USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 89
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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 appear upon the permit. The hoard of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary 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., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within his county the hody of such a person, he shall forthwith go to the place where the body lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall hury a human hody or the ashes thereof which have been brought into the commonwealth until he has re- ceived 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 hody is to be huried 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 observance 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 phy- sician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly hy 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.
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.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual 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. For a person engaged in domestic service for wages, how- ever, designate the occupation by the appropriate terms, as housekeeper --- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
303-A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effeot.
50m (g)-1-41-4667
7 Sullkk (County) Kathrin. 1 (City or Town). No. 61 Birch Rd PLACE OF DEATH Mary a. Scallevan
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health A or its Agent.
Registered No.
251
[ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number) 1
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
61 Bach Ord. Winthrop
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACEJ
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that faot here.
AGE.
8
76
Years
Months.
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Insurance
10 or Business :
industry
Mass Bonding Ins Co.
11 Social Security No. 012 -- 12 -- 5825
12 BIRTHPLACE (City)
Newton
(State or country)
Massachusetts
13 NAME OF
FATHER
John Sullivan
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Bridget Slyne
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17
Arthur J Sullivan (Newthat any
Informant.
(Address)455 East 51st Street N. Y. C.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued: Walter of - Maviliça
(Signature of Agent of Board of Health of other) ....
1/2/47
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December - 30 -1946
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: {If an injury was involved, state fully.) acute cardiac Failure: Hypertensive Heart Disease
20 Accident, suicide, or homicide (specify)
Date of occurrence.
19
Where did
Injury occur?
(City or town and State)
Did injury ooour in or about home, on farm, in Industrial place, or In publio
place ?
(Specify type of place) Manner of Collapsed etter walking in
Injury
Nature of
cold winds day
Injury
While at work ?
Was there an autopsy?
21 Was disease or injury In any way related to ocoupation of deceased?
If so, specify.
(Signed)
......
M. D.
(Address)
Boston
beate-31 -19 46
Boston
22
Calvary
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
January 3
1947
23 NAME OF
FUNERAL DIRECTOR
John . O Malley
ADDRESS
Winthrop ..... Mass.
Received and filed JAN 3 -19-4-7
19
(Registrar)
PHYSICIAN - IMPORTANT
{{was deceased a
U. S. War Veteran,
If so specify WAR)
(Usual place of abode)
... years
months
days.
In this community 20 yrs.
mos.
days.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after 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 supposed 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.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall hury 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 containing 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 required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian 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 re- quired of the attending 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 pos- session of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody shall be returned to the town from which it was removed within thirty-six hours after such re- moval, 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 appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for regis- tration. 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 re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived 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 per- son appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General 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 .- General Laws, Chap. 38, Sec. 7.
... The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance 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 physiclans 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 physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly 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.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify : (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death. )"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
H
+
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH
State File No. 252
Registrar's No.
State of maine
1. PLACE OF DEATH:
2. USUAL RESIDENCE OF DECEASED:
(a) State 27das (b) County Jaffa
(c) City or town
Winthropl
(If outside city or town limita, write RURAL)
(d) Street No.
(If rural, give location)
(If not in hospital or institution, write street number or location)
(d) Length of stay: In hospital or institution
In this community
Imot
(Specify whether
years. months or days)
3. (a) FULL NAME Come D. Field
20. Date of death: Month Slept day
27
Year 1946 hour
minute
No.010-09- 8906 21. I hereby certify that I attended the deceased from
19
== , to
19
4. Sex
6. (b) Name of husband or wife
6. (a)Single, widowed, married
divorced
Div
6. (c) Age of husband or wife if
alive
3
1899
that I last saw h _____ alive on
19 ____:
and that death occurred on the date and hour stated above.
-
_ year
Immediate cause of death
7. Birth date of deceased May (Monthy
(Day) (Year)
8. AGE:
Years
Months
Days
If less than one day
47
4
24 -hr.
miri,
9. Birthplace Lewiston Mai e Due to
10. Usual occupation Waithead
11. Industry or business
12. Name Charles Loved
13. Birthplace (Oky. town, or county ) of foreign country ) 14. Maiden name Zilla allen
Major findings:
Of operations
Of autopsy
Underline the cause to which death should be charged sta- tistically.
22. If death was due to external causes, fill in the following:
(a) Accident, suicide, or homicide (specify)
1 (b) Date of occurrence
(c) Where did injury occur?
(City or town)
(County) (State)
place?
While at work?
(Specify type of place) (e) Means of injury
19. (a) act. 1, 1946 (b) C. Walter abbott 23 Signature freephi
(Date received local registrar)
(Registrar's signature)
Address South Paria Me. Date signed
JAN 2 3 1947
V
8-6917
U. S. GOVERNMENT PRINTING OFFICE 16-13493
Other conditions Might hemiplegial (Include pregnancy within 5 months of death)
PHYSICIAN
MOTHER FATHER
15. Birthplace Hartford me. (City. town, or country (State or foreign country)
16. (a) Informant's own signature
Patie Home
(b) Address _.....
17. (a) Burial (Burial, cremation, or removal)
(b) Date thereof Slept 29,1944 (Month) (Day) (Year) (c) Place; burial or cremation South Maria, me
18. (a) Signature of funeral director Clarence 13. Huff ) Did injury occur in or about home, on farm, in industrial place, in public
(b) Address South La arie me ..
2 4. Villa (M. D. or other ) m.L
County Luffek
(a) County
(b) City or town South Paris (mal)
ffoutside city or town limits, write RURAL) (c) Name of hospital or institution:
k If foreign born, how long in U. S. A .?
years.
