Telecoms boom leaves rural Africa behind

JOHANNESBURG/FREETOWN (Reuters) – While mobile phone usage has exploded across Africa over the last decade, transforming daily life and commerce for millions, it’s a revolution that has left behind perhaps two thirds of its people.

Poor or no reception outside the towns helps explain why the continent’s mobile penetration, in terms of the percentage of the population using the service, is far lower than previously thought, and the cost of providing that service to impoverished, sparsely populated areas remains prohibitive.

In rural Sierra Leone, a country where GDP per capita is less than $ 400 a year, money doesn’t grow on trees, but mobile reception can, says street trader Abass Bangura in Freetown, the West African country’s capital.

In parts of Tonkolili, a district in the center of the country, or Kailahun to the east, it’s the only way you can get reception, he said.

“You climb stick, like mango tree, before you have network,” he said.

In South Sudan, the world’s newest state, it’s a similar story. Less than a year old, the country already has five mobile operators, and its capital, Juba, is teeming with giant billboards advertising mobile phones, but go just a few kilometers beyond a handful of fast-growing towns, and cell phones become useless.

Multiple SIM cards help users navigate patchy network coverage and take advantage of price promotions from rival operators.

That is typical of much of the continent.

With a population of just over a billion people, Africa has over 700 million SIM cards, but with most users owning at least two cards, penetration is only about 33 percent, according to a study released in November by industry research firm Wireless Intelligence.

“If we look at the fact that the rural population of Africa is about 60-70 percent of the population, and if we look at the degree of penetration into the rural market, it’s very, very low,” said Spiwe Chireka of advisory firm IDC.

In Nigeria, Africa’s most populous country, there are more than enough SIM cards for everyone, but penetration is only 61 percent, according to a 2012 study by research firm Informa.

The average mobile phone user in Nigeria owns an average of 2.39 SIM cards. Globally, only Indonesia is higher, with an average of 2.62 SIM cards per user.

Even in Africa’s biggest economy, South Africa, SIM numbers comfortably exceed the population, but given the number of people using multiple devices, actual population penetration is closer to 80 percent, says market leader Vodacom.

“You’ve got a lot of people buying SIMs, but maybe not enough phones to put it in,” said Olayemi Jinadu, an executive with the Sierra Leone arm of Indian telco Bharti Airtel.

COST VERSUS BENEFIT

The unserved rural millions could represent another growth opportunity for Africa-focused telcos like South Africa’s MTN Group, Bharti Airtel and Kuwait’s Zain, but first they have to figure out a cost-effective way to push into sub-Saharan Africa’s remote corners.

“There’s great potential, but the big concern for us is operational costs,” said Andre Claasson, chief operating officer at Zain South Sudan.

In rural Africa, the cost of running a network tower often exceeds the revenue it reaps. Fuel is typically about 40 percent of a tower’s operating cost, and in remote areas companies burn more diesel by bringing fuel to towers than is used powering them.

Although roughly 73 percent of Africa’s land has cell phone coverage, according to market research firm IDC, that still leaves vast tracts of rural Africa without network access.

Africa has 170,000 mobile towers now and needs another 60,000, according to tower company IHS Group, which at an average $ 200,000 each means an outlay of $ 12 billion.

“If you are an operator asked to spend $ 200,000 to build a site and another $ 2,000 a month to run it in an area with 500 people herding cows, it doesn’t make sense,” said Issam Darwish, IHS’s chief executive.

Average revenue per user is also low. It can vary between $ 1 and $ 10 per month, much lower than in developed markets such as the United States, which delivered ARPU of $ 51 in 2012 or Britain, $ 27.

Bharti, sub-Saharan Africa’s third-largest telecom group, says it makes $ 6.40 per user in Africa, which is higher than its home Indian market, where it makes only $ 3.30 a month, but the cost of operating in Africa is much higher and there isn’t a comparable middle class ready and able to spend more.

“You either have a handful of people in the affluent part of the society or you have lots of people who can’t afford the services,” its Chairman Sunil Mittal said last year.

Operators can save money by sharing towers, but even then, some sites will never make sense without government subsidies, analysts say.

African expansion has not been cheap for telcos. Over the past five years, mobile operators have spent a combined $ 16.5 billion on capital expenditure in the key markets of South Africa, Nigeria, Kenya, Senegal and Ghana, according to Wireless Intelligence.

