Standardizing Minzu: A Content Analysis of the Depiction of Shaoshu Minzu in Three Chinese Elementary Curriculum Standards and Textbooks

Thesis (Ph.D.)--University of Washington, 2016-08

Apoio governamental à inovação tecnológica: análise da indústria farmacêutica paraense

The transformations economical, cultural and social that happen in world ambit they are associated to the intense progress and expansion of new technologies, forcing governments, people, companies and nations to the introduction of new patterns of behavior, forcing, in that way, to the continuous renewal of products and technological processes to maintain the competitiveness, so much among nations, as in the managerial world. In that matter, the technological innovation is recognized as basic factor of maintainable economical competitiveness, being the responsible for the breaking and/or improvement of the techniques and production processes, what presupposes the systematization varied institutional arrangements that they involve firms, interaction nets among companies, government agencies, universities, research institutes, laboratories of companies and scientists and engineers activities. Those arrangements, to the if they articulate with the educational system, with the industrial and managerial section and, also, with the financial institutions, they take the form that Freeman (1987) it coined of national system of innovation, promoted through public politics of CT&I, which seek to induce and to support innovative initiatives in the companies, as well as to establish demands and to prioritize vocations and regional potentialities. In that context of government support to the technological innovation interferes this study, that it looked for to know the reasons of the fragility innovative in the pharmaceutical industry of State of Pará in Brazil, pointed for PINTEC (2005), starting from the point of view of the businessmen of that section. For such, the qualitative approach was used - with interviews directing semi and the technique of the content analysis. The results of the research pointed that the fragilities innovative of the section links to the ignorance of the government support to the technological innovation on the part of the businessmen of the pharmaceutical industry of State of Pará in Brazil

Cultural influences on positive affect and reward processing in depressed youth

Thesis (Ph.D.)--University of Washington, 2016-07

Unlocking Characteristics of Outstanding Leadership in Schools and Colleges in England

The workshop will invite participants to engage in a discussion of the characteristics of outstanding leadership by taking part in an interactive activity which we have developed and used in different types of schools and colleges in England. The activity uses Q-methodology to develop and refine characteristics of outstanding leaders and outstanding leadership in education from a range of stakeholder perspectives. Q-methodology is a research method which originates from psychology and is used to study people's subjective viewpoints. We are applying the methodology to the study of enacted leadership practice in different educational contexts. Our sample of stakeholders consists of school and college leaders, governors, middle leaders, teachers, teacher educators, researchers and scholars in educational leadership and management research and practice. The range of contexts in which they work represents different age phases of education; primary, secondary and further education colleges, urban and rural schools and colleges and selective and non-selective schools. In the workshop participants will be invited to take part in the Q-sort activity we have used with in our research, using statements from leadership theory and practice. The Q-sort will be followed by discussion and reflection on the statements in relation to participants’ own experiences of leadership, management and governance in different contexts.

Investigating Social Mobility: Cultural Frames and Cultural Frame Switching in First-Generation College Students

Thesis (Ph.D.)--University of Washington, 2016-08

An Analysis of the Implementation and Perceived Effectiveness of the SchoolMAX Family Portal

ABSTRACT Title of Document: AN ANALYSIS OF THE IMPLEMENTATION AND PERCEIVED EFFECTIVENESS OF THE SCHOOLMAX FAMILY PORTAL Warren Wesley Watts, Doctor of Education, 2015 Directed By: Margaret J. McLaughlin, Ph.D. Department of Counseling, Higher Education and Special Education School districts have spent millions of dollars implementing student information systems that offer family portals with web-based access to parents and students. One of the main purposes of these systems is to improve school-to-home communication. Research has shown that when school-to-home communication is implemented effectively, parent involvement improves and student achievement increases (Epstein, 2001). The purpose of the study was to (a) understand why parents used or refrained from using the family portal and (b) determine what barriers to use might exist. To this end, this descriptive study identified the information parent users accessed in the SchoolMAX family portal, determined how frequently parents accessed the portal, and ascertained whether parents perceived an increase in communication with their children about academic matters after they began accessing the portal. Finally, the study sought to identify whether barriers existed that prevented parents from using the family portal. The inquiry employed three data sources to answer the aforementioned queries. These sources included (a) a survey sent electronically to 19,108 parents who registered online for the SchoolMAX family portal; (b) SchoolMAX portal usage data from the student information system for system usage between January 1, 2015 and June 30, 2015; and (c) a paper survey sent to 691 parents of students that had never used the SchoolMAX family portal in one elementary school, one middle school and one high school that were representative of other schools in the district. Survey results indicated that parents at all grade levels used the family portal. Usage data also confirmed that approximately 19% of the students had parents who monitored their progress through the family portal. Usage data also showed that parents were monitoring approximately 25% of students in secondary schools (6th – 12th grade) and 16% of students in elementary schools. Of the wide menu of resources available through the SchoolMAX family portal, parents used three areas most frequently: attendance, daily grades, and report cards. Approximately 70% of parents responded that their communication had improved with their children about academic matters since they started using the SchoolMAX family portal, and 90% of parents responded that the SchoolMAX family portal was an effective or somewhat effective tool. Parents also expressed interest in the addition of additional information to the SchoolMAX family portal. Specifically, the top three additions parents wanted to see included homework assignments, high stakes test scores, and graduation requirements. Parents also reported that 92% of them spoke to their children at least 2 to 3 times per week about academics. Due to the low response rate of the parent non-user survey, potential barriers to using the SchoolMAX family portal could not be addressed in this study. However, this issue may be a useful research topic in a future study. Keywords: school to home communication, student information systems, family portal, parent portal

