USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1937 > Part 91
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(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examinera will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
R-302
PLACE OF DEATH
SUFFOLK (County) BOSTON
(City or Town)
No. New England Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No .... 10008
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Donald
Singer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No.
28 ... Beoch Rd
.St., .............
. Ward,
Winthrop
(If nonresident, give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred
JTs.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
M
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full) (Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 9 Years
1
Months
Days
If less than 1 day .Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
school
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
11 Total time (years) spent in this occupation.
year) Nov 1 1937
12 BIRTHPLACE (City) (State or country) Boston Mass
13 NAME OF
FATHER
Reuben Singer
14 BIRTHPLACE OF
FATHER (City)
(State or country) England
15 MAIDEN NAME
OF MOTHER
Minna Dayis
16 BIRTHPLACE OF MOTHER (City) (State or country) Boston Mass
17
Informant
(Address)
Father-
as above
A TRUE COPY,
ATTEST:
Hilda Ofedition Suite
(Registrar of city or town where death occurred)
DATE FILED Nov 13 193.7
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Noy
10
193 7
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Nov .7
19
37 to
Nov 10
.19.3 ... 7
I last saw h ... im alive on Nov ... 10 19 .... 3.7 death is said to have occurred on the date stated above, at.6.25A.m. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
peritonitis ruptured appendix
Contributory causes of importance not related to principal cause:
Name of operation
appendectomy
Date oll 1 737.
What test confirmed diagnosis? Was there an autopsy? no
20 Was disease or injury in any way related to occupation of deceased?
.no
If so, specify
(Signed)
(Address)
C Zaurabeff
Boston
Date
11/10/93 .7
M. D.
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
Pride of Jacob
W Rox
(Cemetery)
(City or town)
DATE OF BURIAL
Nov .... 11
19.3.7
22 NAME OF
UNDERTAKER
J H Levine
ADDRESS
Boston
Received and filed 19
(Registrar of City or Town where deceased resided)
important.
50m-9-'31. No. 3385-g
tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
1
.St.,
.........
Ward
(If U. S.
239
War Veteran,
specify WAR)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
single
PARENTS
R-302
tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important.
A TRUE COPY.
ATTEST:
Auta Ofedition Quirks
...
(Registrar of city or town where death occurred) 12/3/37
DATE FILED 19 3
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
November 27/37
193
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
11/27/37
19
11/27/37
19.3.
I last saw h ... jm. alive on
11/27 37
.. , 19.
death is said
7:40P m.
to have occurred on the date stated above, at. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Prematurity
Contributory causes of importance not related to principal cause:
Name of operation What test confirmed diagnosis?
Date of
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased? If so, specify
. (Signed)
DEReid
M. D.
(Address)
171 Bay State Rd
Date
11/27983.7
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
St. Joseph's
(Cemetery)
Dec 2/37
DATE OF BURIAL
193
22 NAME OF
UNDERTAKER
G M Linehan
Boston
ADDRESS
Received and filed
JAN 1
19
1
PLACE OF DEATH
SUFFOLK (County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No. 10593
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Heiland
(If deceased is a married, wi. „wed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence. No ..
(Usual place of abode)
15 Charles
St., ...............
. Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE Years . Months
Days
If less than 1 day
6 .Hours52.
.Minutes
OCCUPATION,
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
11 Total time (years) spent in this occupation
year)
Boston
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Harold Heiland
14 BIRTHPLACE OF
FATHER (City)
Addy
(State or country)
Washington
15 MAIDEN NAME
OF MOTHER
Minnie Riggs
16 BIRTHPLACE OF MOTHER (City) (State or country)
Swansboro N C
17 lafermant (Address)
Hosp Rec
50m-9-31. No. 3385.@
No. Boston Lying In Hosp
St.,
Ward
(If U. S.
240
War Veteran,
.. , to.
(Give maiden name of wife in full)
PARENTS
(City or town)
(Registrar of City or Town where deceased resided)
R-301A
in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very tion should be carefully supplied. Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH See instructions and extracts from the laws on back of certificate.
1
PLACE OF DEATH
Suffolk ( (County) Winthrop (City or Town)
No 203 Shore Drive
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 241
Registered No. S (If death occurred in a hospital or institution, Ward \ give its NAME' instead of street and number) St.
