Explaining health metrics to patients.

Have you ever felt overwhelmed by the numbers and charts your doctor presents during a checkup? You're not alone. Many patients find themselves lost in a sea of medical jargon and confusing metrics, unsure of what they mean for their health. But what if you could decode these health metrics and take control of your wellness journey?

In this blog post, we'll demystify the world of health metrics, empowering you to become an active participant in your healthcare. From common laboratory tests to vital signs and fitness trackers, we'll break down the essential numbers that paint a picture of your overall health. 🩺📊 By the end, you'll be equipped to understand your test results, interpret medical imaging, and make informed decisions about your well-being.

Join us as we dive into the five key areas of health metrics: common health indicators, laboratory test results, vital signs, fitness and wellness tracking, and medical imaging. Let's embark on this journey to better health literacy together!

Understanding Common Health Metrics

As we delve into the world of health metrics, it's crucial to understand the key indicators that healthcare professionals use to assess our overall well-being. These metrics provide valuable insights into our body's functioning and can help identify potential health risks before they become serious issues. Let's explore some of the most common health metrics and what they mean for your health.

A. Blood Pressure: What the Numbers Mean

Blood pressure is one of the most frequently measured health metrics, and for good reason. It's a vital indicator of cardiovascular health and can signal potential risks for heart disease and stroke. But what do those two numbers actually mean?

Blood pressure is measured in millimeters of mercury (mmHg) and is recorded as two numbers:

1. Systolic pressure: The top number, representing the pressure in your arteries when your heart beats.

2. Diastolic pressure: The bottom number, indicating the pressure in your arteries between heartbeats.

Here's a breakdown of blood pressure categories:

Category Systolic (mmHg) Diastolic (mmHg) Normal Less than 120 and Less than 80 Elevated 120-129 and Less than 80 Hypertension Stage 1 130-139 or 80-89 Hypertension Stage 2 140 or higher or 90 or higher Hypertensive Crisis Higher than 180 and/or Higher than 120

It's important to note that a single high reading doesn't necessarily mean you have high blood pressure. Factors like stress, caffeine intake, and recent physical activity can temporarily elevate your blood pressure. That's why healthcare providers often take multiple readings over time to get an accurate picture of your blood pressure health.

B. Body Mass Index (BMI) and Its Significance

Body Mass Index (BMI) is a simple yet widely used metric to assess body composition and potential health risks associated with weight. It's calculated using your height and weight, providing a rough estimate of body fat percentage.

The formula for BMI is:

• BMI = weight (kg) / [height (m)]²

Or in imperial units:

• BMI = 703 × weight (lbs) / [height (inches)]²

Here's how BMI categories are typically interpreted:

BMI Range Weight Status Below 18.5 Underweight 18.5 - 24.9 Normal or Healthy Weight 25.0 - 29.9 Overweight 30.0 and Above Obese

While BMI is a useful screening tool, it's important to understand its limitations:

1. It doesn't distinguish between muscle mass and fat mass.

2. It doesn't account for body fat distribution.

3. It may not be accurate for athletes, the elderly, or certain ethnic groups.

Therefore, BMI should be used in conjunction with other health metrics and assessments for a comprehensive evaluation of health status.

C. Cholesterol Levels Explained

Cholesterol plays a crucial role in our body's functioning, but too much of it can lead to serious health problems. Understanding your cholesterol levels is key to maintaining good cardiovascular health.

There are several types of cholesterol measured in a lipid panel:

1. Total Cholesterol

2. Low-Density Lipoprotein (LDL) - Often called "bad" cholesterol

3. High-Density Lipoprotein (HDL) - Often referred to as "good" cholesterol

4. Triglycerides - A type of fat in the blood

Here's a general guide to interpreting cholesterol levels (measured in mg/dL):

Cholesterol Type Desirable Borderline High Risk Total Cholesterol Less than 200 200-239 240 or higher LDL Less than 100 100-159 160 or higher HDL 60 or higher 40-59 Less than 40 Triglycerides Less than 150 150-199 200 or higher

It's important to note that these are general guidelines, and your healthcare provider may set different targets based on your individual health status and risk factors.

