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I have no idea. So I, oh I think that's, I think that sound, it's not sound guys a little screen. It's like, oh, can handout. I'm so sorry. Thank you so much for letting me know. Um Great. I've not said a lot of things other than what's on the slides. So you've not missed a lot. Um Just a question. Now, what is dark and what is like? Right. That's, I think it's enough time to think about it. Anybody on the next ray I've done some things like that. Yeah. Yep. Yep. Yep. Great. So here's a quick, this is an X ray of a chicken bone. Um but it's trying to show you so it's submerged in like vegetable oil and water. Um I'm just trying to show you like in when bonus against water or getting bonus against some tissue oil fat or bone against air, they all look different, but then that is just one bone. Um But generally yes, so if you've got something dense, it's going to show up whiter, something like air is going to be black like the top. Um And that defines kind of anything that is really dense like a bone much better than if the bone was in water. Say so like edema in the body or fluid in the body. Um It's quick demonstration. Um Then your next part of the pneumonic is ripe. So that stands for rotation, inspiration, projection and exposure. Um So, in terms of rotation, what you're looking at here is the clavicles. So I don't know if I can convince you guys to see like you're kind of trickier is the middle of like where you would expect the clavicle bones to end ish. Yeah. Um So if it is, then the patient's not rotated. So if you think of your looking at somebody like this, they're rotated, then things might look a bit bigger or smaller on one side. So, you know, if it's, if it's like that, then you have to take, you have to interpret it with caution, wherever it's equity, you know, equity and you're like, oh, it's fine um inspiration. So can can five or six anterior risk. You see now, this is the question, which ones are the anterior ribs have a guess. I mean, it's either uh you know, the ones that are very obvious, like, you know, this curved one here or there are some that coming around like this side, those ones good. That was a nice 50 50 guess. I think a lot of you actually don't you think like, oh, the obvious ones are the ones at the front back she does on the back ones and then what your ribs that is like it comes around like this. So the ones that point down. So like your top one, that's your this little ring here. That's your first trip. So that's one of the side, the left one. Um You can see the second one here. 3rd, 4/5 6th. Yeah. So this is a good inspiration like this person has been a good breath. Hold to take the chest X ray um projection. So pa pa anyone know what that stands for? Yeah, posterior, anterior, anterior, posterior, what that means is is the X ray coming from behind to the front of the patient or from the front to behind of the patient. Um and it's important when we look at certain organs and we'll come to that. Um But you need to note which way is normally most films are pa so posterior anterior, which means that the patient kind of stand against aboard the X ray comes from like this. They hold onto the board and take a deep breath and then they take the photo. Um they have to be well enough to do that. So if you have an A P film, it means the patient is actually probably and well um and they're different ways to take that we'll talk about later exposure can the vertebral bodies be seen behind the heart. So I'm going to convince myself what it is there. I can't enlarged on there. Thanks David. Just pointing out, pointing out. Yeah. Yeah. But um or if you got your own X ray, obviously, look at it and be like, okay, I can kind of see like little rectangles behind the heart. They won't be very obvious because there's loads of organs in front of those vertebral bodies but very faintly. That means um exposure as good as in X ray has gone through it very well. Okay. Sure. And then like with anything, there's another pneumonic. So usually what we use is a TUI. Um So this is kind of a systematic way of going through the chest X ray. So you don't miss anything that potentially could be pathological or explain your patient symptoms. So usually we start with a for airway beef breathing, see for cardiac D for diagram and E for everything else. Um which is kind of like a casual, like anything else you might notice when you kind of stand back and you're like, oh, that's a bit strange. Um So first is a for airway, so you have the trachea and the main question is whether that's central. Um And yeah, that's just here and you can see it's traveling down and then you have the carina here, which is the point where it separates into, to bronchitis. So you have the left, the right main bronchus. Um And as it says here, it can be useful in N G in session. So in nasogastric tubes, you'd expect it to travel down into the esophagus, which is behind the trachea, which is why you'd also see it here, but you'd see it traveling in between the carina. So that would kind of ensure you that it's not going into one of the lung lobes. Um, and it's, in fact traveling down into the stomach, which would be down there somewhere. Um, and then you have a look at the bronch. I, so you're just looking for