 Thank you very much. Hello everyone, and thank you very much. I'm really grateful for this opportunity. I want to thank John and Mark and the Meadow family for this chance to come back home to Chicago and try and embarrass Bill in front of all of you. We'll see what I can do. I was a resident here, as John mentioned, from 1997 to 2000, and I did my neonatology fellowship here from 2000 to 2003. And I've been out in San Francisco ever since. I met my wife here. We got married and had our reception in the quad club, so I feel in a lot of ways like I grew up here, and so it is kind of a homecoming. And Bill was a huge part of that. So I know that a lot of people will be talking about his academic scholarship, his contributions as an ethicist, but I want to give a little different perspective as a trainee. So I want to talk about Bill as an educator, a clinician, and really a life mentor. I know that like so many other trainees in the past, I can say that I really would not be who or what I am today without Bill. So it's not with hyperbole, but I'll try and explain exactly what I mean by that with my remarks. So some people have an amazing ability to plan out their careers from day one. They follow a very clear game plan from A to Z, and they achieve their goals at any cost. That was not who I was. That was never one of my moduses. Instead, I took a very circuitous route into medicine, and I tended to follow my interests and trust that they would eventually guide me to the right place. In my fourth year of medical school, I actually had done a NICU fellowship in Colorado. I did a pediatric surgery sub eye in Seattle, so I had an interest in neonatal intensive care. But for some reason, I never really envisioned myself as a neonatologist. I just did those things because I found them interesting. And whether it was a lack of confidence or I didn't think I had the right temperament for it or I just had no idea how to plan a career like that, I just didn't see that for myself. I couldn't imagine it. So at the start of my intern year, part of me still believed that there was a computer glitch in the National Residency Matching Program, and I matched into this program by mistake. So I was really thinking any day now somebody was gonna call me and say, I'm sorry, there's been a terrible mistake. You're gonna have to leave and make room for the person who really deserves to be here. So my strategy for residency was really about surviving month to month and not screwing up. So I wasn't really career planning beyond the next rotation. So whether by luck or visionary planning on the part of the residency program, I was scheduled for my first rotation of my intern year in the NICU. And this was in July and everyone knows that Bill takes service in July with all the new interns. I think that's to make sure that we don't screw up and have any major disasters. I can remember trying to pre-round that day, not really knowing what I was doing, but standing there terrified, holding my papers, waiting for rounds to start. In came Bill, bigger than life. He opened the door and he started smiling and chanting and saying, all of medicine is a neonatology. It was like he was quoting somebody, which of course he was, he was quoting himself. But I think at that point, I think he did a little jig or a dance in his clogs and he reached out his hand and he said, hi, I'm Bill Meadow, welcome to the NICU, you're gonna love it here. It immediately set me at ease and I have loved neonatology ever since. I may be conflating my memory of this with the beginning of Willy Wonka, but it was very similar. He clearly was the king of that domain, he ruled that domain and he exuded this brightness that was just irresistible. So he immediately set us at ease. Now some might take this nature as, or attitude as being cavalier or arrogant, but instead it really had a magical way of both reassuring us and diffusing the tension over this incredibly serious responsibility that we were about to take on. Every day Bill would enter the NICU with a flourish singing whatever struck his fancy and during my time it was usually some song that Beanie had introduced him to, like I'm Slim Shady, yeah, I'm the Slim Shady or when I was a young warthog from Lion King and then there was always the Amherst fight song, which he would follow by prompting everybody on the team to represent their alma mater in song. So Bill always set the tone and he really taught me that the attending really sets the tone for the team and the unit and that anger and intimidation really have no place in promoting a learning environment. When Bill was on service he would come in almost every night to check on the unit. Maybe it was just when I was on call, but he did come in and since he only lived a few blocks away he would ride his bike into the hospital and it was usually around 11 o'clock right after George Michael's sports machine was over which pre ESPN days and he would bring grapes or tangerines or donut holes and he would hand them to the nurses and the residents and then he would sweep through the unit and after about two minutes he would have the entire unit assessed. It was really something amazing. I've never seen anyone who's able to do something like this and assess the acuity so quickly then he'd come up to you and he'd ask you who do you think are the three sickest babies in the unit? Just to see if