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Two novel nitrogen-rich green energetic compounds were synthesized for the first time from readily available and cost-effective pyrazine starting materials. All newly synthesized molecules were comprehensively characterized, including infrared spectroscopy, nuclear magnetic resonance, elemental analysis, mass spectrometry, and thermogravimetric analysis-differential scanning calorimetry. All compounds have additionally been validated by single-crystal X-ray diffraction analysis. The physicochemical properties of compounds 2, 4, and 5 were thoroughly investigated. Notably, all compounds exhibit remarkable performance, such as a high density (>1.84 g cm-3), excellent detonation properties (VOD > 8582 m s-1, and DP > 31.3 GPa), outstanding thermostability (>205 °C), and high insensitivity (IS > 35 J, and FS = 360 N). These attributes are quite comparable to those of secondary benchmark explosives such as TATB, RDX, LLM-105, and FOX-7. This tuned performance evidences that the incorporation of hydrazine, nitro, and aminotetrazole into the pyrazine framework fosters robust nonbonded interactions, ultimately enhancing thermal stability and reducing sensitivity. The findings of this study not only signify that compounds 2 and 5 have excellent detonation properties and stability but also prove that the strategy of replacing amino groups with hydrazine and aminotetrazole is a practical means of developing new insensitive energetic materials.
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OBJECTIVES: Lumbar spine surgery is a common procedure for treating disabling spine-related pain. In recent decades, both the number and cost of spine surgeries have increased despite technological advances and modification in surgical technique. For those patients that have continued uncontrolled back and/or lower extremity pain following lumbar spine surgery, spinal cord stimulation (SCS) has emerged as a viable treatment option. However, the impact of lumbar spine surgical history remains largely unstudied. Specifically, the current study considers the impact of number of prior lumbar spine surgeries on pain relief outcomes following SCS implantation. MATERIALS AND METHODS: We queried the electronic medical record of five separate pain practices for all patients who have undergone a SCS implant between January 1, 2017, and March 1, 2020. Inclusion criteria consisted of any patients with an SCS implant who underwent a prior lumbar spine surgery. The primary outcome was the mean calculated percentage pain relief in patients based on number of prior lumbar spine surgeries. RESULTS: There was a total of 1974 total SCS implant cases identified across five separate pain clinics. There was no difference in mean calculated pain relief in patients with one prior spine surgery versus those with two or more prior spine surgeries (28.2% vs. 25.8%, adjusted ß-coefficient -3.1, 95% CI -8.9 to 2.7, p = 0.290). Similarly, when analyzing number of spine surgeries as a continuous variable, there was no association between number of spine surgeries and calculated pain relief (adjusted ß-coefficient -1.5, 95% CI -4.0 to 1.1, p = 0.257). Additionally, after patients were stratified based on waveform, there was no association between number of prior lumbar spine surgeries (analyzed both as a categorical and continuous variable) and calculated percentage pain relief. CONCLUSIONS: This multicentered retrospective study found that there was no significant difference in pain scores in individuals who received SCS following one or more lumbar spine surgeries. Additionally, the waveform of the SCS device had no statistically significant impact on post-operative pain scores following one or more lumbar spine surgeries.
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Inflammatory necrosis of the falciform ligament is an extremely rare cause of acute right upper quadrant pain. Due to overlapping symptoms with pathologies affecting the gall bladder and liver, this poses a diagnostic challenge with limited existing literature. Here, we report a case of a 62-year-old female patient presenting in the accident and emergency department with right upper quadrant pain. The patient underwent ultrasonography and revealed thickened and echogenic falciform ligament. Further, a computed tomography revealed swollen falciform ligament with associated fat stranding. The patient was kept under conservative management and improved over 2 weeks.
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High energetic 2-(1-hydroxy-2,2-dinitrovinyl)guanidine and guanidinium dinitromethanide (GDNM) salt were synthesized in one and two steps using a simple and cost-effective methodology from commercially available inexpensive starting materials with a high yield. NMR, IR spectroscopy, elemental analysis, and differential scanning calorimetry studies were used to characterize compound 2a and GDNM salt. Single-crystal XRD, Hirshfeld surface analysis, and SEM analysis were used to study the crystal structure, hydrogen-bonding/noncovalent interactions, and morphology of the GDNM salt, respectively. The physicochemical and energetic properties of compound 2a and GDNM salt reveal their good energetic performance, specific impulse, and high mechanical insensitivity, which are better than that of propellants such as ADN and AP and close to that of the benchmark explosives such as RDX and FOX-7.