Bharti has earmarked $ 1.5 billion for capex this year, while fourth-placed France Telecom is spending $ 9.3 billion between 2010 and 2015.

Spare cash is increasingly rare for debt-strapped European telecoms operators, which are cutting their dividends to cope with falling revenues and network upgrade costs in their home markets.

Some African regulators have set up funds to promote coverage, to which operators are expected to contribute.

In Sierra Leone, the Universal Access Development Fund (UADF) is yet to subsidize the cost of putting up a single mast, though it has been active for several years. The regulator complains networks do not contribute the fees they should.

“If we can’t subsidize, they’ll never erect towers there,” said Bashir Kamara, Project Manager at UADF.

($ 1 = 0.6350 British pounds)

(Additional reporting by Hereward Holland in Juba and Chijioke Ohuocha in Lagos; Editing by David Dolan and Will Waterman)

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Diem Brown Blogs: How I Cope With My Anxiety

In her PEOPLE.com blog, Diem Brown, the Real World/Road Rules Challenge contestant recently diagnosed with ovarian cancer for the second time, opens up about her desire for a child and the ups and downs of cancer and fertility procedures.

The waiting game.

We have the technology to put a man on the moon, and the President and the Pope Tweet us in real-time updates. But when it comes to medical test results, it feels as if things move at a snail's pace. After waiting since Jan. 4 to supposedly find out on Jan. 25 about the "suspicious," "concerning" spot on my liver after my last CT scan, I come to find out these test results aren't as instant as I had imagined.

The waiting game is one that can – no lie – drive you mad! If I allow my anxiety to take control, I can immediately feel the tension all around me like a boa constrictor that is seemingly taking up the slack every time I let out an exasperated breath.

I know it hasn't been that long since Jan. 25, but it's been a long time in my mind, as I've been waiting since Jan. 4 to hear if I am in the final chapter of this cancer book or am I just starting "book one" of a very long series.

This may seem funny, but I have the same coping mechanism when I'm pissed off as when I'm anxious ... I organize and clean! So weird, I know, especially because, I swear, my dad, boyfriend and sister piss me off sometimes just to get me into cleaning mode! I guess that, for me, organizing is a way to be productive and in control when I feel I have neither.

Diem Brown

Matt Sayles / Invision

I will rearrange a whole apartment, changing the furniture direction in every room. I will raid the "junk" drawers, coat closets, filing cabinets, garages and anything else that will take me at least a good half-day to accomplish. This, my friends has becomes my magic anxiety release pill.

Funny enough, because it's tax season now, I started making piles of old receipts I found in some random purse. Then, glancing up at the TV, I saw the most amazing aid to my crazy arsenal ... The NeatDesk. It was like a beautiful bright light was shining directly on my TV in between Bravo Housewives marathons. So, logically, I bought the machine and now I'm on a scanning mission!

I want to get all my medical crap in order – including bills, test results, prescription receipts, doctor's notes, etc. so I am using this NeatDesk thingamajig and getting some order and control back into my weird medical world.

I have also realized (especially as I read my logic) that stress kept indoors can make ya even more crazy than you have already become. That said, I've been trying to say yes to everything and get my compulsive booty outdoors to socialize with actual people other than those lovely ladies that reign on my TV.

I was so wrapped up and content in my apartment; my comfort with my weird organizing ways had turned me into a hermit. Girls' nights in are amazing but ... you need to get out!

I think winter in general can have that "hermit" effect on most people, as you tend to get so lazy and make excuses to not do things because you are too cold or feel just plain winter frumpy.

But since I realized and addressed my lazy, crazy ways instead of fretting about what news my test results will bring, I am choosing the word "yes!"

Diem Brown

Matt Sayles / Invision

I have always believed in the power of positive thinking, but sometimes when you have gotten knocked down or disheartened it takes more effort to stick with the positive mindset. So for that I say follow that old Jim Carrey movie and say "yes" to whatever social offers are out there. Being social, laughing, dancing, having fun, etc. helps you not dwell on a test result or an outcome that you have no control over.

I hate the waiting game but I'm not going to let the waiting game chain me to my crazy mind and allow me to think of the negative "what ifs." That's just not me. However, as humans, those negative thoughts relentlessly try to creep into your mindset ... but, as the powerful human that you are, you have the power of choice and can choose to turn that negative channel off.

