Glycated hemoglobin (A1C) is a valuable indicator of glycemic treatment effectiveness and should be measured at least every 3 months when glycemic targets are not being met and when antihyperglycemic therapy is being adjusted. In some circumstances, such as when significant changes are made to therapy or during pregnancy, it is appropriate to check A1C more frequently.
Awareness of all measures of glycemia—self-monitored blood glucose results, including self-monitored blood glucose (SMBG), flash glucose monitoring (FGM), continous glucose monitoring (CGM) and A1C—provides the best information to assess glycemic control.
Self-monitoring of blood glucose, FGM and CGM should not be viewed as glucose-lowering interventions, but rather as aids to assess the effectiveness of glucose-lowering interventions and to prevent and detect hypoglycemia.
Timing and frequency of SMBG may be determined individually based on the type of diabetes, the type of antihyperglycemic treatment prescribed, the need for information about blood glucose levels and the individual's capacity to use the information from testing to modify healthy behaviours or self-adjust antihyperglycemic agents.
SMBG, FGM and CGM linked with a structured educational and therapeutic program designed to facilitate behaviour change can improve blood glucose levels and prevent hypoglycemia.
A1C is a measurement of your average blood glucose control for the last 2 to 3 months. Approximately 50% of the value comes from the last 30 days.
You should have your A1C measured every 3 months when your blood glucose targets are not being met or when you are making changes to your diabetes management. In some circumstances, such as when significant changes are made to your glucose-lowering therapy or during pregnancy, your health-care provider may check your A1C more frequently.
Help you and your diabetes health-care team to make health behaviour and medication changes that will improve your blood glucose levels.
Discuss with your diabetes health-care team how often you should check your blood glucose level.
Glycated hemoglobin (A1C) is a reliable estimate of mean plasma glucose (PG) levels over the previous 8 to 12 weeks (1). The mean blood glucose (BG) level in the 30 days immediately preceding the blood sampling (days 0 to 30) contributes 50% of the result and the prior 90 to 120 days contributes 10% (2,3). In uncommon circumstances, where the rate of red blood cell turnover is significantly shortened or extended, or the structure of hemoglobin is altered, A1C may not accurately reflect glycemic status (Table 1).
A1C is the preferred standard for assessing glycated hemoglobin, and laboratories are encouraged to use assay methods that are standardized to the Diabetes Control and Complications Trial (DCCT) reference (4–6). A1C is a valuable indicator of treatment effectiveness and should be measured at least every 3 months when glycemic targets are not being met and when diabetes therapy is being adjusted or changed. Testing at 6-month intervals may be considered in situations where glycemic targets are consistently achieved (4,7). In some circumstances, such as when significant changes are made to therapy, or during pregnancy, it is appropriate to check A1C more frequently (see Diabetes and Pregnancy chapter, p. S255).
A1C may also be used for the diagnosis of diabetes in adults (see Screening for Diabetes in Adults chapter, p. S16). In Canada, A1C is reported using the National Glycohemoglobin Standardization Program (NGSP) units (%). In 2007, a consensus statement from the American Diabetes Association, European Association for the Study of Diabetes and the International Diabetes Federation called for A1C reporting worldwide to change to dual reporting of A1C with the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) SI units (mmol/mol) and derived NGSP units (%) with the hope of fully converting to exclusive reporting in SI units (8). However, this has not been adopted worldwide, and both Canada and the United States still use the NGSP units (%) (9). Although there are some advantages to reporting in SI units, the most notable disadvantage is the massive education effort that would be required to ensure recognition and adoption of the new units. Canada is currently not performing dual reporting; therefore, throughout this document, A1C is still written in NGSP units (%). For those who wish to convert NGSP units to SI units, the following equation can be used: IFCC = 10.93 (NGSP) − 23.50 (10) (see Appendix 15. Glycated Hemoglobin Conversion Chart for conversion of A1C from NGSP units to IFCC SI units).
