The ethnic gap in mobility: a comparison of Russian, Somali and Kurdish origin migrants and the general Finnish population.

BACKGROUND: Many ethnic minority populations have poorer health than the general population. However, there is limited knowledge on the possible ethnic gap in physical mobility. We aim to examine the prevalence of mobility limitations in working-age Russian, Somali and Kurdish origin migrants in comparison to the general population in Finland. We also determine whether the association between ethnic group and mobility limitation remains after taking into account socio-economic and health-related factors. METHODS: We used data from the Finnish Migrant Health and Wellbeing Study (Maamu) and the Finnish Health 2011 Survey. The participants comprised 1880 persons aged 29-64 years. The age-adjusted prevalence of difficulties in various mobility tasks was calculated using predictive margins. Logistic regression analysis was used to examine the association between socio-economic, health- and migration-related factors and mobility limitation (self-reported difficulty in walking 500 m or stair climbing). The association between ethnic group and mobility limitation was calculated using logistic regression analysis. RESULTS: Mobility limitations were much more prevalent among Somali origin women (46 %) and Kurdish origin men (32 %) and women (57 %) compared to men and women in the general Finnish population (5-12 %). In Russian origin men and women, the prevalence of mobility limitation (7-17 %) was similar to the general Finnish population. Socio-economic and health-related factors, but not migration-related factors (time lived in Finland and language proficiency in Finnish or Swedish), were found to be associated with mobility limitation in the studied populations. Somali and Kurdish origin migrants were found to have increased odds for mobility limitation compared to the general Finnish population, even after adjusting for socio-economic and health-related factors (Somalis odds ratio [OR] 3.61; 95 % confidence interval [CI] 2.07-6.29, Kurds OR 7.40; 95 % CI 4.65-11.77). CONCLUSIONS: This study demonstrates a functional disadvantage in Somali and Kurdish origin populations compared to the general Finnish population, even after adjusting for socio-economic and health-related factors. The high prevalence of mobility limitation among Somali origin women and Kurdish origin men and women in Finland demonstrates an acute need to promote the health and functioning of these populations.

Changes in time of sowing, flowering and maturity of cereals in Europe under climate change.

The phenological development of cereal crops from emergence through flowering to maturity is largely controlled by temperature, but also affected by day length and potential physiological stresses. Responses may vary between species and varieties. Climate change will affect the timing of cereal crop development, but exact changes will also depend on changes in varieties as affected by plant breeding and variety choices. This study aimed to assess changes in timing of major phenological stages of cereal crops in Northern and Central Europe under climate change. Records on dates of sowing, flowering, and maturity of wheat, oats and maize were collected from field experiments conducted during the period 1985-2009. Data for spring wheat and spring oats covered latitudes from 46 to 64°N, winter wheat from 46 to 61°N, and maize from 47 to 58°N. The number of observations (site-year-variety combinations) varied with phenological phase, but exceeded 2190, 227, 2076 and 1506 for winter wheat, spring wheat, spring oats and maize, respectively. The data were used to fit simple crop development models, assuming that the duration of the period until flowering depends on temperature and day length for wheat and oats, and on temperature for maize, and that the duration of the period from flowering to maturity in all species depends on temperature only. Species-specific base temperatures were used. Sowing date of spring cereals was estimated using a threshold temperature for the mean air temperature during 10 days prior to sowing. The mean estimated temperature thresholds for sowing were 6.1, 7.1 and 10.1°C for oats, wheat and maize, respectively. For spring oats and wheat the temperature threshold increased with latitude. The effective temperature sums required for both flowering and maturity increased with increasing mean annual temperature of the location, indicating that varieties are well adapted to given conditions. The responses of wheat and oats were largest for the period from flowering to maturity. Changes in timing of cereal phenology by 2040 were assessed for two climate model projections according to the observed dependencies on temperature and day length. The results showed advancements of sowing date of spring cereals by 1-3 weeks depending on climate model and region within Europe. The changes were largest in Northern Europe. Timing of flowering and maturity were projected to advance by 1-3 weeks. The changes were largest for grain maize and smallest for winter wheat, and they were generally largest in the western and northern part of the domain. There were considerable differences in predicted timing of sowing, flowering and maturity between the two climate model projections applied.

Shifts in comparative advantages for maize, oat and wheat cropping under climate change in Europe.

