Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse–patient relationship. We firstly considered and secured the most relevant Heideggerian elements to (...) nurse–patient Being-with. Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode, and the authentic self-mode. Through circumspection, technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement was expressed through either leaping-in care or leaping-ahead care. There was a place for both inauthentic and authentic discourse that nurses wove through the ontic everydayness of nursing tasks. (shrink)

Volume 20, Issue 7, July 2020, Page 77-80.

We draw on three illustrative vignettes to examine how REBs manage participants’ agency in the context of qualitative research. We ask: Who owns a participant’s consent? Central to informed consent is the principle of Respect for Persons, which privileges the autonomy of individuals to make decisions about what happens (or not) to them. Yet, REBs sometimes require researchers to get permission from organizations to conduct research on their current and former members, even when the research is not about those organizations. (...) Our aim is to raise awareness about the inherent contradictions of this practice and to consider guidelines for determining the appropriateness of involving organizations that may be tangentially connected to the research objectives or potential participants. (shrink)

This provocative book paved the way for nursing research informed by f eminist scholarship, critical theory, and post-modern thought. Controv ersial then, relevant today.

What considerations place genuine constraints on an adequate semantics for normative and evaluative expressions? Linguists recognize facts about ordinary uses of such expressions and competent speakers’ judgments about which uses are appropriate. The contemporary literature reflects the widespread assumption that linguists don’t rely upon an additional source of data—competent speakers’ judgments about possible disagreement with hypothetical speech communities. We have several good reasons to think that such judgments are not probative for semantic theorizing. Therefore, we should accord these judgments no (...) probative value for the development of a semantics for our moral terms. Such judgments can no longer be presumed to put pressure on theories according to which our moral expressions share a semantics with ordinary, descriptive terms. Many rivals to pure, Descriptivist theories count among their advantages the ability to accommodate these judgments. If these judgments have no probative value, such theories lose an important source of support. (shrink)

Many UK public companies invest considerable resources in charitable donations and community involvement. Using semi‐structured interviews with public company officers, the author sought to investigate the motivations behind this activity. Was it undertaken because of an expectation of commercial benefit, out of a sense of obligation, or for other reasons? It appeared that public companies were increasingly anxious to make connections between corporate activity in the community and business activities. Public companies linked with local communities clearly felt a sense of (...) connection with them. Corporate officers were constantly dealing with the management of reputation, which was seen as a valuable business asset, and community links made this task easier. (shrink)

The purpose of this article is to assess Rosabeth Moss Kanter's work on tokenism in light of more than a decade of research and discussion. While Kanter argued that performance pressures, social isolation, and role encapsulation were the consequences of disproportionate numbers of women and men in a workplace, a review of empirical data concludes that these outcomes occur only for token women in gender-inappropriate occupations. Furthermore, Kanter's emphasis on number balancing as a social-change strategy failed to anticipate backlash from (...) dominants. Blalock's theory of intrusiveness suggests that surges in the number of lower-status members threaten dominants, thereby increasing gender discrimination in the forms of sexual harassment, wage inequities, and limited opportunities for promotion. Although Kanter's analysis of the individual consequences of tokenism was compelling to researchers and organizational change agents, continued reliance on numbers as the theoretical cause of, and as the solution to, gender discrimination in the workplace neglects the complexities of gender integration. (shrink)

The aim of this workshop was to ask potential end-users of the citizens’ information pack on legal and ethical issues around ICTs the following questions: What is your knowledge of the EU’s General Data Protection Regulation, and what actions have you taken in response to these regulations? What challenges are you experiencing in ensuring the protection and security of your project data, and compliance with the GDPR, within existing data management processes/systems? What information/tools/resources do you need to overcome these challenges? (...) What are the best formats/channels for receiving, sharing and acting upon this information? What is the most appropriate structure/format for the citizens’ information pack? (shrink)