D. Blood Sugar Measurements for Diabetes Management

Blood sugar, or glucose, measurements are crucial for diagnosing and managing diabetes. There are several tests used to assess blood sugar levels:

1. Fasting Plasma Glucose (FPG) Test

2. Oral Glucose Tolerance Test (OGTT)

3. Hemoglobin A1C Test

4. Random Plasma Glucose Test

Let's focus on two of the most common tests:

Fasting Plasma Glucose (FPG) Test

This test measures your blood sugar after an 8-hour fast. Here's how to interpret the results:

FPG Level (mg/dL) Diagnosis Below 100 Normal 100-125 Prediabetes 126 or higher Diabetes

Hemoglobin A1C Test

This test provides an average of your blood sugar levels over the past 2-3 months. It's particularly useful for long-term diabetes management.

A1C Level Diagnosis Below 5.7% Normal 5.7% - 6.4% Prediabetes 6.5% or higher Diabetes

For those managing diabetes, the American Diabetes Association generally recommends an A1C target of less than 7%. However, your healthcare provider may set a different target based on your individual circumstances.

Understanding these common health metrics is crucial for taking an active role in your health management. These numbers provide valuable insights into your overall well-being and can help you and your healthcare provider make informed decisions about your health.

Remember, while these metrics are important, they're just part of the picture. Factors like family history, lifestyle, and other health conditions all play a role in your overall health status. Always consult with your healthcare provider to interpret your specific results and develop an appropriate health plan.

Now that we've covered these fundamental health metrics, we'll move on to interpreting laboratory test results, which will provide even more detailed insights into your health status.

Interpreting Laboratory Test Results

Now that we've covered the basics of common health metrics, let's delve into the crucial realm of laboratory test results. Understanding these results is essential for patients to take an active role in their healthcare journey.

A. Complete Blood Count (CBC) Breakdown

A Complete Blood Count (CBC) is one of the most common and comprehensive blood tests ordered by healthcare providers. It offers a wealth of information about your overall health and can help detect various conditions.

Key Components of a CBC:

1. Red Blood Cells (RBCs)

2. White Blood Cells (WBCs)

3. Platelets

4. Hemoglobin

5. Hematocrit

Let's break down each component and what it means for your health:

Red Blood Cells (RBCs): These cells carry oxygen throughout your body. An abnormal RBC count can indicate conditions such as anemia or polycythemia.

White Blood Cells (WBCs): These are your body's defense against infections. Elevated WBCs often suggest an ongoing infection or inflammation.

Platelets: Essential for blood clotting, abnormal platelet counts can lead to bleeding disorders or increased risk of blood clots.

Hemoglobin: This protein in RBCs carries oxygen. Low levels can indicate anemia.

Hematocrit: This measures the percentage of RBCs in your blood volume. It's another indicator of anemia or polycythemia.

Here's a quick reference table for normal CBC ranges in adults:

Component Normal Range RBCs 4.5-5.5 million cells/mcL WBCs 4,500-11,000 cells/mcL Platelets 150,000-450,000/mcL Hemoglobin 13.5-17.5 g/dL (men), 12.0-15.5 g/dL (women) Hematocrit 38.8-50% (men), 34.9-44.5% (women)

Remember, these ranges can vary slightly depending on the laboratory and individual factors.

B. Liver Function Tests Demystified

Liver function tests (LFTs) are a group of blood tests that provide information about the health of your liver. These tests measure various enzymes, proteins, and substances that are produced or processed by the liver.

Key Liver Function Tests:

1. Alanine Transaminase (ALT)

2. Aspartate Transaminase (AST)

3. Alkaline Phosphatase (ALP)

4. Gamma-Glutamyl Transferase (GGT)

5. Bilirubin

6. Albumin

ALT and AST: These enzymes are found primarily in liver cells. Elevated levels can indicate liver damage from various causes, including viral hepatitis, alcohol abuse, or certain medications.

ALP: This enzyme is found in several organs, including the liver and bones. Elevated levels can suggest liver or bone disorders.

GGT: Often used in conjunction with other tests, elevated GGT can indicate liver disease or alcohol abuse.

Bilirubin: This yellowish pigment is a waste product from the breakdown of red blood cells. High levels can cause jaundice and may indicate liver problems or certain blood disorders.

Albumin: This protein is produced by the liver. Low levels can suggest advanced liver disease or malnutrition.

Understanding your LFT results can help you and your healthcare provider monitor your liver health and detect potential issues early.

