Spellings that kill

Spellings that kill

Current English spellings are taken for granted.  People may be surprised to learn that our spelling regime is a huge financial and moral burden on society and results in many deaths each year.  It is no over statement to say that a disease with similar statistics would be labelled a pandemic and there would be a mass call to action.  It is not an overstatement to say that its consequences on our society are more damaging than the work of many terrorist organizations combined.  Most of us don’t notice the spelling problem because we have been desensitized to the issue for such a large portion of our lives.  Allow me to surprise you with some observations. 

I’ll start with the basic facts, then show the consequences.  We have been conditioned to believe that English words ‘build up’ from appropriate letters, as they do in Italian and Finnish.  If this were true, spoken English would contain five vowel sounds and 21 consonant sounds.  Depending on accent, the English language uses about 42 spoken sounds, and spells these sounds in over 400 ways.  For example, the sound normally represented by k has 11 common spellings: key, cat, back, bouquet, chemistry, Mecca, Pinocchio, dekko, khan, lacquer, and biscuit. If English spelling was consistent, comb, tomb, and bomb would rhyme, and they, say, and weigh would not.  Unlike most languages, there are multiple ways to spell nearly every phoneme (sound), and most letters also have multiple pronunciations depending on their position in a word and the context. Robert Burchfield, lexicographer for the Oxford English Dictionary, tells us “English spelling is quite seriously unrelated to pronunciation.”

English used to have a more consistent spelling regime but was corrupted by the Normans in the eleventh century and later misguided scholars.  Today, English orthography is a collection of weak rules, many exceptions, and lots of ambiguities. Is this a problem?

Most English speakers are daunted by the idea of learning to write in Chinese, where one has to learn a unique symbol for every word, and yet English is not so very different, having to learn an (almost) unique combination of letters for each word.  Neither language is phonemic orthographic (where written characters directly relate to sounds).  For this reason, lexicographers (dictionary compilers), linguists, classical singers etcetera use alternatives to describe pronunciation such as the International Phonetic Alphabet.  

English speaking countries are among the most affluent in the world, many of them outspending most other countries on education. Look at the top 20 countries for literacy, however, and we do not see any English-speaking nation.  The former Russian state of Georgia has the highest level of literacy, followed by Cuba, and Estonia. Russia, Tonga and Poland are all ahead.  The USA and UK, with massive education budgets, only score as well as Albania, the poorest country in Europe.

The above statistics are not surprising when we learn that Georgian and Albanian have a high correspondence between letter and sound.

Few adult Anglophones can spell all of the words they normally use.  A MORI poll in the USA in 2009 showed that one in four of the population believed they had a spelling problem, but when tested, it was found that half of the population could not spell many common words.  A similar poll in the UK a year earlier showed strikingly similar results[1].  There is now concern about the deplorable literacy of many graduates.

Illiteracy in the English-speaking world is higher than in other developed countries, despite the fact that more money and time is spent teaching our primary language than in non-English speaking countries.  Many children experience great trauma in learning to spell, and for a huge number of native English speakers, it is too much; they never learn to read and write adequately.  79% of New York City’s high school graduates lack basic literacy skills.  Without access to the written word those people suffer in all other areas of education; difficulties are presented for them becoming productive members of society.  Society suffers from having an under skilled workforce; arguably it is not graduates we are most short of, but literate and numerate workers.  ‘More education’ (more of the same), eg increasing the school leaving age, at great cost, is not going to solve the problem.

‘Poor readers’ are six times more likely to drop out of school than average readers.  It has been estimated that high school dropouts cost the United States $158 billion in lost earnings, and $36 billon in lost state and federal income taxes for every year’s cohort of school leavers.   There is therefore a very compelling economic argument for improving our spelling conventions.  Those who learn spelling with ease would have time freed up to learn genuinely interesting things, the government would have more tax revenue to spend on public services without having to raise tax rates, and everyone would benefit from a more buoyant economy.

Resolving the spelling problem could be the third most cost effective measure to improve not only the national economy of English-speaking nations over a generation, but all those economies where English is being acquired as the first genuinely global language.  Spelling reform could benefit our globalizing economy by making English easier to acquire as a second language, and have a similar impact to the introduction of the printing press that enabled the Renaissance. 