they would match his list and of course he was always right but he would clue you into the babies you had to keep an eye out for and sometimes they weren't the babies you expected. So really in 13 years of practice and I've been at UCSF and met some giants in the field I have to put Bill still right at the top of my list as a neonatologist for his clinical acumen really astounding. Whenever babies were sick or families were grieving Bill was always there to provide the right level of compassion and support. When trainees were melting down or frustrated on rounds Bill could diffuse the tension with a deft touch. On rounds if a resident was being argumentative Bill would usually listen understandingly, smile, walk over and give him a big hug. When babies were dying and it was clear that we were only providing care at the end of life Bill still set the tone and guided families to hold their babies. He understood the importance of those final minutes regardless of what had happened in the previous months. Then Bill would always check to see if the nurses and the residents were okay. So Bill also taught me that attending meant being there at the bedside where you were needed. As everyone knows Bill has a gift for language as well. He can turn a phrase like no other. One of my favorites that I still use is this concept of saving one therapy for later. Just in case you need it, just a little something extra. This could be an extra dose of Lasix, an extra presser, event setting of some sort. But Bill would call it leaving an arrow in your quiver. I always love that. Bill always gave us feedback at the end of the month as well and I remember at the end of my intern rotation he called me into his office and told me he did a great job, you're a star. What do you want to do when you grow up? You should be a neonatologist. I felt it was so over the top and so undeserved. I thought for sure it was another catchphrase that he was just spewing out. He probably said this to every intern. But I didn't care, I just felt great and I knew that Bill had my back. And it's true ever since I have felt that way. The following month I was on the wards in general pediatrics and my medical student was my future wife Janet. Apparently that's frowned upon to date your medical students but I'll leave that to the ethicist in the room to decide. But anyway Janet thought she wanted to be a surgeon at the time and the following year she matched into general surgery in Colorado. So being the poor planner that I am I thought what I'll do is just follow her out to Colorado, get a job in general pediatrics and we'll live out the rest of our lives in Denver. Well Janet came to her senses a few months later and realized that surgery was not for her. She wanted to do pediatrics after all and she came back to Chicago. But that left me kind of scrambling wondering what I was gonna do after graduation. So I went to ask Bill for his advice because I trusted him. And to my surprise he offered me a fellowship spot here in neonatology right on the spot. He didn't ask me to send him my updated CV or a personal statement or three letters of recommendation so he could set up a day of interviews. He just said, you should be a NICU fellow here. And I've been the program director at UCSF now for the last eight years and I still am amazed that he would do that for me. It clearly was a decision that changed my life forever and impacted all the patients, families and trainees that I've encountered in neonatology ever since. Janet came back to UC here and completed her pediatric residency while I did my NICU fellowship. And my fellowship experience here was amazing largely because of Bill and Dr. Lee and Dr. Singh, Mike Schreiber, Steve Wall, Jeremy. I had a great experience and great colleagues like Jen Liedl and Janelle Fuller, Leslie Caldarelli, many of whom are here today. And as a resident, Janet always made sure that she made her schedule to be on in July with Bill. So she wanted to get every bit of learning from him as possible. Bill sponsored us for our wedding reception at the Quad Club when we got married. So we really feel kind of like he's a godfather for us and our child. So it's hard to overstate the influence that Bill has had on me and continues to have on my personal and professional life. Though Janet did her neonatology fellowship at UCSF, she still considers Bill to be one of her mentors. So I get a lot of secondhand exposure to Bill still through her all the time. There's probably not a month that goes by that Janet doesn't look at me sideways with exasperation and say, yes, dear. Looking back now, I feel so fortunate to have trained here and Bill really set the tone. He allowed trainees to practice safely to test the waters of our critical thinking and our clinical skills and allowed us to have so many important experiences. I had my first intubation, felt ownership of my first patients and grew in confidence at a time when I really, really needed it. He's influenced my teaching, my patient care, my scholarship in a measurable ways. And I've learned so much that I just wanna say thank you. And really on behalf of myself, Janet and all of your past trainees, thank you so much, Bill. I really wish you many more arrows in your quiver. Annie is a neonatologist and a bioethicist of wonder. Annie Jung, VA from Montreal. Annie is a neonatologist and a bioethicist of