Whether you need to distract yourself with other projects to keep your mind at ease or make yourself be social (friends, support chat rooms, dates, etc.) give yourself the green light to have fun and enjoy the moment.

The news will eventually come, no matter what you do while you wait. If it's bad news, have faith you can handle it. If it's good news, you will kick yourself for stressing over something nonexistent.

As I "patiently" wait for my results to come in, I'm feeling good! I'm visualizing the scan being clear and imagining my doc saying I am at the finish line to my second bout with cancer. I just need him to call me – stat – before I start knocking on neighbors' doors asking if they want their closets cleaned!

Thank you all so very much for your comments, prayers and Tweets. I have never felt more supported in my life and I'm very aware of how very lucky I am to have y'all back me. Thank you and hope you are all having a wonderful week!

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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.

___

Online:

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

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

___

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

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Wall Street flat after mixed data; Qualcomm lifts Nasdaq

NEW YORK (Reuters) - Stocks were little changed on Thursday as investors mulled a mixed bag of economic data, though earnings from Qualcomm helped lift the Nasdaq.

Data showed the labor market improved modestly; the number of Americans filing new claims last week for unemployment benefits rose, beating expectations and bouncing off five-year lows in the prior week.

That comes ahead of Friday's payrolls report, which is expected to show employers added 160,000 jobs in January after an increase of 155,000 in December.

A separate report showed incomes climbed in December by the most in eight years, in an encouraging sign that the economy may be propelled forward through consumer spending.

A gauge of business activity in the U.S. Midwest showed a pick up in January from a more than three-year low in December as new orders jumped. The report followed a disappointing survey from the mid-Atlantic and New York regions.

Qualcomm Inc gained 5.9 percent to $67.25 as the top boost to the Nasdaq 100 <.ndx> after the world's leading supplier of chips for cellphones beat analysts' expectations for quarterly profit and revenue, and raised its targets for the year.

The worst performer on the Nasdaq was Facebook Inc , which lost 5.9 percent to $29.39. The social network company said Wednesday it doubled its mobile advertising revenue in the fourth quarter; however, that growth trailed some of Wall Street's most aggressive estimates.

The Dow Jones industrial average <.dji> gained 22.88 points, or 0.16 percent, to 13,933.30. The Standard & Poor's 500 Index <.spx> gained 0.21 points, or 0.01 percent, to 1,502.17. The Nasdaq Composite Index <.ixic> gained 8.43 points, or 0.27 percent, to 3,150.73.

The S&P 500 <.spx> has gained 5.3 percent in January, after legislators in Washington temporarily sidestepped a "fiscal cliff" of automatic tax increases and spending cuts that could have derailed the economic recovery, and amid improving economic data and better-than-expected corporate earnings.

But the benchmark index has stalled recently and is virtually flat for the week, hovering near the 1,500 mark, as investors look for fresh trading incentives to justify further gains.

"Unfortunately it's still a mixed picture, it appears we are just getting a lot of conflicting data right now," said Jack Ablin, chief investment officer at BMO Private Bank in Chicago.

"There is certainly a lot of information coming out this week - a lot of economic data, a lot of earnings and of course we have the employment number looming Friday, so with 1,500 right here, my guess is there is just not enough conviction to push us substantially higher yet."

United Parcel Service Inc lost 1.6 percent to $79.95 after the world's largest parcel delivery reported fourth-quarter earnings below analysts' estimates on Thursday and forecast weaker-than-expected profit for 2013.

But the Dow Jones Transportation average <.djt> gained 0.5 percent as Kirby Corp added 7.6 percent to $71.57 and Ryder Systems Inc climbed 4.7 percent to $56.79 after posting quarterly results.

Thomson Reuters data through Thursday morning shows that of the 231 companies in the S&P 500 that have reported earnings this season, 69.3 percent have exceeded expectations, a higher proportion than over the past four quarters and above the average since 1994.

Overall, S&P 500 fourth-quarter earnings are forecast to have risen 3.7 percent. That's above a 1.9 percent forecast at the start of the earnings season, but well below a 9.9 percent profit growth forecast on October 1, the data showed.

