Biochemistry Exams Research Articles

Transnational online education in biochemistry during and after the COVID-19 pandemic in Binzhou Medical University: challenges, strategies and outcome

BackgroundDue to the global outbreak of the COVID-19 epidemic, schools were forced to shift teaching from face-face to online. During this period, a large number of studies on how to better carry out online teaching emerged. However, these studies were basically conducted with domestic students as teaching objects. The research on transnational online education conducted by overseas students is very limited.MethodsWe first conducted a questionnaire survey on the obstacles of transnational online learning of 64 international students from our school who were staying abroad at the beginning of the fall semester of 2020, analyzed the results using the two-tailed student’s t-test and changed the teaching platform accordingly and compared the results of the biochemistry exams conducted for 2018 spring class with those of 2018 fall class and the 2019 fall class, so as to verify the superiority of the DingTalk as a transnational online education platform.ResultsThe results showed that the main difficulties of overseas students in transnational online learning are poor network conditions and time difference. By using DingTalk as an online teaching platform, these difficulties were overcome. In the spring class of 2018, the results of online study students’ biochemistry were significantly lower than those of students in face-face study (t-test, p = 0.01). However, after the switch to the DingTalk platform, online students’ results in the 2018 fall class (t-test, p = 0.35) and the 2019 fall class (t-test, p = 0.7) were equivalent to the academic performance of face-face students.ConclusionOur exploration and application of DingTalk software in transnational online education successfully solved the dilemma of overseas students’ online learning, and provided a feasible method to guarantee the efficacy of online teaching.

Paired-Term, Open-Ended Biochemistry Exam

The paired-term biochemistry exam comprises five pairs of “unrelated” biochemical terms, where the collection of pairs, overall, is unique for each student. The student selects four of the pairs and answers three short essay questions about each, with a focus on how structure leads to function at the molecular level. Both “structure” and “function” can be interpreted broadly by the student, depending on their understanding of the terms, and their creativity. To do well on the exam, the student needs to have a good understanding of biochemistry. The exam is easy to prepare; holds back cheating even when taken remotely; can be open-book (as practiced here); and received a favorable student response in both an undergraduate and graduate course.

From the inverted classroom to the online lecture hall: Effects on students' satisfaction and exam results.

On-site teaching at Ulm University was restricted in the summer semester (SS) 2020 due to the Corona pandemic. The biochemistry seminar "From gene to protein" in the 2nd preclinical semester, which had been successfully conducted as an Inverted Classroom (IC), had to be changed to an online concept. The aim of this study was to analyze the concept conversion in terms of students' satisfaction and knowledge acquisition. In the seminar, human medical students of the 2nd semester acquired biochemical and competency-oriented learning content. In SS2019, the course was taught using the IC concept. For the conversion to the online format in the SS2020, alternative teaching materials were developed and used. Students' satisfaction was assessed by an evaluation questionnaire and knowledge acquisition was tested by a written biochemistry exam. For both teaching concepts a high level of satisfaction was detected. Individual evaluation criteria were evaluated similarly by the students for both concepts. The online concept led up to significantly higher biochemistry exam scores. Due to the high levels of students' satisfaction in both concepts and the results of the biochemistry exam, it can be concluded that online teaching offers a suitable substitute. Based on these results, it is worth to undertake further research on digitization of studies.

Cistite flegmonosa severa: relato de caso

Relata-se um caso de cistite flegmonosa severa, ou cistite purulenta, decorrente de infecção por bactérias em uma fêmea da espécie ca­nina, da raça dachshund, com nove anos de idade, apresentando disúria há aproximadamente uma semana. Exames bioquímicos foram realizados, além de análise de cálculo e exame de ultrassonografia abdominal. Os exames de bioquímica não apresentaram alterações. A análise de cálculos apresentou carbonato de cálcio/urato. A confirma­ção do diagnóstico foi obtida pela ultrassonografia com a visualização de uma área de aspecto heterogêneo, hipoecogênico e hiperecogê­nico em região caudal à bexiga. O animal passou por cirurgia, na qual foi retirada uma massa aderida à bexiga, e encaminhada para exame histológico, resultando em perda de revestimento epitelial e severa infiltração leucocitária. Este relato salienta a importância do diagnóstico, que pode ser realizado com o emprego de exames laboratoriais e exames de imagem, como importantes auxiliares.

