Hi and welcome to nursing school explained in this video on artificial airways. Now artificial airways can be by any means really the most common one that we see in the emergency setting is endotracheal intubation but it can also be if it's needed for longer care it can be a tracheostomy which is usually a surgically inserted airway or there can be intubation required through the nose through the other access between the nasal and the oral fairings and reason for nasal intubations would be for example trauma to the jaw where there's a lot of surgery required or some other injury to the jaw and mouth areas. So this video will mostly focus on endotracheal intubation and the procedure and then the nursing care related to it and I'll do my best to explain the devices to you so that you can kind of picture how this is done. So indications for intubation are usually any kind of upper airway obstruction apnea so a patient that is unable to breathe on their own when there's a high risk for aspiration when the patient is in respiratory distress and when there's ineffective clearance of secretions and so ineffective clearance of secretions can be anything that relates to the airway so lots of mucus but it can also relate to the stomach such as if the patient has projectile vomiting due to an upper GI bleed and they just keep vomiting and vomiting sometimes you really have to protect the airway and intubation is required and then respiratory distress really encompasses a wide variety of disorders this can be an acute asthma exacerbation this can be somebody with a severe pneumonia or maybe even from a car accident or anything like that. So let's look into the different artificial airways here. I'm kind of drawn out an endotracheal tube over here you can see in blue here this is the tube and it's usually not too long and it's usually inserted with a what's called a stylet because the tube itself is somewhat stiff but the stylet just helps the provider to guide it down and keep in mind you have to be trained in how to insert an endotracheal tube because it's a it's a highly skilled procedure and most of the times you'll see either doctors maybe specially trained nurse practitioners or physician assistants but also paramedics are able to insert artificial airways. So the tube typically there is a stylet and then at the end it has a balloon like a lot of other devices that you might know such as a catheter or maybe even a feeding tube a gastrostomy tube that will just kind of help to keep the tube in place once it's been inserted. Then there's also a little port here for the balloon to inflate the balloon to actually keep it there once it's inserted and then there's a subglottic suctioning a lot of the more newer endotracheal tubes come with a sub suctioning here which will allow you to suction right above this balloon because the patient will still have oral secretions that then fall down into the airway although the balloon is inflated on the bottom but if you need to check the balloon of it for some reason deflates then these secretions would drop down into the patient's airways or the lungs really and could cause some trouble there. So that subglottic suctioning port is a very nice invention that's just come out over the past 10 years or so that I've seen it. Now for the intubation procedure itself the complications that might occur is a chipped teeth because usually it's done with a laryndoscope again by a trained provider and it requires a certain amount of kind of leverage and to open up the airways so chipped teeth are always a possibility but that's why it's a specialized skill and these providers have to go through rigorous training to actually do that and then we always want to be cautious in patients with C-spine or cervical spine precautions. So again back to that example for somebody who has had a motor vehicle accident and we are not sure if they have injured their neck but they require an artificial airway we always need to be particularly aware of this and assist the provider that performs the intubation to best protect the patient's neck because usually we hyperextend the patient's neck so that the airway can be easier visualized by the person performing the intubation but if there's a concern for cervical spine injury we certainly can't do that and the patient will have some sort of a C-collar on and so we have to go with the jaw thrust maneuver rather than the head-tailed chin lift and if you haven't taken CPR in a while go ahead and redo that these two maneuvers and then the size of the in the tracheal tube will depend mostly on the patient's height and weight and again the provider performing the intubation will be selecting the equipment. Now a very important role in this whole procedure and really maintaining the artificial airways as well as the ventilators is our friends the respiratory therapists remember they go to school specifically and they're especially trained in these kind of airways and they are the experts on the mechanical ventilator so you really want to always have the respiratory therapist there with you when the procedure is occurring. Now certainly there can be circumstances where the respiratory therapist might not be available and then you and most likely another nurse will