The Digital Age: Impacts on Social Media and Writing

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I. Introduction

“Social media” is a term we often hear these days, describing mainstream sites and apps such as Facebook, Instagram, Snapchat, and many others. Essentially, social media can be defined as sites that allow people to interact with each other worldwide. However, because the term is so vague, many use it to describe any website utilized for communicating while others have a restricted view in which social media equates to social networking. In fact, blogs and discussion forums for people with this restricted view are not considered “social media.” So what are the defining characteristics of social platforms and their influencers? And furthermore, how do these characteristics change across different cultures and personalities? 

With the gradual prevalence of the digital age in our lives, the role of writing, both traditionally and digitally, across multiple mediums has changed dramatically. While some writers prefer to continue writing for print, others have slowly moved towards writing for the digital web. However, the foundational writing format essentially remains the same in both traditional and digital writing. For instance, a digital author writing fiction will still develop a plot and character, just like a traditional author would do. The glaring differences between them are their audiences and visual delivery. With digital writing, writers would need to understand that their content should be precise and broken down to accommodate for the short attention spans of online readers. As a result, how do mediums that exist in both physical and digital formats successfully capture their audiences’ attention, and how are the differences in writing affected across these mediums?

II. Social media platforms: What are the differences and how do they impact the success of influencers?

Think about it. When you visit platforms such as Facebook and Twitter, what kind of posts do you look forward to? Chances are if you’re looking for something interesting, other online users are looking for the same thing – relevant, valuable, and easy-to-read posts they would want to share themselves. 

However, if you want to establish an online presence, it’s important to understand each social media platform where your posts will be published and their unique qualities. Afterall, a “Tiktoker” may not be as successful on Instagram. 

In an article by Alina Gorbatch, the defining characteristics of these major social media platforms were explored. Let’s start with Facebook. The core of the platform has been defined as “friendship” where everyone is treated as a friend through light and informal tones. Typically, you would often “like” their photos and message them without ever starting your message with “Dear.”Another feature of Facebook is that it compiles a feed that presents posts more relevant to your interests based on the past posts you’ve engaged with either through “liking” or commenting. As a result, influencers who would like to create an online presence would have to understand their target audience to build a following. Research has shown that people engage mostly with posts and memes that are funny or inspirational. Moreover, the time to post is an important factor as Facebook is often a site people check during lunch breaks and after dinner (Gorbatch).

Okay, now if Facebook represents a party in which you know everyone, Twitter is exactly not that. In fact, your readers are not “friends” anymore. Instead, it becomes your news broadcasting channel where your time and space are limited – about 140 characters to be exact. With that said, your tweets must be short and catchy because you’re suddenly drowned in a huge crowd with very short attention spans. Not only that but imagine millions of other news being broadcasted and your tweet does not reach your followers. Is that the end of its life? Of course not, you should re-post it, and maybe this time, you could add a #hashtag to further expose your tweet to anyone who searches for that specific hashtag or even better, create your own hashtag (Gorbatch). 

However, what IS common among both Facebook and Twitter is that their “aging” is becoming more apparent than ever. In fact, according to research, less than two-fifths of Facebook’s adult user base in the United States is between ages 18 to 34. Furthermore, in a survey of U.S. teens, only 24% named Twitter as the most important social network and only 14% pointed to Facebook. While Facebook and Twitter remain relatively popular among young adults, it is gradually being abandoned by teens migrating to Snapchat and Instagram (Hoelzel). 

So, let’s explore Instagram. While influencers can certainly upload short videos as well, Instagram’s defining feature of instantaneous photo-sharing plays a large role in its quick emergence. The platform also allows for users to capture and share memorable moments with friends through the use of filters, accentuating beauty in almost anything. According to research, it was noticed that nearly 46.6% of the photos in the dataset collected showed selfies and friends. On the other hand, it was observed that pets and fashion were the least popular photos to post, with less than 5% of the total number of photos collected (Hu et al.) These results go on to support the conventional wisdom that Instagram is heavily focused on self-promotion and social networking with other Instagram users. 

