New push for most in US to get at least 1 HIV test

WASHINGTON (AP) — There's a new push to make testing for the AIDS virus as common as cholesterol checks.

Americans ages 15 to 64 should get an HIV test at least once — not just people considered at high risk for the virus, an independent panel that sets screening guidelines proposed Monday.

The draft guidelines from the U.S. Preventive Services Task Force are the latest recommendations that aim to make HIV screening simply a routine part of a check-up, something a doctor can order with as little fuss as a cholesterol test or a mammogram. Since 2006, the Centers for Disease Control and Prevention also has pushed for widespread, routine HIV screening.

Yet not nearly enough people have heeded that call: Of the more than 1.1 million Americans living with HIV, nearly 1 in 5 — almost 240,000 people — don't know it. Not only is their own health at risk without treatment, they could unwittingly be spreading the virus to others.

The updated guidelines will bring this long-simmering issue before doctors and their patients again — emphasizing that public health experts agree on how important it is to test even people who don't think they're at risk, because they could be.

"It allows you to say, 'This is a recommended test that we believe everybody should have. We're not singling you out in any way,'" said task force member Dr. Douglas Owens of Stanford University and the Veterans Affairs Palo Alto Health Care System.

And if finalized, the task force guidelines could extend the number of people eligible for an HIV screening without a copay in their doctor's office, as part of free preventive care under the Obama administration's health care law. Under the task force's previous guidelines, only people at increased risk for HIV — which includes gay and bisexual men and injecting drug users — were eligible for that no-copay screening.

There are a number of ways to get tested. If you're having blood drawn for other exams, the doctor can merely add HIV to the list, no extra pokes or swabs needed. Today's rapid tests can cost less than $20 and require just rubbing a swab over the gums, with results ready in as little as 20 minutes. Last summer, the government approved a do-it-yourself at-home version that's selling for about $40.

Free testing is available through various community programs around the country, including a CDC pilot program in drugstores in 24 cities and rural sites.

Monday's proposal also recommends:

—Testing people older and younger than 15-64 if they are at increased risk of HIV infection,

—People at very high risk for HIV infection should be tested at least annually.

—It's not clear how often to retest people at somewhat increased risk, but perhaps every three to five years.

—Women should be tested during each pregnancy, something the task force has long recommended.

The draft guidelines are open for public comment through Dec. 17.

Most of the 50,000 new HIV infections in the U.S. every year are among gay and bisexual men, followed by heterosexual black women.

"We are not doing as well in America with HIV testing as we would like," Dr. Jonathan Mermin, CDC's HIV prevention chief, said Monday.

The CDC recommends at least one routine test for everyone ages 13 to 64, starting two years younger than the task force recommended. That small difference aside, CDC data suggests fewer than half of adults under 65 have been tested.

"It can sometimes be awkward to ask your doctor for an HIV test," Mermin said — the reason that making it routine during any health care encounter could help.

But even though nearly three-fourths of gay and bisexual men with undiagnosed HIV had visited some sort of health provider in the previous year, 48 percent weren't tested for HIV, a recent CDC survey found. Emergency rooms are considered a good spot to catch the undiagnosed, after their illnesses and injuries have been treated, but Mermin said only about 2 percent of ER patients known to be at increased risk were tested while there.

Mermin calls that "a tragedy. It's a missed opportunity."

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Hamas leader: Cease-fire with Israel near

JERUSALEM (AP) — A diplomatic push to end Israel's nearly weeklong offensive in the Gaza Strip gained momentum Tuesday, with Egypt's president predicting that airstrikes would end within hours and Israel's prime minister saying his country would be a "willing partner" to a cease-fire with the Islamic militant group Hamas.

As international diplomats raced across the region to cement a deal, a senior Hamas official said an agreement was close even as relentless airstrikes and rocket attacks between the two sides continued. President Barack Obama dispatched Secretary of State Hillary Rodham Clinton to the Mideast from Cambodia, where she had accompanied him on a visit.

"We haven't struck the deal yet, but we are progressing and it will most likely be tonight," Moussa Abu Marzouk said Tuesday from Cairo, where cease-fire talks were being held.

Egyptian President Mohammed Morsi, perhaps the most important interlocutor between Hamas, which rules the Palestinian territory, and the Israelis, said the negotiations between the two sides will yield "positive results" during the coming hours.

In Brussels, a senior official of the European Union's foreign service said a cease-fire would include an end of Israeli airstrikes and targeted killings in Gaza, the opening of Gaza crossing points and an end to rocket attacks on Israel. The official spoke on condition of anonymity because he was not authorized to speak to the media.

Violence raged on as the talks continued. An airstrike late Tuesday killed two journalists who work for the Hamas TV station, Al-Aqsa, according to a statement from the channel. The men were in a car hit by an airstrike, Gaza health official Ashraf al-Kidra said. Israel claims that many Hamas journalists are involved in militant activities. Earlier this week it targeted the station's offices, saying it served as a Hamas communications post.

By Tuesday, 128 Palestinians, including at least 54 civilians, were killed since Israel began an air onslaught that has so far included nearly 1,500 strikes. Some 840 people have been wounded, including 225 children, Gaza health officials said.

Three Israeli civilians have also been killed and dozens wounded since the fighting began last week, the numbers possibly kept down by a rocket-defense system that Israel developed with U.S. funding. More than 1,000 rockets have been fired at Israel this week, the military said.

