Recent research suggests that some human-like social skills evolved in dogs during domestication as an incidental by-product of selection for “tame” forms of behavior. It is still possible, however, that the social skills of certain dog breeds came under direct selection that led to further increases in social problem solving ability. To test this hypothesis, different breeds of domestic dogs were compared for their ability to use various human communicative behaviors to find hidden food. We found that even primitive breeds (...) with little human contact were able to use communicative cues. Further, “working” dogs were more skilled at using gestural cues than were non-working breeds. This difference in performance existed regardless of whether the working breeds were more or less genetically wolf-like. These results suggest that subsequent to initial domesticating selection giving rise to cue-following skills, additional selection on communicative abilities in certain breeds has produced substantive differences in those breeds’ abilities to follow cues. (shrink)

Background In earlier work, we found important selection biases when we tried to obtain consent for participation in a national stroke registry. Recognizing that not all registries will be exempt from requiring consent for participation, we examine here in greater depth the reasons for the poor accrual of patients from a systems perspective with a view to obtaining as representative sample as possible. Methods We determined the percent of eligible patients who were approached to participate and, among those approached, the (...) percent who actually consented to participate. In addition we examined the reasons why people were not approached or did not consent and the variation across sites in the percent of patients approached and consented. We also considered site variation in restrictions on the accrual and data collection process imposed by either the local research ethics board or the hospital. Results Seventy percent of stroke patients were approached, with wide variations in approach rates across sites (from: 41% to 86%), and considerable inter-site variation in hospital policies governing patient accrual. Chief reasons for not approaching were discharge or death before being approached for consent. Seventeen percent of those approached refused to participate (range: 5% to 75%). Finally, 11% of those approached did not participate due to language or communication difficulties. Conclusion We found wide variation in approach and agree rates across sites that were accounted for, in part, by different approaches to accrual and idiosyncratic policies of the hospitals. This wide variation in approach and agree rates raises important challenges for research ethics boards and data protection authorities in determining when to waive consent requirements, when to press for increased quality control, when to permit local adaptation of the consent process, and when to permit alternatives to individual express consent. We offer several suggestions for those registries that require consent for participation. (shrink)

This book explores the epistemology and the methodology of political knowledge and social inquiry. What can we know, and how do we know? Friedrich V. Kratochwil and Ted Hopf question all foundational claims of inquiry and envisage science as a self-reflective practice. Brian Pollins and Fred Chernoff accept their arguments to some degree and explore the implications for logical positivism. David A. Waldner, Jack Levy, and Andrew Lawrence address the purpose and methods of research. They debate the role of explanation (...) versus prediction, the relationship of theory to evidence, and their implications for the Democratic Peace research program. A concluding chapter by Mark Lichbach offers a pluralistic reformulation of neopositivism. An alternative conclusion by Steven Bernstein, Richard Ned Lebow, Janice Gross Stein and Steven Weber contends that social science should be modeled on medicine and reformulated as a set of case-based diagnostic tools. The distinguishing feature of the book is the inclusion of authors who represent different approaches to social science and their willingness to engage with one another in a constructive debate. (shrink)

This book explores the epistemology and the methodology of political knowledge and social inquiry. What can we know, and how do we know? Friedrich V. Kratochwil and Ted Hopf question all foundational claims of inquiry and envisage science as a self-reflective practice. Brian Pollins and Fred Chernoff accept their arguments to some degree and explore the implications for logical positivism. David A. Waldner, Jack Levy, and Andrew Lawrence address the purpose and methods of research. They debate the role of explanation (...) versus prediction, the relationship of theory to evidence, and their implications for the Democratic Peace research program. A concluding chapter by Mark Lichbach offers a pluralistic reformulation of neopositivism. An alternative conclusion by Steven Bernstein, Richard Ned Lebow, Janice Gross Stein and Steven Weber contends that social science should be modeled on medicine and reformulated as a set of case-based diagnostic tools. The distinguishing feature of the book is the inclusion of authors who represent different approaches to social science and their willingness to engage with one another in a constructive debate. (shrink)

