Kate's Illness Sometimes Linked to Twins

Hyperemesis gravidarum, the reason newly pregnant Kate Middleton is in the hospital, is a rare but acute morning sickness that results in weight loss and accounts for about 2 percent of all morning sickness, doctors say.

The condition is sometimes associated with women having twins, experts said.

Women diagnosed with hyperemesis gravidarum have lost 5 percent of their pre-pregnancy weight, or 10 pounds, said Dr. Ashley Roman, a professor and OB/GYN at New York University Langone Medical Center.

It poses little danger to the tiny heir, doctors said.

"It's traditionally thought that nausea and vomiting is a sign of a healthy pregnancy," Roman said

Dr. Nancy Cossler, an OB/GYN at University Hospitals in Ohio said the condition does not cause loss of pregnancy or birth defects, but it can be a torture to endure.

"The biggest problem with this is how it interferes with your life," Cossler said. "Constantly feeling sick and puking is difficult."

Click here to read about other women with hyperemesis gravidarum.

Hyperemesis gravidarum is thought to be caused by higher levels of the pregnancy hormone, hCG, or human chorionic gonadotropin, Cossler said. Extra hCG can often be brought on by carrying more than one fetus, she said.

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In other words, it could be a sign that Middleton is carrying twins. Although there's very little data on twins and hyperemesis gravidarum, one study showed that women carrying twins had a 7.5 percent higher risk of experiencing the acute morning sickness, Roman said.

The extreme morning sickness is usually diagnosed about nine weeks into the pregnancy, and in most cases resolves itself by 16 or 20 weeks, Roman said. In rare cases, it can last the whole pregnancy.

"As the pregnancy is in its very early stages, Her Royal Highness is expected to stay in hospital for several days and will require a period of rest thereafter," a statement from St. James Palace said. Prince William is at the hospital with Middleton, according to the Britain's Press Association.

Click here for photos of Kate through the years.

Roman said doctors prescribe vitamins and ginger capsules at first. If that doesn't stop the vomiting, they will prescribe antihistamines and stronger anti-nausea medications.

Women with hyperemesis gravidarum are also treated with fluids, said Dr. Jessica Young, an OB/GYN at Vanderbilt University. But if left untreated, a pregnant woman who is severely dehydrated for a long period of time could die, "just like any person," Young said.

In extreme cases in which the woman is losing weight and unable to eat, doctors will treat her with intravenous nutrition, Young said.

Hospital stays can vary, and women will often have to be admitted more than once before the condition passes, doctors said.

Hyperemesis gravidarum is somewhat mysterious because some expectant mothers have acute morning sickness during only one of their pregnancies, but have no morning sickness for subsequent pregnancies.

There is a chance that higher levels of hCG, which likely caused Middleton's nausea, could be a sign of a molar pregnancy instead of twins, Cossler said. This would mean Middleton is carrying only a benign growth in her uterus instead of a fetus, or she is carrying a fetus with abnormal DNA and a benign growth. Neither is considered a viable pregnancy.

However, Cossler said molar pregnancies become apparent early on, and doctors would already know whether Middleton had one.

"They would not have released this information," Cossler said of the birth announcement. "I'm certain that they have already eliminated both of those [types of molar pregnancies]."

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Egypt's top court shuts down, blames protesters

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

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

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

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

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

Judges supervise voting in Egypt, and Mursi will need them to oversee the referendum.

But in a blow to the president, an influential body representing judges decided on Sunday not to oversee the vote, the state news agency reported. The Judges' Club's decisions are not binding on members, however.

Vice President Mahmoud Mekky said on Sunday he was confident the judges would perform that role, despite calls by Mursi's critics in the judiciary for a boycott.

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

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

The National Salvation Front, an alliance of liberal, leftist and socialist opposition groups, called for protests in Tahrir Square on Tuesday against Mursi holding the referendum on what it branded an "illegitimate constitution".

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

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

DEEP SUSPICION

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

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

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

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

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

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

It will also override the November 22 decree that drew concern from Western governments and a rebellion by sections of the judiciary. The decree shielded Mursi from judicial oversight.

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

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

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

OPPOSITION INFURIATED

But opposition parties have been infuriated by what they see as the Brotherhood's attempt to ram through a constitution that does not enjoy national consensus. Mursi's opponents warn of deeper polarization ahead.

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

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

New York-based Human Rights Watch said the draft constitution protected some rights while undermining others.

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

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

The Islamists are gambling that they will be able to secure a "Yes" vote by mobilizing their core support base.