C. Thyroid Function Indicators

Thyroid function tests are crucial for assessing the health of your thyroid gland, which plays a vital role in regulating metabolism, growth, and development.

Key Thyroid Function Tests:

1. Thyroid Stimulating Hormone (TSH)

2. Free Thyroxine (T4)

3. Free Triiodothyronine (T3)

TSH: This is typically the first test ordered to evaluate thyroid function. High levels can indicate hypothyroidism, while low levels may suggest hyperthyroidism.

Free T4 and Free T3: These tests measure the actual thyroid hormones in your blood. They're often ordered if TSH levels are abnormal to confirm a diagnosis.

Here's a simplified interpretation guide:

Test High Level Low Level TSH May indicate hypothyroidism May indicate hyperthyroidism Free T4 May indicate hyperthyroidism May indicate hypothyroidism Free T3 May indicate hyperthyroidism May indicate hypothyroidism

It's important to note that thyroid function can be complex, and results should always be interpreted by a healthcare professional in the context of your overall health and symptoms.

D. Kidney Health Markers

Kidney function tests are essential for assessing the health of your kidneys, which play a crucial role in filtering waste products from your blood, regulating blood pressure, and producing hormones.

Key Kidney Function Tests:

1. Creatinine

2. Blood Urea Nitrogen (BUN)

3. Estimated Glomerular Filtration Rate (eGFR)

4. Urine Albumin-to-Creatinine Ratio (UACR)

Creatinine: This waste product is produced by muscle metabolism. High levels in the blood can indicate decreased kidney function.

BUN: Urea is another waste product filtered by the kidneys. Elevated BUN levels can suggest kidney problems, but can also be affected by other factors like dehydration or high-protein diets.

eGFR: This calculated value estimates how well your kidneys are filtering waste. It's based on your creatinine level, age, sex, and race. A lower eGFR indicates decreased kidney function.

UACR: This test checks for small amounts of the protein albumin in your urine, which can be an early sign of kidney damage.

Here's a quick reference for interpreting eGFR results:

eGFR (mL/min/1.73 m²) Kidney Function 90 or higher Normal 60-89 Mildly decreased 30-59 Moderately decreased 15-29 Severely decreased Less than 15 Kidney failure

Understanding these kidney health markers can help you and your healthcare provider monitor your kidney function and detect potential issues early.

As we've explored the intricacies of laboratory test results, from CBC to kidney function tests, it's clear that these metrics provide valuable insights into your overall health. By familiarizing yourself with these tests and their interpretations, you can engage in more informed discussions with your healthcare provider and take a proactive approach to your health management. Next, we'll delve into vital signs and their importance in assessing your immediate health status.

Vital Signs and Their Importance

Now that we've covered laboratory test results, let's delve into vital signs - the critical indicators of your body's essential functions. Understanding these metrics is crucial for both patients and healthcare providers in assessing overall health and detecting potential issues early.

A. Heart Rate: Normal Ranges and Variations

Your heart rate, or pulse, is the number of times your heart beats per minute. It's a key indicator of your cardiovascular health and overall fitness level.

Normal Heart Rate Ranges

Age Group Normal Resting Heart Rate (beats per minute) Newborns (0-1 month) 70-190 Infants (1-11 months) 80-160 Children (1-2 years) 80-130 Children (3-4 years) 80-120 Children (5-6 years) 75-115 Children (7-9 years) 70-110 Children (10+ years) and Adults 60-100 Well-trained Athletes 40-60

It's important to note that these ranges are for resting heart rates. Your heart rate naturally increases during physical activity, stress, or emotional excitement.

Factors Affecting Heart Rate

Several factors can influence your heart rate:

1. Age: As you age, your resting heart rate tends to slow down slightly.

2. Fitness level: Regular exercise can lower your resting heart rate.

3. Body position: Standing up can increase your heart rate.

4. Emotions: Stress, anxiety, or excitement can cause your heart to beat faster.

5. Medications: Some drugs can affect your heart rate.

6. Hydration levels: Dehydration can cause your heart to beat faster.

Understanding your typical resting heart rate can help you identify when something might be amiss. A consistently high resting heart rate could indicate stress, dehydration, or underlying health issues.

B. Respiratory Rate: What It Tells Us

Respiratory rate refers to the number of breaths you take per minute. It's often overlooked but provides valuable information about your overall health.

