Looking really good now.
I found that I needed to let the game control the settings not the card so switched the AA and AS etc over to the game but left the CUDA-GPUs on all (not sure on the effect of that) and texture filtering set to quality etc. on the card.
Then in the first game settings screen I set the slider to 7/10, AS to x4 and ticked the multi-core then in the game options panel I ticked everything and set them all to high. I get very smooth frame rates, good AA, nice lighting and long draw distance with fine details.
It's the best it's ever looked.
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IL2, FSX, ROF, SOW, Cliffs of Dover...
Vista Ultimate 64bit. Core2Quad9550 @ 3GHz, Nvidia 560Ti 1GB @ 1920x1080P, 4GB RAM, Creative SB X-FI