Point-of-care A1C analyzers are bench-top instruments that use a finger-prick capillary blood sample. They are designed for use in a health-care provider's office, a treatment room or at a bedside. The blood is applied to a test cartridge and the sample is analyzed within several minutes (11). Point-of-care A1C testing has several potential advantages over laboratory A1C testing, including rapid test results to expedite medical decision-making, convenience for people with diabetes, potential improved health system efficiency and improved access to testing for underserved populations (12). A number of point-of-care A1C devices are commercially available for monitoring glycemic control; however, a United Kingdom systematic review concluded that evidence of the impact of using point-of-care A1C testing on medication use, clinical decision-making and participants' outcomes is lacking, and that a randomized trial with economic evaluation is needed (13). Currently, no point-of-care A1C analyzers are approved for the diagnosis of diabetes.
Several studies have shown that A1C concentrations are higher in some ethnic groups (African, Asian, Hispanic) than in Caucasian persons with similar plasma glucose concentrations (14–19). In 1 cross-sectional study, A1C was 0.13 to 0.47 percentage points higher in African American than in Caucasian persons, with the difference increasing as glucose intolerance worsened. However, all of these studies estimated mean glucose levels on the basis of very limited measurements and, as a result, it is not clear whether the higher A1C observed in certain ethnic groups is due to worse glycemic control or racial variation in the glycation of hemoglobin. If differences in A1C between ethnic groups exist, the differences appear to be small and have not been shown to significantly modify the association between A1C and cardiovascular outcomes (20), retinopathy (21) or nephropathy (22).
Monitoring blood glucose levels, whether using traditional self monitoring of blood glucose (SMBG) devices or more recent flash glucose monitoring (FGM), can serve as a useful adjunct to other measures of glycemia, including A1C. Most people with diabetes benefit from monitoring BG for a variety of reasons (23,24). Monitoring BG is the optimal way to confirm and appropriately treat hypoglycemia. It can provide feedback on the results of healthy behaviour interventions and antihyperglycemic pharmacological treatments. It can increase one's empowerment and adherence to treatment. It can also provide information to both the person with diabetes and their diabetes health-care team to facilitate longer-term treatment modifications and titrations as well as shorter-term treatment decisions, such as insulin dosing for people with type 1 or type 2 diabetes. Finally, in situations where A1C does not accurately reflect glycemia (Table 1), monitoring BG is necessary to adequately monitor glycemia (25).
Monitoring BG is most effective when combined with an education program that incorporates instruction for people with diabetes on healthy behaviour changes in response to BG values and for health-care providers on how to adjust antihyperglycemic medications in response to BG readings (26–30). As part of this education, people with diabetes should receive instruction on how and when to perform self-monitoring; how to record the results in an organized fashion; the meaning of various BG levels and how behaviour and actions affect BG results.
The recommended frequency of monitoring BG may be individualized to each person's unique circumstances. Factors influencing this recommendation include type of diabetes, type of antihyperglycemic therapy, changes to antihyperglycemic therapy, adequacy of glycemic control, literacy and numeracy skills, propensity to hypoglycemia, awareness of hypoglycemia, occupational requirements and acute illness.
For people with type 1 diabetes, monitoring BG is essential to achieving and maintaining good glycemic control. In a large cohort study, performance of ≥3 self-tests per day was associated with a statistically and clinically significant 1.0% absolute reduction in A1C (8). The evidence is less certain in people with type 2 diabetes treated with insulin, although the above principle likely applies (8). In a large, non-randomized study of individuals with stable type 2 diabetes using insulin, testing at least 3 times a day was associated with improved glycemic control (31). More frequent testing, including preprandial and 2-hour postprandial PG (31,32) and occasional overnight BG measurements, is often required to provide the information needed to reduce hypoglycemia risk, including unrecognized nocturnal hypoglycemia (33–37).
