Distinct Concepts Research Articles

Anti-Competition and Anti-Corruption Controversies in the European Financial Sector: Examining the Anti-ESG Factors with Entropy Weight and TOPSIS Methods

(1) Background: This research aims to investigate the impact of environmental, social, and governance (ESG) factors on European banking corruption. Thus, its novelty is based on considering anti-competitive concerns as a major component that may considerably impact fraud and bribery in corruption investigations. (2) Methods: To approach the research question, we conducted an examination of anti-competitive practices at 344 financial institutions headquartered in Europe throughout the period 2018 to 2022 using the entropy weight and TOPSIS methods. (3) Results: This study reveals that anti-competitive actions are typified by environmental debate and genuine policy competition. Analysing the results prompted us to reach this conclusion. The present study’s findings reveal that financial institutions in Scandinavian nations demonstrate the most significant anti-competitive activity. (4) Conclusions: This research is the first study to underscore the concept of anti-competition disputes and their impact on the emergence of corruption, extortion, and fraud in the European banking sector. Although anti-competitive and corrupt practices may appear to be distinct concepts, they both lead to the financial sector acquiring disproportionate control over the market.

Does School Education Improve Children’s Health Literacy? Evidence from a Performance-Based Survey

Abstract Background Children begin using digital sources of health information at a young age and are quickly exposed to a variety of unmoderated health content. Health literacy helps children navigate, understand, evaluate, and act on this content. But is the educational system preparing young people for these tasks? This study develops a validated, performance-based measure of health literacy and applies it to a sample of 9- to 13-year-old children (grades 4 to 7). Methods A performance-based tool to measure children’s health literacy was developed through expert consultation and qualitative and quantitative pretesting. The tool uses vignettes and quizzes and captures three dimensions of health literacy: nutrition, physical activity, and psychosocial health. The validated tool was then used in a cross-sectional survey of Austrian children aged 9 to 13 years (n = 780): Diet, Physical Activity, and Psychosocial Health. Results Results show that the performance-based health literacy scores do not correlate with self-reported scores. Girls (vs. boys) and native speakers perform better on the performance-based literacy test, while boys and children reporting more robust financial backgrounds overestimate their literacy on self-reported questions. Most importantly, the data do not show meaningful increases in performance-based health literacy across grade levels. For nutrition literacy, the study even shows a slight negative trend across grade levels. Conclusions This study questions the heavy reliance on self-reported health literacy, which is often confounded with self-efficacy and social environment. Performance-based instruments are needed to measure health literacy as an educational outcome. This study presents one of the first validated instruments. Most importantly, the study shows that the current educational system may not produce meaningful increases in performance-based health literacy, calling for deeper educational reforms. Key messages • Performance-based health literacy is a distinct concept from the subjective health literacy measures that dominate current health literacy research. • Performance-based health literacy did not increase with grade level, indicating a poor performance of the education system in strengthening health literacy.

Ibn Jinni's Reading of the Book of Characteristics Offers Insights into Language and Signs

The sign is a distinctive concept in linguistic thought, serving as the foundation for research into the origin of language and the acquisition of its significance. Almost no philosophical theory, whether ancient or modern, makes any mention of it. Indeed, modern linguistics has become inextricably linked with the sign because of its bond with the signifier, which is the basis of language and relied upon in its study.In the fourth century, Ibn Jinni was the most prominent linguist. His linguistic thought was linked to the fundamentalists of logic and speech, as evidenced in his book Al-Khassas. In this work, he presented the origins of language and the processes by which connotations are obtained and acquired.In addition to his contributions to the field of linguistics, Ibn Jinni also presented a printed work on jurisprudence and speech, as well as undertaking linguistic investigations.This paper examines the concept of the 'mark' as it is presented in the thought of Ibn Jinni, exploring it through a number of different axes.

Postoperative complications and symptoms of anxiety and depression in patients with gastric and esophageal cancer: a retrospective cohort study

ABSTRACT Context. Gastric and oesophageal cancers are common. They are also expected to increase in incidence in the next few years and are characterized by poor prognosis. Surprisingly, whereas the incidence of severe anxiety and depression is high in patients with gastric and oesophageal cancers, the influence of symptoms of depression and anxiety on postoperative complications has barely been explored. Methods. In a retrospective study based on a prospectively collected database, 629 cancer patients were enrolled. Symptoms of depression and anxiety (Hospital Anxiety and Depression Scale scores) and sociodemographic and medical information were collected immediately after diagnosis and before any treatment. The surgical approach (i.e. gastrectomy or oesophagectomy) and postoperative complications according to the Clavien–Dindo classification were collected after surgery. Results. After controlling for known medical predictors (i.e. surgical strategy, alcohol and tobacco consumption, American Society of Anaesthesiologists classification physical status score) of postoperative complications, no effect of symptoms of depression or anxiety was detected. Discussion. The observed results are surprising given the literature. However, several potential arguments can be put forwards regarding methods and measures, controlling variables, and conceptual distinctions. Despite the absence of significant results, this topic should be more deeply investigated by applying methodological and conceptual adjustments.