A new theory of how the brain constructs emotions that could revolutionize psychology, health care, law enforcement, and our understanding of the human mind Emotions feel automatic, like uncontrollable reactions to things we think and experience. Scientists have long supported this assumption by claiming that emotions are hardwired in the body or the brain. Today, however, the science of emotion is in the midst of a revolution on par with the discovery of relativity in physics and natural selection in biology--and (...) this paradigm shift has far-reaching implications for us all. Leading the charge is psychologist and neuroscientist Lisa Feldman Barrett, whose theory of emotion is driving a deeper understanding of the mind and brain, and shedding new light on what it means to be human. Her research overturns the widely held belief that emotions are housed in different parts of the brain and are universally expressed and recognized. Instead, she has shown that emotion is constructed in the moment, by core systems that interact across the whole brain, aided by a lifetime of learning. This new theory means that you play a much greater role in your emotional life than you ever thought. Its repercussions are already shaking the foundations not only of psychology but also of medicine, the legal system, child-rearing, meditation, and even airport security. Why do emotions feel automatic? Does rational thought really control emotion? How does emotion affect disease? How can you make your children more emotionally intelligent? How Emotions Are Made answers these questions and many more, revealing the latest research and intriguing practical applications of the new science of emotion, mind, and brain. (shrink)

The phenomenon of industrial melanism became widely acknowledged as a well-documented example of natural selection largely as a result of H.B.D. Kettlewell’s pioneering research on the subject in the early 1950s. It was quickly picked up by American biology textbooks starting in the early 1960s and became ubiquitous throughout the 1970s, 1980s and 1990s. While recent research on the phenomenon broadly supports Kettlewell’s explanation of IM in the peppered moth, which in turn has strengthened this example of natural selection, textbook (...) IM entries have actually declined in recent years in favor of other examples. In a previous paper, we drew attention to the pivotal role visual aspects played in the introduction of IM into textbook accounts. The present article continues this investigation by analyzing textual passages on industrial melanism within a stratified random sample of textbooks from the 1960s to the 2000s. The fact that this example of natural selection was included by multiple publishers independently, in a short period of time, makes it uniquely qualified for a textbook study of this kind. The purpose of the present project was to determine whether these textbooks contain what has come to be known as the standard peppered moth story. Three complete series were also inspected for change across time. Our analysis focused on the amount of text devoted to industrial melanism; what specific science content elements were present; and what, if any, nature of science aspects were included. The study documents an increase in the amount of text devoted to industrial melanism over the decades. In spite of this increase, only modest changes in science content and NOS aspects were found. (shrink)

This chapter discusses three puzzles about practical conditionals and inferences and shows how the flexible, contextualist semantic framework for “ought”. The chapter develops elsewhere resolves all three puzzles more satisfactorily than any of its three most prominent rivals, the relativist account of Niko Kolodny and John MacFarlane, the wide-scoping account of John Broome, and the “trying on” account of James Dreier. The chapter first introduces the puzzle cases and six desiderata for their solutions, and then shows how only flexible contextualism (...) about “ought” is able to resolve each while satisfying all six desiderata. (shrink)

Delusions are a common symptom of schizophrenia and dementia. Though most English dictionaries define a delusion as a false opinion or belief, there is currently a lively debate about whether delusions are really beliefs and indeed, whether they are even irrational. The book is an interdisciplinary exploration of the nature of delusions. It brings together the psychological literature on the aetiology and the behavioural manifestations of delusions, and the philosophical literature on belief ascription and rationality. The thesis of the book (...) is that delusions are continuous with ordinary beliefs, a thesis that could have important theoretical and practical implications for psychiatric classification and the clinical treatment of subjects with delusions. By bringing together recent work in philosophy of mind, cognitive psychology and psychiatry, the book offers a comprehensive review of the philosophical issues raised by the psychology of normal and abnormal cognition, defends the doxastic conception of delusions, and develops a theory about the role of judgements of rationality and of attributions of self-knowledge in belief ascription. Presenting a highly original analysis of the debate on the nature of delusions, this book will interest philosophers of mind, epistemologists, philosophers of science, cognitive scientists, psychiatrists, and mental health professionals. (shrink)

Perhaps more controversial than whether physicalism is true is what exactly would have to be true for physicalism to be true. Everyone agrees that, intuitively at least, physicalism is the thesis that there is nothing over and above the physical. The disagreements arise in how to get beyond this intuitive formulation. Until about ten years ago, participants in this debate were concerned primarily with answering two questions. First, what is it for a property, kind, relation, or individual to be a (...) physical one? (shrink)

