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Pain Medication Entitlement Annual Renewal

#21 User is offline   neddy 

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Posted 01 September 2007 - 10:30 PM

I wasn't going to add to the last post but I must.

Why is it that someone can be like the proverbial dump truck and dump all over us?

We all have aches, pains,and differing degrees of depression. We all have differing needs,

The major thing is there are those who just get on with it and take each little step at a time because they have to, or they have chosen wisely not to be in a mind numbed space but to accept reality as it exists.

There are some crackers onthis site who despite ravaging injuries and constant pain, are able to keep bright and smiling, able to pass on good advice or a good yarn or two, they are gems to be treasured.

If it's a legitaimate gripe, by all means share it, but don't come on with all the "why me, poor me unique me" crap, we have enough of our own to sort without yours.

I'll probably cop some strife for this posting,but that's the nature of the beast, I just wan't to say how I feel.
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#22 User is offline   Sparrow 

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Posted 02 September 2007 - 08:11 AM

You have hit the nail on the head Neddy, good for you!
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#23 User is offline   flowers 

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Posted 02 September 2007 - 09:40 AM

every body should be able to challenge doctors.
Trouble is if you have the big bucks and lawyers you can afford the best guns.
The rest of kiwianna go suck, probably without legal aid.
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#24 User is offline   Alan Thomas 

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Posted 02 September 2007 - 01:32 PM

Each year the ACC has been stopping my pain medication. They then asked the doctor to make a decision as to whether or not I still need for pain medication.

What is the basis in law that the ACC is relying upon to stop treatment even though the doctor is still prescribing it?
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#25 User is offline   waddie 

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Posted 02 September 2007 - 02:42 PM

Alan - pharmaceuticals are an ancillary service to the treatment provided by your GP. Without a superior opinion to say the treatment you are receiving is not the correct treatment, there is no basis for declining to fund the ancillary service - the pharmaceuticals.

The logic being, if ACC are paying for the treatment from your GP as per the regulations, then they should be paying for the ancillary service required for that treatment.

Its an area where ACC are getting it qwrong. For instance, they hardly every issue a decision, but tell the pharmacist they will not be paying for further medication, leaving up to the pharmacist to advise the claimant. Same goes for when a chiro requests an extension of treatment, ACC decline but don't advise the claimant. That does not comply with ACC requirement to issue a decision in writing, with review rights, to the claimant.
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#26 User is offline   Alan Thomas 

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Posted 02 September 2007 - 05:58 PM

Waddie thank you very much for that helpful advice. I am confident that you are correct then made submissions to that effect to the reviewer on Friday.

In my case they had issued a "decision" to the pharmacist that they would be stopping claimant in one year but argued at the review hearing last year when the letter was produced that the letter to the pharmacist was not a decision. The reviewer John Greene agreed that the letter to the pharmacist was an administrative matter and therefore he did not have jurisdiction to hear a review hearing. On Friday I was reviewing the factor that my medication stopped and that are required a decision to stop the funding following a previous decision some years ago to provide the funding and that that had to have been a decision to stop funding treatment.

The ACC branch manager argued to the reviewer that as treatment has been started again, also without a decision, that the reviewer still did not have jurisdiction.

I explained to the reviewer that the matter is very clear in as much as I have paid for the treatment because someone decided not to pay for it even though the previous decision letter from the ACC accepted liability for this treatment and there had been no medical advice to the ACC to the contrary.

A side issue. The ACC had asked for a prehearing (interrogatory) so as the reviewer can determine whether or not they have jurisdiction to hear my review hearing application. As the reviewer was to make a decision about whether or not jurisdiction existed beyond the three months allowed that there had been no review hearing date set within three months, as the date was yet to be set, and as such a deemed decision had come into existence in my favour. The branch manager voiced an opinion that any deemed decision would be a relevant as the ACC had continued to pay for the medication and so attempted to persuade the reviewer that they still had authority to determine the case. I of course argue that I had a deemed decision and that ACC had to reimburse the money I have spent on the interim and once more the deemed decision was to the effect that the ACC could not write to the pharmacist to cancel treatment unless they had superior medical advice from my treatment provider changing the treatment protocols of which the Corporation was to remain liable.
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#27 User is offline   doppelganger 

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Posted 02 September 2007 - 06:23 PM

Well Allan I just wondered if John Greene had learned from his mistake in my case. The decision that ACC makes is what is to be reviewed. He tried the No jurisdiction ob a decision to change the injuries for what was accepted in 1981 with out any medical evidence. He claimed that the ACC had not made a decision because the letter came from Ruthie the truthie. the truth is thst Ruthie got the information from the file and probably the pathways via someone in ACC.