Late Tuesday, a Palestinian rocket hit a house in the central Israeli city of Rishon Letzion, wounding two people and badly damaging the top two floors of the building, police spokesman Micky Rosenfeld said.

With the death toll rising, the international community stepped up efforts to bring a halt to the fighting that began last Wednesday with an Israel's assassination of the Hamas military chief.

"If a long-term solution can be put in place through diplomatic means, then Israel would be a willing partner to such a solution. But if stronger military action proves necessary to stop the constant barrage of rockets, Israel wouldn't hesitate to do what is necessary to defend our people," Israeli Prime Minister Benjamin Netanyahu said during a joint press conference in Jerusalem with visiting U.N. chief Ban Ki-moon.

Ban condemned Palestinian rocket attacks, but urged Israel to show "maximum restraint."

"Further escalation benefits no one," he said.

Minutes before Ban's arrival in Jerusalem from Egypt, Palestinian militants fired a rocket toward the holy city. Earlier Tuesday, a man identified as Hamas' militant commander urged his fighters to keep up attacks on Israel, even as Israeli airstrikes killed a senior Hamas militant identified as Amin al-Dada and five others in a separate attack on a car, according to Gaza health officials.

Israeli warplanes dropped leaflets on several Gaza neighborhoods asking residents to evacuate and head toward the center of Gaza City along specific roads. The army "is not targeting any of you, and doesn't want to harm you or your families," the leaflets said. Palestinian militants urged residents to ignore the warnings, calling them "psychological warfare."

Clinton was scheduled to meet with Netanyahu in Jerusalem, Palestinian President Mahmoud Abbas in the West Bank and Egyptian leaders in Cairo. Turkey's foreign minister and a delegation of Arab League foreign ministers traveled to Gaza on a separate truce mission. Airstrikes continued to hit Gaza even as they entered the territory.

"Turkey is standing by you," Turkish Foreign Minister Ahmet Davutoglu told the Hamas prime minister in Gaza, Ismail Haniyeh. "Our demand is clear. Israel should end its aggression immediately and lift the inhumane blockade imposed on Gaza."

It was unclear how diplomatic efforts to achieve a cease-fire and stave off a threatened Israeli ground invasion into Gaza were hampered by the hard-to-bridge positions staked out by both sides — and by the persistent attacks. Tens of thousands of Israeli soldiers have been dispatched to the Gaza border in case of a decision to invade.

Residents of Jerusalem ran for cover Tuesday as sirens sounded after Palestinians fired a rocket toward the holy city for the second time since the fighting started last Wednesday.

Rosenfeld said the rocket landed harmlessly in an open area in Gush Etzion, a collection of Jewish West Bank settlements southeast of the city. Last Friday's attempt to hit Jerusalem, nearly 80 kilometers (50 miles) from Gaza, landed in the same area. No one was wounded in either attack.

Jerusalem had previously been considered beyond the range of Gaza rockets — and an unlikely target because it is home to the Al-Aqsa Mosque compound, Islam's third-holiest shrine.

In a sign of the difficulty diplomats will have in forging such a cease-fire, a man identified as Mohammed Deif, Hamas' elusive military commander, urged his fighters to keep up attacks on Israel.

Speaking from hiding on Hamas-run TV and radio, Deif said Hamas "must invest all resources to uproot this aggressor from our land," a reference to Israel.

Deif is one of the founders of Hamas' military wing and was its top commander until he was seriously wounded in an Israeli airstrike in 2003. He was replaced as the de facto leader by Ahmed Jabari, who was assassinated by Israel last week in the opening salvo of its latest Gaza offensive.

The U.S. considers Hamas, which has killed hundreds of Israelis in suicide and other attacks, to be a terror group and does not meet with its officials. The Obama administration blames Hamas for the latest eruption of violence and says Israel has the right to defend itself. At the same time, it has warned against a ground invasion, saying it could send casualties spiraling.

Netanyahu said earlier Tuesday that Israel was exploring a diplomatic solution, but wouldn't balk at a broader military operation.

"I prefer a diplomatic solution," Netanyahu said in a statement after meeting with Germany's Foreign Minister Guido Westerwelle, who is also in the region trying to advance peace efforts. "But if the fire continues, we will be forced to take broader measures and will not hesitate to do so."

Westerwelle said a truce must be urgently pursued, "but of course, there is one precondition for everything else, and this is a stop of the missile attacks against Israel."

The conflict erupted last week, when a resurgence in rocket fire from Gaza set off the Israeli offensive, which included hundreds of airstrikes on militants' underground rocket launchers and weapons' stores.

The onslaught turned deadlier over the weekend, as airstrikes began targeting the homes of suspected Hamas activists, leading to a spike in civilian casualties. Israel sent warnings in some cases, witnesses said, but in other instances missiles hit suddenly, burying residents under the rubble of their homes.

Hamas is deeply rooted in densely populated Gaza, and the movement's activists live in the midst of ordinary Gazans. Israel says militants are using civilians as human shields, both for their own safety and to launch rocket strikes from residential neighborhoods.

Early Tuesday, Israeli aircraft targeted another Hamas symbol of power, the headquarters of the bank senior Hamas officials set up to sidestep international sanctions on the militant group's rule. The inside of the bank was destroyed. A building supply business in the basement was damaged.

Fuad Hijazi and two of his toddler sons were killed Monday evening when missiles struck their one-story shack in northern Gaza, leaving a crater about two to three meters (seven to 10 feet) deep in the densely populated neighborhood. Residents said the father was not a militant.