Normal Respiratory Rate Ranges

Age Group Normal Respiratory Rate (breaths per minute) Newborns (0-6 weeks) 30-60 Infants (6 weeks - 6 months) 24-38 Toddlers (6 months - 3 years) 20-30 Preschoolers (3-6 years) 20-25 School-age children (6-12 years) 18-25 Adolescents (13-18 years) 12-20 Adults 12-20 Elderly (65+ years) 12-28

Significance of Respiratory Rate

Your respiratory rate can provide insights into various aspects of your health:

1. Lung function: Abnormal rates may indicate respiratory issues.

2. Cardiovascular health: The heart and lungs work together, so respiratory rate can reflect heart problems.

3. Metabolic state: Increased breathing rate might signal metabolic acidosis.

4. Fever: Respiratory rate often increases with elevated body temperature.

5. Pain levels: Severe pain can cause rapid, shallow breathing.

A consistently high respiratory rate (tachypnea) or low rate (bradypnea) should be discussed with a healthcare provider as it may indicate underlying health issues.

C. Body Temperature: When to Be Concerned

Body temperature is a measure of your body's ability to generate and get rid of heat. While 98.6°F (37°C) is often cited as the "normal" body temperature, everyone's baseline can vary slightly.

Normal Temperature Ranges

Method of Measurement Normal Temperature Range Oral 97.6°F - 99.6°F (36.4°C - 37.6°C) Rectal 97.9°F - 100.4°F (36.6°C - 38°C) Armpit 95.7°F - 99.1°F (35.4°C - 37.3°C) Ear 96.4°F - 100.4°F (35.8°C - 38°C)

When to Be Concerned

Fever is generally considered when body temperature rises above 100.4°F (38°C). However, the following situations warrant medical attention:

1. High fever: Temperature above 103°F (39.4°C) in adults.

2. Persistent fever: Lasting more than three days.

3. Fever with other symptoms: Such as severe headache, stiff neck, or rash.

4. Fever in infants: Any fever in babies under 3 months old requires immediate medical attention.

5. Low temperature: Body temperature below 95°F (35°C) can indicate hypothermia.

Remember, fever is often a sign that your body is fighting an infection. While uncomfortable, it's typically a good sign that your immune system is working.

D. Oxygen Saturation Levels

Oxygen saturation (SpO2) measures the percentage of hemoglobin in the blood that is saturated with oxygen. It's a critical vital sign, especially for those with respiratory or cardiovascular conditions.

Normal Oxygen Saturation Levels

For most healthy individuals, normal oxygen saturation levels are:

• 95% to 100% at sea level

• 90% or above for those with chronic lung diseases

Interpreting Oxygen Saturation Levels

Oxygen Saturation Level Interpretation 95% - 100% Normal 91% - 94% Mild hypoxemia 86% - 90% Moderate hypoxemia Below 86% Severe hypoxemia

Low oxygen saturation levels (hypoxemia) can indicate various health issues:

1. Lung diseases (e.g., COPD, pneumonia)

2. Sleep apnea

3. Anemia

4. Heart problems

5. High altitude exposure

It's important to note that oxygen saturation levels can fluctuate slightly throughout the day. However, consistently low levels or sudden drops should be evaluated by a healthcare professional.

Understanding these vital signs empowers you to take an active role in monitoring your health. Regular tracking can help you establish your personal baselines and identify potential health issues early. Remember, while these guidelines are helpful, they're not a substitute for professional medical advice. Always consult with your healthcare provider about any concerns or significant changes in your vital signs.

Next, we'll explore how you can track various fitness and wellness metrics to get a more comprehensive picture of your overall health.

Tracking Fitness and Wellness Metrics

As we delve deeper into understanding health metrics, it's crucial to explore how we can monitor our daily fitness and wellness. These metrics provide valuable insights into our overall health and can be powerful tools for maintaining and improving our well-being.

Steps and Activity Levels

One of the most accessible and widely used fitness metrics is step count. This simple measurement can provide a wealth of information about your overall activity level and has become increasingly popular with the rise of wearable fitness trackers and smartphones.

Why Steps Matter

• Easy to measure: Most smartphones and fitness trackers can count steps automatically.

• Encourages movement: Having a daily step goal can motivate you to be more active.

