Curriculum development in Liberia's first postgraduate psychiatry training programme.

This paper describes the implementation of curricula for Liberia's first-ever psychiatry training programme in 2019 and the actions of the only two Liberian psychiatrists in the country at the time in developing and executing a first-year postgraduate psychiatry training programme (i.e. residency) with support from international collaborators. It explores cultural differences in training models among collaborators and strategies to synergise them best. It highlights the assessment of trainees' (residents') basic knowledge on entry into the programme and how it guided immediate and short-term priority teaching objectives, including integrated training in neuroscience and neurology. The paper describes the strengths and challenges of this approach as well as opportunities for continued growth.

Building a postgraduate psychiatry training program in Liberia through cross-country collaborations: initiation stages, challenges, and opportunities.

Background: About 80% of the nearly 2 billion people experiencing psychiatric conditions worldwide do not have access to quality, affordable mental health care. In Africa, there are 0.004 psychiatrists per 10,000 people, with the shortage exacerbated by a limited number of postgraduate psychiatry training opportunities. As of 2018, there were only two psychiatrists in Liberia. Methods: This paper aims to offer a framework for developing postgraduate (i.e., residency) psychiatry training in resource-constrained settings to disseminate best practices and lessons learned. This article describes the approach to developing the formal global academic partnership that supported the initiation of Liberia's first postgraduate psychiatry training program in July 2019. Results: Authors describe strengths, challenges, and opportunities for improvement in the planning and initiation stages of the postgraduate program. Key strengths of the program planning process include: (1) collaboration with a coalition of local and national stakeholders committed to improving mental health care in Liberia; (2) early procurement of quality video conferencing equipment and internet service to facilitate remote learning and broaden access to digital materials; and (3) leveraging of intra-continental partnerships for subspecialty training. Challenges experienced include: (1) navigating the intricacies of local political and administrative processes; (2) recruiting candidates to a medical specialty with historically lower salaries; and (3) the added burden placed on the limited number of local specialists. Identified opportunities include building a monitoring, evaluation, and learning (MEL) framework, further diversifying subspecialty areas of psychiatric and neurological training, and obtaining full accreditation of the postgraduate psychiatry program through the West African College of Physicians (WACP). Conclusion: The successful launch of the postgraduate psychiatry training program in Liberia is attributed to several factors, including a long-standing academic collaboration of over 10 years and support for mental health capacity-building efforts at national and local levels.

Orphans in post-conflict Liberia: Seeking care in fractured communities.

Orphans in post-conflict settings have unique needs that have not been well-characterized. In post-conflict Liberia, maternal orphans are more likely to be without care than paternal orphans. This study examined the experiences of maternal orphans in Liberia, as they attempted to care for themselves and seek care from others, and the barriers they faced. In-depth interviews were conducted with 75 post-conflict Liberian orphans. We performed a secondary narrative analysis of interview transcripts from all maternal or double orphans (n = 17). We identified similar elements across narratives: traumatic loss, disconnection from family and community, and the desire for a savior. Female high-risk orphans were more likely to have formal substitute caregiving arrangements in which they were living with someone who was a relative or had been selected by a relative. Male orphans more commonly lacked arranged substitute care, but this allowed them to form relationships with substitute caregivers of their choosing. Sex also played a role in the provision of caregiving; substitute care was provided by women. Findings highlighted the syndemic relationship between poverty, violence, transactional sex, trauma, and substance use that traps high-risk Liberian orphans. Interventions are needed to improve access to mental health care, sober communities, housing, and education support. The need to integrate these services into indigenous institutions and address barriers related to stigma is explored.

Computational Study of the Donor-Acceptor Interactions Underlying the Variable Oxygen Probe.

The variable oxygen probe (VOP) is a crystallographic technique that has been used to explore the relative donor abilities of various filled orbitals ranging from vicinal lone pairs to polarized heteroatom-carbon bonds, remote π functionalities, and strained carbon-carbon (CC) bonds. In this study, the donor-acceptor interactions which underlie the VOP have been explored in the gas phase using density functional theory on the model systems 1-13 with natural bond orbital analysis of the various donor-acceptor interactions involving both neutral and charged σ* antibonding orbitals as the acceptor probes. Updated values for the VOP slopes of 1-13 were shown to relate qualitatively with the sum of all significant donor-acceptor interactions present in these derivatives. Application of the VOP to calculated structures of 1-13 with various -OR substituents revealed a similar relationship between the C-OR bond distance to pKa (ROH). However, the VOP slopes in the gas phase were significantly smaller in magnitude than those obtained from crystal structural data, likely due to the valence form (C+-OR) being disfavored in the former, highlighting the advantage of the VOP as an experimental technique to discriminate donor ability more effectively than calculated structures.

