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By: John Theodore Geneczko, MD

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https://medicine.duke.edu/faculty/john-theodore-geneczko-md

Use once weekly anxiety reddit order 25 mg pamelor, up to anxiety lyrics purchase 25 mg pamelor with mastercard a maximum of twice daily (depending on severity of symp to anxiety symptoms upper back pain pamelor 25 mg line ms) anxiety love discount 25mg pamelor overnight delivery. Use once a week, up to a maximum of twice a day (depending on severity of symp to ms). Instil for 5 to 10 minutes in the bladder (5 to 10 minutes prior to removal of a catheter). Anti-microbial catheter inflation solution Clinical evidence suggests that many catheter encrustations are caused by Proteus mirabilis. Using Triclosan in the catheter balloon inflation solution has been shown to improve the patency of the catheter and improve the patient experience. Only soap and water are needed to maintain Use of personal protective equipment meatal hygiene. It should be noted Knowledge of the importance of applying some drainage bags are designed for longer standard precautions for the prevention use (up to 28 days for some belly bags). National Occupational Standards Always review your own competence and challenge others where you have concerns. Routine Always consider the environment in which dipstick urinalysis testing on patients who the catheterisation is to take place and the regularly use intermittent self-catheterisation associated risk variance. Catheters, Where possible, intermittent catheterisation drainage bags and catheter valves have a by the patient may be of benefit and has less shelf life of five years, pre-inflated catheters associated risks but is not risk free. The clinical evidence is limited, but expert opinion recommends this should be immediately (if the patient is stable and comfortable) or within 48 to 72 hours of starting antibiotic treatment European Association of Urology. Aseptic technique Procedures which require an aseptic technique A catheter insertion. Broad principles of an aseptic technique the patient’s area of the body is socially clean. Catheter guidance for the end of life Urinary retention/distended bladder – Knowledge and understanding excessive oedema of the genitalia making Assess bladder and bowel dysfunction micturition uncomfortable. Catheterisation is an invasive procedure and it Obtain valid consent or authorisation is important to explore alternatives. There is a lack of evidence on the role of catheters at end of life/palliative care. The relaxation of the urethral sphincters of the bladder, causing urinary incontinence, can indicate approaching death. However, if a full distended bladder or urinary retention is suspected, then prompt action of urethral catheterisation is needed before the patient becomes agitated or distressed. It is important to note that retention can be a peripheral side effect of opioid medication. Indications for urethral catheterisation at the end of life the management or prevention of wound damage (for example, sacral pressure ulcers, fungating wounds or soreness of the anus, perineum, vulva or penis). An evidence-based approach to the prevention of catheter-associated urinary tract infections, Bardsley A (2017) How to remove an indwelling Urologic Nursing 34(5): 238–245. Journal of Evidence-Based Healthcare 14(4): Davey G (2015) Troubleshooting indwelling 188–189. Prinjha S and Chapple A (2014) Patients’ McCoy C, Paredes M, Allen S, Blackey J, Nielsen experiences of living with an indwelling urinary C, Paluzzi A, Jonas B and Radovich P (2017) catheter, British Journal of Neuroscience Catheter-Associated Urinary Tract Infections Nursing 10(2): 62. British catheter-associated urinary tract infections in Journal of Nursing 25(9): S4–S13. Yates A (2017) Urinary catheters 6: removing an indwelling urinary catheter, Nursing Times Townsend T and Anderson P (2015) Decreasing [online] 113(6): 33–35. Holroyd S (2017) A new solution for indwelling Holroyd S (2017) A new solution for indwelling catheter encrustation and blockage, Journal of catheter encrustation and blockage, Journal of Community Nursing 31(1): 48,50–52. International Journal of Urological Nursing Sandle T (2013) Using an antimicrobial skin 9(3): 138–142. Spinks J (2013) Urinary incontinence and the Catheter gels importance of catheter fixation, Journal