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 Table of Contents  
REVIEW ARTICLE
Year : 2019  |  Volume : 35  |  Issue : 2  |  Page : 102-107

The phantom syndrome


1 Department of Otolaryngology and Head Neck Surgery (ENT), Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Biotechnology, National Institute of Pharmaceutical Education and Research, Guwahati, Assam, India

Date of Submission31-Jul-2018
Date of Decision08-Oct-2018
Date of Acceptance29-Oct-2018
Date of Web Publication26-Jun-2019

Correspondence Address:
Atul Kumar Goyal
Department of Otolaryngology and Head Neck Surgery (ENT), Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_63_18

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  Abstract 


Communication technology evolved extensively in recent years and the introduction of the featured smartphones considered as the critical milestone in the mobile phone history. Unlike traditional phones, smartphones have the number of applications which keep the users engage to a greater extent of time like never before. Such unbroken psychological association of the individuals with their smartphones has led to an emergence of a new kind of psychological problem called as the phantom syndrome characterized by the frequent false feeling of ringing and vibration from the smartphones. Although the phenomenon of the phantom is widespread, only a limited number of studies are available on it. Furthermore, most of the studies available are to exploratory nature with lack of standard study designs. Keeping all such aspect into the consideration, the present review endeavors to extend the current scientific knowledge on phantom syndrome by providing a thorough understanding and new ideas for future research.

Keywords: Mental, mobile phone, psychological, ringing, vibration


How to cite this article:
Goyal AK, Saini J. The phantom syndrome. Indian J Soc Psychiatry 2019;35:102-7

How to cite this URL:
Goyal AK, Saini J. The phantom syndrome. Indian J Soc Psychiatry [serial online] 2019 [cited 2019 Jul 20];35:102-7. Available from: http://www.indjsp.org/text.asp?2019/35/2/102/261487




  Introduction Top


Technology, nowadays, is not just limited to human desires but has shifted to the needs of humanity. Such continuous influx of technology into human life has influenced human behavior in several ways. One of the behaviors influenced by technology is the way people communicate. In the past, people tend to communicate through letters due to geographical differences. Mobile phone emerged as a communication technology[1] when Motorola launched its first mobile phone in 1973.[2] Soon after that mobile phone becomes the most acceptable means for communication.[3] At present, around 66% of the world population is using a mobile phone, and approximately 1.16 billion mobile phones user are present in India.[2] Traditional mobile phones include the primary features that allow users to call or text someone and they lost their popularity soon after the smartphones come on the market in 2013.[3] Apart from the conventional voice calls and text messages, smartphone emerges as a tool for entertainment, social networking, education, business promotion, and for the related activities. As a result of which, nowadays, adults spent most of their leisure time on their smartphones. Individuals are commonly seen to engage with smartphones even if they occupied with the other important activities of their daily lives, and for most of the individuals, it is impossible to go through without their smartphones even for an hour.[4] This utmost unbroken association of the individuals with their smartphones has led to the emergence of a new kind of psychological disorder called as the phantom syndrome characterized by a frequent false feeling of ringing and vibration from the smartphones. At present, there is insufficient research available on the phantom syndrome and most of the studies conducted so far, lacks standard methodological designs. Taking all these aspects into consideration, the present narrative endeavors to extend the current scientific knowledge on the phantom by providing the critical understanding of the phenomenon and by proposing directions for future research on the phantom syndrome.


  Search Strategy and Selection Criteria Top


References for this review were identified through searches of PubMed for articles published from 1985 to current year by use of the terms “Phantom,” “Vibration and Ringing,” “Mobile Phones,” and “Ringxiety.” Relevant articles published were identified through searches in the authors' files, in Google Scholar, Research Gate, and Springer Online Archives Collection. Materials resulting from these searches and relevant references cited in those articles were reviewed, and information from 24 articles was incorporated in the present review. Articles published in a language other than English were also included in the present review.