Functional Capacity, Functional Performance, and Symptoms in People With Heart Failure: An Integrative Review.

Heart failure (HF) is a clinical syndrome that has a negative effect on functional status, a multidimensional concept characterizing one's ability to provide for the necessities of life. Symptoms might be associated with different aspects of functional status in HF. However, the terms functional capacity and performance have been misused interchangeably, and no previous review has focused on the extent to which symptoms contribute to functional capacity and performance among people with HF. The aim of this study was to comprehensively review and synthesize the existing literature on the relationship between symptoms, functional capacity, and functional performance in people with HF. We conducted an integrated review of observational studies in which authors examined the relationship between at least 1 symptom and at least 1 aspect of functional capacity or performance in people with HF 18 years or older. The Joanna Briggs Institute's critical appraisal tools were used to analyze the quality of studies. We included 23 studies with 7219 participants and an age range of 40 to 86 years. Fifteen symptom measures were used to measure dyspnea, fatigue, pain, insomnia symptoms, depressive symptoms, and anxiety symptoms. Three functional capacity measures were assessed in 9 studies, and 7 functional performance measures were assessed in 17 studies. As often measured with the Six-Minute Walk Test, functional capacity was inversely associated with pain/discomfort, insomnia symptoms, and psychological symptoms. Functional performance, often measured by the New York Heart Association functional class and Medical Outcome Scale Short Form 36, was associated with sleep difficulties, fatigue, depressive symptoms, and anxiety. Four studies combined functional capacity and performance measures to elicit functional status. Depressive symptoms, fatigue, pain, and insomnia symptoms are associated with decreased functional performance and capacity. Commonly, symptoms experienced in HF are associated with declining functional status. However, this finding depends on the measures or metrics used to assess symptoms, functional capacity, and performance. The observed dissimilarities in the relationship between symptoms and functional capacity and performance highlight the conceptual distinctions, suggesting that authors of future studies should judiciously select appropriate dimensions and measures of functional status based on the study's purposes, design, and available resource.

Decolonial Critical Bioethics and Access to Treatment for Hemophilia in the Americas

Over the past two decades, the integration of sociology with the analytical and normative practices of bioethics has become firmly established. This integration has given rise to two similar yet distinct conceptions of bioethics: empirical bioethics, which utilizes social sciences to enhance ethical scrutiny, and critical bioethics, which not only employs research methods but also draws from established social theories. Critical bioethics aims to overcome the decontextualized analyses inherent in the concept of applied ethics, which relies solely on moral philosophy. This epistemic deepening enables a comprehensible evaluation of the impacts of biotechnologies’ production and distribution within their social and global contexts, ultimately leading to more robust normative frameworks. This article presents the conceptual framework of a model of critical bioethics that we term “decolonial”, developed through the synthesis of the Frankfurt School and decolonial studies. To illustrate the relevance of its analytical parameters, we will examine to clotting factor concentrates in countries across the Americas.

A Thematic Study of Nyaya Philosophy with Research Methodology

This thematic study explores the intricate components of Nyaya philosophy and its methodological implications for educational research. This review examines the conceptual distinctions in ontological and epistemological perspectives currently employed within the theoretical framework of educational research. Nyaya philosophy, rooted in the universal truths of Hindu philosophy, serves as a foundation for developing research methodologies. Its sixteen divisions of Padarthas support four primary modes of knowledge acquisition: perception, inference, comparison, and testimony. Nyaya subtly steers researchers towards theoretical generalization in research design, emphasizing the importance of incorporating inductive and deductive procedures in the theoretical processes of educational research. Nyāya philosophy enhances research rigor through its ontological and epistemological principles. By using Nyāya’s categories of existence, substance, quality, and action—research questions are clearly defined. Nyāya’s logical rigor in data analysis ensures valid, consistent conclusions, aiding critical evaluation. Theory building is strengthened by its causation principles and categories, leading to comprehensive theories. Nyāya’s principles also improve the critical evaluation of literature, helping researchers assess and build upon existing knowledge systematically, achieving greater clarity and validity in their studies.