Climate change is anticipated to affect European agriculture, including the risk of emerging or re-emerging feed and food hazards. Indirectly, climate change may influence such hazards (e.g. the occurrence of mycotoxins) due to geographic shifts in the distribution of major cereal cropping systems and the consequences this may have for crop rotations. This paper analyses the impact of climate on cropping shares of maize, oat and wheat on a 50-km square grid across Europe (45-65°N) and provides model-based estimates of the changes in cropping shares in response to changes in temperature and precipitation as projected for the time period around 2040 by two regional climate models (RCM) with a moderate and a strong climate change signal, respectively. The projected cropping shares are based on the output from the two RCMs and on algorithms derived for the relation between meteorological data and observed cropping shares of maize, oat and wheat. The observed cropping shares show a south-to-north gradient, where maize had its maximum at 45-55°N, oat had its maximum at 55-65°N, and wheat was more evenly distributed along the latitudes in Europe. Under the projected climate changes, there was a general increase in maize cropping shares, whereas for oat no areas showed distinct increases. For wheat, the projected changes indicated a tendency towards higher cropping shares in the northern parts and lower cropping shares in the southern parts of the study area. The present modelling approach represents a simplification of factors determining the distribution of cereal crops, and also some uncertainties in the data basis were apparent. A promising way of future model improvement could be through a systematic analysis and inclusion of other variables, such as key soil properties and socio-economic conditions, influencing the comparative advantages of specific crops.

Effect of age on the association between body fat percentage and maximal walking speed.

OBJECTIVE: To study the effect of age on the association between body fat percentage and maximal walking speed in older people. DESIGN AND PARTICIPANTS: Cross-sectional analysis of data collected in the Finnish population-based Health 2000 Survey involving 916 men and 1 222 women aged 55 years and older with complete data on body composition and a walking speed test. METHODS: Body fat percentage was assessed using bioelectrical impedance analysis and maximal walking speed based on a timed walking test over a distance of 6.1 meters. Linear regression models were used to study the effect of age on association between body fat percentage and maximal walking speed. RESULTS: The association between body fat percentage quartiles and maximal walking speed differed significantly between persons of different ages (p for age interaction = 0.027). In the age-stratified analyses, the association between body fat percentage and maximal walking speed remained significant among 60-69-year olds and 70-79-year-olds, but disappeared among 55-59-year-olds and 80-year and older after adjustment for potential covariates. Body fat percentage explained 11% of the variation in maximal walking speed among 55-59-year-olds, 21% among 60-69-year-olds, 17% among 70-79-year-olds and 11% among 80-year and older. CONCLUSION: Association between body fat percentage and maximal walking speed was strongest between the ages of 60 and 79 years. The results suggest that the effects of excess body fatness are especially harmful for physical functioning among adults in their sixties and seventies and they could benefit from interventions.

Postural balance in a random sample of 7,979 subjects aged 30 years and over.

BACKGROUND: Reliable normative data for force platform measurements of postural balance have not been available. METHODS: Data on postural balance were collected from a representative nationwide sample of a Finnish population aged >or=30 years (n = 7,979). As part of a comprehensive health survey (Health 2000), postural balance was measured with the help of a force platform system in four test conditions: normal standing with eyes open and closed (both for 30 s), semi-tandem (20 s) and tandem stand with eyes open (20 s). In addition, balance abilities were also evaluated by a non-instrumented field test. RESULTS: The main findings of this study indicated that the differences in balance between subjects belonging to different age categories were apparent already among young and middle-aged subjects. This is true, however, only for the more accurate force platform measurements, as the field test showed a clear ceiling effect up to 60 years of age. At higher ages both methods indicated a further, accelerating decline in balance function. In most cases, males tended to have more pronounced sway, as indicated by the speed and amplitude aspects of the movement of the center of pressure during the force platform registrations and these differences were larger in the older age groups. In contrast, in the field test a larger proportion of males were able to achieve the highest category (10 s in tandem stand) and the proportion of subjects unable to stand for a minimum of 10 s feet side by side was larger among females than males. These observations may partly be due to differences in the participation/acceptable performance in the different tests. In addition, the field test and force platform measurements may partially reflect different aspects of balance abilities. CONCLUSION: The results of the present study provide normative values for force platform balance tests at an age of 30 years and above. Deterioration in balance function clearly starts at relatively young ages and further accelerates from at about 60 years upwards. Due to systematic differences between males and females, separate normative values for both sexes are needed. Due to marked ceiling effects the field test can only be recommended for older individuals, aged >/=60. On the other hand, force platform registrations in the more demanding tests (semi-tandem and tandem stands) suffer from floor effects in the oldest age groups.

