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. 2023 Nov 27;19(4):e1369.
doi: 10.1002/cl2.1369. eCollection 2023 Dec.

Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map

Vivian Welch  1 , Elizabeth T Ghogomu  2 , Victoria I Barbeau  1 , Sierra Dowling  1 , Rebecca Doyle  3 , Ella Beveridge  1 , Elisabeth Boulton  4 , Payaam Desai  1 , Jimmy Huang  1 , Nour Elmestekawy  1 , Tarannum Hussain  1 , Arpana Wadhwani  1 , Sabrina Boutin  5 , Niobe Haitas  5 , Dylan Kneale  6 , Douglas M Salzwedel  7 , Roger Simard  5 , Paul Hébert  2 , Christopher Mikton  8
Affiliations

Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map

Vivian Welch et al. Campbell Syst Rev. .

Abstract

Background: Social isolation and loneliness are more common in older adults and are associated with a serious impact on their well-being, mental health, physical health, and longevity. They are a public health concern highlighted by the COVID-19 pandemic restrictions, hence the need for digital technology tools to enable remotely delivered interventions to alleviate the impact of social isolation and loneliness during the COVID-19 restrictions.

Objectives: To map available evidence on the effects of digital interventions to mitigate social isolation and/or loneliness in older adults in all settings except hospital settings.

Search methods: We searched the following databases from inception to May 16, 2021, with no language restrictions. Ovid MEDLINE, Embase, APA PsycInfo via Ovid, CINAHL via EBSCO, Web of Science via Clarivate, ProQuest (all databases), International Bibliography of the Social Sciences (IBSS) via ProQuest, EBSCO (all databases except CINAHL), Global Index Medicus, and Epistemonikos.

Selection criteria: Titles and abstracts and full text of potentially eligible articles were independently screened in duplicate following the eligibility criteria.

Data collection and analysis: We developed and pilot tested a data extraction code set in Eppi-Reviewer and data were individually extracted and coded based on an intervention-outcome framework which was also used to define the dimensions of the evidence and gap map.

Main results: We included 200 articles (103 primary studies and 97 systematic reviews) that assessed the effects of digital interventions to reduce social isolation and/or loneliness in older adults. Most of the systematic reviews (72%) were classified as critically low quality, only 2% as high quality and 25% were published since the COVID-19 pandemic. The evidence is unevenly distributed with clusters predominantly in high-income countries and none in low-income countries. The most common interventions identified are digital interventions to enhance social interactions with family and friends and the community via videoconferencing and telephone calls. Digital interventions to enhance social support, particularly socially assistive robots, and virtual pets were also common. Most interventions focused on reducing loneliness and depression and improving quality of life of older adults. Major gaps were identified in community level outcomes and process indicators. No included studies or reviews assessed affordability or digital divide although the value of accessibility and barriers caused by digital divide were discussed in three primary studies and three reviews. Adverse effects were reported in only two studies and six reviews. No study or review included participants from the LGBTQIA2S+ community and only one study restricted participants to 80 years and older. Very few described how at-risk populations were recruited or conducted any equity analysis to assess differences in effects for populations experiencing inequities across PROGRESS-Plus categories.

Authors' conclusions: The restrictions placed on people during the pandemic have shone a spotlight onto social isolation and loneliness, particularly for older adults. This evidence and gap map shows available evidence on the effectiveness of digital interventions for reducing social isolation or loneliness in older adults. Although the evidence is relatively large and recent, it is unevenly distributed and there is need for more high-quality research. This map can guide researchers and funders to consider areas of major gaps as priorities for further research.