WMS Industries Inc surged 52.5 percent to $24.96 after the company agreed to be acquired by Scientific Games Corp for $26 per share in cash. Scientific Games jumped 19 percent to $10.63.

(Editing by Bernadette Baum)

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Merkel urges Egypt's Mursi to hold crisis dialogue

CAIRO/BERLIN (Reuters) - Authorities in an Egyptian city scaled back a curfew imposed by President Mohamed Mursi, and the Islamist leader cut short a visit to Europe on Wednesday to deal with the deadliest violence in the seven months since he took power.

Two more protesters were shot dead before dawn near Cairo's central Tahrir Square on Wednesday, a day after the army chief warned that the state was on the brink of collapse if Mursi's opponents and supporters did not end street battles.

More than 50 people have been killed in the past seven days of protests by Mursi's opponents, raising global concern over whether the Islamist leader can restore stability to the most populous Arab country.

Mursi imposed a curfew and a state of emergency on three Suez Canal cities on Sunday but that only seemed to further provoke crowds in a week of unrest marking the second anniversary of the uprising that toppled Hosni Mubarak.

The governor of Ismailia, one of the three canal cities, said on Wednesday he was scaling back the curfew, which would now take effect nightly from 2:00 a.m. instead of 9:00 p.m..

Mursi, speaking in Berlin before hurrying home to deal with the crisis, called for dialogue with opponents but would not commit to their demand that he first agree to include them in a unity government.

Asked about that proposal, he said the next government would be formed after parliamentary elections in April.

Egypt was on its way to becoming "a civilian state that is not a military state or a theocratic state", Mursi said.

The violence at home forced Mursi to scale back his European visit, billed as a chance to promote Egypt as a destination for foreign investment. He flew to Berlin but called off a trip to Paris and was due back home after only a few hours in Europe.

Chancellor Angela Merkel, who met him, echoed other Western leaders who have called on him to give his opponents a voice.

"One thing that is important for us is that the line for dialogue is always open to all political forces in Egypt, that the different political forces can make their contribution, that human rights are adhered to in Egypt and that of course religious freedom can be experienced," she said at a joint news conference with Mursi.

SPIRIT OF REVOLUTION

Mursi's critics accuse him of betraying the spirit of the revolution by keeping too much power in his own hands and those of his Muslim Brotherhood, the Islamist movement banned under Mubarak which won repeated elections since the 2011 uprising.

Mursi's supporters say the protesters want to overthrow Egypt's first democratically elected leader. The current unrest has deepened an economic crisis that saw the pound currency tumble in recent weeks.

Near Cairo's Tahrir Square on Wednesday morning, dozens of protesters threw stones at police who fired back teargas, although the scuffles were brief.

"Our demand is simply that Mursi goes, and leaves the country alone. He is just like Mubarak and his crowd who are now in prison," said Ahmed Mustafa, 28, a youth who had goggles on his head to protect his eyes from teargas.

Opposition politician Mohamed ElBaradei called for a meeting of the president, ministers, the ruling party and the opposition to halt the violence. But he also restated the precondition that Mursi first commit to seeking a national unity government.

The worst violence has been in the Suez Canal city of Port Said, where rage was fuelled by death sentences passed against soccer fans for roles in deadly riots last year.

After decades in which the West backed Mubarak's military rule of Egypt, the emergence of an elected Islamist leader in Cairo is probably the single most important change brought about by the wave of Arab revolts over the past two years.

Mursi won backing from the West last year for his role in helping to establish a ceasefire between Israel and Palestinians that ended a conflict in Gaza. But he then followed that with an effort to fast-track a constitution that reignited dissent at home and raised global concern over Egypt's future.

Western countries were alarmed this month by video that emerged showing Mursi making vitriolic remarks against Jews and Zionists in 2010 when he was a senior Brotherhood official.

German Foreign Minister Guido Westerwelle said ahead of Mursi's visit that the remarks, in which Mursi referred to Zionists as "descendants of apes and pigs" were "unacceptable".

"NOT AGAINST JEWS"

Asked about those remarks at the news conference with Merkel, Mursi repeated earlier explanations that they had been taken out of context.

"I am not against the Jewish faith," he said. "I was talking about the practices and behavior of believers of any religion who shed blood or who attack innocent people or civilians. That's behavior that I condemn."