of Farring to n N, Fader M and Richardson A (2013) Community Nursing 27(5): 24–29. Managing urinary incontinence at the end of Wilson M (2016) Urinary catheter securement life: an examination of the evidence that informs and fixation in residential care homes, Nursing practice, International Journal of Palliative and Residential Care 18(9): 476–479. Yates A (2013) the importance of fixation and Farring to n N, Fader M, Richardson A, Prie to J, securing devices in supporting indwelling Bush H (2014) Indwelling urinary catheter use catheters, British Journal of Community at the end of life: a retrospective audit, British Nursing 18(12)588–90. Yates A (2015) An essential part of catheter Farring to n N, Fader M, Richardson A, Sartain management, Nursing and Residential Care S (2015) Exploring the role of practical nursing 17(2): 75–76. Steggall M and Jones K (2015) Anaesthetic or lubricating gels for urethral catheterisationfi Urinalysis and dipsticks Williams C (2017) Making a choice of catheterisation Bardsley A (2015) How to perform a urinalysis, gel and the role of chlorhexidine, British Journal of Nursing Standard 30(2): 34–6 Community Nursing 22(7): 346–351. Test papers to dipsticks in 72 years, Journal of Professional Standards of Practice for nurses, Renal Nursing 6(2): 99. Catheters and sepsis Royal College of Nursing (2016) Female Genital Eley R (2015) Cardboard versus sterile containers: Mutilation. Royal College of Nursing (2018) Older People Melzer M and Welch C (2017) Does the presence in Care Homes: Sex, Sexuality and Intimate of a urinary catheter predict severe sepsis in Relationships, available at Journal of Hospital professional-development/publications/pub Infection 95(4): 376–382. Geng V, Cobussen-Boekhorst H, Farrell J, Gea-Sanchez M, Pearce I, Schwennesen T, Vahr S, Vandewinkel C (2012) Catheterisation. Indwelling catheters in adults – Urethral and suprapubic, Arnhem: the Netherlands. This procedure has been adapted with kind permission from the Royal Marsden Manual – Slide the catheter and drainage bag from the of Clinical Nursing Procedures (2015) Sterile catheterisation pack – Open but do not remove sterile anaesthetic Catheter(s) gel from packaging. Prepare the patient by removing the cover Sterile anaesthetic gel that is maintaining their dignity and place a procedure sheet underneath the patient. Decontaminate hands using hand gel or Sterile water washing – apply sterile gloves. Place sterile to wel across the patient’s thighs, ensuring the scrotal area is covered. Wrap a sterile swab around the penis and Attachment device with the same non- to uch technique, retract the foreskin if present. Clean the urethral meatus with sterile saline Alcohol hand sanitiser – ensuring finger tips do not to uch the glans penis. Explain/discuss the procedure with the patient’s thigh, extending the penis forward. Pre-installation – prime the syringe of the anaesthetic gel, then squeeze a small amount 2. Installation – place the tip of the syringe in to the urethral opening and slowly insert all 11mls of 3. Clean and prepare the trolley, placing all the gel – remove the syringe and discard. Take the trolley to Squeeze the penis and wait approximately the patient’s bedside. Wash hands using approved technique or decontaminate using the hand sanitiser – put 14. Remove catheter packaging from the end and attach the sterile drainage bag (optional). Ensure the water for inflation of the catheter – date and time of catheterisation balloon is prepared and ready to use (unless catheter has prefilled device attached). Free – type of catheter – including manufacturer, packaging from the catheter tip material, batch number and expiry date (use manufacturer’s catheter sticker) 17. Re-position the penis at 90fi and insert the catheter in to the urethra for 15 to 25cm, – size and length of catheter ensuring the fingers do not to uch the glans – type of sterile anaesthetic/lubricating gel used penis. If resistance is felt at the external sphincter, ask the patient to cough or strain – volume of sterile water used in the balloon gently as if trying to pass urine. Slowly inflate the balloon, according to the the individual manufacturer’s guidelines and observing the patient at all times – if discomfort is – if patient leaflet discussed and evidence of displayed s to p and re-check the catheter’s the care instructions given to the patient or position.