Shoulder joint impairment among Finns aged 30 years or over: prevalence, risk factors and co-morbidity.

OBJECTIVES: To describe the prevalence, risk factors and consequences of shoulder joint impairment in the population. METHODS: A representative sample (n = 7217) of the Finnish population aged > or = 30 yr participated in a health examination survey (the Mini-Finland Health Survey). The design of the survey allowed an independent assessment of disability, reported shoulder pain, shoulder joint impairment and major chronic co-morbidity. RESULTS: Shoulder impairment was observed in 8.8%, while pain was reported by 30%. The prevalence of shoulder pain decreased among the elderly, whereas impairments increased up to 20% of those aged 75-80 yr. In addition to age, sex, previous injury to the shoulder joint and a history of physically heavy work, diabetes was associated with shoulder impairment (OR 1.6, 95% CI 1.2-2.1). Shoulder impairment was associated with disability (adjusted OR 2.0, CI 1.6-2.5). CONCLUSIONS: Shoulder impairment is an important component of ill health among the elderly, and cannot be reduced to reported pain alone.

Abdominal wall competence after free transverse rectus abdominis musculocutaneous flap harvest: a prospective study.

A prospective study was designed to evaluate the possible changes in abdominal wall strength following free transverse rectus abdominis musculocutaneous (TRAM) flap surgery for breast reconstruction. Twenty-two patients were examined 1 day before surgery, and at 3, 6, and 12 months postoperatively. Trunk muscle strength was measured by the same physiotherapist using an isokinetic dynamometer (Lido Multi Joint II, Loredan Biomedical Inc., Davies, CA). The peak torque and average torque for both flexion and extension at 60 degrees per second angular velocity were recorded from the curves obtained. There was a significant reduction in trunk flexion strength at 3 months postoperatively (peak torque mean, 92% of the preoperative value; p = 0.04), but this was corrected by 6 months (mean, 96%), and improved to 98% by 12 months. The patient's ability to do curled trunk sit-ups was evaluated by the same physiotherapist and graded on a scale from 1 to 6. In 9 of 19 patients the operation had no effect on sit-up performance during follow-up. In 10 of 19 patients there was a reduction of one or two grades at 3 months that did not improve by 12 months. Magnetic resonance imaging of the abdominal wall was performed on 9 patients. The mean area of the upper third of both rectus muscles was measured on the axial images. At 3 months postoperatively the mean area of the upper third of the donor muscle was significantly larger than the contralateral (p = 0.03). There was no difference in size at 6 months, and by 12 months the donor side was smaller. This prospective study shows that harvesting of a free TRAM flap can cause a subclinical reduction in abdominal strength, although this was not noticed by the patients themselves.

Comparison of trunk strength measurements between two different isokinetic devices used at clinical settings.

Intradevice reliability of isokinetic trunk strength measurements has been studied frequently, but no evidence is available on interdevice reliability. This motivated the present study, in which two isokinetic devices, the Ariel 5000 and Lido Multi-Joint II, were compared in a sample of 41 subjects (20 healthy and 21 low back pain subjects). The measurements were made in a random order with both machines. The results showed that the two isokinetic machines gave quite different results in trunk flexion-extension strength measurements. A statistically significant difference was present in the average peak torques between the two devices, with the exception of flexion at low angular velocity (60 degrees/s), and the correlations between the two measurements were low. The results were assumed to be more of a reflection of the interdevice variations (hardware and software, attachment of the subject) than of learning effects or other phenomena. We conclude that isokinetic trunk-muscle strength test results with the Ariel and Lido are device specific, and one cannot automatically compare results obtained from different devices with each other.

Isokinetic performance capacity of trunk muscles. Part I: The effect of repetition on measurement of isokinetic performance capacity of trunk muscles among healthy controls and two different groups of low-back pain patients.