"I am a Muslim. I'm a believer and my religion obliges me to believe in all prophets, to respect all religions and to respect the right of people to their own faith," he added.

Egypt's main liberal and secularist bloc, the National Salvation Front, has so far refused talks with Mursi unless he promises a unity government including opposition figures.

"Stopping the violence is the priority, and starting a serious dialogue requires committing to guarantees demanded by the National Salvation Front, at the forefront of which are a national salvation government and a committee to amend the constitution," ElBaradei said on Twitter.

Those calls have also been backed by the hardline Islamist Nour party - rivals of Mursi's Brotherhood. Nour and the Front were due to meet on Wednesday, signaling an unlikely alliance of Mursi's critics from opposite ends of the political spectrum.

Brotherhood leader Mohamed El-Beltagy dismissed the unity government proposal as a ploy for the Front to take power despite having lost elections. On his Facebook page he ridiculed "the leaders of the Salvation Front, who seem to know more about the people's interests than the people themselves".

In a sign of the toll the unrest is having on Egypt's economy, ratings agency Fitch downgraded its sovereign rating by one notch to B on Wednesday.

German industry leaders see potential in Egypt but are concerned about political instability.

"At the moment many firms are waiting on political developments and are cautious on any big investments," said Hans Heinrich Driftmann, head of Germany's Chamber of Industry and Commerce.

(Additional reporting by Yasmine Saleh and Marwa Awad in Cairo, Stephen Brown and Gernot Heller in Berlin and Arshad Mohammed in Washington; Writing by Peter Graff; Editing by Peter Millership)

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RIM starts glitzy BlackBerry 10 launch parties

NEW YORK (Reuters) – Research In Motion Ltd on Wednesday kicked off a string of global launch parties for a long-delayed line of smartphones it says will put it on the comeback trail in a market it once dominated.

The new BlackBerry 10 phones will compete with Apple‘s iPhone and devices using Google‘s Android technology, both of which have soared above the BlackBerry in a competitive market.

They boast fast browsers, new features, smart cameras and, unlike previous BlackBerry models, enter the market primed with a large app library.

(Writing by Janet Guttsman; Editing by Frank McGurty)

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Karolína Kurková: Why I Chose Natural Childbirth

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For Karolína Kurková, there was no place like home to welcome her first child.

Setting up a birthing suite in the comforts of her Tribeca apartment, the model mama admits her motivation behind her decision to deliver naturally was simple: childbirth is nothing new.

“Of course we had the midwife, we had the doula, but that’s something we really did a lot of research on and we wanted to do,” Kurková, 28, tells Access Hollywood Live.

“Centuries women have been giving birth naturally and I think your body adjusts to it and you get into a zone.”

Her active labor lasted 2½ hours — a process she calls “quite quick” — and, by keeping her concentration on seeing her son, little time was left to think of the pain.

“It’s not like, ‘Oh my God, it’s a pain. I’m dying, I’m dying,’” the supermodel coach of The Face says. “It was so gradual you just kind of deal with it. You get in a zone, you really focus.”

With her husband Archie Drury preparing “green juice and coconut water” to keep his wife hydrated, it wasn’t long before Kurková’s midwife let her know baby boy was on his way.

“I really wanted to do it in the water because it’s better for the baby to be born in the water — from water to water — and it’s less painful for the mom,” she explains of her decision to deliver in a birthing pool.

“When he’s born in the water, there’s still that umbilical cord so until you clip it they can still breathe through it. He was born in the water [then] we put him on my chest.”

Recalling the big day as an “incredible experience” Kurková will “absolutely” do it all over again — eventually. Until then, 3-year-old Tobin Jack has all his mama’s attention.

“I want to enjoy [Tobin] first and learn everything and really spend time with him,” she explains.

– Anya Leon

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Soldier with new arms determined to be independent

BALTIMORE (AP) — After weeks of round-the-clock medical care, Brendan Marrocco insisted on rolling his own wheelchair into a news conference using his new transplanted arms. Then he brushed his hair to one side.

Such simple tasks would go unnoticed in most patients. But for Marrocco, who lost all four limbs while serving in Iraq, these little actions demonstrate how far he's come only six weeks after getting a double-arm transplant.

Wounded by a roadside bomb in 2009, the former soldier said he could get by without legs, but he hated living without arms.