(Writing by Tom Perry; Editing by Alistair Lyon and Roger Atwood)

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China manufacturing expands in November: HSBC

BEIJING: Manufacturing activity in China hit a 13-month high in November, HSBC said on Monday, in another sign that the world's second largest economy is emerging from a drawn-out slumber.

The banking giant's purchasing managers' index (PMI) hit 50.5 last month, up from 49.5 in October, putting it above the 50 mark that indicates growth. A reading below signals contraction.

The figure signals a return to growth after 12 consecutive months of contraction as the crucial sector has been hit by a global slowdown and the debt crisis in key market Europe, where demand for Chinese goods has slumped.

China's official PMI reading also showed expansion in November for the second month in a row, hitting 50.6 last month, from 50.2 in October and 49.8 in September.

Despite the news Shanghai's composite index slipped, trading 0.28 per cent lower in early trade.

The HSBC index, compiled by information services provider Markit, tracks manufacturing activity and is a closely watched barometer of the health of the economy.

Qu Hongbin, a Hong Kong-based economist with HSBC, said the figure was helped by increasing new business and expanding production. "This confirms the Chinese economy continues to recover gradually," he said.

The bank expects China's economic growth to pick up modestly to around eight per cent in the fourth quarter "as the easing measures continue to filter through", he added.

Economic growth hit a more than three-year low of 7.4 per cent in the third quarter from July to September.

But recent data has fuelled optimism that the worst is over. Exports, industrial production, retail sales and fixed asset investment -- a key gauge of infrastructure spending -- have all shown improvement.

Premier Wen Jiabao and Commerce Minister Chen Deming have both said in recent months that they expect China to achieve its targeted 2012 growth rate of 7.5 per cent despite the impact of the global slowdown.

- AFP/xq

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FDI in retail to safeguard international market mafias' interest: BJP

ANI Dec 1, 2012, 03.28PM IST

NEW DELHI: India's main opposition Bharatiya Janata Party (BJP) today said retail reform is a step taken by the Congress led-federal government to safeguard the interests of the international market mafias at the cost of national interest.

BJP vice president Mukhtar Abbas Naqvi said on Saturday that voting inside the parliament would decide as to who is in favour of national interest and who is working for international interests.

"The government feels that their responsibility is to safeguard the interest of international market mafias instead of national interest and for saving the interest of international market mafias, the government is ready to compromise with national interests. Now, the parliament will decide as to who is in support of international market mafias and who are supporting national interests," said Naqvi.

The government's decision to allow foreign supermarket chains such as Wal-Mart had triggered protest not only from opposition parties but also from some of its allies.

BJP had sought debate on the issue of allowing Foreign Direct Investment (FDI) in the retail sector, under the rule that entails voting after discussions.

Meanwhile, Minister in the Prime Minister Office (PMO), V Narayanaswamy said the government would answer all the queries raised by the opposition parties in the parliament and will explain the benefits of allowing FDI in retail sector.

The lower house of parliament has set December 04 and 05 as the date to vote and debate on FDI. The dates for the upper house are yet to be decided.

Narayanaswamy said the government is confident of becoming victorious in the debate.

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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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Boehner on Fiscal Cliff Talks: 'You Can't Be Serious'

President Obama and his White House team appear to have drawn a line in the sand in talks with House Republicans on the "fiscal cliff."

Tax rates on the wealthy are going up, the only question is how much?

"Those rates are going to have to go up," Treasury Secretary Tim Geithner flatly stated on ABC's "This Week." "There's no responsible way we can govern this country at a time of enormous threat, and risk, and challenge ... with those low rates in place for future generations."

But the president's plan, which Geithner delivered last week, has left the two sides far apart.

In recounting his response today on "Fox News Sunday," House Speaker John Boehner said: "I was flabbergasted. I looked at him and said, 'You can't be serious.'

"The president's idea of negotiation is: Roll over and do what I ask," Boehner added.

The president has never asked for so much additional tax revenue. He wants another $1.6 trillion over the next 10 years, including returning the tax rate on income above $250,000 a year to 39.6 percent.

TOBY JORRIN/AFP/Getty Images

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Boehner is offering half that, $800 billion.

In exchange, the president suggests $600 billion in cuts to Medicare and other programs. House Republicans say that is not enough, but they have not publicly listed what they would cut.

Geithner said the ball is now in the Republicans' court, and the White House is seemingly content to sit and wait for Republicans to come around.

"They have to come to us and tell us what they think they need. What we can't do is to keep guessing," he said.

The president is also calling for more stimulus spending totaling $200 billion for unemployment benefits, training, and infrastructure projects.

"All of this stimulus spending would literally be more than the spending cuts that he was willing to put on the table," Boehner said.