For people with type 2 diabetes treated with healthy behaviour interventions, with or without noninsulin antihyperglycemic agents, the effectiveness and frequency of monitoring BG in improving glycemic control is less clear (23,24,38–47). A series of recent meta-analyses, all using different methodologies and inclusion criteria, have generally shown a small benefit to reducing A1C in those individuals performing SMBG compared to those who did not (48–54). The magnitude of the benefit is small, with absolute A1C reductions ranging from 0.2% to 0.5%. These analyses demonstrated greater A1C reductions in those performing SMBG when the baseline A1C was >8% (30,48,51,55). SMBG has been demonstrated to be most effective in persons with type 2 diabetes within the first 6 months after diagnosis (56). Also of significance, there is no evidence that SMBG affects one's satisfaction, general well-being or general health-related quality of life (56).
Most trials in noninsulin-treated people with type 2 diabetes are of limited value as baseline A1C levels were typically <8.0%, and the trials did not include a component of educational and therapeutic intervention in response to BG values. Several recent, well-designed randomized controlled trials that have included this component have demonstrated reductions in A1C (30,57,58). In the Structured Testing Program (STeP) trial, 483 poorly controlled participants with diabetes not on insulin (mean A1C >8.9%) were randomized to either an active control group with enhanced usual care or a structured testing group with enhanced usual care and at least quarterly use of structured SMBG (30). At 1 year, there was a significantly greater reduction in mean A1C in the structured testing group compared with the active control group (−0.3%, p=0.04). Significantly more structured testing group participants received a treatment change recommendation compared with active control group participants. In the Role of Self-Monitoring of Blood Glucose and Intensive Education in Patients with Type 2 Diabetes Not Receiving Insulin (ROSES) trial, participants were randomly allocated to either a self-monitoring-based diabetes management strategy with education on how to modify health behaviours according to SMBG readings or to usual care (57). Results of SMBG were discussed during monthly telephone contact. After 6 months, significantly greater reductions in mean A1C (−0.5%, p=0.04) and body weight (−4.0 kg, p=0.02) were observed in the SMBG group compared with the usual care group. In the St. Carlos trial, newly diagnosed people with type 2 diabetes were randomized to either an SMBG-based intervention or an A1C-based intervention (58). In the SMBG intervention group, SMBG results were used as both an educational tool to promote adherence to healthy behaviour modifications as well as a therapeutic tool for adjustment of antihyperglycemic pharmacologic therapy. Treatment decisions for the A1C cohort were based strictly on A1C test results. After 1 year of follow up, median A1C level and body mass index (BMI) were significantly reduced in participants in the SMBG intervention group (from 6.6% to 6.1%, p<0.05; and from 29.6 kg to 27.9 kg, p<0.01). In the A1C-based intervention group, there was no change in median A1C or BMI. The evidence is less clear about how often, once recommended, SMBG should be performed by persons with type 2 diabetes not treated with insulin.
Separate from the ability of the person with diabetes to use self-monitored glucose to lower A1C, monitoring glucose should be considered for the prevention, recognition and treatment of hypoglycemia in persons whose regimens include an insulin secretagogue due to the higher risk of hypoglycemia with this class of antihyperglycemic agents (59). On the other hand, for people with type 2 diabetes who are managed with healthy behaviour interventions, with or without non-insulin antihyperglycemic agents associated with low risk of hypoglycemia, and who are meeting glycemic targets, very infrequent monitoring may be needed (see Appendix 5. Self-Monitoring of Blood Glucose [SMBG] Recommendation Tool for Health-Care Providers).