The aim of this study was interpret the existential construct of family caring following Acute Coronary Syndrome. Family support is known to have a positive impact on recovery and adjustment after cardiac events. Few studies provide philosophically-based, interpretative explorations of carer experience following a spouse’s ischaemic event. As carer experiences, behaviours and meaning-making may impact on the quality of the support they provide to patients, further understanding could improve both patient outcomes and family experience. Fourteen spouses of people experiencing Acute (...) Coronary Syndrome in Sydney, Australia were engaged in a single, semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analysed using hermeneutic interpretation within a Heideggerian phenomenological framework. Acute Coronary Syndrome disrupts lived temporality, and the projected potential for carers’ being-alongside. Carers experienced an existential uncertainty that arose from difficulty in diagnosis, and situated fear as an attuned, being-towards-death. They constructed protective strategies to insulate their partner and themselves from further stress and risk, however, unclear boundaries for protection heightened carer anxiety. The existential structure of care included one of two possible Heideggerian modes: leaping-in care was a dominating mode that required a high level of carer vigilance; leaping-ahead care was a metaphorical walking alongside, as carers gave back control, freeing opportunities for the person to ‘own’ care. Supporting carers through the intensive phase of leaping-in care, and equipping them for informed leaping-ahead care should be a focus in both the acute and post-discharge care phases. (shrink)

This article analyses the two main rhetorical techniques of “argumentation” and “persuasion” employed in politico-philosophical debates recorded in early Chinese argumentative texts of the Warring States period. Through the analysis of pertinent case studies drawn from the received literature, the contribution explores the formal, structural, and grammatical features of these techniques, with attention paid to the wide selection of rhetorical and literary devices they make use of. It also further provides an overview of the historical and socio-cultural background against which (...) such techniques developed among so called “wandering persuaders”, who were travelling from court to court to offer their services as political advisors and diplomats to the local rulers of the time. (shrink)

This volume presents cutting-edge theory and research on emotions as constructed events rather than fixed, essential entities. It provides a thorough introduction to the assumptions, hypotheses, and scientific methods that embody psychological constructionist approaches. Leading scholars examine the neurobiological, cognitive/perceptual, and social processes that give rise to the experiences Western cultures call sadness, anger, fear, and so on. The book explores such compelling questions as how the brain creates emotional experiences, whether the "ingredients" of emotions also give rise to other (...) mental states, and how to define what is or is not an emotion. Introductory and concluding chapters by the editors identify key themes and controversies and compare psychological construction to other theories of emotion. (shrink)

This article analyzes organizational mechanisms, and their contexts, leading to gender inequality among stockbrokers in two large brokerages. Inequality is the result of gender differences in sales, as both firms use performance-based pay, paying entirely by commissions. This article develops and tests whether performance-support bias, whereby women receive inferior sales support and sales assignments, causes the commissions gap. Newly available data on the brokerages’ internal transfers of accounts among brokers allows measurement of performance-support bias. Gender differences in the quality and (...) quantity of transferred accounts provide a way to measure gender differences in the assignment of sales opportunities and support. Sales generated from internally transferred accounts, controlling for the accounts’ sales histories, provide a “natural experiment” testing for gender differences in sales capacities. The evidence for performance-support bias is women are assigned inferior accounts and women produce sales equivalent to men when given accounts with equivalent prior sales histories. (shrink)

The Cultural Career of Coolness: Discourses and Practices of Affect Control in European Antiquity, the United States, and Japan. Edited by Ulla Haselstein, Irmela Hijiya-Kirschnereit, Catrin Gersdorf, and Elena Giannoulis. Lanham, Md.: Lexington Books, 2013. Pp. vi + 283. $100.

Kindheit in der japanischen Geschichte: Vorstellungen und Erfahrungen / Childhood in Japanese History: Concepts and Experiences. Edited by Michael Kinski, Harald Salomon, and Eike Grossmann. Wiesbaden: Harrassowitz Verlag, 2015. Pp. xv + 542. $133.