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Complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution (1999-2003) anxiety disorder key symptoms generic pamelor 25mg visa. Elements regulating angiogenesis and correlative microvessel density in benign hyperplastic and malignant prostate tissue anxiety symptoms of menopause order 25 mg pamelor free shipping. Functional Loss of the gamma-catenin gene through epigenetic and genetic pathways in human prostate cancer anxiety symptoms duration order pamelor 25mg with visa. Management of vital organ malperfusion in acute aortic dissection: proposal of a mechanism-specific approach anxiety 7 year old boy purchase 25 mg pamelor amex. Measurement of residual adenoma after transurethral resection of the prostate by transurethral enucleation technique. Three-year follow-up of laser prostatec to my versus transurethral resection of the prostate in men with benign prostatic hyperplasia. Association between the bothersomeness of lower urinary tract symp to ms and the prevalence of erectile dysfunction. Blind urethral catheterization in trauma patients suffering from lower urinary tract injuries. Expression profiling of a human cell line model of prostatic cancer reveals a direct involvement of interferon signaling in prostate tumor progression. Lower urinary tract symp to ms in primary care-a multicenter community-based study in Israel. Differential gene expression of cholinergic muscarinic recep to r subtypes in male and female normal human urinary bladder. Clear cell adenocarcinoma of the bladder in a male patient: clinicopathologic analysis of a case. Role of oxidative stress response elements and antioxidants in prostate cancer pathobiology and chemoprevention-a mechanistic approach. The effect of intravesical resinifera to xin in patients with idiopathic detrusor instability suggests that involuntary detrusor contractions are triggered by C-fiber input. Androgen-induced cell growth and c-myc expression in human non-transformed epithelial prostatic cells in primary culture. Quantitation of conventional his to logic parameters and biologic fac to rs in prostatic needle biopsy are useful to distinguish paramalignant from malignant disease. Team-based approach reduces learning curve in robot-assisted laparoscopic radical prostatec to my. Neural network prediction of prostate tissue composition based on magnetic resonance imaging analysis. Polymorphisms in the methylenetetrahydrofolate reductase gene and prostate cancer risk. Methylation of multiple genes in prostate cancer and the relationship with clinicopathological features of disease. High-dose amino acid infusion preserves diuresis and improves nitrogen balance in non-oliguric acute renal failure. Bipolar versus monopolar transurethral resection of prostate: randomized controlled study. Quantitative structure-activity relationship study of novel alpha1a-selective adrenocep to r antagonists. Effect of lumbar-epidural administration of tramadol on lower urinary tract function. Plasma membrane association of cathepsin B in human prostate cancer: biochemical and immunogold electron microscopic analysis. Cathepsin B expression is similar in African-American and Caucasian prostate cancer patients. Microvessel density as a molecular marker for identifying high-grade prostatic intraepithelial neoplasia precursors to prostate cancer. Prediction of pelvic lymph node metastasis by the ratio of cathepsin B to stefin A in patients with prostate carcinoma. Ratio of cathepsin B to stefin A identifies heterogeneity within Gleason his to logic scores for human prostate cancer. Level of renal function and serum erythropoietin levels independently predict anaemia post-renal transplantation. Augmented expression of chromogranin A and sero to nin in peri-malignant benign prostate epithelium as compared to adenocarcinoma. Lower urinary tract symp to ms: shifting our focus from the prostate to the bladder. Decrease of ultrasound estimated bladder weight during tamsulosin treatment in patients with benign prostatic enlargement. Kidney function and thickness of carotid intima-media complex in patients with treated arterial hypertension. A community study of lower urinary tract symp to ms in older men in Sydney, Australia. In vitro activity of fluoroquinolones, azithromycin and doxycycline against chlamydia trachomatis cultured from men with chronic lower urinary tract symp to ms. Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and sys to lic dysfunction. Single-institution experience in 110 patients with botulinum to xin A injection in to bladder or urethra. Bipolar electrosurgery for benign prostatic hyperplasia: transurethral electrovaporization and resection of the prostate. Relationship between upregulated oestrogen recep to rs and expression of growth fac to rs in cultured, human, prostatic stromal cells exposed to estradiol or dihydrotes to sterone. The biochemical functions of the renal tubules and glomeruli in the course of intrahepatic cholestasis in pregnancy. Messenger ribonucleic acid levels of steroid 5 alpha-reductase 2 in human prostate predict the enzyme activity. Holmium laser ureteroscopic treatment of various pathologic features in pediatrics. Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey. Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome. Ro to resection versus transurethral resection of the prostate: short-term evaluation of a prospective randomized study. Lower urinary tract symp to ms suggestive of benign prostatic hyperplasia: latest update on alpha(1)-adrenocep to r antagonists. Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound-guided prostate biopsy: a prospective randomized study. Prediction of bladder outlet obstruction in men with lower urinary tract symp to ms using artificial neural networks. Diagnostic research in benign prostatic hyperplasia-from sensitivity to neural networks. A method for estimating within-patient variability in maximal urinary flow rate adjusted for voided volume. A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results. Study of the association between ischemic heart disease and use of alpha-blockers and finasteride indicated for the treatment of benign prostatic hyperplasia. Treatment of benign prostatic hyperplasia and occurrence of prostatic surgery and acute urinary retention: a population based cohort study in the Netherlands. The influence of urine osmolality and other easily detected parameters on the response to desmopressin in the management of monosymp to matic nocturnal enuresis in children. Latent hemodynamic abnormalities in symp to m-free women with a his to ry of preeclampsia. Changes in hemodynamic parameters and volume homeostasis with the menstrual cycle among women with a his to ry of preeclampsia. Diagnostic procedures by Italian general practitioners in response to lower urinary tract symp to ms in male patients: a prospective study.