Increasing Active Learning in the Biochemistry Classroom: Using Group Quizzes to Stimulate Discussion

A variety of pedagogical methods (such as POGIL and teaching through case studies) that encourage discussion are particularly adaptable for biochemistry courses. However, these methods often fall short when students in the classroom are not motivated to engage in discussion of the material. In the Monmouth College Biochemistry classroom, group multiple‐choice quizzes have been used to stimulate discussion and collaborative work. Students are assigned to a group of 3 or 4 students; each student takes an individual multiple‐choice quiz prior to working on the group quiz. The individual quiz allows each student to organize their thoughts before taking the quiz as a group thereby avoiding the issue of group dynamics and students who move through the quiz at different rates. The group quiz is self‐scored using an IF‐AT scorecard. With these low stakes quizzes, almost all students actively engage in the discussion of the material and take an interest in what is being discussed. Student feedback suggests that this process enhances their ability to work collaboratively and increases their comprehension of the material. Finally, due to the multiple‐choice format of these quizzes and the increased comprehension of the material, students have shown an improvement on the ACS standardized biochemistry exam since this method has been implemented.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The Benefit of a Switch: Answer‐Changing on Multiple‐Choice Exams by First‐Year Dental Students

The aim of this study was to determine if dental students would benefit from changing their initial responses to what they have deemed to be more suitable answers during high-stakes multiple-choice examinations. Students are often advised to stay with their first answers despite evidence from other fields suggesting this is not the best course for obtaining optimal final exam scores. Data were collected for 160 first-year DMD students in fall 2013 for three operative dentistry and four biochemistry exams at Tufts University School of Dental Medicine. As students take all of their exams through ExamSoft, a test-taking software application that tracks and records all changes students make during the exam period, the subjective nature of previous studies on answer changing was eliminated. The results showed that all students changed their answers on a minimum of nine questions over the seven exams, with an average of 26.55 (SD=8.8) questions changed per student. Answers changed from an incorrect to a correct response comprised nearly 65% of total answer changes, while changes from a correct to an incorrect answer encompassed slightly above 10% of answer changes. Nearly all students (99.4%) benefitted from answer-changing with a net gain of at least two correct questions, with only one student not increasing the final score. Overall, the students greatly benefitted from changing their answer choice, suggesting that dental students could be advised to change their answers from their first choice if they identify a better option when taking multiple-choice exams.

Evaluation of physiological parameters of dogs submitted to uterine lymphatic mapping using patent blue V dye for anaphylaxis detection

ABSTRACT: Lymphatic mapping has been performed in humans and dogs. Although several cases of anaphylaxis have been reported in humans, there are no such reports in dogs. The objective of this study was to identify the occurrence of adverse reactions to patent blue V dye in bitches undergoing uterine lymphatic mapping procedures using cardiovascular and hematological evaluations. The experiment was performed in 14 mongrel bitches without any reproductive disease, randomly assigned into two equal groups (PBV- uterine lynphatic mapping and OHE; Control - OHE only). The animals were submitted to pre- and postoperative hematological and serum biochemistry exams (7 days). The anesthetic protocol was: sedation (morphine and acepromazine), induction (propofol), maintenance (isoflurane), transoperative analgesia (fentanyl). Systolic blood pressure was monitored throughout the procedure and arterial blood gas analysis was performed immediate pre and postoperatively. For lymphatic mapping was injected patent blue V in the uterine wall, 10 minutes before OEH. Comparisons between the pre- and postoperative parameters within the same animal were performed using the Wilcoxon-Mann-Whitney test. To compare the values between control and PBV group was obtaining the difference between the pre and post of each group, subjected to the Mann-Whitney test (significance of 5%). Differences were observed (P<0.05) between the pre- and postoperative evaluations in the PBV (total protein and the albumin serum), in both groups (arterial partial pressure of oxygen) and in the Control (arterial oxygen saturation). There were no signs of adverse reactions to the patent blue V dye in the healthy bitches submitted to lymphatic uterine mapping.

Blog construction as an effective tool in biochemistry active learning.