The conflict showed signs of spilling into the West Bank, as hundreds of Palestinian protesters in the town of Jenin clashed with Israeli forces during a demonstration against Israel's Gaza offensive.

Two Palestinian protesters were killed in anti-Israel demonstrations in the West Bank on Monday, according to Palestinian officials. Separate clashes occurred Tuesday in Ramallah, the seat of the Palestinian government, during the funeral for one of the dead.

Palestinian President Mahmoud Abbas, who lost control of Gaza to Hamas in 2007, now governs from the West Bank. Abbas claims to represent both areas, and there is widespread sympathy among West Bank Palestinians for their brethren in Gaza.

Israel demands an end to rocket fire from Gaza and a halt to weapons smuggling into Gaza through tunnels under the border with Egypt. It also wants international guarantees that Hamas will not rearm or use Egypt's Sinai region, which abuts both Gaza and southern Israel, to attack Israelis.

Hamas wants Israel to halt all attacks on Gaza and lift tight restrictions on trade and movement in and out of the territory that have been in place since Hamas seized Gaza by force in 2007. Israel has rejected such demands in the past.

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Associated Press writers Hamza Hendawi in Cairo, and Karin Laub and Ibrahim Barzak in Gaza City, Gaza Strip, contributed to this report.

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Obama makes history with Myanmar, Cambodia visits

PHNOM PENH, Cambodia (AP) — On a history-making trip, President Barack Obama on Monday paid the first visit by an American leader to Myanmar and Cambodia, two Asian countries with troubled histories, one on the mend and the other still a cause of concern.

Obama's fast-paced, pre-Thanksgiving trip vividly illustrated the different paths the regional neighbors are taking to overcome legacies of violence, poverty and repression.

Cheered by massive flag-waving crowds, Obama offered long-isolated Myanmar a "hand of friendship" as it rapidly embraces democratic reforms. Hours later, he arrived in Cambodia to little fanfare, then pointedly criticized the country's strongman leader on the issue of human rights during a tense meeting.

Obama was an early champion of Myanmar's sudden transformation to civilian rule following a half-century of military dictatorship. He's rewarded the country, also known as Burma, with eased economic penalties, increased U.S. investment and now a presidential visit, in part to show other nations the benefits of pursuing similar reforms.

"You're taking a journey that has the potential to inspire so many people," Obama said during a speech at Myanmar's University of Yangon.

The Cambodians are among those Obama is hoping will be motivated. White House officials said he held up Myanmar, a once-pariah state, as a benchmark during his private meeting Monday evening with Prime Minister Hun Sen, the autocratic Cambodian leader who has held power for nearly 30 years. Hun Sen's rivals have sometimes ended up in jail or in exile.

Unlike the arrangement after Obama's meetings with Myanmar's President Thein Sein and democracy leader Aung Sun Suu Kyi, the U.S. and Cambodian leaders did not speak to the press following their one-on-one talks. They did step before cameras briefly before their meeting to greet each other with a brisk handshake and little warmth.

In private, U.S. officials said, Obama pressed Hun Sen to release political prisoners, stop land seizures and hold free and fair elections. Aides acknowledged the meeting was tense, with the Cambodian leader defending his practices, even as he professed to seek a deeper relationship with the U.S.

Ben Rhodes, Obama's deputy national security adviser, said the president told Hun Sen that without reforms, Cambodia's human rights woes would continue to be "an impediment" to that effort.

White House officials emphasized that Obama would not have visited Cambodia had it not been hosting two regional summit meetings the U.S. attends, a rare admonishment of a country on its own soil.

The Cambodian people appeared to answer Obama's cold shoulder in kind. Just a few small clusters of curious Cambodians gathered on the streets to watch his motorcade speed though the streets of Phnom Penh.

A welcome sign did greet Obama upon his arrival — but it heralded Chinese Premier Wen Jiabao, not the American president.

Human rights groups fear that because Obama delivered his condemnation of Hun Sen in private, government censors will keep his words from reaching the Cambodian people. And they worry the prime minister will then use Obama's visit to justify his grip on power and weaken the will of opposition groups.

"If Hun Sen's narrative about this visit is allowed to gel, it will create a perception that the United States and other international actors stand with Hun Sen, and not with the Cambodian people," said John Sifton, Asia director at Human Rights Watch. "It will be a tremendous blow to Cambodians who challenge his rule."

Obama's visit to Myanmar was also viewed critically by some international organizations, which saw the trip as a premature reward for a country that still holds political prisoners and has been unable to contain ethic violence.

Aware of that criticism, Obama tempered some of his praise for Myanmar during his six-hour visit. He underscored that the reforms that have taken hold over the past year are "just the first steps on what will be a long journey."

Perhaps the sharpest calls for caution came from Suu Kyi, Myanmar's longtime democracy champion. After meeting with Obama at the home where she spent years under house arrest, she warned that the most difficult part of the transition will be "when we think that success is in sight."

"Then we have to be very careful that we're not lured by the mirage of success," Suu Kyi said, speaking with Obama by her side.

The president, winding down his first foreign trip after winning re-election, had meetings scheduled in Cambodia Tuesday with his counterparts in the East Asia Summit. Obama has added the summit to his annual list of high-priority international meetings as he seeks to expand U.S. influence in the region.