MEDICAL CERTIFICATION
3. (b) If veteran, name war
3. (c) Social Security
5. Color or
race
Duration
mary throm frais
Coronaryartery
ity./town, or counte) (State or foreign country)
1f
R-302
Essex
(County)
Danvers
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
253
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Julia E. Howe (Julia E. Tabor)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
125 Cliff Ave.
(Usual place of abode)
Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay : In hospital or institution
(Before death)
(Specify whether)
years
months
28 days.
in this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
Widowed
5a if married, widowsd, or divorced HUSBAND of
(or) WIFE of
Frank Howe
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that fact here.
8
AGE ....
72 Years.
Months. Days
If less than 1 day Hours. .Minutes
Usual
9 Occupation :
Unable to work
Industry 10 or Business :
11 Soolal Security No ........ None
12 BIRTHPLACE (City)
(State or country)
New York
13 NAME OF
FATHER
Arthur Tabor
14 BIRTHPLACE OF
Troy
FATHER (City)
(State or country)
N. Y.
15 MAIDEN NAME
OF MOTHER
Mary A. Jones
16 BIRTHPLACE OF
Troy
MOTHER (City)
(State or country)
New York
17 Ii. K. McPhillips
Relation, if any
Informant.
(Address)
Hathorne Mass.
A TRUE COPY.
ATTEST :
Chcetehan
(Registrar of city or town where death occurred)
1946
18 DATE OF
DEATH
November 16,
1946.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Oct. 19
1940
to NOV. 16
That I attended deceased from
19
40
I last saw h .............. allve on.
Nov 16
19 46
death is sald to
have occurred on the date stated above, at 11:50 P. .m.
Duration
Immediate cause of death.
Generalized Arteriosclerosis
5 yrs
Chronis Myocarditis
2 yrs
Due to
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis ?.
Clinical
20 Was disease or Injury in any way related to oooupation of deceased ?.
If so, specify ..
Francis X. Sullivan
(Signed)
M. D.
(Address)
Hathorne, Mass. Date] ]-221946
21 PLACE OF BURIAL, Winchendon Cemetery, CREMATION OR REMOVAL .... Winchendon ...... 9.9.s ....
DATE OF BURIAL
November 20
(Cemetery)
(City or Town)
19
46
Richard H. white
22 NAME OF
FUNERAL DIRECTOR
Winthrop, Lass
ADDRESS
Received and filed
JAN 1 21941
.19
DATE FILED
NOV. 25,
(Registrar of City or Town where deceased resided)
50m. (b) -6-44-14607
of the city of town in which the deceased resided. (see Umap. so, sec. 12, U. L.) PARENTS
PLACE OF DEATH
(City or Town) Hanvers State Hospital, Hathorne , Mass .. No.
1
-
Major findings:
Of operations
Date of
Of autopsy
Troy
MARRIED
WIDOWED
or DIVORCED
(if U. S.
War Veteran,
specify WAR)
2-302 1
PLACE OF DEATH
Suffolk (County)
Revere
No.
(City or Town) Sunnyside Home
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE
(City or town making return)
Registered No.
254
-.
St. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Gitano Carnicelli
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
106 Shirley
SŁ
Winthrop
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
Home
1years - months -
in this community
20yrs. - mos. - days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACEJ
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
5ª If married, widowed,
HUSBAND of
(Give maiden name of wife in full)
Marta DiBiase
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that faot here.
8 AGE.9.2 .. Years - .. Months .. Days
if less than 1 day
Hours ............ Minutes
Usual
9 Ocoupatlon:
Tailor
Industry
10 or Business :
Retired
11 Social Security No. None.
12 BIRTHPLACE (City)
(State or country)
Italy
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Louise Bartelli
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17 Peter Carnicelli
Relation, if any Son
informant (Addreee) 1060Shirley St .. Winthrop
A TRUE COPY.
ATTEST:
DATE FILED
(Regietrar of city or town where death occurred)
December 4,
1946
18 DATE OF
DEATH
December 3 1946
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Nov. 29
1946
...
That i attended deceased
from
to
Dec. 3
19
46
I last saw h.im ...... ailve on
Dec
3
.... , 19.4.6, death Is sald to
have occurred on the date stated above, at.
12
m.
Duration
Immediate cause of death
Bronchopneumonia
5 days ....
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis ?.
clinical
20 Was disease or Injury in any way related to oooupation of deceased ?.
If so, specify
(Signed)
H. L. Masters
M. D.
(Address)
62 Revere St.
tere
Date 12/3 19.
46
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Holy Cross,
Malden ..
(Cemetery )
(City or Town)
DATE OF BURIAL
Dec. 6,
1946
22 NAME OF
FUNERAL DIRECTOR
Patsy Rapino
ADDRESS
9 Chelsea St. ,
Boston
Received and filed. JAN 1-1017 19
(Registrar of City or Town where deceased resided)
50m-(b)-6-44-14607
1
13 NAME OF
FATHER
Vincent Carnicelli
Of autopsy
.No
White
(If U. S.
War Veteran,
speolfy WAR)
None
-
R-302
Essex
(County)
Danvers (City or Town) Danvers Sate Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
255
MA
(If death occurred in a hospital or institution,
St.
give its NAME instead of etreet and number)
2 FULL NAME
Catherine Cobb
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution ..
(Before death)
(Specify whether)
years
9
months
days.
In this community
yre.
moe.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F.male
4 COLOR OR RACE| 5 SINGLE
White
(write the word)
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