Variability can exist between BG results obtained using SMBG devices and laboratory testing of PG. At BG levels >4.2 mmol/L, a difference of <15% between SMBG and simultaneous venous fasting plasma glucose (FPG) (after at least an 8-hour fast), is considered acceptable (60). In order to ensure accuracy of SMBG, results should be compared with a laboratory measurement of FPG at least annually or when A1C does not match SMBG readings. Periodic re-education on correct SMBG technique may improve the accuracy of SMBG results (61,62). In rare situations, therapeutic interventions may interfere with the accuracy of some SMBG devices. For example, icodextrin-containing peritoneal dialysis solutions may cause falsely high readings in meters utilizing glucose dehydrogenase. Care should be taken to select an appropriate meter with an alternative glucose measurement method in such situations.
Meters are available that allow SMBG using blood samples from sites other than the fingertip (forearm, palm of the hand, thigh). Accuracy of results over a wide range of BG levels and during periods of rapid change in BG levels is variable across sites. During periods of rapid change in BG levels (e.g. after meals, after exercise and during hypoglycemia), fingertip testing has been shown to more accurately reflect glycemic status than forearm or thigh testing (63,64). In comparison, blood samples taken from the palm near the base of the thumb (thenar area) demonstrate a closer correlation to fingertip samples at all times of day and during periods of rapid change in BG levels (65,66).
Ketone testing is recommended for all individuals with type 1 diabetes during periods of acute illness accompanied by elevated BG, when preprandial BG levels remain elevated (>14.0 mmol/L), or when symptoms of diabetic ketoacidosis (DKA) (such as nausea, vomiting or abdominal pain) are present (4). If all of these conditions are present in type 2 diabetes, ketone testing should be considered, as DKA also can occur in these individuals.
During DKA, the equilibrium that is usually present between ketone bodies shifts toward formation of beta-hydroxybutyric acid (beta-OHB). As a result, testing methods that measure blood beta-OHB levels may provide more clinically useful information than those that measure urine acetoacetate or acetone levels. Assays that measure acetoacetate through urine testing may not identify the onset and resolution of ketosis as quickly as those that quantify beta-OHB levels in blood, since acetoacetate or acetone can increase as beta-OHB decreases with effective treatment (60). Meters that quantify beta-OHB from capillary sampling may be preferred for self-monitoring of ketones, as they have been associated with earlier detection of ketosis and may provide information required to prevent progression to DKA (66–68). This may be especially useful for individuals with type 1 diabetes using continuous subcutaneous insulin (CSII) therapy, as interruption of insulin delivery can result in rapid onset of DKA (69).
Continuous glucose monitoring (CGM) systems measure glucose concentrations in the interstitial fluid. Two types of devices are available. The "real time" (also called "personal") CGM provides information directly to the user by displaying moment-to–moment absolute glucose levels and trending arrows, and by providing alarm notifications in the event that the glucose level is above or below a preset limit. A "blinded" (sometimes referred to as "professional") CGM captures, but does not display, the glucose readings, which are then downloaded onto a computer for viewing and retrospective analysis by the health-care provider (typically in conjunction with the user).
CGM technology incorporates a subcutaneously inserted sensor, an attached transmitter and, in the case of real-time CGM, a display unit (which may be a stand-alone unit or be integrated into an insulin pump). In professional CGM, the "transmitter" captures and retains the data. In Canada, 2 real-time CGM and 2 professional CGM are available. Real-time CGM has been consistently shown to reduce A1C in both adults (70–81) and children (71,73,75,76,78,79,82) with type 1 diabetes with and without CSII, and to reduce A1C in adults with type 2 diabetes (83). Real-time CGM also has been shown to reduce the time spent in hypoglycemia (78,80,81,84). Professional CGM has been shown to reduce A1C in adults with type 2 diabetes (85) and in pregnant women with type 1 or type 2 diabetes (86).
Successful use of CGM is dependent on adherence with duration of time the CGM is used. The greater the time wearing the device, typically the better the A1C (72,73,76,77,82,86). Like SMBG, CGM provides the best outcomes if it is associated with structured educational and therapeutic programs. CGM is not a replacement for SMBG because SMBG is still required for calibration of the CGM device. Some real-time CGM devices require SMBG to confirm interstitial measurements prior to making therapeutic changes or treating suspected hypoglycemia; whereas other devices only require SMBG if glucose alerts and readings do not match symptoms.
