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Aims To establish if a relationship exists between the prescribing costs of diabetes treatments and the achievement of Quality and Outcome Framework DM6 standards of glycaemic control. Methods A retrospective cross-sectional study of all 92 primary care organizations in the north of England comparing net ingredient cost of diabetes treatments, corrected for diabetic population, with the percentage of patients achieving HbA1c < 7.4% (Quality and Outcome Framework DM6 indicator). Results The overall net ingredient cost for diabetes treatments varies from £225 to £382 per person per year. On regression analysis, expenditure on all diabetes treatments, on glitazones or on blood glucose test strips have no significant impact upon the percentage of people achieving an HbA1c < 7.4%. There is an inverse relationship between spending on analogue insulins and target achievement ( r = −0.08, P = 0.001). Conclusions At primary care organization level, there is no association between weighted expenditure on diabetes treatments and achievement of glycaemic control targets. Although there are limitations to what can be inferred from analyses of this type, these data support a judicious and carefully directed approach to the use of newer, more expensive treatments until clear evidence of added benefit is forthcoming. [ABSTRACT FROM AUTHOR]

1. Changes in the frequency of extreme events, such as droughts, may be one of the most significant impacts of climate change for ecosystems. Models predict more frequent summer droughts in much of England: this paper investigates the impact on different types of plants in an ex-arable grassland community.2. A long-term experiment simulated increased and decreased summer precipitation. Substantial interannual variation allowed the effects of summer drought to be tested in combination with wet and dry weather in other seasons. This is important, as climate models predict increased winter precipitation.3. Total cover abundance in early summer increased with increasing water supply in the previous summer; there was no effect of winter precipitation. Productivity is therefore likely to decrease with more frequent summer droughts, with no mitigating effect of wetter winters.4. The percentage cover of perennial grasses declined during a natural drought in 1995–97; this was exacerbated by the experimental drought treatment and reduced by supplemented rainfall. Simultaneously, short-lived ruderal species increased; this was greatest in drought treatments and least with supplemented rainfall.5. These trends were subsequently reversed during several years of unusually wet weather, with perennial grasses increasing and short-lived forbs decreasing. This occurred even in experimentally droughted plots, and we propose that it resulted from rapid coverage of gaps during wet autumns and winters.6. Deep-rooted species generally proved to be more drought resistant, but there were exceptions.7. We conclude that increased frequency of summer droughts could have serious implications for the establishment and successional development of ex-arable grasslands. Increased winter precipitation would moderate the impact on species composition, but not on productivity.Functional Ecology(2004)18, 648–655 [ABSTRACT FROM AUTHOR]

1. One of the climate change scenarios predicted for the UK is warmer winters and additional summer rainfall, which may favour growth and survival of fungal pathogens. We tested several hypotheses on the fate of persistent seeds in the soil and the role of fungal pathogens under this predicted climate change. 2. We buried seed bags containing fungicide-treated and non-fungicide-treated seeds of four species with persistent seed banks (Convolvulus arvensis L., Lotus corniculatus L., Medicago lupulina L. and Rubus fruticosus L.) under control and simulated climate change (winter warming plus supplemented summer rain) conditions, and monitored seed survival over 1 to 2 years. 3. Fungicide treatment resulted in a significant increase in the percentage of intact seeds recovered for only two of the four species, M. lupulina and R. fruticosus. Seeds of M. lupulina that were treated with fungicide remained viable in the soil for longer than non-treated seeds. Thus, the effect of fungal pathogens on seed persistence in the soil appears to be species specific. 4. There was no significant effect of the simulated climate (winter warming plus supplemented summer rain) on seed persistence in the soil, for any of the four species. Neither was a significant climate × fungicide treatment interaction found for any of the four species. Thus, it does not appear that the conditions provided in the simulated climate plots favoured the growth and survival of fungal pathogens affecting the soil seed banks of the four species studied here. 5. The use of fungicides in manipulative experiments and the importance of field experiments that simulate predicted climate change are discussed. [ABSTRACT FROM AUTHOR]

Myeloid and erythroid progenitors from myelodysplastic marrows have been separated from accessory cell populations likely to influence their in-vitro growth. Myeloid colony-forming cells were enriched 23-fold and erythroid progenitors 5-7-fold but, in both cases, retained their abnormal growth characteristics. After enrichment and removal of lymphocytes and monocytes, erythroid burst formation became markedly more dependent on the addition of 5637 bladder carcinoma conditioned medium as an exogenous source of haemopoietic growth factors. This suggests that lymphocytes and monocytes usually support erythropoiesis in cultures of myelodysplastic marrow and demonstrates that erythroid burst-forming progenitor cells from myelodysplastic patients can respond to these populations in vitro. Haemopoietic failure in myelodysplasia appears to result from a defect within the preleukaemic clonogenic cell, rather than from an aberration in exogenous factors. The procedure outlined here can be used as a first step towards the isolation of these abnormal progenitors.