Category Archives: Science2.0/Health2.0

At the Movies: Public Health Aspects of E-Cigarettes, 10 (Or So) Thought-Provoking Videos

The Risk Bites video series is touching on many of my favorite emerging technologies topics. Every now and then, I’m hoping to take some of their topics and dig into the issues a little more. Today’s topic is e-cigs, which I’ve blogged about here before. Earlier this week, the e-cigarette panel discussion at the annual meeting of the American Public Health Association (#APHA14) attracted a great deal of attention, including attendance from the current Surgeon General.

In addition, APHA endorsed a public call to the FDA to push forward on regulating electronic cigarettes.

20149 Regulation of electronic cigarettes — Calls on the U.S. Food and Drug Administration to develop regulations that hold e-cigarettes to the same marketing and advertising standards as conventional tobacco cigarettes and calls for the federal funding of research on the short- and long-term health consequences of e-cigarette use. Urges the Consumer Product Safety Commission to require special packaging, including warning labels, on e-cigarette cartridges to help prevent childhood poisoning. Also calls on state and local official to restrict the sale of e-cigarettes to minors as well as the use of e-cigarettes in enclosed public areas and workplaces. APHA News Releases: New 2014 policy statements http://www.apha.org/news-and-media/news-releases/apha-news-releases/2014-policy-statements

This all makes this topic especially timely, and worthwhile of reviewing once more. Please note, I am NOT saying these are the reasons behind the APHA call for action, or even that there is research to support the points below. I am saying only that these are things I’ve noticed and found interesting. If there isn’t research, maybe there needs to be. If existing research doesn’t yet answer important safety questions, maybe we should act with caution until we do have those answers. It there is, then maybe I could share some in another post. I do believe that the issue of e-cigs is more nuanced than we might be led to believe by much of the public dialog around it — that there are both benefits and risks. So, with that caveat, here we go!

NUMBER 10


Electronic cigarettes and health – the basics https://www.youtube.com/watch?v=mToznqKD5Ac

Primary public health perspectives mentioned in this video:
– What are the impacts of use by children?
– E-Cigs reduce toxins from smoke for regular smokers
– Are e-cigs simply an easier path to nicotine addiction?
– Aside from the intended nicotine, there may be impurities & contaminants from e-liquid solutions
– The FDA only has oversight over certain aspects of e-cigs, and there may be a lack of regulation for other potentially risky aspects of the device & liquids.

This is a truly excellent introduction in very few minutes to the most important considerations of e-cigarette use. The best quick overview I’ve seen. There are a few other issues to possibly address. See the following videos for a broader picture of public health aspects of e-cigarettes.

NUMBER NINE

There have been (few, but some) reports of e-cigarette devices that were flawed in manufacture and did nasty stuff like explode in someone’s face. This is another aspect for the attention of regulators. Some of the explosions have been when on charge (as in this video), or have been modified in some way by the user (“at your own risk” becomes a very meaningful phrase). There are reports of this happening while in use and damaging the user’s face. Because this is not a medical device, these events are not being recorded in a way that allows healthcare systems to document and define the level of risk. Without that, you are basically depending on the industry to self-police manufacturing standards and error rates.


E-cigarette on charge explodes in bartender’s face: CAUGHT ON CCTV CAMERA https://www.youtube.com/watch?v=x1VrzgeG7jk

NUMBER EIGHT

We live in a MAKER world. People hack their medical devices, and people hack their home devices. Why should e-cigarettes be any different? According to this video people hack their e-cig devices to make them hotter, and to have less of a draw, so they can get more vapor with less effort. According to the scientists, this changes the risks associated with the chemicals. We need to ask not only what people are already doing to hack these devices, but what else they might do with them or their components. I’m sure we have yet to imagine everything that could be done with vape pens.


Mashable: How to Hack Your Own E-Cigarettes https://www.youtube.com/watch?v=rmxwnuTRMiw

NUMBER SEVEN

Vaping is a drug delivery mechanism. Nicotine is only one drug. There is talk about using vaping as a tool for delivering other medications that require inhalation, such as asthma meds. Of course, it needn’t be used solely for prescription meds, either. Vaping is also a tool for delivering street drugs, illegal drugs, and home made drugs. This, again, could be good or bad, depending on the circumstances.