The aim of this investigation was to assess the reproducibility of the isokinetic trunk muscle performance measurement among patients with different degrees of low-back pain. Twenty-two healthy volunteers, 20 patients with mild and 18 patients with severe low-back pain participated in isokinetic measurements. Lidoback isokinetic dynamometer was used. The measurements were performed with the subjects standing, using velocities of 60, 90 and 120 degrees/second. Five repetitions were performed at each velocity. All subjects were tested three times with a 1-week interval between the tests. Peak torque, average peak torque, coefficient of variation, total work done and peak torque to body weight ratio were calculated for each velocity for both flexion and extension. The results showed that in every measurement peak torque, average peak torque, peak torque to body weight ratio and total work done correlated with each other very strongly both in flexion and extension (r > or = 0.9). The average peak torques increased in further measurements. The change had a strong correlation with the severity of the back problem, which was evaluated by means of the Oswestry disability index. The critical value was found to be 20% in the Oswestry index: values above this meant big changes between measurements and values below this meant small changes between measurements.

Sequelae in the abdominal wall after pedicled or free TRAM flap surgery.

Twenty-seven free transverse rectus abdominis musculocutaneous (TRAM) and 16 pedicled TRAM flap breast reconstruction patients were studied for 7 to 41 months (mean, 23 months) postoperatively to compare abdominal sequelae after these two operations. The patient groups were demographically similar; mean age was 47 years in both groups. Subjective grading of the results was similar in both groups. The incidence of minor lower abdominal bulges was higher (44%, 7/16) in the pedicled group than in the free TRAM flap group (4%, 1/27). No hernias were found. Delayed healing of the abdominal scar occurred in 3 free TRAM flap and 1 pedicled TRAM flap patients. Two free TRAM flap (8%) and 7 pedicled TRAM (44%) flap patients had minor edge necrosis of the breast. Trunk strength was tested using an isokinetic device (Lido Multi Joint II), and peak torque for flexion (mean, 111 Nm +/- 25 Nm in the free TRAM flap group and 123 Nm +/- 28 Nm in the pedicled TRAM flap group) and extension (mean, 144 Nm +/- 38 Nm and 167 Nm +/- 45 Nm) were measured. No statistical differences occurred between these groups. Sit-up performance was tested and graded from 1 to 6. Both groups performed equally (4.8 and 4.8) and within normal values for this age group. Ultrasonography of the rectus muscles revealed that in the free TRAM flap group, the rectus muscle of the operated side was significantly thinner (cranial segment 6.8 mm vs. 7.8 mm, p < 0.05), thus the harvesting of a segment of muscle below the umbilicus seems to disturb the quality of the entire muscle. The mean size of the muscular defect in the free TRAM flap group was 4.3 x 6.1 cm. In this study no differences in patient satisfaction or trunk strength could be found between free and pedicled TRAM flap patients.

Caries experience and treatment need among adults responding to an invitation for dental examination and treatment in two Karelian communities in Russia.

This study was planned and conducted by the Health Authorities of Karelia in the Russian Federation and the Faculty of Dentistry, University of Kuopio, Finland. The aim of the study was to analyze caries experience and treatment need among adults who responded to an invitation for dental examination and offered free dental treatment in two communities in Karelia. A total of 227 adults aged 30-72 years from 2 rural communities were examined clinically in accordance with WHO criteria by a team of Finnish dental specialists. The participants represented two major ethnic groups (Fenno-Ugrians, 68%; Slavs, 32%). The mean DMFT and DMFS were 15.8 and 58.8, respectively. Among dentate subjects (n = 225) 88% had at least one carious tooth and 80% had one or more filled or crowned teeth. Altogether, 34% of the subjects needed extraction(s), and 83% needed restorative treatment. The main finding of the study was that with regard to caries experience, oral health was quite good compared with that found in Finland and the UK.

Distribution of all-trans-retinoic acid in normal and vitamin A deficient mice: correlation to retinoic acid receptors in different tissues of normal mice.

