Sex to burn calories? Authors expose obesity myths

Fact or fiction? Sex burns a lot of calories. Snacking or skipping breakfast is bad. School gym classes make a big difference in kids' weight.

All are myths or at least presumptions that may not be true, say researchers who reviewed the science behind some widely held obesity beliefs and found it lacking.

Their report in Thursday's New England Journal of Medicine says dogma and fallacies are detracting from real solutions to the nation's weight problems.

"The evidence is what matters," and many feel-good ideas repeated by well-meaning health experts just don't have it, said the lead author, David Allison, a biostatistician at the University of Alabama at Birmingham.

Independent researchers say the authors have some valid points. But many of the report's authors also have deep financial ties to food, beverage and weight-loss product makers — the disclosures take up half a page of fine print in the journal.

"It raises questions about what the purpose of this paper is" and whether it's aimed at promoting drugs, meal replacement products and bariatric surgery as solutions, said Marion Nestle, a New York University professor of nutrition and food studies.

"The big issues in weight loss are how you change the food environment in order for people to make healthy choices," such as limits on soda sizes and marketing junk food to children, she said. Some of the myths they cite are "straw men" issues, she said.

But some are pretty interesting.

Sex, for instance. Not that people do it to try to lose weight, but claims that it burns 100 to 300 calories are common, Allison said. Yet the only study that scientifically measured the energy output found that sex lasted six minutes on average — "disappointing, isn't it?" — and burned a mere 21 calories, about as much as walking, he said.

That's for a man. The study was done in 1984 and didn't measure the women's experience.

Among the other myths or assumptions the authors cite, based on their review of the most rigorous studies on each topic:

—Small changes in diet or exercise lead to large, long-term weight changes. Fact: The body adapts to changes, so small steps to cut calories don't have the same effect over time, studies suggest. At least one outside expert agrees with the authors that the "small changes" concept is based on an "oversimplified" 3,500-calorie rule, that adding or cutting that many calories alters weight by one pound.

—School gym classes have a big impact on kids' weight. Fact: Classes typically are not long, often or intense enough to make much difference.

—Losing a lot of weight quickly is worse than losing a little slowly over the long term. Fact: Although many dieters regain weight, those who lose a lot to start with often end up at a lower weight than people who drop more modest amounts.

—Snacking leads to weight gain. Fact: No high quality studies support that, the authors say.

—Regularly eating breakfast helps prevent obesity. Fact: Two studies found no effect on weight and one suggested that the effect depended on whether people were used to skipping breakfast or not.

—Setting overly ambitious goals leads to frustration and less weight loss. Fact: Some studies suggest people do better with high goals.

Some things may not have the strongest evidence for preventing obesity but are good for other reasons, such as breastfeeding and eating plenty of fruits and vegetables, the authors write. And exercise helps prevent a host of health problems regardless of whether it helps a person shed weight.

"I agree with most of the points" except the authors' conclusions that meal replacement products and diet drugs work for battling obesity, said Dr. David Ludwig, a prominent obesity research with Boston Children's Hospital who has no industry ties. Most weight-loss drugs sold over the last century had to be recalled because of serious side effects, so "there's much more evidence of failure than success," he said.

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Online:

Obesity info: http://www.cdc.gov/obesity/data/trends.html

New England Journal: http://www.nejm.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Former Police Captain Cleared of Ex-Wife's Murder

A former Ohio police captain has been cleared in the murder of his ex-wife and released from prison, where he had been for 15 years -- but prosecutors say they plan to appeal the ruling.

"I'm just a jumble of emotions and I just can't wait to hug all of my family," Douglas Prade told reporters outside the prison when he was released Tuesday afternoon, according to ABC News' Cleveland affiliate WEWS-TV.

He thanked "all of the people that supported me and communicated with me and told me to keep my spirits up."

Prade's ex-wife, Dr. Margo Prade, 41, was found shot to death in her minivan outside of her medical practice in November 1997.

Douglas Prade was an Akron, Ohio, police captain at the time.

At trial, he was convicted on murder and wiretapping charges and sentenced to life in prison.