Flash glucose monitoring (FGM) also measures glucose concentration in the interstitial fluid, however, FGM differs from CGM technology in several ways. FGM is factory calibrated and does not require capillary blood glucose (with SMBG device) calibration. BG levels are not continually displayed on a monitoring device but instead are displayed when the sensor is "flashed" with a reader device on demand. The FGM reader also displays a plot profile of the last 8 hours, derived from interpolating glucose concentrations recorded every 15 minutes. Therefore, when the person with diabetes performs ≥3 sensor scans per day at ≤8 hour intervals, the FGM records 24-hour glucose profiles. The sensor can be worn continuously for up to 14 days. The device does not provide low or high glucose alarms.
In the Randomised Controlled Study to Evaluate the Impact of Novel Glucose Sensing Technology on Hypoglycaemia in Type 1 Diabetes (IMPACT) trial, FGM without the use of SMBG decreased hypoglycemia in participants with well-controlled type 1 diabetes (A1C <7.5%) on either MDI or CSII, an average of 74 minutes per day, for a 38% reduction compared with a control group (87). In addition, a 40% reduction in the time spent in hypoglycemia at night, a 50% reduction in serious hypoglycemia and a reduction of routine SMBG measurements by 91%. In the Randomised Controlled Study to Evaluate the Impact of Novel Glucose Sensing Technology on HbA1c in Type 2 Diabetes trial, in individuals with type 2 diabetes, the use of FGM vs. SMBG resulted in a similar drop in A1C, but a significant reduction in time spent in hypoglycemia, <3.9 mmol/l by 43%, <3.1 mmol/L by 53%, reduced nocturnal hypoglycemia by 54%, reduced glycemic variability and improved quality of life. There was a statistical reduction in A1C for participants <65 years at 3 and 6 months (−0.53% and -0.20% respectively) (88).
For most individuals with diabetes, A1C should be measured approximately every 3 months to ensure that glycemic goals are being met or maintained [Grade D, Consensus]. In some circumstances, such as when significant changes are made to therapy, or during pregnancy, it is appropriate to check A1C more frequently. Testing at least every 6 months should be performed in adults during periods of treatment and healthy behaviour stability when glycemic targets have been consistently achieved [Grade D, Consensus].
For individuals using insulin more than once a day, SMBG should be used as an essential part of diabetes self-management [Grade A, Level 1 (34), for type 1 diabetes; Grade C, Level 3 (23), for type 2 diabetes] and should be undertaken at least 3 times per day [Grade C, Level 3 (23,31)] and include both pre- and postprandial measurements [Grade C, Level 3 (31,32,89)]. For individuals with type 2 diabetes on once-daily insulin in addition to noninsulin antihyperglycemic agents, testing at least once a day at variable times is recommended [Grade D, Consensus].
For individuals with type 2 diabetes not receiving insulin therapy, frequency of SMBG recommendations should be individualized depending on type of antihyperglycemic agents, level of glycemic control and risk of hypoglycemia [Grade D, Consensus].
If achieving glycemic targets or receiving antihyperglycemic medications not associated with hypoglycemia, infrequent SMBG is appropriate [Grade D, Consensus].
In many situations, for all individuals with diabetes, more frequent SMBG testing should be undertaken to provide information needed to make health behaviour or antihyperglycemic medication adjustments required to achieve desired glycemic targets and avoid risk of hypoglycemia [Grade D, Consensus].
In people with type 1 diabetes who have not achieved their glycemic target, real-time CGM may be offered to improve glycemic control [Grade A, Level 1A (71,80,81) for non-CSII users; Grade B, Level 2 for CSII users (71)] and reduce duration of hypoglycemia [Grade A, Level 1A (78,80,84)] in individuals who are willing and able to use these devices on a nearly daily basis.