Montreal. Started a graduate program in bioethics up there. And she and her husband, Keith, are also parents of a previous VA, so have experienced neonatology from both sides of the class of now. So it's a pleasure to be here and speak about Bill. And I'm from Montreal, so I'm not representing, I'm just room presenting outsiders like the SPCA dogs that Bill takes when they're in distress. One of them being me. So in 2000, after my dad had died of cancer and a terrible death that lasted a year and a half, and I had cancer myself and I was going through divorce. And I had interviewed for theater school because I thought I shouldn't do medicine anymore. I had to go to a PS to present a dink poster. And I thought, you know, I'll go to see everything that has nothing to do with neonatology because I'll probably not do medicine very long. And I selected Drosophila medicine and zebrafish mutations and the bioethics podium. So I went at the bioethics session and wow, these people were exciting compared to the average people in medicine. And they were dressed differently. And actually I saw Bill, a revelation, religious revelation almost on the podium who came with his hat and challenged everything that we knew it was your statistics and memories quarterback phenomenon podium. And I thought, geez, you know, I was like in a notion for the last year and a half wondering what was the purpose of life and if life had any purpose. And finally I saw a little island of possibility. I was, it wasn't a good time in my life. So I rushed myself and threw myself with desperation on Bill and told him, I wanna do what you do. I don't want the autonomy, justice, beneficence, crap ethics theory. I've been learning like how can I do, how can I do the ethics that you're doing? And maybe because I was hanging to him with desperation he accepted to have a coffee with this nobody that he's never seen. But I think it's because he does it with everybody. So we went to have a coffee and what do you wanna do? I didn't tell him about all the problems in my life. I kept to my frustration with ethics and he's like, oh, you have to start somewhere. There's too many things. And since then, if I hadn't met him I would probably be like a trainer in a gym or something. Or in a theater somewhere not making money and you know. But it was a life-saving revelation. So the remainder of the talk I'll speak about Bill as how I see him, unconventional and original as ever intelligent, honest and challenging and generous. Bill is so unconventional. It was so nice to see another angry person challenging everything that could be challenged. And he's a devil's advocate in research. He finds all these little places where everybody thinks they're right and just goes, oh, and I love doing that too. It's very fun. In clinical it looks like he's a bit weird too. So once when I was visiting in Chicago giving a talk I had the worst UTI in my life. So he brought me Cipro and Sceptra and a leader of organic, organic, cranberry juice to be all taken at the same time for two days. And then afterwards you don't need anything because you gotta kill the buggers and then it's over. And I'm like, okay, two Cipros, three Sceptras. Go, go, go. I'm like, I'm not sure this is the right thing but he's my PhD director. So, but I can see he's a bit extreme like this. And just in his titles he always had screwed up titles for the Canadian Pediatric Society or any kind of conference for people. He'd be like, they just have to come to your talk. So there's so many titles. If you look at all the things that he's published, the mathematics of morality, neonatology's never been a bargain, 500 gram infants and 800 pound gorillas in the delivery room. But if you go on PubMed and look at all his articles he's got like some sexiness in his titles. Bill is also unconventional and original. And it's really refreshing at Ethics Conference, well not Ethics but yeah, Ethics with brown socks philosophers, no offense to philosophers in the room. And at Pediatric Society with flowers curts and with, you know, the PAS outfit which is tan pants, blue shirt, red tie and a navy blue, I hope nobody has that in the room. But it's nice to see Bill with his hat and his scarf. I've chosen one for Edward, the Koeningen's scarf. And Bill, there's still Keith who's actually giving you a little bit of a challenge there. This is the princess and the prince who came to visit our unit and Keith on purpose to piss off royalty and academics was not complying with the dress code and had silver running shoes. Keith is also so intelligent. He knows about Neonatology. Oh, and Bill too, I see Keith being a little bit jealous there, my other mentor. So Bill is very brilliant. He knows about Neonatology, Physiology. See Keith, you don't know about Ethics in Lasso too bad. About Ethics, Law, Economics and actually Bill can think about all these things at the same time and sometimes we'll speak about something and it's almost, it's like a volcano in his head and he's so intelligent. I don't know how he organizes his thoughts and he can actually speak about them accurately in 10 words or 25 words unlike me who speaks for hours when I have my head boiling like that. And Bill is very honest and challenging which is very good for trainees especially the SPCA trainees from out of town that you take under your wing. He came to McGill many times when he was supervising