officials from Mr. Saakashvili’s government with crimes like corruption and torture, and they may prosecute his former interior minister, who is also the leader of the Parliament’s main opposition party.

Alexander Rondeli, a political analyst, said Mr. Ivanishvili was following in the winner-take-all tradition of Georgian politics.

“In Georgia, the political enemy is an enemy. I don’t think it gives a very good image to this country, but it is our culture,” said Mr. Rondeli, president of the Georgian Foundation for Strategic and International Studies. “It’s clear now that the new political force wants to annihilate the previous one. So that is completely clear. It does not look very much like democracy, but they say that the rule of law is higher.”

It was apparent there would be some kind of legal reckoning if Mr. Saakashvili lost power. Though his government was embraced in the United States and Europe for its pro-Western orientation, complaints mounted at home, especially about police brutality and the lack of due process in the justice system.

This fall, video was released showing prison inmates being beaten and sodomized by guards, releasing a huge wave of public anger. Rights activists have long complained that officials acted with impunity in grave cases, like the death of Sandro Girgvliani, a bank executive who was abducted by law enforcement officers in 2006 after an altercation.

As a candidate, Mr. Ivanishvili promised to deliver justice swiftly, sometimes claiming he could create an independent court system in as little as a year. Asked how, he told Forbes, “You have to jail one minister — two, max — to show everyone that there will be no forgiveness. Show that there’s political will up there, and it will all line up quickly.”

Georgia’s new prosecutor, Archil Kbilashvili, said that more than 3,000 criminal complaints had been filed against former officials over the last month, and he planned to triple the number of investigators in the division handling misuse of authority. If there is a criticism he hears most often from Georgians, he said, it is that he is acting too slowly.

As an example, he offered the case of Bacho Akhalaia, a much-feared former defense and interior minister who fled the country after the elections, evidently expecting to be arrested. When news got out that Mr. Akhalaia had returned, Mr. Kbilashvili said, he had been in his job for just five days when he was inundated with “many, many phone calls” asking why he had not ordered Mr. Akhalaia’s arrest.

“I said I have no evidence against him, he is a free citizen of this country,” Mr. Kbilashvili said. Still, the next day, Mr. Akhalaia was arrested based on the relatively mild charges of striking a sergeant with a knife handle and publicly beating servicemen. After that, new allegations began to flow in from citizens who were “somehow encouraged” to testify against Mr. Akhalaia, Mr. Kbilashvili said.

Two prominent legal rights groups have already warned that Mr. Ivanishvili’s team is approaching questions of justice too hastily. Tamar Chugoshvili, of the Georgian Young Lawyers’ Association, said her group withdrew from a parliamentary effort to compile a list of political prisoners for release, because a two-week deadline made it “impossible to really study the cases in detail.”

Olesya Vartanyan contributed reporting.

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Taking a page from Louis C.K., Chill launches online store for films, comedy specials

NEW YORK (TheWrap.com) – Chill, a social video platform with close to 20 million users, has launched Chill Direct, a new store for creatives like Maria Bamford and Michael Urie to sell their movies, specials and documentaries directly to fans.

Comedian Louis C.K. sent shockwaves through the entertainment industry this summer by selling a comedy special directly online rather than making a distribution deal with a television network or online service. He made millions, and various others have followed suit, including Jim Gaffigan and Aziz Ansari.

Chill sees an opportunity to enter this emerging market, empowering artists and offering them an opportunity to control the distribution and monetization of their ongoing projects.

“The community gives filmmakers and comedians the ability to distribute premium video directly to fans,” CEO Brian Norgard told TheWrap. “The common analogy is to Louis C.K. and his ‘Live at Beacon Theater.‘ That was a seminal moment in the entertainment business and a lot of things now allow direct-to-fan to become a viable model.”

Artists who choose to sell through Chill also can sell their videos elsewhere, but Chill Direct launches with eight videos exclusive to the site. That slate includes “Maria Bamford: the Special Special Special!,” an hour-long comedy special starring Bamford, “Thank You For Judging,” a documentary from “Ugly Betty” actor Urie about high school speech and debate and “Unknown Sender,” a suspense series from “48 Hrs” and “Die Hard” scribe Stephen E. de Souza.

Starting Thursday, any artist can create a page for a project and has complete creative control over the page, from information about the project to trailers to pricing. Meanwhile, Chill handles distribution across devices as well as payments.

