Global Understanding Research Articles

Peirce Polymath

We present succinctly Peirce’s extremely diversified works in mathematics and logic, trying to underline both their differential specificities and their integral connections. As a result, the global understanding of Peirce as a polymath is also reflected in its local mathematical architecture.

Problems of the public good in higher education: building the common amid sovereign individualism, capital and the state

AbstractAnglophone societies in which the sovereign individual is primary vis and vis social relations, and policy focuses on economic competition and consumption in education, find it hard to grasp non-pecuniary outcomes in higher education. These include the self-formation of students as persons and collective goods like knowledge, technological capability, social inclusion, political connectedness, tolerance and global understanding. While other cultures generate insights into non-pecuniary outcomes, the paper focuses critically on meanings of ‘public’ in English: (1) public as state, (2) public good as universal well-being, (3) public as inclusive-communicative as in ‘public opinion’, (4) public and private goods in economics. None of these meanings of ‘public’ enables the resolution of the non-pecuniary outcomes of higher education. The paper tackles four central questions. First, why is there an undue emphasis on the individual and individualised pecuniary benefits, vis a vis social relations, in Euro-American and especially Anglophone societies? Second, can these societies strengthen public or common goods by augmenting the state in higher education? Third, what other practices of public and common might advance non-pecuniary outcomes? Fourth, how to advance collective outcomes beyond the nation-state? The paper finds that while Anglophone public good is constrained by the state in capitalist society, higher education’s role in the production and distribution of common good through primarily local networks, while also pressuring central states to provide support, offers a promising way forward.

Intercontinental Insights into Autism Spectrum Disorder: A Synthesis of Environmental Influences and DNA Methylation

Abstract Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder characterized by a broad range of symptoms. The etiology of ASD is thought to involve complex gene-environment interactions, which are crucial to understanding its various causes and symptoms. DNA methylation is an epigenetic mechanism that potentially links genetic predispositions to environmental factors in the development of ASD. This review provides a global perspective on ASD, focusing on how DNA methylation studies may reveal gene-environment interactions characteristic of specific geographical regions. It delves into the role of DNA methylation in influencing the causes and prevalence of ASD in regions where environmental influences vary significantly. We also address potential explanations for the high ASD prevalence in North America, considering lifestyle factors, environmental toxins, and diagnostic considerations. Asian and European studies offer insights into endocrine-disrupting compounds (EDC), persistent organic pollutants (POP), maternal smoking, and their associations with DNA methylation alterations in ASD. In areas with limited data on DNA methylation and ASD, such as Africa, Oceania, and South America, we discuss prevalent environmental factors based on epidemiological studies. Additionally, the review integrates global and country-specific prevalence data from various studies, providing a comprehensive picture of the variables influencing ASD diagnoses over region and year of assessment. This prevalence data, coupled with regional environmental variables and DNA methylation studies, provides a perspective on the complexities of ASD research. Integrating global prevalence data, we underscore the need for a comprehensive global understanding of ASD’s complex etiology. Expanded research into epigenetic mechanisms of ASD is needed, particularly in underrepresented populations and locations, to enhance biomarker development for diagnosis and intervention strategies for ASD that reflect the varied environmental and genetic landscapes worldwide.

Editorial: Break the stigma: autism. The future of research on autism stigma - towards multilevel, contextual & global understanding

Editorial: Break the stigma: autism. The future of research on autism stigma - towards multilevel, contextual & global understanding

Cross-Cultural Views on Contemporary Philippine Literature in English

This study explores cross-cultural views on contemporary Philippine literature in English, focusing on how foreign critics engage with and interpret Filipino literary works written in the postcolonial language of English. While Philippine literature in English has gained traction globally, varying interpretations among foreign critics reveal a unique reception shaped by differing cultural frameworks. However, a gap exists in fully understanding how these cross-cultural perspectives influence both the global visibility of Philippine literature and its local authenticity. This study aims to investigate this gap by analyzing the critical reception of contemporary works, where colonial and postcolonial identities are often discussed but less often reconciled. The research employs a qualitative content analysis method, drawing on secondary data from literary reviews, journal articles, and critiques from publications. The analysis reveals that while foreign critics often appreciate the political engagement and thematic depth of Philippine literature in English, they may overlook its cultural specificity, leading to a somewhat generalized perception. The study concludes that greater cultural sensitivity in criticism could enrich global understanding and appreciation of Philippine literature. It also recommends more collaboration between Filipino scholars and foreign critics to address these cross-cultural disconnects. The findings underscore the importance of critical discourse in enhancing the global literary standing of Philippine contemporary works.

Characterization of virus species associated with sweet potato virus disease in Costa Rica and riboprobe development for its rapid detection

AbstractSweet potato (Ipomoea batatas) is a crucial crop for food security and economic stability in many regions, including Costa Rica. This study aimed to assess the prevalence and genetic diversity of two major viruses associated with sweet potato virus disease (SPVD) in Costa Rica: sweet potato feathery mottle virus (SPFMV) and sweet potato chlorotic stunt virus (SPCSV). A total of 50 leaf samples displaying typical viral disease symptoms were collected from major sweet potato‐growing regions. Using multiplex reverse transcription (RT)‐PCR, SPFMV was detected in 82% of the samples and SPCSV in 52%, with a coinfection rate of 48%. Genetic analysis revealed that SPFMV isolates belonged predominantly to phylogenetic group B, while SPCSV isolates clustered with the West African (WA) strain. The low genetic diversity within these viral populations suggests a limited number of initial infection events followed by local spread. Riboprobe technology was evaluated as an alternative to RT‐PCR for virus detection. While the riboprobes for SPFMV demonstrated sensitivity comparable to RT‐PCR, the SPCSV riboprobes showed slightly lower sensitivity, particularly when using crude leaf extracts. Despite this, riboprobes offer significant advantages in terms of cost and ease of use for large‐scale screening. Our findings underscore the need for robust diagnostic and management strategies to control SPVD and highlight the importance of continuous monitoring and research to mitigate the impact of viral diseases on sweet potato production in Costa Rica. These insights contribute to the global understanding of SPVD and support collaborative efforts in plant pathology research.

BCBA: An IIoT encrypted traffic classifier based on a serial network model

With the rapid development of the Industrial Internet of Things (IIoT), ensuring the security and privacy of network traffic has become particularly important. Classifying and identifying encrypted traffic is a critical step in enhancing network security, but traditional traffic classification methods often struggle to handle the complexities of the IIoT environment. In this paper, we propose the BCBA model, a bidirectional encoder representation from transformers (BERT)-based serial network model, which significantly improves the encrypted traffic classification performance and can be trained more than four times faster than the original BERT classifier. The BCBA method obtains word vector representations from the embedding layer of the pretrained BERT model, uses convolutional neural networks (CNNs) to extract local features, employs bidirectional long short-term memory (BiLSTM) networks to capture temporal dependencies in traffic data, and leverages a multihead self-attention mechanism to improve global dependency understanding. In experiments on six types of regular encrypted traffic from the ISCXVPN2016 dataset, the BCBA model achieved an F1 score of 99.10%, outperforming traditional traffic classification techniques across multiple performance metrics. This study demonstrates the effectiveness of deep learning in enhancing the security of the IIoT. It also provides new perspectives and technical routes for future research, particularly in encrypted traffic processing and classification applications.

EEG frequency tagging reveals the integration of dissimilar observed actions

Extensive research has demonstrated that visual and motor cortices can simultaneously represent multiple observed actions. This ability undoubtedly constitutes a crucial ingredient for the understanding of complex visual scenes involving different agents. However, it is still unclear how these distinct representations are integrated into coherent and meaningful percepts. In line with studies of perceptual binding, we hypothesized that similar movements would be more easily integrated. To test this hypothesis, we developed an EEG frequency tagging experiment in which two hand movements were displayed simultaneously at two different presentation rates. Crucially, the degree of similarity between the two movements varied along two dimensions, namely action identity (i.e., same or different performed movement), and agent identity (i.e., one agent performing a bimanual movement, or two agents moving each one hand). Contrary to our predictions, we found a larger intermodulation oscillatory component, indexing the integrated processing of the two individual movements, when they were less similar. We propose that integration-by-dissimilarity might serve as a top-down process to solve conflict caused by incongruent movements, thus contributing to the global understanding of distinct moving individuals in a complex social scene.

Listening to children with lower limb loss: Rationale, design, and protocol for delivery of a novel globally applicable research toolkit-Prosthetic user needs, quality of life, pain, and physical function.

Rehabilitation after childhood lower limb loss is complex and dependent on multiple stakeholders and environmental factors. While research with adults underscores the importance of involving prosthetic limb users and caregivers in discussions to drive innovation, children are often excluded or not effectively engaged. This protocol lays out the development and implementation protocol for an internationally applicable research toolkit which has been designed and evaluated around the essential presence of the child. Research domains span their unique prosthetic needs, quality of life, pain, and mobility. Cohorts of children in contrasting environments were identified (Cambodia, Gaza Strip, and the UK) to provide a comprehensive global understanding of the child with lower limb loss. A literature review revealed a lack of appropriate tools for identifying paediatric prosthetic user requirements leading to the development of novel interview guides for each key stakeholder: child, caregiver, and prosthetist. The child's guide centred around enjoyment and engagement using card games and activities. A panel of experts in paediatric limb loss and mental health rigorously reviewed the guides. Guides were integrated with existing validated measures for quality of life, pain, and mobility to form a comprehensive toolkit. The toolkit was successfully piloted with 5 children, their families, and 2 prosthetists. This protocol lays out the toolkit rationale and implementation plan (Jan 2023 to Dec 2025). This work offers the opportunity for this cohort to enjoyably engage with research that seeks to radically improve prospects for all children living with limb loss. The outlined best practices ensure ethical considerations when working with vulnerable cohorts. This study is approved to cover implementation at all geographical locations as well as the researcher institutions. Results will be disseminated through national and international conferences, as well as through manuscripts in leading peer-reviewed journals.

Olympism through the Eyes of Coaches: Metaphorical Texture and Colors of Sport

This study aims to explore coaches' metaphorical perceptions of the concept of “Olympism.” The research sample consists of 170 coaches (86 male, 84 female) from various sports disciplines, working in both public and private organizations in Turkey during the 2023-2024 academic year. Data were collected using a “metaphor form,” where participants were prompted to complete the sentence: “Olympism is like ...; because …”. Content analysis was employed to examine the responses, leading to the development of categories and themes. The metaphors were organized into five categories, each comprising eleven themes. The most prominent category was ‘values of sport,’ followed by ‘abstract concepts and spiritual development’ and ‘universal values.’. The most frequent metaphors included life, Olympiad, summit, success, harmony, spirit, and sport. These findings indicate that coaches view sport as both a physical and a spiritual journey, emphasizing that Olympism supports athletes' personal and professional development. In the category of “Sport and Ethical Competition,” coaches highlighted that Olympism encompasses ethical values and social contributions in addition to achieving success. In the “Abstract Concepts and Spiritual Development” category, coaches described Olympism as a spiritual journey and a philosophy of life. Meanwhile, in the “Universal Values” category, they conveyed that sport serves as a means of fostering global unity and understanding. Overall, the study highlights that metaphors are an effective means of expressing the complex and multifaceted nature of Olympism.

Assessment of microplastic characterization and distribution from surface water and the seabed in the Flores Sea, Indonesia

Despite growing global concerns, there has been limited research on the characterization and distribution of microplastics in the Indonesian Throughflow (ITF) pathways, such as the Flores Sea. The Flores Sea is a component of the Indian–Pacific Current, a significant ocean current system that links the Pacific and Indian oceans and has the capacity to carry pollution over large marine ecosystems, making this research extremely important. Understanding the microplastic pollution in this area informs local environmental management. It provides insights into how these currents may distribute microplastics (MPs) across regional and global scales, impacting marine life and human health far beyond the immediate area. To respond to these concerns, this research aims to determine the characterization and distribution of MPs at six research sites in the Flores Sea that are precisely located within the ITF. This work exhibits an extensive dataset focusing on the occurrence, attributes, and dispersion of microplastics in the Flores Sea. The water sampling was carried out during a Jala Citra 3 by the Indonesian Navy from April to May 2023. Sea surface water samples were collected using a Neuston net, while sediment samples were taken from three stations at the shallowest depth using the Ekman Grab sampler. Additionally, abundance, size, shape, and color analyses were conducted using a light microscope, and microplastic types were identified through Raman spectroscopy. The results indicated that the Flores Sea waters and sediment are polluted with microplastics, with relative abundances ranging from 0.75 ± 0.49 to 2.13 ± 0.25 items/l samples. The most dominant shapes identified were filament (77.45%) and fragment (13.40%), with sizes varying between surface water 4.70 to 3799.25 μm and seabed from 67.20 mm to 2176.87 mm, while black (30.07%) and blue (24.51%) were reported as the common MPs colors. The identified polymers include PET and PE. This study confirms visual evidence of microplastics in the open waters of eastern Indonesia. While it may not fully capture the wide range of temporal variations, it establishes initial microplastic presence and dispersion levels. Given that the ITF influences both the Pacific and Indian Oceans, this research contributes to the global understanding of microplastic distribution across ocean basins, underscoring the need for coordinated international efforts to address marine pollution.

Filmic Representation of ‘A Community with a Shared Future for Mankind’ in The Wandering Earth Series

Over the past 4 years, The Wandering Earth series has garnered significant acclaim and recognition within the market and film festival circuits. This study examines The Wandering Earth series, including The Wandering Earth and The Wandering Earth II, through the lens of ‘a community with a shared future for mankind’. Utilising qualitative content analysis, it explores the representation of global cooperation in these Chinese science fiction films, transcending conventional Western-centric narratives. The study reveals a unified international community by analysing film narratives, characters and visual symbolism, focusing significantly on China and non-Western countries’ roles in saving humanity. This approach aligns with global governance and post-colonial theories, highlighting the series’ challenge to Western hegemony and its contribution to the discourse on China’s growing cultural industry influence. This research enriches understanding of Chinese cinema’s role in shaping cultural values and international cooperation, emphasising the potential of the science fiction genre to reimagine global dynamics from a non-Western perspective. Its implications extend to enhancing the global understanding of China’s cultural narratives and contribute to the international dialogue on the evolution and influence of Chinese science fiction films.

International Tourism Law: Freedom Of Movement of People Between Tourism and Terrorism

Considering the humanization of international law, international tourism continues to challenge the right to freedom of movement. The opportunity to meet other people, visit different places, and experience diverse cultures is a unique and individual experience that can reduce the likelihood of international conflicts. As such, international tourism is an important vehicle through which individuals can contribute to global peace. Ensuring the free movement of international tourists is not only essential for the proper functioning of the tourism industry but also reflects the global rights of individuals. In recent years, the global tourism industry has faced significant challenges beyond terrorism, including the COVID-19 pandemic, geopolitical conflicts such as the Russia-Ukraine war, and the ongoing tensions in regions like the Middle East. These events have underscored the vulnerability of international tourism to external shocks and the resulting impact on global stability and peace. The reinstatement of visa requirements by countries like Brazil in 2024 further illustrates the delicate balance between national security and the right to freedom of movement. This paper discusses the complex relationship between the right to freedom of movement under international law and the various factors that impact international tourism, including terrorism, pandemics, and geopolitical conflicts. It highlights the critical importance of maintaining open and secure borders for the continuation of international tourism and its role in fostering global understanding and peace.

Two Decades of Insights: Comprehensive Histopathological and Epidemiological Analysis of Conjunctival Tumors

This study analyzed 2102 conjunctival lesions excised between 1981 and 2003 at a single tertiary center in Serbia, with the aim of evaluating their histopathological characteristics, anatomical localization, and demographic distribution. Of the total cases recorded, 55.1% were male, indicating a slight male predominance. The bulbar conjunctiva was the most commonly affected site (34.5%), with 39.3% of tumors extended to multiple regions of the conjunctiva, including areas such as the plica and caruncula. The most common benign lesion was compound conjunctival nevus (16.7%), while squamous cell carcinoma (SCC) (11.4%) and melanoma (11.3%) were the most prevalent malignant tumors. Tumor incidence peaked in the 61–70 and 51–60 year age groups, with malignant tumors such as SCC being more frequent in males. Comparisons with similar global studies reveal that our findings align with worldwide trends, such as the predominance of SCC, which has been linked to UV exposure, and the frequency of melanoma in fair-skinned populations. However, the lower prevalence of fibrodegenerative lesions like pterygia and pinguecula in our cohort likely reflects Serbia’s cooler climate compared to regions with higher UV exposure. These findings underscore the diverse nature of conjunctival tumors, the critical role of histopathological examination for diagnosis, and the influence of environmental factors. This study provides valuable insights into the epidemiology of conjunctival tumors, contributing to global understanding and guiding future diagnostic and therapeutic approaches.

Unique brood ester profile in a Varroa destructor resistant population of European honey bee (Apis mellifera)

Varroa destructor is one of the greatest threats to Apis mellifera worldwide and if left untreated will kill a colony in less than three years. A Varroa-resistant population from Gotland, Sweden, has managed to survive for 25 years with little to no Varroa treatment by reducing the mite’s reproductive success. The underlying mechanisms of this trait is currently not known, though previous research indicates that it is the honey bee brood, and not adult bee influence, that contributes to this phenotype. As the mite’s own reproduction is synchronized with the brood’s development though the interception of brood pheromones, it is possible that a change in pheromone profile would disrupt the mite’s reproductive timing. To investigate this, we characterized the brood ester pheromone (BEP) profile of our resistant Gotland population compared to a non-resistant control. This was done by extracting and analyzing key cuticular compounds of the BEP using gas chromatography. A significant difference was found immediately after brood capping, indicating a divergence in their pheromonal production at this time point. This is an important step to understanding the mechanisms of the Gotland population’s Varroa-resistance and contributes to our global understanding of Varroa destructor infestation and survival.

Study of the Characteristics and Functions Astrocytes of the Nervous System

Astrocytes are glial cells located in the central nervous system, that is, in the brain and spinal cord. Like the rest of the glia, astrocytes play supporting roles concerning neurons, the main cells of the nervous system from a functional point of view. Astrocytes are formed from cells of the ectoderm, the layer of the embryonic disc from which the nervous system and epidermis arise, during the organism's early development. Like most glia, astrocytes start from undifferentiated cells similar to those that give rise to neurons. This article aims to relate the characteristics and functions of astrocytes in the brain nutrition function, in the memory and learning process of stroke. Concerned with outlining a public profile of quality research in the area, we sought to answer these questions based on a literature review in the main journals in the area (national and international) classified by the Coordination for the Improvement of Higher Education Personnel (CAPES). To complement this analysis with other types of documents such as books, scientific journals, documents, and digital platforms, the following analysis steps were followed: (1) exhaustive reading of each article aiming at a global understanding and discovery of the approach used by its authors; (2) identification of the central ideas of each article; (3) classification of the ideas around core meanings; (4) comparison between the different core meanings present in the articles studied; (5) classification of the core meanings into broader axes (themes) around which the authors' discussions revolved; and (6) writing of interpretative summaries of each theme. After analyzing the content of the articles, we sought to establish a dialogue between the themes found and the literature that served as a basis for introducing the present study.

Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study.

Strong information systems are essential for safe and effective immunization programs. The COVID-19 vaccine rollout presented all immunization information systems (IIS) with challenging demands-requiring in-depth vaccine implementation data at all health system levels in real time. The system development approaches taken by countries were heterogeneous, with some countries opting to adapt existing systems and others implementing new ones. Using data reported by Member States to the World Health Organization (WHO), we aim to develop a global understanding of (1) the types of IIS used to monitor COVID-19 vaccination implemented in 2021 and (2) the approaches taken by countries to develop these systems. We conducted a descriptive analysis of data reported through a supplemental questionnaire of the WHO/United Nations Children's Emergency Fund (UNICEF) Joint Reporting Form on Immunization, collecting data for 2021 on (1) the use of and developmental approaches taken for 7 IIS functions (appointments, aggregate reporting, individual-level reporting, reminders, home-based records, safety surveillance, and stock management), and (2) modifications needed for digital health frameworks to permit COVID-19 vaccination monitoring. In total, 188 of 194 WHO Member States responded to the supplemental questionnaire, with 155 reporting on the IIS-related questions. Among those reporting, for each of the 7 IIS functions explored, greater than 85% of responding countries reported that the system was in place for COVID-19 vaccines. Among responding countries, "aggregate reporting system" was the system most frequently reported as being in place (n=116, 98.3%), while "reminder system" was the least (n=77, 89%). Among the countries reporting using a system, whether an existing system was adapted for COVID-19 vaccines or a new one was developed varied by system. Additionally, two-thirds (n=127, 67.6%) of countries reported establishing at least one new system, ranging from 72% (n=42) in high-income countries (HICs) to 62% (n=16) in low-income countries. Concurrently, 55.3% (n=104) of countries reported adapting at least one system already in place for COVID-19 vaccines, with 62% (n=36) of HICs reporting this compared to about 53% for other income groups. Of those reporting developing new systems, for each of the systems explored, more than 85% of countries reported that they intended to keep new systems specific to COVID-19 vaccines. Further, 147 of the 188 (78.2%) Member States responding to the supplemental questionnaire responded to the digital health frameworks question. Lastly, 31% (n=46) of responding countries reported needing to adapt them for COVID-19 vaccination systems. HICs had a higher percentage. Nearly all countries have adapted existing or developed new IIS to monitor COVID-19 vaccination. The approaches varied, notably by income group. Reflection is needed on how to sustain the investments made in IIS during the pandemic. Continued support for IIS is critical, given their essential role in program monitoring and performance.

Model of oil pipeline tiny defects detection based on DDPM gated parallel convolutional swin transformer

Abstract To address the challenges of difficult detection of minute magnetic flux leakage (MFL) defects, insufficient inspection data, and low detection accuracy, the denoising diffusion probabilistic model (DDPM) gate dilated parallel convolution swin transformer (DGPST) is proposed. First, we introduce a DDPM-based data generation model, successfully generating a large quantity of diverse and rich MFL defect samples. Second, a gated parallel convolution layer is introduced into the backbone network. This strategy uses the characteristics of dilated convolution to broaden the receptive field of the model, thus enhancing the integration ability of global information. The addition of gating mechanism enables the model to adjust the calculation of attention weight based on broader context information in advance, which not only complicates the shortcomings of window self-attention in global dependence understanding, but also effectively suppress irrelevant calculation. Finally, the loss function of H Intersection over Union is introduced to improve the mean average precision. Following these enhancements, DGPST attains a satisfactory outcome in detecting tiny defects within the MFL problem. Experimental data indicates the accuracy of the algorithm reaches 95.6% and the delay is reduced to 7.6 ms.

Exploring the Innovative Path of Mechanical Design, Manufacturing and Automation under the Concept of Sustainable Development

With the global deep understanding and practice of the concept of sustainable development, the field of mechanical design, manufacturing and automation is also facing the challenge of innovation and change. This paper aims to explore under the concept of sustainable development, mechanical design and manufacturing innovation path in the field of automation, including green design, intelligent upgrade, digital transformation, network collaboration, and modularity and standardization, etc., and put forward the corresponding innovation safeguard measures, in order to provide reference for the sustainable development of the field.

Breast implant-associated anaplastic large cell lymphoma in Romania: First case series of all documented cases

SummaryBreast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon malignancy linked to textured breast implants by moderate evidence in 2021. Documenting Romanian cases provides valuable insights into epidemiology, management, and outcomes, enhancing global understanding and informing clinical practices. Our objectives were to analyze BIA-ALCL cases in Romania, focusing on patient demographics, implant characteristics, clinical presentation, diagnostic methods, treatment, and outcomes.We conducted a retrospective review of all known BIA-ALCL cases in Romania, examining patient demographics, implant details, clinical presentation, diagnostic methods, and outcomes. Data sources included medical records, surgical reports, follow-up data, and implant characteristics like shape, texture, and manufacturer.The mean age at diagnosis was 44.4 years. All patients had textured implants and no replacements, 4 with aesthetic indication and 1 reconstruction. The mean time from implantation to diagnosis was 7.2 years. Clinical presentations were primarily late seromas, diagnosed through fine needle aspiration and immunohistochemistry. Treatments involved multidisciplinary teams, with bilateral en-bloc explantation and adjuvant therapies in two cases. One patient had immediate reconstruction with smooth implants and Acellular Dermal Matrix. No disease recurrence was observed post-treatment.The low BIA-ALCL prevalence in Romania estimated at 1:44,500 compared to the mean of 1:13,745 in Europe indicates the need for an increased awareness and tracking. Establishing mandatory national implant registries, pathology databases, and enhancing physician and patient education will help identify potential cases. All cases involved textured implants, highlighting the need for ongoing research to identify risk factors and guide surgeons consulting patients with these implants.