Prade, now 66, maintained his innocence and, eventually, the Ohio Innocence Project took up his cause and petitioned for his release or a new trial based on new DNA testing.

One of the key factors in Prade's conviction was a bite mark found on Margo Prade's body. The prosecution brought in an expert that testified the bite mark came from Douglas Prade.

Phil Masturzo/Akron Beacon Journal/AP Photo

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The Ohio Innocence Project commissioned a new DNA test that was not available at the time of the trial. The test found that the DNA around the bite was not Douglas Prade's.

Summit County Court of Common Pleas Judge Judy Hunter ruled that Prade should be set free because the new DNA results were "clear and convincing" in Prade's favor, according to the Associated Press.

Prosecutor Sherri Walsh is strongly disputing the new DNA evidence.

"This is a gross misapplication of the law, and we will be appealing Prade's exoneration. The defendant had to present new evidence so convincing that no juror would have found him guilty, and he failed to do so," Walsh said in a statement. "The DNA evidence presented by the Ohio Innocence Project on behalf of Prade is contaminated and unreliable. It does not prove innocence."

Walsh said that all evidence points to Prade as the person who killed Margo Prade.

"He was a serial stalker," Walsh said. "He tapped her phones and recorded more than 400 of her personal calls. He had verbally abused and threatened her. And we know Margo was afraid of him."

Other evidence includes Prade's handwritten tally of the bills he owed subtracted from the life insurance money he'd get if his wife died, Walsh said. Two witnesses placed him at the murder scene.

"We have not seen any credible evidence that suggests innocence, and we are taking all available actions to keep a dangerous killer off the streets," Walsh said.

Margo Prade's family is also upset by the decision.

"I feel like my life is in danger and my family's life is in danger now," Margo Prade's nephew Tony Fowler told the AP. "[Dr. Prade and her mother] are probably turning over in their graves but God will have the final say."

Alison McCarty, the former prosecutor on the case, told WEWS she respected the court's decision, but emphasized that the case is not yet closed.

"[Margo Prade] was such a superstar and it was just such a tremendous loss, and her death still needs justice," McCarty said.

The state has 30 days to file a motion in the court of appeals requesting permission to appeal the decision for a new trial.

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French troops deployed in last Mali rebel strongholds

DOUENTZA, Mali/PARIS (Reuters) - French troops seized the airport in Mali's northern town of Kidal, the last urban stronghold held by Islamist insurgents, as they moved to wrap up the first phase of a military operation to wrest northern Mali from rebel hands.

France has deployed some 4,500 troops in a three-week ground and air offensive to break the Islamist rebels' 10-month grip on major northern towns. The mission is aimed at heading off the risk of Mali being used as a springboard for jihadist attacks in the wider region or Europe.

The French military plans to gradually hand over to a larger African force, tasked with rooting out insurgents in their mountain redoubts near Algeria's border.

Defense Minister Jean-Yves Le Drian said French forces using planes and helicopters defied a sandstorm late on Tuesday to capture the airport but had been prevented by the bad weather from entering the town itself.

"The terrorist forces are pulling back to the Adrar des Ifoghas mountains which are difficult to access," Le Drian told a news conference. "There is support from Chadian and Nigerian troops coming from the south."

The deployment of French troops to remote Kidal puts them in direct contact with pro-autonomy Tuareg MNLA rebels, whose rebellion last year was hijacked by the Islamist radicals. Le Drian said France had established good relations with local Tuareg chieftains before sending in troops.

MNLA leaders say they are ready to fight al Qaeda but many Malians, including the powerful military top brass in the capital Bamako, blame them for the division of the country. They view Paris' liaisons with the Tuaregs with suspicion.

French and Malian troops retook the major Saharan trading towns of Gao and Timbuktu at the weekend.

There were fears that many thousands of priceless ancient manuscripts held in Timbuktu, a UNESCO World Heritage site, might have been lost during the rebel occupation, but experts said the bulk of the texts were safe.

The United States and European governments strongly support the Mali intervention and are providing logistical and surveillance backing but do not intend to send combat troops.

The MNLA rebels, who want greater autonomy for the desert north, said they had moved fighters into Kidal after Islamists left the town earlier this week.