To boost active learning in undergraduate students, they were given the task of preparing blogs on topics of clinical biochemistry. This "experiment" lasted for 12 teaching-semesters (from 2008 to 2013), and included a survey on the blogs' usefulness at the end of each semester. The survey (applied in the 2008-2010 period) used a Likert-like questionnaire with eight questions and a 1-to-6 scale, from "totally disagree" to "fully agree." Answers of 428 students were analyzed and indicated overall approval of the blog activity: 86% and 35% of the responses scored 4-to-6 and 6, respectively. Considering the survey results, the high grades obtained by students on their blogs (averaging 8.3 in 2008-2010), and the significant increase in average grades of the clinical biochemistry exam after the beginning of the blog system (from 5.5 in 2007 to 6.4 in 2008-2010), we concluded that blogging activity on biochemistry is a promising tool for boosting active learning. © 2016 by The International Union of Biochemistry and Molecular Biology, 45(3):205-215, 2017.

Effective Strategies for Integrating Pre‐Requisite Course Concepts into Teaching Biochemistry

Biochemistry is a pre‐requisite heavy discipline; it is built on the fundamentals of chemistry and biology. It is often the fifth chemistry‐related course a student takes. But how much of what they learned in prior classes can they remember and apply in a new setting? Making these connections is a fundamental assumption in the constructivist model of learning. To help foster these connections, a collection of activities that explicitly link general and organic chemistry concepts to biochemistry ideas was written and either assigned as pre‐class work or as discussion activities. A second strategy of regularly integrated in class questions connecting pre‐requisite concepts to course material was also used. Performance on pre‐ and post‐tests covering key pre‐requisite concepts, performance on Biochemistry exams, and student self‐evaluations of their confidence in the concepts from prior courses was collected to determine the effect of these interventions on their understanding of both the pre‐requisite knowledge and the newly acquired information. Our initial analysis suggests that integrative in class questions combined with pre‐class activities enhanced student performance on a pre‐requisite concept inventory.

Case Study of How Turkish University Students Improve Their Biochemistry Achievement

Biochemistry courses have an important place as a common subject in faculties of medicine, food engineering, biology and chemistry. MSLQ, Metacognitive Awareness Inventory and Learning Approach Questionnaire were used. The study also involves repeated observations of the same instructor in a biochemistry class over eight weeks to describe students’ academic performance, instructor practice, teaching methods and generally, learning environment in the biochemistry class. Students achieving the two highest scores, two average scores and the two lowest scores from biochemistry exams were selected for in-depth interviews and results demonstrated that self-efficacy, intrinsic goal orientation, task-value, cognitive strategies such as critical thinking ability and elaboration, metacognitive self-regulated strategies and effort regulation may have a considerable importance in students’ biochemistry achievement. Results of the study also revealed that levels of students’ awareness of what and how they monitor in their biochemistry learning process has an important effect on their biochemistry success.

Usefulness of Combined Bedside Lung Ultrasound and Echocardiography to Assess Weaning Failure From Mechanical Ventilation

Recognition of the cardiac origin of weaning failure is a crucial issue for successful discontinuation of mechanical ventilation. Bedside lung ultrasound and echocardiography have shown a potential in predicting weaning failure. Objective of this report was to describe the case of a patient repeatedly failing to wean from mechanical ventilation, where the combined use of lung ultrasound and echocardiography during a spontaneous breathing trial uncovered an unexpected cause of the failure. Case report. General ICU of a university teaching hospital. Single case, abdominal surgery postoperative patient, not predicted to experience a difficult weaning. Cardiovascular therapy adjustments consistent with lung ultrasound and echocardiography findings acquired during spontaneous breathing trials. All patient's standard hemodynamic and respiratory parameters, datasets from comprehensive lung ultrasound and echocardiographic examinations, and pertinent data from biochemistry exams, were collected during two spontaneous breathing trials. Data from beginning and end of each of the two ultrasound monitored weaning trials, and from the end of the successful weaning trial following therapy and the previously failed one, were analyzed and qualitatively compared. Lung ultrasound performed at the end of the failed spontaneous breathing trial showed a pattern consistent with increased extravascular lung water (diffuse, bilateral, symmetrical, homogeneous sonographic interstitial syndrome). Concurrent echocardiography diagnosed left ventricular diastolic failure. Ultrasound findings at the end of the successful weaning trial showed normalization of the lung pattern and improvement of the echocardiographic one. The patient eventually returned to spontaneous respiration and was discharged from the ICU. The use of bedside lung ultrasound and echocardiography disclosed left ventricular diastolic dysfunction as unexpected cardiogenic cause of weaning failure and lead to subsequent correct patient management.