  Language, Grammar, and Plagiarism Top


The references were inserted using EndNote software version 7.4 (Thomson Reuters, Toronto, Canada). Language and grammar were checked by Grammarly software version 6.6 (Grammarly, Inc., San Francisco, California, United States). Plagiarism is corrected with the help of Plagiarism Checker X software version 5.1 (Techroad Global, New York, USA). The present work was edited by the professional proofreading and editing service provider (doc navigator©, Chandigarh).


  History Top


History of phantom syndrome traced backed to back in 1996 when the cartoonist Scott Adams for first referenced such a sensation as “phantom-pager syndrome” in his comic strip “Dilbert.”[2] In 2003, columnist Robert D. Jones states that our mind or body tells us the imaginary vibrations in the belts, pockets, and even purses in his article entitled “Phantom Vibration Syndrome” published in the New Pittsburgh Courier.[1] The first scientific study on the phenomenon was conducted in 2007 by a researcher who coined the term ringxiety to describe the phantom.[4] In early days, false feeling of ringing and vibrations from smartphones are known by the many names such as vibranxiety, ringxiety, fauxcellarm, and audio illusion[3] until the term “Phantom” had made its way to Australia when the Macquarie Dictionary's in 2012's declared it as the “Word of the Year.”[1]


  Etiology Top


Established etiology is must to design the new prevention, management, and treatment strategies for any given syndrome by the clinicians. So far phantom is characterized as the hallucinations or sensation which the brain perceives when they are not present.[5] At present, there are no well-established clinical criteria for the diagnosis and treatment of the phantom syndrome. Much international organization such as the International Classification of Disease (ICD)-10,[4] American Psychiatric Association's (APA), and diagnostic and statistical manual of mental disorders (DSM-5) do not consider the phantom syndrome into the disease;[3] therefore, the diagnosis of phantom is very difficult. The standard physiological indicators and visible signs of the discomfort which can characterize the phantom are also not defined till date.[6] Available research suggests that the symptoms of phantom found similar to those occurring during the withdrawal from an addiction. So far phantom syndrome is known to occur mainly in two forms, i.e., vibration and ringing forms. In vibration, form individual has a false feeling that his phone is vibrating but it does not, and the same occur in ringing form, but in that case, the user feels the false ringing not vibration. Either ringing or vibration or both could be occurred in the same individual depending on the habits of smartphones use.[1] Studies which can elucidate the diagnostic criteria for the phantom syndrome have paramount importance. Moreover, research on how the phantom syndrome can be prevented, manage, or treated could make phantom syndrome to have a well-established etiology which further could be considered by the international organizations such as ICD-11, APA, and DSM-5.


  Incidence and Prevalence Top


Rothberg et al.[5] conducted a study in 2010 on the phantom syndrome among medical staff and found that nearly 70% of the individuals faced phantom syndrome. In 2012, a study among college undergraduates revealed that almost 90% of the students had felt the phantom vibrations. Most of the students admit that they face symptoms every month every week and almost daily.[1] During 2013, Michelle Drouin conducted a study among 290 undergraduate students which revealed that 89% of the students experience phantom syndrome.[7] Another study conducted in the same year by Lin YH reported that 78% of the individuals perceived phantom vibrations.[8] A study conducted in 2015 at Kurukshetra university shows that 74% of the postgraduate students experience the phantom vibration and ringing on a weekly basis.[1] In 2017, Abolfazal investigated the prevalence of phantom among medical students and found that 54.3% of the students face phantom sensations[9] [Table 1]. Overall, in most of the studies, the phantom vibration was found to be more common compared to the phantom ringing,[10] and hallucination of phantom mostly occurred on a weekly basis.[4] Majority of research conducted to date on phantom syndrome is clustered around the medical staff and students, the reason for which is unknown. Furthermore, conducting studies oriented to a particular segment of population lose validity of study outcomes on the general population. There is always a chance of biasness if the study is repeated with the same conditions. More diverse studies among the various stakeholders of society are required to establish the incidence and prevalence of phantom syndrome. Hospital-based studies in the psychiatry departments could have more importance as individuals on having a feeling of the phantom, initially tends to approach for the psychiatry opinion.
Table 1: Prevalence of phantom syndrome

