Ashley Hebert and J.P. Rosenbaum Are Married

People Exclusive

By Monica Rizzo

12/01/2012 at 06:15 PM EST

J.P. Rosenbaum and Ashley Hebert

Victor Chavez/Getty

It’s official: Bachelorette star Ashley Hebert and her fiancé J.P. Rosenbaum tied the knot Saturday afternoon in Pasadena, Calif.

Surrounded by family, friends and fellow Bachelor and Bachelorette alumni like Ali Fedotowsky, Emily Maynard, and Jason and Molly Mesnick, the couple said "I do" in an outdoor ceremony officiated by franchise host Chris Harrison.

"Today is all about our friends and family," Hebert, whose nuptials will air Dec. 16 on a two-hour special on ABC, tells PEOPLE. "It's about standing with J.P., looking around at all the people we love in the same room there to celebrate our love."

The 28-year-old dentist from Madawaska, Maine, met New York construction manager Rosenbaum, 35, on season 7 of The Bachelorette. The couple became engaged on the season finale.

Hebert and Rosenbaum are the second couple in the franchise's 24 seasons to make it from their show finale to the altar, following in the footsteps of Bachelorette Trista Rehn, who married Vail, Colo., firefighter Ryan Sutter in 2003.

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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

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Cliff fight may knock out December rally

NEW YORK (Reuters) - In normal times, next week's slew of U.S. economic data could be a springboard for a December rally in the stock market.

December is historically a strong month for markets. The S&P 500 has risen 16 times in the past 20 years during the month.

But the market hasn't been operating under normal circumstances since November 7 when a day after the U.S. election, investors' focus shifted squarely to the looming "fiscal cliff."

Investors are increasingly nervous about the ability of lawmakers to undo the $600 billion in tax increases and spending cuts that are set to begin in January; those changes, if they go into effect, could send the U.S. economy into a recession.

A string of economic indicators next week, which includes a key reading of the manufacturing sector on Monday, culminates with the November jobs report on Friday.

But the impact of those economic reports could be muted. Distortions in the data caused by Superstorm Sandy are discounted.

The spotlight will be more firmly on signs from Washington that politicians can settle their differences on how to avoid the fiscal cliff.

"We have a week with a lot of economic data, and obviously most of the economic data is going to reflect the effects of Sandy, and that might be a little bit negative for the market next week, but most of that is already expected - the main focus remains the fiscal cliff," said Peter Cardillo, chief market economist at Rockwell Global Capital in New York.

Concerns about the cliff sent the S&P 500 <.spx> into a two-week decline after the elections, dropping as much as 5.3 percent, only to rally back nearly 4 percent as the initial tone of talks offered hope that a compromise could be reached and investors snapped up stocks that were viewed as undervalued.

On Wednesday, the S&P 500 gained more than 20 points from its intraday low after House Speaker John Boehner said he was optimistic that a budget deal to avoid big spending cuts and tax hikes could be worked out. The next day, more pessimistic comments from Boehner, an Ohio Republican, briefly wiped out the day's gains in stocks.

On Friday, the sharp divide between the Democrats and the Republicans on taxes and spending was evident in comments from President Barack Obama, who favors raising taxes on the wealthy, and Boehner, the top Republican in Congress, who said Obama's plan was the wrong approach and declared that the talks had reached a stalemate.

"It's unusual to end up with one variable in this industry, it's unusual to have a single bullet that is the causal factor effect, and you are sitting here for the next maybe two weeks or more, on that kind of condition," said Sandy Lincoln, chief market strategist at BMO Asset Management U.S. in Chicago.

"And that is what is grabbing the markets."

BE CONTRARY AND MAKE MERRY

But investor attitudes and seasonality could also help spur a rally for the final month of the year.

The most recent survey by the American Association of Individual Investors reflected investor caution about the cliff. Although bullish sentiment rose above 40 percent for the first time since August 23, bearish sentiment remained above its historical average of 30.5 percent for the 14th straight week.

December is a critical month for retailers such as Target Corp and Macy's Inc . They saw monthly retail sales results dented by Sandy, although the start of the holiday shopping season fared better.

With consumer spending making up roughly 70 percent of the U.S. economy, a solid showing for retailers during the holiday season could help fuel any gains.

Ryan Detrick, senior technical strategist at Schaeffer's Investment Research in Cincinnati, believes the recent drop after the election could be a market bottom, with sentiment leaving stocks poised for a December rally.

"The concerns on the fiscal cliff - as valid as they might be - could be overblown. When you look at a lot of the overriding sentiment, that has gotten extremely negative," said Detrick.

"From that contrarian point of view with the historically bullish time frame of December, we once again could be setting ourselves up for a pretty nice end-of-year rally, based on lowered expectations."