Benefits of using a nationally normed biochemistry examination

The American Chemical Society (ACS) Exams Institute produces nationally normed exams for most chemistry courses, including biochemistry. The ACS Biochemistry Exam is created by a committee of educators who teach a biochemistry course. Topics typically covered on the ACS Biochemistry exam include metabolism, genetics, biomolecules, and enzymes. The 2013 Biochemistry exam is designed for use in either one‐semester biochemistry courses or two‐semester sequences. It does this by having 40 core items (for a 1‐semester course) and an additional 20 advanced items for those who use the exam in a two‐semester sequence. Discussion will focus on the benefits of using the ACS Biochemistry Exam as a form of assessment in a biochemistry course.

Influence of scores of CET6 and biochemistry exams on scores of toxicology exam with all-English questions

Objective To explore whether and how the medical students' performance in English and biochemistry studies on their exam scores in toxicology basics (in short:toxicology) with allEnglish questions.Methods The correlations between scores of toxicology exam with all-English questions and scores in college English test band 6 (CET6) and biochemistry test of 187 students in the eight-year medical program were analyzed.Results Score of toxicology exam was positively correlated with scores of CET6 and biochemistry tests to some degree ( the correlation coefficients were 0.359 and 0.413 respectively,P ＜ 0.01 ) ; the students who passed CET6 had higher score in toxicology exam than those who did not pass CET6 (P ＜ 0.01,by t-test).Conclusion Passing CET6 and having a good command of related subjects may be essential for adapting to all-English exam questions. Key words: Eight-year medical program; Toxicology; Bilingual teaching; All-English exam questions

Establishment and evaluation of models for small-for-size graft injury without veno-venous bypass in miniature pigs

Objective To establish small-for-size (SFS) graft injury models in miniature pigs with high standardization, reproducibility and similarity to clinical situation. Methods Ba-Ma miniature pigs were introduced in this study and orthotopic liver transplantations (OLTs) were performed in 12 pigs with 30% liver volume allogeneil grafts (small portion of right paramedian lobe, right lateral lobe and caudate lobe) without veno-venous bypass. The profiles of intra-operational hemodynamics and metabolism were investigated. Animals were observed for 7 days with daily serum biochemistry and coagulation function exam. The survival rate related to operation itself and the SFS grafts were respectively calculated as well as the graft regenerative ratio at post-operational day (POD) 7. Results Graft weight as a percentage of the recipient's native liver weight (GW/RLW) and the total body weight (GW/BW) were (28. 63±4. 42)% and (0. 73±0.06)%. The mean operation time, anhepatic phase, and the time of blockage of infra-hepatic IVC were (191. 7±14. 2) min, (28. 3±3. 6) min, and (45. 0±5. 8) min. The survival rate related to the operation itself and the SFS graft were 83. 33% (10/12) and 40% (4/10), and the graft regenerative ratio at POD7 was (278. 06±42. 95) %. Contrast to the remarkable increase of heart rate and serum potassium during anhepatic phase, the mean arterial pressure, central venous pressure, rectal temperature, PH value and buffer excess had a significant decrease (P<0.01) with a gradual recovery after reperfusioa Serum ALT, AST, PT, Cr, and TB were significantly increased with a peak level at POD1 for the former 4 and POD2 for TB, and then began to decrease and favorably recovered at POD7, but TB, PT, and AST levels were still high when compared to those of prereperfusion (P<0. 05). Conclusion This model of OLT performed with 30% liver volume graft without veno-venous bypass was an ideal large animal model for series studies related to SFS graft injury. Key words: Small-for-size liver transplantation; Miniature pigs; Veno-venous bypass; Small-for-size syndrome

Websites of note

Websites of note

Judging media -articles on health- related issues: a new kind of biochemistry exam for biomedical undergrad students