help the provider perform the procedure and go through all these steps it certainly can't be done without a respiratory therapist but certainly when they're there it's always much smoother and easier and so we collaborate with them very closely. So the equipment they define intubation certainly we need an in the tracheal tube we need a bag valve mask and the valves and the bags have a usually they have the mask attached if you would do rescue breathing for example or during CPR but then that mask just comes off and the tubing from the bag then hooks up to the in the tracheal tube once it's placed and then you can manually ventilate the patient. Certainly we will need oxygen and the bag valve mask again has that connecting system to the actual oxygen tank or the oxygen device on the wall. We will need suction to clear any secretions that might be in the way certainly we do want to have IV access and this most likely you'll want two different IV accesses with a fairly large gauge IV preferably an 18 gauge in the AC if you can get it. We will leave the ventilator because eventually the patient we're not going to continue bagging them we're going to need to place them on that machine to help them breathe and again our respiratory therapist will help us with that then we need an entire CO2 detector and I'll go a little bit more into what that is we'll need to remove dentures because they could get in the way and it's going to be much easier and then certainly we'll need medications again it depends on the patient care situation we'll definitely need sedatives and paralytics because we want to basically nullify that gag reflex that the patient has because most of the patient care scenarios the patient will still have a gag reflex and that certainly is counterproductive to intubation and passing that tube down the throat because the patient will be gagging and that will be very very uncomfortable so sedatives and paralytics are mandatory really and the selection of medications will depend on the provider and the patient's medical history and other circumstances then before the tube gets placed the patient gets pre-oxygenated with 100 or two for at least three to five minutes because the intubation itself if we are not ventilating the patient the patient doesn't get any oxygen so we want to give them a little bit of extra oxygen before the procedure and then each attempt hopefully the whoever is performing the procedure they will be able to get it on the first try but if multiple attempts are required we want to make sure that each attempt is less than 30 seconds so that again the patient doesn't become hypoxemic because now they might not be breathing at all and now we are not ventilating them because we're trying to get that artificial airway in and it's really our responsibility to hold the provider accountable to that 30 seconds to really support the patient and best care for our patient. Now let's look to the actual procedure like I mentioned before we want to put the patient in the sniffing position anything that will help to open up the patient's airway whether that's the head tilt chin lift maneuver or the jaw thrust that will kind of help us open the airway. Now once the tube's been placed we want to inflate the cuff here to hold the tube in place and again most likely that's done by the respiratory therapist then we want to place that famous end-tidal CO2 detector and this is a little device that again goes between the endotracheal tube and the back valve that you're going to ventilate the patient with and it is a nice visual to see if you're getting CO2 back or if you're not getting CO2 back and so if the color changes to gold that's good so gold is good but if it stays purple that usually means that the endotracheal tube is now in the esophagus and so now we're in the wrong spot and we need to pull that tube and re-intubate of course after we've taken some time to pre-opternate the patient beginning. Now once we think that the tube is in the correct place once the end-tidal CO2 detector turns golden then we want to auscultate over the epigastric area because if we would be in the esophagus which is still possible we would hear that kind of a gurgling sound with every BVM that we're providing for the patient just as you would with an NG tube because now we pump an air into their stomach and it's this loud gurgling sound so if we hear that then we automatically know that we're in the wrong spot then we need to re-do the procedure and certainly again if the end-tidal CO2 shows that it's golden it's good and we auscultate over the epigastric area we don't hear any gurgling sounds there certainly we'll need to observe for symmetrical movement of the chest wall because now that we know that we are in the correct airway just like we would observe the patient's breathing for symmetrical chest wall movement same thing if we breathe for the patient we need to make sure if we're in the trachea that we are now inflating and deflating both lungs and then we want to auscultate for bilateral breast sounds again for conformation and certainly check the patient's O2 set right because if the attempt has taken maybe more than 30 seconds the O2 set might drop so now we need to make sure that we provide the patient with