Similar to Instagram, Snapchat is another video and photo-sharing platform. However, a feature that makes it different from the other platforms we’ve discussed is the fact that the pictures or videos disappear seconds after viewing them when engaging in one-on-one conversations. Furthermore, Snapchat has something called “stories” which allows users to post content on their own stories, public stories, or privately send them to friends. After 24 hours, these stories will eventually disappear. In addition to simply taking photos, Snapchatters are given the opportunity to draw on them and add text captions or stickers to personalize their message (Gorbatch). Recent research has shown that there are currently over 100 million Snapchat users worldwide with a user base of young adults between 18 to 29 years old (Alhabash and Ma).

I would like to now shift the focus onto discussion forums and blogs that are “less popular” compared to the big mainstream platform. Tumblr, a micro-blogging platform that consists of many smaller subcommunities where anyone can find a fandom of almost anything. A defining feature of Tumblr is that it’s overall a very sensitive and supportive community, allowing for many users to share thoughts, feelings, and personal stories they would otherwise avoid sharing anywhere else. Gorbatch specifically states in her article, “The community is a proponent of mental health awareness, offers support and advice to those going through sexual or any other identity crisis, advocates diversity, respects opinions of others, and generally offers support and understanding in cases when Facebook, YouTube, and Twitter would troll the hell out of you”(Gorbatch). It is important to note, however, that not all posts are made to help others out. Instead, they are mostly humorous and sarcastic but they rarely offend anyone. 

Similar to Tumblr, Reddit has emerged as the “front page of the Internet” where social news is divided into forums called “subreddits.” Using a point system of votes, the Reddit community determines which content and discussions are important and ultimately, displays them at the top of the feed. Additionally, it seems that users visit Reddit for fun, news, heated discussions, and learning, where topics can range from pop culture to literature. However, I would argue that Reddit could loosely be called “social media” simply because there are still social interactions but the discussion forum strays away from what most people define as social media. With longer paragraphs and conversation occurring amongst users, Reddit isn’t focused on providing visual content (i.e. videos, memes, photos) where users can comment with simple texts. Instead, “Redditors” often join Reddit to participate in discussion threads, debate, “catch up” on news.  

III. Social media influencers: Who are they and what power do they hold?

PewDiePie, Charlie D’Amelio, Pokimane, and Mr.Beast. Are you familiar with these names? Chances are, if you do know them, you probably associate them with their niche platform. But how do they emerge from the billions of other social media users trying to become “Internet-famous”?

Social media influencers are essentially content creators typically supported by a large social media following. And to maintain or grow their following, influencers share quality content to inspire, entertain, inform, and connect with them. Furthermore, social media platforms have made it very accessible for influencers to initiate social conversations, encourage engagement, and set trends amongst their audience. 

As aforementioned, many influencers are associated with their primary social media channel, generally the account that has the most followers and where influencers established their careers. However, it is often that they also distribute their content on other social media platforms or channels, without the expectation that their influence will be equal across each platform. It was pointed out in the previous section of this paper that each social media platform consists of unique characteristics that build differences in user behavior and expectation, forcing influencers to adapt to these different social environments. For instance, “Instagrammers” is a group of influencers who create highly visual content tagged with a short written caption. On the other hand, Twitch broadcasters focus primarily on live streaming their gaming and specialize in very timely and highly engaging content. Again, you can’t expect an Instagrammer to be as successful on Twitch unless they understand the audience and the structure of the platform itself (“What Constitutes”). 

Furthermore, it seems that social media influencers have become a new brand of celebrities. While traditional celebrities certainly have their own fanbase, they may sometimes appear less relatable compared to social media influencers who build their following solely through online content. Moreover, traditional celebrities are mostly focused on building their professional career whereas influencers exclusively focus on building interpersonal relationships and trust with their fans through this constant parasocial interaction. Influencers are then able to consistently gain feedback from their audiences in the form of questions, praise, and concerns as fans feel encouraged to respond to their favorite influencers as if they were personal acquaintances (Nouri). 

A personal favorite crime and mukbang Youtube channel of mine is Stephanie Soo. Stephanie has about 2.58 million subscribers and regularly updates her channel with new crime stories. What I found most interesting about her was not only because of her noteworthy story-telling ability but also because of her second vlog channel – Miss Mango Butt. On this channel, she shares with us her day-to-day life (featuring her two dogs and family members) and allows me to feel as if I personally know her and have a semi-online friend. I point this out to you simply because it goes on to show the importance and effectiveness of maintaining a following through audience interaction. And of course this also explains the differences between traditional and social media influencers. I would like to point out, however, that fan interaction may not be the priority of a traditional celebrity due to the fact that the interaction is not what brought them to fame in the first place, and that’s okay. Essentially, most celebrities don’t seem to mind the disconnection with their fans, some going as far as having others run their social media accounts (Nouri).