"For the moment, there is a coordination with the French troops," said Moussa Ag Assarid, the MNLA spokesman in Paris.

A spokesman for the Malian army said its soldiers were securing Gao and Timbuktu and were not heading to Kidal.

The MNLA took up arms against the Bamako government a year ago, seeking to carve out a new independent desert state.

After initially fighting alongside the Islamists, by June they had been forced out by their better armed and financed former allies, who include al Qaeda North Africa's wing, AQIM, a splinter wing called MUJWA and Ansar Dine, a Malian group.

RISK OF ATTACKS, KIDNAPPINGS

As the French wind up the first phase of their offensive, doubts remain about just how quickly the U.N.-backed African intervention force can be fully deployed in Mali to hunt down the retreating al Qaeda-allied insurgents. Known as AFISMA, the force is now expected to exceed 8,000 troops.

Foreign Minister Laurent Fabius said France's military operation, codenamed Serval (Wildcat), was planned as a lightning mission lasting a few weeks.

"Liberating Gao and Timbuktu very quickly was part of the plan. Now it's up to the African countries to take over," he told the Le Parisien daily. "We decided to put in the means and the necessary number of soldiers to strike hard. But the French contingent will not stay like this. We will leave very quickly."

One French soldier has been killed in the mission, and Fabius warned that things could now get more difficult, as the offensive seeks to flush out insurgents with experience of fighting in the desert from their wilderness hideouts.

"We have to be careful. We are entering a complicated phase where the risks of attacks or kidnappings are extremely high. French interests are threatened throughout the entire Sahel."

An attack on the In Amenas gas plant in Algeria earlier this month by Islamist fighters opposing the French intervention in Mali led to the deaths of dozens of foreign hostages and raised fears of similar reprisal strikes across North and West Africa.

NEED FOR RECONCILIATION

The French operation has destroyed the Islamists' training camps and logistics bases but analysts say a long term solution for Mali hinges on finding a political settlement between the northern communities and the southern capital Bamako.

Interim President Dioncounda Traore said on Tuesday his government would aim to hold national elections on July 31. Paris is pushing strongly for Traore's government to hold talks with the MNLA, which has dropped its claims for independence.

"The Malian authorities must begin without delay talks with the legitimate representatives of the northern population and non-terrorist armed groups that recognize Mali's integrity," French Foreign ministry spokesman Philippe Lalliot said.

After months of being kept on the political sidelines, the MNLA said they were in contact with West African mediators who are trying to forge a national settlement to reunite Mali.

"We reiterate that we are ready to talk with Bamako and to find a political solution. We want self-determination, but all that will be up to negotiations which will determine at what level both parties can go," Ag Assarid said.

There have been cases in Gao and Timbuktu and other recaptured towns of reprisal attacks and looting of shops and residences belonging to Malian Tuaregs and Arabs suspected of sympathizing with the MNLA and the Islamist rebels.

(Additional reporting John Irish and Emmanuel Jarry in Paris, David Lewis and Pascal Fletcher in Dakar; Writing by David Lewis and Daniel Flynn; Editing by Pascal Fletcher and Rosalind Russell)

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Asian markets rise as Dow nears record high

HONG KONG: Asian markets climbed on Wednesday, with continuing weakness in the yen further fuelling a rally in Japan's Nikkei, while the Dow also provided some lift after ending at a near record high.

Traders are keeping an eye on the United States, where the Federal Reserve is due to end a two-day policy meeting, with analysts expecting it to carry on with its loose monetary policy.

Tokyo climbed 1.20 per cent, Hong Kong added 0.48 per cent, Sydney gained 0.23 per cent, Shanghai added 0.20 per cent and Seoul was flat.

The euro and dollar extended their gains against the yen in response to the Bank of Japan's pledge of unlimited easing last week and its target of two per cent inflation.

Investors took on board a comment from Japan's Finance Minister Taro Aso, who defending the country's easing policies against criticism from abroad, said the yen's "excessive strength is in correction".