Cultural and linguistic context and lexical inferencing in English language learning: A case study

In an increasingly multilingual world, English language has kept a marked predominance as a global language. In many countries, English is the primary choice for foreign language learning. There is a long history of research in English language learning. The same applies for research in reading. A main interest since the 1970s has been the reading strategy defined as inferencing or guessing the meaning of unknown words from context. Inferencing has ben widely researched, however, the results and conclusions seem to be mixed. While some agree that inferencing is a useful strategy, others doubt its usefulness. Nevertheless, most of the research seem to agree that the cultural background affects comprehension and inferencing. While most of these studies have been done with texts and contexts created by the researches, little has been done using natural prose. The present study will attempt to further clarify the process of inferencing and the effects of the text’s cultural context and the linguistic background of the reader using a text that has not been created by the researcher. The participants of the study are 40 international students from Turku, Finland. Their linguistic background was obtained through a questionnaire and proved to be diverse. Think aloud protocols were performed to investigate their inferencing process and find connections between their inferences, comments, the text, and their linguistic background. The results show that: some inferences were made based on the participants’ world knowledge, experience, other languages, and English language knowledge; other inferences and comments were made based on the text, its use of language and vocabulary, and few cues provided by the author. The results from the present study and previous research seem to show that: 1) linguistic background is a source of information for inferencing but is not a major source; 2) the cultural context of the text affected the inferences made by the participants according to their closeness or distance from it.

A case study of a district's intended and unintended results connected to the implementation of a required ninth-grade algebra 1 strategic initiative

There is a long history of debate around mathematics standards, reform efforts, and accountability. This research identified ways that national expectations and context drive local implementation of mathematics reform efforts and identified the external and internal factors that impact teachers’ acceptance or resistance to policy implementation at the local level. This research also adds to the body of knowledge about acceptance and resistance to policy implementation efforts. This case study involved the analysis of documents to provide a chronological perspective, assess the current state of the District’s mathematics reform, and determine the District’s readiness to implement the Common Core Curriculum. The school system in question has continued to struggle with meeting the needs of all students in Algebra 1. Therefore, the results of this case study will be useful to the District’s leaders as they include the compilation and analysis of a decade’s worth of data specific to Algebra 1.

