 My name is Jeremy Day. I'm an infectious diseases physician and I'm based in Vietnam where I lead the Central Nervous System and HIV Infections Research Group. Central Nervous System is the brain and the spinal cord and the kinds of illnesses that we deal with therefore are things like meningitis and encevalitis. I work mainly in two hospitals in the hospital for tropical diseases. We see about 250 to 300 cases of CNS infections every year. I'm in Chorae Hospital a couple of kilometres away we see a thousand cases per year and this is in adult patients. I'm a clinician and my main interest is helping patients and particularly helping doctors at the point of diagnosis. When a patient comes into hospital we assess that patient, we work out what the cause of that illness is then having the information to know exactly what the treatment is we should be giving that patient now. That's what our clinical trials are designed to do to help doctors at the point of diagnosis to give that patient the absolutely best available treatment for them. We run two kinds of trials really. The trial we run most frequently is large trials which are inclusive. That means that pretty much any patient coming through the door would be eligible to enter the study if they agreed to do so. And aimed at answering a simple question usually which is how can we reduce the risk of death in this condition. And I think a good clinical trial is one that is easy for the patient to see the value of, easy for the doctor to see the value of and when it's finished is applicable to not only the patients within your local population but also around the world. I think the main challenge to clinical trials is that they are very resource intensive in terms of regulation and gathering high quality information. It's really important that we run trials as carefully as we can that we keep patients as safe as possible and that we gather the highest quality data that we can trust. But we have to balance that with the amount of bureaucracy that that imposes. And the problem is that as the amount of bureaucracy increases it delays the number of trials that are done. So if you took 100 trials in cancer therapy, half of them take more than 650 days from being funded to enrolling a patient. That's nearly two years. It's simply because it's become so complex to set trials up and to get approvals. We need to understand that different kinds of trials I guess might need different kinds of regulation. And where it's a novel agent that we don't understand at all, we don't understand the side effect profile and so on then that may need a different regulatory framework than where we're repurposing an old drug. Within my field of cryptococcal meningitis, the research efforts I think are focused towards prevention. So diagnosing disease early before people really, diagnosing infection early before people have really become ill. And novel ways of using the treatments that we already have. And that reflects the fact that we've really not had any novel agents to treat this disease since the late 1980s, which is a problem. And finally, and the area that I particularly am particularly interested in is repurposing drugs that haven't previously been used to treat cryptococcal meningitis. Try and improve outcomes, try and identify drugs that actually we can add to our current therapy to improve outcomes. Well brain infections are a major problem because not only do they have high mortalities, recovery from brain infections is rarely complete. And so that results in disability. And disability is a major problem, especially in resource poor settings where there are often very few community resources to enable patients to return as much to normality and to have fulfilled lives as possible. There's probably six million disability adjusted life years, that's a technical term for measuring the impact of a disease, lost per year globally from brain infections. And four million of those, two thirds of them are occurring in low middle income countries. And finally for my particular interest, cryptococcal meningitis, that results in about 250 to 300,000 deaths every year. Again predominantly in low middle income countries. And the death rate from that disease, even on best treatment in those areas, is in the order of 40 to 50% three months after diagnosis. And that's why we need to work on it. So we actually sort of do translational medicine in reverse. So our research is absolutely at the bedside next to the patient. And what we learn from patients and we learn from clinical samples from patients, we then take backwards into the laboratory. And we use our insights from clinical presentations and clinical courses of patients to try and understand how pathogens or germs work at the population level. And we've had some really interesting insights into how cryptococcus neoformans causes meningitis by comparing organisms that have come from people who have apparently normal immune systems with people who have damaged immune systems of an HIV patients. And we're using those differences to try and understand how the organism as a whole causes disease. And we hope that that will lead to us identifying novel drug targets. So we're sort of doing translational medicine in reverse at the moment and we hope to go back the other way in the future.