2 FULL NAME
Jane nunes-Yaz
(If U. S. War Veteran
specify WAR)
(a) Residence.
No. 203 Shore Drive
St.,
Ward,
(If nonresident, give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
days.
How long in U.S., if of foreign birth?
years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
1
(Year)
19 I HEREBY CERTIFY That I attended deceased from
19.3.7 .... to.
fre 1
19 37
I last saw b ... A ..... allve on.
19 37, death is said
to have occurred on the date stated above, at.
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
mur 1
Contributory causes of importance not related to principal cause:
Azc /
Name of operation.
Date of.
What test confirmed diagnosis?
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify
M. D.
(Signed)
(Address) 105 ,Meridian
Date 12/1
1937
(City or Town)
22 NAME OF Benjamin t. Soconoro UNDERTAKER
ADDRESS
420 HARVARD ST., BROOKLINE MAGE.
Received and filed 19
1937
agent- Dee. 2/37
(Official Delignation) (Date of Issueof Permit)
(Registrar)
100m 12'35. No. 6156F
17 Informant .: (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
William A. Childress (Signature of Agent of Board of Health or other)
e
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City) ..
(State or country)
Jegland
13 NAME OF
FATHER
14 BIRTHPLACE OF FATHER (City)
PARENTS
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE ..
7 6+ .Years ... ....... Months .. Days
If less than 1 day
.. Hours
.Minutes
OCCUPATION
8 SEX
H
4 COLOR OR RACE
White
(write the word)
1737
6a If married, widowed, er divorced HUSBAND of
5 SINGLE
MARRIED
WIDOWED
OF DIVORCED
widowed
(If deceased is a married, widowed or divorced woman, give also maiden nan e.)
important.
21 .. Relation, if any Place of Burial, (Cremation or Removal. DATE OF BURIAL 19 ...
(State or country)
10 Date deceased last worked at
this occupation (month and
year)
Revised United States Standard Certificate of Death
Statement of occupation. - Precise statement of occupation is- very important, so that the relative healthfulness of various pur- suits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from bus- iness, report the occupation prior to retirement. Children not gainfully employed may be returned as AT SCHOOL OF AT HOME. For a woman whose only occupation was that of home housework, write HOUSEWORK in answer to Question 8 and OWN HOME in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as HOUSEKEEPER-PRIVATE FAMILY, COOK-HOTEL, etc. For a person who had no occupation whatever write NONE.
To be complete, an occupation return must state :
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- The month and year the deceased last worked at the occupation.
11 .- The number of years the deceased followed the occupation.
In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the partic- ular kind of work done and return that, as SPINNER, WEAVER, etc.
In stating the industry or business, avoid the use of such gen- eral terms as "store," "factory," "mill," etc. State the particular kind of store, factory, mill, etc., as GROCERY STORE, SOAP FACTORY, COTTON MILL, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as CIVIL ENGINEER, MECHANICAL ENGIN- EER, MINING ENGINEER, STATIONARY ENGINEER, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic," but give the exact occupation, as CARPENTER, PAINTER, MACHINIST, etc. Distinguish carefully between RETAIL MERCHANTS AND WHOLESALE MERCHANTS. A person who sells goods should be called a SALESMAN and not a CLERK.
Statement of Cause of Death. - Cause of death means the disease, or complication which causes death, NOT the mode of dying, E. G., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
Arteriosclerosis ....
1915
Chronic interstitial nephritis ....
1921
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause :
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, atter the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his sup- posed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . . GEN. LAWS, CHAP. 46, SEC. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement con- taining the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as re- quired by law, or in lieu thereof a certificate as hereinafter pro- vided. If there is no attending physician, or if, for sufficient rea- sons, his certificate cannot be obtained early enough for the pur- pose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attend- ing physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was re- moved within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall ap- pear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death. which the clerk or registrar may require .- CHAP. 114, SEC. 45,, G. L. (TER- CENTENARY EDITION.)