A senior dealer at a major bank in Tokyo said: "The comment is nothing new so it can't push up the pair like a rocket anymore, but it still has some power left."

The dollar was changing hands at 90.95 yen in early Asian trade Wednesday against 90.72 yen in New York Tuesday afternoon.

The euro was at 122.67 yen and $1.3487 against 122.42 yen and $1.3493 in US trade.

On Wall Street the Dow rose 0.52 per cent to finish just 1.5 per cent below its all-time closing high seen in October 2007, despite a lack of buying incentives and a weaker-than-expected consumer confidence reading.

The S&P 500 advanced 0.51 per cent and the Nasdaq was flat.

US dealers are awaiting the outcome of the Fed's policy meeting later in the day, looking for new clues to the state of the economy. That will be followed on Friday by data on job creation.

Oil prices were down, with New York's main contract, light sweet crude for delivery in March dropping 12 cents to $97.45 a barrel and Brent North Sea crude for March delivery shedding five cents to $114.31.

Gold was at $1,664.00 at 0230 GMT compared with $1,661.10 late Tuesday.

- AFP/ck

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Harbhajan Singh to produce Punjabi movies

JALANDHAR: Cricketer Harbhajan Singh (Bhajji) has moved on to film production and would start with Punjabi movies. He revealed this on Tuesday and said that he has started a production house named " Bhajji and Madan Production" which would be producing two Punjabi films initially.

"Work on the first movie would start around April or May. We are doing a lot of spade work and we also plan to call in Bollywood actors," Bhajji said.

Harbhajan clarified that his role would be confined to being a producer only and he would not act in these films.

Bhajji, however, said that he will making guest appearances in the movies.

"You will see some important personalities in these films," he said, but refused to elaborate further.

He said that cast of for his first production has been decided and Sumeep Kang, who directed Punjabi movie "Carry on Jatta", would be the director.

Asked about cricket as his profession, he said that he would be concentrating on the game while a team would be looking after film production.

Bhajji had earlier sung a song with a social message on "mother".

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Jodi Arias Borrowed Gas Cans Before Killing Ex

Accused murderer Jodi Arias borrowed two five-gallon gas cans from a former boyfriend the day before she drove to Arizona to kill another ex, Travis Alexander, according to testimony in Arias' murder trial today.

In cross examination, prosecutors also forced Arias' former live-in boyfriend Darryl Brewer to describe his sex life with Arias as "pretty aggressive."

Brewer, 52, dated Arias for four years and shared a home with her in California for two years. He told the court today that Arias called him in May 2008, asking to borrow gas cans, but would not explain why. She called him again at least two more times, and arrived at his house on June 2008, to borrow the cans.

On the day she picked up the gas cans she told Brewer that she was going to visit friends in California and Arizona.

Prosecutors argue that Arias then drove to Mesa, Ariz., where she allegedly had sex with Alexander, took nude photos of him, and then stabbed him 27 times, slashed his throat, and shot him twice in the head. She is charged with murder and could face the death penalty if convicted.

Arias, who claims she killed Alexander in self defense, had approached prosecutors two years ago offering to plea to a second degree murder charge, which could carry a 25 year term, but the state rejected the offer, Nancy Grace reported on Good Morning America today.

Brewer said that Arias never returned the gas cans. The pair had been broken up two years earlier and they had only spoken "sporadically," he said.

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Prosecutors also showed receipts from Arias' trip from her California home to Alexander's home in Mesa, showing that she purchased a 10 gallons of gas at one gas station the night before she drove to Arizona, and then another 10 gallons from a different gas station 10 minutes later. Prosecutors are expected to argue she brought the gas with her to fill up her car secretly on the way to Alexander's home, showing premeditation for the murder.

Arias' attorneys called Brewer as one of their first witnesses as they began mounting their case that Arias killed Alexander in self defense, arguing that Alexander was controlling and abusive toward Arias.

They asked Brewer to explain how he and Arias had been in a stable relationship for four years, from 2002 to 2006, and had bought a home together before Arias met Alexander at a business conference and began to change.