Click here to view



  Symptoms Top


Phantom found to positively correlated with the duration of smartphone use[1] and several studies have proven that the long-term use of smartphones can lead to the development of symptoms such as headache, extreme irritation, increases in the carelessness, forgetfulness, decrease of reflexes, clicking sound in ears,[11],[12] ear warmth, ear fullness, and ringing in the ears.[13] The further increased frequency of smartphone users can also lead to addictive and compulsive behavior characterized by psychological strain, loneliness, isolation, depression,[14] poor relationships, poor occupational, and academic performances.[15] Nomophobia is a condition in which smartphones users feel frightened if they lost smartphone, and in severe conditions, nomophobia can cause the emotional discomfort in a person characterized by the emotional changes such as anxiety, fear, panic, and depression as well as the physical changes such as changes in breathing, sweating, and trembling.[16] However, to what extent phantom is contributing to each symptom is still a matter of investigation.

Studies also suggested that the phantom syndrome at initial stages can cause the psychological stress, anxiety, hallucinations, depression, attention deficit, over-vigilance, and emotional disturbance and if left unmanaged, primary symptoms progress to advanced stages which leads to the burnout syndrome, effective psychological disorders, depressive psychosis, and pathological stress.[2] Among several symptoms, stress and depression are found to be most common in the phantom. Although earlier studies suggest that there is no relation exists between the phantom and the stress level,[10] many recent studies explain that the over-reliance on smartphones leads the individuals to believe that they cannot function without their smartphone and experience high-stress levels when there is loss of the connectivity.[1],[17] A Nokia study found that the average smartphone user checks their phone every 6.5 min, i.e., 150 times during the waking hours. Such kind of behavior leads to the obsession for phone and become the reason for anxiety when an individual is unable to check their smartphone or entirely loss access to a smartphone.[1] There occurs a positive feedback loop between the phantom and the stress and depression levels. Phantom can enhance by the stress and enhancement of stress can lead to the phantom which was evident by a study among the internship of hospital workers which revealed that the phantom syndrome magnitude increases with the training duration and become low when the training ended. This may be due to the anxiety and depression which remain high during the initial period of training and decrease later as the training ended because workers become more adapted to the hospital environment.[8],[10] A detailed model is needed to be designed to study the positive feedback loop occurs in the phantom syndrome qualitatively and quantitatively.

Sleep is necessary to recover from the fatigue and restoration of the energy. Disturbance in sleep can lead to increased core body temperature, decrease task performance, and the decline in cognitive function.[18] The severity of phantom syndrome can lead to disturbance of biological clock, which in turn can cause fatigue and sleep disorders. A recent study conducted among the 120 students showed a positive correlation between the phantom syndrome and sleep disorders. About 93% of the students found to use smartphones before going to bed at night[19] which could be potentially causing symptoms such as the difficulty in sleeping, waking up from sleep, and trouble in falling asleep again.[20] Detail research which could establish the relationship between sleep patterns and the phantom severity could prove helpful in the establishment of a link between the phantom syndrome and the biological clock/circadian rhythms.


  Risk Factors Top


Investigators have been attempted to identify a pattern of smartphones uses which may be associated with the phantom syndrome. Primary factors which found to be responsible for the phantom sensations can be summarized in four categories including the occupation (students, professionals, housewives, etc.), smartphone location (shirt pocket, belt, pants front pocket, back pocket, bag, etc.), smartphone carrying period (regular, continuous, day only, occasionally, etc.), frequency of use (<6 h, 6–12 h, and >12 h), and mode of use (ringing or vibration). Although few earlier studies found no significant relationship between the phantom syndrome and the amount of the smartphone use,[4] a recent study identifies that the symptoms of phantom directly proportional to the number of hours that the smartphone was carried and the frequency of the phone use.[1] The cognitive score also found to be related with the phantom syndrome in a study in which individuals with high scores for personal fatigue, job fatigue, and service target fatigue found to have more frequent episodes of the phantom. It is possible that the limbic forebrain, hypothalamus, and brainstem that mediate stress responses, emotional learning, and reward processing may be involved in phantom episodes;[21] however, it is mostly correlational research, and confounding factors were hardly adjusted, therefore, more research needs to be done to establish a direct link.