How To Mix & Make Your Own E Juice Liquid DIY https://www.youtube.com/watch?v=x57PaibrOag

SPECIAL REPORT: Teens using E-Cigs to smoke marijuana http://www.nbc11news.com/home/headlines/SPECIAL-REPORT-Teens-using-E-Cigs-to-smoke-marijuana-245882671.html

NUMBER SIX

Remember the phrase “gateway drugs”? There are recipes all over the Internet for how to make your own e-cig liquid, and those recipes include directions for how to make e-cig liquid to deliver illegal drugs. I think the genie is out of the bottle on that one, but it is certainly an issue to address in public health circles. Of course, also keep in mind that e-cigs may be a alternate way to provide medical marijuana to patients.


How To: Potent Water-Soluble Cannabis Concentrate in Glycerin https://www.youtube.com/watch?v=MQyx8br65N0&list=PLpKaVRowbJ84eVJTLbAyVUUdzSXfJwLVS

NUMBER FIVE

People have mentioned the issues of e-cig flavors that are clearly being marketed specifically to children, and how the devices are being marketed as cool/fun/sexy for young adults.


Do Vape Pens Trick Teens? https://www.youtube.com/watch?v=HnKwHWyHH4g


A Sexy View of the ECC 2014 Expo – Vape Club https://www.youtube.com/watch?v=i6SQiu08DxQ

It really makes it look like fun, doesn’t it? That was actually the first thing that attracted my attention to e-cigarettes. I saw so many incredibly beautiful photos streaming thru the sites marketing the devices, it seemed like there was an awful lot of money and genius being poured into the campaigns. It made me wonder why.

NUMBER FOUR

Recent research from the CDC reveals that e-cig use among children and teens is skyrocketing. It may take time to learn the long term outcomes of this trend.


CDC: More kids lighting up e-cigarettes https://www.youtube.com/watch?v=zJ_BEiKpqaE


Growing Number of Youth Smoking Vaporizers https://www.youtube.com/watch?v=0L3so_qfpuo

NUMBER THREE

Research also seems to show that youth who start with e-cigs are more likely to convert to conventional cigarettes. This is, obviously, the reverse of using e-digs as a smoking cessation device.

Study: Youth who have used e-cigarettes are twice as likely to smoke conventional cigarettes
Study: Youth who have used e-cigarettes are twice as likely to smoke conventional cigarettes http://kimt.com/2014/09/24/study-youth-who-have-used-e-cigarettes-are-twice-as-likely-to-smoke-conventional-cigarettes/

Teenage E-Cigarette Use Likely Gateway to Smoking http://www.bloomberg.com/news/2014-03-06/teenage-e-cigarette-use-likely-gateway-to-smoking.html

Intentions to Smoke Cigarettes Among Never-Smoking U.S. Middle and High School Electronic Cigarette Users, National Youth Tobacco Survey, 2011–2013 http://ntr.oxfordjournals.org/content/early/2014/09/16/ntr.ntu166

NUMBER TWO

This video seems to me to be intentionally designed to scare people, BUT, despite the hyperbole and drum rolls, the content is largely factual, just framed to be extra exciting. I’m including links to the source content so you can dig into it more, and don’t have to depend on the video.


CDC Releases Negative Findings of E-Cigarettes https://www.youtube.com/watch?v=3bMUxSw1BoM

CDC: Youth Tobacco Prevention: Electronic Cigarettes: Key Findings: Intentions to smoke cigarettes among never-smoking U.S. middle and high school electronic cigarette users, National Youth Tobacco Survey, 2011-2013 http://www.cdc.gov/tobacco/youth/e-cigarettes/

CDC News Room: E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012 http://www.cdc.gov/media/releases/2013/p0905-ecigarette-use.html

CDC News Room: More than a quarter-million youth who had never smoked a cigarette used e-cigarettes in 2013: http://www.cdc.gov/media/releases/2014/p0825-e-cigarettes.html

CDC: Youth and Tobacco Use: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/

CDC Newsroom: Emerging tobacco products gaining popularity among youth; Increases in e-cigarette and hookah use show need for increased monitoring and prevention http://www.cdc.gov/media/releases/2013/p1114-emerging-tobacco-products.html

CDC Newsroom: New CDC study finds dramatic increase in e-cigarette-related calls to poison centers; Rapid rise highlights need to monitor nicotine exposure through e-cigarette liquid and prevent future poisonings http://www.cdc.gov/media/releases/2014/p0403-e-cigarette-poison.html

NUMBER ONE

The LONG version! An hour long lecture by Dr. Lynne Dawkins from the University of East London.