John Greene will have to think a bit harder as yours is out of time were mine was not out of time when the hearing took place.
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#28 User is offline   waddie 

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Posted 02 September 2007 - 07:04 PM

Alan - there lays the problem with ACC so-called "administrative" decisions. The fact is that ACC is clearly making a decision about an entitlement, therefore it is a reviewable decision.

I pointed this out to a ACC staff member in the relevant department, who agreed, and was going talk to their superior, and get back to me, but didn't. The thing is that ACC are making decisions on treatment and ancillary services without issuing the decision to the claimant, or having review rights attached. This is a clear breach of the Act and I have made ACC aware of it. ACC will be saving millions doing it this way. They have been getting away with it long enough. They are at the moment having to decide whether it is a reviewable decision and pay review costs for revising the decision to fund pharmaceuticals (for the case I'm handling) or not award costs and either go to review for the reviewer to award costs or not, or me appeal on behalf of my client to the Disrict Court on the issue of costs. Either way, it is going to get sorted. The only way for ACC to side-step the issue is to go behind my back an get the claimant to withdraw the review application. A practice McGreevy has condoned in writing.

Ruth Dyson might claim her job is to ensure ACC complies with the Act, but if that is her job then why am I and others having to do it? Either she is not doing her job, or her job is (like VIA decisions) in reality something different. I'm guessing it is the latter, but she is welcome to contact me if I am wrong. Otherwise, I suggest she/ACC start funding claimant representation.

I guess this posting gives the ACC staff who like to entertain themselves by monitoring the site something to think about and report on.
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#29 User is offline   tonyj 

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Posted 03 September 2007 - 07:59 AM

Waddie,

I go along with you on this one,

To me the problem actually starts with a wishy washy statement in a specialist report , that the ACC interpret in a manner that suits their purposes . The ones i encountered usually concerned Viagra or Cyalis , must admit to never have see it happen with heavy pain meds or the like .

tony
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#30 User is offline   Battleaxe 

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Posted 03 September 2007 - 02:21 PM

The review of medications is a time-consuming process. Remember you are the one in pain, not your CM, so he/she is not going to hurry with getting this done.

I had a similar problem a while ago and after I received a letter from my CM saying that my meds had been approved for another 6 months, I realized that I must not allow the full 6 months to run and then let the review process start. So I wrote to my CM and told her that I want the review to start after 4 months have run, therefore leaving 2 months for the review to be completed. I have diarised this date to remind myself to call her about starting the review, and I will 'hound' her for the following 2 months so as to avoid my medication scripts expiring. I can think of no other way to deal with this problem.
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#31 User is offline   Alan Thomas 

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Posted 03 September 2007 - 05:39 PM

Battleaxe the issue was whether or not the ACC have the authority to cancel entitlements after making a decision to accept liability for treatment funding in circumstances where the specialist has stated the treatment is necessary until surgery occurs.

It would appear that the ACC attempting to relabel the reason for my pain to the date of a neuropathic type so as to shift the liability to the taxpayer. It appears that the ACC making moves on all long term pain sufferers to label them as being chronic pain sufferers and therefore neuropathic pain sufferers so as Pharmac will accept liability.

As for addressing the reassessment protocols in advance I had done away more than that by seeking a review hearing however the reviewer decided that he did not have jurisdiction as the decision to cancel payment had not taken effect. Once the decision did take effect I then submitted a new review hearing application. Even though I followed the protocols of reapplying for treatment funding the ACC still took four months to address the issue and then only pay for one of the medication is and not the other for a further six months. The treatment that I find myself in the meantime the ACC claim no liability because there was not on the opinion an active decision to accept liability during this period.
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#32 User is offline   Hardwired 

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Posted 03 September 2007 - 06:58 PM

 Hardwired, on Sep 1 2007, 06:34 PM, said:

same as you have the right to challenge acc.

query= do you have cover for an accident to give you pain meds meaning what have you got acc cover for ''exactly''??????/ ???///

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#33 User is offline   Alan Thomas 

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Posted 03 September 2007 - 07:16 PM

Hardwired I thought you were very familiar with my case.