Obama will also meet separately on the sidelines of the summit with Japanese Prime Minister Yoshihiko Noda and with Wen, the Chinese premier. It's likely to be Obama's last bilateral meetings with both men.

Yoda dissolved his country's parliament last week, setting the stage for new elections his party is unlikely to win. And China is undergoing its first leadership transition in a decade, with Wen and President Hu Jintao stepping down to clear the way for new leaders in the country's Communist Party.

Obama will return to Washington before dawn Wednesday, in time for the ceremonial pardoning of the Thanksgiving turkey.

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Associated Press writers Jim Kuhnhenn and Grant Peck contributed to this report.

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Follow Julie Pace at http://twitter.com/jpaceDC

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MTV special profiles young people with HIV

NEW YORK (AP) — MTV is airing a special next week with profiles of three young people who have the HIV infection, amid worries that some people are taking the condition too casually.

The special, "I'm Positive," is scheduled to air Dec. 1 at 7 p.m. ET/PT. Drew Pinsky, who is one of the show's producers, said that if it does well, he hopes it can become a regular series.

In three decades, infection with the virus that causes AIDS has gone from a virtual death sentence to a chronic condition that can be controlled with early detection and a drug regimen. But even if it doesn't develop into full-blown AIDS, there's still some doubt about the long-term health implications of living with HIV and the drugs designed to keep control of it, Pinsky said.

"People are taking it too casually ... and forgetting about it," Pinsky said.

A generational divide is evident in the profiles on "I'm Positive." California girl Kelly, one of the three subjects, feels in control of the situation despite her infection. The mother of Stephanie, a single Southern girl infected through one instance of unprotected sex, is distraught and thinks her daughter is about to die.

The third profile subject, Otis, had a hard time telling his family that he was HIV positive since it was only a year earlier that he revealed he was gay.

As proven by its programming on teenage pregnancy, MTV finds that this documentary-style programming is a good way to reach its young viewers with a message.

"Young people relate when they see their peers struggling with this phenomenon," Pinsky said.

MTV began running "safe sex" campaigns in 1985, and has been encouraging youngsters to get themselves tested for 15 years in an effort funded together with the Kaiser Family Foundation.

Two in five people infected with HIV each year in the United States are between the ages of 13 and 29, MTV's targeted audience. More than 1.1 million Americans are living with HIV infection, according to the Centers for Disease Control.

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MTV is owned by Viacom Inc.

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EU drug regulator OKs Novartis' meningitis B shot

LONDON (AP) — Europe's top drug regulator has recommended approval for the first vaccine against meningitis B, made by Novartis AG.

There are five types of bacterial meningitis. While vaccines exist to protect against the other four, none has previously been licensed for type B meningitis. In Europe, type B is the most common, causing 3,000 to 5,000 cases every year.

Meningitis mainly affects infants and children. It kills about 8 percent of patients and leaves others with lifelong consequences such as brain damage.

In a statement on Friday, Andrin Oswald of Novartis said he is "proud of the major advance" the company has made in developing its vaccine Bexsero. It is aimed at children over two months of age, and Novartis is hoping countries will include the shot among the routine ones for childhood diseases such as measles.

Novartis said the immunization has had side effects such as fever and redness at the injection site.

Recommendations from the European Medicines Agency are usually adopted by the European Commission. Novartis also is seeking to test the vaccine in the U.S.

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Israel says prefers diplomacy but ready to invade Gaza

GAZA/JERUSALEM (Reuters) - Israel bombed dozens of targets in the Gaza Strip on Monday and said that while it was prepared to step up its offensive by sending in troops, it preferred a diplomatic solution that would end Palestinian rocket fire.

Mediator Egypt said a deal for a truce to end the fighting could be close. The leader of Hamas said it was up to Israel to end the new conflict it had started. Israel says its strikes are to halt Palestinian rocket attacks.

U.N. Secretary-General Ban Ki-moon, touring the region in hopes of helping broker a peace arrived in Cairo, where he met Egypt's foreign minister in preparation for talks with the new, Islamist president, Mohamed Mursi, on Tuesday. He also plans to meet Israeli Prime Minister Benjamin Netanyahu in Jerusalem.

Israeli attacks on the sixth day of fighting raised the number of Palestinian dead to 101, the Hamas-run Health Ministry said, listing 24 children among them. Hospital officials in Gaza said more than half of those killed were non-combatants. Three Israeli civilians died on Thursday in a rocket strike.

Militants in the Gaza Strip fired 110 rockets at southern Israel on Monday, causing no casualties, police said.

For the second straight day, Israeli missiles blasted a tower block in the city of Gaza housing international media. Two people were killed there, one of them an Islamic Jihad militant.

Khaled Meshaal, exiled leader of Hamas, said a truce was possible but the Islamist group, in charge of the Gaza Strip since 2007, would not accept Israeli demands and wanted Israel to halt its strikes first and lift its blockade of the enclave.

"Whoever started the war must end it," he told a news conference in Cairo, adding that Netanyahu, who faces an election in January, had asked for a truce, an assertion a senior Israeli official described as untrue.

Meshaal said Netanyahu feared the domestic consequences of a "land war" of the kind Israel launched four years ago: "He can do it, but he knows that it will not be a picnic and that it could be his political death and cost him the elections."

For Israel, Vice Prime Minister Moshe Yaalon has said that "if there is quiet in the south and no rockets and missiles are fired at Israel's citizens, nor terrorist attacks engineered from the Gaza Strip, we will not attack."