anything someone might have accidentally swallowed. Um, and the hilum, which is kind of, oh, it starts lagging which way is kind of these regions here. Um where it kind of looks kind of wisp to point out it's these regions here. It's kind of this whiskey nous um whether how many branches just separating more. So, yeah, there's the trachea and the bronchi I, and then you have the highland region. Um So breathing next, you're going to want to check the lungs themselves. So you're looking at the three different zones of the lungs. Um And there can be some confusion sometimes because they're zones and then there are lobes. So on the left, you have two lobes, on the right, you have three lobes, but on both sides, you have three zones. And usually when you're discussing an X ray or chest, actually they won't need to discuss zones because it can be quite confusing even if something is quite low down, it might in fact, be the middle zone just because of how it's projected. Um So it's kind of a safer rule just to stick to zones rather than lobes. Um So you're gonna have a look at the upper middle and lower zones and you're gonna have a look at the lung markings themselves and discuss whether they're symmetrical or whether you can see some asymmetry in it. Um So if you kind of have a look all the way to the edges of the lung fields, you can still see this kind of differentiation in the film itself and you kind of see it up to here and you can see it over here as well and that just shows that there's no air or anything caught in the lining or there's no fluid or anything like that. Um Any other question is, do they extend all the way to the edge of the lung field? And then c is for cardiac? So, um first question is, does it appear normal? And like Helen was saying before pizza, like, like Helen was saying before, there is a difference between A P and pee films. So when you're having a pa film, generally, that's when you're allowed to comment on the size of the heart. So if in a pa film, the heart appears to be more than 50% of the thoracic cavity, you would consider that heart to be enlarged. Whereas if it was an AP film, if it was more than 50% of the thoracic cavity. You don't know either way whether it's enlarged or not. Sometimes you can say that heart is very large, irrespective of whether it's P O A P. And usually that's because like Helen was saying, if the X rays are coming from the back, your heart is more close to the film itself. So it's not gonna be the x rays come out in a cone. So it's not gonna make your heart look as big. Whereas if you're standing this way, the cone is going to be a bit more expanded when it gets to the film. So yeah, I was gonna appear a little bit bigger on a PPI than PA. Thank you, my wonderful assistant. And you also want to comment on whether you can trace the heart borders. So if I go back to this one, you can see it has quite clean borders, you can say it's like quite well defined and quite sharp. Um And if you look at this one, you can see it's kind of like grossly extended um and better seen on this one. So, um kind of this thing that I mentioned down here, the lingula consolidation, the lingula is kind of a little extra bit that you see in the left lung. It's where the middle lobe would be. Um But since there's only two lobes, uh it just kind of has this like little extra bit called the lingula instead. Um So this would be a lingula consolidation here and, or, you know, potentially it could be something else. And then if it were on the right, it would more likely to be a right middle lobe consolidation instead. And you can see how this 10 year olds lingula consolidation was improved after six weeks, the power of medicine. Um And then we move on to diaphragm. Also just any questions ask if I'm going too fast or something doesn't make sense. Um So then move on to the diaphragm. So usually the diaphragm you'd see is this nice curve band, it's usually higher on the right, just because of the position of the liver and slightly low on the left, you have these very sharp defined angles here where you'd expect it to go towards the liver or go towards the spleen on this side. And um your first question really is, can you see the angles? Are they as sharp as they should be? Um And if you look at this one on the left, you can see it has this meniscus appearance, they call it, it's um basically shows that there's fluid inside the pleura which is building up and causing this meniscus instead of seeing the sharp angle. Um And, and, and this one on the right, you can see that there's some free air trapped under the diaphragm itself. And typically, the way you would see this is you'd have a patient stood up to do the chest X ray. So all of the air in their stomach would travel upwards and be caught under the diaphragm because it can't uh pierce into the thoracic cavity from there through the diaphragm. Um And that would be from things like bowel perforations or any way that free you could get into their stomach or the abdomen basically. Um So just a quick note on plural effusions, uh generally, you can, well, generally there's only two ways you can see them. They're either on one side or on both sides of unilateral or bilateral. If it's unilateral, it tends to be a malignancy or an infection or chylothorax. I think that's