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In the electronic age, documents appear to have escaped their paper confinement. But we are still surrounded by flows of paper with enormous consequences. In the planned city of Islamabad, order and disorder are produced through the ceaseless inscription and circulation of millions of paper artifacts among bureaucrats, politicians, property owners, villagers, imams (prayer leaders), businessmen, and builders. What are the implications of such a thorough paper mediation of relationships among people, things, places, and purposes? Government of Paper explores this question in the routine yet unpredictable realm of the Pakistani urban bureaucracy, showing how the material forms of postcolonial bureaucratic documentation produce a distinctive political economy of paper that shapes how the city is constructed, regulated, and inhabited. Files, maps, petitions, and visiting cards constitute the enduring material infrastructure of more ephemeral classifications, laws, and institutional organizations. Matthew S. Hull develops a fresh approach to state governance as a material practice, explaining why writing practices designed during the colonial era to isolate the government from society have become a means of participation in it.

To document the marketing and distribution of nano-enabled products into the commercial marketplace, the Woodrow Wilson International Center for Scholars and the Project on Emerging Nanotechnologies created the Nanotechnology Consumer Products Inventory (CPI) in 2005. The objective of this present work is to redevelop the CPI by leading a research effort to increase the usefulness and reliability of this inventory. We created eight new descriptors for consumer products, including information pertaining to the nanomaterials contained in each product. The project was motivated by the recognition that a diverse group of stakeholders from academia, industry, and state/federal government had become highly dependent on the inventory as an important resource and bellweather of the pervasiveness of nanotechnology in society. We interviewed 68 nanotechnology experts to assess key information needs. Their answers guided inventory modifications by providing a clear conceptual framework best suited for user expectations. The revised inventory was released in October 2013. It currently lists 1814 consumer products from 622 companies in 32 countries. The Health and Fitness category contains the most products (762, or 42% of the total). Silver is the most frequently used nanomaterial (435 products, or 24%); however, 49% of the products (889) included in the CPI do not provide the composition of the nanomaterial used in them. About 29% of the CPI (528 products) contain nanomaterials suspended in a variety of liquid media and dermal contact is the most likely exposure scenario from their use. The majority (1288 products, or 71%) of the products do not present enough supporting information to corroborate the claim that nanomaterials are used. The modified CPI has enabled crowdsourcing capabilities, which allow users to suggest edits to any entry and permits researchers to upload new findings ranging from human and environmental exposure data to complete life cycle assessments. There are inherent limitations to this type of database, but these modifications to the inventory addressed the majority of criticisms raised in published literature and in surveys of nanotechnology stakeholders and experts. The development of standardized methods and metrics for nanomaterial characterization and labelling in consumer products can lead to greater understanding between the key stakeholders in nanotechnology, especially consumers, researchers, regulators, and industry.

In this article, I investigate the ongoing battle between villagers on the outskirts of Islamabad, Pakistan, and the state development agency attempting to expropriate their land. This battle has been waged through the medium of documents, particularly lists, which villagers and colluding officials have used to defraud the Pakistani government of the equivalent of millions of dollars. Through this case study, I develop an approach to contemporary state governance as material practice, showing how government discourse is shaped by the material forms it takes and highlighting the issue of reference and predication (or how words relate to things).

This review surveys anthropological and other social research on bureaucratic documents. The fundamental insight of this literature is that documents are not simply instruments of bureaucratic organizations, but rather are constitutive of bureaucratic rules, ideologies, knowledge, practices, subjectivities, objects, outcomes, even the organizations themselves. It explores the reasons why documents have been late to come under ethnographic scrutiny and the implications for our theoretical understandings of organizations and methods for studying them. The review argues for the great value of the study of paper-mediated documentation to the study of electronic forms, but it also highlights the risk of an exclusive focus on paper, making anthropology marginal to the study of core bureaucratic practices in the manner of earlier anthropology.

Background Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic. Methods A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews. Results All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data. Conclusion Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.

