 So, yes, I'm going to focus a little bit on the cost and cost effectiveness assessments we did looking at some of these devices. I do just want to first of all thank some of my colleagues and notably Nancy to want to sanity, who actually led on this work. So, just before I talk about the devices themselves. Very quick background just about malaria in Laos. It is still around has been declining over the past 1020 years or so. But there are still pockets where it is alive and well. So, as for the prevalence of falsified or substandard anti-malarial we don't have a lot of data to go on but there were some servers that were done in Laos. There was one that dates back to 2009 where they found that 88% of pharmacies stocked substandard or falsified artesumate. And a few years later, there was another survey that found about a quarter of a city samples to be with the wrong API. So, it definitely was a problem of large magnitude, we think things might have improved but we don't really know. And as for the consequences of this also very little data to actually put hard numbers on this but we do think we can safely presume it does have quite nasty implications in terms of health outcomes patients and other knock on effects which will come back to in a bit. Celine mentioned a lot of the background work that went into looking at the potential usefulness how accurate these devices can be picking out poor quality medicines. And we thought we would focus in the context of Laos on what they might do in terms of post market surveillance for helping to pick out substandard medicines in for anti-malarial specifically. Now, it's not because that is their only use to have a much wider potential use but this was just an area where we thought we have relatively better data more evidence to go on in terms of quantifying the costs and effects of implementing these devices. We shortlisted the devices that performed best in the evaluation that Celine already described. And we then had to do a lot of speculation as to what the implementation of these devices might actually look like in post market surveillance systems. So they do have surveillance going on these are usually visual inspections. And so, and we did get some data as to how useful these visual inspections are detecting poor quality medicines. And we also had to speculate how these devices actually be used and what would be the added benefit, the added costs and benefits. And we also had to come up with a lot of speculative scenarios as to what the current prevalence is of substandard falsified medicine. So we chose two scenarios, which you can see at the bottom here and said, if this is what was, what is currently going on, what are the costs and benefits of these devices. These are very simple decision tree models. And it's really one model which kind of simulate a scenario where you have inspectors going to a pharmacy and using these devices. This, they could also take either one, two or three samples from each one of the item is the combination therapies in a pharmacy and run these run the test to see whether or not the device indicates that it is substandard or falsified. This did suggest that is substandard falsified, we then assumed that that facility that we would be able to replace the substandard medicines with genuine ones. And we also assumed that this would last for approximately one month after which we conservatively assumed that things just returned to the same levels of prevalence of poor quality medicine. So we do come up with another model just speculating what will be the impact on patients. So, we have a patient model say if someone has malaria and we just use data on the incidence or malaria in these regions. If they took a medication that was basically not to doing any good for them, what the health implications are for that. So we put all of that together, both the costs and the effects, and we used disability adjusted life years as a measure of effectiveness in terms of the burden of malaria, and the health outcomes that could be improved with the use of these devices. So, putting all of that together in our incremental cost effectiveness ratios, we were able to determine whether or not these devices they use could be considered cost effective or not. We also used a similar measure called net monetary benefit, where we take the incremental effectiveness and add on what's referred to as a decision threshold or willingness to pay threshold, using the loud GDP per capita. And that kind of give us some money, it gives us a monetary quantification of this benefit, which we can then compare with the added costs to say whether or not something is cost effective. So it's a very quick summary looking at the different devices, what the annual cost would be what you can see here. So this is the incremental cost as compared with visual inspections alone. These are the number of dailies averted. We have our ICES incremental cost effectiveness ratio and finally the net monetary benefit, which is very useful when we want to make these multiple comparisons across many different devices and different sampling strategies. So, thinking about our two scenarios, we found that all devices could be considered cost effective in the background against background of high levels of both substandard and falsified medicines. So this is a scenario where things have improved and we think that this may well be the case in more recent years. We see a little bit more variation in the results and some devices no longer looking quite as cost effective. The devices that definitely have the highest advantage are the ones that could do something towards quantifying the API. As I mentioned, some devices simply give you a pass or fail whether or not the API is detected at all, whereas in others you could actually quantify the API, and it's these devices that could be particularly useful and potentially cost effective. So a budget impact analysis to say if policymakers were to look at this and decide favorably to try and implement these devices in the malaria endemic provinces in Laos. And we found the total cost. So you can see the ballpark figure measured in up to a few million, which does sound like a lot. But I think it's useful to kind of think what else might be done with these kind of figures and could say this might be similar to rolling out bed nets to the population in this area in the malaria endemic areas just to give some kind of kind of more real life feel for what these kind of figures would mean in the alternative, perhaps next best use. So summary we did find that these devices could well be cost effective when focusing on a very narrow sliver of the potential benefits thinking only about optimistic combination therapies. They could be used for, of course, other medication, notably antibiotics and we know that there are also very high levels of substandard count for antibiotics out there as well. So we found that these devices, which we didn't look at we've identified one device which we thought was probably the most cost effective. There's a lot of limitations to this work, notably, well all the assumptions we had to make to try and come up with what we thought was a sensible estimate of their cost effectiveness. It's a very conservative one so we made sure that all our estimates were on the side of caution so we think that if we did find that these results look appear to be cost effective. They are likely to be much more cost effective than the estimates we put out there. But there are a lot of other factors that could and should be considered if you did want to do a more comprehensive assessment of the cost effectiveness of these devices. The results have already been mentioned the potential impact that having a lot of poor poor quality medicine out there might have towards accelerating the emergence and spread of AMR. There's toxicity and adverse effects sorry about the typo there that we didn't consider either there's a loss of confidence in health systems all these things could be brought into the models as well to have a more comprehensive view of the economic benefits these devices could have. But notably I also just want to measure that as we do try and move towards elimination of malaria in Southeast in Southeast Asia. It's absolutely critical that remaining cases are treated effectively. And having poor quality medicine out there it's clearly undermining our efforts to eliminate malaria in the region. That's just one more area where these devices could have a very beneficial effect. Last but not least I think this is something I always wanted to emphasize in talking about cost effectiveness cost effectiveness is not a inherent feature of an intervention, it is all about the context where the interventions are being used and that is probably the case here more so than things like medications where there is a inherent effectiveness here it is all about how the interventions are used in practice, how the teams that go out and use them actually relate to the findings that the test provide. There's going to be a lot of unintended consequences when they are implemented in the real world. So one obvious thing is they could just make inspectors more lax in terms of the visual inspections of of the difference medicine so for all these reasons we really need to have large scale implementation studies to really determine the real impact and cost effectiveness of the devices. That's it from me so just one more big thanks to Nancy, who should have presented but wasn't available for it and other colleagues working on this. Thank you.