Experimenting with a strong dual necessity approach to social progress

Different social progress indices assess well-being and development differently and thus reflect distinct conceptions of social progress. Broadly, these conceptions fall into two categories: ‘subjective’—the attitudes of individuals; and ‘objective’—external standards. Our starting point is a strong ‘dual necessity’ claim, namely that the two categories of conception have joint-special significance. Such a strong dual necessity conception, when operationalized, demands very low compensability/degree of substitution between the two independent indices, objective and subjective. Experimenting with this idea, we hypothesize that implementing low substitution empirically influences outcomes. Previous research presented this concept and exemplified initial empirical outcomes. The present work enhances and broadens this research by employing the constant elasticity of substitution (CES) function, which allows for the adjustment of substitution levels and comparison of resulting rankings. Furthermore, we demonstrate the results using two different well-known and commonly used indices: Human Development Index (HDI) and Sustainable Development Goals Index (SDGI). Our findings show that using a low substitution approach alters the social progress rankings of many countries in comparison to the original components’ rankings and to a high substitution combination of the two. This holds particularly true for countries in the middle of the original rankings. The paper’s original contribution is that it establishes the CES function as a useful device for implementing the idea of ‘dual necessity.’ Importantly, by experimenting with low substitution, and exemplifying its empirical significance with the CES function, the paper also contributes to further validating a strong dual necessity conception and justifies its own measurement. Such measurement should be of value to social scientists, practitioners and policymakers who care for balanced social progress: social progress that does not neglect either of the two aspects (subjective or objective).

Silence in the workplace: what do we know from research?

PurposeThe purpose of this article is to examine the antecedents and consequences of organizational silence and employee silence to determine whether these two concepts should be distinguished rather than used interchangeably in research.Design/methodology/approachThis study conducted a systematic literature review of 79 studies on organizational silence and 113 on employee silence, leading to three major findings.FindingsFirst, this study shows that organizational silence is a collective phenomenon and employee silence occurs at the individual level; therefore, indicating they should be treated as two distinct concepts. Second, both types of silence are influenced by contextual factors (internal and external) and leadership. Third, organizational silence impacts both individual and organizational outcomes, whereas employee silence mainly affects an individual’s psychological health and performance.Originality/valueThis research clarifies the distinction between organizational silence and employee silence, offering guidance for researchers on how to approach these concepts. It also highlights the critical need to address workplace silence and the potential harm it may cause to both organizational and individual well-being if left unaddressed. Furthermore, this research supports organizational leaders and human resource developers in fostering a healthier work culture, improving performance and driving continuous improvement.

What repoliticisation means and requires: Creating the climate for disagreement

This paper makes a conceptual distinction between repoliticisation and politicisation and evaluates what this means for post-foundational political geography and its collective endeavour of achieving a more egalitarian future. Post-foundational political geography is being consolidated as a distinct disciplinary subfield. Within the existing body of literature, significant attention has been directed towards depoliticisation and post-politicisation, but repoliticisation is yet to amass the same critical attention. While literature nonetheless considering repoliticisation treats it as almost synonymous with politicisation, in this paper, I argue repoliticisation is more specifically about enacting, or opening the door to, politicisations. To illustrate the case, I draw upon (auto)ethnographic, scholar-activist work, operating as a carbon accountant for the City of Manchester, UK, as part of a wider project evaluating the role experts (could) play in restricting and enabling political change. Taking post-foundational political geography's insistence that expert, technocratic modes of governance depoliticise seriously, and in mobilising this distinction between repoliticisation and politicisation, I explore what existing subjects like accountants can do to repoliticise. Doing so illustrates how repoliticisations could be triggered from within existing orders of politics and demonstrates how repoliticisation and politicisation are overlapping, related, yet distinct, concepts.

Power, Politics, and Personification: Toward a Critique of Postone’s Theory of Antisemitism

Abstract This essay offers an immanent critique of Moishe Postone’s theory of antisemitism. It argues that his account of modern antisemitism as a form of fetishistic anti-capitalism contains a decisive ambiguity. Postone oscillates between two distinct conceptions of anti-capitalism: explicit and implicit. These conceptions are conflated when Postone draws a line from his paradigm case of modern antisemitism to recent anti-imperialist criticism of particular nation-states. This conflation also allows him implicitly to suggest that anti-communism is a form of anti-capitalism. More attention to the differences between these senses of anti-capitalism could have led Postone to a richer theoretical account of the place of abstraction in the distinctively political dangers that obsessed modern antisemitism, which might, in turn, have drawn his attention in the present toward contemporary Islamophobia, rather than criticism of the US, as redolent of certain aspects of the modern antisemitic imaginary.

