Experts: No link between Asperger's, violence

NEW YORK (AP) — While an official has said that the 20-year-old gunman in the Connecticut school shooting had Asperger's syndrome, experts say there is no connection between the disorder and violence.

Asperger's is a mild form of autism often characterized by social awkwardness.

"There really is no clear association between Asperger's and violent behavior," said psychologist Elizabeth Laugeson, an assistant clinical professor at the University of California, Los Angeles.

Little is known about Adam Lanza, identified by police as the shooter in the Friday massacre at a Newtown, Conn., elementary school. He fatally shot his mother before going to the school and killing 20 young children, six adults and himself, authorities said.

A law enforcement official, speaking on condition of anonymity because the person was not authorized to discuss the unfolding investigation, said Lanza had been diagnosed with Asperger's.

High school classmates and others have described him as bright but painfully shy, anxious and a loner. Those kinds of symptoms are consistent with Asperger's, said psychologist Eric Butter of Nationwide Children's Hospital in Columbus, Ohio, who treats autism, including Asperger's, but has no knowledge of Lanza's case.

Research suggests people with autism do have a higher rate of aggressive behavior — outbursts, shoving or pushing or angry shouting — than the general population, he said.

"But we are not talking about the kind of planned and intentional type of violence we have seen at Newtown," he said in an email.

"These types of tragedies have occurred at the hands of individuals with many different types of personalities and psychological profiles," he added.

Autism is a developmental disorder that can range from mild to severe. Asperger's generally is thought of as a mild form. Both autism and Asperger's can be characterized by poor social skills, repetitive behavior or interests and problems communicating. Unlike classic autism, Asperger's does not typically involve delays in mental development or speech.

Experts say those with autism and related disorders are sometimes diagnosed with other mental health problems, such as depression, anxiety, bipolar disorder or obsessive-compulsive disorder.

"I think it's far more likely that what happened may have more to do with some other kind of mental health condition like depression or anxiety rather than Asperger's," Laugeson said.

She said those with Asperger's tend to focus on rules and be very law-abiding.

"There's something more to this," she said. "We just don't know what that is yet."

After much debate, the term Asperger's is being dropped from the diagnostic manual used by the nation's psychiatrists. In changes approved earlier this month, Asperger's will be incorporated under the umbrella term "autism spectrum disorder" for all the ranges of autism.

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AP Writer Matt Apuzzo contributed to this report.

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Online:

Asperger's information: http://1.usa.gov/3tGSp5

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Conn. Shooter Had Hundreds of Rounds

Adam Lanza had hundreds of rounds and used multiple high capacity magazines when he went on a rampage at Sandy Hook Elementary School, killing 20 first graders and six adults, Connecticut State Police said today.

After shooting at victims in two classrooms and a hallway with a high-powered semi-automatic rifle, he put a bullet into his own head with a handgun.

"The weapon that was utilized most of the time during this horrific crime was identified as a Bushmaster AR-15 assault weapon," Connecticut State Police Lt. Paul Vance said. "The trajectory of the shots and all of the ammunition used in the horrible crime will be examined."

Vance said three weapons were found at the scene, while a fourth, a shotgun, was recovered from Lanza's vehicle.

While the shattered community of Newtown awaits President Obama's visit this afternoon, plans for the first funerals were announced.

Noah Pozner, the first grader whose twin sister survived the massacre, and 6-year-old Jack Pinto, will be laid to rest in separate ceremonies Monday afternoon.

The funeral for Jessica Rekos, 6, will be held on Tuesday at St. Rose of Lima Roman Catholic Church, where several of the victims' families attend mass.

The community faced a new shock today when parishioners attending the midday service at Rose of Lima were told to evacuate after a church official became aware of a credible threat.

About 1,000 people were gathered inside the church at the time observing one of four memorial services being held there.

Witnesses said police entered the church and told parishioners that a threat had been made against the church and the surrounding area and that everyone had to leave immediately.

More than a dozen state troopers armed with assault rifles entered the church's education center next to the church, but after a short time it was determined that threat was over.

Brian Wallace, director of communications for the Diocese of Bridgeport, said that after massacre on Friday, he felt evacuation was a vital precaution to take.

"I don't think any of us could be surprised about anything after what has happened," Wallace said.

Meanwhile, police are working to understand what set Lanza off on his rampage.

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ABC News has learned that investigators have seized computers belonging to the 20-year-old from the home he shared with his mother Nancy, the same place he killed her before going to the Sandy Hook Elementary School, where he slaughtered students in two first-grade classes and teachers and staff.

