Sustained positive behaviour change of wounded, injured and sick UK military following an adaptive adventure sports and health coaching recovery course

INTRODUCTION

A rising trend has occurred in the physical and mental health challenges faced by recovering UK service personnel. To support these individuals, bespoke inclusive multiactivity and adventurous training courses (MAC) have been developed. This study investigated the MAC's influence on participants' ability to sustain day-to-day changes that facilitate positive mental health and psychological need satisfaction.

METHODS

The 146 UK service personnel who participated in this study attended a five-day MAC 12 months ago. To investigate how the supportive experience influenced participants' lives, quantitative and qualitative data were collected via an online survey. Open-ended questioning and abductive analysis were conducted to understand mechanisms, influential aspects of the course and positive behaviour change.

RESULTS

Positive behaviour changes were reported by 74% of the respondents. These changes align with positive psychological well-being (98%). Impactful elements of the course experienced by participants mostly aligned with the three basic psychological needs of autonomy (34%), competence (36%) and relatedness (61%).

CONCLUSIONS

Recovery support programmes that encompass health coaching adventurous activities, such as the MAC, can initiate long-term positive behaviour change for recovering military personnel. In this specific context, the concurrence of the self-determination theory concepts that underpin the course delivery and participant outcomes is a powerful endorsement of implementation fidelity.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Good things come to those who mate: analysis of the mating behaviour in the menstruating rodent, Acomys cahirinus

Background

The Egyptian spiny mouse (Acomys cahirinus) is the only known rodent to exhibit true, human-like menstruation and postpartum ovulation, and is an important new model for reproductive studies. Spiny mice do not produce a visible copulatory plug, and calculation of gestational age is therefore restricted by the need to use mated postpartum dams. The current inefficient method of monitoring until parturition to provide a subsequent estimate of gestational age increases study duration and costs. This study addressed this issue by comparing the mating behaviour of spiny mice across the menstrual cycle and proposes a more accurate method for staging and pairing animals that provides reliable estimates of gestational age. In experiment 1, mating behaviour was recorded overnight to collect data on mounting, intromission, and ejaculation (n = 5 pairs per stage) in spiny mice paired at menses and at early and late follicular and luteal phases of the menstrual cycle. In experiment 2, female spiny mice were paired at the follicular or luteal phases of the menstrual cycle to determine any effect on the pairing-birth interval (n = 10 pairs).

Results

We report a broad mating window of ~ 3 days during the follicular phase and early luteal phase of spiny mice. Males displayed a discrete ‘foot twitch’ behaviour during intromission and a brief copulatory lock during ejaculation. Litters were delivered after 40–43 days if pairing occurred during the mating window, compared with 46–48 days for spiny mice paired in the late luteal phase. When pairing occurred during the late luteal phase or menses no mating activity was observed during the recording period.

Conclusion

This study clearly demonstrates an effect of the menstrual cycle on mating behaviour and pregnancy in the spiny mouse and provides a reliable and more effective protocol for estimating gestational age without the need for postpartum dams.

The Spiny Mouse—A Menstruating Rodent to Build a Bridge From Bench to Bedside

Menstruation, the cyclical breakdown of the uterine lining, is arguably one of evolution's most mysterious reproductive strategies. The complexity and rarity of menstruation within the animal kingdom is undoubtedly a leading contributor to our current lack of understanding about menstrual function and disorders. In particular, the molecular and environmental mechanisms that drive menstrual and fertility dysregulation remain ambiguous, owing to the restricted opportunities to study menstruation and model menstrual disorders in species outside the primates. The recent discovery of naturally occurring menstruation in the Egyptian spiny mouse (Acomys cahirinus) offers a new laboratory model with significant benefits for prospective research in women's health. This review summarises current knowledge of spiny mouse menstruation, with an emphasis on spiral artery formation, inflammation and endocrinology. We offer a new perspective on cycle variation in menstrual bleeding between individual animals, and propose that this is indicative of fertility success. We discuss how we can harness our knowledge of the unique physiology of the spiny mouse to better understand vascular remodelling and its implications for successful implantation, placentation, and foetal development. Our research suggests that the spiny mouse has the potential as a translational research model to bridge the gap between bench to bedside and provide improved reproductive health outcomes for women.

1326 Otorhinolaryngology Education and Training Innovation: A Literature Review of the Academic Year 2019-2020

Aim

We aimed to summarise the literature on educational research and training in otorhinolaryngology during the academic year of 2019-2020.

