 Mi yw Catherine Maitland. I'm a pediatrician and I'm based at the Cymru Welcome Trust programme in Caliphia in Kenya. I've been there for the last 20 years where I have been, my focus of my research is the critically ill child, particularly the child who's just presented to hospital and we've been looking at how best to keep that child alive. So first of all we did a series of what we would call physiological studies to try and understand what was causing them to be unwell, particularly children with severe malaria. So my initial focus was trying to establish whether children with severe malaria who came in in a very desperate state, whether they actually had features of what we call shock. And so we had to actually underpin the work that we subsequently did by looking at the physiology of these children, putting in central venous pressure lines and studying them over time and over their course of illness. And we were able to establish that like children with sepsis, children with severe malaria also do have shock. And then that allowed us to be able to justify to do fluid intervention studies as you would normally do in the emergency rooms in the UK. I went on from that study to do a very large phase three trial and the results were extremely surprising for all of us. We weren't anticipating them. They actually showed that although children who had shock, and this was not just children with severe malaria but also children with sepsis, we were able to give them fluid and that corrected shock, but that did not save lives. In fact it actually worsened the outcome. So children receiving what's normally given in the emergency rooms here actually had a worse outcome than children who actually didn't receive fluid boluses. That piece of research was published in the New England Journal in 2011 and it caused quite a stir in the world. And I think we're now eight years following that and people are still trying to understand the results of that trial. But that's not only changed practice in Africa but it's also changed practice elsewhere. If you think about what you do when you first see a very sick child, the first thing that we recognise is that a very sick child comes in in this chaos. Everybody's wanting to do something and I think the most important thing is that all the teams are trained and there's a course called emergency treatment and triage which is EATAP for short. And that's had a very significant impact because it trains teams not only to recognise very sick children but also to actually then do a standard set of treatment and also looking after them beyond that. And I think getting people to work together in an organised systematic way has an enormous effect but that's before we even start to consider the treatments. So the second part of trying to improve outcome is looking at the guidelines which is what people try to follow and say well has this guideline which is often give very strong recommendations, has this been tested in a clinical trial? Because that's the best evidence. So as I've given you an example before about the feast trial, it's the only controlled trial that's ever been conducted in the world and the results were surprising. So we also need to test other interventions that are commonly given in the emergency room. So for example one of the recent research trials that we've completed and just published this August in the New England Journal of Medicine was a transfusion trial. For this trial it was in African children who have severe anemia and there's no surrogate population around the world. This is a very, very specific question for children in Africa. So severe anemia is a very common problem when they present to hospital and the WHO guidelines often recommend because the children use a lot of blood from the blood transfusion services. They often recommend not to transfuse children who are less severely ill even though they are very unwell because they've been hospitalised. And doctors don't believe it so they transfuse away and that means that they're using up the resource of blood and often when you get a very sick child who really does need blood there's no blood in the blood bank. So we actually conduct the trial that showed that with between a hemoglobin of four and six if the child is stable you do not need an immediate transfusion. So we actually confirmed the WHO guideline but there's one caveat to that. This is that we were able to show that you must monitor these children and by monitoring them you'll find that at least half of them or nearly half of them will develop severe and complicated anemia within the next 24 hours needing a transfusion. So we were able to show that you can allocate transfusions according to not just as soon as they come through the door but if you monitor children you were able to show that you can preserve the very precious supplies of donor blood. So over the last decade I think what's really been instrumental in making big changes in terms of research and output is the way people work. I think it's been recognised instead of one group of people working at a single centre producing a small piece of research showing A or X and another group saying oh no we disagree why. Now people are beginning to work as quite considerably large consortia which means that actually you can move through research questions in a much more integrated manner and you also have a much bigger impact. Not just obviously in clinical trials but across huge consortia and I think many of the other people who work in this department have been able to show that when you pool your data you pool your efforts you work collaboratively. You can make enormous impact for the populations that you're working with but also to policy makers because you come with a very very strong body of evidence. I think I've often been asked we know why you're not trying to prevent children from coming into hospital then actually trying to save them when they come in because they're very sick. Well it's a really important targeted way of reducing child mortality because if you have a very strong evidence base that you're able to show that treating children in a particular way because you've done this in a clinical trial then that can save lives. It actually is a very cost effective way of improving outcome. Where our research group and our focus of our research group actually has similarities with the rest of the world is that even in rich emergency rooms in the UK and beyond many of the guidelines have not been tested and so it's not a unique field. And I think people struggle. I mean it's also actually conducting this type of research has huge ethical challenges and practicality challenges and we've been able to address those in Africa and so we think we're an exemplar for the rest of the world. So our research is almost immediately translatable because we do large clinical trials designed to be run in the settings in which the actual guidelines will be taken up. And so we don't try to replicate artificial settings so when we come up with a result and it's a definitive result it can be immediately translated into policy and also then put in to practice another words translation. So we think we have a capital T for translation in terms of our research. Thank you.