FGM may be offered to people with diabetes to decrease time spent in hypoglycemia [Grade B, Level 2 (87) for type 1 diabetes; Grade B, Level 2 (88) for type 2 diabetes].
In order to ensure accuracy of BG meter readings, meter results should be compared with laboratory measurement of simultaneous venous FPG (8-hour fast) at least annually and when A1C does not match glucose meter readings [Grade D, Consensus].
Individuals with type 1 diabetes should be instructed to perform ketone testing during periods of acute illness accompanied by elevated BG, when preprandial BG levels remain >14.0 mmol/L or in the presence of symptoms of DKA [Grade D, Consensus]. Blood ketone testing methods may be preferred over urine ketone testing, as they have been associated with earlier detection of ketosis and response to treatment [Grade B, Level 2 (67)].
A1C, glycated hemoglobin; BG, blood glucose; BMI, body mass index CBG; capillary blood glucose; CGM, continuous glucose monitoring; CGMS, continuous glucose monitoring system; CSII, continuous subcutaneous infusion infusion; DKA, diabetic ketoacidosis; FGM; flash glucose monitoring; FPG, fasting plasma glucose; PG, plasma glucose; SMBG, self-monitoring of blood glucose.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097 (91).
Lori Berard has received consulting and/or speaker fees from Bayer, Boehringer Ingelheim, Sanofi, Eli Lilly, Novo Nordisk, Janssen, AstraZeneca, and Merck. Rick Siemens reports personal fees from Sanofi, Novo Nordisk, Mont-Med, Abbott, Merck, AstraZeneca, Lifescan, and Janssen, outside the submitted work. Dr. Woo has nothing to disclose.
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UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837–53.
Notice: New requirements for medical device licence applications for lancing devices and blood glucose monitoring systems [press release]. Ottawa, 2014.
Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care 2001;24:561–87.
Bergenstal R, Pearson J, Cembrowski GS, et al. Identifying variables associated with inaccurate self-monitoring of blood glucose: Proposed guidelines to improve accuracy. Diabetes Educ 2000;26:981–9.
Jungheim K, Koschinsky T. Glucose monitoring at the arm: Risky delays of hypoglycemia and hyperglycemia detection. Diabetes Care 2002;25:956–60.
Ellison JM, Stegmann JM, Colner SL, et al. Rapid changes in postprandial blood glucose produce concentration differences at finger, forearm, and thigh sampling sites. Diabetes Care 2002;25:961–4.
Bina DM, Anderson RL, Johnson ML, et al. Clinical impact of prandial state, exercise, and site preparation on the equivalence of alternative-site blood glucose testing. Diabetes Care 2003;26:981–5.
Jungheim K, Koschinsky T. Glucose monitoring at the thenar: Evaluation of upper dermal blood glucose kinetics during rapid systemic blood glucose changes. Horm Metab Res 2002;34:325–9.
Bektas F, Eray O, Sari R, et al. Point of care blood ketone testing of diabetic patients in the emergency department. Endocr Res 2004;30:395–402.
Khan AS, Talbot JA, Tieszen KL, et al. Evaluation of a bedside blood ketone sensor: The effects of acidosis, hyperglycaemia and acetoacetate on sensor performance. Diabet Med 2004;21:782–5.
Guerci B, Benichou M, Floriot M, et al. Accuracy of an electrochemical sensor for measuring capillary blood ketones by fingerstick samples during metabolic deterioration after continuous subcutaneous insulin infusion interruption in type 1 diabetic patients. Diabetes Care 2003;26:1137–41.
Guerci B, Floriot M, Bohme P, et al. Clinical performance of CGMS in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs. Diabetes Care 2003;26:582–9.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Bode B, Beck RW, et al. Sustained benefit of continuous glucose monitoring on A1C, glucose profiles, and hypoglycemia in adults with type 1 diabetes. Diabetes Care 2009;32:2047–9.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Effectiveness of continuous glucose monitoring in a clinical care environment: Evidence from the Juvenile Diabetes Research Foundation continuous glucose monitoring (JDRF-CGM) trial. Diabetes Care 2010;33:17–22.