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Figures

Figure 1
Figure 1
Needs‐based approach framework (Adapted from Jopling et al., 2020).
Figure 2
Figure 2
Strategy‐based approach framework (Adapted from Masi et al., 2011).
Figure 3
Figure 3
Conceptual framework.
Figure 4
Figure 4
Sample map.
Figure 5
Figure 5
PRISMA flow diagram.
Figure 6
Figure 6
Intervention strategies to reduce social isolation and loneliness.
Figure 7
Figure 7
Interventions for social cognitive training.
Figure 8
Figure 8
Interventions for improving social skills.
Figure 9
Figure 9
Interventions for enhancing social interactions.
Figure 10
Figure 10
Outcome categories.
Figure 11
Figure 11
Individual level outcomes.
Figure 12
Figure 12
Community level outcomes.
Figure 13
Figure 13
Process indicators.
Figure 14
Figure 14
Quality assessment of reviews.
Figure 15
Figure 15
Geographic heat map for primary studies.
Figure 16
Figure 16
World Health Organization regions.
Figure 17
Figure 17
World Bank income classification.
Figure 18
Figure 18
Setting.
Figure 19
Figure 19
PROGRESS‐Plus categories used to describe participants.
Figure 20
Figure 20
Participant age groups.
Figure 21
Figure 21
Health conditions of participants.
Figure 22
Figure 22
Equity focus of vulnerability across PROGRESS‐Plus factors.
Figure 23
Figure 23
Recruitment strategies for at‐risk populations.
Figure 24
Figure 24
Equity analyses to assess differences in effects across any PROGRESS‐Plus factor.
See this image and copyright information in PMC

Update of

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    1. Sciamanna, C. , Ballentine, N. H. , Bopp, M. , Chinchilli, V. M. , Ciccolo, J. T. , Delauter, G. , Fisher, A. , Fox, E. J. , Jan De Beur, S. , Kearcher, K. , Kraschnewski, J. L. , Lehman, E. , McTigue, K. M. , McAuley, E. , Paranjape, A. , Rodriguez‐Colon, S. , Rovniak, L. , Rutt, K. , Smyth, J. M. , Stewart, K. J. , Stuckey, H. L. , & Tsay, A. (2021). Working to increase stability through exercise (WISE): Screening, recruitment, and baseline characteristics. Trials, 22, 1–12. - PMC - PubMed

Scoglio 2019

    1. Scoglio, A. A. , Reilly, E. D. , Gorman, J. A. , & Drebing, C. E. (2019). Use of social robots in mental health and well‐being research: Systematic review. Journal of Medical Internet Research, 21(7), e13322. - PMC - PubMed

Shah 2021

    1. Shah, S. G. S. , Nogueras, D. , van Woerden, H. , & Kiparoglou, V. (2021). Evaluation of the effectiveness of digital technology interventions to reduce loneliness in older adults: Systematic review and meta‐analysis. Journal of Medical Internet Research, 23(6), e24712. - PMC - PubMed

Shapira 2007

    1. Shapira, N. , Barak, A. , & Gal, I. (2007). Promoting older adults' well‐being through Internet training and use. Aging & Mental Health, 11(5), 477–484. - PubMed

Shapira 2021

    1. Shapira, S. , Yeshua‐Katz, D. , Goren, G. , Aharonson‐Daniel, L. , Clarfield, A. M. , Sarid, O. , & Evaluation of a Short‐Term Digital Group . (2021). Intervention to relieve mental distress and promote well‐being among community‐dwelling older individuals during the COVID‐19 outbreak: A study protocol. Frontiers in Public Health, 9, 577079. - PMC - PubMed

Shapira 2021a

    1. Shapira, S. , Yeshua‐Katz, D. , Cohn‐Schwartz, E. , Aharonson‐Daniel, L. , Sarid, O. , & Clarfield, A. M. (2021). A pilot randomized controlled trial of a group intervention via Zoom to relieve loneliness and depressive symptoms among older persons during the COVID‐19 outbreak. Internet Interventions, 24, 100368. - PMC - PubMed

Shishehgar 2018

    1. Shishehgar, M. , Kerr, D. , & Blake, J. (2018). A systematic review of research into how robotic technology can help older people. Smart Health, 7–8, 1–18.