me for my PhD and he was actually banned from McGill. Keith will speak about this later and he gave me professional recommendations of you know do you really wanna stay here in your life and which actually followed his recommendation and left which was a very good career advice. He was very honest about some research so sometimes I speak to him very, oh this is what I'm boring, just stop this, this is never gonna make it. No, no, no, tell me when it's over yet. So I knew these were not good subjects. And I don't know if Bill remembers my first in 2002 my first two P.S. podiums like one after the other at a conference, important conference. At the sushi place in San Francisco where I was giving my talking, we're going. It's fucking boring, everybody's, no nobody's yet, they're gonna leave the room and then you delete it one slide after the other and all that is left was the disclosure slide. Oh and the introduction slide too, there are two slides left. And the thank you slide, no three slides left. And Bill, I've got no slides left. Well just let's make a PowerPoint, but it's for tomorrow. Oh we have time to make one for tomorrow. So there was no sign which feedback ever. I don't know if you know then you, it's more of an American thing of a sign which feedback like you're here in time, you're dressing very well, you've got a good breath, your presentation's shit. And then, but it's good that you're somebody who's very interesting. So two nice buns and at the middle to have some meat. And with Bill we never, sometimes it was crumbs to hold the meat in the middle. And sometimes when we had the buns and the, it means it was true. And then there was the second and the third PS podium and the nth, all these podiums. And at the last PS I didn't ask for his advice and I can't be the first person crying here so I'm gonna hold it myself. And I remember coming back sitting down next to Bill and he said Annie you don't need me anymore. And it was one of the biggest compliments I had. And also very nostalgic to think that you know this phase was over. The thing is I know he's like that with all the mentees that he's mentored over the years. So I'll give you the Bill Meadows slide. It's got a trademark on it. Needs to be black and white, no blue and white and all that crap as he said. It needs to be minimalist, no fluff and fairies and flowers and stuff like this. 36 font minimum. And a max of four lines. And read the fucking slide. Often I've heard that from, ah, read the fucking slide, my heart hurts. Delete this, delete this, delete this. So this is one of the dress rehearsals with Bill and you can see his scarf, he hadn't had his hat yet. And the article I wrote with Bill. What was left is the best interest is generally viewed as a guiding principle for decision making. If it is shown in court, that. And then there was many ideas from Bill on the side of this that I had to reorganize in a paper. But I did exactly what he was asking. So but that was the first, it was published in pediatrics in the end. And so Bill is very generous with his ideas, with his thoughts, with his smiles. He recognizes people, shows people they're important, show trainees who have a spark of an interest that their spark is important. Whatever big that spark. And mentoring and teaching for him is a vocation. And you can tell he has it in his heart to do this. It's a passion of his. And he gives everybody a chance. And it's very empowering for us later on when any student that comes knock at your door and you say, oh, I don't have time. You just have to say, Bill did the same. You have to do this. And he's there for everybody, for his trainees, his friends, his collaborators. And he's a networking champion. So he's made me meet very important people in my life, like John and Martha. And a lot of people in this room, Lainey, Bridget, Dr. Siegler-Rhee, John, Naomi, Bonnie, the list goes on that I've met through Bill. And because I knew Bill and he was generous with having us know each other. He's also helped me navigate through different professional, personal struggles and challenges. So being a trailer spouse, I think he was empathizing with me. I'm the trailer spouse of Keith Barrington here. And he says he's also a trailer spouse. And I was always in the shadows of incredibly powerful and intelligent people. So he told me how to play that role. And about three years ago, Keith was introduced as Annie Jean-Vier's husband, which he was very touching to me. And I was also the mother of a premature baby violet that was when she was very small and when she got bigger and how to actually ask decisions, things that I was researching in myself, I guess. And how do you navigate between being the mom of a preemie baby and also researching the exact thing you were living? And he's also always supported me as an author of short stories in Neonatology. And this book will be translated, Don't Worry, Bill. And you can read it in English. But he's always been very supportive of me being an author and writing different things. And he's always been there for us and his community of whether it's mentee students, collaborators. I think Bill is an attending, an attending to his family, to babies, to students, colleagues, and in life. So maybe the title should have been how Bill saved my life. But thank you, Bill, for everything you are. This one's just for the video. There's