SOME FEEL THE BIG CHILL

Others view the fiscal cliff as such an unusual event that any historical comparisons should be thrown out the window, with a rally unlikely because of a lack of confidence in Washington to reach an agreement and the economic hit caused by Sandy.

"History doesn't matter. You're dealing with an extraordinary set of circumstances that could very well end up in the U.S. economy going into a recession," said Phil Orlando, chief equity market strategist at Federated Investors in New York.

"And the likelihood of that is exclusively in the hands of our elected officials in Washington. They could absolutely drag us into a completely voluntary recession."

(Wall St Week Ahead runs every Friday. Questions or comments on this column can be emailed to: charles.mikolajczak(at)thomsonreuters.com )

(Reporting by Chuck Mikolajczak; Editing by Jan Paschal)

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Facebook Powerball frenzy: Purported winner offers to ‘share’ $1 million

His name is Nolan Daniels, and he’s just about to give some random dude or dudette $ 1 million. Or so he claims.

Purporting to be the second Powerball winner in Wednesday’s $ 588 million payout, Mr. Daniels posted a Facebook photo late Thursday of himself holding a ticket showing the winning numbers. The photo is the only one visible on Daniels’s account, which dates to 2008.

“Looks like I’m not going to work … EVER!!!” the smiling purported winner exclaimed. The numbers on his ticket – 5-23-16-22-29-Powerball 6 – correspond to the winning combination, but the ticket has not been publicly verified.

To make the Facebook announcement that much more bizarre, Daniels vowed to give $ 1 million of his winnings to a “random” person who “shares” his photo.

That set off a frenzy Friday as thousands of Facebook users got in on the action, with the photo being shared over 1,000 times a minute, with over 100,000 shares as of 3:30 p.m.

On his Facebook page, Daniels chastised skeptics and suggested, “Anyone who doubts the legitimacy of this photo will not be included in the 1 million dollar drawing.”

There were two winners in the drawing. The only winners confirmed so far are Cindy and Mark Hill of Dearborn, Mo., who decided to take a lump sum payment. Lottery authorities have not revealed the name of the other winner, who bought a ticket in Arizona. Earlier on Friday, some guessed that a video of a man celebrating in Maryland might show the winner.

The payout is the second largest in US history after three ticket buyers shared a $ 656 million jackpot in March. As the amount grew this week, tickets were selling at a rate of 130,000 a minute.

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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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U.S. Moves Toward Recognizing Syria Opposition

Bryan Denton for The New York Times

Rebels in Aleppo, Syria’s largest city, in August. The opposition to the Syrian government is developing a political structure.

WASHINGTON — The United States is moving toward recognizing the Syrian opposition as the legitimate representative of the Syrian people as soon as it fully develops its political structure, American officials said Thursday.

A decision to recognize the group could be announced at a so-called Friends of Syria meeting that Secretary of State Hillary Rodham Clinton is expected to attend in Morocco on Dec. 12. It is the most immediate decision facing the Obama administration as it considers how to end the government of Bashar al-Assad and stop the violence that has consumed Syria.

President Obama has not signed off on the move, and the meetings to decide the issue have yet to be held. Debates within the administration concern legal issues about the implications of diplomatic recognition, how such a move might affect efforts to enlist Russian support for a political transition in Syria and, most importantly, the state of the opposition.

Britain, France, Turkey and the Gulf Cooperation Council have already recognized the opposition, which was enlarged and overhauled at a meeting in Doha, Qatar, last month at the insistence of the United States and other nations. It is formally known as the National Coalition of Syrian Revolutionary and Opposition Forces.

“They are a legitimate representative of the Syrian people’s aspirations,” Robert Ford, the American ambassador to Syria, said Thursday at a conference on the Syrian humanitarian crisis. “They are making real progress and I expect that our position will evolve as they themselves develop,” he added.

American officials who favor the move are hoping to use formal recognition as a reward to the opposition for uniting opponents of the Assad government inside and outside Syria and fleshing out its political structure so that it can play a credible role if Mr. Assad is ousted.

The National Coalition of Syrian Revolutionary and Opposition Forces is in the process of developing a series of committees on humanitarian assistance, education, health, judicial and security issues. If opposition leaders are able to present their group at the Morocco meeting as a functioning organization, one senior American official said, recognition by the United States might follow at the gathering, a conference of more than 70 nations that is to be held in Marrakesh.

“We’ve been looking for them to establish a leadership structure that’s clear to everybody, but also discrete committees that can deal with the various issues that they are assuming responsibility for,” Victoria Nuland, the State Department spokeswoman, said Thursday. “We don’t want to get ahead of the game here.”

At an appearance here on Thursday, Mrs. Clinton expanded on Ms. Nuland’s remarks. “We have been deeply involved in helping stand them up, and we’re going to carefully consider what more we can do,” she said at a conference co-hosted by the publisher of the magazine Foreign Policy. “It appears as though the opposition in Syria is now capable of holding ground, that they are able to bring the fight to the government forces.”