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INTRODUCTION: Lumbar spinal stenosis affects more than 200,000 adults in the United States, resulting in approximately 38,000 operations among the Medicare population and greater than $1.5 billion in hospital bills alone. Fortunately, Minimally Invasive Lumbar Decompression (MILD) and the Superion Indirect Decompression System have shown lasting benefit and cost savings compared to more aggressive surgical options. OBJECTIVE: Our primary objective was to retrospectively determine the rate of lumbar decompression surgery following the MILD and Superion procedures. MATERIALS AND METHODS: This was a pooled retrospective review of LSS patients who received MILD and/or Superion procedures between January 2011 and July 2019. Adult patients with CPT codes for MILD and Superion procedures were identified. Patients were included if they had a follow-up visit at least 2 years from the procedure date, preprocedural MRI results, and surgical notes. RESULTS: A total of 199 patients were included in the final analysis, of which 57 patients (28.6%) underwent MILD procedure only, 124 patients (62.3%) underwent Superion only, and 18 patients (9.0%) underwent an MILD procedure initially followed by a Superion procedure. Two patients had an MILD procedure performed twice at the same level at separate encounters. A total of four patients in the entire cohort (2.0%; MILD 5.3%, Superion 0.8%) underwent subsequent lumbar spine surgery when followed for at least 2 years. It is notable that some of these patients may not have been surgical candidates and this may have skewed the results. CONCLUSIONS: Patients undergoing minimally invasive decompression treatment of lumbar spinal stenosis have low rates of subsequent open surgery which potentially results in cost savings and a reduction in severe adverse events. The reason for low surgical rate may reflect improvement in their symptoms, a preference to avoid surgery, or being deemed not a surgical candidate.
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Estenose Espinal , Adulto , Descompressão Cirúrgica/métodos , Humanos , Incidência , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Estenose Espinal/cirurgia , Resultado do TratamentoRESUMO
SARS CoV -2 infection is rapidly evolving as a serious global pandemic. The present study describes the clinical characteristics of SARS CoV-2 infection patients. The Samples were subjected to RT - PCR or Rapid Antigen test for diagnosis of SARS CoV- 2. A cohort of 3745 patients with confirmed diagnosis of SARS CoV -2 infection in a tertiary care center in New Delhi, India were included in this study. Data was collected from offline and online medical records over a period of six months. Amongst 3745 SARS CoV -2 infected patients, 2245 (60%) were symptomatic and 1500 (40%) were asymptomatic. Most common presenting symptom was cough (49.3%) followed febrile episodes (47.1%), breathlessness (42.7%) and sore throat (35.1%). Cough along with breathlessness (24.1) was the most common combination of symptoms followed by fever with cough (22.7). The most common comorbidity found among symptomatic group was diabetes (42.5%) followed by hypertension (21.4%) and chronic kidney disease (18%). Comorbidities like diabetes mellitus, chronic diseases of lungs, heart and kidneys were found to be common in symptomatic group and this was found to be statistically significant (p<0.05). COVID-19 is an evolving disease and data from our study help in understanding the clinic-epidemiological profile of patients. This article is protected by copyright. All rights reserved.
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INTRODUCTION: Dorsal root ganglion (DRG) stimulation is an effective treatment option for lower extremity complex regional pain syndrome and other focal pain conditions. However, the patient characteristics that may predict long-term outcomes have not been defined. MATERIALS AND METHODS: This was a retrospective observational study that included 93 patients who were implanted with a DRG stimulator at a single private practice institution. A variety of demographic data was collected. Follow-up results were reviewed from multiple time points more than 12 months. Patients were classified as either "responder" or "nonresponder" status using two different thresholds, "greater than or equal to 50% pain relief" and "greater than or equal to 80% pain relief." RESULTS: A history of prior chronic opioid use was associated with significantly lower rates of responder status based on both a 50% pain relief threshold and 80% pain relief threshold at the one week to one month, three months, and 12-months visits. CONCLUSIONS: This single-center retrospective study found patients prescribed chronic opioids at the time of DRG stimulator implantation had a higher likelihood of less than 50% pain relief and 80% pain relief at one month, three months, and 12 months follow-up visits.