CLICK HERE for full coverage of the tragedy at the elementary school.

Authorities are forensically investigating those computers and are also examining devices owned by Ryan Lanza, the gunman's older brother, to see if they can learn anything more about Adam and what caused him to snap.

Members of the community gathered today at churches across the small town, seeking comfort, clarity or just a cry.

With intermittent freezing rain falling, the bells tolled at St. Rose of Lima as parishioners came for the morning service.

Little more than a week before Christmas when congregants celebrate the birth of the savior, they instead were mourning the deaths of people they knew.

Many of the victims attended the church and the clergy is preparing for the funerals of eight of the children.

As parishioners arrived at the church for the morning service, many stopped at a makeshift memorial with flowers, teddy bears and candles. On large white boards, people wrote notes that express condolences, hope, and even forgiveness.

One says "Rest in Peace Sweet Angels."

After a man and woman knelt down at the memorial -- the woman overcome by grief crying into her husband's arms -- two police officers opened their cars with a delivery: bouquets of flowers and teddy bears stacked in the back of their vehicles. They delicately placed each one down and then both knelt down at the vigil.

The female officer began crying and her male partner put his arm around her to comfort her. She quickly got up, walking to her car while wiping away tears, and then they pulled away.

READ: Complete List of Sandy Hook Victims

A mother and two young daughters came next. She gripped one while she also wiped away tears. A father and his young daughter also came up, the father kneeling and talking to the girl before they slowly walked into the church.

A state police trooper was also among those dropping flowers at the memorial comprised of candles, stuffed toys and a sign that says "Sleep in heavenly peace."

Police Tracing Guns Used in Shooting

At a news conference this morning, Vance said there are many pieces missing in the investigation and investigators continue to work inside Sandy Hook Elementary School to collect evidence.

Key to the investigation will also be the four firearms found at or near the crime scene, he said.

"We are tracing them historically, all the way back to when they were on the workbench being assembled," Vance said.

Authorities are wrapping up their processing of the exterior crime scene, which included vehicles parked in the school's lot at the time of the shooting, Vance said, and have began to release the cars back to their owners.

Vance declined to say what evidence has or has not been collected.

"We can't take segments of an investigation and discuss that publicly because something taken out of context could be misinterpreted," he said, adding that in the end, the "goal is to answer every single question.

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Motor Racing: Grosjean thrills Bangkok with Race of Champions win

BANGKOK: French Formula One star Romain Grosjean claimed the Race of Champions in Bangkok late on Sunday, besting some of the biggest names in motorsport including Sebastian Vettel and Michael Schumacher.

Grosjean beat Le Mans legend Tom Kristensen in the best-of-three final to the competition, which brought together heavyweights from all racing disciplines in the same type of car including IndyCar Series champion Ryan Hunter-Reay and rally driver Sebastien Ogier.

Grosjean, who endured a controversy-marked season in his Formula One Lotus car, ended the year in style with the inspired win at the custom-built tarmac track in Bangkok's 50,000-capacity Rajamangala Stadium.

Grand prix legend Schumacher was knocked out by Grosjean in the semi-final of the headline event while three-time Formula One champion Vettel stumbled at the quarters for the second year running.

But it was not all bad news for the German superstar, as he claimed the ROC Nations Cup on Saturday for the sixth time in a row with compatriot Schumacher.

The 25th edition of the event comes as Thailand makes moves to host its first Formula One race in 2014.

- AFP/fa

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Violence flares in Cairo as Egyptians vote

CAIRO (Reuters) - Islamists attacked the offices of an Egyptian opposition party newspaper on Saturday, security sources said, as people voted on a new constitution intended to pull the country out of a growing political crisis.

The newspaper of the Wafd party in Cairo was targeted with petrol bombs and birdshot, the sources said, in the latest of a series of violent incidents surrounding a divisive referendum designed to pave the way to national elections next year.

The attack came as officials began counting votes after polling stations closed at 11 p.m. (1600 ET).

Official results will not come until after a second round of voting in remaining areas of the country next Saturday, but conflicting claims were already emerging from the rival camps.

A spokesman for the opposition National Salvation Front said it had indications that 60-65 percent of voters in Cairo and other cities had rejected the new constitution, while President Mohamed Mursi's Muslim Brotherhood allies said that after 1 million votes had been counted, 72.5 percent were in favor.