Health-relatedpopular articlesissues and medical tips (or “Dr Google”) have taken over the i nternet. Misconception sare very common ly found among these sources, butrecognizing them may require good biomedical knowledge. The ability to judge knowledge is, according to Bloom’s scale,a very advanced step in the learning process. In this sense, we decided to use fragments of articles from the i nternet as part of a formal exam to evaluate students' overall learning of Clinical and Applied Biochemistry (CAB) . This tes t, known as the True -or-False (T -or-F) exam, is made up of statements found online that are judged by freshman medical and nutrition students taking Basic Biochemistry (BioBio). In the last 4 semesters, students' acceptance and responses to BioBio´s T -or -F exam were evaluated through questionnaires(using a 5-point Likert scale) . Results from 258 students indicate dthat 69% of them felt the exa m was difficult, 87% thought the exam was of good quality, and 69% believed that using media-questions is relevant for learning CAB. However, only 64% thought the exam evaluated satisfactorily what they learned in class. Also, the average grade obtained was 5. 85(out of 10) . This is probably because students are not familiarized with this examination, which requires more than only memorization of biochemical pathways and reactions – it evaluates the application of knowledge. Thus, BioBio´s T-or-F exam is an innovative way of evaluating knowledge and of enabling students to be critic about information receive d. The major ity of students acknowledged the exam´s relevance f or learning purposes and, so, it could be well-applied to other fields of science.

The use of multiple tools for teaching medical biochemistry

In this work, we describe the use of several strategies employing the philosophies of active learning and problem-based learning (PBL) that may be used to improve the teaching of metabolic biochemistry to medical and nutritional undergraduate students. The main activities are as follows: 1) a seminar/poster system in a mini-congress format (using topics of applied biochemistry); 2) a true/false applied biochemistry exam (written by peer tutors); 3) a 9-h exam on metabolism (based in real publications); 4) the Advanced Biochemistry course (directed to peer tutors, where students learn how to read and criticize real medical papers); 5) experiments about nutrition and metabolism, using students as volunteers, and about free radicals (real science for students); 6) the BioBio blog (taking advantage of the "web age," this enhances out of class exchanges of information between the professor, students, and peer tutors); 7) student lectures on public health issues and metabolic disorders directed to the community and lay people; and 8) the BioBio quiz show. The main objective of these activities is to provide students with a more practical and interesting approach to biochemistry, such as the application of theoretical knowledge to real situations (diseases, experiments, media information, and scientific discoveries). In addition, we emphasize the importance of peer tutor activities for optimized learning of both students and peer tutors, the importance of a closer interaction between students and teaching staff, and the necessity to initiate students precociously in two broad fields of medical activity: "real" basic science and contact with the public (also helping students--future doctors and nutritionists--to be able to communicate with lay people). Most activities were evaluated by the students through written questionnaires and informal conversations, along various semesters, indicating good acceptance and approval of these methods. Good student scores in the biochemistry exams and seminars indicated that these activities are also working as valid educational tools.

Too complex to comprehend?

The English mathematician and philosopher Alfred North Whitehead (1861–1947) said, “seek simplicity and distrust it”—a quote I first encountered as an essay title in my final biochemistry exams at university. The fact that it has stuck in my mind might be related to the traumatic circumstances of this experience, but is probably also due to its inherent wisdom. The words resonate with the development of science; practicing scientists seek out simplistic, utilitarian descriptions of reality and distrust them for their simplicity. But, because we know that our descriptions are only approximations, we are able to continue to refine our understanding. Yet, the process is rarely straightforward or predictable, and without a regular critical assessment of our knowledge and without asking new questions, we would remain in an erroneous comfort zone. All research is based on the belief that eventually any puzzle can be solved and any phenomenon comprehended, if only we do the right experiments in a rigorous manner. Time and again, however, we arrive at an impasse where the available techniques are insufficient to discover the next piece of information …

THE USE OF MULTIPLE TOOLS FOR TEACHING MEDICAL BIOCHEMISTRY

The pros and cons of Problem Based Learning (PBL) have been extensively discussed in the literature. We describe PBL-like strategies used at UnB (some of them since 1999) that may be useful elsewhere to improve undergraduate biochemistry teaching with clinical applications. The main activities are: (i) a seminar/poster system, (ii) a true-or-false applied biochemistry exam (prepared by peer tutors), (iii) a 9-hour-exam on metabolism (based in actual papers), (iv) an Advanced Biochemistry course (directed to peer tutors), (v) pizza-and-pasta (for metabolism teaching) and free radicals (real science for students) experiments, (vi) the BioBio blog (http://www.biobio-unb.blogspot.com), (vii) student lectures on health issues directed to the community, and (viii) the BioBio Show. The main objective of these activities is providing students with a more practical and entertaining approach to biochemistry using philosophic PBL principles such as the application of basic knowledge to real situations (diseases, experiments and scientific discoveries). We also emphasize (a) the importance of peer-tutor activity for optimized learning of students and peer tutors, (b) the relevance of a closer interaction between students and professors, and (c) the necessity to initiate students precociously in actual basic/medical science and contact with the public. Most activities have been evaluated by the students through written questionnaires and informal conversations, for several semesters, indicating good acceptance and approval of these methods.

