Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial

Background Hawthorn (Crataegus laevigata) leaves, flowers and berries are used by herbal practitioners in the UK to treat hypertension in conjunction with prescribed drugs. Small-scale human studies support this approach. Aim To investigate the effects of hawthorn for hypertension in patients with type 2 diabetes taking prescribed drugs. Design of study Randomised controlled trial. Setting General practices in Reading, UK. Method Patients with type 2 diabetes (n = 79) were randomised to daily 1200 mg hawthorn extract (n = 39) or placebo (n = 40) for 16 weeks. At baseline and outcome a wellbeing questionnaire was completed and blood pressure and fasting blood samples taken. A food frequency questionnaire estimated nutrient intake. Results Hypotensive drugs were used by 71% of the study population with a mean intake of 4.4 hypoglycaemic and/or hypotensive drugs. Fat intake was lower and sugar intake higher than recommendations, and low micronutrient intake was prevalent. There was a significant group difference in mean diastolic blood pressure reductions (P = 0.035): the hawthorn group showed greater reductions (baseline: 85.6 mmHg, 95% confidence interval [Cl] = 83.3 to 87.8; outcome: 83.0 mmHg, 95% Cl = 80.5 to 85.7) than the placebo group (baseline: 84.5 mmHg, 95% Cl = 82 to 87; outcome: 85.0 mmHg, 95% Cl = 82.2 to 87.8). There was no group difference in systolic blood pressure reduction from baseline (3.6 and 0.8 mmHg for hawthorn and placebo groups, respectively; P = 0.329). Although mean fat intake met current recommendations, mean sugar intake was higher and there were indications of potential multiple micronutrient deficiencies. No herb-drug interaction was found and minor health complaints were reduced from baseline in both groups. Conclusions This is the first randomised controlled trial to demonstrate a hypotensive effect of hawthorn in patients with diabetes taking medication.

From ideals to reality: The women's smallholding colony at Lingfield, 1920-39

The immediate impetus for the colony at Lingfield in Surrey was the desire by the Women's Farm and Garden Association to enable women who had worked on the land during the First World War to be able to farm on their own account. However the motivation for the colony can also be traced back to late nineteenth-century ideals. The colony soon ran into problems which were exacerbated by the adverse agricultural conditions of the early 1920s. The association responded constructively but the colony was wound down from 1929. At one level the colony could be seen as a failure, yet this article argues that the 19 colony provided a rural community where single women lived in a mutually supportive environment.

Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial

Background: Hawthorn (Crataegus laevigata) leaves, flowers and berries are used by herbal practitioners in the UK to treat hypertension in conjunction with prescribed drugs. Small-scale human studies support this approach. Aim: To investigate the effects of hawthorn for hypertension in patients with type 2 diabetes taking prescribed drugs. Design of study: Randomised controlled trial. Setting: General practices in Reading, UK. Method: Patients with type 2 diabetes (n = 79) were randomised to daily 1200 mg hawthorn extract (n = 39) or placebo (n = 40) for 16 weeks. At baseline and outcome a wellbeing questionnaire was completed and blood pressure and fasting blood samples taken. A food frequency questionnaire estimated nutrient intake. Results: Hypotensive drugs were used by 71% of the study population with a mean intake of 4.4 hypoglycaemic and/or hypotensive drugs. Fat intake was lower and sugar intake higher than recommendations, and low micronutrient intake was prevalent. There was a significant group difference in mean diastolic blood pressure reductions (P = 0.035): the hawthorn group showed greater reductions (baseline: 85.6 mmHg, 95% confidence interval [Cl] = 83.3 to 87.8; outcome: 83.0 mmHg, 95% Cl = 80.5 to 85.7) than the placebo group (baseline: 84.5 mmHg, 95% Cl = 82 to 87; outcome: 85.0 mmHg, 95% Cl = 82.2 to 87.8). There was no group difference in systolic blood pressure reduction from baseline (3.6 and 0.8 mmHg for hawthorn and placebo groups, respectively; P = 0.329). Although mean fat intake met current recommendations, mean sugar intake was higher and there were indications of potential multiple micronutrient deficiencies. No herb-drug interaction was found and minor health complaints were reduced from baseline in both groups. Conclusions: This is the first randomised controlled trial to demonstrate a hypotensive effect of hawthorn in patients with diabetes taking medication.

Predictability of the western North Pacific summer climate demonstrated by the coupled models of ENSEMBLES

The Asian monsoon system, including the western North Pacific (WNP), East Asian, and Indian monsoons, dominates the climate of the Asia-Indian Ocean-Pacific region, and plays a significant role in the global hydrological and energy cycles. The prediction of monsoons and associated climate features is a major challenge in seasonal time scale climate forecast. In this study, a comprehensive assessment of the interannual predictability of the WNP summer climate has been performed using the 1-month lead retrospective forecasts (hindcasts) of five state-of-the-art coupled models from ENSEMBLES for the period of 1960–2005. Spatial distribution of the temporal correlation coefficients shows that the interannual variation of precipitation is well predicted around the Maritime Continent and east of the Philippines. The high skills for the lower-tropospheric circulation and sea surface temperature (SST) spread over almost the whole WNP. These results indicate that the models in general successfully predict the interannual variation of the WNP summer climate. Two typical indices, the WNP summer precipitation index and the WNP lower-tropospheric circulation index (WNPMI), have been used to quantify the forecast skill. The correlation coefficient between five models’ multi-model ensemble (MME) mean prediction and observations for the WNP summer precipitation index reaches 0.66 during 1979–2005 while it is 0.68 for the WNPMI during 1960–2005. The WNPMI-regressed anomalies of lower-tropospheric winds, SSTs and precipitation are similar between observations and MME. Further analysis suggests that prediction reliability of the WNP summer climate mainly arises from the atmosphere–ocean interaction over the tropical Indian and the tropical Pacific Ocean, implying that continuing improvement in the representation of the air–sea interaction over these regions in CGCMs is a key for long-lead seasonal forecast over the WNP and East Asia. On the other hand, the prediction of the WNP summer climate anomalies exhibits a remarkable spread resulted from uncertainty in initial conditions. The summer anomalies related to the prediction spread, including the lower-tropospheric circulation, SST and precipitation anomalies, show a Pacific-Japan or East Asia-Pacific pattern in the meridional direction over the WNP. Our further investigations suggest that the WNPMI prediction spread arises mainly from the internal dynamics in air–sea interaction over the WNP and Indian Ocean, since the local relationships among the anomalous SST, circulation, and precipitation associated with the spread are similar to those associated with the interannual variation of the WNPMI in both observations and MME. However, the magnitudes of these anomalies related to the spread are weaker, ranging from one third to a half of those anomalies associated with the interannual variation of the WNPMI in MME over the tropical Indian Ocean and subtropical WNP. These results further support that the improvement in the representation of the air–sea interaction over the tropical Indian Ocean and subtropical WNP in CGCMs is a key for reducing the prediction spread and for improving the long-lead seasonal forecast over the WNP and East Asia.

British railways and the challenge from road haulage: 1919-39

Interwar Britain witnessed the rapid rise of road transport as a serious competitor to the railways. This article examines road–rail competition for freight traffic. It demonstrates that, contrary to previous accounts—which have been highly critical of the railway companies—their failure to prevent rapid loss of traffic to the roads was the inevitable consequence of the regulatory framework under which the railways had been returned to private control in 1921. Given the constraints imposed by this framework, price competition with road hauliers would have further depressed railway company profits. Railway policy thus concentrated on pressing for a revision of the legislative framework governing road–rail competition.