Schools are interesting as complex organizations in and of themselves but even more so for how they refract the societal dynamics by which inequality is reproduced, an enduringly vexing question (Fligstein & McAdam, 2012:3). Educational attainment is core to socioeconomic status and connected to outcomes in housing, health, and employment. Unequal schools in fields characterized by stratification are often the subject of reform attempts (Tyack, 1974). We examine how a wealthier and a poorer school responded to a state-level regulatory mandate (...) for change, in the U.S. context of schools as putative engines of opportunity. Bourdieu’s “master concepts” of field, habitus, and cultural capital (Swartz, 2008) are often applied, and we used them to answer frequent but still relatively unanswered calls in the literature: first, to use the master concepts together rather than singularly, and second, to attend specifically to the organization level and what it refracts (Dobbin, 2008; Emirbayer & Johnson, 2008; Hallett & Gougherty, 2018; Lounsbury & Ventresca, 2003; Mohr, 2013). For this integrative and organizational level approach, we derived the concept of “class signature,” which enabled us to focus on practices in organizations. This lens revealed “resistant compliance” in the wealthier school and “compliant resistance” in the poorer school, both of which reshaped the stratified field, even if stratification was not rectified. These responses appeared to reproduce inequality, not simplistically, we argue, but along a winding path fraught with practical experiments, protection against penalties, redefinition of the reform’s terms, and some small gains to remedy intra-organizational inequalities. (shrink)

At the intersection of law, feminism and philosophy, this book analyses the ways in which certain bodies and 'selves' continue to be treated as monstrous aberrations from the 'ideal' figure or norm. Employing contemporary feminist philosophy to rethink accepted legal ideas, the book is divided into three sections. The first focuses on the different relational ontologies of philosophers Adriana Cavarero and Christine Battersby - also considering their work via a third term: Spinoza. The second turns to diverse feminist engagements with (...) the social contract theorists. The third section employs insights from throughout the book to focus more explicitly on law - and, in particular privacy law and the so-called 'wrongful birth' cases. Bringing together more than twenty years of sustained reflection, this book offers an insightful account of how contemporary feminist philosophy can contribute to a richer understanding of law. It will be of enormous interest to scholars and students working in the areas of legal theory, feminist thought and philosophy. (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.

This paper begins by isolating the reductive component of Brandom's inferentialism. In order to assess to what extent that reductive component is supported by the considerations Brandom marshals in its defense, I assess the comparative degree of support those considerations provide a non-reductive counterpart of Brandom's original, reductive theory. One of the central claims here is that once the reductive and non-reductive theories are placed side-by-side, it is clear that, save one, all of the considerations Brandom marshals in defense of (...) inferentialism equally well support its non-reductive counterpart. This shows that those considerations offer no support for the reductions at inferentialism's heart. -/- What the considerations raised here ultimately show is that Brandom's defense of the reductive core of his theory ultimately rests on the simple fact that it has a certain feature, namely, that it is reductive in the sense reserved here. I close with a brief discussion of some advantages that some reductive theories have over non-reductive ones, but show how none of these advantages are had by Brandom's theory in particular. (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)

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)

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)

The Exchange of Words is a philosophical exploration of human testimony, specifically as a form of intersubjective understanding in which speakers communicate by making themselves accountable for the truth of what they say. This account weaves together themes from philosophy of language, moral psychology, action theory, and epistemology, for a new approach to this basic human phenomenon.

The paper argues for the centrality of believing the speaker (as distinct from believing the statement) in the epistemology of testimony, and develops a line of thought from Angus Ross which claims that in telling someone something, the kind of reason for belief that a speaker presents is of an essentially different kind from ordinary evidence. Investigating the nature of the audience's dependence on the speaker's free assurance leads to a discussion of Grice's formulation of non-natural meaning in an epistemological (...) light, concentrating on just how the recognition of the speaker's self-reflexive intention is supposed to count for his audience as a reason to believe P. This is understood as the speaker's explicitly assuming responsibility for the truth of his statement, and thereby constituting his utterance as a reason to believe. (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 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)

In this volume Rorty offers a Deweyan account of objectivity as intersubjectivity, one that drops claims about universal validity and instead focuses on utility for the purposes of a community. The sense in which the natural sciences are exemplary for inquiry is explicated in terms of the moral virtues of scientific communities rather than in terms of a special scientific method. The volume concludes with reflections on the relation of social democratic politics to philosophy.