Bergenstal RM, Tamborlane WV, Ahmann A, et al. Effectiveness of sensoraugmented insulin-pump therapy in type 1 diabetes. N Engl JMed 2010;363:311–20.
Lind M, Polonsky W, Hirsch IB, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treatedwith multiple daily insulin injections: The GOLD randomized clinical trial. JAMA 2017;317:379–87.
Chase HP, Beck RW, Xing D, et al. Continuous glucose monitoring in youth with type 1 diabetes: 12-month follow-up of the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial. Diabetes Technol Ther 2010;12:507–15.
Yoo HJ, An HG, Park SY, et al. Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes. Diabetes Res Clin Pract 2008;82:73–9.
Garg SK, Voelmle MK, Beatson CR, et al. Use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injections versus continuous subcutaneous insulin infusion therapy: A prospective 6-month study. Diabetes Care 2011;34:574–9.
Cosson E, Hamo-Tchatchouang E, Dufaitre-Patouraux L, et al. Multicentre, randomised, controlled study of the impact of continuous sub-cutaneous glucose monitoring (GlucoDay) on glycaemic control in type 1 and type 2 diabetes patients. Diabetes Metab 2009;35:312–18.
Murphy HR, Rayman G, Lewis K, et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: Randomised clinical trial. BMJ 2008;337:a1680.
Bolinder J, Antuna R, Geelhoed-Duijvestijn P, et al. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: A multicentre, non-masked, randomised controlled trial. Lancet 2016;388:2254–63.
Haak T, Hanaire H, Ajjan R, et al. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: A multicenter, open-label randomized controlled trial. Diabetes Ther 2017;8:55–73.
Rohlfing CL, Wiedmeyer HM, Little RR, et al. Defining the relationship between plasma glucose and HbA(1c): Analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care 2002;25:275–8.
Kempf K, Tankova T, Martin S. ROSSO-in-praxi-international: Long-term effects of self-monitoring of blood glucose on glucometabolic control in patients with type 2 diabetes mellitus not treated with insulin. Diabetes Technol Ther 2013;15:89–96.


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Antitrust Alert: U.S. Merger Notification and Interlocking Directorates Thresholds Announced for 2013
January 2013 Alerts
Yesterday the Federal Trade Commission announced the Hart-Scott-Rodino ("HSR") Act thresholds that will apply to transactions closing on or after February 11, 2013. The Commission also announced revised jurisdictional thresholds that trigger the prohibition on interlocking directorates under Section 8 of the Clayton Act, which will take effect immediately upon publication in the Federal Register. These thresholds are revised annually to reflect changes in the gross national product.
New HSR thresholds
Size-of-Transaction Threshold. An HSR filing may be required if the acquirer will hold, as a result of the transaction, voting securities, non-corporate interests and assets of the acquired person valued in excess of $70.9 million. If the Size-of-Transaction is between $70.9 million and $283.6 million, the transaction also must satisfy the Size-of-Persons threshold. Transactions valued in excess of $283.6 million may require a filing without regard to the Size-of-Person threshold.
Size-of-Person Threshold. If the value of the securities, non-corporate interest and assets held as a result of a transaction is between $70.9 million and $283.6 million, the transaction must be reported in most cases if either the acquired or acquiring person has annual net sales or total assets of at least $141.8 million and the other party to the transaction has at least $14.2 million in annual net sales or total assets.
New Interlocking Directorates Thresholds
Section 8 of the Clayton Act prohibits the same person from serving as an officer or director of competing corporations if the statutory thresholds are met. Based on the revised thresholds, competitor corporations are covered by Section 8 if each one has capital, surplus, and undivided profits aggregating more than $28,883,000 (Section 8(a)(1)), except that no corporation is covered if the competitive sales of either are less than $2,888,300 (Section 8(a)(2)(A)).