• Correlates with health outcomes: Higher step counts have been associated with reduced risk of various health conditions.

The commonly cited goal of 10,000 steps per day originated from a Japanese marketing campaign in the 1960s. However, recent research suggests that health benefits can be achieved at lower levels. Here's a breakdown of step counts and their potential health impacts:

Step Count Potential Health Impact < 5,000 Sedentary lifestyle 5,000-7,499 Low active 7,500-9,999 Somewhat active 10,000+ Active 12,500+ Highly active

Remember, any increase in steps can be beneficial. If you're currently sedentary, aim to increase your daily steps gradually.

Sleep Quality Measurements

Sleep is a crucial component of overall health and wellness. Poor sleep can negatively impact various aspects of health, including cognitive function, mood, and physical performance. Modern sleep tracking devices can provide insights into several key sleep metrics:

1. Total Sleep Time: The amount of time you actually spend asleep.

2. Sleep Efficiency: The percentage of time in bed that you're actually asleep.

3. Sleep Stages: Typically categorized as light sleep, deep sleep, and REM sleep.

4. Sleep Latency: The time it takes to fall asleep after getting into bed.

Interpreting Sleep Data

• Sleep Duration: Adults generally need 7-9 hours of sleep per night.

• Sleep Efficiency: A sleep efficiency of 85% or higher is considered good.

• Sleep Stages: While needs vary, a typical night might include:

  • 50-60% light sleep

  • 20-25% deep sleep

  • 20-25% REM sleep

It's important to note that while these devices can provide useful insights, they're not as accurate as clinical sleep studies. Use the data as a general guide rather than a definitive measure.

Resting Heart Rate as a Health Indicator

Resting heart rate (RHR) is the number of times your heart beats per minute when you're at rest. It's a simple yet powerful indicator of your cardiovascular health and overall fitness level.

Factors Affecting Resting Heart Rate

• Age

• Fitness level

• Hydration status

• Body position

• Emotions and stress levels

• Medications

Interpreting Resting Heart Rate

Resting Heart Rate (bpm) General Health Indication < 60 Excellent 60-70 Good 71-80 Average 81-90 Below Average > 90 Poor

Keep in mind that athletes and very fit individuals often have lower RHRs, sometimes below 60 bpm. Conversely, a consistently high RHR (above 100 bpm) could be a sign of an underlying health issue and should be discussed with a healthcare provider.

Stress Levels and HRV (Heart Rate Variability)

In recent years, Heart Rate Variability (HRV) has gained attention as a metric for tracking stress and recovery. HRV measures the variation in time between successive heartbeats.

Understanding HRV

• Higher HRV generally indicates better cardiovascular fitness and a more resilient stress response.

• Lower HRV can be associated with increased stress, poor sleep, or overtraining.

HRV is highly individual, so it's most useful to track your own trends over time rather than comparing to others. Many factors can influence HRV:

1. Age

2. Fitness level

3. Genetics

4. Diet

5. Sleep quality

6. Alcohol consumption

7. Stress levels

Using HRV to Guide Training and Recovery

Many athletes and fitness enthusiasts use HRV to guide their training:

• A higher than usual HRV might indicate good recovery and readiness for intense training.

• A lower than usual HRV might suggest the need for more recovery or lighter training.

It's important to note that while HRV can be a useful tool, it shouldn't be the sole factor in making decisions about your health or training. Always consider how you feel and consult with healthcare professionals or trainers when making significant changes to your routine.

By tracking these fitness and wellness metrics - steps, sleep quality, resting heart rate, and HRV - you can gain valuable insights into your overall health and make informed decisions about your lifestyle and activities. Remember, these metrics are tools to help you understand your body better, but they don't tell the whole story. Always consider how you feel and consult with healthcare professionals for a comprehensive view of your health.

Now that we've explored how to track and interpret various fitness and wellness metrics, let's move on to understanding medical imaging results, which provide another crucial perspective on our health status.

Understanding Medical Imaging Results

Medical imaging plays a crucial role in diagnosing and monitoring various health conditions. As patients, understanding these results can empower us to participate actively in our healthcare decisions. Let's explore the most common types of medical imaging and what to look for in their results.

X-rays: What to Look For

X-rays are one of the oldest and most widely used forms of medical imaging. They provide a two-dimensional view of the body's internal structures, particularly useful for examining bones and detecting certain lung conditions.