Using local terminology to measure substance use behaviours among youth in post-conflict Liberia: a mixed methods study.

This mixed methods study aimed to use local terminology to accurately characterize the prevalence and risk factors associated with substance use and risky health behaviors among school-based youth in Monrovia, Liberia. An 86-question survey was validated using qualitative data obtained from focus groups at two secondary schools in central and greater Monrovia. The revised survey was then administered to 400 students from eight different secondary schools in this region. The observed prevalence estimates for lifetime and current substance use were considerably higher than previously reported among adolescents in the West African region. Among students who were former child soldiers, the rates of current substance use were 5.8-33.8% higher compared to the overall study sample. Male gender, academic seniority, and peer approval of substance use were all found to be strong predictors of current substance use among secondary students. Results suggest the need for targeted, trauma-informed interventions to reduce rates of substance use and risky health behaviors among youth in Liberia and similar post-conflict settings.

Experimental evidence of chalcogen bonding at oxygen.

An o-nitro-O-aryl oxime was observed to exhibit a short OO contact, which exhibited characteristics consistent with a chalcogen bond. The O-N bond length of the oxime was appreciably longer than the expected value, and NBO calculations indicated the presence of a n(O) → σ(O-N) orbital delocalisation. Topological analysis of the experimental electron density of two analogues shows the presence of a bond path between the two oxygen atoms, with ρ(r) and ∇2ρ(r) values consistent with an electrostatic interaction. Finally, electrostatic potential calculations indicate the presence of a σ-hole, the "smoking gun" indicating a Ch-bond. These results are unusual as oxygen is not typically considered to be a Ch-bond donor, especially in unactivated systems such as oximes.

Narratives of Agency and Capability from Two Adolescent Girls in Post-conflict Liberia.

Between 1989 and 2003, Liberia experienced a brutal civil war characterized by ethnic killings, sexual violence and the use of child soldiers. Five years after the war ended, half the population of Liberia was under 18 years old. Understanding the needs of these youth is thus essential to the recovery of the nation. This study focuses on the narratives of two female adolescents, selected from 75 in-depth individual interviews with post-conflict Liberian youth conducted in 2012. A narrative analysis approach was employed to examine each interview for multiple layers of meaning. The aim of the study was to elucidate factors that may enable post-conflict youth to reclaim a sense of agency and return to normal developmental tasks. The study explores the ways in which these youth navigate complicated power dynamics in the post-conflict setting and how gender impacts their experiences of their own agency and capability. The dynamics between the participants and the interviewer are explored to further illustrate how power dynamics manifest. These narratives support the involvement of youth in projects that help others as an avenue for promoting agency and resilience for themselves.

Structure-reactivity correlations of the abnormal Beckmann reaction of dihydrolevoglucosenone oxime.

A structural, spectroscopic and computational study of a series of oximes was undertaken to investigate how geometric and structural changes relevant to the reaction coordinate for the Beckmann reaction (normal Beckmann) and Beckmann fragmentation (abnormal Beckmann) manifest in the ground state. X-ray structures of a range of oximes derived from dihydrolevoglucosan (Cyrene™; which undergoes the abnormal Beckmann reaction), in which the oxygen substituent was systematically varied were determined. As the electron demand of the OR group increased, the major structural changes included lengthening of the N-OR bond distance, and a decrease in the magnitude of the C2[double bond, length as m-dash]N-O bond angle, consistent with the changes seen for cyclohexanone oximes, which undergo the normal Beckmann reaction. However, unique to the Cyrene oximes, an increase in the length of the fissile C1-C2 bond was observed, which correlated with a decrease in the 13C-13C 1-bond coupling constants as the electron demand of the OR substituent increased. Computational studies of Cyrene and cyclohexanone oximes using Natural Bond Orbital analysis support an electronic structure involving n(O) → σ*C1-C2 and σC1-C2 → σ*N-O localized orbital interactions.

Seleniranium Ions Undergo π-Ligand Exchange via an Associative Mechanism in the Gas Phase.