like, is that limp or is it pus? I think it's past okay passed. Apparently, I forgot to check that. Plus, I think um a fluid that shouldn't be there or hemothorax, which is just blood in the, in the urine cavity or if it's bilateral, it's most likely to just be um pulmonary edema from heart failure, potentially. And then you have everything else. So um scans like this. So we kind of only mentioned a P or PA so far, but you can also have lateral scans, you can have slightly other positions. Um You can have scans that are taken internally rather than externally and things like that. It's all just for different presentations and what you're looking for. But as you can see here, this is probably a kid who swallowed a coin and then you can see it here as well. So it gives you having the pa and the lateral views also give you different views of different subjects. So from the front, you'll never be able to tell whether that was circular or whether it's flat or whether it's spikey or whether you could actually get it out. But if you look from the side, you can see it's just flat, which potentially could change the management or the way that you remove it, um which is quite important. And then on this side, you just have other random stuff that you might find in people or not surround um but not so random but like a pacemaker. And then you can see the leads going into the heart itself can see this heart is absolutely massive as well. Um If it was P A, you'll be able to comment on that. Uh Any questions so far from 80. No great. And then there's just to like slides I made just for extra kind of tips and things to look out for. I know we've obviously been through 88 people sometimes, you know, I feel like these other areas where you should like, look out for. So at the top of the lungs and the apex of both, both lungs, um because it's covered by the first rib and second rib sometimes and then you're also your clavicles. Um There might be cancer uh at the lungs on the bones, etcetera in that area. And it's very easy to miss that or a little tiny Numa forex and then that little edge and you're like, you have to zoom into like 100 times the picture to actually see it. So just have a good look around and see, you know, if something doesn't look, you're like on the shore, you'll be like, you can't comment on it. There's no, you know, there, there might experience radiologist be like, that's nothing is fine, but you might be like, well, I'm not sure. So I, I am looking here, at least that shows that you're looking at, you know, where potential things can be hidden. Um Same with the hilar vessels when we go. If we just go back to kind of one of the ones, it's just, there's vessels there, there's, you know, there's um your little air type, what they call branches Broncos, um, there as well. So anything that are in those bronchioles or vessels, they can be obscured by each other. One way another, it can be quite hard to tell and any masses that come kind of behind those, they might be quite hard to um to be actually seen on the chest X ray. So if there's a little bit of fuzziness, you're like, that might be something, you know, you can just make a note of that. Um We had a cardiac stuff that we talked about how large decide that the reason why we need to comment on the cardiac um size, the heart sizes because anything behind it or in front of it because the heart is densest muscle, you won't be able to see. Um So that's actually an area where, you know, we we be careful of um and then lungs posterior to the diaphragm. So, well, I mean, because, you know, diaphragm is not flat, even though on the chest X ray looks like, you know, stay on this one. It just looks like two little curse, but actually it's like this. So there's a bit that's like it tips the front, there's a little top of the dome and there's also the back and then if there's, you've got a liver on the right side, so the liver is quite dense. So anything that kind of goes behind the liver that is still part of the lung, you might not be able to see. Um or if there's a mass there, something like that, then you might not be able to see. So it's just an area to look out for. But then that's why I think the key thing, I think most common thing is still just like blunting of the cost a phrenic angle, which is afraid you might have heard of because that just indicates something in the uh in the, in the fluid, in the some fluid in the lungs or um of some kind. So that's that um yeah, you get the slides after, so it's fine. Um, and then I wanted to talk later about our medical jargon. Does anyone want pizza? Like, please feel free to take some now before they are cold? Just Melanie you a bit intimidating and sit back from the pizza. Take a two minute break. Pizza. Yeah, I'm sorry. To all the online attendees, you're please feel free to grab your own food. Um, we'll have like a 22 minute break. It's half past. So yeah, any questions so far? Actually let me just check. Looks like you guys are all good. Previous slide. Yes, maybe if I can manage it. No, I can't. Yeah. This one a Catherine. Can you help me take a photo of the gathering, the gathering and the food, people gathering in the food place? I'm like busy. You can courage, I guess if necessary like tear off the lid so you can have them with like plates. I'm