So far, we have established who influencers are and how they maintain their online presence through parasocial interactions. Understanding these foundational characteristics makes it easier to now explore the degree of influence an influencer has, specifically on consumer behavior. Studies have shown that the credibility of information presented by influencers depends on factors of “trustworthiness, expertise, attractiveness, and similarity.” However, one of the key elements responsible is expertise. For instance, a blogger who particularly focuses on a specific niche, such as cooking, is perceived to have more authority in that topic. Additionally, this authoritative game is strengthened by large numbers of followers, shares, and likes which provides the audience with a form of “social proof (Fastenau)”. 

Another key element is attractiveness as humans are susceptible to a term called “attractiveness bias.” In an article by Jelle Fastenau, he explains that we “subconsciously attribute attractive or charismatic people with many other qualities simply because they are good looking (Fastenau).” As a result, if an influencer is taking part in online marketing, positive associations between the influencer and the brand are formed. 

Furthermore, as discussed earlier, what really sets social media influencers apart from traditional celebrities to build their credibility is relatability. Despite having a large following, influencers are still perceived as “normal, down-to-earth people.” In a research study, 18 female Instagram users between the ages of 18 to 30 were interviewed and asked about their opinions in regards to social media product promotion. The majority of the participants expressed that they valued the opinions of “Instafamous” influencers and “blogger-type celebrities” over traditionally famous celebrities. In fact, one user had reported that they trusted influencers’ opinions more as they seemed less superficial compared to typical Hollywood personalities (Djafarova and Rushworth). After exploring this section of who influencers are and what kind of power they hold, it is evident that social media has not only fulfilled its job as an entertainment tool. Instead, it also serves as an influential “townsquare” where online users are able to find a sense of belonging and a powerful marketing tool. 

IV. Personality traits towards social media and social media usage across countries

While the importance of how influencers present themselves on certain social media platforms (i.e. relatability, trustworthiness) impacts the success of their career, there still lies extraneous factors that should be considered. One of the factors that I wanted to discuss was social media usage across cultures. With global connectivity, there has been an increase in the usage of social media everywhere. However, this doesn’t mean that all 4.14 billion online users are using Snapchat or Instagram. There are many great differences in how people use social media throughout different countries and influencers should certainly understand how different countries interact through social media if they want to develop both a local and international network. 

According to a large global survey, it was reported that the five main driving factors that determine the choice of platforms and content include: “purposes of using social media, how open the culture is to share information online, online purchasing behavior, languages other than English being used, and the number and types of social media users among total population (Egros).” Moreover, it was seen that within the Asia-Pacific region, social media was mainly used for family and friends, followed by online product reviews. For instance, in China and Australia, online users mostly prefer to use social media to stay in touch with a friend. People in Japan use social media to research products to buy, South Korea uses it to stay up to date on news, and India primarily researches for work opportunities as the top social media usage motivation. 

If we take a look at Europe, the same trends were seen across France, the UK, and Italy, respectively. One interesting observation I came across was the United States’ unexpected use of social media to research products to buy as its number one motivation. Watching videos online was surprisingly low in the U.S. compared to other regions (Egros). Moreover, despite the high rate of social media usage in both advanced and developing countries, there are some countries that actually have high rates of internet use and small shares of adults reporting that they use social media. For instance, in Germany, 87% of people use the internet with less than half that claim to use social media (Poushter et al.).

On social media, there is no such thing as “one-size-fits all” content. For an influencer who wants to expand their channel globally, it becomes important to understand that it’s not about how large their global audience is but to know how to reach users through consideration of cultural sensitivity and customization to online behaviors of target audiences in different countries. 

Another factor that may affect an influencer’s success is the personality traits of their target audience. Personality traits are generally reflected in the way people communicate and are therefore, directly related to the patterns of media consumption. 