Animalism, according to its strongest proponents, is the view that human beings are ‘essentially or most fundamentally animals’. Specifically, ‘we are essentially animals if we couldn’t possibly exist without being animals’ (Olson 2008). Although contemporary animalism offers an account superior to its Lockean competitors, Olson’s ‘biological approach’ has certain limitations, particularly in its denial of any psychological continuity whatsoever as either necessary or sufficient for individual persistence through time. I propose a number of amendments towards a Thomistic variety of animalism (...) that avoids these difficulties. Although prone to misinterpretation, animalism understood properly is compatible with Aquinas’s theory of subsistent intellect. Against recent challenges, I defend the view that Thomistic animalism not only is intelligible, but is indeed crucial for understanding Aquinas’s view of human nature and rationality. (shrink)

This essay argues that religion is a distinctive form of human activity, and offers a philosophical account of what religion fundamentally is (and what it is not), within the context of the Free Exercise Clause. §I promotes religion as an action-theoretic concept. §II presents the claim that atheism can be regarded as a religion: this claim is rejected on the basis that religion cannot be defined as a set of propositional beliefs concerning metaphysics and morality. §III defends a paradigmatic account (...) of religion as a kind of activity ordered to a concept of transcendence or superior nature, and argues that morally excellent human actions can be identified as religious, but only in a secondary or derivative way. §IV contends with the problem of including act-omissions as instantiations of religious exercise, and proposes a solution with reference to recent arguments implicating two-way powers. (shrink)

This thesis develops a disjunctivist approach to action as an alternative to the standard causal theory, or 'causalism'. The standard theory promotes a concept of action as constituted by a bodily event joined to certain mental conditions by a bond of causation. A disjunctivist approach, in contrast, claims that action must be distinguished by more than merely its etiology: action and mere movement are fundamentally different kinds. Recent objections to the causal theory of action are first surveyed, and the common (...) causalist assumption claiming Aristotle as the progenitor of the causal theory is examined and dismissed. More refined interpretations of Aristotle's thought on action yield two different concepts: action as change, and action as a unified psychophysical process. The latter in particular is argued to hold promise as a basis for developing the disjunctivist approach to action. The remainder of the thesis therefore considers a contemporary account of psychophysicality, known as 'embodiment theory', with the conclusion that the intelligibility of the account depends on appeal to a recent variant of top-down causation. The thesis also concludes that consideration of the concept of an animal agent makes it entirely unsurprising that the mental and physical are always found together in voluntary movement, and that the embodiment theory’s central notion of ‘property fusion’ potentially complements a naturalistic variant of top-down causation in explanations of agency. (shrink)

This thesis develops a disjunctivist approach to action as an alternative to the standard causal theory, or 'causalism'. The standard theory promotes a concept of action as constituted by a bodily event joined to certain mental conditions by a bond of causation. A disjunctivist approach, in contrast, claims that action must be distinguished by more than merely its etiology: action and mere movement are fundamentally different kinds. Recent objections to the causal theory of action are first surveyed, and the common (...) causalist assumption claiming Aristotle as the progenitor of the causal theory is examined and dismissed. More refined interpretations of Aristotle's thought on action yield two different concepts: action as change, and action as a unified psychophysical process. The latter in particular is argued to hold promise as a basis for developing the disjunctivist approach to action. The remainder of the thesis therefore considers a contemporary account of psychophysicality, known as 'embodiment theory', with the conclusion that the intelligibility of the account depends on appeal to a recent variant of top-down causation. The thesis also concludes that consideration of the concept of an animal agent makes it entirely unsurprising that the mental and physical are always found together in voluntary movement, and that the embodiment theory’s central notion of ‘property fusion’ potentially complements a naturalistic variant of top-down causation in explanations of agency. (shrink)

The mechanism(s) by which lentiviruses and related non‐oncogenic retroviruses (e.g. HTLV‐III, the etiologic agent of AIDS) escape immune surveillance, and thereby create long term progressive disease conditions, has been unknown until recently. Studies with two lentiviruses have begun to illuminate the mechanisms. In one, antigenic drift in the virus appears to be the primary mechanism of escape from immune surveillance; in the second, selective masking of the viral envelope glycoprotein epitope, which normally elicits neutralizing anti‐body, appears to provide the means (...) of escape. (shrink)

In recent years, there has been significant interest in injustices that do not consist in inflicting physical or material harm on others, but operate in more subtle ways, e.g. by targeting our status as epistemic agents. In a similar fashion, this paper aims to bring to the forefront a currently overlooked kind of injustice that occurs in relation to our concepts: conceptual injustice, which is characterised by wrongful in- or exclusion from the application of a concept. The first part of (...) the paper is concerned with spelling out the notion, discussing its characteristic wrongs, and with tracing it in a number of examples. In the second part, I discuss conceptual injustice in relation to connected but different forms of injustice, such as epistemic injustice. This highlights the advantages of having the notion on hand: it enhances our understanding of other forms of injustice like hermeneutical injustice, and allows us to capture a ‘remainder of injustice’ for which we could not account otherwise. (shrink)