Yaalon also said Israel wanted an end to Gaza guerrilla activity in the neighboring Egyptian Sinai peninsula.

Although 84 percent of Israelis supported the current Gaza assault, according to a poll by Israel's Haaretz newspaper, only 30 percent wanted an invasion, while 19 percent wanted their government to work on securing a truce soon.

DIPLOMACY "PREFERRED"

"Israel is prepared and has taken steps, and is ready for a ground incursion which will deal severely with the Hamas military machine," a senior official close to Netanyahu told Reuters.

"We would prefer to see a diplomatic solution that would guarantee the peace for Israel's population in the south. If that is possible, then a ground operation would no longer be required. If diplomacy fails, we may well have no alternative but to send in ground forces," he added.

Egypt, where Mursi has his roots in the Muslim Brotherhood seen as mentors to Hamas, is acting as a mediator in the biggest test yet of Cairo's 1979 peace treaty with Israel since the fall of Hosni Mubarak.

"I think we are close, but the nature of this kind of negotiation, (means) it is very difficult to predict," Egyptian Prime Minister Hisham Kandil, who visited Gaza on Friday in a show of support for its people, said in an interview in Cairo for the Reuters Middle East Investment Summit.

Egypt has been hosting leaders of both Hamas and Islamic Jihad, a smaller armed faction.

Israeli media said a delegation from Israel had also been to Cairo for truce talks. A spokesman for Netanyahu's government declined comment on the matter.

Egypt's foreign minister, who met U.N. chief Ban on Monday, is expected to visit Gaza on Tuesday with a delegation of Arab ministers.

THOUSANDS MOURN FAMILY

Thousands turned out on Gaza's streets to mourn four children and five women, among 11 people killed in an Israeli strike that flattened a three-storey home the previous day.

The bodies were wrapped in Palestinian and Hamas flags. Echoes of explosions mixed with cries of grief and defiant chants of "God is greatest".

The deaths of the 11 in an air strike drew more international calls for an end to six days of hostilities and could test Western support for an offensive Israel billed as self-defense after years of cross-border rocket attacks.

Israel said it was investigating its air strike that brought the home crashing down on the al-Dalu family, where the dead spanned four generations. Some Israeli newspapers said the wrong house may have been mistakenly targeted.

In scenes recalling Israel's 2008-2009 winter invasion of the coastal enclave, tanks, artillery and infantry have massed in field encampments along the sandy, fenced-off border and military convoys moved on roads in the area.

Israel has also authorized the call-up of 75,000 military reservists, so far mobilizing around half that number.

The Gaza fighting adds to worries of world powers watching an already combustible region, where several Arab autocrats have been toppled in popular revolts for the past two years and a civil war in Syria threatens to spread beyond its borders.

In the absence of any prospect of permanent peace between Israel and Islamist factions such as Hamas, mediated deals for each to hold fire unilaterally have been the only formula for stemming bloodshed in the past.

Israel's declared goal is to deplete Gaza arsenals and force Hamas to stop rocket fire that has hit Israeli border towns for years.

Hamas and other groups in Gaza are sworn enemies of the Jewish state which they refuse to recognize and seek to eradicate, claiming all Israeli territory as rightfully theirs.

Hamas won legislative elections in the Palestinian Territories in 2006. A year later, after the collapse of a unity government under President Mahmoud Abbas, the Islamist group seized Gaza in a brief civil war with Abbas's forces.

(Writing by Jeffrey Heller, Dan Williams and Peter Graff; Editing by Alastair Macdonald)

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US, Britain warn of risks of Israeli ground war

BANGKOK (AP) — The U.S. and Britain on Sunday warned about the risks of Israel expanding its air assault on the Gaza Strip into a ground war, while vigorously defending the Jewish state's right to protect against rocket attacks.

The remarks by President Barack Obama and Britain Foreign Secretary William Hague were part of a diplomatic balancing act by the West as it desperately seeks an end to violence without alienating its closest ally in the region.

"Israel has every right to expect that it does not have missiles fired into its territory," President Barack Obama said at a news conference in Bangkok at the start of a three-nation visit to Asia.

"If that can be accomplished without a ramping up of military activity in Gaza, that's preferable," Obama said. "It's not just preferable for the people of Gaza. It's also preferable for Israelis, because if Israeli troops are in Gaza, they're much more at risk of incurring fatalities or being wounded."

The president spoke shortly before an Israeli airstrike leveled a home in a residential neighborhood. Palestinian medical officials said at least 11 civilians, mostly women and children, were killed. The attack was the single deadliest incident of the 5-day-old Israeli operation.

The Israeli military said the target was a top rocket mastermind of the Islamic Jihad militant group. The claim could not be immediately verified, and the attack raised speculation that Israel could face increased international pressure if the civilian death toll continued to rise.

Hague said Hamas, Gaza's militant rulers, "bears principal responsibility" for initiating the violence and must stop all rocket attacks on Israel. But Hague also made clear the diplomatic risks of an Israeli escalation.

"A ground invasion is much more difficult for the international community to sympathize with or support, including the United Kingdom," he said.

Israeli officials say the airstrikes are aimed at ending months of rocket fire out of the Hamas-ruled territory. Israel began the offensive with an unexpected airstrike that killed Hamas' military chief, and since then has targeted suspected rocket launchers and storage sites.