SCHOOL DISTRICT GOVERNANCE AND KNOWLEDGE-FIT IN DECISION RIGHTS: HOW DISTRICTS RECRUIT AND HIRE SCHOOL LIBRARIANS

This study examines the organizational structures and decision-making processes used by school districts to recruit and hire school librarians. For students to acquire the information and technology literacy education they need, school libraries must be staffed with qualified individuals who can fulfill the librarian’s role as leader, teacher, instructional partner, information specialist, and program administrator. Principals are typically given decision rights for hiring staff, including school librarians. Research shows that principals have limited knowledge of the skills and abilities of the school librarian or the specific needs and functions of the library program. Research also indicates that those with specific knowledge of school library programs, namely school district library supervisors, are only consulted on recruiting and hiring about half the time. School districts entrust library supervisors with responsibilities such as professional development of school librarians only after they are hired. This study uses a theoretical lens from research on IT governance, which focuses on the use of knowledge-fit in applying decision rights in an organization. This framework is appropriate because of its incorporation of a specialist with a specific knowledge set in determining the placement of input and decision rights in the decision-making processes. The method used in this research was a multiple-case study design using five school districts as cases, varying by the involvement of the supervisors and other individuals in the hiring process. The data collected from each school district were interviews about the district’s recruiting and hiring practices with principals, an individual in HR, library supervisors, and recently hired school librarians. Data analysis was conducted through iterative coding from themes in the research questions, with continuous adjustments as new themes developed. Results from the study indicate that governance framework is applicable to evaluating the decision-making processes used in recruiting and hiring school librarians. However, a district’s use of governance did not consistently use knowledge-fit in the determination of input and decision rights. In the hiring process, governance was more likely to be based on placing decision rights at a certain level of the district hierarchy rather than the location of specific knowledge, most often resulting in site-based governance for decision rights at the school-building level. The governance of the recruiting process was most affected by the shortage or surplus of candidates available to the district to fill positions. Districts struggling with a shortage of candidates typically placed governance for the decision-making process on recruiting at the district level, giving the library supervisor more opportunity for input and collaboration with human resources. In districts that use site-based governance and that place all input and decision rights at the building level, some principals use their autonomy to eliminate the school library position in the allotment phase or hire librarians that, while certified through testing, do not have the same level of expertise as those who achieve certification through LIS programs. The principals in districts who use site-based governance for decision rights but call on the library supervisor for advisement stated how valuable they found the supervisor’s expertise in evaluating candidates for hire. In no district was a principal or school required to involve the library supervisor in the hiring of school librarians. With a better understanding of the tasks involved, the effect of district governance on decision-making, and the use of knowledge to assign input and decision rights, it is possible to look at how all of these factors affect the outcome in the quality of the hire. A next step is to look at the hiring process that school librarians went through and connect those with the measurable outcomes of hiring: school librarian success, retention, and attrition; the quality of school library program services, outreach, and involvement in a school; and the perceptions of the success of the school librarian and the library program as seen from students, teachers, administrators, parents, and other community stakeholders.

Shadows of militarism: an ethnography of trauma and resistance among soldiers and veterans in post-9/11 USA.

This thesis critically examines the military disciplining of trauma through a detailed ethnographic study of post-9/11 lower-enlisted soldiers and veterans in the U.S. who have links to a national movement of resistance to, and healing from, militarism. Drawing on 12 months of ethnographic fieldwork at two G.I. coffeehouses and with the post-9/11 veteran anti-militarism movement in U.S., it analyses the journey of joining the military, becoming a soldier, leaving the military and veteran identities. It explores militarism and military power as a cultural process which reproduces and conceals itself within normative conceptions of the everyday, and military trauma as a site of contested power and resistance. In doing so, this research addresses an urgent need to critically engage with military trauma as a means to challenge normalised discourses of militarism. This research reveals a disjuncture between the imagined and lived reality of military identities in the post-9/11 era. It explores the politics of recognition of veterans’ public and private lives, their contested identities, and their constrained relationship to the state. It argues that veterans are silenced and their identities reduced to symbolic tools in a public military imaginary which constructs military trauma into politically manageable categories, while disciplining and silencing the nation from critically examining war and militarism. In this way, this thesis argues that veterans serve a vital function in U.S. society by absorbing and containing the violence of the state, which then becomes unspeakable, unhearable, and inescapable. This thesis shows how a small number of soldiers and veterans are pushing back against this narrative. In sum, this thesis seeks to challenge the disciplinary effects of militarism upon trauma and support veteran voices to speak their own truths.

COMPREHENSIVE ELECTRICAL/OPTICAL/THERMAL CHARACTERIZATIONS OF HIGH POWER LIGHT EMITTING DIODES AND LASER DIODES

Thermal characterizations of high power light emitting diodes (LEDs) and laser diodes (LDs) are one of the most critical issues to achieve optimal performance such as center wavelength, spectrum, power efficiency, and reliability. Unique electrical/optical/thermal characterizations are proposed to analyze the complex thermal issues of high power LEDs and LDs. First, an advanced inverse approach, based on the transient junction temperature behavior, is proposed and implemented to quantify the resistance of the die-attach thermal interface (DTI) in high power LEDs. A hybrid analytical/numerical model is utilized to determine an approximate transient junction temperature behavior, which is governed predominantly by the resistance of the DTI. Then, an accurate value of the resistance of the DTI is determined inversely from the experimental data over the predetermined transient time domain using numerical modeling. Secondly, the effect of junction temperature on heat dissipation of high power LEDs is investigated. The theoretical aspect of junction temperature dependency of two major parameters – the forward voltage and the radiant flux – on heat dissipation is reviewed. Actual measurements of the heat dissipation over a wide range of junction temperatures are followed to quantify the effect of the parameters using commercially available LEDs. An empirical model of heat dissipation is proposed for applications in practice. Finally, a hybrid experimental/numerical method is proposed to predict the junction temperature distribution of a high power LD bar. A commercial water-cooled LD bar is used to present the proposed method. A unique experimental setup is developed and implemented to measure the average junction temperatures of the LD bar. After measuring the heat dissipation of the LD bar, the effective heat transfer coefficient of the cooling system is determined inversely. The characterized properties are used to predict the junction temperature distribution over the LD bar under high operating currents. The results are presented in conjunction with the wall-plug efficiency and the center wavelength shift.