In a research study on personality traits and social media use, five different kinds of personalities were analyzed – extraversion, agreeableness, conscientiousness, emotional stability, and openness. In a large sample of 20 countries, it was concluded that extraversion, agreeableness, and conscientiousness were all positive predictors of the use of social media and social interaction. The results indicate that an individual who feels comfortable talking to others or striking new conversations will typically use social media to consume news and relate to others or meet new people with shared interests. Moreover, individuals who scored high on agreeableness and conscientiousness were found to sympathize with others and take the extra mile to comfort them. Emotional stability is negatively related to social media usage and interaction as an individual would find themselves not needing extra attention or validation from the network. Finally, openness positively predicted the use of social media since these individuals tend to be curious, drawn to new experiences, and are, therefore, willing to seek out new communication technologies (Zúñiga et al.). 

Another study has found that introverts are rather successful in social interactions online as they find it easier to express themselves online and are drawn to the online connections they’ve formed that are otherwise lacking in their offline or “real” lives. Furthermore, it was observed that introverts feel a need to “control the amount of social interaction they subject themselves to” and the online world offers them this ability. In fact, Facebook is among the most preferred social platforms for individuals because introverted people can simultaneously be connected with their own online world and be by themselves. What this means is that Facebook has given introverts the opportunity and comfort to “pre-screen their friends as they choose and present themselves in the way that they choose.” As a result, introverts may actually adopt a more extroverted character online with the possibility to construct their own identity in various ways on social media (Harbaugh).

As you can see, personality plays a powerful role in explaining social media usage worldwide and highlights the need for accounting the different needs that are fulfilled when people use social media platforms. 

V. Bonus: Traditional and digital writing across writing mediums

Imagine an influencer on Instagram captioning their post with paragraphs of description and punctuation marks only to simply express their love for pizza. Do you think users would spend more, less, or the same amount of time on the post? 

In an article written by Hassan Akhtar, he discusses and highlights the general characteristics between traditional writing and digital writing. Some differences include the tailoring of writing that focuses on the audience, the involvement of catchy titles or “conversational” tones, the presentation (typically in terms of paragraph lengths and spatiality) of text, and the utilization of keywords on search engines. For instance, when focusing on the characteristics of writing tailored to an author’s audience, Akhtar mentions that compared to a physical novel, web content writing should be adjusted to the reading style of the reader. In fact, it has been a common trend that, “People scanning the web for information have much shorter attention spans, different eye tracking patterns when reading online content as opposed to reading a book or a magazine, and want their information given to them in small bits and pieces.” Therefore, if the reader is not drawn to the content offered, there is a risk of “losing” them to another website. Furthermore, Akhtar mentions that with digital writing, first and second-person speaking styles are used to better connect with the audience (Akhtar)

The internet has slowly become the “norm” as access to the internet has given people the chance to indefinitely contact others and freely gather information. As a result, digital publishing started to take off ranging from articles on the internet to blogging with the press of a button. Additionally, with the ability to publish online, there are endless possibilities for the author to create and explore their creative visual ideas by altering the color, font, spacing, and animation of text to make their piece more appealing. Moreover, digital authors are able to also add videos to their content with the purpose of creating an engaging digital atmosphere. This would certainly explain the reason why some readers prefer e-books over physical books (Yii).

On the other hand, traditional writing has been around for many centuries and texts have been published in books, newspapers, and magazines. However, despite the uprising of other publishing mediums, traditional writing does not seem to be disappearing with time. Traditional print has always served as a medium for leisure, research, and creative production. Moreover, a great majority still prefer reading traditional texts as one can always reliably pick up a book when they feel like it even when the internet “goes down.” As a result, without the option to access any distractions (i.e. hyperlinks), physical novels are believed to maintain readers’ attention throughout the text from front to back (Yii). Other distractions can be as simple as navigation and display of the book as well as the action of scrolling. Research studies have shown that reading comprehension with e-texts was actually “inferior” compared to printed texts as students who were presented with print-based texts performed significantly better on reading comprehension exams than those reading e-texts. But while these differences could be due to simple “distractions,” other research studies have argued that e-texts are less taxing cognitively because they’re easier to navigate, allowing for a more free capacity of comprehension (Ross et al.). 