Method

A literature search was conducted on Medline, Embase and Cochrane in accordance with PRISMA guidelines for ““(ENT or otorhino* or otolaryngo* or (ear, nose, and throat)) and (educat* or train or training or teach*)””. The search was conducted independently on 13/09/20 by two authors (JOH, JM), any discrepancy was further reviewed by a third author (JC). All original research papers published between 2019-2020 were included.

Results

68 papers were included in our study. Educational research this year shifted focus on how to combat the negative impact of COVID-19 on otorhinolaryngology teaching. Although many of the interventions created for postgraduate and undergraduate education have not been formally assessed, virtual electives for medical students were found to increase interest and knowledge in the specialty. Surgical simulation represented the most common teaching method reported aside from COVID-19. 3D models were used for emergency training with an aim to increase trainee exposure to an anterior neck abscess, retrobulbar haematoma and paediatric tracheostomy. 3D models were positively rated for face and content validity and gave statistically significant improvements in confidence for trainees.

Conclusions

The otorhinolaryngology training in 2019-2020 has changed massively due to the pandemic. Improving on virtual learning and adapting simulation training are the key to maintain a positive learning environment for medical students and doctors in the short term. Research on the effect of COVID-19 on otorhinolaryngology education and training will be the focus in 2021.

Successful sperm cryopreservation in Egyptian spiny mice Acomys cahirinus

The menstruating Egyptian spiny mouse has recently been proposed as a new animal model for reproductive health research. Unfortunately, little is known about reproduction in males. This study compared several characteristics of sperm function before and after cryopreservation. Epididymal spermatozoa were cryopreserved in different concentrations of raffinose and skim milk and tested for motility and membrane integrity (Experiment 1). Further evaluations of motility, plasma membrane and acrosome integrity, mitochondrial membrane potential and DNA integrity were conducted with the addition of l-glutamine to the extender (Experiment 2). The results show that, following cryopreservation, motility and membrane integrity were reduced, but were better maintained in the presence of l-glutamine (P<0.05). Moreover, although all sperm parameters were significantly reduced following cryopreservation (P<0.05), most cryopreserved spermatozoa retained acrosome, membrane and DNA integrity while also maintaining motility and mitochondrial membrane potential. This study provides a new step towards the development of assisted reproductive techniques and archiving the important genetics of the world's only known menstruating rodent.

1012 Surgical Trainee Satisfaction Variations with Seniority and Region: An Evaluation of General Medical Council National Training Survey

Aim

The General Medical Council (GMC) National Training Survey invites all doctors in training and this study evaluates satisfaction in surgical training and variations with speciality, seniority, and training region.

Method

All survey results were obtained from the GMC website. Responses of trainees, ranging from foundation training to registrar, were collected and categorised by speciality, training stage and location.

Results

9465 surgical trainees completed the study in 2019. The highest indicators were Educational Supervision (97.68), Clinical Supervision (87.42) and Clinical Supervision (out of hours) (87.28). The lowest were Workload (44.60), Rota Design (56.00) and Local Teaching (59.31). Highest and lowest ranking specialities were oral and maxillofacial surgery (84.25) and vascular surgery (73.95).

Satisfaction varied significantly across training stages, with speciality trainees highest (82.58) overall and foundation year 1 lowest (70.03). London scored highest (77.95) and Northern Ireland, Scotland and Wales collectively scored 77.13. Within England, South England ranked highest in five specialities but only orthopaedics and neurosurgery showed significant national variations.

Conclusions

Our data show variations in training satisfaction across many training cohorts. Satisfaction increases with surgeon seniority. Trainers and educational boards should target interventions to improve the quality of training for all grades of trainees and ensure appropriate curriculum coverage and address specific concerns.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Changing player behaviour in sport during the COVID-19 pandemic: Shake on it?

To prevent the spread of infection during matches and training activities is a major challenge facing all sports returning from the enforced COVID-19 shutdown. During training and matches, rugby league players make contact with others which can result in SARS-CoV-2 virus transmission. While these interactions characterise the appeal of the game, a number of them can be avoided, including shaking hands and conversing after the match. This paper presents a framework underpinned by behavioural science (capability, opportunity, motivation and behaviour model, COM-B) to support stakeholders in helping players adopt new social distance norms and behaviours. This framework helps to ensure the players have the capability, opportunity, and motivation to adopt new COVID-19 risk minimising behaviours, which they will need to commit to 100%.

Parental experiences of their child's vulvovaginitis: a qualitative interview study

INTRODUCTION

Vulvovaginitis is described as a common self-limiting paediatric gynaecological condition. Parents' experiences of their child being diagnosed with this condition and subsequent treatment have not previously been described.