Electronic cigarettes: What we know so far https://www.youtube.com/watch?v=f6KBGH2F63A

Among other issues, she points out that excessive regulation of vape pens and e-digs could lead to people making their own devices. The genie is out of the lamp — people know what these are and how they work. It isn’t going to be that hard to make your own, but it may create other kinds of risks and quality control issues. Right now, you can actually buy kits to make your own vape pen at home.


How To Make A Home Made Vaporizer Out Of House Hold Items http://www.youtube.com/watch?v=2N0w34OWVx0


Just for balance, here are a couple of infographics about e-cigs and the balance of research, information, and evidence currently available.

Risk Bites Ten Thousand! (Or, The Bravery of Academic Discourse On Youtube)

"Help us unleash the Elements of Risk Song!"

I LOVE RISK BITES!!! Ok, there you have it. I confess. Here is part of why I like them so much. You see, I don’t just love Risk Bites. I love a LOT of Youtube science education channels. But of the top science channels on Youtube, the ones with a huge fan base and almost aggressive vitality, most of them are either created by kids, young adults, and hobbyists, or they are from huge big money operations. (Please see the APPENDIX at the bottom of this post for more about “What do popular science channels look like?”) What’s missing? Academics and professionals.

And why not? Why shouldn’t there be popular science video channels from academics? WHY NOT?

Yes, universities have Youtube channels and make videos highlighting research by their faculty. Typically, they don’t go viral. Look at them, and you can tell why. They’re good, but dry. They are just not going to get the eyeballs in the same way. They aren’t, well, FUN! A lot of the reason why they aren’t fun is that they’re afraid. They’re afraid of not looking academic. They’re afraid of what their peers will say. They’re afraid of taking the risk, and maybe having someone misunderstand what they said. They’re afraid of looking silly.

MLGSCA09 Cerritos: SocMed Risks - Looking Silly

Academics tend to judge other academics. They complain bitterly when the general public won’t listen to them, but on the flip side, God help any academic who does succeed in getting public attention for communicating science well. Typically, they are ridiculed and undermined by their academic peers. We, as academics, as institutions of learning, need to cut that out. When we belittle and criticize other academics for communicating effectively with the public, it makes all of us look bad. It undermines the credibility of all of science. It weakens our justification for funding, and the understanding the public has of what we do. If you have to criticize another scientist or researcher, stick to the science, and don’t blame them for “being popular.”

Risk Bites is brave. They take the risks that other academics are often afraid to take. They talk about important and sometimes controversial topics. They do so in an engaging and still accurate way, sticking to the good science, and providing more resources in the notes for people who want to explore or learn more. They engage in the conversation with people who comment. They even make videos responding to points brought up in conversation. They are building a community.

Risk Bites is the best example I know of an academic or professional voice that intentionally, purposefully, and responsibly positions itself in the space inhabited by FUN science education videos. Here is more about the background and thought behind what they are trying to do.

So, when I say I love Risk Bites, I am not just talking about the great videos, or the quality of the content, or the awesome and relevant timely selection of topics. I’m talking also about the vision, the mission, the willingness to take risks, the BRAVERY of what they are doing. And I passionately want others to notice, pay attention, and support this grand effort.

When I heard that Risk Bites has a subscription drive, I wanted to write this. I want you to stop and think about how academic science information in Youtube compares to the popular science channels. Check out Sixty Symbols, from the University of Nottingham. That is the only popular science channel I could find from an academic source. Think about why more of us aren’t there, why WE aren’t there, why YOU aren’t there.

And then I want you to do the right thing. I want you to help to get eyeballs on another strong academic science voice in Youtube. I want you to support the people who are brave enough to try. I want you to go to the Risk Bites channel, watch some of their videos, comment, ask questions, tell them what they can do better, and SUBSCRIBE!