The Mideast ally is now at a crossroads: launch a ground invasion or pursue Egyptian-led truce efforts. But with Israel and Hamas far apart on any terms of cease-fire, Israeli Prime Minister Benjamin Netanyahu declared at the start of the weekly Cabinet meeting: "The Israeli military is prepared to significantly expand the operation."

The crisis threatened to overshadow Obama's trip to Asia, which includes stops in Myanmar and Cambodia as part of a broader effort to expand the U.S. economic and military presence in a region long dominated by China.

So far, the U.S. has thrown its weight behind Israel, and Obama has called on Egypt and Turkey to intervene on Israel's behalf. Obama said the Palestinians won't have a chance to pursue their own state and a lasting peace with Israel so long as rockets are fired into Israel.

"If we're serious about wanting to resolve this situation and create a genuine peace process, it starts with no more missiles being fired into Israel's territory, and that then gives us the space to try to deal with these longstanding conflicts that exist," Obama said.

Obama pointed to the next 48 hours "to see what kind of progress we can make."

He said he has told Egypt's president, Mohammed Morsi, and Turkey's prime minister, Recep Tayyip Erdogan that "those who champion the cause of the Palestinians should recognize that if we see a further escalation of the situation in Gaza, then the likelihood of us getting back on any kind of peace track that leads to a two-state solution is going to be pushed off way into the future."

Members of the U.S. Congress, which overwhelmingly supports Israel, criticized Egypt and Turkey for not doing enough to intervene. They said all eyes were on President Mohammed Morsi, Egypt's first civilian and freely elected leader.

"Egypt, watch what you do and how you do it," said Sen. Sen. Lindsey Graham, R-S.C., in an interview on NBC's "Meet the Press." ''You're teetering with the Congress on having your aid cut off if you keep inciting violence between the Israelis and the Palestinians."

In a separate interview on ABC's "This Week," Sen. Carl Levin, chairman of the Armed Services Committee, called Egypt's response to the crisis "pretty weak" so far.

"I think that they're going to have to take some very serious steps diplomatically to make it clear to Hamas that they're going to lose support in the Arab world if they continue these rocket attacks on Israel," said Levin, D-Mich.

Lawmakers also blamed Iran for arming Hamas militants, and questioned Egypt's role in that.

"My guess is there has to be some tacit involvement in Egypt and the border or these things wouldn't be getting in to Gaza," said Rep. C.A. "Dutch" Ruppersberger of Maryland, the top Democrat on the House Intelligence Committee.

Sen. Joseph Lieberman, I-Conn., said he thinks the threat of a ground war is overblown.

"I don't think the Israelis really want a ground war," he told "Fox News Sunday." ''They'll go into Gaza if they feel they need to, to eliminate the remainder of the missiles. ... So really, the decision is up to Hamas, as to whether there will be a ground invasion of Gaza or not."

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Flaherty reported from Washington.

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'Twilight' finale dawns with $141.3M weekend

LOS ANGELES (AP) — The sun has set on the "Twilight" franchise with one last blockbuster opening for the supernatural romance.

"The Twilight Saga: Breaking Dawn — Part 2" sucked up $141.3 million domestically over opening weekend and $199.6 million more overseas for a worldwide debut of $340.9 million, according to studio estimates Sunday.

The finale ranks eighth on the list of all-time domestic debuts, and leaves "Twilight" with three of the top-10 openings, joining 2009's "New Moon" (No. 7 with $142.8 million) and last year's "Breaking Dawn — Part 1" (No. 9 with $138.1 million).

Last May's "The Avengers" is No. 1 with $207.4 million. "Batman" is the only other franchise with more than one top-10 opening: July's "The Dark Knight Rises" (No. 3 with $160.9 million) and 2008's "The Dark Knight" (No. 4 with $158.4 million).

Though "Twilight" still is a female-driven franchise, with girls and women making up 79 percent of the opening-weekend audience, the finale drew the series' biggest male crowds. Action-minded guys had more to root for in the finale as Kristen Stewart, Robert Pattinson and Taylor Lautner join in a colossal battle to end the story of warring vampires and werewolves.

"Our male audience particularly has enjoyed this film," said Richie Fay, head of distribution for Lionsgate, whose Summit Entertainment banner releases the "Twilight" movies. "With the action scenes in this one, we're hoping the holdover business will reflect the fact that males have kind of found it out."

The movie also helped lift Lionsgate into the big leagues among Hollywood studios. Paced by its $400 million smash with "The Hunger Games" and now the "Twilight" finale, Lionsgate surpassed $1 billion at the domestic box office for the first time.

Some box-office watchers had expected the last "Twilight" movie to open with a franchise record the way the "Harry Potter" finale did last year with $169.2 million, the second-best domestic debut on the charts.

"I thought that for the final installment, it might eclipse the franchise record, but to look at $141.3 million and say that's a disappointment, that's kind of crazy," said Paul Dergarabedian, an analyst for box-office tracker Hollywood.com. "It's one of the most consistently performing franchises of all time."

The "Twilight" finale took over the No. 1 spot from Sony's James Bond adventure "Skyfall," which slipped to second place with $41.5 million domestically in its second weekend. "Skyfall" raised its domestic total to $161.3 million.

The franchise's third film starring Daniel Craig as Bond, "Skyfall" began rolling out overseas in late October and has hit $507.9 million internationally at the box office. The film's global total climbed to $669.2 million, helping to lift Sony to its best year ever with $4 billion worldwide, topping the studio's $3.6 billion haul in 2009.