Shishehgar 2019

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Smallfield 2018

    1. Smallfield, S. , & Molitor, W. L. (2018). Occupational therapy interventions supporting social participation and leisure engagement for community‐dwelling older adults: A systematic review. American Journal of Occupational Therapy, 72(4), 7204190020p1–7204190020p8. - PubMed

Smith 2006

    1. Smith, T. L. , & Toseland, R. W. (2006). The effectiveness of a telephone support program for caregivers of frail older adults. Gerontologist, 46(5), 620–629. - PubMed

Smith 2011

    1. Smith, L. J. (2011). The effect of training in internet use on perceived loneliness, depression and well‐being with the African American elderly. Dissertation Abstracts International: Section B: The Sciences and Engineering, 71(12–B), 7354.

Smith 2017

    1. Smith, S. K. , & Astell, A (2017). Independent living functions for the elderly (IN‐LIFE): Supporting communication in dementia. Studies in Health Technology and Infomatics, 242, 16–22. - PubMed

Song 2009

    1. Song, J. H. (2009). [Effects of a robot pet‐assisted program for elderly people with dementia]. Journal of Korean Academy of Nursing, 39(4), 562–573. - PubMed

Song 2019

    1. Song, Y. , & van der Cammen, T. J. M. (2019). Electronic assistive technology for community‐dwelling solo‐living older adults: A systematic review. Maturitas, 125, 50–56. - PubMed

Sosa 2012

    1. Sosa Giovanni, W. (2012). The impact of a video game intervention on the cognitive functioning, self‐ efficacy, self‐esteem, and video game attitudes of older adults. Dissertation Abstracts International Section A: Humanities and Social Sciences, 73(5–A), 1885.

Su 2020

    1. Su, Z. , Meyer, K. , Li, Y. , McDonnell, D. , Joseph, N. M. , Li, X. , Du, Y. , Advani, S. , Cheshmehzangi, A. , Ahmad, J. , da Veiga, C. P. , Chung, R. Y. , & Wang, J. (2020). Technology‐based interventions for nursing home residents: Implications for nursing home practice amid and beyond the influence of COVID‐19: A systematic review protocol. Research Square, 18, 18.

Tanaka 2012

    1. Tanaka, M. , Ishii, A. , Yamano, E. , Ogikubo, H. , Okazaki, M. , Kamimura, K. , Konishi, Y. , Emoto, S. , & Watanabe, Y. (2012). Effect of a human‐type communication robot on cognitive function in elderly women living alone. Medical Science Monitor, 18(9), CR550–CR557. - PMC - PubMed

Thodberg 2016

    1. Thodberg, K. , Sorensen, L. U. , Christensen, J. W. , Poulsen, P. H. , Houbak, B. , Damgaard, V. , Keseler, I. , Edwards, D. , & Videbech, P. B. (2016). Therapeutic effects of dog visits in nursing homes for the elderly. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 16(5), 289–297. - PubMed

Tomasino 2017

    1. Tomasino, K. N. , Lattie, E. G. , Ho, J. , Palac, H. L. , Kaiser, S. M. , & Mohr, D. C. (2017). Harnessing peer support in an online intervention for older adults with depression. American Journal of Geriatric Psychiatry, 25(10), 1109–1119. - PMC - PubMed

Tsai 2010

    1. Tsai, H. H. , Tsai, Y. F. , Wang, H. H. , Chang, Y. C. , & Chu, H. H. (2010). Videoconference program enhances social support, loneliness, and depressive status of elderly nursing home residents. Aging & Mental Health, 14(8), 947–954. - PubMed

Tsai 2011

    1. Tsai, H. H. , & Tsai, Y. F. (2011). Changes in depressive symptoms, social support, and loneliness over 1 year after a minimum 3‐month videoconference program for older nursing home residents. Journal of Medical Internet Research, 13(4), e93. - PMC - PubMed

Tsai 2020

    1. Tsai, H. H. , Cheng, C. Y. , Shieh, W. Y. , & Chang, Y. C. (2020). Effects of a smartphone‐based videoconferencing program for older nursing home residents on depression, loneliness, and quality of life: A quasi‐experimental study. BMC Geriatrics, 20(1), 27. - PMC - PubMed