FEEDING AND DIABETES MELLITUS: PERCEPTION AND FOOD CONSUMPTION BY ELDERLY PEOPLE IN THE HINTERLANDS OF PERNAMBUCO

Objective: To evaluate the knowledge of diabetes diet and identify factors that may interfere with the adherence to nutritional therapy and food choices of participants in a Community Center for the Elderly in Sairé, PE. Methods: A quantitative, descriptive and cross-sectional study, which evaluated 39 attendees of that center, from July to August 2014, with or without diabetes mellitus. Two questionnaires were applied to assess socioeconomic data, nutrition knowledge and cultural factors, and check the consumption of food with high and low glycemic index. Data was analyzed using the Assistat Program 7.0 Beta version. Results: The majority of the respondents have knowledge about types of foods that may influence the treatment of diabetes mellitus, as 51.2% (n=20) reported knowing some food that can reduce the risk for diabetes onset or assist in its treatment. Most of the participants reported having acquired such knowledge through the television 35% (n=7) and conversation with peers 35% (n=7). Evaluation of the food intake evidenced higher consumption of foods with high glycemic index. However, among diabetic patients, foods with low glycemic index are consumed more times per week. Conclusion: The knowledge about nutrition and diabetes mellitus was considered adequate, but socioeconomic and cultural factors may interfere in the adherence to diet therapy for diabetes or in the food choices made by the individuals. However, food consumption was considered appropriate among diabetics.

No crisol das lógicas de territorialização educativa nas escolas portuguesas se frágua a ação do poder político local e das parcerias

Abordamos hermenêuticamente a descentralização e a territorialização educativa em Portugal, numa tríade de relações: ‘escola-comunidade educativa’, parceria socioeducativa e política educativa local. A intervenção do poder local na educação processa-se numa perspetiva instrumental virada para o desenvolvimento e coesão social. As autarquias são os parceiros responsáveis pela educação e os professores valorizam a relação escola-comunidade educativa, principalmente na promoção da qualidade. A relação ’escola-poder local’ efetua-se numa interação participativa dos laços redutores e promotores da administração e gestão escolar, com lógicas de ação e racionalização das parcerias.

Essays on cultural and institutional dynamics in economic development using spatial analysis

This thesis seeks to research patterns of economic growth and development from a number of perspectives often resonated in the growth literature. By addressing themes about history, geography, institutions and culture the thesis is able to bring to bear a wide range of inter-related literatures and methodologies within a single content. Additionally, by targeting different administrative levels in its research design and approach, this thesis is also able to provide a comprehensive treatment of the economic growth dilemma from both cross-national and sub-national perspectives. The three chapters herein discuss economic development from two broad dimensions. The first of these chapters takes on the economic growth inquiry by attempting to incorporate cultural geography within a cross-country formal spatial econometric growth framework. By introducing the global cultural dynamics of languages and ethnic groups as spatial network mechanisms, this chapter is able to distinguish economic growth effects accruing from own-country productive efforts from those accruing from interconnections within a global productive network chain. From this, discussions and deductions about the implications for both developed and developing countries are made as regards potentials for gains and losses from such types and levels of productive integration. The second and third chapters take a different spin to the economic development inquiry. They both focus on economic activity in Africa, tackling the relevant issues from a geo-intersected dimension involving historic regional tribal homelands and modern national and subnational administrative territories. The second chapter specifically focuses on attempting to adopt historical channels to investigate the connection between national institutional quality and economic development in demarcated tribal homelands at the fringes of national African borders. The third chapter on the other hand focuses on looking closer at the effects of demarcations on economic activity. It particularly probes how different kinds of demarcation warranted by two different but very relevant classes of politico-economic players have affected economic activity quite distinguishably within the resulting subnational regions in Africa.