The distribution of all-trans-retinoic acid (RA) was investigated using whole-body autoradiography of normal and partial vitamin A deficient (VAD) mice. Retinoic acid receptors (alpha, beta, and gamma) were also studied in normal mice using immunoblotting. Normal and VAD mice were injected with 5 muCi 14C RA. The distribution of RA was quantitatively studied using a computer-assisted image analysis system. 14C RA was incorporated 0.5 hr after RA administration in both normal and VAD mice, while the labelling peak was at 6 hr in most organs in normal and VAD mice. The most intense labeling was found in liver, kidney, intestine, lung, Harderian gland, and salivary gland at all time points. A band of M(r) 51K was found in all mouse tissues by immunoblotting using the polyclonal antibody RAR82 against total RARs or the RAR alpha-specific monoclonal antibody R alpha 13. In some tissue, an additional band of 55-58K was also found. Lung, large intestine, small intestine, testis, seminal vesicle, and spleen contained highest concentration of total RARs, while heart, lung, small intestine, spleen, salivary gland, and preputial gland had the highest concentration of RAR alpha. The uptake of labeled RA correlated well with RAR or RAR alpha concentration in the corresponding tissues.

Distribution of L-tryptophan in normal and glucose - loaded mice.

L-tryptophan is an essential amino acid in food, but is also widely used as a drug on the basis of several physiological actions. Lately, tryptophan's uses as a drug and as a food supplement have been discontinued in several countries due to its severe side-effects.In the present study, the distribution of tryptophan in mice was studied with special attention on the target organs, where the drug has been shown to have pathological or physiological effects.The results showed that several organs took up tryptophan and that glucose loading increased the accumulation. An interesting finding was that the highest concentration of tryptophan was found in the pancreas. The hypophysis and adrenal glands were also sites of accumulation. Within the brain the highest accumulation was found in the cerebrum. High concentrations were also seen in the gastrointestinal tract and bone marrow.The connection between the accumulation of tryptophan and its normal and pathophysiological effects is discussed.

Isokinetic and non-dynamometric tests in low back pain patients related to pain and disability index.

STUDY DESIGN: This study compared isokinetic and non-dynamometric tests for their correlation with subjective low back pain symptoms. METHODS: A total of 185 patients with chronic low back pain were examined. RESULTS: The repetitive arch-up and sit-up tests correlated significantly with pain and disability (Million index) both in men and women (r ranged from -0.39 to -0.46; P < 0.001). In women, the isokinetic trunk flexion and extension tests and the non-dynamometric tests correlated equally well with the Million index. In men, the isokinetic flexion and extension tests had weaker correlations. Overall, the isokinetic lifting tests showed lower correlations than did the isokinetic trunk extension tests. In the isokinetic flexion and extension tests, fast testing speeds (120 degrees/sec and 150 degrees/sec) correlated somewhat better with the subjective symptoms than did the lowest speed (30 degrees/sec). CONCLUSIONS: The non-dynamometric tests are still useful in clinical practice in spite of the development of more accurate muscle strength evaluation methods.

Epstein-Barr virus (EBV) genomes and c-myc oncogene in oral Burkitt's lymphomas.

In addition to Burkitt's lymphomas, tentative evidence suggests the involvement of Epstein-Barr virus (EBV) in malignant lymphomas of T-cell origin. The c-myc proto-oncogene is strongly associated with the development of lymphoid neoplasias. In the present study, a series of 38 biopsies of oral lymphomas (29 Burkitt's lymphomas, 9 malignant lymphomas of other type) obtained from patients in Tanzania were studied using in situ hybridization (ISH) and polymerase chain reaction (PCR) for detection of EBV DNA and c-myc oncogene. In ISH applied on formalin-fixed, paraffin wax-embedded biopsies, the Bam HI W fragment of EBV DNA was used as the probe. Amplification of c-myc oncogene was studied by PCR with a primer set from Exon II area. As an internal standard beta-globin gene was simultaneously amplified. EBV DNA was disclosed by ISH in five Burkitt's lymphomas only. Using the PCR, 20 of the 29 cases (70%) of Burkitt's lymphomas showed amplification for EBV DNA. Of the other EBV-positive lymphomas, two were of the lymphocytic type (large non-cleaved cell), one histiocytic and one Burkitt's-like lymphoma. All EBV-positive cases found on the agarose gel were positive also with the dot blot, when hybridized with the 32P-labeled EBV Bam HI W-fragment probe. All lymphomas showed similar bands on the gel for c-myc and beta-globin indicating that no amplification of c-myc was present.

A quantitative method for measuring labeled compounds with whole-body autoradiography in tissue sections.