Apart from the economic concern, there is a moral concern.  Poor readers are three times more likely to consider or attempt suicide than average readers.  Many of these deaths are preventable.  Depending on how you measure it, the illiteracy rate is over 60% in the prison population.  Those unable to make it through our education system, including some highly intelligent dyslexics[2], are denied their rightful place in our increasingly knowledge-based economy.  Some may decide that they have no prospect of earning a living legally.  

“I’ve had guys say to me ‘brother, I can’t get a job because I can’t fill out an application.   I’m not going to the job centre ’cos I’m embarrassed that I can’t fill out an application.  I’d rather commit a crime ’cos I know how to do that.’ ” Carl Smith, reformed criminal who served 3 prison terms.

The prison population in English speaking countries is higher than in comparable countries.  The 5 countries with the highest proportion of prisoners are all English speaking (USA ranks 1st); the next 20 countries are either English speaking, non-democratic, or formerly non-democratic countries with a high historic prison population.   Modernizing our spelling regime may be the least expensive method of cutting crime, including preventing many of the brightest people from becoming criminals.  And why would we want some of the most inventive people in prison anyway?; the toothbrush was invented in prison by an inmate.  The Erie Canal, linking the Atlantic to the Great Lakes, that allowed the expansion of the United States economy and paid for itself during its first year of operation was conceived and designed in detail in prison by another poorly educated inmate.  Septicemia was cured by another poorly educated inmate. Even the modern novel was invented in prison.

Our spelling system can cost lives on the front line. In Afghanistan in July 2008, a hand full of Western mentoring troops were on a mission with a unit of the fledgling Afghan National Army.  They were attacked by a large Taliban force and needed to call in air support to extricate themselves.  Broadcasting real grid references was not permitted; the code word of the day was used to encode the location before transmission.  A farcical situation developed; the commander did not know how the code word was spelled.  Troops under lethal fire were interrupted to see if they could spell the word!  None of them could.  

This was not an isolated example, but an effect that dates back at least to the second world war.  Britain’s SOE, Special Operations Executive, operated secret agents in occupied countries, working with resistance groups.  Agents used 5 words chosen at random from a pre-agreed passage of text to produce a unique cypher for the message. These 5 words formed an indicator group at the head of the message.  One agent operating in France, miss-spelled the indicator word ‘rapping’ (he used only one P).  It took 3,000 attempts by SOE in Britain before the message was deciphered[i].   

We cheat to cope with existing spellings.  TV news presenters have the text of each news article projected on a Teleprompter/Autocue mounted in front of the camera.  Difficult to pronounce words are spelled phonetically as an aide to presenters.  And, of course, we rely on spell checkers as we type.          

Solving the problem

Progressive thinkers can see the overall benefit to society of implementing a solution.  Just as some recognize problems and advocate solutions, we also have ‘traditionalists’ who refuse to recognize problems, or down play them, preferring to maintain the status quo instead.  Although it is selfish to ignore the needs of others, they claim that historical precedent is more important than usefulness or relevance today.  However, historical precedent is often on the side of today’s reformers; many of our words were spelt more sensibly in the past: island was once spelled iland, friend was spelled frend, and there as ther; these more phonetic spellings were deliberately corrupted by linguists in a misguided desire to use spelling as a guide to etymology.  Here are a cache of spellings from Middle English (used during the late middle ages when the Latin alphabet was introduced), they are preceded by their corrupted modern forms: build ? bild, come ? cum, chief ? cheef, crystal ? cristal, force ? fors, ghost ? gost, leaf ? leef, liquor ? licur, parliament ? parlement, phantom ? fantum, pheasant ? fesant, rhyme ? rime, salmon ? samon, scholar ? scoler, scythe ? sithe, trousers ? trowsers, tongue ? tung, world ? wurld, wonder ? wunder (there are many more).  Many of the above accurate phonetic spellings in Middle English are to be found in children’s writing today, where it is sadly ‘corrected’ into today’s corrupted form.

Not spelling words phonetically has yielded many different words with different sounds that are confusingly spelt the same, here are some:  “As Farmer Brown stood in the pig sty he remembered the idea of getting the sow to sow corn, their attempt to entrance her once she was though the entrance, and the row with Billy about getting the seeds in a row; well, they had to find some more efficient way to produce produce. He had hammered his thumb a number of times and the more he did so the number it got.  He would lead the sow back in but first he had to tie the leather lead around the lead pipe, if he could wind the other end around the gate latch the wind would not bang it closed.   The object of his thoughts was ensuring that Billy would not object to the new object, and would not be forced to stand too close to the gate to close it.”   My job title was once Lead Consultant, which was misinterpreted on a visit to Hungary where a potential client thought I must have something to do with the metal. 