Artists retain rights to their own intellectual property while Chill takes a 30 percent cut of any transaction.

“What Chill does is let anyone build out socially integrated marketing pages – we call them story pages – beautiful, high-resolution tantalizing receptacles of premium videos,” Norgard said.

Chill, funded by WME and Kleiner Perkins Caulfield & Byers and others, has previously enabled frictionless uploading, consumption and sharing of the web’s most popular videos. This maintains a social layer, allowing for commenting and offering bundles that combine the video with other perks like merchandise or meeting the creator.

“The land of premium video is still a very closed marketplace,” Norgard said. “If you have tremendous business development skills or connections to sell a film to Netflix or Hulu, you’re lucky. The ad-supported model doesn’t fit every type of content. There is plenty of stuff out there like documentary films and comedy specials where creators are between a rock and a hard place and wan to get it out there, distribute it, own the right but not put it on a free streaming site like YouTube.”

Selling direct to fans also offers a new revenue stream to a company that until now was mostly luring people a few times a day for videos.

Internet News Headlines – Yahoo! News

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The X Factor Announces Top 6

TV Watch

The X Factor

11/29/2012 at 09:40 PM EST

From left; Demi Lovato, Britney Spears and Simon Cowell

FOX

Mario Lopez called the first elimination on Thursday's The X Factor a "bit of a shocker."

And so was the second.

The top eight contestants sang No. 1 hits Wednesday in an emotional night. Keep reading to find out which two performers were sent packing – and who's in season 2's top six ...

Paige Thomas was the first to go – which is shocking because she toned down her over-the-top performing style to sing Rick Astley's "Never Gonna Give You Up" like a like a "legitimate pop star," according to Simon Cowell.

That left Demi Lovato with just one singer on her team: CeCe Frey, who was told (by Cowell) to "pack her bags" Wednesday after her performance of "Lady Marmalade."

But L.A. Reid's contestant Vino Alan and Team Britney's Diamond White were in the bottom two and had to sing for survival. He performed "Trouble" and she sang Beyoncé's "I Was Here."

L.A. voted to send home Diamond; Britney returned the favor and voted to send home Vino. Demi voted Vino out as well. That left Simon ... and he fell in line with the female panelists, voting to get rid of Vino. Either one would have been a shock but Vino had been ranked third last week.

Here's how the top six rank this week:
1. Carly Rose Sonenclar
2. Tate Stevens
3. Emblem3
4. Fifth Harmony
5. CeCe Frey
6. Diamond White

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Clinton releases road map for AIDS-free generation

WASHINGTON (AP) — In an ambitious road map for slashing the global spread of AIDS, the Obama administration says treating people sooner and more rapid expansion of other proven tools could help even the hardest-hit countries begin turning the tide of the epidemic over the next three to five years.

"An AIDS-free generation is not just a rallying cry — it is a goal that is within our reach," Secretary of State Hillary Rodham Clinton, who ordered the blueprint, said in the report.

"Make no mistake about it, HIV may well be with us into the future but the disease that it causes need not be," she said at the State Department Thursday.

President Barack Obama echoed that promise.

"We stand at a tipping point in the fight against HIV/AIDS, and working together, we can realize our historic opportunity to bring that fight to an end," Obama said in a proclamation to mark World AIDS Day on Saturday.

Some 34 million people worldwide are living with HIV, and despite a decline in new infections over the last decade, 2.5 million people were infected last year.

Given those staggering figures, what does an AIDS-free generation mean? That virtually no babies are born infected, young people have a much lower risk than today of becoming infected, and that people who already have HIV would receive life-saving treatment.

That last step is key: Treating people early in their infection, before they get sick, not only helps them survive but also dramatically cuts the chances that they'll infect others. Yet only about 8 million HIV patients in developing countries are getting treatment. The United Nations aims to have 15 million treated by 2015.

Other important steps include: Treating more pregnant women, and keeping them on treatment after their babies are born; increasing male circumcision to lower men's risk of heterosexual infection; increasing access to both male and female condoms; and more HIV testing.

The world spent $16.8 billion fighting AIDS in poor countries last year. The U.S. government is the leading donor, spending about $5.6 billion.

Thursday's report from PEPFAR, the President's Emergency Plan for AIDS Relief, outlines how progress could continue at current spending levels — something far from certain as Congress and Obama struggle to avert looming budget cuts at year's end — or how faster progress is possible with stepped-up commitments from hard-hit countries themselves.