We’ve briefly discussed the differences between traditional and digital writing, but what about different reading mediums that exist in both formats? How can we determine if one format will “overtake” the other? In this section of the paper, I explored three different mediums that exist in both the digital and printed format. The first one is novels. As ebooks gradually started gaining popularity, there has been a constant debate on whether one should read a physical or digital book. According to a survey conducted, 85.9% and 70.3% preferred print books when reading with a child and sharing books with other people, respectively. With e-books, 85.2% preferred them when they needed to get a book quickly and 76.6% preferred them while traveling or commuting. It was concluded that e-books and print books essentially offered unique functions in different situations, leading to a certain preference for one over the other. Furthermore, it was also reported that frequent readers did not have a clear preference as long as they were able to access a book (Zhang and Kudva). Overall, “… it just comes down to the fact that both mediums of publishing, writing and reading are noticeably different in many aspects, but neither is better or worse, as it depends on the viewership, the readers, and which method the author themselves prefer” (Yii). 

The second medium explored is magazines. In a text, Achmad Firdaus refers to magazines as a “cabinet of curiosities” that consists of essays, stories, poems, recipes, images, and many more. These “display objects” serve a role as conversational pieces and expressions of writers’ interests in magazines where readers are gifted with a unique, mind-expanding reading experience. Moreover, when people think of magazines, they most likely think of Vogue or TIME. Popular magazines like these often exhibit similar characteristics in which non-technical language is used to cater to the general public. To add on, these magazines typically include interviews, general interest articles, and illustrations that are eye-catching and often colorful. Firdaus predicts that with the digital age, the future of magazines will be in the hands of digital publishers. However, despite magazines moving into the digital realm, they will still serve the same function where related content is packaged together as one to represent the authors and entertain the general public (Firdaus).

Finally, let us discuss the future of newspapers. In an article by Tony Roger, he sheds light upon the reasons behind the gradual decline of newspapers despite the fact that they have a long history dating back hundreds of years. It was indicated that the decline of newspapers began with radios and TV’s. With their growing popularity, TV’s and radios often became the source of news for many, resulting in less dependency on newspapers for news. With television grabbing more attention and audiences, editors have retooled newspapers with a “feature-type” approach, emphasizing storytelling over breaking news, and redesigned them to be more visually appealing with an emphasis on layouts and graphic design. Next, the internet emerged where information was free from charge and people realized that if they could access news online for free, then there was no reason to pay for a newspaper subscription. As a result, most newspapers introduced websites where they gave away their most valuable commodity of content for free, with the fear of being “left behind.” Roger concluded the article by acknowledging the opinions of what newspapers should do next. While many say papers should start charging web content to support print issues, others argue that printed papers are inevitably destined to become “online-only” entities (Rogers).

VI. Conclusion

While social media is accessible to anyone, it shouldn’t be seen as a simple platform of digital interaction when you’re trying to become an influencer. In this paper, I explored the different parts that make up this virtual community in an attempt to demonstrate that an influencer should consider these unique aspects of social media to build a successful presence online. Among the many, I specifically focused on the different platforms and how their defining features impact the way an influencer should approach each platform. For instance, while an Instagrammer may thrive on a photo-sharing platform, they may not achieve the same success if they apply their Instagram knowledge and experience on Twitter, a platform often defined as a “news-broadcasting station.” 

I then went on to identify who influencers are and the power they hold on social media. It was concluded that they are essentially content creators supported by a large social media following with foundational characteristics such as attractiveness, relatability, and trustworthiness. Moreover, they exclusively focus on building interpersonal relationships with their fans, allowing for social media to become a place where people can find a sense of belonging and serve as a powerful marketing tool. 

Personality traits and social media usage across countries was another factor that I investigated. After understanding the different uses of social media across countries, it was revealed that there is no such thing as “one-size-fits all.” Instead, an influencer must realize that it is important to consider cultural sensitivity and customize their content according to the online behaviors of their target audience. Additionally, personality traits also play a powerful role in social media usage and further highlights the need to, once again, account for the different needs people use social media for. 

And finally, the effect of digital and traditional writing on the success of different mediums such as books, magazines, and newspapers. Essentially, digital writing focuses on the involvement of catchy titles or “conversational” tones, the visual rhetoric involved with the text being presented, and the audience reading it. In regards to e-books and physical books, it was concluded that preferences between them just depends on the viewership, the readers, which method the author themselves prefer, and even the situation. I would argue that magazines also exhibit the same trend as books. On the other hand, it seems that digital newspapers may slowly overtake physical newspapers as more and more viewers are getting their news online in today’s society. 