This article examines birthday party decorations as a way of understanding the materiality and religious place-making of an expanding Baptist congregation in central Sweden in the early twentieth century. The fiftieth birthday party for Magnus Johanson, held at Salem Chapel in Falun, Dalarna county, in 1906, was decorated with birch branches, large Swedish flags and bunting and an elaborately laid table featuring coffee cups and refreshments. From an analysis of these material elements and a deeper investigation into the lives of (...) Johanson and his wife Kristina, it can be seen that evangelicals had a flexible approach to their ‘sacred’ spaces. Social activities and the act of decorating them created not only a sense of congregational fellowship and belonging but also the opportunity for congregations to display their connection to external cultural and political identities. Through the construction of chapel buildings and their subsequent decoration, male and female members were able to demonstrate a complementary creativity. Together they contributed to the cre-ation of Salem as a multi-purpose, comfortable and accepted place within Falun’s evolving religious landscape. (shrink)

While the richness of Heideggerian philosophy is attractive as a healthcare research framework, its density means authors rarely utilise its fullest possibilities as an hermeneutic analytic structure. This article aims to clarify Heideggerian hermeneutic analysis by taking one discrete element of Heideggerian philosophy (Being-towards-death), and using it’s clearly defined structure to conduct a meta-synthesis of Heideggerian phenomenological studies on the experience of living with a potentially life-limiting illness. The findings richly illustrate Heidegger’s philosophy that there is either an inauthentic positioning (...) towards death, or an authentic positioning towards death with a proposition that (1) death is certain; (2) death is indefinite; (3) death is non-relational; and (4) death is not-to-be-outstripped. None of the 29 included studies on the experience of a confrontation with death fully utilised this framework, despite claiming a grounding in Heideggerian thought. This demonstrates the value in modelling how Heideggerian existential structures can be used proactively as analytical ‘hooks’ for data in research claiming a basis in this philosophy and/or method. By modelling the potential application of an important Heideggerian philosophical construct to published qualitative data, this meta-synthesis has revealed new domains and more nuanced understandings of the temporal structure of Being-towards-death. Such an approach helps to more fully unveil the existential concerns of people at the core of interpretative phenomenological enquiry and may provide a blueprint to map either primary or synthesised data to other key ontological existentials. (shrink)

We are currently seeing dramatic changes in the ways we imagine and experience time. Permanent debt, unending violent conflict, climate change, economic instability, and widening social inequalities have led to suggestions that we are now living in the time of the 'end times'. In the shadow of a foreshortened future, the present is increasingly experienced as a form of 'non-stop inertia', resulting in experiences of time as both frenetic but also stuck - revving up, as Ivor Southwood puts it, to (...) go nowhere. So, where do we go and how when all options seem to have run their course and time is no longer moving forward? Enduring Time proposes some alternative relations of time which provide hopeful alternatives to the dominating models of oppression, limitation and exploitation. A strikingly original philosophy of time which also provides students and scholars with a rigorous and detailed survey of contemporary theories of time, Enduring Time is an indispensable read for those attempting to live meaningfully in the current age. (shrink)

Lisa Bortolotti argues that some irrational beliefs are epistemically innocent and deliver significant epistemic benefits that could not be easily attained otherwise. While the benefits of the irrational belief may not outweigh the costs, epistemic innocence helps to clarify the epistemic and psychological effects of irrational beliefs on agency.

Experiences of emotion are content-rich events that emerge at the level of psychological description, but must be causally constituted by neurobiological processes. This chapter outlines an emerging scientific agenda for understanding what these experiences feel like and how they arise. We review the available answers to what is felt (i.e., the content that makes up an experience of emotion) and how neurobiological processes instantiate these properties of experience. These answers are then integrated into a broad framework that describes, in psychological (...) terms, how the experience of emotion emerges from more basic processes. We then discuss the role of such experiences in the economy of the mind and behavior. (shrink)