Mostafa Shafik, managing editor at Wafd's newspaper, which is located next to the party headquarters, said his offices had been damaged.

"The attackers used Molotov cocktails to enter, which left minor areas burned," he said.

A Reuters photographer saw a dozen or so cars damaged inside the Wafd headquarters' grounds, their windows broken. Glass was also broken in the headquarters, but he saw no immediate signs of fire damage. Two people appeared to have been injured.

Wafd blamed followers of Hazem Abu Ismail, a Salafist preacher, for the attack, but he used his Facebook page to deny involvement.

Violence in Cairo and other cities has marred the run-up to the referendum. Several party buildings belonging to the Muslim Brotherhood's Freedom and Justice party have been burned in protests.

Rival factions armed with clubs, knives and swords fought in the streets of Alexandria on Friday. Opposition supporters trapped a Muslim preacher inside his mosque after he backed a "yes" vote in favor of the constitution.

ANGRY DEMONSTRATIONS

President Mursi provoked angry demonstrations when he issued a decree last month expanding his powers and then fast-tracked the draft constitution through an assembly dominated by his Muslim Brotherhood group and its allies. At least eight people were killed in clashes last week outside the presidential palace.

His liberal, secular and Christian opponents say the constitution is too Islamist and tramples on minority rights. Mursi's supporters say the charter is needed if progress is to be made towards democracy nearly two years after the fall of military-backed strongman Hosni Mubarak.

"The sheikhs (preachers) told us to say 'yes' and I have read the constitution and I liked it," said 53-year-old Adel Imam as he queued to vote in Cairo on Saturday. "The country will move on."

Turnout was high enough for voting to be extended by four hours in Cairo and some other cities.

In order to pass, the constitution must be approved by more than 50 percent of voters who cast ballots. A little more than half of Egypt's electorate of 51 million are eligible to vote in the first round in Cairo and other cities.

Rights groups reported some abuses, such as polling stations opening late, officials telling people to vote "yes", bribery and intimidation.

But Gamal Eid, head of the Arab Network for Human Rights Information, which is monitoring the vote, said nothing reported so far was serious enough to invalidate the referendum.

TRANSITION

Christians, making up about 10 percent of Egypt's 83 million people and who have long complained of discrimination, were among those waiting at a polling station in Alexandria to oppose the basic law. They fear Islamists, long repressed by Mubarak, will restrict social and other freedoms.

"I voted 'no' to the constitution out of patriotic duty," said Michael Nour, a 45-year-old Christian teacher in Alexandria. "The constitution does not represent all Egyptians."

Howaida Abdel Azeem, a post office employee, said: "I said 'yes' because I want the destruction the country is living through to be over and the crisis to pass."

Islamists are counting on their disciplined ranks of supporters and the many Egyptians who may fall into line in the hope of ending turmoil that has hammered the economy and sent Egypt's pound to eight-year lows against the dollar.

Mursi was among the early voters after polls opened at 8 a.m. (0600 GMT). He was shown on television casting his ballot shielded by a screen and then dipping his finger in ink - a measure to prevent people voting twice.

The second round will be held in other regions on December 22 because there are not enough judges willing to monitor all polling stations after some said they would boycott the vote.

Egyptians are being asked to accept or reject a constitution that must be in place before a parliamentary election can be held next year to replace an Islamist-led parliament dissolved in June. Many hope this will lead Egypt towards stability.

If the constitution is voted down, a new assembly will have to be formed to draft a revised version, a process that could take up to nine months.

The army has deployed about 120,000 troops and 6,000 tanks and armoured vehicles to protect polling stations and other government buildings. While the military backed Mubarak and his predecessors, it has not intervened in the present crisis.

(Writing by Edmund Blair and Giles Elgood; Editing by Tom Pfeiffer)

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Interaction key to end Kudankulam-like stir: IAEA chief

KORIYAMA (FUKUSHIMA): UN nuclear watchdog IAEA chief Yukiya Amano on Saturday called for 'better communication and higher transparency' in dealing with Kudankulam-like protests. Even as he sought to distance himself from both sides — protesters as well as votaries of nuclear power —the director-general said that the issue of spent N-fuel, which is at the core of protests in India, was one of the lessons the world learnt from the accident at Fukushima Daiichi N-plant in Japan last year.

Amano was talking exclusively to TOI here on the sidelines of the Fukushima ministerial conference that saw many smaller countries pleading for nuclear power generation to deal with rising fossil fuel prices and climate change issues. The conference, which was presided over by Japanese foreign minister Koichiro Gemba, was held to strengthen N- safety worldwide.