Social media is all the rage right now. If you want to become an influencer, I’d say “go for it. Don’t let anything stop you.” However, I will say that creating quality content consistently, promoting your work, and listening to your audience every step of the way will certainly serve as a good starting point in your journey to becoming “Internet-famous.” Keep in mind that there are no shortcuts and it could essentially take months to years of hard work and dedication, but the rewards are worth striving for.

VII. Acknowledgements

Akhtar, Hassan. “Writing for the Web – How Is It Different from Traditional Writing?” WP Gurus, wpgurus.net/writing-for-the-web-how-is-it-different-from-traditional-writing/. Accessed 19 Oct. 2021.

Alhabash, Saleem, and Mengyan Ma. “A Tale of Four Platforms: : Motivations and Uses of Facebook, Twitter, Instagram, and Snapchat among College Students?” Social Media + Society, Jan. 2017, pp. 1-13, journals.sagepub.com/doi/pdf/10.1177/2056305117691544.

Djafarova, Elmira, and Chloe Rushworth. “Exploring the Credibility of Online Celebrities’ Instagram Profiles in Influencing the Purchase Decisions of Young Female Users.” Computers in Human Behavior, vol. 68, Mar. 2017, pp. 1-7. ScienceDirect, https://doi.org/10.1016/j.chb.2016.11.009.

Egros, Anne. “Social Media Usage Across Cultures.” Compukol, 11 Oct. 2011, www.compukol.com/social-media-usage-across-cultures/.

Fastenau, Jelle. “Under the Influence: The Power of Social Media Influencers.” Crobox, 6 Mar. 2018, medium.com/crobox/under-the-influence-the-power-of-social-media-influencers-5192571083c3.

Firdaus, Achmad. “Writing for Magazines.” PDF.

Gorbatch, Alina. “Different Social Media Platforms: How Do They Vary and What Does It Mean to You?” Awario, 4 July 2016, awario.com/blog/social-media-platforms/.

Harbaugh, Erin Ryan. “The Effect of Personality Styles (Level of Introversion- Extroversion) on Social Media Use.” The Elon Journal of Undergraduate Research in Communications, vol. 1, no. 20, 2010, pp. 70-86.

Hoelzel, Mark. “Instagram Is Now the Go-To Social Network for US Teens.” Insider, 15 July 2015, www.businessinsider.com/instagram-is-now-go-to-social-network-for-us-teens-2015-6?r=US&IR=T.

Hu, Yuheng, et al. “What We Instagram: A First Analysis of Instagram Photo Content and User Types.” PDF.

Nouri, Melody. “The Power of Influence: Traditional Celebrity vs Social Media Influencer.” Pop Culture Intersections, 12 Sept. 2018, scholarcommons.scu.edu/engl_176/32/.

Poushter, Jacob, et al. “Social Media Use Continues to Rise in Developing Countries but Plateaus across Developed Ones.” Pew Research Center, 19 June 2018, www.pewresearch.org/global/2018/06/19/social-media-use-continues-to-rise-in-developing-countries-but-plateaus-across-developed-ones/.

Rogers, Tony. “Are Newspapers Dying?” ThoughtCo., 28 Aug. 2019, www.thoughtco.com/are-newspapers-dying-2074122.

Ross, Bella, et al. “Print versus Digital Texts: Understanding the Experimental Research and Challenging the Dichotomies.” Research in Learning Technology, vol. 25, 2017, files.eric.ed.gov/fulltext/EJ1163201.pdf.

“What Constitutes an Influencer.” Mediakix, mediakix.com/blog/influencer-definition-marketing/. Accessed 21 Nov. 2021.

Yii, Jazz. “Digital Text vs Traditional Text.” Jazzy Reviews, jazzyreviews.weebly.com/digital-writing-vs-traditional-writing.html. Accessed 23 Oct. 2021.

Zhang, Yin, and Sonali Kudva. “E-books versus Print Books: Readers’ Choices and Preferences across Contexts.” Journal of the American Society for Information Science and Technology, vol. 65, no. 8, Aug. 2014.

Zúñiga, Homero Gil de, et al. “Personality Traits and Social Media Use in 20 Countries: How Personality Relates to Frequency of Social Media Use, Social Media News Use, and Social Media Use for Social Interaction.” Cyberpsychology, Behavior, and Social Networking, vol. 20, no. 9, Sept. 2017, pp. 540-52. PubMed, pubmed.ncbi.nlm.nih.gov/28922034/.