Apart from the factors mentioned above, emotional attachment to the smartphone revealed as another significant risk factor for the phantom syndrome.[2] Individuals who become attached to the contents of their smartphone, like contacts, apps, games, and other stuff, generally have more desire to receive notifications for their Facebook, Twitter, and WhatsApp updates[3] which makes them more prone to the phantom syndrome. The extraversion and agreeableness are the types of social personalities characterized by the need for social connectivity. Extroverts are talkative and like to socialize. They enjoy the presence of others, and want to be engaged. Agreeableness describes attitudes such as the straightforwardness, altruism, and kindheartedness. People who score high on the extraversion and agreeableness should be more prone to the phantom as the frequency of continuous engagement with the smartphone high is such cases.[3] Neuroticism is another form of the emotional stability characterized by anxiety and stress. Neurotics individuals become paranoid very frequently when they lose the engagement with their smartphone.[3] Although studies on direct examination of the relationship between the neuroticism and the phantom vibrations found no significant correlation,[7] phantom ringing is still needed to be a screen for the neuroticism. As opposed to neuroticism, conscientiousness is characterized by the strong will. There are two assumptions are conceivable in case of the conscientious individuals:First, conscientious individuals are dedicated toward the assigned task[22] and may, therefore, be more alert to the incoming notifications on phone which could increase the likelihood of phantom phone sensations; second, due to their goal-directness and self-discipline, conscientious individuals are less attentive to the extraneous stimuli[7] which could make them less susceptible for phantom. Another phobia of the modern age is the nomophobia which is defined as the fear of being out of mobile phone contact. In a recent study, it was found that mobile phone addiction is directly associated with the nomophobia. Clearly, the individuals with nomophobia supposed to be more susceptible to the phantom syndrome.[23] However, which assumption among above two will dominate is still a matter of investigation. Conclusively, only rudiment studies are available to date on the behavior analysis and further focused research is required to established emotional behavior as a risk factor for the phantom syndrome.


  Management and Treatment Top


Few investigations in the literature attempted to explore whether phantom can be avoided, managed, or treated. Studies suggested that the phantom can be easily managed by the time-bounded use of smartphone, decrease the possible dependency of smartphone, frequently change the alert modes like vibration to ringing, lifestyle modifications, counseling and guidance regarding the hallucinations and affective aspects, use different devices, carrying smartphone in different pockets or positions, and by avoiding the vibration mode of smartphones.[1],[2] However, there are no clinical criteria, or standard treatment is present and clinical trials need to be conducted to design systemic treatment protocol for the phantom syndrome.


  Theories Explaining Mechanism Top


Most studies conducted so far on the phantom syndrome are of exploratory nature, attempting to outline the prevalence and features of the phenomena. These studies lack the qualitative behavioral and psychological component. There have been comparatively fewer explorations into the causes behind the phantom and whatever theories are proposed, lacks the systemic view. At present stage, there is no accepted theory available for explanation of the phantom syndrome. In the present article, we are introducing several theories based on the existing fragmented literature on which further detailed research could be carried out to establish them as standard theories describing the phenomenon of the phantom.