AIM

The aim of this study was to explore parents' experiences of their child's diagnosis and management of vulvovaginitis.

STUDY DESIGN

The study was conducted in the north west of England over a two-year period. Qualitative data were generated by semistructured in-depth interviews. Mothers of nine children with vulvovaginitis consented to participate. Data were analysed using thematic analysis.

RESULTS

The analysis of the data resulted in four themes: trauma and uncertainty of initial symptoms, seeking a diagnosis; an uncertain journey, managing the symptoms; a process of trial and error and managing the impact; keeping it private. Parents experienced a difficult and protracted journey to their child's diagnosis and were involved in a process of trial and error to try and monitor and manage what can be a difficult ongoing condition.

DISCUSSION

Clinical reports suggest that vulvovaginitis is a minor childhood condition; this is not necessarily the perceptions and experiences of parents, who can experience uncertainty and ongoing difficulty after their child's diagnosis.

CONCLUSION

The diagnosis of vulvovaginitis can have a major and ongoing impact on children's and their family's lives.

Associations between food environment typologies and body mass index: Evidence from Yorkshire, England

International research linking food outlets and body mass index (BMI) is largely cross-sectional, yielding inconsistent findings. However, addressing the exposure of food outlets is increasingly considered as an important adult obesity prevention strategy. Our study investigates associations between baseline food environment types and change in BMI over time. Survey data were used from the Yorkshire Health Study (n=8,864; wave one: 2010-2012, wave two: 2013-2015) for adults aged 18-86. BMI was calculated using self-reported height (cm) and weight (kg). Restaurants, cafés, fast-food, speciality, convenience and large supermarkets were identified from the Ordnance Survey Point of Interest database within 1600m radial buffer of home postcodes. K-means cluster analysis developed food environment typologies based on food outlets and population density. Large supermarkets, restaurants, cafés, fast-food, speciality and convenience food outlets all clustered together to some extent. Three neighbourhood typologies were identified. However, multilevel models revealed that relative to cluster one all were unrelated to change in BMI (cluster 2, b= -0.146 [-0.274, 0.566]; cluster 3, b= 0.065 [-0.224, 0.356]). There was also little evidence of gender-based differences in these associations when examined in a three-way interaction. Policymakers may need to begin to consider multiple types of food outlet clusters, while further research is needed to confirm how these relate to changed BMI.

Fast-food outlet availability and obesity: Considering variation by age and methodological diversity in 22,889 Yorkshire Health Study participants

This study investigated if the relationship between residential fast-food outlet availability and obesity varied due to methodological diversity or by age. Cross-sectional data (n = 22,889) from the Yorkshire Health Study, England were used. Obesity was defined using self-reported height and weight (BMI ≥ 30). Food outlets ("fast-food", "large supermarkets", and "convenience or other food retail outlets") were mapped using Ordnance Survey Points of Interest (PoI) database. Logistic regression was used for all analyses. Methodological diversity included adjustment for other food outlets as covariates and continuous count vs. quartile. The association between residential fast-food outlets and obesity was inconsistent and effects remained substantively the same when considering methodological diversity. This study contributes to evidence by proposing the use of a more comprehensive conceptual model adjusting for wider markers of the food environment. This study offers tentative evidence that the association between fast-food outlets and obesity varies by age.

A comparison of complication rates between locking and non-locking plates in distal fibular fractures

BACKGROUND

Locking compression plates have become increasingly popular in orthopaedic surgery. However, the gold standard of treatment for distal fibular fractures remains fixation with a non-locking one-third tubular plate. It has been reported that locking plates in distal fibular fractures are associated with an increased complication rate.

HYPOTHESIS

The objective of this study is to assess the complication rates of locking versus non-locking plates in patients who underwent surgical fixation of distal fibular fractures.

MATERIALS & METHODS

A retrospective analysis of closed distal fibular fractures that underwent surgical repair over a 2-year period with either a locking or non-locking plate was undertaken, analysing the groups for both wound and overall postoperative complications.

RESULTS

A total of 160 patients were treated over 2 years, of which 129 and 31 patients were treated with non-locking and locking plates respectively. There was no significant difference between the non-locking and locking plates overall complication rates (13.5% versus 15.4%, p=0.76) or wound complication rates (3.97% versus 3.85%, p=1.00).

DISCUSSION

Distal fibular fractures managed with locking plates do not have a higher complication rate in comparison to those managed with non-locking plates.

LEVEL OF EVIDENCE

III (case control study).