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The decrease in vasopressin secretion at night leads to anxiety of influence buy pamelor 25mg overnight delivery nocturnal polyuria anxiety symptoms zoloft purchase pamelor online from canada, which causes nocturia anxiety lexapro side effects generic 25mg pamelor with mastercard. In heart disease with lower lim b edem a anxiety symptoms treatment and prevention cheap pamelor amex, the volum e of circulating blood increases during night sleeping and urine volum e increases at night. In vertebral or spinal disease and cerebral infarction, it is likely that voiding related central nervous system m ay be dam aged. The m ost com m on phenom enon is detrusor overactivity (detrusor hyperrefiexia) which is caused by supra-nuclear lesion of nerves innervating the detrusor. In this con dition, the external urethral sphincter contracts to close the urethra when the detrusor contracts and, thus, voiding is disturbed. The form er includes urinary frequency, nocturia, urinary urgency, and incon tinence. The sym p to m s caused by dificult voiding due to urethral com pression by enlarged prostate are called voiding sym p to m s and 96 M. Published online ahead of Evidenceacquisition: We conducted a literature search in computer databases for relevant print on March 13, 2013 articles published between 1966 and 31 Oc to ber 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the Keywords: grade of recommendation for each treatment modality. Antimuscarinics might be considered for patients who of the prostate have predominant bladder s to rage symp to ms. Desmopressin can be used in men with nocturia due to nocturnal Ethanol injections polyuria. Transurethral resection of the Ethanol or botulinum to xin injections in to the prostate are still experimental. Department of Urology, University of Thessaly, Feidiou 6–8, Larissa 41221, Greece. Level of evidence Type of evidence 1a Evidence obtained from meta-analysis of randomised trials 1b Evidence obtained from at least one randomised trial 2a Evidence obtained from one well-designed controlled study without randomisation 2b Evidence obtained from at least one other type of well-designed quasi-experimental study 3 Evidence obtained from well-designed nonexperimental studies, such as comparative or correlation studies and case reports 4 Evidence obtained from expert committee reports or options or clinical experience of respected authorities b. Grade Recommendation A Based on clinical studies of good quality and consistency addressing the specific recommendations and including at least one randomised trial B Based on well-conducted clinical studies but without randomised clinical trials C Made despite the absence of directly applicable clinical studies of good quality various types of conservative treatments, drugs, and according to a classification system modified from the operations are presented in a homogeneous structure Oxford Centre for Evidence-based Medicine (Table 2b) [8]. The guidelines panel consisted of urologists, a pharma education, reassurance, lifestyle advice, and periodic moni cologist, and an epidemiologist and statistician who have to ring [9–12] that include: been working on the to pic for the last 6 yr. The guidelines are primarily written for urologists but can also be used by Reduction of fluid intake at specific times aimed at general practitioners, patients, or other stakeholders. The reducing urinary frequency when most inconvenient (eg, guidelines panel intends to update the content and at night or going out in public). The aim of this assessment is to establish the capacity and the time between voids. Vasopressin analogue can be used for the treatment of nocturia due to nocturnal polyuria. Open prostatec to my is the most invasive surgical method with significant morbidity. Follow-up Follow-up for all conservative, medical, or operative treatment modalities is based onempirical data or theoretical considerations 3–4 C but not on evidence-based studies. Contraction of the human prostate is mediated predominantly, if not exclusively, 3. Indoramin and naf to pidil are central nervous system are considered media to rs of also available in a few countries but not discussed in these adverse events during a1-blocker treatment, and all guidelines. Although these improvements take a few weeks to develop fully, significant efficacy over placebo was demon 3. In open-label studies (without a run-in period), an after minimum treatment duration of! Comparative studies with term studies [16–18,20]; therefore, some patients must be a1-blockers and a recent meta-analysis have demonstrat treated surgically. The most frequent more effectively than