the appropriate amount of oxygen so that their O2 set can come back up then we will place the patient on a ventilator in the game that's done by the respiratory therapists because they are the experts on that device and for definitive placement we want to snap a chest x-ray and while the chest x-ray will tell us the proper placement is usually two to six centimeters above the carina so let's look at this here so over here we have a picture of the trachea and then the right and left main stem bronca so this is the airways that go down from the trachea and the junction here is called the carina and so we want the tube to be about two to six centimeters above the carina to make sure the air gets in here and then distributed through both lungs now what can happen sometimes if the tube gets placed the right main stem broncus over here is a little bit more vertical than the left one so if the tube gets placed too far then it usually ends up in the right main stem broncus so now if we go through our confirmation here we would not see the we would not observe the symmetrical chest wall movement because now if we're in that right main stem then only the left lung gets aerated and we would also ascultate for bilateral breast sounds and not hear any breast sounds over the left side because now we're in that right main stem broncus and that's really what it's called it's called right main stem broncus intubation which is definitely not good so then once we have that chest x-ray right after intubation and after we've gone through all these other verifications then the reading will come back from the radiologist and they'll say okay let's pull the tube back two centimeters three centimeters whatever that might be then we'll pull the tube back out now we're now in the trachea and now both sides here get ventilated we also once this has been completed we want to mark the depth of the tube because now we want to know what's the ideal depth for this patient and just like most tubes the endotracheal tube will have markings on the tube so you can see what level of centimeters that you are and your marking either at the teeth or at the lips depending on the patient's mouth and teeth circumstances and this will get charted and then that will with the patient so that everybody knows where that endotracheal placement is supposed to be now after about 15 or 30 minutes after the intubation we want to take some arterial blood gases because now we want to see how the patient is doing and adjust the ventilator settings as needed and then certainly we will need continuous monitoring of O2 sat and entire CO2 to see how our patient's oxygenation and ventilation is doing now over here as for nursing care and I put here shared with the respiratory therapist because again they are our best friends when it comes to ventilators and artificial airways because that is their specialty but certainly we're always collaborating so first we need to maintain correct placement and that kind of goes along with the marking that I just talked about because remember this is going to be a patient that's going to the ICU so they're going to have sedatives they're going to have other medications on board and they will not be able to turn themselves so we will need to do all that for them so whenever a procedure is done or the patient is to simply transfer it for a gurney to a bed there is a chance that that ET tube might become dislodged or move out or move in a little bit too far so we need to make sure that we maintain that correct tool placement number two maintain proper cuff inflation again this is that cuff that balloon that we have at the end of the endotracheal tube that keeps it in place now if we inflate that with too much air it can cause a pressure ulcer inside the patient's airway which clearly we don't want that's not very good so checking the cuff on a daily or per the policy and procedures at the facility that you're working with will be very very important to again make sure that we protect the patient's airway another thing is that the endotracheal tube goes through the patient's vocal cords so we want to make sure that we don't exert too much pressure on those because that can be permanent damage if the ET tube is in place for too long we certainly want to monitor the patient's oxygenation and ventilation and so whenever we think about hypoxemia we always have to think of changes in mental status and although the patient might be sedated you might notice certain signs that the patient is now not getting enough oxygen so always be aware of those and check for any signs such as agitation or maybe they start to pull on the tool but they get a little bit more alert or they wake up but anything like that and then you will have to provide the proper medications to keep the patients sedated so that now they're able to breathe easier and that their oxygenation is in order and then for ventilation again we keep auscultating the lungs we keep checking the chest wall movement to make sure everything is in the correct place and then we have to make sure that the endotracheal tube remains patent that endotracheal tube is the patient's lifeline right it's their airway so if we don't have an airway we don't have anything according to our ABs and Cs