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. . .- GEN. LAWS, CHAP. 38, SEC. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- GEN. LAWS, CHAP. 38, SEC. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . .- CHAP. 114, SEC. 46, G. L. (TERCENTENARY EDITION.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ob- servance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septi- cemia), and by the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
R-301A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
No. 16 Pres
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
012
§ (If death occurred in a hospital or institution, Ward \ give its NAME instead of street and number)
2 FULL NAME
Beufmen Gewirts
(If deceased is a married, widowed of divorced woman, give also maiden name.)
(a) Residence.
No.
Ward,
Winthrop
16 Pm
St.
(Usual place of abode)
Length of residence in city or town where death occurred 22 years
months
days.
How long in U.S., if of foreign birth? 5 years
(If nonresident, give city or town and state)
Months
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
8 SEX
Well
4 COLOR OR RACE
White
5 SINGLE
MAARMED
WIDOWED
OF DIVORCED
(write the word)
Marined
ba If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 65
AGE
Years Months Days
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .....
Tailor
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ..
For Himself
10 Date deceased last worked at
11 Total time (years)
spent in this
monthand
occupation.
this occupation
year)
2 ....
12 BIRTHPLACE (City)
Russia
(State or country)
13 NAME OF
FATHER
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Russia )
(State or country)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
17 Informant (Address)
Henry Gewarts(
I HEREBY CERTIFY, that o satisfactory standard certificate of death was tilød with me BEFORE the burial or transit permit was issued:
Www. D.
(Signature of Agent of Board of Health or other) Dealto Officer 12/3 137
Omcial Designation)
(Date of Issue of Farmit)
18 DATE OF
DEATH
Dec
3
1937
(Year)
(Month)
(Day)
19 I HEREBY CERTIFY, That I attended deceased from now 20 1836 to Dec 3 1937
I last saw bamm alive on Dec 2 193 7, death is said to have occurred on the date stated above, at 2.05Am. The principal cause of death and related causes of Importance In order of onset were as follows: Date of Onset IMPORTANT Pul. Emphysema
musculation
Mr736 Ur 1936
Contributory causes of importance not related to principal cause:
Cardiac astlima
Name of operation
Date of.
What test confirmed diagnosis?
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
Frans Frandla
(Signed)
M. D.
(Address)
Date: Dec3 1987
Wi .. TI.
21
Place of Burial, Cremation or Removal. (City or Town)
19 ......
22 NAME OF
UNDERTAKER
ADDRESS
Received and filled.
19
(Registrar)
100m 11-36 No 9080 F
important. See instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very tion should be carefully supplied. Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH
Relation, if any DATE OF BURIAL .....
.St.,
(If U. S. War Veteran
specify WAR)
Revised United
d States Standard Certificate o
Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pur- suits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from bus- iness, report the occupation prior to retirement. Children not gainfully employed may be returned as AT SCHOOL Or AT HOME, For a woman whose only occupation was that of home housework, write HOUSEWORK in answer to Question 8 and OWN HOME in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as HOUSEKEEPER-PRIVATE FAMILY, COOK-HOTEL, etc. For a person who had no occupation whatever write NONE.
To be complete, an occupation return must state :
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- The month and year the deceased last worked at the occupation.
11 .- The number of years the deceased followed the occupation.
In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the partic- ular kind of work done and return that, as SPINNER, WEAVER, etc.
In stating the industry or business, avoid the use of such gen- eral terms as "store," "factory," "mill," etc. State the particular kind of store, factory, mill, etc., as GROCERY STORE, SOAP FACTORY, COTTON MILL, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as CIVIL ENGINEER, MECHANICAL ENGIN- EER, MINING ENGINEER, STATIONARY ENGINEER, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic," but give the exact occupation, as CARPENTER, PAINTER, MACHINIST, etc. Distinguish carefully between RETAIL MERCHANTS AND WHOLESALE MERCHANTS. A person who sells goods should be called a SALESMAN and not a CLERK.
Statement of Cause of Death. -- Cause of death means the disease, or complication which causes death, NOT the mode of dying, E. G., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
Arteriosclerosis ...
1915
Chronic interstitial nepbritis ...
1921
Cerebral hemorrhage
July 5. 1927
Contributory causes of importance not related to principal cause :
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
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