Help us unleash the Elements of Risk Song! https://www.youtube.com/watch?v=neOQEEAiwQM&list=UU8cxoTk9M0HdZB3gyJNjEtw


APPENDIX: 31 POPULAR YOUTUBE SCIENCE CHANNELS BY SUBSCRIBERS

VSauce 8,016,315
National Geographic 3,597,161
ASAP Science 3,146,879
VSauce2 3,096,072
Minute Physics 2,573,651
Charlie Is So Cool Like 2,402,791
SciShow 2,234,369
Smarter Every Day 2,194,233
VSauce3 2,112,344
Veritasium 1,965,852
Discovery 1,257,189
Mental Floss 1,123,990
Animal Planet 985,375
Minute Earth 918,132
NatGeoWild 649,592
PBS Idea Channel 580,887
Periodic Videos 500,874
NASA 450,711
The Verge 432,404
Sixty Symbols 426,072
Sick Science 399,926
Discovery TV 330,897
Science Channel 266,605
The Brain Scoop 248,660
SciShow Space 246,757
It’s OK to be Smart 239,810
Best0fScience 162,251
Bizarre ER 159,184
Spangler Science TV 146,369
Hard Science 131,431
New Scientist 117,609

Healthcare Risk Management (#ASHRM2014) – Hashtags of the Week (HOTW): (Week of November 10, 2014)

The American Society for Healthcare Risk Management recently had their annual conference using the hashtag #ASHRM2014 to collection conversation and nuggets of useful information. It looks like it was a lovely event.

Topics included Ebola, injections, infographics, informed consent, data security, emerging tech solutions for discharge followup, patient safety toolkits, and more! Here’s a few of the nuggets.

One thing I learned is that Magic Johnson is much taller than I had imagined.

Sexual Abuse – Hashtags of the Week (HOTW): (Week of November 3, 2014)

Last week, Mike Tyson, famous boxer and convicted rapist, opened up on talk radio to having been sexually assaulted as a child. The revelation is being taken as informing his earlier statements of how a drive to fight bullying informed his abilities as a boxer.

When asked, “Did you tell anyone?”, Tyson replied, “No, it’s nobody’s business to know.” And when asked, “Did you drastically change after that day?”, he answered, “I don’t know if I did or not.” Those are not unusual responses for victims of child sexual abuse, many of whom only touch on the topic openly much later in life (Tyson is 48). I thought this might be a good opportunity to share information about the Twitter hashtag #SexAbuseChat, where people do talk, share, and provide support on a weekly basis. Also, this makes a lovely introduction to “No More Shame” November, a month long focus on sexual assault and childhood sexual abuse awareness and advocacy.

Residency Education & Care in the Digital Age – Hashtags of the Week (HOTW): (Week of October 27, 2014)

International Conference on Residency Education

The big hashtag splash in Twitter’s healthcare universe this week was the International Conference on Residency Education, with a theme this year of Residency Education and Care in the Digital Age (English Program) (Abstracts) (Facebook). Pretty darn awesome, if you ask me. Two hashtags, for two languages.

#icre2014

#cifr2014

Topics ranged from social media to apps to flipped classrooms to Facebook to fatigue to professionalism to other innovations in learning.

Global Innovation – Hashtags of the Week (HOTW): (Week of October 20, 2014)

Cool Toys pics of the day: Engelbart Mural

Last week has been rich with ideas for innovation on Twitter, this time with a national and international flavor. Just walking through a sampler of examples from several different conversations (AMA’s Equity Chat, the bioethics Twitter collaboration with the ASBH annual conference, international open access week, and capping the list with the BBC’s World Changing Ideas Summit).


EquityChat

I was riding the train home from Iowa, having visited my very ill father and feeling a tad distraught and fragmented, then stumbled into the AMA’s Equity Chat without a clue it was even happening. It just showed up in my stream, and I joined in. What a great chat about how to shift medical education toward a more diverse and inclusive community, and how doing so will benefit society at large, small communities, marginalized groups, and ultimately everyone.


BIOETHX + ASBH14 = ASBH14 BIOETHX

Not that I haven’t seen this before, but shouldn’t EVERY major conference partner with a topically affiliated Twitter chat community during the conference to help engage a broader community in discussing the issues and pushing out important information and findings presented at the conference? We talk about translational medicine, but isn’t this a fundamental strategy for communicating core fundings to the audiences most likely to disseminate and implement them? Anyway, so the bioethics weekly chat teamed up with the American Society of Bioethics and Humanities for their annual meeting this week. I guarantee that a LOT more people noticed the conference than would have otherwise!


Open Access Week

While open access is not, right now, this year, a brand new shiny idea, it is still very much novelty historically and absolutely pivotal in promoting and supporting innovation. That was a big part of why the University of Michigan invited Jack Andraka to be the keynote speaker for our own Open Access Week events with the theme of Generation Open. These tweets are not just from Jack’s presentation, though, but also from other innovations taking place as part of OAW.