Many people are adventurous when the are young, accepting the new technologies of the time, and thinking that older generations are stuffy and old fashioned.  Later in life they see new developments more negatively, and in old age refuse to accept technologies that have become mainstream.  While there are ‘silver surfers’, pensioners who spend much of their time on the world-wide web, there are those who refuse to learn to use a computer, and even sustain the belief that the world would be better off without them.  When my mother was a girl, her parents would exclaim “Get your head out of that book and do something useful”, a generation later it had become “Stop watching so much television, why don’t you read a book instead?” now it’s “Don’t play video games all the time, come and watch telly with us”.  People in each generation equate their youth with a ‘golden age’, and encourage the next generation to conform to it, without realizing that their golden age is generational prejudice.   The desire to maintain current spelling is also generational prejudice.

There are several genuine solutions to the spelling problem.  All of the methods reduce the average word length, and hence reduce the number of pages needed by publications.  The saving in trees and publication costs alone would be colossal.

Rationalize

Many different teaching systems have been tried, some with beneficial results, but none have solved the problem of illiteracy.  This is because the problem is endemic in our spelling ‘system’, though system is the wrong word to use since it is anything but systematic.  Over half the US population agree that spelling requires memory rather than logic.  According to the surveys, 40% of US citizens and 69% of Britons would support updating our spellings, and yet English Spelling has not been officially reformed since 1906 when President Theodore Roosevelt signed an executive order that improved the spelling of 300 words. Other languages have seen more recent reform eg, Japanese in1946, Danish in 1948, Chinese in the 1950s, Latvian in 1914, 1946, and 1957, Indonesian in 1947 and 1972, French in 2004 when they changed the spelling of 2000 words and some grammar rules, the German speaking countries signed an agreement on spelling reforms in 1996, to be implemented by 2005, Norwegian in 1907, 1917, 1938, 1941, 1981, and 2005, Dutch (agreement between Nederland and Belgium) in 2005, Taiwanese in 2009, and others.  Not all of these have been well received at the time, and not all of the changes have stuck, but generations have or will benefit.  

Everyone reading this text has benefitted from spelling reforms and natural changes in the past.  We would not wish to go back to spelling logic as logique, or war as warre, or town as toune; we can thank the reforms of 1662 for improving these words.  Musick changed to music only in the 1880s, shew changed to show in about 1914, and fantasy was spelled phantasy until the 1920s; the latter three changes occurring organically.  Any student of English will know that our rules of grammar and spelling have changed over the centuries; Old English is unintelligible to English speakers today: “Ic ?lfric wolde Tas lytlan boc” (I, Aelfric, wished to translate this little book).

Despite the best attempts of some to ‘standardize’ English over the centuries, the language and spelling have continued to evolve.  Trying to prevent change was no more successful than King Canute trying to hold back the tide.  The introduction of printing retarded spelling change, but change has continued still: silent fn… and w… have disappeared, v and u, and i and j have become separate letters while T has been replaced by th.  In some cases pronunciation has altered to fit spellings; in the 1930s the silent h at the beginning of words adopted from French (such as herb, hospital and hotel) became enunciated.

Some prefer that we just change the most commonly misspelled words, 10, 20, 100, or 300 of them depending on the advocate;  this is not really a solution but it does reduce the extent of the problem.  Others advocate that we use the Latin letters more systematically, using digraphs and trigraphs to represent all the sounds that we use, replacing the various inconsistent combinations of letters used today.  Cut spelling reduces the need to represent vowels in certain situations.         

One approach to reform is to embark on progressive change; each stage being planned in a series.  For example, each stage could include four components:

  • One systemic spelling change.
  • Removal of one grammatical anomaly.
  • Rationalizing the 20 most commonly misspelled words at that time (eg foreign), directly to their ultimate spelling.  
  • Rationalizing the 20 most illogically spelled words in regular usage at that time (eg bureaucracy), directly to their ultimate spelling.