sorry. We didn't bring any plates but because you grab some pig atolls. Uh No cardiac. Is the hang on? Is it this one runner? I'm just answering questions first high. Lovely to meet you. Yeah. Is this helping so far? Uh I thought it was uh thanks. Okay, a slide that she wanted to have a look cause I was like, okay. Uh oh my God can screen. Say that so. Okay, everyone's like you're dying. Nice, nice. Uh uh You're not uh pilots really growing every Uh uh uh well, alright guys if you want to grab some pizza, sit back down when you're ready, we'll get start again with people at home. Uh I'm looking uh uh welcome back, welcome back to everyone online as well. Um, yeah, keep going for food. Don't worry about leaving, put your hand up or stuff. I just wanted to slide to um go through about medical jargon that uh radiologist use um in in the kind of comments or reports, consolidation. Consolidation is the word that started around everywhere. You know, you see something is like, oh it's a consolidation. What does it actually mean? So when the long alvito lie gets filled with fluid, so it flew. Any fluid plus water blood, there's going to be a shadow on the chest X ray that's like what they call consolidation sometimes. Um Although people use it to just say there's a bit of shadow on chest X ray. So it's kind of synonymous now, although technically, it only means like it should only mean that there is fluid in within the alveolar line. Um Yeah, but I would say have I call it up that? Nope, let me click. Oh there we go. Um Yeah, so any fluid filling the LDL I technically that should only be consolidation, but you might hear it as in like, oh that's consolidation is there's a shadow there, but it doesn't necessarily necessarily mean a shadow doesn't necessarily be fluid. So that's just something to be aware of. Um The other one is ground glass opacity, oh pacification. Um That one, it's a term for CT not really for chest X ray. Um Although sometimes people might just want to sound fancy and use it to describe a chest X ray, it kind of means the same thing, but it's just because it looks different on the chest X ray. Um Yeah, on the CT even on a CT when you kind of like, I think when you look at it actually, so when you cut the body open like this and then you look at a long from like above um from below two above, um it kind of looks like dots ground glass. Um So that's why there's this name Air Bronchogram. Now this really confused me how to look it up. I was like, why, why is there another name for something? It just means seeing more bronchi branch is because the our vo lie is being filled. So it's basically like consolidation RBL are being filled, but then feeling so much that you can even see like more bronch, bronch, bronch eyes, bronchioles. Um and it's like things other than air, which is why I can see it because normally you shouldn't see wrong pills. Um You know, we, we went to, we had a chest x very well. You can see trachea, Karinna, the two main bronch, bronch I and then kind of the stuff that goes further and you don't really see. Um, but if you can see it, it means maybe something is filling the space around it. So you see the outline. Um, and then there's still a website. Does it show up on here that doesn't show up? Uh That's what, that's an air bronchogram. So left handed four miles now. So you see the, that's one of the main Bronchus here, the left one and then you see these branches coming out. Normally you don't see that and you shouldn't see that. I think I highlight it like that. You see what I mean, the do it again, these things. Um So that's everyone Karam. Um don't use it for anything else if you see it like just say this looks weird here. It doesn't matter if you use a fancy term or not. Um And then do I have a silhouette side to show you guys? Yeah, silhouette side. I've just written it there. Um Basically something pushing the border of the heart, a lesion density, pushing the border of the heart um or the diaphragm and you can't see the border of it um off on the chest X ray. So I don't have a picture of that for some reason. Um Let me just think so it would have been better to just show you the picture. Um go and look at have a Google picture. Um It's very common um in a way um People use this term to kind of describe any kind of masses of that. Let me just show you, can I just pull up a, let me use this one to describe. Let me go back to the cardiac side to describe. So you see here, you've got border, you've got border of the border of the heart diaphragm. Yeah. Um, diaphragm here. But if say like this border looked a bit fuzzy, looked a bit obscured by something that's basically kind of like to the website because something is either next to it behind the heart on the heart, somewhere in that region, either in front or behind it. And it's kind of taking away that border, same for like the rest of it like um this side or the diaphragm does that kind of makes sense. It's not the best explanation. I'm very sorry. Um Right. Any questions so far for this one? No, let's move on to our clinical cases, right? So um interactive. So we need a lot of input that you don't have to, you can shout out or welcome that, but there's also the hustle I'd for you to type in. So case one, we've got a 99 year old female, her new school is