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)

Richard Swinburne presents a powerful new case for substance dualism and for libertarian free will. He argues that pure mental events are distinct from physical events and interact with them, and claims that no result from neuroscience or any other science could show that interaction does not take place. Swinburne goes on to argue for agent causation, and claims that it is we, and not our intentions, that cause our brain events. It is metaphysically possible that each of us could (...) acquire a new brain or continue to exist without a brain; and so we are essentially souls. Brain events and conscious events are so different from each other that it would not be possible to establish a scientific theory which would predict what each of us would do in situations of moral conflict. Hence, we should believe that things are as they seem to be: that we make choices independently of the causes which influence us. It follows that we are morally responsible for our actions. (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)

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)

BackgroundLittle is known about volunteers from Northern research settings who participate in vaccine trials of highly infectious diseases with no approved treatments. This article explores the motivations of HIV immunocompromised study participants in Canada who volunteered in a Phase II clinical trial that evaluated the safety and immunogenicity of an Ebola vaccine candidate.MethodsObservation at the clinical study site and semi-structured interviews employing situational and discursive analysis were conducted with clinical trial participants and staff over one year. Interviews were recorded, transcribed (...) and analysed using critical qualitative interpretivist thematic analytical techniques. Patterns were identified, clustered and sorted to generate distinct and comprehensive themes. We then reassembled events and contexts from the study participants’ stories to develop two ideal portraits based on "composite characters" based on study participants features. These provide ethnographically rich details of participants’ meaningful social worlds while protecting individual identities.ResultsTen of the 14 clinical trial participants, and 3 study staff were interviewed. Participant demographics and socio-economic profiles expressed limited contextual diversity. Half were men who have sex with men, half were former injection drug users experiencing homelessness, one was female, none were racialized minorities and there were no people from HIV endemic countries. Fully 90% had previous involvement in other clinical studies. Their stories point to particular socio-economic situations that motivated their participation as clinical labor through trial participation.ConclusionsOur findings support Fisher’s argument of “structural coercion” in clinical trial recruitment of vulnerable individuals experiencing precarious living conditions. Clinical trials should provide more detail of the structural socio-economic conditions and healthcare needs which lie “under consent” of study participants. Going well beyond an overly convenient narrative of altruism, ethical deliberation frameworks need to sufficiently address the structural conditions of clinical trials. We offer concrete possibilities for this and acknowledge that further research and clinical data should be made available underlying study participant contexts with regards to recruitment and participation in resource poor settings, in both the South and the North. (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)

Richard Swinburne offers an original treatment of a question at the heart of epistemology: what makes a belief rational, or justified in holding? He maps the rival accounts of philosophers on epistemic justification ("internalist" and "externalist"), arguing that they are really accounts of different concepts. He distinguishes between synchronic justification (justification at a time) and diachronic justification (synchronic justification resulting from adequate investigation)--both internalist and externalist. He also argues that most kinds of justification are worth having because they are indicative (...) of truth; however, it is only justification of internalist kinds that can guide a believer's actions. Swinburne goes on to show the usefulness of the probability calculus in elucidating how empirical evidence makes beliefs probably true. (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 year 2019 saw the 130th anniversary of the death of Julian Tenison Woods, Founder of the Sisters of St Joseph and Sisters of Perpetual Adoration. He died in Sydney on 7 October 1889, aged fifty-six. In the anniversary year the Sisters of St Joseph of the Sacred Heart invited the Lochinvar Sisters of St Joseph to join them in raising his profile and recognising him as Founder. The founding of the sisters in South Australia and the life of Mary (...) MacKillop have been well publicised and St Mary is widely recognised. Still, though Woods is portrayed and acclaimed in the writing of many, his relatively short and varied life, his remarkable gifts, his impact in the Australian church and the world of science is little known. Woods, the man, the priest, the founder, the scientist, the man of God, a man for our time awaits wider recognition. (shrink)

Almost 40 years ago, scholars identified a “chilly climate” for women in college classrooms. To examine whether contemporary college classrooms remain “chilly,” we conducted quantitative and qualitative observations in nine classrooms across multiple disciplines at one elite institution. Based on these 95 hours of observation, we discuss three gendered classroom participation patterns. First, on average, men students occupy classroom sonic space 1.6 times as often as women. Men also speak out without raising hands, interrupt, and engage in prolonged conversations during (...) class more than women students. Second, style and tone also differ. Men’s language is assertive, whereas women’s is hesitant and apologetic. Third, professors’ interventions and different structures of classrooms can alter existing gender status hierarchies. Extending Ridgeway’s gender system framework to college classrooms, we discuss how these gendered classroom participation patterns perpetuate gender status hierarchies. We thus argue that the chilly climate is an underexplored mechanism for the stalled gender revolution. (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)