so the endotracheal tube could become obstructed such as with secretions or vomit or or really anything else that can occur there so we need to suction the patient and so before we perform any kind of suction just like with the intubation we need to hyper-oxygenate the patient before the procedure and the max for suctioning is always 10 seconds and this is something that likes to come up on a on a test on an exam so you might want to take note of that and really the reason is because when we're suctioning the patient we're trying to remove the secretions but we're also suctioning oxygen out of the patient's lungs and so if we don't hyper-oxygenate them before then they might have signs and symptoms of hypoxemia like we just discussed and then oral and oral care and skin integrity are also very important the endotracheal tube is going to require the patient to have their mouth open so their mouth will dry out they are not they're unable to swallow the lips might get chapped and that endotracheal tube is usually on the side of the mouth so again when anything is in place for too long it can cause a pressure so then it's our responsibility to check around the tube and then maybe move it from one side of the mouth to the other to prevent these kind of injuries and also provide oral care and suctioning and that again comes back to not only oral suctioning but we also want to usually have a low suction low continuous suction hooked up to the subclotic port so that whatever secretions do drip down from the mouth into that patient's airway and end right there at the cuff that we want to make sure that we remove these as well and then certainly complications right again if we don't have an airway we don't have an endotracheal tube and the patient requires it then we have nothing if you don't have an airway you don't have anything so it's very important to maintain that but if an unplanned extubation occurs for whatever whatever happens we always need to make sure we stay with the patient we have a bvm at the back at the bed we provide the oxygenation certainly we want to call for help and then get the patient re-intubated as soon as possible and then another complication is aspiration sometimes no matter how much attention we pay to meticulous oral care and suctioning aspiration can happen so we need to make sure we again check lung sounds frequently check the patient's conditions perform the oral care with the subclotic suctioning and all these measures to prevent the aspiration and certainly another one that's real big here is to make sure that we keep the head of the bed elevated because again when the patient's flat maybe they have a gag reflex now or they're throwing up or they're getting feeding through an ng-tube or a g-tube when there's some regurgitation we don't want them to aspirate so keeping the bed elevated will definitely help with that and then here's a very nice acronym in case you notice that something is going on with your patient that is not normal if they're intubated so it's called the dope acronym so there's a quick way to remember all the things that could be going wrong with your patient who has an artificial airway so it could be D the slosh that the tube has come the slosh because the patient has been moved or maybe they're starting to wake up and they want to remove that tube maybe there's an obstruction so again we need to be careful to pay attention to the patient's secretions and suction them as needed P for normal thorax because the patient will be on an on an ventilator and a lot of times they will receive positive pressure ventilation which means that the machine pushes the air into the patient's lungs now if that is too much pressure or there are any other complications it could put too much pressure in that lung and then the alveoli will rupture causing a pneumothorax and certainly that's an emergency that we need to take care of and we would assess that by again listening to bilateral breath sounds and maybe find absent breath sounds over one side and then E is for equipment so equipment failure maybe our suctioning is not working correctly or maybe the ventilator has failed maybe the settings are not correct maybe the patient has come off the monitor and the O2 sap probe is no longer attached to them and we think it's an equipment failure or an emergency but it's really just that the sticker has come off so that's the other thing here for equipment so it's a very nice acronym to follow here to kind of problem solve if the patient has an artificial airway or is on a ventilator or both of those so if you haven't already done so please watch the video on mechanical ventilation where I go into explaining the different ventilator settings and a little bit more to this positive pressure that can cause this pneumothorax I also have videos on pneumothorax and hemothorax so I highly encourage you to watch these as well in my critical care playlist please like this video give me a thumbs up if you enjoyed it also check on Instagram at nursing school explain for any new videos that are being released and some study tips and I'll see you again soon right here on nursing school explain thanks for watching