Lowering the burden: Shorter versions of the Program Sustainability Assessment Tool (PSAT) and Clinical Sustainability Assessment Tool (CSAT)

BackgroundAlthough significant advances have been made in the conceptualization of sustainability, having pragmatic, psychometrically valid tools remains a need within the field. Our previous work has developed frameworks and tools to assess both program sustainability and clinical sustainability capacity. This work presents new, psychometrically tested short versions of the Program Sustainability Assessment Tool (PSAT) and the Clinical Sustainability Assessment Tool (CSAT).MethodsThese methods were conducted in identical, parallel processes for the CSAT and PSAT. Previously collected data for these instruments was obtained across a variety of settings, contexts, and participants. We first conducted testing to determine cronbach’s alpha of shortened domains (3 items each) and then conducted Confirmatory Factor Analysis to ensure that the domains were still appropriate for the tool. After, the team met to review the results and determine the final versions of the short PSAT and short CSAT.ResultsThe short PSAT retained cronbach’s alpha’s of 0.82 – 0.91 for each domain of the tool, with which maintains excellent reliability for the tool. Confirmatory factor analysis highlights that the short PSAT retains conceptual distinction across the 8 domains, with CFI scores greater than 0.90, RMSEA scores below 0.6, and SRMR scores less than 0.08. The short CSAT had cronbach’s alpha of 0.84 – 0.92 for each of the domains of the tool, also suggesting excellent reliability of the domains within the measure after dropping two items/domain. Confirmatory factor analysis of the short CSAT meets the same specifications as above, again highlighting conceptual distinction across the domains.ConclusionEach tool was able to be shortened to three items per domain while maintaining strong psychometric properties. This results in a tool that takes less time to complete, meeting one of the key calls for pragmatic measures within implementation science. This advances our abilities to measure and test sustainability within implementation science.

“TESTIMONY STOPS WHERE HISTORY BEGINS”: UNDERSTANDING AND ETHICS IN RELATION TO HISTORICAL AND PRACTICAL PASTS

ABSTRACTThis article explores the relation between testimony and history by considering the recent “ethical turn” toward experience and memory in historical research. By way of a brief history of the concept of testimony in historical research, the article pinpoints current discussions as being about historical understanding rather than factual knowledge about the past. With reference to the revaluation of history within the linguistic turn, influential historical theorists have argued that abandoning objectivism calls for a rapprochement between historical research and attempts to make sense of the past in accounts of memory. Both history and memory accounts, they argue, offer forms of understanding that are equally conditioned by language as well as politics, culture, and identity. Thus, the inclusion of testimony has been framed as not only legitimate but also important for an “ethical” understanding of the past within historiographical discourse. In relation to this development, the article shows that abandoning objectivism in the wake of the linguistic turn cannot justify a general rapprochement between history and memory accounts. On the contrary, abandoning objectivism only increases the importance of appreciating the conceptual distinction between testimony and history as different forms of understanding. For clarifying the conceptual distinction, the article reexamines R. G. Collingwood's (in)famous contention that “testimony … stops where history begins.” Collingwood's main point was not, as previous interpreters have argued, only about epistemology but was about the qualitative difference between historical and practical pasts. In conclusion, the article articulates the importance of the distinction between history and practice in relation to questions about the historian's ethical responsibility.

“Warning: ultra-processed”: an online experiment examining the impact of ultra-processed warning labels on consumers’ product perceptions and behavioral intentions