Boehner also voiced some derision over the president's proposal to strip Congress of power over the country's debt level, and whether it should be raised.

"Congress is not going to give up this power," he said. "It's the only way to leverage the political process to produce more change than what it would if left alone."

The so-called fiscal cliff, a mixture of automatic tax increases and spending cuts, is triggered on Jan. 1 if Congress and the White House do not come up with a deficit-cutting deal first.

The tax increases would cost the average family between $2,000 and $2,400 a year, which, coupled with the $500 billion in spending cuts, will most likely put the country back into recession, economists say.

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Mursi calls December 15 referendum, Islamists rally

CAIRO (Reuters) - Egypt's President Mohamed Mursi called a December 15 referendum on a new constitution, hoping to end protests over a decree expanding his powers, as at least 200,000 of his Islamist supporters rallied in Cairo on Saturday.

Approval of the constitution drafted by an assembly stacked with Mursi's Islamist allies will override the November 22 decree that temporarily shielded Mursi from judicial oversight and triggered statements of concern from Western governments.

The decree plunged Egypt into its worst crisis since Mursi won office in a June election and sparked countrywide protests and violence in which two people have been killed and hundreds injured. This hit an economy just showing signs of recovery.

"I renew my call for opening a serious national dialogue over the concerns of the nation, with all honesty and impartiality," said Mursi after receiving the final draft from the constituent assembly. "We must move beyond the period of confrontation and differences, and get on to productive work."

The constitution is meant to be the cornerstone of democracy after three decades of army-backed autocracy under President Hosni Mubarak. Yet drafting it has been divisive, exposing splits between newly empowered Islamists and their opponents.

Protesters in an open-ended sit-in in Cairo's Tahrir Square, which was also the focus of demonstrations against Mubarak, accuse Mursi's Muslim Brotherhood of trying to impose a flawed constitution.

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

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

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

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

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

JUDGES TO SUPERVISE VOTE

To hold the referendum, Mursi will depend on a judiciary which has been on partial strike over the November 22 decree, and which he and the Brotherhood suspect of links to the Mubarak regime. Judges oversee elections in Egypt.

Vice President Mahmoud Mekky said he trusted the judiciary would supervise the vote, state news agency MENA reported.

Mursi is betting the Islamists' core supporters and ordinary Egyptians fed up with instability will pass the constitution.

While Mursi only secured the presidency by a slim margin, the Islamists have won all elections since Mubarak was toppled.

The opposition must decide whether to urge a boycott or a "No" vote in the referendum. If they secure a "No", the president could retain the powers he has unilaterally assumed.

The referendum call met with cheers from the pro-Mursi rally at Cairo University. Streets were clogged with those sympathetic to the Muslim Brotherhood and more hardline Salafi parties.

The rally was a show of strength by Islamists who feel under attack from leftist, liberal and socialist parties. By early evening, the crowd peaked at at least 200,000, said Reuters witnesses, basing estimates on previous Cairo rallies. Authorities declined to give an estimate for the crowd's size.

"The people want the implementation of God's law," chanted flag-waving demonstrators, many bussed in from the countryside.

Tens of thousands of Egyptians protested against Mursi on Friday, chanting: "The people want to bring down the regime," echoing a trademark slogan of the revolts against Arab leaders.

Rival demonstrators threw stones after dark in the northern city of Alexandria and a town in the Nile Delta. Similar clashes erupted again briefly in Alexandria on Saturday, state TV said.

Mohamed Noshi, 23, a pharmacist from Mansoura, said he had joined the rally in Cairo to support Mursi and his decree. "Those in Tahrir don't represent everyone. Most people support Mursi and aren't against the decree," he said.

Egypt cannot hold a new parliamentary election until a new constitution is passed. The country has been without an elected legislature since the Supreme Constitutional Court ordered the dissolution of the Islamist-dominated lower house in June.

The court is due to meet on Sunday to discuss the legality of parliament's upper house.

"We want stability. Every time, the constitutional court tears down institutions we elect," said Yasser Taha, a 30-year-old demonstrator at the Islamist rally in Cairo.

(Additional reporting by Marwa Awad, Yasmine Saleh and Tamim Elyan; Writing by Alistair Lyon and Tom Perry; Editing by Myra MacDonald and Jason Webb)

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Seven trapped in fiery Japan tunnel collapse

KOSHU, Japan: At least seven people were trapped inside a highway tunnel in Japan after it collapsed on Sunday, setting a car ablaze and raising fears of another cave-in that forced a halt to rescue efforts.

Two vehicles were crushed in the original collapse and one other was set ablaze when large concrete ceiling panels fell in inside one of Japan's longest motorway tunnels at nearly five kilometres long.