no, no. What I did learn Sunday after Sunday is what it looks like to be a coach who's a teacher. A teacher of soccer, but as we all know, to be a teacher of soccer is to be a teacher of life. Now, also, I guess I need to mention some of Bill's contributions to the lexicon of soccer. There are the words cute and vicious. I've heard them hundreds of times, but I still don't know what they mean. A girl would be dribbling the ball in the voice and it's really quite a booming voice for a man who's not cute. Would come saying be cute now, be cute now, or be vicious, be vicious. But the contrast clearly has something to do with using fine-grained soccer skills versus having a kind of forceful burst of energy. But what confused me was first that, I mean, I could never tell why a given situation called for being cute rather than being vicious. And second, I could never see any clear. Maybe after during the reception, Bill will have a small group meeting on cute versus vicious. Keith Barrington is next. Keith is also a neonatologist from Montreal, was head of the division of neonatology there for many years, but now is a free man. And student on that job publishes the most widely read of the law about neonatology and neonatal research. The neonatal research talk. Org. Sorry. Keith. Thank you very much, John. And we're going to take a little change in direction right now because my understanding of a feshtrip was the group of scientific presentations and not all of these cute memories of them. So I'm going to give you a scientific presentation so you can see from the slide I don't follow Bill's rules for us. And first of all, the disclosures. The other disclosure is that this is the first time in 15 years that I've done a presentation wearing a jacket. This shows the respect that I have for Bill. But just to sort of vary this a little bit, I also think I'd try and copy a bit of his style. So I actually got the request from John Lantos that there's no need for a scientific presentation too late. His emails get to me about 25 milliseconds and it takes me about 25 days to read them because I'm not very as efficient as he and Bill are. So I'm going to present for you a systematic review and a meta-analysis of the effect of a dose of Bill Meadow on the inactal research. And for those of you who are involved in clinical research, but first of all, a little background I have to start with an introduction. So the introduction is that my very first interactions with Bill date from when I was a very junior faculty in Edmonton and doing some research which was along very similar lines to the research that Bill was doing, investigating hemodynamics and specifically hemodynamics in piglets with pulmonary hypertension. Bill was doing a lot of work specifically with Group B Streptococcus and pulmonary hypertension and I was looking at that model and other models of pulmonary hypertension in instrumented piglets. And so my first interactions with Bill was when I was presenting my very first posters from my animal model and Bill would, or every year, Bill would come over to my poster, look at the title, look at the introduction and the methods and then without reading the results he would turn to me and tell me what I had found. He was always right. A couple of years later, I actually got a review back from pediatric research and I thought that review sounds just like Bill Meadow. I can't imagine anyone else writing getting quite that way and that's one thing I'm going to come back is that Bill's very singular voice. But this experience made me wonder when he was right about the results of my research, is he always right? And so the research question is what are the effects of a dose of Bill Meadow on a neonatal research subject? So I've put this into this PICO format which I hope we're all aware of which is you have to ask your research question in terms of patients intervention, control, outcome, and timing. So the patients here are newborn infants. The intervention is Bill Meadow. The controlled group is no Bill. The outcome is improved care and the timing is for the future. So what I've done is this systematic review of the literature. I compared the findings from results the Bill has performed, the findings of research on related topics. So I started off doing a public search for MeadowW and I looked at all the retrieved documents. I'm supposed to say this when you do systematic reviews these days. Screened the titles, read the abstracts, but to be honest, I couldn't be bothered to write the full text. And so there's several themes of Bill's research that have emerged over the years. And many of these have already been talked about and will probably be touched on again. And as I said, there's pulmonary hypertension with or without groovy strep in both in piglets and in babies. The use of resources in neonatology, how much it costs, standards of care and expert witnesses, predicting death, ethical issues and withholding and withdrawing care for sick newborns. And of course, those last four are all quite related. And then there's several other individual studies such as the study of caffeine that he did. So to go back to pulmonary hypertension, Bill has described the effects of various interventions in his model. One of the things that I think was very important is he demonstrated that pylazoline, which many of us were using at the time was just not a