Clinton warned Thursday that the U.S. must continue doing its share: "In the fight against HIV/AIDS, failure to live up to our commitments isn't just disappointing, it's deadly."

The report highlighted Zambia, which already is seeing some declines in new cases of HIV. It will have to treat only about 145,000 more patients over the next four years to meet its share of the U.N. goal, a move that could prevent more than 126,000 new infections in that same time period. But if Zambia could go further and treat nearly 198,000 more people, the benefit would be even greater — 179,000 new infections prevented, the report estimates.

In contrast, if Zambia had to stick with 2011 levels of HIV prevention, new infections could level off or even rise again over the next four years, the report found.

Advocacy groups said the blueprint offers a much-needed set of practical steps to achieve an AIDS-free generation — and makes clear that maintaining momentum is crucial despite economic difficulties here and abroad.

"The blueprint lays out the stark choices we have: To stick with the baseline and see an epidemic flatline or grow, or ramp up" to continue progress, said Chris Collins of amFAR, the Foundation for AIDS Research.

His group has estimated that more than 276,000 people would miss out on HIV treatment if U.S. dollars for the global AIDS fight are part of across-the-board spending cuts set to begin in January.

Thursday's report also urges targeting the populations at highest risk, including gay men, injecting drug users and sex workers, especially in countries where stigma and discrimination has denied them access to HIV prevention services.

"We have to go where the virus is," Clinton said.

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First marine wilderness in continental U.S. is designated

The federal government cleared the way Thursday for waters off the Northern California coast to become the first marine wilderness in the continental United States, ending a contentious political battle that pitted a powerful U.S. senator against the National Park Service.

Interior Secretary Ken Salazar settled the dispute by refusing to extend a permit for a commercial oyster farm operating in Point Reyes National Seashore. Congress designated the area as potential wilderness in 1976 but put that on hold until the farm's 40-year federal permit ended.

As the expiration date approached, the farm became the center of a costly and acrimonious fight that dragged on more than four years, spawned federal investigations and cost taxpayers millions of dollars to underwrite scores of scientific reviews.

"I believe it is the right decision for Point Reyes National Seashore and for future generations who will enjoy this treasured landscape," Salazar said Thursday. The area includes Drakes Estero, an environmentally rich tidal region where explorer Sir Francis Drake is believed to have made landfall more than 400 years ago.

Salazar's decision drew a sharp response from Sen. Dianne Feinstein, who had championed the Drakes Bay Oyster Co. in its fight with the government. Feinstein said in a statement that she was "extremely disappointed" with Salazar's decision.

She had argued that the National Park Service contorted scientific studies to make the case that oyster harvesting operations caused environmental harm to Drakes Estero, a dramatic coastal sweep of five bays in Marin County north of San Francisco.

"The National Park Service's review process has been flawed from the beginning with false and misleading science," her statement said. "The secretary's decision effectively puts this historic California oyster farm out of business. As a result, the farm will be forced to cease operations and 30 Californians will lose their jobs."

Feinstein had attached a rider to an appropriations bill giving Salazar the unusual prerogative to extend the farm's permit. The company was seeking a 10-year extension of its lease.

Salazar said he gave the matter serious consideration, including taking into account legal advice and park policies. He directed the park service to develop a jobs-training plan for the oyster company's employees and to work with the local community to assist them in finding employment.

The company will have 90 days to remove its racks and other property from park land and waters. When that occurs, the 2,500-acre Drakes Estero will be managed as wilderness, with prohibitions on motorized access to the waterway but allowances for snorkeling, kayaking and other recreation.

The new wilderness will become only the second marine protected area in the national park system and the first in the Lower 48 states. The only current marine wilderness is 46,000 acres in Alaska's Glacier Bay National Park and Preserve.

Environmental groups applauded the decision, which they lobbied for.

"We are ecstatic that this ecological treasure will be forever protected as marine wilderness," said Amy Trainer, executive director of the Environmental Action Committee of West Marin.

The heart of the debate is an agreement that Kevin Lunny and his family inherited when they took over a failing oyster operation in the park in 2004. That lease with the park service stipulated that the business would cease operations in 2012.