Tsai 2020a

    1. Tsai, H. H. , Cheng, C. Y. , & Shieh, W. Y. (2020). Effectiveness of laptop‐based versus smartphone‐based videoconferencing interaction on loneliness, depression and social support in nursing home residents: A secondary data analysis. Journal of Telemedicine & Telecare, 29(3), 177–186. - PubMed

Tyack 2017

    1. Tyack Charles, S. M. , & Camic Paul, M. (2017). Touchscreen interventions and the well‐being of people with dementia and caregivers: A systematic review. International Psychogeriatrics, 29(8), 1261–1280. - PubMed

University of Texas at Austin 2020

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Uppsala University 2020

    1. Uppsala University . (2020). Treatment of depressive symptoms in older individuals in isolation during Covid‐19. clinicaltrials.gov.

Van Den Heuvel 2019

    1. Van Den Heuvel, R. , Lexis, M. , & Daniels, R. (2019). CRDL—Interactive technology eliciting engagement in elderly people with dementia. Technology and Disability, 31(Supplement 1), S114.

Van Houwelingen‐Snippe 2021

    1. Van Houwelingen‐Snippe, J. , Ben Allouch, S. , & Van Rompay, T. J. L. (2021). Virtual reality representations of nature to improve well‐being amongst older adults: A rapid review. Journal of Technology in Behavioral Science, 6, 464–485. - PMC - PubMed

Vanova 2018

    1. Vanova, M. , Irazoki, E. , Garcia‐Casal, J. A. , Martinez‐Abad, F. , Botella, C. , Shiells, K. R. , & Franco‐Martin, M. A. (2018). The effectiveness of ICT‐based neurocognitive and psychosocial rehabilitation programmes in people with mild dementia and mild cognitive impairment using GRADIOR and ehcoBUTLER: Study protocol for a randomised controlled trial. Trials [Electronic Resource], 19(1), 100. - PMC - PubMed

VanRavenstein 2020

    1. VanRavenstein, K. , Brotherton, S. , & Davis, B. (2020). Investigating the feasibility of using telemedicine to deliver a fall prevention program: A pilot study. Journal of Allied Health, 49(3), 221–227. - PubMed

Vazquez 2019

    1. Vazquez, F. L. , Torres, A. J. , Otero, P. , Blanco, V. , Lopez, L. , Garcia‐Casal, A. , & Arrojo, M. (2019). Cognitive‐behavioral intervention via interactive multimedia online video game for active aging: Study protocol for a randomized controlled trial. Trials [Electronic Resource], 20(1), 692. - PMC - PubMed

Wasilewski 2017

    1. Wasilewski, M. B. , Stinson, J. N. , & Cameron, J. I. (2017). Web‐based health interventions for family caregivers of elderly individuals: A scoping review. International Journal of Medical Informatics, 103, 109–138. - PubMed

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    1. White, H. , McConnell, E. , Clipp, E. , Bynum, L. , Teague, C. , Navas, L. , Craven, S. , & Halbrecht, H. (1999). Surfing the net in later life: A review of the literature and pilot study of computer use and quality of life. Journal of Applied Gerontology, 18(3), 358–378.

White 2002

    1. White, H. , McConnell, E. , Clipp, E. , Branch, L. G. , Sloane, R. , Pieper, C. , & Box, T. L. (2002). A randomized controlled trial of the psychosocial impact of providing internet training and access to older adults. Aging & Mental Health, 6(3), 213–221. - PubMed

Woodward 2011

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Zaccaria 2020

    1. Zaccaria, D. , Guaita, A. , Vaccaro, R. , Casanova, G. , Abbondanza, S. , Pettinato, L. , Cerati, G. , Rolandi, E. , & Sala, E. (2020). Assessing the impact of social networking site use on older people's loneliness and social isolation. A randomized controlled trial: The Aging in a Networked Society‐Social Experiment Study (ANS‐SE). Contemporary Clinical Trials Communications, 19, 100615. - PMC - PubMed