selective agent in any way, caused as much systemic hypotension as it did to decrease the pulmonary artery pressure, at least in piglets, even when you give it by nebulization directly into the lungs. And he went on to show similarly that there was a lack of that in babies. I think partly because of that data and others, pylazoline's no longer used. In fact, it's no longer available in Canada. I'm not sure it's available at all in the USA. And many of the younger members of this audience who are in neonatology won't even ever really have heard of it. An indication that was toxic and ineffective in which we've abandoned because of important research, including that of Bill. And then other findings that he had helped to define the pathophysiology and treatment options in pulmonary hypertension. For example, as you can see there from the references to papers that we showed that we both were looking at the same thing in terms of the systemic, the circulatory effects of epinephrine in pulmonary hypertension model is in piglets. He several years before I got round to doing it and showed that there might be some role for this epinephrine in piglets. To go on to his research to do with caffeine, he showed an increase in cardiac output after loading of caffeine, an increase of about 15%. And in fact, it confirmed two slightly earlier studies. And we now use caffeine very early, very frequently in very many very immature babies. And his data confirms that the cardiovascular effects are mostly positive. And I can't do a systematic review without showing you a forest plot. So here's a forest plot that I could put together showing how Bill's study, the second of those three was actually the most powerful of the three studies, had many more babies than the other three and the results were all very consistent. And I did want to point out that although I've put Meadow 2009 on the forest plot, in fact, he would be the first, I know, to give credit to the people who actually did many of the measurements and were involved in doing the studies. And he would be the first to wish that, that didn't say Meadow 2009, but Solovecic 2009. So Bill went on to talk to, from that time on, I must say after I started meeting Bill at the SBR meetings, every year I would meet up with him at the SBR meetings, even when he was no longer doing the piglet research and I was still for a while doing that, I've no longer doing that myself. And he would still be able, even though he was not in that field, to come up to my poster and tell me what I had shown. And if I hadn't shown it, I must have done something wrong. But one of the things that really sort of impressed me about Bill was then his work in the law and in expert witnesses. And when I was doing this systematic review, I noted that he's actually published in law journals, and I don't know many other neonatologists who've published in the Duke Journal of Law. But as he pointed out, that anyone with some experience can be called an expert witness and get on the stand and speak any crap that they want. But like anything else in medicine, standard of care should be evidence-based. He showed that evidence have often no idea what goes on and they often don't remember what went on in the past. Much of the rest of his research has been around these issues. And I was going to talk about them separately, but then I realized back in 2007 in the very interesting neonatal ethics journal called the Journal of Pediatric Gastroenterology and Nutrition, Bill had published this very nice review article. And I actually just want to, although this is many, many what more words than Bill Maddu would ever allow on a slide, just a quote from a section of that review article, which actually points out this particular voice of Bill. And if you read those phrases, you'd know this is Bill Maddu who's written this, even if you didn't look at who the author was. And he in fact had four issues that he talked about in that article. And I'll come back to the fourth one later, but basically he says that there's no credible arguments against an NICU care that rely on invoking costs. The vast majority of infants admitted to the NICU survive, and medical caretakers are very poor at predicting who will survive. Another example of his singular voice is this which you find, there's not very often you'll find this phrase in a scientific article, a bit of drying, a slap on the butt and they're good to go. I want to talk a little bit about the visit to McGill that has been alluded to earlier because once Annie had made contact with Bill and invited him to McGill and was doing her PhD with him, and he was invited to McGill and he gave this amazing presentation. It was as many of you will know, stimulating, challenging, funny, thought-provoking. The residents thought it was great. There were many of the residents who actually gave this sort of evaluation. It's the best ethics talk we've ever had. And the result of that was that he was banned. Now, it may be because I remember at one section he was sat in front of a room of people, probably about half as many people as we have here, pediatric residents and the ethics people themselves from the ethics group, and Annie and I and the neonatologists, and he would actually walk around the room and ask people questions as he was giving his presentation. So one of the things that I remember him asking was, so this