"Not having arms takes so much away from you. Even your personality, you know. You talk with your hands. You do everything with your hands, and when you don't have that, you're kind of lost for a while," the 26-year-old New Yorker told reporters Tuesday at Johns Hopkins Hospital.

Doctors don't want him using his new arms too much yet, but his gritty determination to regain independence was one of the chief reasons he was chosen to receive the surgery, which has been performed in the U.S. only seven times.

That's the message Marrocco said he has for other wounded soldiers.

"Just not to give up hope. You know, life always gets better, and you're still alive," he said. "And to be stubborn. There's a lot of people who will say you can't do something. Just be stubborn and do it anyway. Work your ass off and do it."

Dr. W.P. Andrew Lee, head of the team that conducted the surgery, said the new arms could eventually provide much of the same function as his original arms and hands. Another double-arm transplant patient can now use chopsticks and tie his shoes.

Lee said Marrocco's recovery has been remarkable, and the transplant is helping to "restore physical and psychological well-being."

Tuesday's news conference was held to mark a milestone in his recovery — the day he was to be discharged from the hospital.

Next comes several years of rehabilitation, including physical therapy that is going to become more difficult as feeling returns to the arms.

Before the surgery, 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.

"We'll get it back together. We've been through a lot worse than that," his father, Alex Marrocco, said.

For the next few months, Marrocco plans to live with his brother in an apartment near the hospital.

The former infantryman said he can already move the elbow on his left arm and rotate it a little bit, but there hasn't been much movement yet for his right arm, which was transplanted higher up.

Marrocco's mother, Michelle Marrocco, said he can't hug her yet, so he brushes his left arm against her face.

The first time he moved his left arm was a complete surprise, an involuntary motion while friends were visiting him in the hospital, he said.

"I had no idea what was going through my mind. I was with my friends, and it happened by accident," he recalled. "One of my friends said 'Did you do that on purpose?' And I didn't know I did it."

Marrocco's operation also involved a technical feat not tried in previous cases, Lee said in an interview after the news conference.

A small part of Marrocco's left forearm remained just below his elbow, and doctors transplanted a whole new forearm around and on top of it, then rewired nerves to serve the old and new muscles in that arm.

"We wanted to save his joint. In the unlucky event we would lose the transplant, we still wanted him to have the elbow joint," Lee said.

He also explained why leg transplants are not done for people missing those limbs — "it's not very practical." That's because nerves regrow at best about an inch a month, so it would be many years before a transplanted leg was useful.

Even if movement returned, a patient might lack sensation on the soles of the feet, which would be unsafe if the person stepped on sharp objects and couldn't feel the pain.

And unlike prosthetic arms and hands, which many patients find frustrating, the ones for legs are good. That makes the risks of a transplant not worth taking.

"It's premature" until there are better ways to help nerves regrow, Lee said.

Now Marrocco, who was the first soldier to survive losing all four limbs in the Iraq War, is looking forward to getting behind the wheel of his black 2006 Dodge Charger and hand-cycling a marathon.

Asked if he could one day throw a football, Dr. Jaimie Shores said sure, but maybe not like Baltimore Ravens quarterback Joe Flacco.

"Thanks for having faith in me," Marrocco interjected, drawing laughter from the crowd.

His mother said Marrocco has always been "a tough cookie."

"He's not changed that, and he's just taken it and made it an art form," Michelle Marrocco said. "He's never going to stop. He's going to be that boy I knew was going to be a pain in my butt forever. And he's going to show people how to live their lives."

___

Associated Press Chief Medical Writer Marilynn Marchione in Milwaukee and AP writer David Dishneau in Hagerstown, Md., contributed to this report.

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Wall Street edges higher, Amazon offsets GDP

NEW YORK (Reuters) - Stocks were flat on Wednesday as an unexpectedly weak read on fourth-quarter economic activity was offset by strong results at Boeing and Amazon.com.

Equities continued to shrug off negative news, with the S&P 500 staying above 1,500, a level that market technicians call an inflection point that will determine the overall direction in the near term.

The first read showed gross domestic product fell 0.1 percent, far below expectations for growth of 1.1 percent. However, private sector employment topped forecasts, with the ADP National Employment report showing 192,000 jobs added in January, higher than the 165,000 expectation.