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Síndromes da Dor Regional Complexa , Estimulação da Medula Espinal , Gânglios Espinais , Humanos , Manejo da Dor , Estudos RetrospectivosRESUMO
BACKGROUND: Low back pain is the leading cause of years lost to disability worldwide. Approximately 15% to 45% of chronic low back pain is due to facet joint arthropathy. Currently, no large-scale retrospective studies have investigated long-term clinical predictors of success in individuals receiving radiofrequency ablation (RFA) of the medial branches for facet joint arthropathy. OBJECTIVE: To determine the clinical factors associated with success and failure of RFA of lumbar facet joints at 1-year follow-up. METHODS: Clinical data were gathered from 500 consecutive patients with an International Classification of Diseases (ICD)-10 diagnosis of lumbar spondylosis. VAS pain scores for patients undergoing lumbar medial branch RFA procedures were recorded at multiple time points, up to the 1-year follow-up visit. A responder was defined as having ≥30% improvement in VAS score from the pre-procedural VAS score. For our primary analysis, regression analysis was conducted to identify associations between responder status and patient characteristics, including age, gender, body mass index (BMI), hormone use, opiate dose, and smoking history at multiple time points, up to the 1-year follow-up visit. RESULTS: A total of 500 patients were included in the study. At the 1-year post-RFA follow-up visit, responder status was associated with a lower rate of prior opioid use (43.22% vs. 55.76%, odds ratio 0.60 [95% confidence interval (CI) 0.40 to 0.92], P = 0.018), lower pre-procedural opioid consumption in oral morphine equivalents (10.16 ± 16.02 vs. 14.67 ± 20.65, ß -4.50 [95% CI -8.57 to -0.44], P = 0.030), and a higher pre-VAS pain score (6.36 ± 2.17 vs. 5.85 ± 2.17, ß 0.50 [95% CI 0.06 to 0.95], P = 0.028). There were no significant associations between responder status and age, gender, BMI, hormone use, and smoking history at the 1-year follow-up visit. CONCLUSIONS: Our results suggest that patients prescribed opioids, particularly at higher dosages, may find less pain relief 1 year following RFA for facetogenic pain. Additionally, patients with higher pre-procedural VAS pain scores may be more likely to have a positive response at 1 year.
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Dor Lombar/cirurgia , Manejo da Dor/métodos , Ablação por Radiofrequência/métodos , Articulação Zigapofisária/cirurgia , Humanos , Região Lombossacral , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Espondilose/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Dorsal root ganglion stimulation (DRG-S) is a neuromodulation technique introduced in the last decade with evolving implant methods. Initial prospective research found low incidences of lead migration and lead fracture with DRG-S. However, several recent studies have highlighted high lead migration and lead fracture rates with DRG-S. We investigated the influence of lead anchoring on migrations and fractures. METHODS: We performed a retrospective review between 2016 and 2020 of individuals implanted with DRG-S leads by 4 experienced implanters. The implanters independently changed their standard practice regarding lead anchoring over time, with opposing trends (no anchoring > anchoring, anchoring > no anchoring). We compared lead migration and lead fracture rates between anchored and unanchored DRG-S leads in the entire study cohort. Cox regression was performed on lead migration and fracture distributions. RESULTS: We included 756 leads (n = 565 anchored and n = 191 unanchored) from 249 patients. In unanchored leads, migration occurred in 16 leads (8.4%) from 13 patients (21.0%). In anchored leads, migration occurred in 8 leads (1.4%) from 5 patients (2.7%). Fracture in unanchored leads occurred in 6 leads (3.1%) from 6 patients (9.7%). Fractures in anchored leads occurred in 11 leads (1.9%) from 9 patients (4.8%). The migration survival distributions for the anchored and unanchored leads were statistically significantly different (p < 0.01) with decreased survival for unanchored leads (hazard ratio = 5.8, 95% confidence interval [CI] = 2.2-15.5). DISCUSSION: We found that anchoring DRG-S leads significantly reduces lead migration when compared to leads placed without an anchor. There was no significant difference in fracture rate between anchored and unanchored leads.