Systemic spelling changes could build on one another, perhaps first taking all occurrences of c that sound like s and changing them to s.  Later, all occurrences of c that sound like k be changed to k, leaving only those c letters in the digraph ch.  Some time later, when people have come to associate c only with the sound ch, the h will no longer be needed in the digraph and can be dropped.  We would then have returned to the more sensible state enjoyed by English speakers in the 10th Century. Other systemic changes could include:

  • Replacement of ph with f, a change that has been gradually happening for years.
  • Replacement of q with k (as in Turkish);  qu becomes kw.  The non-English qu spelling was imposed on English by the Normans. 
  • Replacement of x with ks and eks (also as in Turkish[3]) and with z (as represented in Xavier). Replaced letters would still be available for use in Mathematics and Science where they have non-English meanings. 
  • Moving any ‘magic e’ (‘silent e’) from the end of the word to immediately after the vowel that it affects.  This has already happened to some words, eg shepe (1398) → sheep (today).
  • Dropping unnecessary letters such as redundant doubled consonants and silent letters eg p… (as in pneumatic).

School children could be taught new spellings suitably in advance, so that by the time they leave education, the spellings they learned would be in general use.  This would prevent many children from having to re-learn words during their schooling.  Youngsters leaving education might regard former spellings as quaint, and use them to indicate antiquity, just as we do today, eg Ye Olde Shoppe.

As long as the changes occur sufficiently slowly that existing users can master them without too much difficulty, they could be acceptable to the population.  Provided that governments work to ensure that the media, education system, government departments, and government contractors use the revisions, I think that progressive change would become acceptable to the same extent that it has for other languages.   

The disadvantage of progressive change is that it’s messy.  We would be leaving in our wake a whole series of spelling changes, with some words changing multiple times, once at each stage.  The new spellings of some words would be the same as the old spelling of other words; show would change its spelling to shoe (the ‘magic e’ affecting the vowel o to ‘say’ O), shoe would be spelled Shoo, and Shoo would be spelled Shew; a tad confusing.  Reading older printed works would be problematic.   

New spelling convention

Other people advocate that we create an entirely new spelling convention, based on existing sounds.  For your curiosity, you can read a paragraph in three of the proposed reformed systems:

This paru-graf iz ritun in &NuEnglsih&.  It āmz tu hav u 1 tu 1 kō-resp*onduns bet*wēn soundz and leturz, hwīl prez*urving az much egz*isting sound tu letur kō-resp*onduns az posubul.  It iz 1 uv thu nūest sistumz, prōd*ūst in 2005 and rev*īzd in 2009.

This pairugraf iz ritin in Truspel. It iz naat soe much u rifformd speleeng sistim az u funnetik sistim that kan bee yuezd tue rikkord enee prununseeyyaeshin in enee Eenglish dieyulekt, ullouweeng thu reeder tue reed thu dieyulekt az wel az thu werdz.

dhis par?graaf iz rit?n in SaypYu, witsh standz for "sey az yu pr?nawns yuniv??rs?li".  dhis f?netik speling sist?m woz divel?pt in 2012.  SaypYu yusiz 23 let?rz ov dh? rowm?n alf?bet, pl?s '?' for dh? ‘a’ sawnd in man.

While these solutions avoid messy progressive change, implementing them would be just as difficult as implementing the following bolder solution, but arguably less good.  If we are going to fix this problem, lets do it the most effective way.

New Alphabet

Some of the suggested solutions require new alphabets with one letter or digraph for each English sound, which is called phonemic orthography; technically it is an orthography (system for writing a language) in which the graphemes (written symbols) correspond to the phonemes (significant spoken sounds).  These can take the opportunity to add some logical consistency to the symbols used, and/or ensure that the letters are quicker to write than the medieval alphabet that we still use today[4].  

An obvious choice would be the International Phonetic Alphabet used in many dictionaries, it is already in use in China and other countries to teach English in order to prevent the hurdle of English spelling making the language too difficult to learn. However, native English speakers find the choice of symbols in the IPA counter intuitive (eg the y sound is represented by j, because the j character is used for that sound in many other languages); ‘International’ written in IPA is [??nt??n??(?)n(?)?].  As a result, anglophone friendly alternatives have appeared and are used in many American dictionaries, and the Pronunciation Respelling Key (which only uses the Roman alphabet plus ?) has been developed for Wikipedia’s Wiktionary. 