According to signal detection theory, smartphone in the pocket exists in two possible states as follows: either ringing or not. Similarly, the human brain also has two possible states as follows: the judgment that the phone is ringing or is not. Brain, similar to match above-mentioned states in the correct way, i.e., ringing, should go with “it's ringing,” and no ringing should go with “it's not ringing.” These faithful matches called as the “true positive” and “true negative” signal, respectively. However, in other conditions, it is also possible that the brain mismatch the ringing with “it's not ringing” or mismatch the no ringing with “it's ringing.” These mismatches called as the “true negative” and “false-positive” signal, respectively. The false-positive signal can lead to the phantom syndrome.[1]

Sensations are repetitive memories theory prosed by Dr. Larry Rosen tells that the phantom sensations are repetitive memories of previous real experiences triggers by the present situation. The actual stimulus which mimics the phantom is unknown; however, candidate sensations might include the touch or sensation arise from the from clothing, muscle contractions, or other sensory stimuli.[24] A recent study put the evidence in support of this theory in which students carrying the phone in their pocket felt vibration even when the phone is switched off which may be due to sensations from the surroundings.[1]

Theory of neuroplasticity explains that the phantom syndrome may be due to the brain's ability to form new connections in response to changes in the environment. When cellphone users regularly experience sensations, such as vibration or ringing, their minds become wired to those sensations[24] and lead to phantom. It works in the same way as how our brain remains to keep adapting for the new information.

Transcutaneous electrical nerve stimulation theory proposed by a professor of psychology at the University of Sydney suggested that the phantom may be due to the sensation interpreted by the nerves on the skin caused by a very small discharge of electricity given off by the phone when it connects to a new tower. However, a recent study contradicts this study in which students found to felt phantom from pocket even when, the phone in their pocket is switched off, or they do not have a phone in their pocket.[1]

Dopamine theory hypotheses that every text, WhatsApp, Facebook, or Twitter notification is positively reinforced our brains for the release of a little spurt of the dopamine. A dysregulated dopamine system has a central role in psychotic symptoms such as hallucinations.[25] However, no research-based evidence is present in support of this theory.


  Future Directions Top


Clinicians and researchers wonder what if it is possible to manage the symptoms of the phantom syndrome. It is also not known what happens when the individuals have phantom and who's most likely going to be affected by it. Phantom syndrome somehow shows analogy to an auditory hallucination[10] such as tinnitus which is a condition of auditory phantom perception. Individuals who faced the tinnitus experience auditory dysfunction such as hearing loss and vertigo. However, to date, no such outcomes have been reported by any study in case of the phantom syndrome. However still, the phantom syndrome is an issue that needs to be looked at as a serious problem. Clinical information could be of great importance in treatment planning, prognosis, and monitoring treatment outcomes, and therefore, clinicians must design a diagnostic criterion to diagnose the phantom syndrome.

Most of the studies, we reviewed in the present article used self-reported measures, and therefore, there is a possibility of erroneous estimation of the frequency or severity of phantom. Participants in these studies were usually told that the study was on general behaviors related to the smartphone usage to keep the study blinded as the probability of biasness increased if the participants were told the real purpose of the study. Most of the studies conducted to date lack the robust methodology. Study designs for phantom syndrome investigation need to be standardized by developing appropriate statistical tools. Moreover, there is no questionnaire available for the study of the phantom syndrome. A standard questionnaire needs to be designed to assess the causes, severity, stress, and related factor of the phantom syndrome. The questionnaire should be based on sound theoretical background, for example, first of all, a theoretical premise needs to be built upon, which can be done by qualitative methodology. The questionnaire then must be validated on a large population to check questionnaire reliability and reproducibility.


  Conclusion Top


New technology is a wonderful thing, but the more reliant we become to it, the more negatively we will be affected by it. Technology has taken over our lives in so many ways, and recently, it impacted the psychological health in the form of the phantom syndrome. The present article reviewed the available research available on the phantom syndrome and pinned down the specific research ideas to design effective prevention, management, and treatment strategies for the phantom.

Acknowledgement

The authors are highly acknowledged to all the colleagues who reviewed the present work.