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Gânglios Espinais , Estimulação da Medula Espinal , Análise de Dados , Humanos , Estudos Prospectivos , Estudos RetrospectivosRESUMO
We demonstrate a new form of capillary force experienced by neutrally buoyant spherical particles adsorbed simultaneously at both interfaces of a thin liquid film of spatially varying thickness. The force is proportional to the slope of the interface and the difference between the local contact angle and the equilibrium value, and exists even when the two bounding interfaces have zero curvature. We derive the expression for the force, which when balanced against the hydrodynamic drag gives the trajectory of the particle. The measured trajectories for spherical particles of varying diameters in thin films compare well with predictions.
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AIMS: To investigate Ki-67 index with regard to its ability to predict achievement of pathologic complete response (pCR) to neoadjuvant chemotherapy (NACT) in breast cancer patient. MATERIAL AND METHODS: It was a prospective observational study, conducted in Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Center (RGCIRC), New Delhi from February 2014 to March 2016. A total of 134 patients with Stage II/III breast cancer who underwent NACT followed by surgery at our center were enrolled and analyzed. Before starting the treatment, clinical, tumor-related and treatment-related factors were recorded. Response evaluation was done clinically and radiologically after completion of NACT and pathologically on the surgical specimen. We calculated Ki-67 cut-off of 35% to label it as high by area under Receiver operating characteristic curve analysis for prediction of pCR. RESULTS: Clinical complete response (cCR) was observed in 35/134 (26.1%) patients while pCR was observed in 32/134 (23.9%) patients. On univariate analysis, higher grade (III), high Ki-67 index (>35%) and number of chemotherapy cycles (>3) were associated with better CCR rates. On multivariate analysis, number of chemotherapy cycles (>3) and high Ki-67 index (>35%) were independent predictive factors. For the predictive factors of pCR, univariate analysis showed grade (III), estrogen receptor/progesterone receptor negativity, HER-2 positivity, number of chemotherapy cycles (>3), TNBC and high Ki-67 index (>35%) to be associated with higher pCR rates. On multivariate analysis, Ki-67 index >35% and HER-2 positivity were the only independent predictive factors of pCR. CONCLUSIONS: We suggest 35% as best cut-off for Ki-67 expression for predicting response to NACT and achievement of pCR. Validation of this cut-off is required in larger studies.
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Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Antígeno Ki-67/análise , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Curva ROC , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
Temperature excursion and exposure to sub-zero temperatures may reduce the potency of the freeze-sensitive vaccines. This study assessed temperature during vaccine transfers at various levels under the Universal Immunization Program. This cross-sectional study undertaken in 21 districts of three states of India - Bihar (n = 8), Kerala (n = 8), and Gujarat (n = 5). We documented temperature inside the cold boxes and vaccine carriers using LogTag-Trix8 data loggers. In total, 110 vaccine transportation episodes were observed; 55 inter-facility transfers and 55 outreach sessions. Sizable proportions of inter-facility (9% to 35%) and outreach vaccine transfers (18%) were exposed to sub-zero temperature. The proportions of exposure to temperature to >8°C were in the range of 0.8%-11.3% for inter-facility transfers and 2.3% for outreach sessions. The vaccines were exposed to freezing temperatures for significant durations during transportation across the cold chain. Rigorous monitoring of temperature integrity is essential to ensure the delivery of potent vaccines and to avoid vaccine failure.
