A) They're countries where applications have been filed for the same or similar patent. Those patents comprise the paten family. The applications all claim priority from the same document(s). Only the US patent application has been granted.
B) The main reason is the backlog patent offices have, so every step can take a long time. Patents applications are usually rejected at first and then bounce back/forth before a grant occurs (or abandonment etc)
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Ann: iPPS SIGNIFICANT OA PAIN REDUCTION AT 12 MONTHS, page-227
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