A comprehensive rescue effort was launched but more than five hours after the incident, workers pulled out of the tunnel because of concerns that more of the roof might collapse, a fire official told AFP.

The cave-in happened on Tokyo-bound lanes of the Sasago tunnel on the Chuo Expressway, 80 kilometres (50 miles) west of the capital, at around 8:00 am (2300 GMT Saturday), an official at the expressway traffic police said.

"Concrete ceiling panels, 20 centimetres (8 inches) thick, collapsed over 50-60 metres (yards)," an official from the East Yamanashi Fire Department told AFP by telephone.

"At least two vehicles were trapped under the debris. Another, a light vehicle, caught fire but the fire was under control, meaning almost extinguished, as of 11:00 am (0200 GMT)," he said.

NHK footage from inside the tunnel showed a white ambulance and several firefighters wearing protective gear, working in a section shrouded in smoke. A number of cars with their lights flashing were also seen.

"According to information from local fire authorities, seven people are missing but the number has not been confirmed," an official at the government's Fire and Disaster Management Agency told AFP.

The fire department official said emergency crews had pulled out of the tunnel shortly before 1:00 pm "due to the possibility of a secondary collapse".

A 28-year-old woman was taken to hospital by ambulance after she emerged from the tunnel by herself, a traffic police official said.

The woman told the fire rescue unit she had been travelling in a rented van with five other people, fire department official Kazuya Tezuka told AFP by telephone.

"I have no idea about what happened to the five others. I don't know how many vehicles were ahead and behind ours," she was quoted as saying.

The tunnel, which passes through hills not far from Mount Fuji, is one of the longest in Japan at 4.7-kilometres (three miles) long, according to the highway operator, and sits on a major road connecting Tokyo with the centre and west of the country.

One of the fire department officials told AFP that emergency workers had taken two women to hospital.

"Both were conscious. One of them, 28, suffered injuries to the head, face and and both hands. The other, 37, suffered bruising," he said.

"A truck driver inside the tunnel called a colleague for help. So he appeared to be trapped in his vehicle. An ambulance is on its way to him," he added.

A reporter for NHK said he happened to be driving through the tunnel on his way to Tokyo when it started to disintegrate.

"I managed to drive through the tunnel but vehicles nearby appeared to have been trapped," he said. "Black smoke was coming and there seemed to be a fire inside the tunnel."

Thick smoke inside the tunnel had hampered rescuers' attempts to reach the caved-in point, two kilometres (one mile) from the Tokyo-side exit, the fire department's Tezuka said.

Aerial footage on NHK showed several red trucks from the local fire department waiting outside the Tokyo side of the tunnel.

Dozens of people were seen waiting at an expressway bus stop just outside the exit. They were believed to have exited from the tunnel, NHK said.

A man in his 30s, who was just 50 metres (yards) ahead of the caved-in spot when the incident happened, recounted details of the terrifying experience.

"A concrete part of the ceiling fell off all of a sudden when I was driving inside. I saw a fire coming from a crushed car. I was so frightened I got out of my car right away and walked one hour to get outside," he told NHK.

"The traffic was not so heavy," he added.

A stream of people was seen coming out of the other exit after abandoning their vehicles in the tunnel, the broadcaster said.

- AFP/xq

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FDI in retail to safeguard international market mafias' interest: BJP

NEW DELHI: India's main opposition Bharatiya Janata Party (BJP) today said retail reform is a step taken by the Congress led-federal government to safeguard the interests of the international market mafias at the cost of national interest.

BJP vice president Mukhtar Abbas Naqvi said on Saturday that voting inside the parliament would decide as to who is in favour of national interest and who is working for international interests.

"The government feels that their responsibility is to safeguard the interest of international market mafias instead of national interest and for saving the interest of international market mafias, the government is ready to compromise with national interests. Now, the parliament will decide as to who is in support of international market mafias and who are supporting national interests," said Naqvi.

The government's decision to allow foreign supermarket chains such as Wal-Mart had triggered protest not only from opposition parties but also from some of its allies.

BJP had sought debate on the issue of allowing Foreign Direct Investment (FDI) in the retail sector, under the rule that entails voting after discussions.

Meanwhile, Minister in the Prime Minister Office (PMO), V Narayanaswamy said the government would answer all the queries raised by the opposition parties in the parliament and will explain the benefits of allowing FDI in retail sector.

The lower house of parliament has set December 04 and 05 as the date to vote and debate on FDI. The dates for the upper house are yet to be decided.

Narayanaswamy said the government is confident of becoming victorious in the debate.

Read More..

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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