Neighbourhood typologies and associations with body mass index and obesity: A cross-sectional study

Little research has investigated associations between a combined measure of the food and physical activity (PA) environment, BMI (body-mass-index) and obesity. Cross-sectional data (n=22,889, age 18-86years) from the Yorkshire Health Study were used [2010-2013]. BMI was calculated using self-reported height and weight; obesity=BMI≥30. Neighbourhood was defined as a 2km radial buffer. Food outlets and PA facilities were sourced from Ordnance Survey Points of Interest (PoI) and categorised into 'fast-food', 'large supermarkets', 'convenience and other food retail outlets' and 'physical activity facilities'. Parks were sourced from Open Street Map. Latent class analysis was conducted on these five environmental variables and availability was defined by quartiles of exposure. Linear and logistic regressions were then conducted for BMI and obesity respectively for different neighbourhood types. Models adjusted for age, gender, ethnicity, area-level deprivation, and rural/urban classification. A five-class solution demonstrated best fit and was interpretable. Neighbourhood typologies were defined as; 'low availability', 'moderate availability', 'moderate PA, limited food', 'saturated' and 'moderate PA, ample food'. Compared to low availability, one typology demonstrated lower BMI (saturated, b=-0.50, [95% CI=-0.76, -0.23]), while three showed higher BMI (moderate availability, b=0.49 [0.27, 0.72]; moderate PA, limited food, b=0.30 [0.01, 0.59]; moderate PA, ample food, b=0.32 [0.08, 0.57]). Furthermore, compared to the low availability, saturated neighbourhoods showed lower odds of obesity (OR=0.86 [0.75, 0.99]) while moderate availability showed greater odds of obesity (OR=1.18 [1.05, 1.32]). This study supports population-level approaches to tackling obesity however neighbourhoods contained features that were health-promoting and -constraining.

In-patient characteristics in a regional secure unit

A survey of 100 completed Regional Secure Unit (RSU) in-patient episodes shows that most patients are young, male, short-stay and suffering from chronic psychotic disorders. Substance abuse is prevalent, and many currently face serious charges. A significant minority of patients had previously been admitted to the Unit, especially those admitted directly from the community. Nearly half of all discharges were directly into community placements, and nearly as many remained under the care of the forensic service. Despite the sampling frame, it is clear that a few ‘long-stay’ patients contribute disproportionately to overall bed occupancy, so that beds for acute admissions may be blocked. Further, ‘parallel care’ is operating to a significant degree in this service, with the inevitable accumulation of patients who will continue to require future in-patient care. These two factors in particular suggest that the ability of the RSU to fulfil its basic functions may become increasingly compromised, particularly with respect to emergency requirements for medium secure beds at the district level.

Associations between the combined physical activity environment, socioeconomic status, and obesity: a cross-sectional study

AIMS

This study investigates associations between the combined physical activity environment and obesity and explores any sub-group effects by individual-level socioeconomic status.

METHODS

In a large cross-sectional cohort ( n = 22,889) from the Yorkshire Health Study, body mass index was calculated using self-reported height and weight and obesity was defined as a body mass index ≥ 30. The physical activity environment was split into 'unfavourable physical activity', 'moderately favourable physical activity' and 'favourable physical activity' environments. This was based on the count of parks and physical activity facilities within a 2 km radial buffer centred on home addresses. A favourable physical activity environment was defined as having ≥1 physical activity facility and ≥1 park, unfavourable as having no physical activity facility and park and any other combinations defined as moderately favourable. Logistic regression (odds ratios) identified associations with obesity.

RESULTS

Relative to 'unfavourable physical activity environments', individuals within favourable physical activity environments were less likely to be obese (odds ratio = 0.90; 95% confidence interval = 0.82-0.97), and there was no effect for moderately favourable environment. Furthermore, once stratified by education level, this relationship was only present for those of higher education.

CONCLUSION

Our findings provide novel UK evidence and is one of the first papers internationally that highlights the importance of considering the interplay of individual-level socioeconomic factors when investigating associations between the physical activity environment and obesity.

Access and quality of parks and associations with obesity: A cross-sectional study

Public health is increasingly engaging with multi-faceted obesity prevention efforts. Although parks represent key community assets for broader public health, they may not be distributed equitably and associations with obesity are equivocal. We investigated park access and quality relative to deprivation and obesity with individual-level data from the Yorkshire Health Study. Compared to the least deprived areas, the moderately and most deprived areas had a greater park access and park quality in terms of features and amenities. However, parks in the moderately and most deprived areas also had the most safety concerns and incivilities. Although deprivation was associated with obesity, contrary to current policy guidance, both park access and quality appear less important for understanding variations in obesity within this study. Although sub-group analyses by deprivation tertile revealed that low quality park amenities in highly and moderately deprived areas may be important for understanding obesity prevalence, all other associations were non-significant.