baby with trisomy 18, would you offer them cardiac surgery? Oh, no, no, no. And why not? And the answers were always couched in terms of, oh, it's not in their best interest or it's not going to the many go or similar sort of, we've got to, you know, we want to promote non-maleficence. And he would say, no, no, no, no. You know the real reason you don't want to do it? He's just too dumb. And that was the kind of things that makes you stand back and say, how can you say that? And you think, I know why he's saying that. He's saying that to make me think. He's saying that to provoke me to examine my own prejudices and my own preconceptions and anyone with any sense knows that's why he was saying that. But one of the group that banned him had previously written this gem, frenetic comprehending calls for creative control of that which is meaningful and meaning-making in a situation. For some people it seems clarity is a fault. To go back to the systematic review, Bill's talked about resource use and now there's other people who followed him who talked about resource use. Lex Dodd in particular, Melbourne has talked about the value of neonatology and how it's really good value for money. And Bill has also done some direct comparisons with the adult ICU and it's also been now compared to cardiac intensive care in particular, which is the most costly form of medical intervention for quality-justed life here. Also to the PDS ICU, to renal dialysis programs and certainly in comparison to the latest new agent for advanced breast cancer, NICU is remarkably good value for money. When I talk about does the systematic review of predictions of survival, I don't think anyone else has done quite what Bill and his colleagues have done, but all of the data about trying to predict outcomes in babies have shown that he was right all along and that the only way you can predict outcome as survival with more than 50% accuracy is actually just from base on group characteristics, not for individuals. People working in the NICU allows you predicting outcomes. And predicting long-term outcomes, well, in fact, one of the things that Bill has done, again in collaboration here with some of the other people in this room, in particular, Brie, shown there's no gradient of gestational age on long-term neurodevelopmental outcomes among survivors and that's been confirmed by another systematic review by Greg Moore. So this is Greg Moore's data on your left showing that when you look at outcome studies of formally extremely preterm babies, once they reach four to eight years of age was when he did the systematic review, there's actually no significant effect of which week you were born on the developmental outcomes among survivors and the similar data in the graph, which is on your right from, which again I've said there, meadow 2012, but he would be the first again to say that that was Brie Andrew's work that he collaborated with. So let's go back to the journal of this paper and the journal of patriotic, whatever it's called. And I can ask you the question, is Bill ever wrong? Well, here I wanted to address his fourth point because he says fourth and finally medical caretakers seem to be reasonably good at identifying burdensome outcomes while babies are still sick enough that an alternative is ethically possible. So only 5% of ventilated extremely low birth weight babies predicted to die before NICU discharge. Will be alive and neurologically unscathed at two years of age. And here I have to say, Bill, I love you, but you're wrong. Because your definition of what's neurologically unscathed is not appropriate. Having a barely two score less than 70 doesn't mean that you are scathed. If you can be scathed, I guess if you can be unscathed, you can be scathed. This is some data to get back to caffeine from the study of the long-term follow up of the five-year follow up of the children in the caffeine for Avenue of Prematurity study where you can see that the outcomes at 18 months of age, which are along the bottom axis, are really very poorly correlated with the actual, the long-term, intellectual capacity of the children. And in fact, that in general, the scores at five years of age are much better than those 18 months of age and that all the dots in that parallelogram are wrongly classified as being scathed or being damaged. If you classify them at 18 months of age, when you see them again at five years of age, you'll find that their developmental scores are within the normal range. So I think, Bill, you've still got some more work to do. You need to go back and see whether or not we can actually predict outcomes that are more meaningful with more profound neurodevelopmental impairments and not just Bailey's scores at 18 months to two years of age. So how has Bill affected my career? Well, I'm still investigating some of those areas that I was investigating all those years ago. About hemodynamics, hemodynamics and sepsis. We're still doing some more caffeine studies. I've become involved with Annie and Barbara Fado looking at interventions and outcomes of children with trisomy 18 and 13 and have collaborated even with Bill on some ethics papers. And I'm blogging about almost anything to do with neonatal research. So what's the conclusions of my systematic review? A dose or two of Bill Meadow in a neonatal research domain improves outcomes for babies. Thank you, Bill.