"Skyfall" passed the previous franchise high of $599.2 million worldwide for 2006's "Casino Royale."

Steven Spielberg and Daniel Day-Lewis' Civil War drama "Lincoln" expanded nationwide after a week in limited release and came in at No. 3 with $21 million. Distributed by Disney, "Lincoln" lifted its domestic haul to $22.4 million.

The comic drama "Silver Linings Playbook," released by the Weinstein Co., got off to a good start in limited release, taking in $458,430 in 16 theaters for a solid average of $28,652 a cinema. By comparison, the "Twilight" finale averaged $34,717 in 4,070 theaters.

"Silver Linings Playbook" stars Bradley Cooper, Jennifer Lawrence and Robert De Niro in a quirky romance involving a man fresh out of a psychiatric hospital and an emotionally troubled young widow.

Keira Knightley's period drama "Anna Karenina" also started well in limited release with $315,395 in 16 theaters, for an average of $19,712. The Focus Features film stars Knightley in the title role of Leo Tolstoy's tragic romance.

Estimated ticket sales for Friday through Sunday at U.S. and Canadian theaters, according to Hollywood.com. Where available, latest international numbers also are included. Final domestic figures will be released Monday.

1. "The Twilight Saga: Breaking Dawn — Part 2," $141.3 million ($199.6 million international).

2. "Skyfall," $41.5 million ($49.6 million international).

3. "Lincoln," $21 million.

4. "Wreck-It Ralph," $18.3 million ($4.8 million international).

5. "Flight," $8.6 million ($1 million international).

6. "Argo," $4.1 million.

7. "Taken 2," $2.1 million ($2 million international).

8. "Pitch Perfect," $1.3 million ($4.1 million international).

9. "Here Comes the Boom," $1.2 million.

10 (tie). "Cloud Atlas," $900,000.

10 (tie). "Hotel Transylvania," $900,000.

10 (tie). "The Sessions," $900,000.

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Online:

http://www.hollywood.com

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Universal and Focus are owned by NBC Universal, a unit of Comcast Corp.; Sony, Columbia, Sony Screen Gems and Sony Pictures Classics are units of Sony Corp.; Paramount is owned by Viacom Inc.; Disney, Pixar and Marvel are owned by The Walt Disney Co.; Miramax is owned by Filmyard Holdings LLC; 20th Century Fox and Fox Searchlight are owned by News Corp.; Warner Bros. and New Line are units of Time Warner Inc.; MGM is owned by a group of former creditors including Highland Capital, Anchorage Advisors and Carl Icahn; Lionsgate is owned by Lions Gate Entertainment Corp.; IFC is owned by AMC Networks Inc.; Rogue is owned by Relativity Media LLC.

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EU drug regulator OKs Novartis' meningitis B shot

LONDON (AP) — Europe's top drug regulator has recommended approval for the first vaccine against meningitis B, made by Novartis AG.

There are five types of bacterial meningitis. While vaccines exist to protect against the other four, none has previously been licensed for type B meningitis. In Europe, type B is the most common, causing 3,000 to 5,000 cases every year.

Meningitis mainly affects infants and children. It kills about 8 percent of patients and leaves others with lifelong consequences such as brain damage.

In a statement on Friday, Andrin Oswald of Novartis said he is "proud of the major advance" the company has made in developing its vaccine Bexsero. It is aimed at children over two months of age, and Novartis is hoping countries will include the shot among the routine ones for childhood diseases such as measles.

Novartis said the immunization has had side effects such as fever and redness at the injection site.

Recommendations from the European Medicines Agency are usually adopted by the European Commission. Novartis also is seeking to test the vaccine in the U.S.

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Medics: Israel strike intended for militants kills 11 Gaza civilians

GAZA CITY, Gaza Strip (AP) — An Israeli missile flattened a two-story house in a residential neighborhood of Gaza City on Sunday, killing at least 11 civilians, mostly women and children, Palestinian medical officials said, as Israel expanded a military offensive to target homes of wanted militants.

The attack, which Israel said targeted a militant, was the single deadliest incident of the five-day-old Israeli operation and hiked a toll Sunday that was already the highest number of civilians killed in one day, according to Gaza medics. The bloodshed is likely to raise international pressure for a cease-fire, with Egypt taking the leading role in mediating between Israel and Hamas.

President Barack Obama said he had been in touch with the leaders of Israel, Egypt, and Turkey in an effort to halt the fighting. "We're going to have to see what kind of progress we can make in the next 24, 36, 48 hours," he said.

Obama cautioned against a potential Israeli ground invasion into Gaza, warning it could only deepen its death toll. At the same time, he blamed Palestinian militants for starting the round of fighting by raining rockets onto Israel, and he defended Israel's right to defend itself.

"Israel has every right to expect that it does not have missiles fired into its territory," Obama said in Thailand at the start of a three-nation tour in Asia.

An Israeli envoy arrived in Cairo on Sunday and held talks with Egyptian officials on a ceasefire, according to Egyptian security officials and Nabil Shaath, a top aide of Palestinian President Mahmoud Abbas who was in the Egyptian capital.

But Israel and Gaza's militant Hamas rulers remain far apart on any terms for a halt in the bloodshed, which has killed 70 Palestinians — including 36 civilians, according to Gaza health officials — and three Israeli civilians.