I am covered for the accident event injury causing incapacity 1989 of a broken wrist that requires surgery. The ulnar styloid process had broken into several fragments that a grinding away inside the wrist. Out of the 26 ligaments holding the wrist on to the arm there are only 5 left functioning properly which means all of the bones in the wrist are badly disorganised. There is various other soft tissue damage such as stretched and torn arteries main nerves and various branches of nerves. During a botched operation one of the main nerves was damaged with the scalpel.

I will not bore you with the detailsBut the pain specialist confirms that I am not suffering from neuropathic or chronic pain syndromes but simply suffer from the pain that anyone would with a badly disorganised wrist while waiting for surgery.
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#34 User is offline   neddy 

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Posted 03 September 2007 - 07:44 PM

There are challenges and outright declaration of War. The trick is knowing which one to use. Some case managers are approachable if dealt with in a polite enquiring way, but come on too strong and they'll bite you.

I feel the litigious and at times vexatious nature of Alan's gets in the way of his getting what he may or he feels he may be entiltled to.

I feel if he was to learn to moderate his approach, cut out all multiple sylables he uses, and kept it simple so anyone could understand, there could be constructive dialogue as opposed to "It's my right, right or wrong and here is the multiple page document to prove it."

The age old philosophy of KISS, keep it simple, stupid!
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#35 User is offline   tonyj 

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Posted 03 September 2007 - 08:27 PM

I have yet to see ACC not fund medication if an appropriate specialist or specialists confirm the cause is ACC approved and a non pharmac subsidized medication is superior .
It may be that the prescribing specialist has at times had to get involved and challenge at times ,but seldom .

I can only presume Alan it is historic and more related to you personally for whatever reason or the prescribing specialist has not been enthusiastic enough about the need for specific medications .

tony
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#36 User is offline   Alan Thomas 

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Posted 04 September 2007 - 10:33 AM

Neddy from day one of the ACC had not been very polite or kindly disposed towards me because the medical people gave them a good bollockings. Not satisfied that the ACC were medically wrong they then sought other ways to avoid their liabilities, fraud investigation. In 1992 to review hearings were against the ACCs perceptions and in my favour. The ACC did not give up and relentlessly pursued me as if I was a fraudster. They just would not accept the expert information and proof beyond reasonable doubt that they were wrong.

Far from me being vexatious it is the ACC that his vexatious. It is not vexatious to be defending yourself against false allegation.

When you are being beaten with a stack it is very difficult to moderate your cowering on the ground mode of defence. I do not sympathise with my attackers for my vocal screams of pain and distress. It is very difficult having constructive dialogue when Gerard McCreevy instructs the entire ACC staff, more than 2000, that they are forbidden from communicating with me and that the trespass notices are renewed every two years even though I had not been on the premises.

ACC do not believe in your KISS philosophy as they like to determine everything by way of lots and lots of smoke and mirrors with dust in the air for added effect.

Tonyj the ACC having arguments with specialist concerning medication is very common. The ACC have a department that challenges medical specialists. In my case they are arguing with professors and the leaders of their field. The latest is just the other week Where the Branch Medical Adviser challenged my doctor about what was being prescribed without knowing what the clinical condition was all the reason for the prescription. Apparently the branch medical adviser was referring to "evidence-based medicine" and made a recommendation based on statistics without reference to my actual condition but common conditions for the prescription of this medication.

There is currently one of the more significant frauds committed by the ACC with the drug gabapentin. The taxpayer will find it if the person is suffering from neuropathic pain but the ACC is required to fund it if it is prescribed for any other reason the specialists had prescribed it in relation to the injury. For this reason the ACC have falsified documents to the tax funded medication through Pharmac so as Pharmac become liable. The ACC alleged that I am suffering from neuropathic pain despite the fact that the specialists say I am not. I think this is called producing a false document for pecuniary advantage.

To the contrary about specialist enthusiasm and the ACC. I ensure that my treatment providers are technically competent, have ethics and will stand by their personal integrity for the care of their patient and will not be afraid of the marauderring hippopotami that have passed the use by date who have sold their soul to the ACC.
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#37 User is offline   neddy 

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Posted 04 September 2007 - 02:01 PM

Alan can you answer the following questions?