currently free. That's her what she score NG for respite about high heart rate, bit high, bit of hypertension, but I think that's quite normal at her age probably uh she's not got temperature. Uh She's got confusion. What else you want? To know. So now this is not really chest X right now, but this is how, you know, like, say an Aussie presentation with present or like a kind of single best answer exam type question represented, be like do this and then I'll give you some other information. I just want to turn on your brain and think of what else you would want to know. Um You can go onto our lovely, where is it this way? Yep. Um If I go and click, can I click? Oh, you know what you got? All right. Well, if you want to go, there we go. Now you can answer. Uh, currently probably so you should be able to just like type and join in, I assume. Yep. How long she's been confused for? Okay. Caribe, elderly. I had to like the office. All they were. I avoided that cause I didn't know it was David's question. Mhm. Home abilities, any of the symptoms, recent blood E C G S breath styles. Any current medications, confusion, normal new. That's, that's good. I like that. Medications, ologist injuries on second season Tacky Ziggy. Uh huh. I love this interaction, mobility. Um, that's very important for the elderly. I agree with that. I can't switch back to everyone. Continue issue. Usually computing, sorry, switchbacks, everyone can see. Oh, really? Out to yourself. Oh, I didn't know. I forgot. Uh, there we go. We got some answers. Sorry, I was just reading it. To myself, not share in the joy or some of these questions, you can rate other people's as well by the way, which I kind of like, what does that say? Cool. Oh, cool. Explain your answer. Well, that's good. Yeah, we all know our history. So again you go through your past medical history or history, presenting complaint, past medical history. Um, Tom, a history will be as relevant here. But you might want to ask anyway, social history, drugs allergies. That's good. Okay. So from going back on this, basically, there we go. Um we got an investigations. There's not much else from the history that you ask, even though you've done an amazing thorough history. Um You're very on it. So you did an E C G for her as well. That shows nothing I'll be ordinary. Uh She's got a bit of a respiratory alkalosis though, however, on the A B G that you did for her, um and what they thought was just maybe she's got a little uti although at that point, I would have probably got a urine dipstick result as well. Uh But we're here for chest X ray teaching. So we'll go to her chest X ray. So have a look and then you should be able to go back onto the house lies and describe Betty's chest X ray should probably match. I went into the Thank you. Do you know, comment everyone online? All right, just check. Welcome to join. Um Am I all right? Just to switch to the other one. The, just this slide, whatever funded should probably switch it up normal. Okay. Gutsy. Gutsy. Mhm. You want to switch back to the chest X ray just so you can have another look at it. Catherine. Do you mind helping me turn off these lights the front? I might help being short. Better. Good. Have. Yeah. Uh Oh, sorry. 50%. Who was the dog? Oh, I'll have it like 25%. That's all right. Animal thought a few more consolidation around the heart. Uh Okay. And here's a thought you can type anything like we're not gonna it's not really a Noski station, is it so type anything you like? I hope they didn't discuss uh the breast. Uh anyone else? Yeah. Uh Okay. Yeah, I've always been called showing what people say. Uh Okay. Okay, let's go back on here. So we see I'm gonna point it from here. Um So we got some, I got like a some someone just that normal hint hint it is. How did you get to that conclusion? So somewhere else was looking at clear costophrenic angles. A normal heart size troche is not deviated and they thought there was no consolidation that's fine. Again, if we just go for R A T E obviously you can do your doctor ride. But if you're like speaking out, I would recommend you like, you know, just doing that even um as practice between friends, etcetera. Um But in terms of just looking at a chest X ray, again, we're looking at um going from 1000 front airway first, you can clearly see this right here, your clean off the carina. Um I would say I can definitely see it on if we stop, stop spasming um on the right side, but the left side is kind of covered by the water. Um This is the all take not like not cool by the way, like they also um and then you'll be be for breathing. Uh Yeah, you can check the cost of Frederick angles. That's very important. You check the long edges and you know, I don't see any kind of long edges that are, they're not going, that are not long that I'm not going to the edge. So that's good. Um There's no like big Highland Bronco grams and things that we talked about. Um I think the consolidation you might have been trying to look at these things here. Possibly hilum is a very difficult area. Um um Just, well, chest X ray also just doesn't it comes up differently for everyone if you imagine like one of the vessels so highly unusual festivals, right? So these vessels are like nicely there just like this. But if you imagine a vessel coming out at