Mr. Ford and other experts attending a conference organized by the Middle East Institute and International Relief and Development, two nongovernment organizations, described a deepening humanitarian crisis because of the Syrian conflict. The number of internally displaced people in Syria has soared to about 2.5 million, according to Kelly Clements, a deputy assistant secretary in the State Department’s Bureau of Population, Refugees and Migration.

The number of refugees has also climbed. About 140,000 Syrians have registered for assistance as refugees in Jordan, some 25,000 of whom are in refugee camps. There are also believed to be more than 100,000 additional Syrian refugees who have not registered. In Turkey, there are 125,000 Syrian refugees in camps and another 75,000 who are not residing in camps, she said. In Lebanon, there are an estimated 135,000 Syrian refugees, none of whom live in refugee camps.

In Iraq, some 60,000 Syrians have registered as refugees, half of whom live in camps. More than 35,000 additional Iraqis who fled the conflict in Iraq for Syria have since returned to Iraq.

The Assad government, Mr. Ford said, has often interfered with the delivery of humanitarian assistance. He also said that Iran had helped the Assad government track down opposition figures who are voicing their view on the Internet.

Mr. Ford indicated that the subject of providing arms to opposition fighters was also being reviewed, but said that any discussion of arms needed to be part of a broader strategy for a political transition if Mr. Assad leaves power. “Arms are not a strategy; arms are a tactic,” he said.

He suggested that the government was still able militarily. “There is no sign of any kind of political deal to be worked out between the opposition groups and the regime,” he said. “The fighting is going to go on.”

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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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Shares edge lower as U.S. budget talks stall

LONDON (Reuters) - Concerns about the deadlock in crucial U.S. budget talks capped gains in world equity markets on Friday, while falling yields on Spanish and Italian bonds kept the euro near a one-month high.

Markets are on edge over the lack of progress by political leaders in Washington as a failure to resolve their differences by year-end would trigger automatic spending cuts and tax rises that will tip the U.S. economy into recession.

Many investors also expect that once the so called 'fiscal cliff' is resolved, the brighter economic outlook for China and the U.S., along with signs of stabilization in the euro zone will fuel a major rally in riskier assets like equities.

"The market is subject to mood swings by investors who pay close attention to small developments in the U.S. budget talks," said Takuya Takahashi, an analyst at Daiwa Securities.

In the latest development the leading Republican politician, House of Representatives Speaker John Boehner, dampened hopes for a early deal on Thursday, less than 24 hours after he said he was "optimistic" about reaching a pact.

The lack of progress saw European shares edge lower at the start of trading but they remain on course for their best month since August and their sixth straight monthly gain.

The FTSEurofirst 300 index <.fteu3> of top European shares was down 0.2 percent at 1,119.74 in early trade, having jumped 1.1 percent on Thursday to its highest close since July 2011. London's FTSE 100 <.ftse>, Paris's CAC-40 <.fchi> and Frankfurt's DAX <.gdaxi> were flat to slightly lower.

A 0.2 percent drop in U.S. stock futures also hinted at a weaker Wall Street open. <.l><.eu><.n/>

Earlier MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> rose 0.6 percent to its highest since March 1, and was on course for a monthly gain of 2.1 percent.

EUROPEAN FEARS EASE

The euro was up 0.3 percent to just over $1.30 and at a seven-month high against the yen 107.55 yen as hopes the euro zone's crisis was easing supported demand.

A deal agreed earlier this week to release aid funds to Greece and strong demand at an Italian bond auction that cut Rome's borrowing costs to a two year low, have encouraged investors into Europe's peripheral markets and the euro.

Amid the unclear prospects for the U.S. budget talks and the better outlook for Europe's debt crisis, investors sought trade incentives from data out of Asian countries on Friday and Saturday that could offer signals for the likely direction of global economic growth.

India's economy grew at a lower-than-expected annual 5.3 percent in the quarter ending in September, against analysts' forecasts of 5.4 percent. Asia's third largest economy is still growing faster than many other major economies, but it has slowed from 6.5 percent in the 2011/12 fiscal year.

The data followed mixed reports from Japan, the world's third-largest economy, earlier in the day.

Japanese industrial output unexpectedly rose 1.8 percent in October, the first increase in four months, suggesting the negative impact of the global slowdown and a diplomatic row with China may have run its course.

But Japanese manufacturing activity contracted in November at the fastest pace in 19 months, according to a survey indicating it was hurt by falling exports, weak domestic demand and declining capital expenditure.

In South Korea, another big export-reliant economy, industrial output grew for a second month in a row in October, backing expectations for a recovery in the current quarter.

On Saturday, China will release the official manufacturing PMI for November, which is likely to show factory activity expanding at its fastest pace in seven months.

(Reporting by Richard Hubbard; editing by Philippa Fletcher)

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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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