The responsible research and innovation framework seeks to bring science closer to society, with scientific research conducted not just for the benefit of society, but with role players in society engaging with scientists on research and innovation at every stage. A central focus of the RRI framework is the approach taken to embed these concepts in the higher education training of science students. In this study the direct engagement between science students and the public is explored as an opportunity for (...) achieving RRI learning outcomes. The study also explores the potential benefits that such direct engagement with the public holds for postgraduate biotechnology students. The case study described here suggests that even brief interactions with the public through science engagement activities such as “Speed-Date-a-Scientist” can contribute towards affirmation of choice of career, students’ motivation as researchers and shaping of their identity as scientists, important processes in their own learning to become scientists. Students also indicated a greater sense of motivation to do research that benefits the public, resonating with RRI learning outcomes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reifying Relevance in Mild Cognitive Impairment:An Appeal for Care and CautionJanice E. Graham (bio) and Karen Ritchie (bio)KeywordsAlzheimer’s disease, construction, dementia, market forces, mild cognitive impairmentWe thank the reviewers for their thoughtful comments that probe shadowy areas in our argument, and we welcome this opportunity to elucidate our position. First, we are not repudiating the natural and social facts of pathologic brain degeneration and the physical and cognitive impairments (...) that manifest in people affected by dementia disorders. We are, however, questioning the epistemology, politics, and persistence by some to harden the construct of mild cognitive impairment (MCI) prematurely as a "natural" precursor to dementia. We suggested insufficiencies in viewing MCI as prodromal to Alzheimer's disease (AD; Graham and Ritchie 2006, 36), and pointed to evidence for the prognostic irrelevance of some MCI subcategories (35). The commentators have read our manuscript as suggesting that AD and MCI are different kinds, and that a diagnosis of AD is more "real" than that of MCI. But AD is also fraught with classification issues, as we describe in the section of our paper that deals with consensus committees, published practice guidelines, and the determination of treatment efficacy. Like MCI, AD is a heterogeneous condition, but unlike MCI, AD is a constructed practical kind that does some "work" beyond essentialist (neural degeneration, brain atrophy) claims. Its criteria identify people with well-defined dementia symptoms and multiple cognitive and functional impairments who are in need of, and benefit from, support. Even with these criteria, however, there have been great attempts to achieve definitional accuracy in dementia diagnoses. Practical refinements to the differential diagnosis of dementia based on solid research evidence have made way for more specific recognitions of vascular dementias, dementia of the Lewy body type, and other subtypes beyond AD. So AD too has been subject to more careful, more cautious operationalization in recent years, with research supporting multiple factors and the comorbidity of several types (kinds) of dementia in any one individual.Our paper takes up concerns that are not resolved for dementia and suggests that the nascent category of MCI is still so insufficiently defined as to be ambiguous, and as such, is in danger of identifying individuals with what will be, and has [End Page 57] already been, linked to a debilitating and deeply stigmatizing and fatal disorder (AD). We are not contesting the reality that some people begin to display early signs of cognitive loss, nor are we suggesting that symptoms be ignored; as researchers, we stand behind the careful tracking of symptoms and signs in patients and research participants as an essential clinical and research practice. In a era where the public has been made wary of the potentially fatal effects of new treatments whose more careful scrutiny in specific populations would have saved lives (e.g., Fontanarosa, Rennie, and DeAngelis 2004; Psaty and Furberg 2005), and made all the more popular by what Kramer coined "diagnostic bracket creep" (1993, 15), we are questioning the drivers and value of a premature diagnostic classification whose definitional accuracy is neither sufficient nor effective for specific identification of individuals.That matters of fact are constructed does not take away from their natural fact. Some people have subjective reports or show objective evidence of cognitive decline while having preserved activities of daily living—the construction of this evidence indicates they are not normal and they are not demented. Based on such evidence, where then does the balance of probability for MCI lie? A multidisciplinary international group of experts gathered in Stockholm in 2003 to discuss MCI concepts (Winblad et al. 2004). They acknowledged that the heterogeneous etiology of MCI contributes to "some confusion concerning the specific boundaries of the condition", stating that this "not normal, not demented" condition is nonetheless "useful both clinically and as a research entity" (p. 241). Importantly, they concluded that MCI needs "better definition" (p. 246). It was at this stage that we first wrote our manuscript, and in the subsequent two years we have eagerly awaited new studies, and the recognition of flexible, practical subtypes to evolve.We state "that MCI cannot be considered to be a separate clinical entity" (Graham and... (shrink)