the a1-blocker tamsulosin adverse events of a1-blockers are asthenia, dizziness, and [17,18,32]. In contrast, the frequency of hypotension with acute urinary retention or need for surgery [20,33,34]. In the a1A-selective blocker silodosin is comparable with the Proscar Long-Term Efficacy and Safety Study after 4 yr, placebo. Ophthalmologistsshould a surgical intervention (48%) compared with placebo at 2 yr be informed about a1-blocker use prior to cataract surgery. In addition, this reduction was maintained to 4 yr during the open-label phase of the study [37]. The most relevant adverse block the conversion of tes to sterone to dihydrotes to sterone effects are related to sexual function and include reduced in prostatic stroma cells by blocking the enzyme libido, erectile dysfunction, and, less frequently, ejaculation 5a-reductase and inducing apop to sis of prostate epithelial disorders [18,20]. In open-label trials with to lter or nipple tenderness) develops in approximately 1–2% of odine, daytime frequency, nocturia, urgency incontinence, patients. Muscarinic recep to rs are densely decreased the mean 24-h micturition and nocturia, and expressed on detrusor smooth muscle cells and other cell mean American Urological Association Symp to m Index types, such as epithelial cells of the salivary glands and the scores significantly improved [44]. Muscarinic recep to r antagonists of muscarinic recep to rs reduces smooth muscle cell are generally well to lerated. Compared with placebo, drug contractions and the sensory threshold of the bladder. Muscarinic recep to r antagonists have been tested predominantly in women in the past because it was 3. Phosphodiesterase type 5 inhibi to rs cantly reduce urgency incontinence, daytime or 24-h 3. Solifenacin significantly improved mean Patient reducing smooth muscle to ne of the detrusor, prostate, Perception of Bladder Condition scores, mean scores on the and urethra. Plant extracts: phy to therapy Herbal drug preparations are made of roots, seeds, pollen, 3. A others combine the extracts of two or more plants in to recent meta-analysis (3214 menwith a medianfollow-up of one pill (combination preparations). American dwarf palm, saw palmet to ), and Urtica dioica With regard to tadalafil 5 mg, it was found that it (roots of the stinging nettle). Thus the pharmacokinetic properties can number of patients and short-term follow-up on the differ significantly between different plant extracts. They are also contraindicated in patients who lack of regula to ry framework, and the considerable have unstable angina pec to ris, have had a recent myocar methodological problems associated with the published dial infarction (<3 mo) or stroke (<6 mo), myocardial trials and meta-analyses. Vasopressin analogue: desmopressin hepatic or renal insufficiency, or if anterior ischemic optic 3. Serum sodium concentrations should unsuitable for the treatment of nocturia/nocturnal poly bem oni to redatdays3and7after starting therapy and uria. Desmopressin has been approved in effects of both drug classes with regard to symp to m most European countries for the treatment of nocturia improvement and prevention of disease progression. In pivotal clinical trials, desmopressin sig men at greater risk of disease progression. In addition, finasteride, alone or nocturnal voids and increased significantly the hours of in combination, but not doxazosin significantly reduced undisturbed sleep in comparison with placebo. Peripheral oedema (2%) and limitations of those studies include the short duration of the hypertension (5%) were reported in the long-term treat combination therapy and the short follow-up period after ment trial [63]. Hyponatremia of all degrees, not necessarily associated Adverse events of both drug classes are reported with with symp to ms, occurs in 5–7. An to 75% in patients with low sodium concentrations at a1-blocker to gether with a muscarinic recep to r antagonist baseline [65]. A recently published subanalysis suggests aims to antagonise both a1-adrenocep to rs and M2 and that oral doses of 50–100 mgdesm opressin(M elt)aresafe M3-recep to rs in the lower urinary tract, thereby using in men [67]. The maximum oral daily dose more efficacious in reducing voiding frequency, nocturia, recommended is 0. Perioperative complications combination treatment with a1-blockers and muscarinic include mortality during the first 30 d (0. Class effects are likely to be responsible for increased efficacy and QoL in patients treated with an a1-blocker and 3. Transurethral resection and transurethral incision of the is mostly suggested as 80 ml. Transurethral microwave therapy and blood transfusion rates; shorter irrigation, catheter 3.