"I saw a lot of changes in Jodi. She became a different person than I had known previously," Brewer said, describing how Arias' behavior changed in May 2006 when she joined a company called Pre-Paid Legal. There, she met Alexander and began seeing him. She continued to live with Brewer.

"She had continued to pay the mortgage, but she was not paying other household bills, she began getting into debt or financial trouble," Brewer said. "For me it seemed she was not as rational or logical."

Arias also converted to Mormonism while living with Brewer, telling him that he could no longer curse and she would no longer have sex with him because she was saving herself for marriage.

The pair had previously had an "enthusiastic" and "aggressive" sex life, Brewer admitted to prosecutors. They had engaged in anal sex, Arias had taken nude photos of Brewer, and Arias had purchased breast implants in 2006, he testified.

Brewer said that after Arias began to change, he made arrangements to move closer to his son from his first marriage, and he and Arias broke up.

They kept in touch with occasional phone calls until Arias asked to borrow the gas cans in June 2008, and then called him a week after borrowing the cans to say that her friend had been killed.

Martinez, reading notes from an interview Brewer gave to authorities during the investigation into Alexander's death, asked if Arias had ever mentioned needing an "alibi." Brewer said he did not recall any conversation about alibis.

"After this date of June 4, 2008," Martinez asked, "you received a call from Jodi Arias, and she was very agitated?"

"She was sad," Brewer said.

"Did she tell you that her friend had been killed and she did not have an alibi?"

"I don't remember that," Brewer said.

Arias was arrested a month after Alexander was found dead, in July 2008.

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Sixty-five people executed in Syria's Aleppo: activists

BEIRUT (Reuters) - At least 65 people were found shot dead with their hands bound in the northern Syrian city of Aleppo on Tuesday in a "new massacre" in the near two-year revolt against President Bashar al-Assad, activists said.

Opposition campaigners blamed the government but it was impossible to confirm who was responsible. Assad's forces and rebels have been battling in Syria's commercial hub since July and both have been accused of carrying out summary executions.

U.N.-Arab League mediator Lakhdar Brahimi told the U.N. Security Council "unprecedented levels of horror" had been reached in Syria, and that both the government and rebels had committed atrocious crimes, diplomats said.

He appealed to the 15-nation council to overcome its deadlock and take action to help end the civil war in which Syria is "breaking up before everyone's eyes".

More than 60,000 people are estimated to have been killed in the war, the longest and deadliest of the revolts that began throughout the Arab world two years ago.

The U.N. refugee agency said the fighting had forced more than 700,000 people to flee. World powers fear the conflict could envelop Syria's neighbors including Lebanon, Jordan and Turkey, further destabilizing an already explosive region.

Opposition activists posted a video of at least 51 muddied male bodies alongside what they said was the Queiq River in Aleppo's rebel-held Bustan al-Qasr neighborhood.

The bodies had what looked like bullet wounds in their heads and some of the victims appeared to be young, possibly teenagers, dressed in jeans, shirts and trainers.

Aleppo-based opposition activists who asked not to be named for security reasons blamed pro-Assad militia fighters.

They said the men had been executed and dumped in the river before floating downstream into the rebel area. State media did not mention the incident.

The British-based Syrian Observatory for Human Rights, which says it provides objective information about casualties on both sides of Syria's war from a network of monitors, said the footage was evidence of a new massacre and the death toll could rise as high as 80.

"They were killed only because they are Muslims," said a bearded man in another video said to have been filmed in central Bustan al-Qasr after the bodies were removed from the river. A pickup truck with a pile of corpses was parked behind him.

STALEMATE

It is hard for Reuters to verify such reports from inside Syria because of restrictions on independent media.

Rebels are stuck in a stalemate with government forces in Aleppo - Syria's most populous city which is divided roughly in half between the two sides.

The revolt started as a peaceful protest movement against more than four decades of rule by Assad and his family, but turned into an armed rebellion after a government crackdown.

About 712,000 Syrian refugees have registered in other countries in the region or are awaiting processing as of Tuesday, the U.N. refugee agency said.

"We have seen an unrelenting flow of refugees across all borders. We are running double shifts to register people," Sybella Wilkes, spokeswoman for the U.N. High Commissioner for Refugees (UNHCR), told Reuters in Geneva.