Against the Current: The Memoirs of Boris Ragula (review)

Reviewed by: Against the Current: The Memoirs of Boris Ragula Marianne Fedunkiw (bio) Inge Sanmiya. Against the Current: The Memoirs of Boris Ragula McGill-Queen’s University Press. 202. $34.95 Against the Current is the second book in a new series published by McGill-Queen's University Press. The Footprints Series focuses on 'life stories' of Canadians, stories which 'help nuance larger historical narratives, at times reinforcing those narratives, at other times contradicting them.' The series is breaking new historical ground, opening up avenues for stories of newer Canadians such as Boris Ragula, who emigrated to take up a medical internship at St Joseph's Hospital in London, Ontario in 1954. In fact, two-thirds of the book deals with Ragula's life before he arrived in Canada. He was born in 1920 in Turec, Belarus, under Polish rule at that time. His father, a physician, died of typhoid, leaving his mother Nadzia with two sons under two. The book is well written and a smooth read, balancing a strong narrative thread with some endnotes, helpful maps, and many pictures. The strongest chapters are the first five, which tell of Ragula's childhood in Belarus; his capture and escape from a German pow camp during the Second World War; his torture in and escape from the nkvd Baranovichi prison; his role in the Belarusian resistance; and finally, after the end of the war, his marriage to Ludmila, medical studies in Germany and Belgium, and his meeting with Pope Pius xii in Rome. Strangely, Ragula's five decades in Canada are covered in just forty-three pages. Two of the most interesting anecdotes while he was in Canada relate to Ragula's challenges with English and his experience as a resident when his diagnosis went counter to that of a specialist. Ragula applied to write his Ontario Medical Council examinations in February 1955, against the advice of his fellow interns who had come from [End Page 586] Germany, India, Poland, Romania, Russia, and Yugoslavia and many of whom had written the exams with no success, in part because of difficulties with English. Ragula tells how he used Latin for his anatomy test and elected to give his answers to the biochemistry exam in chemical formulae. The examiner had to conduct the exam using formulae as well. At one point, the examiner, impressed with Ragula's unorthodox efforts, muttered, 'You make me sick!' Ragula, unaware of the colloquial expression, was stunned. He thought the examiner was truly ill. The examiner explained that this was an idiomatic expression and this was the first time anyone had written a paper entirely using chemical formulae. The second incident happened soon after. A senior staff member in gynecology asked Ragula to write a medical history for a thirty-nine-year-old Ukrainian-Canadian immigrant named Nadia who the specialist believed had a mass in her uterus. After examining Nadia, who, like Ragula spoke Russian, Ragula told the patient and the specialist that he believed the mass was in fact a fetus and that a hysterectomy was definitely unnecessary. Sanmiya writes that after Ragula spoke to the specialist, 'He nearly ruptured my eardrum when he started yelling into the phone that I should keep my opinions to myself, do my duty as an intern, and stop questioning "qualified" staff.' Ragula told the patient to avoid surgery by refusing to sign the consent form. Six months later, Nadia delivered a boy, whom she affectionately called 'the tumour' and she and her son became Ragula's patients. As a family physician, Ragula was interested in public health education, led a fight against smoking (at a time when he was in the vanguard among physicians), and used hypnosis in his practice. He also became involved in aid to Belarus and Belarusian politics, serving as president of the Belarusian National Republic's Rada from 1996 to 1998. The epilogue deals with his interest in Belarus, particularly since the Chernobyl Nuclear Power Station meltdown in 1986. There is one error in this section: in an account of events following the collapse of the Soviet Union in 1991, Sanmiya lists the leaders of Belarus, Russia, and Ukraine who met in December of...