BackgroundNutrient content and degree of processing are complementary but distinct concepts, and a growing body of evidence shows that ultra-processed foods (UPFs) can have detrimental health effects independently from nutrient content. 10 + countries currently mandate front-of-package labels (FOPL) to inform consumers when products are high in added sugars, saturated fat, and/or sodium. Public health advocates have been calling for the addition of ultra-processed warning labels to these FOPLs, but the extent to which consumers would understand and be influenced by such labels remains unknown. We examined whether the addition of ultra-processed warning labels to existing nutrient warning labels could influence consumers’ product perceptions and purchase intentions.MethodsIn 2023, a sample of adults in Brazil (n = 1,004) answered an open-ended question about the meaning of the term “ultra-processed,” followed by an online experiment where they saw four ultra-processed products carrying warning labels. Participants were randomly assigned to view either only nutrient warning labels or nutrient plus ultra-processed warning labels. Participants then answered questions about their intentions to purchase the products, product perceptions, and perceived label effectiveness.ResultsMost participants (69%) exhibited a moderate understanding of the term “ultra-processed” prior to the experiment. The addition of an ultra-processed warning label led to a higher share of participants who correctly identified the products as UPFs compared to nutrient warning labels alone (Cohen’s d = 0.16, p = 0.02). However, the addition of the ultra-processed warning label did not significantly influence purchase intentions, product healthfulness perceptions, or perceived label effectiveness compared to nutrient warning labels alone (all p > 0.05). In exploratory analyses, demographic characteristics and prior understanding of the concept of UPF did not moderate the effect of ultra-processed warning labels.ConclusionsUltra-processed warning labels may help consumers better identify UPFs, although they do not seem to influence behavioral intentions and product perceptions beyond the influence already exerted by nutrient warning labels. Future research should examine how ultra-processed warning labels would work for products that do and do not require nutrient warnings, as well as examine the benefits of labeling approaches that signal the health effects of UPFs.Trial registrationClinicalTrials.gov, NCT05842460. Prospectively registered March 15th, 2023.

Theoretical concepts about alluvial fans and debris cones: case studies of an Alluvial Fan in São Desidério (Bahia, Brazil) and a Debris Cone at Mount Somma, near the Vesuvius Volcano (Naples, Italy)

Analyzing the last 24 years of the Brazilian Journal of Geomorphology and the National Symposiums of Geomorphology (SINAGEO), it is evident that there is a lack of studies on alluvial fans in Brazil and in Portuguese literature. The situation is even more unclear concerning debris cones. This paper aims to provide a concise and comprehensive bibliographic review of alluvial fans and debris cones in Portuguese and to the Brazilian geomorphological science. These features are crucial for understanding and studying the relationship between form and process, paleoenvironmental reconstruction, sensitivity to climate variations, risks associated with mass movements on slopes, and more effective territorial planning by human actions. Additionally, the paper seeks to clarify the main theoretical and conceptual distinctions between alluvial fans and debris cones, proposing a new classification based on two particularly illustrative case studies. Do alluvial fans and debris cones represent the same or different depositional forms in the landscape? To this end, the methodology includes a detailed theoretical and conceptual review of the topic, a survey of relevant data about the subject in the main means of the Brazilian geomorphological community dissemination, a proposal of a new classification to differentiate these forms, and the mapping, characterization, comparison and analysis of two specific study areas: an Alluvial Fan identified in São Desidério (Bahia, Brazil) and a Debris Cone identified in Mount Somma, the ancient crater of the current Vesuvius Volcano (Naples, Italy).

Amelogenin-Based Molecular Methods for Sexual Dimorphism Identification: Protocol of a Scoping Review

Forensic dentistry and sexual dimorphism are distinct concepts. Still, they are related due to the usefulness that the first may have in the second, and this review focuses on them. A scoping review will be performed according to the Joanna Briggs Institute’s methodology. Scientific databases and grey literature will be used, and the following keywords will be applied: amelogenin, analyses, sex determination, and human identification. This scoping review will include in vitro studies concerning the goal of this review. This scoping review will deepen our knowledge concerning using teeth and amelogenin genes in sex identification in a forensic context. According to the available data, it will help implement guidelines for human remains identification. This protocol was registered with the Open Science Framework.

Campbell Standards: Modernizing Campbell's Methodologic Expectations for Campbell Collaboration Intervention Reviews (MECCIR).