You've determined your research topic and gathered information, but are you ready to visit a National Archives facility to conduct your research in person? In this video, we'll describe the two steps every researcher at the National Archives should take to ensure success before you arrive. First, search the National Archives catalog, and second, contact the National Archives reference staff before your visit. First search the National Archives catalog. You can use the catalog to search for your topic and related keywords. If you're having trouble finding relevant results, try narrowing your search with the refine options on the left side of the screen, or by conducting an advanced search. If you have any questions about how to use the catalog, please contact us at catalogatnara.gov. We're here to help you navigate. When you find records of interest, note the National Archives identifier or NADE of the records. This will come in handy in the next step when you contact us. You also want to note any identifier numbers found in the Variant Control Numbers section of the catalog description. These could be HMS or entry numbers, search identifier numbers, and local identifier numbers. This identifying information will help the reference staff locate the records you are interested in seeing and can speed up retrieval. If you're interested in coming to a National Archives facility to view the records in person, first confirm their location in the contact section. This is the physical location of the records. We have National Archives facilities all over the United States, and you'll want to make sure you're coming to the proper location. You'll also want to confirm their availability by checking the access and use restrictions in the details section of the catalog description. This will tell you if the records are unrestricted or if they cannot be accessed because they are classified. If records are listed as unrestricted, you should be able to view the records in person. If records are listed as restricted possibly, restricted partly, or restricted fully, then you may be unable to view them in person. Regardless of the access restrictions, please contact the reference unit listed in the catalog description before your visit. This will give the reference staff enough time to do appropriate investigation and preparation. If you have specific questions about the records you found in the catalog, I encourage you to contact the office listed in the contact section of the description. You can email, call, or write to the reference staff for answers to your questions. When contacting the reference staff, please allow three weeks for a response. Reference staff will be able to confirm the availability of records and possibly prepare them for your visit if available for research. Please provide the identifier numbers you recorded from your catalog searches. But please note, not all facilities will prepare records in advance of your visit. We encourage you to contact us. If you know which facility holds the records you would like to see, you can contact the facility directly. A list of locations with contact information can be found on our website at archives.gov slash locations. This page will show the accessibility, hours, directions, and details of our nationwide network of facilities. If you're unsure of which facility might hold records relevant to your interest, use the general contact us form. It's possible the records you seek haven't been described yet or weren't described in a way that corresponds to the keywords you entered in your search. A reference archivist will be able to help you further. We know in-person visits often involve time and money, so we want to help ensure your visit is as successful and productive as possible. We wish you the best of luck with your research.


So right away, you might wonder, okay, well then, what is virtue? Aristotle's trying to give us this answer, how do you acquire eudaimonia? He just says virtue. All right, now this word has been used in a wide variety of ways. Let's just try to stick with what Aristotle is talking about. So one thing he wants to contrast virtue to is feelings, capacities, and states. So a feeling is, well, that's pretty straightforward, right? Mad, glad, sad, scared. These are our four basic feelings. We could probably try to talk about them in that way. A mad, glad, sad, scared. And this is how you react to a variety of situations. So right now I'm pretty glad to be out here. I like being outside. I saw some javelina earlier and I wasn't terribly afraid of them because, you know, they're javelina, they're not mountain lions. So I wasn't, you know, very scared of them. I'm not mad because there's no air conditioning. These are a variety of feelings and, you know, people can feel a variety of different ways given different states of the world or different ways that the world can be. Well, this is not virtue. This is not contributing to virtue. It doesn't make you virtuous or un-virtuous, anything like that. It doesn't necessarily determine your pneumonia. So you're saying virtues are not feelings. Virtues are not feelings. It's not a capacity. A capacity is just that by which you can feel. And maybe even, you know, the intensity of feeling or something like this. So I'm not sure exactly what Aristotle will consider a capacity. I mean, today we just talk about our nervous system and our brains. Even to some extent our upbringing, right? Nature versus nurture sort of thing. Okay, this is also not virtue. This is not virtue. This is not what Aristotle is dealing with. So virtues are not feelings nor the capacity to feel. Okay, what about states?  