Collision-induced dissociation mass spectrometry of the ammonium ions 4a and 4b results in the formation of the seleniranium ion 5, the structure and purity of which were verified using gas-phase infrared spectroscopy coupled to mass spectrometry and gas-phase ion-mobility measurements. Ion-molecule reactions between the ion 5 (m/z = 261) and cyclopentene, cyclohexene, cycloheptene, and cyclooctene resulted in the formation of the seleniranium ions 7 (m/z = 225), 6 (m/z = 239), 8 (m/z = 253), and 9 (m/z = 267), respectively. Further reaction of seleniranium 6 with cyclopentene resulted in further π-ligand exchange giving seleniranium ion 7, confirming that direct π-ligand exchange between seleniranium ion 5 and cycloalkenes occurs in the gas phase. Pseudo-first-order kinetics established relative reaction efficiencies for π-ligand exchange for cyclopentene, cyclohexene, cycloheptene. and cyclooctene as 0.20, 0.07, 0.43, and 4.32. respectively. DFT calculations at the M06/6-31+G(d) level of theory provide the following insights into the mechanism of the π-ligand exchange reactions; the cycloalkene forms a complex with the seleniranium ion 5 with binding energies of 57 and 62 kJ/mol for cyclopentene and cyclohexene, respectively, with transition states for π-ligand exchange having barriers of 17.8 and 19.3 kJ/mol for cyclopentene and cyclohexene, respectively.

A qualitative analysis of parental loss and family separation among youth in post-conflict Liberia.

Between 1989 and 2003, the Republic of Liberia experienced a brutal civil war. In 2008, the population was approximately 3.5 million people, and there were an estimated 340,000 orphans. Nearly 6000 more children were orphaned by the Ebola epidemic from 2014-2015. The goal of this research was to explore the impact of parental loss, identify moderating factors, and consider interventions that could help vulnerable youth in post-conflict societies following the loss of a parent. Seventy-five young people (age 13-18 years) in Monrovia, the capital city of Liberia, were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically. The loss of a parent or other primary caregiver had a significant impact on psychosocial and emotional health. The timing of the loss, strength of connection with the deceased parent, and relationship with surviving parent or substitute caregiver were all relevant factors. Children separated from living parents were functioning better than those whose parents were deceased. The case of Liberian children underscores the importance of early caregiver relationships and the difficulties children face when such relationships are disrupted. Children who did not experience stable early relationships suffered disconnection from their families and communities.

A qualitative analysis of factors impacting resilience among youth in post-conflict Liberia.

BACKGROUND: In 2008, 5 years after the Liberian civil war ended, there were an estimated 340,000 orphans in Liberia, 18 % of the total child population of the country. Given that children make up half the population and that these children experienced significant trauma and loss both through direct exposure to the war and then to the Ebola epidemic, and indirectly as a result of the trauma experienced by their parents, the recovery of these children is essential to the recovery of the nation as a whole. The goal of this research was to identify factors contributing to resilience among youth in post-conflict Liberia. Resilience was defined as evidence of adaptive functioning and psychological health. METHODS: Seventy-five young people (age 13-18) in the capital city of Monrovia, Liberia were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically. RESULTS: Forty-six of the participants were attending school, and 29 were not enrolled in school. Youth enrolled in school demonstrated greater adaptive functioning. This was particularly true for boys in any school setting and girls attending private school. Youth not attending school were more likely to have lost family members or become estranged from them, and many were also engaging in substance use. Emotion regulation, cognitive flexibility, agency, social intelligence and, in some cases, meaning-making were found in participants who showed resilient outcomes. CONCLUSIONS: Caregiver relationships mediate the development of psychological capacities that impact resilience. These findings suggest that youth who have lost a caregiver, many of whom are not attending school, are experiencing a significant ongoing burden in terms of their daily functioning and psychological health in the post-war period and should be the focus of further study and intervention targeting substance use and community reintegration. Trial registration Partners Healthcare IRB Protocol# 2012P000367.

A mental health needs assessment of children and adolescents in post-conflict Liberia: results from a quantitative key-informant survey.

Between 1989 and 2004, Liberia experienced a devastating civil war that resulted in widespread trauma with almost no mental health infrastructure to help citizens cope. In 2009, the Liberian Ministry of Health and Social Welfare collaborated with researchers from Massachusetts General Hospital to conduct a rapid needs assessment survey in Liberia with local key informants (n = 171) to examine the impact of war and post-war events on emotional and behavioral problems of, functional limitations of, and appropriate treatment settings for Liberian youth aged 5-22. War exposure and post-conflict sexual violence, poverty, infectious disease and parental death negatively impacted youth mental health. Key informants perceived that youth displayed internalizing and externalizing symptoms and mental health-related functional impairment at home, school, work and in relationships. Medical clinics were identified as the most appropriate setting for mental health services. Youth in Liberia continue to endure the harsh social, economic and material conditions of everyday life in a protracted post-conflict state, and have significant mental health needs. Their observed functional impairment due to mental health issues further limited their access to protective factors such as education, employment and positive social relationships. Results from this study informed Liberia's first post-conflict mental health policy.