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Programas de Imunização , Potência de Vacina , Vacinas , Estudos Transversais , Armazenamento de Medicamentos , Humanos , Programas de Imunização/métodos , Programas de Imunização/organização & administração , Índia , Refrigeração , Temperatura , Meios de TransporteAssuntos
Colestase , Anormalidades do Sistema Digestório , Neoplasias , Humanos , Vesícula Biliar , Ducto Cístico , Abdome , Colestase/etiologia , Colestase/cirurgiaRESUMO
We report a novel method for the fabrication of large area, free standing monolayer films of close-packed colloidal particles. The method involves creating a free-standing, wet film of colloidal dispersion containing mono-dispersed hard particles (such as polystyrene or silica) mixed with smaller and softer polymer particles. During drying, hard particles present in the free standing film arrange in a hexagonal close-packed structure in a monolayer while the softer particles fill the interstices, and deform and coalesce to produce a continuous matrix around the hard particles. The deformation of the soft particles dissipates the stress generated during drying thereby preventing rupture of the monolayer film. The method is facile and very general, applicable to a large variety of colloidal particles. The monolayer films exhibit strong iridescence indicating potential application in photonic devices.
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Genitofemoral neuralgia is a cause of neuropathic pain that is often debilitating in nature. It is characterized by chronic neuropathic groin pain that is localized along the distribution of the genitofemoral nerve. The symptoms include groin pain, paresthesias, and burning sensation spreading from the lower abdomen to the medial aspect of the thigh. It may present with scrotal pain in male, while females experience symptoms radiating to the labia majora and mons pubis. Genitofemoral neuropathy has been attributed to iatrogenic nerve injury occurring during inguinal and femoral herniorrhaphy, with cases developing after both open and laparoscopic techniques. Diagnosis of genitofemoral neuralgia can be challenging, due to the overlap in sensory distribution the nerve shares with the ilioinguinal and iliohypogastric nerve. Differential nerve blocks are recommended in effort to differentiate the nerves when patients present with lower abdominal and groin pain. Once a diagnosis has been made, there exist several treatment options for genitofemoral neuralgia ranging from medical management, non-invasive injections, and surgery. Literature has also brought light to radiofrequency ablation and cryoablation performed under ultrasound guidance as emerging treatments. The aim of the current article is to review the anatomy, diagnostic techniques, and treatment options for patients with genitofemoral neuralgia.
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Laparoscopia/efeitos adversos , Plexo Lombossacral/anatomia & histologia , Neuralgia/etiologia , Neuralgia/terapia , Dor Abdominal/etiologia , Ablação por Cateter , Criocirurgia , Denervação , Virilha/inervação , Herniorrafia/efeitos adversos , Humanos , Neuralgia/diagnósticoRESUMO
INTRODUCTION: This study was aimed at analyzing the need for routine use of frozen section analysis (FSA) before performing orthotopic neobladder (ONB) after radical cystectomy for carcinoma urinary bladder. MATERIALS AND METHODS: A total of 233 patients underwent radical cystectomy from January 2000 to June 2013. Of these, 151 (65.6%) patients were planned for ONB. In the initial 109 (72%) patients, FSA of urethral margin was performed, but, in the subsequent 42 (28%) patients, frozen section of urethral margin was not sent. Impact of hydroureteronephrosis, tumor size and location of tumor in relation to the bladder neck on the status of the urethral margin was analyzed. RESULTS: Only three of the 109 (2.7%) patients had a positive urethral margin. Two of them had ileal conduit and one, after negative re-resection, had ONB. Although none of the factors was found to be significant, all three patients with a positive urethral margin had growth at the bladder neck and died of cancer at a mean follow up of 29.33 ± 18.3 months, without urethral recurrence. Among the negative FSA (106), two patients had recurrence in the penile urethra. The mean follow-up was 46.3 ± 25.1 months. None of the patients without FSA (42) had urethral recurrence at the mean follow-up of 36 ± 9.3 months. Of the 28 patients who had their growth located at the bladder neck, three had positive FSA, while none with growth away from the bladder neck had positive FSA. CONCLUSION: Routine FSA of the urethra before performing ONB can be avoided in those patients where the tumor does not reach the bladder neck.