"I don't have any particular comment on opposition to nuclear power anywhere, or those who support it, but if I can give a recommendation, we need to share both good news and bad news to be able to get a better understanding of the problem," he told TOI, replying to a query about protests in India that have delayed the commissioning of the first unit at Kudankulam.

"Communication is one of the areas where we need to improve and IAEA has been organizing meetings of global experts to look into this. We have to explain complicated things in a simple manner and it is only through better communication and higher transparency that we can achieve this," he added.

Amano admitted that the safety aspect of the spent N-fuel was a very important issue. The government's 'success' in acquiring reprocessing rights from Russia has become a millstone around its neck as this prevents it from sending the spent or used fuel back to Russia. The government painstakingly maintains that it considers spent fuel an asset that is used to produce electricity.

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

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Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

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School Shooting Victims Were Shot Multiple Times

The gunman who massacred 20 children in a Connecticut elementary school riddled them with bullets, shooting some of them as many as 11 times, the medical examiner said today.

"I've been at this for a third of a century so my sensibilities may not be the that of the average man, but it's probably the worst I've ever seen," said Chief Medical Examiner H. Wayne Carver II, who has been a medical examiner for 36 years.

A team of 14 medical technicians worked through the night to complete the grisly job of identifying the children killed by Adam Lanza, 20, in the Sandy Hook Elementary School massacre so their names could be released today.

Several weapons were found in the school, including a semi-automatic rifle.

"All the wounds that I know of at this point were caused by the long weapon," Carver said, and many were shot at close range.

CLICK HERE for full coverage of the tragedy at the elementary school.

"I believe many of them were hit more than once," and he said the wounds were "all over" the children's bodies.

"I only did seven of the autopsies. The victims I had ranged from 3 to 11 wounds a piece," Carver said.

The names of the children slain Friday in the Newtown, Conn., school were released today.

To carry out the identifications, Carver said they "did not bring the families and the bodies into contact." He said the identifications were made through photographs of the children's faces. "It's easier on the families," he said.

Additional work is needed to complete the autopsies and identifications of the seven adults slain in Lanza's killing spree.

Emmanuel Dunand/AFP/Getty Images

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Fresh details of the massacre emerged including the fact that all of the young victims were first graders in two rooms.

Based on the Sandy Hook school directory, all the kids killed were in the first grade and were in two classrooms.

In one class, 15 of the 16 students listed were killed. In the other class, five of the 16 students died along with their teacher Victoria Soto. Also, nine of the deceased students have siblings in the school.

At a nearby firehouse that has become a center for the town a makeshift memorial and vigil has emerged under a sign that reads "Sandy Hook School." People have left flowers, candles, signs that read "Rest in Peace" and "God Bless Sandy Hook Elementary," as well as a cross made of blue flowers and a wreath of teddy bears

With the tally of Lanza's carnage complete, authorities and the grieving people of Newtown, Conn., are left to wonder why he turned the elementary school in this quaint New England town into a slaughter house.

Connecticut State Police Lt. Paul Vance said the investigation "did produce some very good evidence" about motive, but he would not go into further detail.

He indicated the evidence came from the shooting scene at the school as well as at the home where Lanza's mother, Nancy, was slain.

Also key will be the lone person shot by Lanza who wasn't killed. The female teacher has not been publicly identified.

"She is doing fine," Vance said at a news conference today. "She has been treated and she'll be instrumental in this investigation."

Vance said it appears that reports of an altercation involving Lanza at the school in the days before the mass slaying are not checking out.

Vance said that Lanza forced his way into the school, but did not say how.

Evidence emerged today that Lanza's rampage began in the office of school principal Dawn Hochsprung while the school intercom was on. It's not clear whether it was turned on to alert the school or whether it was on for morning announcements, but the principal's screams and the cries of children heard throughout the school gave teachers time to take precautions to protect their children.

Hochsprung was among those killed in the Friday morning killing spree.

READ: Connecticut Shooter Adam Lanza: 'Obviously Not Well'

Authorities have fanned out to New Jersey, Connecticut and Massachusetts to interview Lanza's relatives, ABC News has learned.

According to sources, Lanza shot his mother in the face, then left his house armed with at least two semi-automatic handguns, a Glock and a Sig Sauer, and a semi-automatic rifle. He was also wearing a bulletproof vest.