Ada Lovelace Day 2014 (ALD14)

The Equity Chat and Open Access Week both emphasize equality, diversity, and accessibility as essential components of innovation and positive change. Thus, it makes sense to also include tweets from the Ada Lovelace Day events, focused on awareness of women’s contributions to science and creating a vision of science practice that is inclusive of women and engaging to young women. And, speaking of innovation approaches, anyone else notice the incredible creativity and artistry of the efforts in this area? Wow!


World Changing Ideas Summit

I was so excited to discover the BBC’s new (hopefully annual) initiative to promote innovation and awareness of innovation: World Changing Ideas Summit. Aside from the tweets below, check out their collection of great posts and videos.


First posted at THL Blog: http://thlibrary.wordpress.com/2014/10/22/global-innovation-hashtags-of-the-week-hotw-week-of-october-20-2014/

Anonymous Social Media Overview, Part One: Context, Risks, Benefits & Opportunities, Best Practices

CONTEXT

Following on the heels of Monday’s post about suicide prevention as it intersects with anonymous social media, I thought it might be helpful to have an overview of some anonymous social media apps, and the current state of the conversation around their risks and benefits. One of the reasons this seems to keep coming up is the NYMWARS (or, as Danah Boyd puts it, The politics of “real names”). While this issue arose originally in 2011, it never seems to really go away. Today’s Twitter feed for the hashtag #nymwars gives evidence of this.

There is a lot more where that came from. Danah described the issue as being one of power and control.

“When people are expected to lead with their names, their power to control a social situation is undermined. Power shifts. The observer, armed with a search engine and identifiable information, has greater control over the social situation than the person presenting information about themselves. The loss of control is precisely why such situations feel so public. Yet, ironically, the sites that promise privacy and control are often those that demand users to reveal their names.” Comm ACM 2012 55(8):29-31.

There are many who believe that requiring transparency (as in ‘real name’, as in the name on your birth certificate) of all users helps to protect the community from bullying and rudeness and other uncivil behavior. This is debatable, and there is supporting evidence on both sides of the debate. At the same time, forced transparency endangers others in the community (anyone at risk or in a marginalized population) at the same time it undermines identifying anyone who uses a pseudonym as their primary identity.

Facebook is enforcing its “real names” policy, insidiously outing a disproportionate number of gay, trans and adult performers — placing them at risk for attacks, stalking, privacy violations and more. Facebook is strong-arming LGBT and adult performers to use their legal names, telling these at-risk populations that it is to “keep our community safe.” Facebook nymwars: Disproportionately outing LGBT performers, users furious

While there is an acknowledged emphasis in the current fuss over Facebook names on excluding LGBT persons, the problem is much broader, and also effects many people with unusual real names. Chase Nahooikaikakeolamauloaokalani Silva is one recent example, but it is so common that Facebook has a section of their help site devoted to these incidents.

"Facebook says my name is fake. It is real."
Facebook says my name is fake. It is real. https://www.facebook.com/help/community/question/?id=10151790248568209

Unfortunately, when this happens to people, Facebook will only consider correcting the problem when supplied with a copy of a legal government ID, such as a passport, drivers license, or birth certificate. Sometimes, those aren’t good enough, which REALLY annoys people. If it was me, I would not be happy or feel safe supplying a copy of my government ID to Facebook or via electronic means. That entire approach is not only an invasion of privacy, but a strategy that would seem to place the victim at risk of identity theft. It just makes me really nervous. When this arose back in 2011, the Electronic Frontier Foundation distilled the concept of NYMWARS as an important trend for that year.

EFF immediately advocated for the right of users to choose their own names on social networking sites, whether they’re women or minorities concerned about their privacy, activists in authoritarian regimes who want to speak out without the threat of government harassment, or users with persistent nicknames or pseudonyms they’d used online for years…. EFF had been loudly opposed to Facebook’s “real names” policy for years, pointing out that community policing of real names silences some of the people who need this protection the most—people with unpopular opinions—because opponents can easily have their accounts suspended by reporting them as pseudonymous. 2011 in Review: Nymwars.

My favorite piece, and the best short distillation I’ve seen was posted to Facebook a little over a week ago by one of my favorite people in healthcare social media, @DrSnit. It is substantially excerpted here with permission.