Now this is important, right?  You know, states determine how you behave. And this is important. This is related to eudaimonia. But states are themselves not virtues, right? States determine how you behave. And that's important for eudaimonia. But you don't just make yourself one state or another. I can't just decide, aha, from now on I'm going to be honest. It'd be nice if we could do something like this. And this is probably the mistake that we make with New Year's resolutions, right? We think, aha, I made my decision at this one point of the year. And from here on out I am going to be just fine. It doesn't really work that way. You cannot make yourself a particular state, a particular kind of person, just by a decision. And states are important. They will in part determine whether you have actually achieved eudaimonia. Now states are brought about, are determined by virtue. By virtues, okay? And what a virtue is, is a habit, right? A virtue is a habit. So you can't, you know, you can't actually, also by just a mere decision, you can't just make yourself have a habit. It requires a lot of work. You've got to put the work into it. Intentional, deliberate, cumulative actions, right? Making the decision to act according to this, you know, according to this habit for a period of time is eventually what adjusts your behavior. Virtues are hard to acquire. Habits are hard to acquire. And habits are hard to break. You're probably going to have to break a few habits along the way in order to acquire good ones. And that's, that's where the hard work comes in. It's also not virtue of a, it's also not just because of a single decision. It's cumulative, intentional, repeated decisions until you acquire that state where you no longer have to think about it. Where you no longer have to think about it. And these states are affected by the virtues. Okay. So virtues are not feelings. They're not capacities. They're not states. States are important. Feelings and capacities are not virtues. They're not really the topic of eudaimonia. States are related to eudaimonia. You have to be in the right state in order to acquire eudaimonia. But in order to get to that state, you have to adopt the virtue. And as I said, virtues are habit. Okay. Well, which habits matter? Well, not just any habit counts when it comes to a virtue. Now, the question is, what sorts of habits do you develop? Well, you can answer, well, the virtuous ones. Oh, that doesn't help. And it doesn't even help identifying, you know, particular named habits. Like honesty, you should be honest. That should be your habit. Okay. I mean, I think we all know what it means to tell the truth, but it's just not quite simple as that. You can say you should have a healthy diet. Okay. But it's not as simple as that. A name doesn't tell us what the habit is. Habits are intentional, cumulative actions, repeated actions. So when we're talking about a habit, we got to talk about an act. And health is not an act. It might be a quality of an act. It might be what you get out of an act. Okay. But that doesn't tell us what the act is. So to help us out with this, Aristotle tries to identify, you know, a range of actions, right? A range of actions, a range of habits, so to speak. And you can have an excess, a habit that has an excess. Okay. And these are, you know, too much of a good thing, too much of what is good.  All right. You can also have a deficiency where it's not enough. Okay. And what you're looking for, though, is what's between that. Now, not in, you know, a mathematical sense, right? We're not looking for the middle part. We're looking for the relative mean. Because this is going to vary from person to person, depending upon what constitutes that person. Okay. So here's an example. And this is kind of a simple one, right? So we talked about different parts of what you are, and you're, amongst other things, you're at least a body, right? You have a body. And there is this goodness of the body, this, you know, when the body is doing well. Now, one of the, you know, this good that we talked about of the body is health. We've talked about this before, health. This is good. What's, what happens when you have good goodness in this body? Okay. So what habits affect health? What actions of repeated intentional cumulative actions affect health? Well, let's just look at one thing, one particular act, you know, eating in terms of calories, right? There's all kinds of ways we can describe eating, right? Actions as eating. You can describe how fast you eat, how many times a day you eat, what you eat. But let's just deal with how much, and we're going to deal with how much you eat in terms of calories. So in excess of calories, and one way to think about it, 10,000 calories. Well, yes, of course, that's an excess. Yes, 20,000 calories a day. Yes. If you do that, you'll likely will not survive for very long. But when we're talking about excess, let's talk about like at