When looking at an X-ray, keep in mind:

1. Bone structures: Appear white or light gray

2. Soft tissues: Appear in various shades of gray

3. Air-filled spaces: Appear black

Here's a quick guide to interpreting common X-ray findings:

Finding Appearance Potential Indication Fracture Dark line through bone Broken bone Pneumonia White patches in lungs Lung infection Arthritis Narrowed joint spaces Joint inflammation Foreign object Bright white spot Ingested or embedded object

It's important to note that while these general observations can be helpful, only a trained healthcare professional should make a definitive interpretation of X-ray results.

CT Scans: Interpreting Cross-Sectional Images

Computed Tomography (CT) scans provide more detailed images than X-rays by creating cross-sectional views of the body. They're particularly useful for examining soft tissues, blood vessels, and internal organs.

When reviewing CT scan results, consider:

1. Slice thickness: Thinner slices provide more detailed images

2. Contrast: Areas highlighted by contrast material indicate blood flow or tissue characteristics

3. Hounsfield Units (HU): A scale used to measure tissue density

CT scans can reveal:

• Tumors or masses

• Internal bleeding

• Organ abnormalities

• Blood vessel blockages

Understanding CT scan results requires looking at multiple slices to form a complete picture. Radiologists often use specialized software to create 3D reconstructions, which can provide additional insights.

MRI Results: Tissue Differentiation

Magnetic Resonance Imaging (MRI) uses powerful magnets and radio waves to create detailed images of soft tissues, organs, and structures within the body. MRI is particularly useful for examining the brain, spinal cord, and musculoskeletal system.

Key aspects of MRI results include:

1. T1-weighted images: Fat appears bright, water appears dark

2. T2-weighted images: Fat and water both appear bright

3. Contrast enhancement: Areas that absorb contrast material appear brighter

MRI can detect:

• Brain abnormalities

• Spinal cord injuries

• Ligament and tendon damage

• Tumors and cysts

MRI results often include multiple sequences and views to provide a comprehensive assessment. Radiologists analyze these images to identify any abnormalities or changes in tissue structure.

Ultrasound Findings: Real-Time Visualization

Ultrasound imaging uses high-frequency sound waves to create real-time images of structures within the body. It's commonly used for examining organs, blood vessels, and monitoring fetal development during pregnancy.

When interpreting ultrasound results, consider:

1. Echogenicity: How structures reflect sound waves

2. Doppler imaging: Visualizes blood flow

3. Measurements: Size and dimensions of structures

Here's a brief overview of ultrasound echogenicity:

Echogenicity Appearance Example Structures Anechoic Black Fluid-filled structures (e.g., cysts) Hypoechoic Dark gray Solid organs (e.g., liver) Isoechoic Medium gray Similar density to surrounding tissue Hyperechoic White Dense structures (e.g., bone)

Ultrasound is particularly valuable for:

• Monitoring fetal development

• Examining abdominal organs

• Assessing blood flow in vessels

• Guiding needle biopsies

The real-time nature of ultrasound allows for dynamic assessment, making it an excellent tool for observing organ function and blood flow.

Understanding medical imaging results can be complex, but having a basic grasp of what to look for can help you engage more effectively with your healthcare provider. Remember that while these guidelines provide a general understanding, the interpretation of medical imaging requires specialized training and expertise.

As we've explored the various types of medical imaging and their interpretations, it's clear that each modality offers unique insights into our body's structures and functions. This knowledge forms an essential part of the broader picture of health metrics and diagnostic tools available to modern medicine. With this understanding of medical imaging, you're better equipped to comprehend and discuss your health status with your healthcare provider, leading to more informed decisions about your care and treatment options.

Health metrics are crucial tools that empower patients to take control of their well-being. By understanding common health indicators, interpreting laboratory results, monitoring vital signs, tracking fitness metrics, and comprehending medical imaging findings, patients can actively participate in their healthcare journey. These metrics provide valuable insights into one's overall health status and help identify potential health concerns early on.

Armed with this knowledge, patients can make informed decisions about their lifestyle choices and collaborate more effectively with healthcare providers. Remember, health metrics are not just numbers on a chart; they are powerful indicators of your body's functioning. By staying engaged with your health data and seeking clarification when needed, you can pave the way for a healthier, more informed future.