Modes of neighbouring group participation by the methyl selenyl substituent in ß-methylselenylmethyl-substituted 1-phenylethyl carbenium ions.

Selenium substituents which are disposed ß to an electron deficient centre, such as a carbocation p-orbital, or the π* orbital of an electron deficient p-system, interact in a stabilising way by a combination of C-Se hyperconjugation (σ(Se-C)-π* interaction), and a through-space homoconjugative n(Se)-π* interaction. The relative importance of these two modes of interaction is dependant on the electron demand of the cation, with hyperconjugation predominating for low electron demand systems, and the n(Se)-π* interaction predominating for high electron demand cations.

Gas-phase reactions of [VO2(OH)2]- and [V2O5(OH)]- with methanol: experiment and theory.

The gas-phase reactivity of the vanadium hydroxides [VO(2)(OH)(2)](-) and [V(2)O(5)(OH)](-) toward methanol was examined using a combination of ion-molecule reactions (IMRs) and collision-induced dissociation (CID) in a quadrupole ion trap mass spectrometer. Isotope-labeling experiments with CD(3)OH, (13)CH(3)OH, and CH(3)(18)OH were used to confirm the stoichiometry of ions and the observed sequence of reactions. The experimental data were interpreted with the aid of density functional theory calculations, carried out at the B3LYP/SDD6-311++G** level of theory. While [VO(2)(OH)(2)](-) is unreactive, [V(2)O(5)(OH)](-) undergoes a metathesis reaction to yield [V(2)O(5)(OCH(3))](-). The DFT calculations reveal that the metathesis reaction of methanol with [VO(2)(OH)(2)](-) suffers from a barrier of +0.52 eV (relative to separated reactants) but that the reaction of [V(2)O(5)(OH)](-) with methanol readily proceeds via addition/elimination reactions with both transition states being below the energy of the separated reactants. CID of [V(2)O(5)(OCH(3))](-) (m/z 213) yields three ions arising from activation of the methoxo ligand: [V(2), O(6), C, H](-) (m/z 211); [V(2), O(5), H](-) (m/z 183); and [V(2), O(4), H](-) (m/z 167). Additional experiments and DFT calculations suggest that these ions arise from losses of H(2), formaldehyde and the sequential losses of H(2) and CO(2), respectively. The use of an (18)O-labeled methoxo ligand in [V(2)O(5)((18)OCH(3))](-) (m/z 215) showed the competing losses of H(2)C(16)O and H(2)C(18)O and [H(2) and C(16)O(18)O] and [H(2) and C(16)O(2)], highlighting that (16)O/(18)O exchange between the methoxo ligand and the vanadium oxide occurs prior to the subsequent fragmentation of the ligand. DFT calculations reveal that a key step involves hydrogen atom transfer from the methoxo ligand to the oxo ligand of the same vanadium center, producing the intermediate [V(2)O(4)(OH)(OCH(2))](-) containing a ketyl radical ligand and a hydroxo ligand. This intermediate can either undergo CH(2)O loss, or the ketyl radical can couple with an oxo ligand of the adjacent vanadium center, producing [V(2)O(3)(µ(2)-O(2)CH(2))](-), which is a key intermediate in the (16)O/(18)O scrambling and in the H(2) loss channel.

Orbital interactions in selenomethyl-substituted pyridinium ions and carbenium ions with higher electron demand.

Computational, solution phase, and crystal structure analysis of 2- and 4-organoselenylmethyl-substituted pyridinium ions (10a-c and 11a-c) provides strong evidence for C-Se hyperconjugation (σ(C-Se)-π*) between the C-Se σ-bond and the π-deficient aromatic ring and a through-space interaction (n(Se)-π*) between the selenium p-type lone pair and the π-deficient aromatic ring. There is also a weak anomeric-type interaction (n(Se)-σ*(CC)) involving the selenium p-type lone pair electrons and the polarized CH(2)-C(Ar) σ-bond. NBO analysis of calculated cations with varying electron demand (B3LYP/6-311++G**) show that C-Se hyperconjugation (σ(C-Se)-π*) is the predominant mode of stabilization in the weakly electron-demanding pyridinium ions (10d, 11d, 14, and 15); however, the through-space (n(Se)-π*) interaction becomes more important as the electron demand of the ß-Se-substituted carbocation increases. The anomeric interaction (n(Se)-σ*(CC)) is relatively weak in all ions.