that point, right? When it's, you know, try to get at that point where it really starts to become unhealthy. And for somebody, you know, my age, my gender, right? Okay, at my age and my gender, when I start pushing 3,000 calories, it might even be before that, right? Close to 2,500 calories. That's an excess, right? Given my, you know, you would probably also think there are other activities, right? I am not a world-class athlete. I am not, you know, running every day, something like this. You know, my work involves pretty much, you know, being still as bad as that is, right? That's another habit we could talk about. But given my activity level, given my age, given my gender, 3,000 calories, that's really starting to push it, right? It might even be close to like 2,800 calories, 2,500 calories. That's probably starting to push it. That's where the excess is really starting to begin. Okay. The same token, so that's the excess. The calories are good. We're not saying calories are bad. Calories are good that contribute to health of the body. But when I start pushing 3,000 calories, that's the excess. What about the deficiency? Well, okay, so start going the other direction, right? 1,000 calories. If I only have 1,000 calories per day, yeah, that's probably too, that's definitely too little. All right. I could probably even bring it up maybe like 1,500, right? If I start having like 1,500 calories a day. I don't know. That actually may not be terrible, but I wouldn't want to push that for years. But definitely around 1,000 or 1,500,000 calories a day. That's the deficiency. Calories are a good thing. They are good for health, but when you start getting too few of them, that's when we start having the deficiency. The relative mean is, it's not, again, it's not mathematically, and that's the absolute mean. What Aristotle calls the absolute mean. It's not the absolute mean. It's the relative mean. And this is something that has to be discovered usually through trial and error. And yeah, it's about 2,000 calories. If I'm watching, you know, when I watch what, how much I consume, and not only just how much, but what kind, right? That's another thing to consider too. Start watching what I consume. It's right about 2,000 calories, right? That's the relative mean. That's the virtue, right? That habit of having 2,000 calories a day, limiting to right about 2,000 calories a day. That's the virtue. So when I acquire this virtue, again, through repeated, cumulative, deliberate actions, that's when I start to acquire that state of health, and this is what contributes to eudaimonia. This is what contributes to eudaimonia. Now, what other virtues are there? There are other virtues besides diet. There are other goods besides health. To figure out these other virtues, you have to figure out, well, I mean, we talked about this already. What are the goods that you strive for? And to figure that out, you have to figure out, well, what are you?  This is part of what makes you what you are. Oh, okay. What are the goods for these things? We got health for body. That's not the only good. We can even talk about strength, endurance, stamina. These are all good. You can't disassociate any one of these from health, but strength is not the same thing as stamina. Strength is not the same thing as diet. Okay. So what are these other goods of the body? What about the mind? Epicure has talked about tranquility. That's certainly a good thing. What other goods are there for, I'm sorry, not the mind, for emotion. What other goods are there for emotion? What habits promote tranquility? Silence tends to help, by the way. What you can do, you can be excessive in your silence, and you can certainly be deficient. And this is going to be a relative mean for different people. What are the habits? What are the goods for the mind? We talked about comprehension. This is certainly a good of the intellect. A good of the mind, okay. What habits promote comprehension? Are there other goods related to comprehension? To understanding the will. You probably can't separate anything in the virtues from the will. After all, you have to make the decision to complete the acts, to perform the acts repeatedly, and tell it becomes part of, well, the phrase is a part, you know, it becomes second nature. And Aristotle speak, this means to be, where you acquire the state, and then you don't have to deliberately perform the act. It's now a habit. We use perseverance as a good of the will, but what else is there? And Aristotle uses the phrase self-mastery. Perseverance is when you continue on, even in the face of adversity or failure. Okay, that's an important thing, but that's slightly different than self-mastery. You probably need self-mastery in order to persevere. And you're going to need perseverance in order to perform the deliberate actions to acquire the virtue, this habit of, sorry, the habits, whatever habits we use to acquire perseverance. None of this is completely distinct from everything else. There's always going to be some kind of effect. But what habits should you pick up? For self-mastery. There's another word for this. We don't like to use it in our culture, but the word that used to be used for this is self-discipline. What do you think those habits are?