you like this, this way, you're gonna see this like see at this angle and it's going to look a bit denser than like the rest of the rest of them that are like going like this. So I would say that's what this is looking like. To me, it doesn't look like a consolidation just because it's so close like this. Uh Again, I think I would say like, look at many chest X ray. Now you kind of get a feel of what's normal, what's not normal. Um There's not no other abnormalities anywhere. Um um really, she doesn't have any symptoms of like respiratory symptoms. So, again, clinical context in the chest X ray is very important. Um cardiac size, again, she's got very good size heart for you. You would assume there's a pa again, it should state that S P A or A P if it doesn't again, just state that. But yeah, heart size definitely normal. Um No borders are obscured. Diaphragm is all right. Your right one is normally higher and left just as a note. Um uh there's no free under there. Everything else. Uh make sure you travel bones as well, not just like um outside from the foreign bodies because sometimes people will be like, oh actually have broken my clavicle and you're like, okay. Uh So yeah, but she looks fine. Yeah, so I don't have a summary slide on that but yeah, this is normal chest X ray. All good to how we got to that. Right? Second cases, Alan, what see do you uh clinical decisions you know uh trying to decide whether they should be admitted or not. Yeah. So basically, if any so overwhelmed they need like a little space for them to go to, but you're not sure if they need award yet, they send them to this clinical decisions unit. You might see it in, I think I've seen it in Jimmy's maybe uh and some of the hospitals, only large hospitals where the any are really overwhelmed. Um Right. Basically. Okay. So his history is like this 55 year old male waiting for a bed on another acronym that I have not have no idea. For news of 10. Sounds a bit serious. Respirator 28 92. Heart rate bic sounds a bit sound doesn't look great. This picture sounds chesty of here, sweaty and unwell. I think this picture is to show his normal self. Um He's unlikely to look like this um presenting in C D you um while you're any thoughts on the French als general broad diagnoses, let's go to our house slides. Um How slides on here is on here. There we go. Yeah, I'm going to go back to the case you guys right in your differentials. Uh The one you're like gets bigger, more people's Adams could be or I can't remember as a nose word cloud. Yeah, sorry. Just become bigger. You ready? Yes. OK. OK. Got more differentials coming up. The history is not great obviously. So put your a friend's als on. Mhm. Uh huh. Uh he uh uh you mentioned you paying for the books, guys, shock sepsis, not certain level, checked. My oh, you forgot stash uh show some of our results. Oh, more will come up. You're welcome to put in more. I think it gives you like three options. Participants are typing. Really? Like you type. Uh let's make it a bit bigger heart failure, even overloaded. Think that's similar to heart failure, pneumonia quite big hypoglycemic shock type of limit status, endocarditis, therapeutic exacerbation. Okay. Numa four A X P E S Stemi COVID. Yeah, we were saying COVID is quite um uh yeah, some definitely something to look out for your uh at this day and age flash pulmonary edema. Very specific. So what's my next line? Yeah. All right, I'm gonna go back. We're gonna move on very quickly. All right. All right. This is his chest X right? Like yeah. Um You can be on a hustle eyes and describe his chest X ray. You're going to be quick about this one. Lucky hope should have done some more ready. Sure. That's all like you're good. Feel free to shout out in the descriptions for you guys in the room. Do you want to? It's she's aware of. So we're gonna be like it's COVID. That's fair enough. No, it's fair enough. We've got some descriptions and I put it up and poor borders, bilateral consolidation through is cul Maneri TB. Mm consolidation, consolidation, I like, yeah, we're using what we've learned. Consolidation, uh blunting of the list, just listening, widespread or passive. The keys are, that's another word, the fuse patchy. Uh okay. Cool. And any differentials were thinking for this one then same things. Sticking to the same thing. Yeah. Um So how I would describe this chest X ray? Let me call back to this. Um Do I have a uh Yep, there we go. OK. Um I definitely agree with the blunted costophrenic angles on both sides issue as well. Um Like you can't, is a little bit fluffy, a little bit fluffy. I would call this a very fluffy chest X ray because it just looks like there's a lot going on there. David described as yucky. It's quite a yucky chest sector. It's not clear. Is it like you expect your lungs to be like nice and seafood as fluid and fishes? I'll go on to that in a minute. Bilateral perry hilar shadowing. So that, that's like these bits are a bit, that's a bit dense. It's not really a line or you know, the hilar vessels that you see uh plural effusions based on the costophrenic angles. Curly be lines. I'll show you the next photo an increased heart size. Possibly we can not really common on that cause I don't know if there's a PRP A film, but yeah, you get very well indeed to comment on it.