Kevin Lunny has from the beginning sought to stay on the property and continue harvesting oysters. His farm has an extensive record of violating state and federal agreements and permits. The California Coastal Commission has fined the farm for various violations, issued two cease and desist orders and repeatedly requested that the Lunnys acquire a coastal development permit.

The state agency initiated another enforcement action against the farm earlier this month.

Lunny could not be reached for comment.

The farm's mariculture operation has found support among west Marin County's advocates for sustainable agriculture, who agreed with Lunny that federal and state agencies were unfairly hounding his operation.

His travails have caused alarm among the historic cattle and dairy ranches that operate within the national seashore in a designated pastoral zone. Park officials have repeatedly said they have no intention of curtailing ranching operations, and Salazar echoed that, adding that he wished to extend the terms of the ranch leases from 10 to 20 years.

The Lunny family also has a cattle operation in the park.

julie.cart@latimes.com

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U.S. Is Weighing Stronger Action in Syrian Conflict

Francisco Leong/Agence France-Presse — Getty Images

Rebels in northern Syria celebrated on Wednesday next to what was reported to be a government fighter jet.

WASHINGTON — The Obama administration, hoping that the conflict in Syria has reached a turning point, is considering deeper intervention to help push President Bashar al-Assad from power, according to government officials involved in the discussions.

While no decisions have been made, the administration is considering several alternatives, including directly providing arms to some opposition fighters.

The most urgent decision, likely to come next week, is whether NATO should deploy surface-to-air missiles in Turkey, ostensibly to protect that country from Syrian missiles that could carry chemical weapons. The State Department spokeswoman, Victoria Nuland, said Wednesday that the Patriot missile system would not be “for use beyond the Turkish border.”

But some strategists and administration officials believe that Syrian Air Force pilots might fear how else the missile batteries could be used. If so, they could be intimidated from bombing the northern Syrian border towns where the rebels control considerable territory. A NATO survey team is in Turkey, examining possible sites for the batteries.

Other, more distant options include directly providing arms to opposition fighters rather than only continuing to use other countries, especially Qatar, to do so. A riskier course would be to insert C.I.A. officers or allied intelligence services on the ground in Syria, to work more closely with opposition fighters in areas that they now largely control.

Administration officials discussed all of these steps before the presidential election. But the combination of President Obama’s re-election, which has made the White House more willing to take risks, and a series of recent tactical successes by rebel forces, one senior administration official said, “has given this debate a new urgency, and a new focus.”

The outcome of the broader debate about how heavily America should intervene in another Middle Eastern conflict remains uncertain. Mr. Obama’s record in intervening in the Arab Spring has been cautious: While he joined in what began as a humanitarian effort in Libya, he refused to put American military forces on the ground and, with the exception of a C.I.A. and diplomatic presence, ended the American role as soon as Col. Muammar el-Qaddafi was toppled.

In the case of Syria, a far more complex conflict than Libya’s, some officials continue to worry that the risks of intervention — both in American lives and in setting off a broader conflict, potentially involving Turkey — are too great to justify action. Others argue that more aggressive steps are justified in Syria by the loss in life there, the risks that its chemical weapons could get loose, and the opportunity to deal a blow to Iran’s only ally in the region. The debate now coursing through the White House, the Pentagon, the State Department and the C.I.A. resembles a similar one among America’s main allies.

“Look, let’s be frank, what we’ve done over the last 18 months hasn’t been enough,” Britain’s prime minister, David Cameron, said three weeks ago after visiting a Syrian refugee camp in Jordan. “The slaughter continues, the bloodshed is appalling, the bad effects it’s having on the region, the radicalization, but also the humanitarian crisis that is engulfing Syria. So let’s work together on really pushing what more we can do.” Mr. Cameron has discussed those options directly with Mr. Obama, White House officials say.

France and Britain have recognized a newly formed coalition of opposition groups, which the United States helped piece together. So far, Washington has not done so.

American officials and independent specialists on Syria said that the administration was reviewing its Syria policy in part to gain credibility and sway with opposition fighters, who have seized key Syrian military bases in recent weeks.

“The administration has figured out that if they don’t start doing something, the war will be over and they won’t have any influence over the combat forces on the ground,” said Jeffrey White, a former Defense Intelligence Agency intelligence officer and specialist on the Syria military. “They may have some influence with various political groups and factions, but they won’t have influence with the fighters, and the fighters will control the territory.”

Jessica Brandt contributed reporting from Cambridge, Mass.

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