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Smartphones have the potential for capturing subtle changes in cognition that characterize preclinical Alzheimer’s disease (AD) in older adults. The Ambulatory Research in Cognition (ARC) smartphone application is based on principles from ecological momentary assessment (EMA) and administers brief tests of associative memory, processing speed, and working memory up to 4 times per day over 7 consecutive days. ARC was designed to be administered unsupervised using participants’ personal devices in their everyday environments.
We evaluated the reliability and validity of ARC in a sample of 268 cognitively normal older adults (ages 65–97 years) and 22 individuals with very mild dementia (ages 61–88 years). Participants completed at least one 7-day cycle of ARC testing and conventional cognitive assessments; most also completed cerebrospinal fluid, amyloid and tau positron emission tomography, and structural magnetic resonance imaging studies.
First, ARC tasks were reliable as between-person reliability across the 7-day cycle and test-retest reliabilities at 6-month and 1-year follow-ups all exceeded 0.85. Second, ARC demonstrated construct validity as evidenced by correlations with conventional cognitive measures (r = 0.53 between composite scores). Third, ARC measures correlated with AD biomarker burden at baseline to a similar degree as conventional cognitive measures. Finally, the intensive 7-day cycle indicated that ARC was feasible (86.50% approached chose to enroll), well tolerated (80.42% adherence, 4.83% dropout), and was rated favorably by older adult participants.
Overall, the results suggest that ARC is reliable and valid and represents a feasible tool for assessing cognitive changes associated with the earliest stages of AD.
This chapter provides a discussion of the conclusions and implications of this research. In many respects, the assumption of initial state interest and resources sufficiency has not been met, although many states have been able to overcome their initial deficiencies in the intervening years. While most observers conclude that the Water Quality Act has served to improve water quality in the nation, the lack of a valid, reliable, and agreed-upon measure of state water quality hampers the ability to reach specific conclusions about the overall effects of the Water Quality Act. The conclusions also highlight the tensions between the financial and environmental elements of the Clean Water State Revolving Fund program, as well as tensions between national environmental goals and state choice in program implementation.
The Water Quality Act of 1987 is a product of the ideas of federalism in place at the time of its development and passage. Driven by the "Reagan revolution," the 1980s was a time of substantial policy change as new imperatives such as states' rights, a smaller national government, an expanded role for the private sector, and deregulation came into vogue. The WQA is an expression of this policy environment, and represents several of these imperatives in the form of a revised infrastructure program to provide clean water. With a switch from a categorical grant to a block grant, the WQA exemplified a policy instrument consistent with the underlying tenets of the "Reagan revolution." This chapter examines the underlying elements of Reagan's philosophy of federalism, and details the ways in which the mechanisms and structure of the WQA reflect this philosophy. Finally, this chapter serves to lay the foundation for context of the development, implementation, and administration of the Water Quality Act.
This chapter introduces the major components of the Water Quality Act of 1987. The chapter guides the reader through the six major titles included in the Water Quality Act, and describes the various programs and functions. The chapter also provides in-depth discussion of the elements of the Clean Water State Revolving Fund program, including the use of leveraging, the reporting and accountability elements of the program, and mechanisms such as the Letter of Credit and the importance of state primacy.
The period of initial state implementation of the Water Quality Act was a critical period in the development of the Clean Water State Revolving Fund (CWSRF). This chapter tests the propositions inherent in the CWSRF that states possessed the administrative, budgetary, political, and organizational resources necessary to implement the program successfully. Drawing on data from EPA and the states, combined with data from a 1990 survey of state program coordinators, this chapter examines the factors critical to state program design and implementation in the early years of the program. The findings from the 50-state analysis suggest that while some states had adequate resources available, many states struggled to balance the environmental and financial elements of the program. The data indicate that some states turned to the private sector for financial assistance, particularly states that chose to leverage their CWSRF capitalization grants. Some states moved quickly with program implementation, while other states proceeded more slowly. The findings highlight the differences in state resources available, and their willingness and ability to implement the program.
The amendments to the Federal Water Pollution Control Act in 1972 represent a significant change in the balance between federal authority and states' rights in water quality policy. The 1972 legislation significantly increased the federal role in clean water, and substantially increased the federal budgetary commitment to water quality. Combined with a new regulatory framework, this legislation set the stage for the development of the Water Quality Act of 1987. The Water Quality Act signifies a substantive redefinition of the federal role in water quality policy. Through the development of a block grant program, the WQA shifted primary responsibility for the distribution of resources for clean water infrastructure to the states, while stating preferences for states to serve certain types of communities. This chapter details the development of the 1987 legislation, the forces that drove the changes in policy instruments, and discusses the modest changes to the program since its initial passage in 1987.
This introduction discusses the impetus for the creation of this research. The year 2016 marks the 30th anniversary of the Water Quality Act, the longest-lived example of federal water pollution policy. The introduction presents a discussion of the major themes of the book, including federalism, states' rights, state choice in water quality policy, and the importance of implementation in policy outcomes. an outline of the content of the chapters is also presented.
The Water Quality Act contained language that expressed the intent of Congress for the Clean Water State Revolving Fund (CWSRF) program to serve certain classes of communities: communities with significant environmental need, communities with populations less than 10,000, and communities facing financial hardship. In addition, Congress allowed CWSRF funds to be used to fund nonpoint pollution projects. Using data from EPA in conjunction with other data, a series of regression models are presented to determine the factors and conditions that lead states to meet these uses. The models and hypotheses tested in this chapter are developed in Chapter Six. Using data for all 50 states measured between 1988 and 2016, the models indicate that factors over which states have control- whether to leverage, the program structure, and others- determine the ability of states to meet the needs of most categories of applicants. State political factors are less important, although demographic variables do provide some explanatory power. Water quality needs matter for communities with significant environmental need. The results also indicate that communities facing financial hardship are not being well served by the program.
This chapter presents in-depth case studies of initial implementation of the Clean Water State Revolving Fund (CWSRF) program. The four states chosen- Alabama, California, Georgia, and New York- represent states that took very different approaches to initial implementation: Alabama represents a state with a highly leveraged program and significant private sector involvement; California is a state with large needs that did not leverage; Georgia is a state that did not leverage and implemented the program without private sector involvement; and New York had huge needs but was delayed in implementation. Data are drawn from state documents, survey data, and in-depth interviews conducted with state program administrators. The case studies highlight the unique circumstances present in each state, and how these circumstances shaped the implementation decisions and, ultimately, the nature of the program developed in the state.