1. Who funds your current meds

2. Are you able to state what meds you are on?

3 Who prescribed the meds, your chosen specialist or ACC, or specialist in conjunction with ACC?

4 Your preferred meds and why you must have them?

5 Where in the Acts does it say ACC must provide a Cetain Medication for a given case eg Methadone for pain?

6 Has it been tested in law or by precedent , that which you are claiming as an entitlement?

7 Just why you have to have this new wonder drug?

Members of my family have had medications changed from Brand name to generic drugs because Pharmac won't fund the dearer alternative and they have to make do as I'm sure there are others on this site who have had the same experience.


Quote "Neddy from day one of the ACC had not been very polite or kindly disposed towards me because the medical people gave them a good bollockings

If you approach a Provider (one who provides things for you under legislation) from day one in an antagonistic attitude, you can expect some reaction! and to be trespassed you must have trangressed in a major way. ACC staff are only people who have feelings too, ruffle their feathers and they may bite back.

The onus is now on you to convince the ACC that you were not fraudulent in your behaviour, and that your behaviour is not severe enough to warrant a blanket trespass order and no amount of compaining on this board will change that,

Were you ever offered some form of mediation so your gripes could be both presented and listened to and a conduit between you and them established, or did you just initiate legal proceedings against ACC?.

I'm sorry, but I find it hard to believe that there is not away for you to be listened to without going to the extrodinary lengths to get I quote from a recent post of yours "Vengeance".
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#38 User is offline   waddie 

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Posted 04 September 2007 - 02:39 PM

It is Alan's treatment provider provides the treatment and decides what medication is to be prescribed, its not up to Alan. The medication is an ancillary service to the treatment.

I assume ACC have not refused to pay the treatment provider for providing the treatment. Therefore, there are no grounds I can see for not paying for the ancillary service without evidence that there is a more cost-effective option that will achieve the same results ie facilitate the treatment - clause 3, schedule 1 of the Act. Even then it would be unreasonable not to consult with the treatment provider before making that sort of decision.
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#39 User is offline   Alan Thomas 

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Posted 04 September 2007 - 02:41 PM

Alan can you answer the following questions?

My first instinct was to ignore your questions as being naive or silly but then I thought maybe that is a good reason to answer. Perhaps you are beguiled into a false sense of security flushing down from head office.

1. Who funds your current meds
ACC has the liability for all of my medications but invariably it has been myself and the taxpayer.

2. Are you able to state what meds you are on?
Hypnotics and pain medication for the treatment of my physical injuries with other medication addressing PTSD. There is nothing special about the medication and that is the only type that is suitable according to the specialist prescribing it after considering other alternatives.

3 Who prescribed the meds, your chosen specialist or ACC, or specialist in conjunction with ACC?
Private specialists and the hospitals specialists.

4 Your preferred meds and why you must have them?
If pain is not treated properly there exists a high chance that I would suffer from a chronic pain syndrome or even a regional pain syndrome. The fact is that I do not because I accessed appropriate treatment. Once I had my surgery I should be away laughing all the way back to my pre employment occupation.

5 Where in the Acts does it say ACC must provide a Cetain Medication for a given case eg Methadone for pain?
The Act requires the ACC to fund whatever the treatment provider decides. The act does not enable the ACC to pick and choose what treatment will or will not be provided unless there is a medical misadventure by the existing treatment provider misdiagnosing and mistreating the claimant. If the ACC disagree with the professional conduct of the treatment provider they should take that up with the Medical Council rather than just stopped payment.

6 Has it been tested in law or by precedent , that which you are claiming as an entitlement?
Providing medical treatment and medical rehabilitation funding is fundamental to the ACC Act. ACC never win these cases where they have challenged the integrity and appropriateness of prescribed treatment when the treatment is acknowledged to be for the purposes of treating an accepted claim for injury.


7 Just why you have to have this new wonder drug?
There are no new wonder drugs. In fact tramol should not be taken for more than six weeks but the only reasonable alternative is its big brother morphine. More than is actually less harmful physically and come up but tramol is less psychologically addictive. Any pain medication of this calibre is going to be addictive and have side-effects. The side effect of not treating pain properly is chronic pain syndromes, regional pain syndromes and other psychological and physiological neurological type disorders that will ultimately require additional rehabilitation.