Background Early identification of people with CKD in primary care, particularly those with risk factors such as diabetes and hypertension, enables proactive management and referral to specialist services for progressive disease. The 2019 NHS Long Term Plan endorses the development of digitally-enabled services to replace the ‘unsustainable’ growth of the traditional out-patient model of care.Shared views of the complete health data available in the primary care electronic health record (EHR) can bridge the divide between primary and secondary care, and offers a practical solution to widen timely access to specialist advice. Methods We describe an innovative community kidney service based in the renal department at Barts Health NHS Trust and four local clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. Results Prior to the start of the service the general nephrology referral rate was 0.8/1000 GP registered population, this rose to 2.5/1000 registered patients by the second year of the service. The majority (> 80%) did not require a traditional outpatient appointment, but could be managed with written advice for the referring clinician. The wait for specialist advice fell from 64 to 6 days. General practitioners (GPs) had positive views of the service, valuing the rapid response to clinical questions and improved access for patients unable to travel to clinic. They also reported improved confidence in managing CKD, and high levels of patient satisfaction. Nephrologists valued seeing the entire primary care record but reported concerns about the volume of referrals and changes to working practices. Conclusions ‘Virtual’ specialist services using shared access to the complete primary care EHR are feasible and can expand capacity to deliver timely advice. To use both specialist and generalist expertise efficiently these services require support from community interventions which engage primary care clinicians in a data driven programme of service improvement.

This study assesses the physical and chemical characteristics of hyperalkaline steel slag leachate from a former steelworks on two streams in England and their impacts on benthic invertebrate communities. Using multivariate methods (CCA), we related invertebrate richness and diversity with chemical parameters along the environmental gradient from point sources to less impacted sites downstream. Point discharges are characterised by high pH (10.6–11.5), high ionic strength (dominated by Ca–CO₃–OH waters), elevated trace elements (notably Li, Sr and V) and high rates of calcium carbonate precipitation. This combination of stressors gives rise to an impoverished benthic invertebrate community in source areas. The total abundance, taxonomic richness and densities of most observed organisms were strongly negatively correlated with water pH. Analysis using biological pollution monitoring indices (e.g. BMWP and Functional Feeding Groups) shows the system to be highly impacted at source, but when pH approaches values close to aquatic life standards, some 500 m downstream, complex biological communities become established. In addition to showing the rapid recovery of invertebrate communities downstream of the discharges, this study also provides a baseline characterisation of invertebrate communities at the extreme alkaline range of the pH spectrum.

We are developing lab-based readout electronics for Transition-edge sensors (TES) using commercial-off-the-shelf (COTS) modules. These COTS modules are advantageous since they increase development speed and keep the cost low. We have developed these electronics to support both non-multiplexed and time-division multiplexing (TDM) readout systems. The system utilizes remote control via Ethernet, and the interface allows many types of measurements to be automated. With the TDM readout system, we have achieved 2.05 eV at 6 keV, 2.1 eV at 7 keV, 2.3 eV at 8 keV, and 2.8 eV at 12 keV with 2-column × 32-row multiplexing. We will be using this system in the characterization of detectors for the X-Ray Integral Field Unit (X-IFU) instrument on Athena. In this paper, we present an overview of the design and their performance.

Studies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs. Using a dataset of GP records for all patients registered in Lambeth, Hackney, Tower Hamlets and Newham in 2013 we investigated new diagnoses of depression and antidepressant use for: Indian, Pakistani, Bangladeshi, black Caribbean and black African patients. Neighbourhood effects were assessed independently of GP practice using a cross-classified multilevel model. Black and minority ethnic groups are up to four times less likely to be newly diagnosed with depression or prescribed antidepressants compared to white British patients. We found an inverse relationship between neighbourhood ethnic density and new depression diagnosis for some groups, where an increase of 10% own-ethnic density was associated with a statistically significant (p < 0.05) reduced odds of depression for Pakistani [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.70-0.93], Indian (OR 0.88, CI 0.81-0.95), African (OR 0.88, CI 0.78-0.99) and Bangladeshi (OR 0.94, CI 0.90-0.99) patients. Black Caribbean patients, however, showed the opposite effect (OR 1.26, CI 1.09-1.46). The results for antidepressant use were very similar although the corresponding effect for black Caribbeans was no longer statistically significant (p = 0.07). New depression diagnosis and antidepressant use was shown to be less likely in areas of higher own-ethnic density for some, but not all, ethnic groups.