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Football: Benteke rampant as Aston Villa curb Liverpool's revival

LIVERPOOL, United Kingdom: Christian Benteke scored twice and made another goal as Aston Villa checked Liverpool's recent resurgence with a 3-1 win at Anfield in the Premier League on Saturday.

Liverpool were bidding for a fourth consecutive win in all competitions but failed to convert a string of first-half chances and were punished when goals from Benteke and Andreas Weimann put Villa 2-0 up at half-time.

Benteke struck again early in the second half and although Steven Gerrard pulled one back, it was too late to prevent Paul Lambert's side - the youngest Villa team ever to start a Premier League game - from extending their unbeaten run to five league games.

Victory eased Villa's relegation fears by carrying them up to 14th place, four days after they beat Norwich City 4-1 to reach the League Cup semi-finals, while Liverpool slipped two places to 12th.

Liverpool manager Brendan Rodgers had talked up his side's chances of a top-four finish in the build-up to the match and they certainly began the game with ambition.

Villa goalkeeper Brad Guzan had to be alert after visiting defender Eric Lichaj diverted Stewart Downing's low cross towards his own goal, while Gerrard could only shoot straight at Guzan from just inside the penalty area.

Downing and Joe Allen fired narrowly wide for the hosts, before Nathan Baker had to produce a last-ditch challenge to thwart Jonjo Shelvey.

Luis Suarez returned to the Liverpool line-up after suspension and he spurned a fine chance in the 27th minute, placing a tame half-volley within Guzan's reach from Shelvey's lay-off.

The hosts were punished for their wastefulness two minutes later, when Benteke gathered possession in the inside-left channel before arrowing a low drive into the bottom-left corner from 25 yards.

It was almost 2-0 shortly afterwards, Weiman lobbing onto the roof of the net following a miscued header from Glen Johnson, but five minutes before the interval, the Austrian made no mistake.

A sweeping move culminated in Weimann rolling a pass into the box for Benteke, whose cute back-heel found Weimann rushing in to dispatch a crisp shot across Pepe Reina.

Rodgers introduced Joe Cole at half-time but he was to play an unwitting role in Villa's third goal in the 51st minute.

After the former England man was robbed in midfield, Benteke collected possession and the Belgian striker was allowed to advance deep into the Liverpool box before prodding the ball past Reina.

Johnson had a penalty appeal turned down when his header seemed to strike Baker's arm, before Gerrard stooped to head home Johnson's left-foot shot to give the hosts an 87th-minute consolation.

English Premier League results:

Liverpool 1 Aston Villa 3
Manchester Utd 3 Sunderland 1
Newcastle 1 Manchester City 3
Norwich 2 Wigan 1
QPR 2 Fulham 1
Stoke 1 Everton 1

- AFP/de

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Sushil Kumar Shinde, Rehman Malik operationalise new visa regime

NEW DELHI: Travel between India and Pakistan will become easier with the operationalisation of a new visa regime on Friday that allows multi-city visas for up to five cities, visitor visas for two years for senior citizens and children below 12 years, visa on arrival for senior citizens, and group tourist visa, besides exempting specified categories of businessmen from police reporting.

The visa agreement was operationalised by home minister Sushil Kumar Shinde and visiting Pakistani interior minister Rehman Malik, both of whom agreed that it would promote people-to-people contact between the two countries. The visa agreement was signed by the two sides on September 8. Malik said the new visa agreement was not only historic but a step forward for peace.

Outlining the key features of the new visa regime, Shinde said visas can now be granted for five places as against the earlier restriction of three cities. Visitor visas can be issued for up to two years where the applicant is above 65 years of age, where a national of one country is married to a national of the other country and children below 12 years accompanying their parents.

Senior citizens (above 65 years of age) can now avail of visa on arrival, to be issued at Attari/Wagah post for 45 days with a single entry. This will, however, take effect only from January 15, 2013.

In a move aimed at promoting economic ties between the neighbours, business visa norms have been eased, with businessmen with income above 5 million Pakistani rupees or having an annual turnover above 30 million Pakistani rupees now exempt from police reporting.

Indians and Pakistanis can travel to each other's country in groups comprising 10-50 members. The groups, organized by approved tour operators and travel agents, will be issued group tourist visas for 30 days. Group visas will, however, be issued from March 15, 2013.

Entry and exit from different designated check-posts has been allowed, if indicated in the application, though a person can exit from Attari/Wagah on foot only if he had also made the entry on foot from the same check-post.

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

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Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

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