Tom D. Smith
tdsmith@jonesday.com
Bevin M.B. Newman
bmnewman@jonesday.com
Pam Taylor
ptaylor@jonesday.com
Pamela L. Taylor
Chicago + 1.312.269.4327

redpajama_set_name: RedPajamaCommonCrawl


Milner School of English is family owned and operated, with over 35 years experience of running language schools. It is located in central Wimbledon - a safe and prosperous area, close to train stations and less than 20 minutes from central London by train. We have multinational classes with an average of 9 students per class, 12 maximum.


Dispute The Tax Problems Canada - Tax 911 NOW!
For many individual taxpayers and small business enterprise owners in Canada, it is prudent to be prepared to deal with the CRA concerning tax disputes. Tax problems Canada are not easily manageable. You have to depend on professional tax help. Knowing a little basics of the process of tax disputes in Canada will help you understand your rights better when you have to deal with the CRA.
The tax system in Canada is based on self-reporting. It means that every Canadian taxpayer carries the obligation to report the tax amount accurately each financial year. This is the main rationale behind the filing of the tax return on an annual basis. The CRA will process the tax returns and decide on whether it agrees or disagrees with the information that has been reported by the taxpayers. It will then provide the taxpayers with a Notice of Assessment. With the receipt of this notice, tax problems Canada will start to surface.
Disputes may take various shapes after you receive the Notice of Assessment from the CRA. It may ask for more information and audit the taxpayers to get more data concerning their tax obligations. An audit could be focused or narrowed down on micro issues or it may be a comprehensive one that reviews information about every aspect of personal finances or business transactions.
Tax problems Canada are not over with the completion of a tax audit. The CRA may decide that the tax return was accurate to begin with and it may agree with whatever that was reported on the individual tax returns. Conversely, it may disagree with whatever was reported on the tax returns. When the CRA disagrees with the taxpayers, the auditor will get a proposal letter issued outlining the position of the CRA on how it proposes to reassess the taxpayers. The current procedure is to give a thirty-day period for the taxpayers to make further submissions to the CRA auditor with respect to the proposal letter, compounding the tax problems Canada. If professional tax help is sought, the consultants will help the taxpayers in facing these tax problems Canada and they will even be able to represent their clients throughout the process of the tax audit by the CRA to make sure that the taxpayers are being treated fairly by the CRA auditor.
When the Notice of Reassessment is received by the taxpayers, it will inform them of the amount of tax that is due from them as a result of that reassessment. The date that is stamped on the Notice of Reassessment is important and it has to be noted down carefully. This is the beginning of the ninety-day appeal period. This letter contains all the information which is required by the taxpayers should they want to dispute the amount of the involved tax along with penalties and interest charges.
If there is something that the taxpayers want to dispute about, tax problems Canada continue and they have to take shape in the form of a Notice of Objection on their part. This objection notice has to be filed with the Chief of Appeals of the CRA. This has to be filed before the ninety day period from the date of the Notice of Reassessment expires.


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Heres Why Fans Are Convinced That Ed Sheeran Is Doing a Remix With Taylor Swift
ByLily James
After teasing fans for years, Ed Sheeran has confirmed his upcoming collaboration with Taylor Swift. The singer and the pop star have been working together since 2012, when Sheeran opened for Swift on her Red Tour. The pair has already teamed up on two tracks – "Hello" and "Shake It Off." But it is still unclear if the duo will do a full-fledged remix.
Fans are convinced that the two singers are collaborating on an upcoming duet. The two have collaborated on a number of songs, and both have hinted that the two may team up again on a song. The pair recently appeared on the greenroom of the Saturday Night Live studio and performed a duet of "The Joker and The Queen." