I think the DiPALS report might be best thought of as a minimus . . . within the report, a statement implies an informal per-protocol analysis was made and showed 'low efficacy.' Their report covers much 'territory,' often with very limited depth. Centers ought to at least meet and should exceed their results. Each of their centers administered less than a pilot study of implants (less then about sixteen). Patients are more likely to obtain an implant at their nearest center . . . patients are more likely to be later in their 'implant opportunity window' in the early period of a center's initiation of implants.