Studies of antihypertensive drug persistence and adherence in the Glasgow Blood Pressure Clinic

Hypertension (HTN) is a major risk factor for cardiovascular diseases including stroke, coronary heart disease (CHD), chronic renal failure, peripheral vascular disease, myocardial infarction, congestive heart failure and premature death. The prevalence of HTN in Scotland is very high and although a high proportion of the patients receive antihypertensive medications, blood pressure (BP) control is very low. Recommendations for starting a specific antihypertensive class have been debated between various guidelines over the years. Some guidelines and HTN studies have preferred to start with a combination of an antihypertensive class instead of using a single therapy, and they have found greater BP reductions with combination therapies than with monotherapy. However, it has been shown in several clinical trials that 20% to 35% of hypertensive patients could not achieve the target BP, even though they received more than three antihypertensive medications. Several factors were found to affect BP control. Adherence and persistence were considered as the factors contributing the most to uncontrolled hypertension. Other factors such as age, sex, body mass index (BMI), alcohol intake, baseline systolic BP (SBP), and the communication between physicians and patients have been shown to be associated with uncontrolled BP and resistant hypertension. Persistence, adherence and compliance are interchangeable terms and have been used in the literature to describe a patient’s behaviour with their antihypertensive drugs and prescriptions. The methods used to determine persistence and adherence, as well as the inclusion and exclusion criteria, vary between persistence and adherence studies. The prevalence of persistence and adherence have varied between these studies, and were determined to be high in some studies and low in others. The initiation of a specific antihypertensive class has frequently been associated with an increase or decrease in adherence and persistence. The tolerability and efficacy of the initial antihypertensive class have been the most common methods of explaining this association. There are also many factors that suggest a relationship with adherence and persistence. Some factors in previous studies, such as age, were frequently associated with adherence and persistence. On the other hand, relationships with certain factors have varied between the studies. The associations of age, sex, alcohol use, smoking, baseline systolic blood pressure (SBP) and diastolic BP (DBP), the presence of comorbidities, an increase in the number of pills and the relationship between patients and physicians with adherence and persistence have been the most commonly investigated factors. Most studies have defined persistence in terms of a patient still taking medication after a period of time. A medication possession ratio (MPR) ≥ 80 has been used to define compliance. Either of these terminologies, or both, have been used to estimate adherence. In this study, I used the same definition for persistence to identify patients who have continued with their initial treatment, and used persistence and MPR to define patients who adhered to their initial treatment. The aim of this study was to estimate the prevalence of persistence and adherence in Scotland. Also, factors that could have had an effect on persistence and adherence were studied. The number of antihypertensive drugs taken by patients during the study and factors that led to an increase in patients being on a combination therapy were also evaluated. The prevalence of resistance and BP control were determined by taking the BP after the last drug had been taken by persistent patients during five follow-up studies. The relationship of factors such as age, sex, BMI, alcohol use, smoking, estimated glomerular filtration rate (eGFR), and albumin levels with BP reductions for each antihypertensive class were determined. Information Services Division (ISD) data, which includes all antihypertensive drugs, were collected from pharmacies in Scotland and linked to the Glasgow Blood Pressure Clinic (GBPC) database. This database also includes demographic characteristics, BP readings and clinical results for all patients attending the GBPC. The case notes for patients who attended the GBPC were reviewed and all new antihypertensive drugs that were prescribed between visits, BP before and after taking drugs, and any changes in the hypertensive drugs were recorded. A total of 4,232 hypertensive patients were included in the first study. The first study showed that angiotensin converting enzyme inhibitor (ACEI) and beta-blockers (BB) were the most prescribed antihypertensive classes between 2004 and 2013. Calcium channel blockers (CCB), thiazide diuretics and angiotensin receptor blockers (ARB) followed ACEI and BB as the most prescribed drugs during the same period. The prescription trend of the antihypertensive class has changed over the years with an increase in prescriptions for ACEI and ARB and a decrease in prescriptions for BB and diuretics. I observed a difference in antihypertensive class prescriptions by age, sex, SBP and BMI. For example, CCB, thiazide diuretics and alpha-blockers were more likely to be prescribed to older patients, while ACEI, ARB or BB were more commonly prescribed for younger patients. In a second study, 4,232 and 3,149 hypertensive patients were included to investigate the prevalence of persistence in the Scottish population in 1- and 5-year studies, respectively. The prevalence of persistence in the 1-year study was 