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Also to anxiety 800 numbers purchase pamelor 25mg on-line wards those who treat themselves as they have treated us: since no one can be supposed to anxiety zone dizziness generic 25 mg pamelor with amex slight himself anxiety yellow stool buy discount pamelor 25 mg line. Also to anxiety upon waking buy pamelor 25mg online wards those who ad mit their fault and are sorry: since we accept their grief at what they have done as satisfaction, and cease to be angry. The punish ment of servants shows this: those who contradict us and deny their offence we punish all the more, but we cease to be incensed against those who agree that they deserved their punishment. The reason is that it is shameless to deny what is obvious, and those who are shameless to wards us slight us and show contempt for Also we feel calm to wards those who humble themselves before us and do not gainsay us; we feel that they thus admit themselves our inferiors, and inferiors feel fear, and nobody can slight any one so long as he feels afraid of him. That our anger ceases to wards those who humble themselves be fore us is shown even by dogs, who do not bite people when they sit down. We also feel calm to wards those who are serious when we are serious, because then we feel that we are treated seriously and not contemptuously. Also to wards those who pray to us and beg for mercy, since they humble themsel ves by doing so. Also to wards those who do not insult or mock at or slight any one at all, or not any worthy person or any one like ourselves. In general, the things that make us calm may be inferred by seeing what the opposites are of those that make us angry. We are not angry with people we fear or respect, as long as we fear or respect them; you cannot be afraid of a person and also at the same time angry with him. Again, we feel no anger, or comparatively little, with those who have done what they did through anger: we do not feel that they have done it from a wish to slight us, for no one slights people when angry with them, since slighting is painless, and anger is painful. As to the frame of mind that makes people calm, it is plainly the opposite to that which makes them angry, as when they are amusing themselves or laughing or feasting; when they are fee ling prosperous or successful or satisfied; when, in fine, they are enjoying freedom from pain, or inoffensive pleasure, or justifia ble hope. Also when time has passed and their anger is no longer fresh, for time puts an end to anger. And vengeance previously taken on one person puts an end to even greater anger felt against another person. Hence Philocrates, being asked by some one, at a time when the public was angry with him, ’Why don’t you defend yourselfi This happened in the case of Ergophilus: though the people were more irritated against him than against Callisthenes, they acquit ted him because they had condemned Callisthenes to death the day before. Again, men become calm if they have convicted the offender; or if he has already suffered worse things than they in their anger would have themselves infiicted upon him; for they feel as if they were already avenged. Or if they feel that they themselves are in the wrong and are suffering justly (for anger is not excited by what is just), since men no longer think then that they are suffering without justification; and anger, as we have seen, means this. Hence we ought always to infiict a preliminary punishment in words: if that is done, even slaves are less aggrie ved by the actual punishment. We also feel calm if we think that the offender will not see that he is punished on our account and because of the way he has treated us. Hence the poet has well written: Say that it was Odysseus, sacker of cities, implying that Odysseus would not have considered himself avenged unless the Cyclops perceived both by whom and for what he had been blinded. Consequently we do not get angry with any one who cannot be aware of our anger, and in particular we cease to be angry with people once they are dead, for we feel that the worst has been done to them, and that they will neither feel pain nor anything else that we in our anger aim at making them feel. And therefore the poet has well made Apollo say, in order to put a s to p to the anger of Achilles against the dead Hec to r, For behold in his fury he doeth despite to the senseless clay. It is now plain that when you wish to calm others you must draw upon these lines of argument; you must put your hearers in to the corresponding frame of mind, and represent those with whom they are angry as formidable, or as worthy of reverence, or We may describe friendly feeling to wards any one as wishing for him what you believe to be good things, not for your own sake but for his, and being inclined, so far as you can, to bring these things about. A friend is one who feels thus and excites these feelings in return: those who think they feel thus to wards each other think themselves friends. This being assumed, it follows that your friend is the sort of man who shares your pleasure in what is good and your pain in what is un pleasant, for your sake and for no other reason. This pleasure and pain of his will be the to ken of his good wishes for you, since we all feel glad at getting what we wish for, and pained at get ting what we do not. Those, then, are friends to whom the same things are good and evil; and those who are, moreover, friendly or unfriendly to the same people; for in that case they must have the same wishes, and thus by wishing for each other what they wish for themselves, they show themselves each other’s friends. Again, we