Financial support and sponsorship

The work in the present article is financially supported by the Junior Research Fellowship (JRF) provided by ICMR, New Delhi. (Grant No. 3/13/JRF -2015/HRD).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Goyal AK. Studies on phantom vibration and ringing syndrome among postgraduate students. Indian J Community Health 2015;27:35-40.  Back to cited text no. 1
    
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Pareek S. Phantom vibration syndrome: An emerging phenomenon. Asian J Nurs Educ Res 2017;7:596-7.  Back to cited text no. 2
    
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Sauer VJ, Eimler SC, Maafi S, Pietrek M, Krämer NC. The phantom in my pocket: Determinants of phantom phone sensations. Mob Med Commun 2015;3:293-316.  Back to cited text no. 3
    
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Deb A. Phantom vibration and phantom ringing among mobile phone users: A systematic review of literature. Asia Pac Psychiatry 2015;7:231-9.  Back to cited text no. 4
    
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Rothberg MB, Arora A, Hermann J, Kleppel R, St. Marie P, Visintainer P, et al. Phantom vibration syndrome among medical staff: A cross sectional survey. BMJ 2010;341:c6914.  Back to cited text no. 5
    
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Walsh SP, White KM, Young RM. Over-connected? A qualitative exploration of the relationship between Australian youth and their mobile phones. J Adolesc 2008;31:77-92.  Back to cited text no. 6
    
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Drouin M, Kaiser DH, Miller DA. Phantom vibrations among undergraduates: Prevalence and associated psychological characteristics. Comput Hum Behav 2012;28:1490-6.  Back to cited text no. 7
    
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Lin YH, Chen CY, Li P, Lin SH. A dimensional approach to the phantom vibration and ringing syndrome during medical internship. J Psychiatr Res 2013;47:1254-8.  Back to cited text no. 8
    
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Mohammadbeigi A, Mohammadsalehi N, Moshiri E, Anbari Z, Ahmadi A, Ansari H, et al. The prevalence of phantom vibration/ringing syndromes and their related factors in Iranian' students of medical sciences. Asian J Psychiatr 2017;27:76-80.  Back to cited text no. 9
    
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Lin YH, Lin SH, Li P, Huang WL, Chen CY. Prevalent hallucinations during medical internships: Phantom vibration and ringing syndromes. PLoS One 2013;8:e65152.  Back to cited text no. 10
    
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Al-Khlaiwi T, Meo SA. Association of mobile phone radiation with fatigue, headache, dizziness, tension and sleep disturbance in Saudi population. Saudi Med J 2004;25:732-6.  Back to cited text no. 11
    
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Panda NK, Gupta K, Patro SK, Verma R, Munjal S, Bakshi J, et al. Mobile phones for mobility or morbidity: Is there an evidence for morbidity? Ann Indian Acad Otorhinolaryngol Head Neck Surg 2017;1:9.  Back to cited text no. 12
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Lu X, Watanabe J, Liu Q, Uji M, Shono M, Kitamura T. Internet and mobile phone text-messaging dependency: Factor structure and correlation with dysphoric mood among Japanese adults. Comput Hum Behav 2011;27:1702-9.  Back to cited text no. 14
    
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Billieux J, Philippot P, Schmid C, Maurage P, De Mol J, Van der Linden M, et al. Is dysfunctional use of the mobile phone a behavioural addiction? Confronting symptom-based versus process-based approaches. Clin Psychol Psychother 2015;22:460-8.  Back to cited text no. 15
    
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Zhitomirsky-Geffet M, Blau M. Cross-generational analysis of predictive factors of addictive behavior in smartphone usage. Comput Hum Behav 2016;64:682-93.  Back to cited text no. 16
    
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Alam M, Qureshi MS, Sarwat A, Haque Z, Salman M, Masroor MA, et al. Prevalence of phantom vibration syndrome and phantom ringing syndrome (Ringxiety): Risk of sleep disorders and infertility among medical students. Int J 2014;2:688-93.  Back to cited text no. 19
    
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Abstract
Introduction
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Incidence and Pr...
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Management and T...
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