Self-esteem outcomes over a summer camp for obese youth

BACKGROUND AND OBJECTIVES

Variation in the existing literature on the psychosocial benefits of weight loss in obese youth results, in part, from methodological limitations and modest weight loss. Accordingly, this research assessed perceived self-competence and low self-esteem during an intensive weight loss programme in a large sample of obese youth and related these to starting weight, gender and weight loss.

METHODS

Over 4 years, 303 obese male and female adolescents (body mass index [BMI] 34.3 kg m^-2 , BMI standard deviation score 2.99; 14.7 years) attended a residential weight loss camp for a mean duration of 31 d. Outcome variables included dimensional self-esteem (Harter) and weight change over the camp.

RESULTS

At the start of camp, obese youth scored highest on social acceptance and lowest on physical appearance and athletic competence. Global self-worth and most domains of self-competence improved significantly over the intervention. The proportion with low global self-worth reduced from 35% to 16%, but there was little change in the proportion reporting high self-competence (23%). Mean weight loss was -5.5 kg (BMI standard deviation scores -0.25) with boys and those heaviest at the start losing most. Weight loss was significantly correlated with improved physical appearance (r = 0.13) and athletic competence (r = 0.19), but not global self-worth.

CONCLUSIONS

This intensive weight loss intervention yielded significant psychological benefit, especially in self-competence and among individuals achieving most weight loss. The weak association with weight loss suggests the influence of other contributing environmental or social features that should be the focus of further research.

Contamination of single-use bronchoscopes in critically ill patients

Disposable bronchoscopes such as the Ambu aScope^TM 3 are marketed as 'single use' The risks of contamination from prolonged device storage before possible re-use are unknown. Following clinical bronchoscopy in patients whose lungs were mechanically ventilated, 20 aScope^TM 3's bronchoscopes received a standard 'social clean' and were then stored. Subsequent paired saline flush and swab samples were taken at time zero, and at 24 h and 48 h. Positive microbiological cultures were obtained from at least one time point from 16 of the 20 bronchoscopes. Pathogens considered at high risk of causing pneumonia were isolated from seven bronchoscopes, with significant quantities from six of them. Our study demonstrates that aScope^TM 3's should not be re-used on the same patient, as clinically significant growth of micro-organisms occurs frequently, despite adequate social cleaning. Culture of bronchoscopes themselves may be a potentially useful diagnostic tool in the context of pulmonary infection. Our data make it clear that these devices are single use and not single patient use.

Incorporating real time velocity map image reconstruction into closed-loop coherent control

We report techniques developed to utilize three-dimensional momentum information as feedback in adaptive femtosecond control of molecular dynamics. Velocity map imaging is used to obtain the three-dimensional momentum map of the dissociating ions following interaction with a shaped intense ultrafast laser pulse. In order to recover robust feedback information, however, the two-dimensional momentum projection from the detector must be inverted to reconstruct the full three-dimensional momentum of the photofragments. These methods are typically slow or require manual inputs and are therefore accomplished offline after the images have been obtained. Using an algorithm based upon an "onion-peeling" (also known as "back projection") method, we are able to invert 1040 × 1054 pixel images in under 1 s. This rapid inversion allows the full photofragment momentum to be used as feedback in a closed-loop adaptive control scheme, in which a genetic algorithm tailors an ultrafast laser pulse to optimize a specific outcome. Examples of three-dimensional velocity map image based control applied to strong-field dissociation of CO and O2 are presented.

Search for charged Higgs bosons in e+e- collisions at [Formula: see text]

A search is made for charged Higgs bosons predicted by Two-Higgs-Doublet extensions of the Standard Model (2HDM) using electron-positron collision data collected by the OPAL experiment at [Formula: see text], corresponding to an integrated luminosity of approximately 600 pb-1. Charged Higgs bosons are assumed to be pair-produced and to decay into [Formula: see text], τντ or AW±. No signal is observed. Model-independent limits on the charged Higgs-boson production cross section are derived by combining these results with previous searches at lower energies. Under the assumption [Formula: see text], motivated by general 2HDM type II models, excluded areas on the [Formula: see text] plane are presented and charged Higgs bosons are excluded up to a mass of 76.3 GeV at 95 % confidence level, independent of the branching ratio BR(H±→τντ ). A scan of the 2HDM type I model parameter space is performed and limits on the Higgs-boson masses [Formula: see text] and mA are presented for different choices of tanβ.