Requiring a “legal name” is problematic for the following: 1) counselors and therapists avoiding a stalking client 2) physicians avoiding patients seeking medical advice 3) Attorneys dealing with angry criminals with a vendetta 4) women (like me) dealing with abusive partners & leaving abusive relationships. Those people who are being stalked or have been stalked WHO DO NOT WISH TO BE FOUND BY THEIR EX’S OR EX’S FAMILY & FRIENDS 5) Gender queer people, butch lesbians, and trans people who use different names than the names they were given at birth. 6) Stage performers, writers, artists who use different names for their art and their family / friends 7) People who use their middle names or nick names from birth or derivatives from birth. (This is off the top of my head – not exhaustive list).

Legal names are good for: stalkers, abusers, ADVERTISERS

FB claims it is to keep stalkers and abusers from taking fake names to harm people – but stalkers are REALLY GOOD at what they do and use nefarious methods to deal their damage. FB isn’t protecting anyone. They are harming people who CHOOSE to use different names because because it messes with their advertising analytics. Don’t let them. You don’t NEED FB bad enough to be harmed by their policy. If anyone you know has been hurt or stalked – let FB know and if they don’t change their policy – use other social media that is more women and safety friendly.

Let me repeat the most important line.

Legal names are good for: stalkers, abusers, ADVERTISERS

So, with that as context, perhaps the explosion of anonymous social networks may be, at least in part, a reaction to the forced transparency of other social networks. I have friends who have always used a “fake” name on Facebook. It is their real identity, and it sounds and looks like a normal name, and Facebook has never given them any trouble about it. I also know of those who are using their legal name, and getting hassled about it. The upshot is that anonymous networks are a justifiable response, but they carry their own risks, and their own benefits. Let’s take a quick look at some of these.

RISKS

There are a lot of nasty words tossed around about the bad side of anonymous online services. The big ones seem to be that (1) they are not really anonymous; (2) people are mean (bullying & more); (3) you can be victimized in many different ways. Here are some of the types of words used in articles that describe the risks of anonymous social media and social networks.

abuse
bullying
character assassination
hacking
harassment
identifiability
falsehoods
lies
not anonymous
prejudice
racism
rape
sexism
sexting
sexual predators
solicitation
stalking

BENEFITS / OPPORTUNITIES

Safe spaces for persons who need anonymity to be safe or to be treated equitably, such as
– Battered wives,
– Persons who are part of a marginalized or abused community,
– Celebrities,
– Whistleblowers,
– Political minorities,
– Political dissidents,
– Crime witnesses.

Suicide prevention & outreach.

Crime prevention

Therapeutic benefits of engaging for those with social anxiety.

Reaching out to those who suffer from shame.

Free speech on unpopular issues without fear of reprisal

Domestic violence support groups or outreach

Advice channels / threads / tags

Therapeutic channels / threads / tags

BEST PRACTICES FOR ENGAGING (MAYBE)

Don’t ask / Don’t tell (personal information).

Don’t identify yourself.

Don’t use your name.

Don’t use a known pseudonym.

Don’t use a friend’s name.

Don’t ask others to identify themselves.

Don’t describe your location, appearance, or other identifiable characteristics.

Don’t give your email address, street address, phone number, or other direct contact information.

Ask others you trust if they’ve had good or bad experiences there.

Post harmless stuff while testing.

TEST IT OUT!!

MORE SOURCES

(1995) Rigby, Karina. Anonymity on the Internet Must be Protected. http://groups.csail.mit.edu/mac/classes/6.805/student-papers/fall95-papers/rigby-anonymity.html

(2002) Dvorjak, John C. Pros and cons of anonymity. http://www.pcmag.com/article2/0,2817,801688,00.asp

(2011) Bayley, Alex Skud. Preliminary results of my survey of suspended Google+ accounts. http://infotrope.net/2011/07/25/preliminary-results-of-my-survey-of-suspended-google-accounts/

(2011) McElroy, Wendy. In Defense of Internet Anonymity. http://mises.org/daily/5541/

(2011-2014) Geek Feminism Wiki. Who is harmed by a “Real Names” policy? http://geekfeminism.wikia.com/wiki/Who_is_harmed_by_a_”Real_Names”_policy

(2013) Santana, Arthur D. Virtuous or Vitriolic: The effect of anonymity on civility in online newspaper reader comment boards. http://www.tandfonline.com/doi/abs/10.1080/17512786.2013.813194