The Latin alphabet we inherited from the Romans is far from ideal; some letters being too easy to misread.  In a 1980 study, children who had just learned to read were found to read faster and more accurately using the roman alphabet with an additional dot or slash on letters with similar forms to help distinguish between them[ii]Dyslexie, OpenDyslexic, and Eulexia are fonts designed specifically to help minimize mirroring, turning and switching errors, but they are a compromise; they achieve improved distinguishability by adding asymmetric weight to existing familiar letter forms; asymmetric weighting is not pleasing to the eye.  A new alphabet, designed to optimize easier and faster reading and writing by using new and easier to distinguish letter forms could provide a benefit to English users for the next 1000 years, and by having a strong link between letter and sound, could provide a consistent alphabet for other languages as well to make learning multiple languages easier.  

The introduction of Hangul, a new phonetic alphabet for Korean, where each letter was carefully designed to indicate its pronunciation, reduced the time it took to learn the written language and led to a massive increase in literacy.  Wouldn’t it be great if people learning English, now and during the next millennia, could reap that same benefit?  The development and introduction of Hangul required real leadership of a king who genuinely cared about the literacy of his people;  he had to overcome the resistance of an educated elite who didn’t want to lose their privileged status.  Do we have the leaders today who genuinely care?  500 years after the introduction of Hangul the benefits are obvious;  the king responsible is one of only 2 Korean monarchs to have been given the title ‘Great’.  

By avoiding letters with similar appearance we would prevent all manner of mistakes from occurring.  During the early second world war, facilities at Britain’s Bomber Command bases were primitive; overworked aircraft fitters taking a break might use the bed inside a bomber (provided for injured crew) in preference to sleeping in a tent.  One such fitter at RAF Grimsby, prepared to put up with a scheduled test flight around the airfield, chose to nap in 142 Squadron’s QT-O ‘orange’ Wellington bomber.  He found himself on a 2,166km (1,346 mile) mission over hostile territory;  he was actually in QT-Q ‘queen’[iii].  

Transcription errors have widespread consequences;  think of this next time you are in a hospital.  In 2009 a teaching hospital conducted a study of transcription errors that cause the wrong medication to be given to patients.  287 charts with 558 opportunities for error were studied.  Of those opportunities, 167 errors (29.9%) resulted[iv].  A more recent study in a Paris teaching hospital showed strikingly similar results;  with 1505 opportunities for error, 430 actual errors were detected (27.6%), of which 6% were classified as having a serious or significant impact on patients[v].   We should all want an alphabet that minimizes the possibility of transcription errors, even if only for our own safety in hospital.  

For international convenience the digits 0…9 could be retained (with a straight stork for the nine rather than being a rotated 6 with the obvious propensity for rotational error).  No letter forms in the new alphabet would be used that can be confused with the digits, eg P, b, d, l, O, Q, and q would be removed or changed.

New alphabets have been proposed, such as the Deseret Alphabet, developed at what is now the University of Utah. Another is Shavian Alphabet, and another Readspel, though these aren’t designed to avoid transcription errors.  A new alphabet, that could include transcription error safe letters from the roman alphabet (to make learning both alphabets easier), or a new orthogonal set designed to minimize other problems of the latin alphabet could be created.

If the public could be informed adequately, and their appetite whetted sufficiently, I’d recommend a new alphabet, with all the possible advantages indicated above, to run alongside our existing alphabet.  For a generation or two, many publications would be available in both alphabets, with schools only teaching the new one.  Because there would be direct correspondence between existing spellings and the new ones, conversion from one system to the other could easily be performed electronically, allowing an author to write in their preferred alphabet and then publish in both.  Kindle and similar electronic media readers, and other computer applications including Web browsers could convert text from one alphabet to the other in real time according to their user’s preference.  Web browsers already accomplish the more complex task of translating between differing languages.  Signage might seem a problem, but in places where two languages are in common use, such as Brussels, street and other signs in dual languages are normal.   We are used to seeing the labelling of our food and instructions for products in multiple languages so there need be no major cultural problem in using two alphabets.  No doubt apps would be produced for mobile devices that would read text and convert it to the preferred alphabet and spelling regime of the user.   