72.9%, while it was only 62.8% in the 5-year study. Those patients taking ARB and ACEI showed high rates of persistence and those taking diuretics and alpha blockers had low rates of persistence. The association of persistence with clinical characteristics was also investigated. Younger patients were more likely to totally stop their treatment before restarting their treatment with other antihypertensive drugs. Furthermore, patients who had high SBP tended to be non-persistent. In a third study, 3,085 and 1,979 patients who persisted with their treatment were included. In the first part of the study, MPR was calculated, and patients with an MPR ≥ 80 were considered as adherent. Adherence rates were 29.9% and 23.4% in the 1- and 5-year studies, respectively. Patients who initiated the study with ACEI were more likely to adhere to their treatments. However, patients who initiated the study with thiazide diuretics were less likely to adhere to their treatments. Sex, age and BMI were different between the adherence and non-adherence groups. Age was an independent factor affecting adherence rates during both the 1- and 5-year studies with older patients being more likely to be adherent. In the second part of the study, pharmacy databases were checked with patients' case notes to compare antihypertensive drugs that were collected from the pharmacy with the antihypertensive prescription given during the patient’s clinical visit. While 78.6% of the antihypertensive drugs were collected between clinical visits, 21.4% were not collected. Patients who had more days to see the doctor in the subsequent visit were more likely to not collect their prescriptions. In a fourth study, 3,085 and 1,979 persistent patients were included to calculate the number of antihypertensive classes that were added to the initial drug during the 1-year and 5-year studies, respectively. Patients who continued with treatment as a monotherapy and who needed a combination therapy were investigated during the 1- and 5-year studies. In all, 55.8% used antihypertensive drugs as a monotherapy and 44.2% used them as a combination therapy during the 1-year study. While 28.2% of patients continued with treatment without the required additional therapy, 71.8% of the patients needed additional therapy. In all, 20.8% and 46.5% of patients required three different antihypertensive classes or more during the 1-year and 5-year studies, respectively. Patients who started with ACEI, ARB and BB were more likely to continue as monotherapy and less likely to need two more antihypertensive drugs compared with those who started with alpha-blockers, non-thiazide diuretics and CCB. Older ages, high BMI levels, high SBP and high alcohol intake were independent factors that led to an increase in the probability of patients taking combination therapies. In the first part of the final study, BPs were recorded after the last drug had been taken during the 5 year study. There were 815 persistent patients who were assigned for this purpose. Of these, 39% had taken one, two or three antihypertensive classes and had controlled BP (controlled hypertension [HTN]), 29% of them took one or two antihypertensive classes and had uncontrolled BP (uncontrolled HTN), and 32% of the patients took three antihypertensive classes or more and had uncontrolled BP (resistant HTN). The initiation of an antihypertensive drug and the factors affecting BP pressure were compared between the resistant and controlled HTN groups. Patients who initiated the study with ACEI were less likely to be resistant compared with those who started with alpha blockers and non-thiazide diuretics. Older patients, and high BMI tended to result in resistant HTN. In the second part of study, BP responses for patients who initiated the study with ACEI, ARB, BB, CCB and thiazide diuretics were compared. After adjusting for risk factors, patients who initiated the study with ACEI and ARB were more respondent than those who took CCB and thiazide diuretics. In the last part of this study, the association between BP reductions and factors affecting BP were tested for each antihypertensive drug. Older patients responded better to alpha blockers. Younger patients responded better to ACEI and ARB. An increase in BMI led to a decreased reduction in patients on ACEI and diuretics (thiazide and non-thiazide). An increase in albumin levels and a decrease in eGFR led to decreases in BP reductions in patients on thiazide diuretics. An increase in eGFR decreased the BP response with ACEI. In conclusion, although a high percentage of hypertensive patients in Scotland persisted with their initial drug prescription, low adherence rates were found with these patients. Approximately half of these patients required three different antihypertensive classes during the 5 years, and 32% of them had resistant HTN. Although this study was observational in nature, the large sample size in this study represented a real HTN population, and the large pharmacy data represented a real antihypertensive population, which were collected through the support of prescription data from the GBPC database. My findings suggest that ACEI, ARB and BB are less likely to require additional therapy. However, ACEI and ARB were better tolerated than BB in that they were more likely to be persistent than BB. In addition, users of ACEI, and ARB have good BP response and low resistant HTN. Linkage patients who participated in these studies with their morbidity and mortality will provide valuable information concerning the effect of adherence on morbidity and mortality and the potential benefits of using ACEI or ARB over other drugs.