Pharmac has nothing whatsoever to do with the ACC act. The only relationship is that ACC bulk fund Pharmac and therefore try to get all ACC claimants on to Pharmac funded drugs. In my case they have disregarded the specialists diagnosis when prescribing gabapentin and changed the reason for the medication to neuropathic pain solely to gain access to the taxpayer funding which is of course producing a document for pecuniary advantage (fraud)

I have always had excellent relationships with treatment providers. It is the treatment providers are that have experienced difficulty with the ACC. For example one of the best hand surgeons in New Zealand wanted to operate on my wrist so the ACC sent me along to a garden variety orthopaedic surgeon who booked me in for surgery to my elbow followed by the ACC suspending my entitlement until I had elbow surgery. While resolving that fiasco I lost my house and family but I remained calm and composed relying upon judicial processes to a successful outcome.

I was originally trespassed forewarning the Henderson branch manager that their staff faced certain danger with the last warning been two months prior to Johnny murdering Mrs Pike. I have been trespassed every two years since providing that message (yes they did bite back they shot the messenger) of course I am traumatised by the murder as I did not provide the branch manager with sufficient warning! Mrs Pike was not the only ACC staff member who have feelings, her husband expressed his feelings to me personally over the following year.

You are incorrect about where the onus lays. The Act requires the ACC to comply with the superior medical information. In cases like Johnny who needed medication to remain psychologically stabilised the onus is not upon him but upon the ACC employing appropriate staff to do with such people appropriately, and I do not mean by a trespass notice, I mean by making sure they reimburse him for his medication in a timely way so he keeps taking it in accordance with the prescription. Placing the onus upon Johnny meant that he did the only thing he knew how, kill someone so he could go to prison so he could receive the medication that was necessary in his case. I am not justifying killing anybody I am just making the point that ACC must employ persons who have the appropriate competency to deal with injured people no matter what the injury.

You make an incredible leap of faith in assuming that there was any behaviour let alone behaviour severe enough for a blanket trespass notice for the last 10 years. As a person who does not get agitated or even swear it is difficult to imagine what information the Corporation had relied upon for the trespass notice. I do not rely upon this board as a venting platform but to make information available to others so as they may make comparisons with their own circumstances against mine so as to gauge some form of relevant to the relationship with the ACC

Despite my many requests to interact with ACC staff they have always refused from day one. Each and every time I have made an approach to the ACC from 1989 until 1995 the only direction I had was to sign an occasional form has rehabilitation had been refused given they thought my condition was permanent despite medical evidence and a review hearing to the contrary.

ACC claim to offer an IRP 1995 but in fact had simply made an appointment with an employment consultant rather than comply with the review hearing decision to provide surgery. The next thing I knew there was a fraud investigation resulting in the ACC initiating legal proceedings against myself. It is the biggest court case in ACCs history, seven weeks with my only opportunity of rebuttal being 3 1/2 days including witnesses. I had not initiated legal proceedings against the ACC but I have appealed but unfortunately there is no legal aid funding.

It is for persons such as yourself I make my postings so as to increase your awareness of what the ACC are doing against invalids. I know you find it hard to believe or to come to grips with but the sooner and more adequately you comprehend what is going on the better you will be able to protect yourself, friends and family.

As New Zealand is quite unique in the Western world by taking the right away from a disadvantaged citizen to the advantage of the guilty party who caused an injury and had failed to live up to the advertised replacement, the ACC Act, we are dealing with an oppressive regime of which citizens are more likely than not going to revolt. When judicial remedy is taking away vengeance is the only form of just as available to the individual that has been offended when being turned into a second-class citizen.
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#40 User is offline   neddy 

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Posted 04 September 2007 - 05:48 PM

[quote name='Alan Thomas' date='Sep 4 2007, 02:41 PM' post='50830']
Alan can you answer the following questions?

My first instinct was to ignore your questions as being naive or silly but then I thought maybe that is a good reason to answer. Perhaps you are beguiled into a false sense of security flushing down from head office.


[
What was naive or silly about my questions which you still have avoided answering by fudging again.

You dive around and do not ever give specifics, so I for one don't know if you are bullshitting or on a genuine bitch and that annoys me.

You take up so much space to say so little of substance, some would think you have a career as a spin-doctor for corrupt politicians.

Gte real, enumerate your bitch in short, succint sentences that can be both read and understood by the average Joe Blow.

And when did you apoint yourself Yaweh? "Vengance is MINE saith the Lord" not Alan Thomas's, taking that line will en in great sorrow.
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