Whole-body autoradiography is an effective method for localizing labeled compounds in various organs. However, the technique is limited in its ability to quantify such material. Using tissue sections, this study investigated certain parameters involved in the quantitative estimation of labeled compounds by whole-body autoradiography. These included correlation between thickness of the section and radioactivity counted, the precision of such measurements, and the reproducibility of the autoradiographic films as tested by image analysis transmission. The precision of radioactivity measurements using tapes with a tissue section or a "punch biopsy" (punching off a piece of tissue from the section) was compared. The results revealed excellent linearity between the thickness of the section and the radioactivity counted (r = 0.97) when section thickness was 10-30 microns. The measurement precision using tapes was better than with the "punch specimen" method. The reproducibility of photographic films was good when transmission was measured by image analysis. It was concluded that a thickness of 30 micron is ideal for use in whole-body autoradiographic studies. It appeared that radioactivity measurement of tissue sections on tapes was superior to direct measurement from organs. Image analysis was employed and statistically evaluated for the first time in this study, and the promising findings suggest that it is likely to become the method of choice for future studies of this type.

Dento-facial morphology and caries experience: an epidemiological study.

The aim of this study was to analyze the association between occurrence of enamel focal demineralization (EFD) lesions and caries on the smooth surfaces of permanent teeth and some parameters concerning dentofacial morphology in different age groups of Finnish children. Altogether 587 children aged 7, 9 and 12 years living in Helsinki and Kuopio, Finland were examined clinically and some parameters of dento-facial morphology were measured. Of the dento-facial morphological parameters, the size of the gonial angle seemed to be associated with caries indicators. The possible predictive value of dento-facial morphology for caries should be confirmed by longitudinal study.

Positive identification of victims by comparison of ante-mortem and post-mortem dental radiographs.

Radiography of jaws and teeth can provide one of the most reliable sources of information for comparison between ante-mortem and post-mortem conditions leading to definitive evidence in cases of identification. Teeth and dental restorations are resistant to destruction by fire and are therefore very important in identification. The forensic odontologist utilizes dental radiographs taken of the victim before death and compares them to dental data from the remains to assist the identification. Three cases described in this paper illustrate the procedures and techniques of identification using ante-mortem and post-mortem radiographs.

Comparison of effects of nicotinic acid or tryptophan on tryptophan 2,3-dioxygenase in acute and chronic studies.

Tryptophan is one of the strongest activators of tryptophan 2,3-dioxygenase, the rate-limiting enzyme in the pathway which degrades tryptophan. One of the metabolites thus formed is nicotinic acid, widely administered as a drug--often at high doses--and a vitamin. This study determined whether nicotinic acid also has a potency to activate tryptophan 2,3-dioxygenase and, if so, by what mechanism, whether changes in plasma tryptophan result, and if such activation is permanent. The results showed that nicotinic acid activated the enzyme almost as strongly as tryptophan. The results confirmed the activation to be of the "substrate" type, i.e., at least partly due to increased tryptophan concentrations in the liver. In repeated nicotinic acid administration plasma tryptophan levels did not diminish, despite the high activation of tryptophan 2,3-dioxygenase (high flux of tryptophan through the kynurenine pathway). However, the activation disappeared after 11 days of treatment. The powerful and sustained activation of tryptophan 2,3-dioxygenase by nicotinic acid may at least partly explain some of its side effects, such as glucose intolerance. However, mental disturbance as a side effect of diminished brain levels of tryptophan is not supported by these findings.

Postmortem pink teeth phenomenon: an experimental study and a survey of the literature.

The appearance of pink teeth after death is a phenomenon long familiar to forensic dentists. Although the application of modern techniques has shed some light on its aetiology, elucidation of the ultimate mechanism underlying the phenomenon is still awaited. In this paper, previous literature on the subject is surveyed, and an experimental approach under standardized conditions to allow analysis of possible causes and biological mechanisms of the pink-teeth phenomenon in rats is described. The experimental results were consistent with most previous observations. It seems probable that colouration of the teeth would be found in those regions of the jaws where the blood is seeking on the basis of gravitation hypostasis. The primary red colouration is most likely due to haemoglobin derivatives within the necrotic pulp tissue in cases in which blood has accumulated in the head and the dependent lividity (hypostasis) is obstructed. The authors discuss the likely causes for the development of the pink teeth phenomenon. It seems that this phenomenon is more dependent on physical than chemical factors after death.