Zhao 2020

    1. Zhao, X. , Wang, L. N. , Ge, C. X. , Zhen, X. T. , Chen, Z. , Wang, J. , & Zhou, Y. Y. (2020). Smartphone application training program improves smartphone usage competency and quality of life among the elderly in an elder university in China: A randomized controlled trial. International Journal of Medical Informatics, 133, 104010. - PubMed

EXCLUDED STUDIES Bolle 2015

    1. * Bolle, S. , van Weert, J. C. , Daams, J. G. , Loos, E. F. , De Haes, H. C. , & Smets, E. M. (2015). Online health information tool effectiveness for older patients: A systematic review of the literature. Journal of Health Communication, 20(9), 1067–1083. - PubMed

Burkow 2015

    1. * Burkow, T. M. , Vognild, L. K. , Johnsen, E. , Risberg, M. J. , Bratvold, A. , Breivik, E. , & Hjalmarsen, A. (2015). Comprehensive pulmonary rehabilitation in home‐based online groups: A mixed method pilot study in COPD. BMC Research Notes, 8(1), 1–11. - PMC - PubMed

Clarkson 2018

    1. * Clarkson, P. , Hughes, J. , Roe, B. , Giebel, C. M. , Jolley, D. , Poland, F. , & Challis, D. (2018). Systematic review: Effective home support in dementia care, components and impacts—Stage 2, effectiveness of home support interventions. Journal of Advanced Nursing, 74(3), 507–527. - PubMed

Cooper 2014

    1. * Cooper, K. , Kirkpatrick, P. , & Wilcock, S. (2014). The effectiveness of peer support interventions for community‐dwelling adults with chronic non‐cancer pain: A systematic review. JBI Evidence Synthesis, 12(5), 319–348.

Dam 2017

    1. * Dam, A. E. , de Vugt, M. E. , van Boxtel, M. P. , & Verhey, F. R. (2017). Effectiveness of an online social support intervention for caregivers of people with dementia: The study protocol of a randomised controlled trial. Trials, 18(1), 1–10. - PMC - PubMed

Dickens 2011

    1. * Dickens, A. P. , Richards, S. H. , Hawton, A. , Taylor, R. S. , Greaves, C. J. , Green, C. , & Campbell, J. L. (2011). An evaluation of the effectiveness of a community mentoring service for socially isolated older people: A controlled trial. BMC Public Health, 11(1), 1–14. - PMC - PubMed

Erfani 2018

    1. * Erfani, S. S. , & Abedin, B. (2018). Impacts of the use of social network sites on users’ psychological well‐being: A systematic review. Journal of the Association for Information Science and Technology, 69(7), 900–912.

Fan 2016

    1. Fan, Q. (2016). Utilizing ICT to prevent loneliness and social isolation of the elderly: A literature review. Cuadernos de Trabajo Social, 29(2), 185–200. 10.5209/CUTS.51771 - DOI

Forsman 2017

    1. * Forsman, A. K. , & Nordmyr, J. (2017). Psychosocial links between Internet use and mental health in later life: A systematic review of quantitative and qualitative evidence. Journal of Applied Gerontology, 36(12), 1471–1518. - PubMed

Gine‐Garriga 2017

    1. * Giné‐Garriga, M. , Coll‐Planas, L. , Guerra, M. , Domingo, À. , Roqué, M. , Caserotti, P. , & Salvà, A. (2017). The SITLESS project: Exercise referral schemes enhanced by self‐management strategies to battle sedentary behaviour in older adults: Study protocol for a randomised controlled trial. Trials, 18(1), 1–14. - PMC - PubMed