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Nanomaterials are at the leading edge of the rapidly developing field of nanotechnology. However the information regarding toxicity of these nanoparticles on humans and environment is still deficient. The present study investigated the toxic effects of three metal oxide nanoparticles, TiO2, ZnO and Al2O3 on mouse erythrocytes, brain and liver. Male mice were administered a single oral dose of 500 mg/kg of each nanoparticles for 21 consecutive days. The results suggest that exposure to these nano metallic particles produced a significant oxidative stress in erythrocyte, liver and brain as evident from enhanced levels of Reactive Oxygen Species (ROS) and altered antioxidant enzymes activities. A significant increase in dopamine and norepinephrine levels in brain cerebral cortex and increased brain oxidative stress suggest neurotoxic potential of these nanoparticles. Transmission electron microscopic (TEM) analysis indicated the presence of these nanoparticles inside the cytoplasm and nucleus. These changes were also supported by the inhibition of CuZnSOD and MnSOD, considered as important biomarkers of oxidative stress. The toxic effects produced by these nanoparticles were more pronounced in the case of zinc oxide, followed by aluminum oxide and titanium dioxide, respectively. The present results further suggest the involvement of oxidative stress as one of the main mechanisms involved in nanoparticles induced toxic manifestations.
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Óxido de Alumínio/toxicidade , Nanopartículas Metálicas/toxicidade , Titânio/toxicidade , Óxido de Zinco/toxicidade , Óxido de Alumínio/administração & dosagem , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/patologia , Eritrócitos/efeitos dos fármacos , Eritrócitos/patologia , Fígado/efeitos dos fármacos , Fígado/patologia , Masculino , Camundongos , Microscopia Eletrônica de Transmissão , Estresse Oxidativo/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Titânio/administração & dosagem , Óxido de Zinco/administração & dosagemRESUMO
2D metal halide perovskites (MHPs), mainly the studied Ruddlesden-Popper (RP) and Dion-Jacobson (DJ) phases, have gained enormous popularity as optoelectronic materials owing to their self-assembled multiple quantum well structures, tunable semiconducting properties, and improved structural stability compared to their bulk 3D counterparts. The performance of polycrystalline thin film devices is limited due to the formation of defects and trap states. However, as studied so far, single crystal-based devices can provide a better platform to improve device performance and investigate their fundamental properties more reliably. This Review provides the first comprehensive report on the emerging field of RP and DJ perovskite single crystals and their use in visible light photodetectors of varied device configurations. This Review structurally summarizes the 2D MHP single crystal growth methods and the parameters that control the crystal growth process. In addition, the characterization techniques used to investigate their crystal properties are discussed. The review further provides detailed insights into the working mechanisms as well as the operational performance of 2D MHP single crystal photodetector devices. In the end, to outline the present status and future directions, this Review provides a forward-looking perspective concerning the technical challenges and bottlenecks associated with the developing field of RP and DJ perovskite single crystals. Therefore, this timely review will provide a detailed overview of the fast-growing field of 2D MHP single crystal-based photodetectors as well as ignite new concepts for a wide range of applications including solar cells, photocatalysts, solar H2 production, neuromorphic bioelectronics, memory devices, etc.
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Heat-resistant explosives play a vital role in indispensable applications. For this, we have synthesized a novel, three-dimensional, solvent-free energetic metal-organic framework (EMOF) potassium 3,5-dinitro-6-oxo-1,6-dihydropyrazin-2-olate (KDNODP) straightforwardly. The synthesized EMOF was characterized through IR, NMR spectroscopy, elemental analysis, and differential scanning calorimetry studies. Furthermore, single-crystal X-ray diffraction provided a complete description of KDNODP. It exhibits a three-dimensional EMOF structure with remarkably balanced properties such as high density (2.11â g cm-3), excellent thermal stability (291 °C), good detonation performance (8127â m s-1 and 26.94â GPa) and low mechanical sensitivity (IS=35â J; FS=360â N) than the commonly used heat-resistant explosives HNS (density=1.74â g cm-3; VOD=7164â m s-1, DP=21.65â GPa, IS=5â J) as well as the similar reported energetic potassium MOFs. To gain insights into the packing and intermolecular interactions, the Hirshfeld surface and a 2D fingerprint analysis were examined. Additionally, scanning electron microscopy was used to investigate the particle size and morphological characteristics of KDNODP. These outcomes highlight a successful method for creating 3D EMOF based on a six-membered heterocycle as a potential heat-resistant energetic material.