The United Nations said it had received aid promises ahead of a donor conference in Kuwait on Wednesday where it is seeking $1.5 billion for refugees and people inside Syria. Washington announced an additional $155 million that its said brought the total U.S. humanitarian aid to the crisis to some $365 million.

Aid group Médecins Sans Frontières said the bulk of the current aid was going to government-controlled areas in Syria and called on donors to make sure they were even-handed.

MISSILES

In the eastern city of Deir al-Zor, insurgents including al Qaeda-linked Islamists captured a security agency after days of heavy fighting, according to an activist.

Some of the fighters were shown carrying a black flag with the Islamic declaration of faith and the name of the al-Nusra Front, which has ties to al Qaeda in neighboring Iraq.

The war has become heavily sectarian, with rebels who mostly come from the Sunni Muslim majority fighting an army whose top generals are mostly from Assad's Alawite sect, an offshoot of Shi'ite Islam. Assad has framed the revolt as a foreign-backed conspiracy and blames the West and Sunni Gulf states.

Fighting also took place in the northern town of Ras al-Ain, on the border with Turkey, between rebels and Kurdish militants, the Observatory said.

In Turkey, a second pair of Patriot missile batteries being sent by NATO countries are now operational, a German security official said.

The United States, Germany and the Netherlands each committed to sending two batteries and up to 400 soldiers to operate them after Ankara asked for help to bolster its air defenses against possible missile attack from Syria.

(Additional reporting by Sylvia Westall in Kuwait, Sabine Siebold in Berlin and Stephanie Nebehay in Geneva; Editing by Andrew Heavens and Robin Pomeroy)

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HDB offers 3,346 new flats under 6 BTO projects

SINGAPORE: The HDB has launched six Build-To-Order (BTO) projects where there will be a total of 3,346 new flats in three non-mature towns - Choa Chu Kang, Hougang and Yishun - and three mature towns - Ang Mo Kio, Kallang Whampoa and Tampines.

This is the first tranche of the 23,000 BTO flats which HDB has planned for 2013.

Eligible first-timer households can enjoy up to S$60,000 of housing grants comprising additional CPF housing grant (S$40,000) and special CPF housing grant (S$20,000).

HDB said with these grants included, 3-room flats will be priced from as low as S$105,000 and 4-room flats from S$214,000.

Priority allocation will be given to first-timer married couples with children under the Parenthood Priority Scheme as announced on 21 January.

HDB will set aside a fixed quota for the BTO and Sales of Balance Flats Sales Exercises for first-timer married couples with a child aged below 16 years old.

For BTO it'll be 30 per cent of flat supply and for SBF it'll be 50 per cent.

Applications for new flats can be submitted online from Tuesday to 4 February.

HDB added that the next batch of BTO flats will be launched in March 2013 where a total of 3,890 new flats will be offered in Bukit Batok, Punggol and Sengkang.

- CNA/ck

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Court adjourns Patiala gang rape case till Feb 4

PATIALA: Patiala court, on Monday, adjourned the Patiala gang rape and suicide case till February 4 after the defence lawyer sought the copy of a compact disc, allegedly containing statement of the victim.

"The CD was prepared by a cameraman of Samana and now police have made that a case property. We want to hear the exact wording of the girl," said Kundan Singh Nagra, counsel of the accused, after coming out of court. All five accused including Balwinder Singh, Gurprit Singh, Sandip Singh, Chinder Kaur and dismissed sub-inspector Nasib Singh were present in the court.

On November 13, 2012, Balwinder and Gurprit had allegedly kidnapped the minor girl from Badshahpr village, and repeatedly raped her at the tubewell room of Sandip Singh near Brahamanmajra village. Instead of taking any action, the cops had allegedly pressurized the family for compromise and had finally registered a rape case on November 27. But since the police did not arrest any accused, who continued to harass the victim, she consumed poison on December 26 and died in the evening.

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Soldier who lost 4 limbs has double-arm transplant

On Facebook, he describes himself as a "wounded warrior...very wounded."