The authors formed a small working group to modernize the Methodological Expectations for Campbell Collaboration Intervention Reviews (MECCIR). We reviewed comments and feedback from editors, peer reviewers of Campbell submissions, and authors; for example, that the Campbell MECCIR was long and some of the items in the reporting and conduct checklists were difficult to cross-reference. We also wanted to make the checklist more relevant for reviews of associations or risk factors and other quantitative non-intervention review types, which we welcome in Campbell. Thus, our aim was to develop a shorter, more holistic guidance and checklist of Campbell Standards, encompassing both conduct and reporting of these standards within the same checklist. Our updated Campbell Standards will be a living document. To develop this first iteration, we invited Campbell members to join a virtual working group; we sought experience in conducting Campbell systematic reviews and in conducting methods editor reviews for Campbell. We aligned the items from the MECCIR for conduct and reporting, then compared the principles of conduct that apply across review types to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-literature search extension (S) and PRISMA-2020 reporting standards. We discussed each section with the aim of developing a parsimonious checklist with explanatory guidance while avoiding losing important concepts that are relevant to all types of reviews. We held nine meetings to discuss each section in detail between September 2022 and March 2023. We circulated this initial checklist and guidance to all Campbell editors, methods editors, information specialists and co-chairs to seek their feedback. All feedback was discussed by the working group and incorporated to the Standards or, if not incorporated, a formal response was returned about the rationale for why the feedback was not incorporated. The guidance includes seven main sections with 35 items multifaceted but distinct concepts that authors must adhere to when conducting Campbell reviews. Authors and reviewers must be mindful that multiple factors need to be assessed for each item. According to the Campbell Standards, the reporting of Campbell reviews must adhere to appropriate PRISMA reporting guidelines(s) such as PRISMA-2020. The editorial board recommends authors use the checklist during their work in formulating their protocol, carrying out their review, and reporting it. Authors will be asked to submit a completed checklist with their submission. We plan to develop an online tool to facilitate use of the form by author teams and those reviewing submissions. We invite the scientific community to provide their comments using this anonymous google form. We will update the Campbell Standards periodically in light of new evidence.

A Comparative Exploration of Human Potential and Self-Transcendence in Iqbal and Nietzsche

This study examines the essential conceptual distinctions between Nietzsche's notion of the Superman and Iqbal's conception of the Perfect Man, two divergent goals of human potential. Nietzsche's Superman, grounded on power, autonomy, and the repudiation of conventional morality, aspires to grandeur via individual supremacy and the transcendence of social norms. Conversely, Iqbal’s Perfect Man is a fusion of heavenly grandeur and beauty, attaining excellence via spiritual self-actualization, ethical integrity, and altruistic service to mankind. Nietzsche’s Superman dismisses metaphysical ideas and flourishes via human will, but Iqbal’s Perfect Man derives power from religion, love, and justice. This contrast highlights a profound philosophical divergence: Nietzsche’s perspective centers on existential power, while Iqbal’s prioritizes spiritual development and collective advancement. The thesis ultimately emphasizes Iqbal’s Perfect Man as a paradigm for harmonious human growth, surpassing Nietzsche’s individualistic ideal.

The emergence of nanoscience

Abstract Nanoscience and nanotechnology have emerged as distinct scientific concepts in the final third of the 20th century, however the way that the history of this field is discussed has not settled into an accepted path. This paper discusses the many ways to approach this history, spanning science intuition, ancient technologies, mythical visions, tool development, commercial opportunities and science fictions. In the brief and accessible discussion here expanding on the different histories of nano, the paper explores some of these concepts and conclude that this is not (yet) a well posed question.

Subsyndromes and symptom clusters: Multilevel factor analysis of behavioral and psychological symptoms of dementia with intensive longitudinal data.

Behavioral and psychological symptoms in dementia (BPSD) are dynamic phenomena with a high amount of intraindividual variability. We applied a multilevel framework to identify subsyndromes (between-person factors) that represent clinically relevant profiles of BPSD and identify symptom clusters (within-person factors) that represent contextually driven daily symptom experiences. This study used an intensive longitudinal design in which 68 co-residing family caregivers to persons living with dementia were recruited to proxy report on their care recipient's daily symptom experiences of 23 different BPSD for eight consecutive days (n=443 diaries). A multilevel exploratory/confirmatory factor analysis was used to account for nested data and separate within-person variances from between-level factor estimates. Exploratory factor analysis identified a 4-between 3-within factor structure based on fit statistics and clinical interpretability. This study offers major methodological and conceptual advancements for management of BPSD within Alzheimer's disease and related dementias by introducing two related but distinct concepts of subsyndromes and symptom clusters. Because behavioral and psychological symptoms of dementia (BPSD) are dynamic temporal phenomenon, this introduces measurement error into aggregate group-level estimates when trying to create subsyndromes. We propose a multilevel analysis to provide a more valid and reliable estimation by separating out variance due to within-person daily fluctuations. Using a multilevel exploratory factor analysis with intensive longitudinal data, we identified distinct and meaningful groups of BPSD. The four factors at the between-person level represented subsyndromes that are based on how BPSD co-occurred among persons with Alzheimer's disease (AD). These subsyndromes are clinically relevant because they share features of established clinical phenomena and may have similar neurobiological etiologies. We also found three within-person factors representing distinct symptom clusters. They are based on how BPSD clustered together on a given day for an individual with AD and related dementias. These clusters may have shared environmental triggers.