"The GDP report is the only negative shock we've had in a while, and it isn't terrible since it showed increases in business and consumer spending, which is what everyone wants to drive growth from here," said Randy Frederick, managing director of active trading and derivatives for Charles Schwab in Austin, Texas.

Deeper losses were prevented by a rise in both Boeing Co and Amazon.com Inc , which rallied after earnings beat expectations, continuing a trend this quarter of high-profile names advancing after results.

Amazon.com Inc rose 6.7 percent to $277.87 a day after reporting strong revenue growth. Boeing rose 0.5 percent to $74 after its results. The Dow component also said that while production continued on its Dreamliner jet, which has had technical problems recently, it was suspending delivery until clearance was granted by the Federal Aviation Administration.

Thomson Reuters data showed that of the 174 companies in the S&P 500 that have reported earnings this season, 68.4 percent have been above analyst expectations, which is a higher proportion than over the past four quarters and above the average since 1994.

The Dow Jones industrial average <.dji> was up 5.50 points, or 0.04 percent, at 13,959.92. The Standard & Poor's 500 Index <.spx> was up 1.09 points, or 0.07 percent, at 1,508.93. The Nasdaq Composite Index <.ixic> was up 5.73 points, or 0.18 percent, at 3,159.39.

The S&P 500 is on track to post its best monthly performance since October 2011 as investors poured $55 billion in new cash into stock mutual funds and exchange-traded funds in January, the biggest monthly inflow on record.

The Dow Jones industrial average has been flirting with 14,000, a level it hasn't seen since October 2007. Many analysts have said markets may need to take a pause.

"I'm neutral on markets at these levels, even though there aren't a lot of negatives out there," Frederick said. "At some point there will be a pullback, but the underlying trends remain strong and I think it is possible the S&P could hit a new all-time high sometime this quarter."

The all-time intraday high for the S&P 500 is 1,576.09, reached October 11, 2007.

The Federal Reserve concludes a two-day meeting on Wednesday, and while the central bank is expected to keep monetary policy on a steady path, intensive debates continue behind the scenes over when the controversial bond-buying program should be curtailed.

Chesapeake Energy Corp rose 11 percent to $21.11 as the S&P's biggest percentage gainer, a day after saying Aubrey McClendon would step down as chief executive after a year in which a series of Reuters investigations triggered civil and criminal probes of the second-largest U.S. natural gas producer.

(Editing by Chizu Nomiyama and Nick Zieminski)

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Army warns unrest pushing Egypt to the brink

CAIRO, Egypt (Reuters) - Egypt's army chief said political unrest was pushing the state to the brink of collapse - a stark warning from the institution that ran the country until last year as Cairo's first freely elected leader struggles to curb bloody street violence.

Abdel Fattah al-Sisi, a U.S.-trained general appointed by President Mohamed Mursi last year to head the armed forces, added in a statement on Tuesday that one of the primary goals of deploying troops in cities on the Suez Canal was to protect the waterway that is vital for Egypt's economy and world trade.

Sisi's comments, published on an official army Facebook page, followed 52 deaths in the past week of disorder and highlighted the mounting sense of crisis facing Egypt and its Islamist head of state who is striving to fix a teetering economy and needs to prepare Egypt for a parliamentary election in a few months that is meant to cement the new democracy.

Violence largely subsided on Tuesday, although some youths again hurled rocks at police lines in Cairo near Tahrir Square.

It seemed unlikely that Sisi was signaling the army wants to take back the power it held for six decades since the end of the colonial era and through an interim period after the overthrow of former air force chief Hosni Mubarak two years ago.

But it did send a powerful message that Egypt's biggest institution, with a huge economic as well as security role and a recipient of massive direct U.S. subsidies, is worried about the fate of the nation, after five days of turmoil in major cities.

"The continuation of the struggle of the different political forces ... over the management of state affairs could lead to the collapse of the state," said General Sisi, who is also defense minister in the government Mursi appointed.

He said the economic, political and social challenges facing the country represented "a real threat to the security of Egypt and the cohesiveness of the Egyptian state" and the army would remain "the solid and cohesive block" on which the state rests.

Sisi was picked by Mursi after the army handed over power to the new president in June once Mursi had sacked Field Marshal Hussein Tantawi, in charge of Egypt during the transition and who had also been Mubarak's defense minister for 20 years.