Brendan Marrocco was the first soldier to survive losing all four limbs in the Iraq War, and doctors revealed Monday that he's received a double-arm transplant.

Those new arms "already move a little," he tweeted a month after the operation.

Marrocco, a 26-year-old New Yorker, was injured by a roadside bomb in 2009. He had the transplant Dec. 18 at Johns Hopkins Hospital in Baltimore, his father said Monday.

Alex Marrocco said his son does not want to talk with reporters until a news conference Tuesday at the hospital, but the younger Marrocco has repeatedly mentioned the transplant on Twitter and posted photos.

"Ohh yeah today has been one month since my surgery and they already move a little," Brendan Marrocco tweeted Jan. 18.

Responding to a tweet from NASCAR driver Brad Keselowski, he wrote: "dude I can't tell you how exciting this is for me. I feel like I finally get to start over."

The infantryman also received bone marrow from the same dead donor who supplied his new arms. That novel approach is aimed at helping his body accept the new limbs with minimal medication to prevent rejection.

The military sponsors operations like these to help wounded troops. About 300 have lost arms or hands in Iraq or Afghanistan.

Unlike a life-saving heart or liver transplant, limb transplants are aimed at improving quality of life, not extending it. Quality of life is a key concern for people missing arms and hands — prosthetics for those limbs are not as advanced as those for feet and legs.

"He was the first quad amputee to survive," and there have been four others since then, Alex Marrocco said.

The Marroccos want to thank the donor's family for "making a selfless decision ... making a difference in Brendan's life," the father said.

Brendan Marrocco has been in public many times. During a July 4 visit last year to the Sept. 11 Memorial with other disabled soldiers, he said he had no regrets about his military service.

"I wouldn't change it in any way. ... I feel great. I'm still the same person," he said.

The 13-hour operation was led by Dr. W.P. Andrew Lee, plastic surgery chief at Johns Hopkins. It was the seventh double-hand or double-arm transplant done in the United States.

Lee led three of those earlier operations when he worked at the University of Pittsburgh, including the only above-elbow transplant that had been done at the time, in 2010.

Marrocco's "was the most complicated one" so far, Lee said in an interview Monday. It will take more than a year to know how fully Marrocco will be able to use the new arms.

"The maximum speed is an inch a month for nerve regeneration," he explained. "We're easily looking at a couple years" until the full extent of recovery is known.

While at Pittsburgh, Lee pioneered the immune-suppression approach used for Marrocco. The surgeon led hand-transplant operations on five patients, giving them marrow from their donors in addition to the new limbs. All five recipients have done well, and four have been able to take just one anti-rejection drug instead of combination treatments most transplant patients receive.

Minimizing anti-rejection drugs is important because they have side effects and raise the risk of cancer over the long term. Those risks have limited the willingness of surgeons and patients to do more hand, arm and even face transplants.

Lee has received funding for his work from AFIRM, the Armed Forces Institute of Regenerative Medicine, a cooperative research network of top hospitals and universities around the country that the government formed about five years ago. With government money, he and several other plastic surgeons around the country are preparing to do more face transplants, possibly using the new immune-suppression approach.

Marrocco expects to spend three to four months at Hopkins, then return to a military hospital to continue physical therapy, his father said. Before the operation, he had been fitted with prosthetic legs and had learned to walk on his own.

He had been living with his older brother in a specially equipped home on New York's Staten Island that had been built with the help of several charities. Shortly after moving in, he said it was "a relief to not have to rely on other people so much."

The home was heavily damaged by Superstorm Sandy last fall.

Despite being in a lot of pain for some time after the operation, Marrocco showed a sense of humor, his father said. He had a hoarse voice from the tube that was in his throat during the long surgery and decided he sounded like Al Pacino. He soon started doing movie lines.

"He was making the nurses laugh," Alex Marrocco said.

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Associated Press Writer Stephanie Nano in New York contributed to this report.

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Online:

Army regenerative medicine:

http://www.afirm.mil/index.cfm?pageid=home

and http://www.afirm.mil/assets/documents/annual_report_2011.pdf

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Follow Marilynn Marchione at http://twitter.com/MMarchioneAP .

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