It would not be any more difficult to become conversant with both alphabets than it is today for people to use both the roman alphabet and shorthand; Pitman shorthand was originally designed as an easier alphabet using more rational spelling.  Japanese is successfully written in two systems, Katakana is phonetic, Kanji is the Chinese system where each character represents a mora, where it is extended with Hiragana to suit the Japanese language.  The Usbek, Serbian and Chechen languages are written in both the Latin alphabet and the Cyrillic alphabet (as used for Russian). Many countries that were a part of the Soviet Union have changed their alphabet from Cyrillic to Latin.  These countries demonstrate that migrating from one alphabet to another is practical. I’d select a new rational alphabet if there were enough enthusiasm for change because the problem would be cleanly fixed in a generation or so.  Those who prefer the existing alphabet and spellings can continue to use them and therefore would not be a significant source of resistance.

China introduced the phonetic Pinyin alphabet in 1958 and achieved an astonishing increase in literacy as a result.

To avoid using accents, some additional letters could be introduced (especially for vowel sounds), and digraphs can be used (eg the ‘magic e’ can follow a vowel that is to ‘say it’s name’), ‘oo’ can represent the sound in zoo, and other letters that affect sounds can be adopted such as the Slavonic letter ь (yer);  it has no meaning on it’s own;  it indicates that the preceding consonant is soft (palatalized).  

Do nothing

The last alternative is that we do nothing.  If so, I suspect that ‘text speak’ spellings will overrun current spelling.  Text speak grew in popularity among the young for mobile phone texting, spread to online instant messaging, made rapid gains in email and blogs, and now appears in advertising.  It will supplant our archaic spellings as surely as English, the language of the uneducated, replaced Latin, the respectable but absurdly complex language of the ‘learned’ at the end of the sixteenth century.

Although text speak is shorter than conventional spelling, it lacks a systematic spelling scheme, so is not a desirable replacement.  Perhaps the only hope of saving traditional English from being overrun by text speak, is to remove English’s Achilles’ heel; its abysmal non-phonetic and inconsistent spelling.  The positive view of text speak (apart from its shorter length for texting) is that its rapid growth indicates the willingness of people to rapidly adapt to new spellings.

Those wishing to learn more on this subject can find details at the English Spelling Society www.EnglishSpellingSociety.org or the American Literacy Council www.AmericanLiteracy.com.  

[1] Both surveys were sponsored by the English Spelling Society.

[2] Reputed dyslexics include: Albert Einstein, Thomas Edison, Leonardo da Vinci, Pablo Picasso, Alexander Graham Bell, Michael Faraday, John Chambers (CEO of Cisco), John Lennon, Richard Branson, Henry Ford, Walt Disney, Charles Conrad (third astronaut to walk on the moon), Ingvar Kamprad (founder of IKEA), Anita Roddick (founder of Body Shop), Paul Orfalea (founder of FedEx Office), Tom Pellereau (serial inventor), Ferdinand Pi?ch (grew Audi and Volkswagen and named Car Executive of the Century in 1999), Hal Prewitt (founder of CORE, later sold to SONY), Charles Schwab (founder of the US brokerage firm), Ben Way (founder of a string of Web businesses), Paul MacCready (aviation inventor and founder of AeroVironment) and Dean Kamen (entrepreneur, inventor, and presenter of the Dean of Invention TV series).  All arguably have extremely well developed visual-spatial skills and are visionaries.

[3] When Turkey moved from the Arabic alphabet to the Latin alphabet in the 1920s, they removed these 2 redundant letters.

[4] Our modern alphabet is slightly different to the ancient version, as new letters (J, U, and W) and lower-case versions of letters were introduced in the medieval period.

[i] Leo Marks, Between Silk and Cyanide; a Codemaker’s War 1941-1945, Harper Collins (2000), pp12-13.

[ii] Lockhead, G., & Crist, W. (1980). Making letters distinctive. Journal of Educational Psychology, 72(4), pp483-493.

[iii] W E Wilkinson, Halifax and Wellington by Chaz Bowyer & Brian J Rapier, Promotional Reprint Company (1994), p225.

[iv] Fahimi F et all, Transcription errors observed in a teaching hospital, Arch Iran Med, March 2009, 12(2):173-5 p1.

[v] Berdot S et all, Evaluation of drug administration errors in a teaching hospital, BMC Health Ser. Res, (Mar 2012) 12:60. Doi: 10.1186/1472-6963-12-60.493.

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