The instability has provoked unease in Western capitals, where officials worry about the direction of a powerful regional player that has a peace deal with Israel. The United States condemned the bloodshed and called on Egyptian leaders to make clear violence was not acceptable.

DEEPLY POLARISED

The 58-year-old previously headed military intelligence and studied at the U.S. Army War College. Diplomats say he is well known to the United States, which donates $1.3 billion in military aid each year, helping reassure Washington that the last year's changes in the top brass would not upset ties.

One of Sisi's closest and longest serving associates, General Mohamed el-Assar, an assistant defense minister, is now in charge of the military's relations with the United States.

Almost seven months after Mursi took office, Egyptian politics have become even more deeply polarized.

Opponents spurned a call by Mursi for talks on Monday to try to end the violence. Instead, protesters have rallied in Cairo and Alexandria, and in the three Suez Canal cities - Port Said, Ismailia and Suez - where Mursi imposed emergency rule.

On Tuesday, thousands were again on the streets of Port Said to mourn the deaths of two people in the latest clashes there, taking the total toll in Mediterranean port alone to 42 people. Most were killed by gunshots in a city where weapons are rife.

Mohamed Ezz, a Port Said resident speaking by telephone, heard heavy gunfire through the night. "Gunshots damaged the balcony of my flat, so I went to stay with my brother," he said.

Residents in the three canal cities had taken to the streets in protest at a nightly curfew now in place there. The president's spokesman said on Tuesday that the 30-day state of emergency could be shortened, depending on circumstances.

In Cairo on Tuesday afternoon, police again fired teargas at stone-throwing youths in a street near Tahrir Square, the center of the 2011 uprising. But the clashes were less intense than previous days and traffic was able to cross the area. Street cleaners swept up the remains of burnt tires and other debris.

The police have been facing "unprecedented attacks accompanied by the appearance of groups that pursue violence and whose members possess different types of weapons", the state news agency reported, quoting the Interior Ministry spokesman.

Street flare-ups are a common occurrence in divided Egypt, frustrating many people desperate for order and economic growth.

WARY MILITARY

Although the general's comments were notably blunt, Egypt's military has voiced similar concerns in the past, pledging to protect the nation. But it has refused to be drawn back into a direct political role after its reputation as a neutral party took a pounding during the 17 months after Mubarak fell.

"Egyptians are really alarmed by what is going on," said Cairo-based analyst Elijah Zarwan, adding that the army was reflecting that broader concern among the wider public.

"But I don't think it should be taken as a sign that the military is on the verge of stepping in and taking back the reins of government," he said.

In December, Sisi offered to host a national dialogue when Mursi and the rivals were again at loggerheads and the streets were aflame. But the invitation was swiftly withdrawn before the meeting went ahead, apparently because the army was wary of becoming embroiled again in Egypt's polarized politics.

Protests initially flared during the second anniversary of the uprising which erupted on January 25, 2011 and toppled Mubarak 18 days later. They were exacerbated in Port Said when residents were angered after a court sentenced to death several people from the city over deadly soccer violence.

Since the 2011 revolt, Islamists who Mubarak spent his 30-year rule suppressing have won two referendums, two parliamentary elections and a presidential vote.

But that legitimacy has been challenged by an opposition that accuses Mursi of imposing a new form of authoritarianism. Mursi's supporters says protesters want to overthrow Egypt's first democratically elected leader by undemocratic means.

The army has already been deployed in Port Said and Suez and the government agreed a measure to let soldiers arrest civilians as part of the state of emergency. Sisi reiterated that the army's role would be to support the police in restoring order.

Mursi's invitation to rivals to a national dialogue with Islamists on Monday was spurned by the main opposition National Salvation Front coalition, which described it as "cosmetic".

The presidency said a committee would be formed to look at changes to the constitution, but it ruled out changing the government before the parliamentary election.

Mursi's pushing through last month of a new constitution which critics see as too Islamic remains a bone of contention.

(Additional reporting by Yasmine Saleh and Omar Fahmy in Cairo, Yusri Mohamed in Ismailia and Abdelrahman Youssef in Alexandria; Writing by Edmund Blair; Editing by Alastair Macdonald and Peter Millership)

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