Hamas is linking a truce deal to a complete lifting of the border blockade on Gaza imposed since Islamists seized the territory by force. Hamas also seeks Israeli guarantees to halt targeted killings of its leaders and military commanders. Israeli officials reject such demands. They say they are not interested in a "timeout," and want firm guarantees that militant rocket fire into Israel will finally end. Past ceasefires have been short lived.

As the offensive moved forward, Israel found itself at a crossroads — on the cusp of launching a ground offensive into Gaza to strike an even tougher blow against Hamas, or pursuing Egyptian-led truce efforts.

"The Israeli military is prepared to significantly expand the operation," Israeli Prime Minister Benjamin Netanyahu declared at the start of the weekly Cabinet meeting.

At the same time, Gaza militants continued their barrage of rocket fire at Israel, firing more than 100, including two at Tel Aviv. More than 10 Israelis were injured by shrapnel, two moderately, according to police spokesman Mickey Rosenfeld. Israel's "Iron Dome" rocket-defense system shot down at least 30 rockets, including the ones aimed at Tel Aviv.

Israel's announcement Sunday that it was widening its campaign to target homes of militants appeared to mark a new and risky phase of the operation, given the likelihood of civilian casualties in the densely populated territory of 1.5 million Palestinians. Israel launched the offensive Wednesday in a bid to end months of intensifying rocket fire from the Hamas-ruled Gaza Strip.

The day's deadliest strike hit the home of the Daloo family in Gaza City, reducing the structure to rubble.

Frantic rescuers pulled the bodies of several children from the ruins of the house, including a toddler and a 5-year-old, as survivors and bystanders screamed in grief. Later, the bodies of the children were laid out in the morgue of Gaza City's Shifa Hospital.

Among the 11 dead were four small children and five women, including an 80-year-old, Gaza health official Ashraf al-Kidra said.

Israeli military spokesman Brig Gen. Yoav Mordechai told Channel 2 TV that the Israeli navy had targeted the building and killed a "global jihad" militant.

"The targets are exact," Mordechai said. "Every (Israeli) missile has an address."

He said the army would continue its operation "as if there were no (cease-fire) talks in Egypt."

The presence of a militant in the house could not be verified. Al-Kidra said the two adult men killed in the strike were civilians.

Sami Abu Zuhri, a Hamas spokesman, said that "the Israeli people will pay the price" for the killing of civilians. One of the rocket attacks targeting Tel Aviv came soon after the strike on the Daloo home.

More than a dozen homes of Hamas commanders or families linked to Hamas were struck on Sunday. Though most were empty — their inhabitants having fled to shelter — at least three still had families in them. Al-Kidra said 19 of the 24 people killed Sunday were civilians, mostly women and children.

Israeli Vice Premier Moshe Yaalon said civilian casualties are inevitable.

"You can't avoid collateral damage if they position the rockets in densely populated areas, in mosques, school yards. We shouldn't be blamed for the outcome," he said.

Israel also struck two high-rise buildings housing media outlets, damaging the top floor offices of the Hamas TV station, Al Aqsa, and a Lebanese-based broadcaster, Al Quds TV, seen as sympathetic to the Islamists. Six Palestinian journalists were wounded, including one who lost a leg, a Gaza press association said.

Foreign broadcasters, including British, German and Italian TV outlets, also had offices in the high-rises.

Two missiles made a direct hit on Al Aqsa TV's 15th floor offices, said Bassem Madhoun, an employee of Dubai TV, which has offices in the same building.

Building windows were blown out and glass shards and debris were scattered on the street below. Some of the journalists who had been inside the building at the time took cover in the entrance hallway.

Lt. Col. Avital Leibovich, an Israeli military spokeswoman, said the strikes targeted Hamas communications equipment on the buildings' rooftops. She accused the group of using journalists as "human shields," and urged journalists to stay clear of Hamas bases and facilities.

The repeated militant rocket fire on Tel Aviv and a volley fired Friday toward Jerusalem have significantly escalated the hostilities by widening the militants' rocket range and putting 3.5 million Israelis, or half the country's population, within reach. The attempt to strike Jerusalem also has symbolic resonance because both Israel and the Palestinians claim the holy city for a capital.

Israeli radio stations repeatedly interrupted their broadcasts to air "Code Red" alerts warning of impending rocket strikes. In the southern city of Ashkelon, rocket fire damaged a residential building, punching a hole in the ceiling and riddling the facade with shrapnel.

With fighting showing no signs of slowing, international attempts to broker a ceasefire continued.

Nabil Shaath, an aide to Palestinian President Mahmoud Abbas who was in Cairo, confirmed that the Israeli envoy had arrived in Egypt for talks, saying there are "serious attempts to reach a ceasefire." There was no immediate Israeli confirmation.

Hamas' prime minister, Ismail Haniyeh, spoke to Egyptian President Mohammed Morsi. He told the Egyptian leader he supports such efforts, provided Hamas receives "guarantees that will prevent any future aggression" by Israel, his office said in a statement.

Morsi over the weekend hosted talks with Hamas' supreme leader, as well as leaders from Hamas allies Turkey and Qatar. He also held contacts with Western leaders.

French Foreign Minister Laurent Fabius visited Israel on Sunday to offer his country's help toward forging an "immediate ceasefire," the French government said.

Meeting with Fabius, Israeli Foreign Minister Avigdor Lieberman thanked him for "France's efforts to prevent casualties" but said "the moment that all the terror organizations announce a ceasefire, we can consider all the ideas that French foreign minister and other friends are raising."

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Aron Heller contributed reporting from Beersheba.

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