Gorenko 2021

    1. * Gorenko, J. A. , Moran, C. , Flynn, M. , Dobson, K. , & Konnert, C. (2021). Social isolation and psychological distress among older adults related to COVID‐19: A narrative review of remotely‐delivered interventions and recommendations. Journal of Applied Gerontology, 40(1), 3–13. - PubMed

Jones 2019

    1. * Jones, C. A. , Siever, J. , Knuff, K. , Van Bergen, C. , Mick, P. , Little, J. , & Miller, H. (2019). Walk, Talk and Listen: A pilot randomised controlled trial targeting functional fitness and loneliness in older adults with hearing loss. BMJ Open, 9(4), e026169. - PMC - PubMed

Lara 2016

    1. * Lara, J. , O'Brien, N. , Godfrey, A. , Heaven, B. , Evans, E. H. , Lloyd, S. , & Mathers, J. C. (2016). Pilot randomised controlled trial of a web‐based intervention to promote healthy eating, physical activity and meaningful social connections compared with usual care control in people of retirement age recruited from workplaces. PLoS One, 11(7), e0159703. - PMC - PubMed

Nicholson 2012

    1. * Nicholson, N. R. (2012). A review of social isolation: An important but underassessed condition in older adults. The Journal of Primary Prevention, 33(2), 137–152. - PubMed

Nijman 2019

    1. * Nijman, S. A. , Veling, W. , Greaves‐Lord, K. , Vermeer, R. R. , Vos, M. , Zandee, C. E. , & Pijnenborg, G. H. (2019). Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for social cognition and social functioning in people with a psychotic disorder: Study protocol for a multicenter randomized controlled trial. BMC Psychiatry, 19(1), 1–11. - PMC - PubMed

Perkins 2012

    1. * Perkins, E. A. , & LaMartin, K. M. (2012). The Internet as social support for older carers of adults with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities, 9(1), 53–62.

Preston 2019

    1. * Preston, C. , & Moore, S. (2019). Ringing the changes: The role of telephone communication in a helpline and befriending service targeting loneliness in older people. Ageing & Society, 39(7), 1528–1551.

Rebollar 2015

    1. * Rebollar, A. M. , & Francisco, W. C. (2015). Correlación entre actividades de interacción social registradas con nuevas tecnologías y el grado de aislamiento social en los adultos mayores. Revista mexicana de ingeniería biomédica, 36(3), 181–190.

Selak 2019

    1. * Selak, Š. , Bacaicoa, O. A. , & Gabrovec, B. (2019). Can we manage frailty at individual level by the use of information and communication technologies: A narrative literature review. Slovenian Medical Journal, 88(5–6), 249–262.

Sumner 2021

    1. * Sumner, J. , Chong, L. S. , Bundele, A. , & Wei Lim, Y. (2021). Co‐designing technology for aging in place: A systematic review. The Gerontologist, 61(7), e395–e409. - PMC - PubMed

Toh 2016

    1. * Toh, H. M. , Ghazali, S. E. , & Subramaniam, P. (2016). The acceptability and usefulness of cognitive stimulation therapy for older adults with dementia: A narrative review. International Journal of Alzheimer's Disease, 2016, 5131570. - PMC - PubMed

Winterton 2011

    1. * Winterton, R. , & Warburton, J. (2011). Models of care for socially isolated older rural carers: Barriers and implications. Rural and Remote Health, 11(3), 203–215. - PubMed

Zeppegno 2018

    1. * Zeppegno, P. , Gattoni, E. , Mastrangelo, M. , Gramaglia, C. , & Sarchiapone, M. (2019). Psychosocial suicide prevention interventions in the elderly: A mini‐review of the literature. Frontiers in Psychology, 9, 2713. - PMC - PubMed

STUDIES AWAITING CLASSIFICATION

    1. Ongoing studies
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Donovan 2020

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Falk 2021

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Findlay 2003

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Gardiner 2018

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Hagan 2014

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Ibarra 2020

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Jopling 2020

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Kelly 2017

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Khosravi 2016

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Leigh‐Hunt 2017

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    1. Other published versions of this review
    1. Classification pending references

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