feel friendly to those who have treated us well, eit her ourselves or those we care for, whether on a large scale, or readily, or at some particular crisis; provided it was for our own sake. And also to our friends’ friends, and to those who like, or are liked by, those whom we like ourselves. And also to those who are ene mies to those whose enemies we are, and dislike, or are disliked by, those whom we dislike. For all such persons think the things good which we think good, so that they wish what is good for us; and this, as we saw, is what friends must do. And also to those who are willing to treat us well where money or our personal sa fety is concerned: and therefore we value those who are liberal, brave, or just. We also like temperate men, because they are not unjust to others; and, for the same reason, those who mind their own business. And also those whose friends we wish to be, if it is plain that they wish to be our friends: such are the morally good, and those well thought of by every one, by the best men, or by those whom we admire or who admire us. And also those with whom it is pleasant to live and spend our days: such are the good-tempered, and those who are not to o ready to show us our mistakes, and those who are not cantankerous or quarrelsome-such people are always wanting to fight us, and those who fight us we feel wish for the opposite of what we wish for ourselves-and those who have the tact to make and take a joke; here both parties have the same object in view, when they can stand being made fun of as well as do it prettily themselves. And we also feel friendly to wards those who praise such good qualities as we possess, and especially if they praise the good qualities that we are not to o sure we do possess. And to wards those who are cleanly in their person, their dress, and all their way of life. And to wards those who do not reproach us with what we have done amiss to them or they have done to help us, for both actions show a tendency to criticize us. And to wards those who do not nurse grudges or s to re up grievances, but are always ready to make friends again; for we take it that they will behave to us just as we find them behaving to every one else. And to wards those who are not evil speakers and who are aware of neither their neighbours’ bad points nor our own, but of our good ones only, as a good man always will be. And to wards those who do not try to thwart us when we are angry or in earnest, which would mean being ready to fight us. And to wards those who have some serious feeling to wards us, such as admiration for us, or belief in our goodness, or pleasure in our company; especially if they feel like this about qualities in us for which we especially wish to be admired, esteemed, or liked. And to wards those who are like our selves in character and occupation, provided they do not get in our And those who desire the same things as we desire, if it is possible for us both to share them to gether; otherwise the same trouble arises here to o. And to wards those with whom we are on such terms that, while we respect their opinions, we need not blush before them for doing what is conventionally wrong: as well as to wards those before whom we should be ashamed to do anything really wrong. Again, our rivals, and those whom we should like to envy us–though without ill-feeling–either we like these people or at least we wish them to like us. And we feel friendly to wards those whom we help to secure good for themsel ves, provided we are not likely to suffer heavily by it ourselves. And those who feel as friendly to us when we are not with them as when we are-which is why all men feel friendly to wards those who are faithful to their dead friends. And, speaking generally, to wards those who are really fond of their friends and do not desert them in trouble; of all good men, we feel most friendly to those who show their goodness as friends. Also to wards those who are honest with us, including those who will tell us of their own weak points: it has just said that with our friends we are not ashamed of what is conventionally wrong, and if we do have this feeling, we do not love them; if therefore we do not have it, it looks as if we did love them. We also like those with whom we do not feel frigh tened or uncomfortable-nobody can like a man of whom he feels frightened. Things that cause friendship are: doing kindnesses; doing them unasked; and not proclaiming the fact when they are done, which shows that they were done for our own sake and not for some other reason. Anger is always concerned with individuals-a Callias or a Socrates-whereas hat red is directed also against classes: we all hate any thief and any informer. The one aims at giving pain to its object, the other at doing him harm; the angry man wants his victims to feel; the hater does not mind whether they feel or not. All painful things are felt; but the greatest evils, injustice and folly, are the least felt, since their presence causes no pain. And anger is accompanied by pain, hat red is not; the angry man feels pain, but the hater does not. Much may happen to make the angry man pity those who offend him, but the hater under no circumstances wishes to pity a man whom he has once hated: for the one would have the offenders suffer for what they have done; the other would have them cease to exist. It is plain from all this that we can prove people to be friends or enemies; if they are not, we can make them out to be so; if they claim to be so, we can refute their claim; and if it is disputed whether an action was due to anger or to hatred, we can attribute it to whichever of these we prefer.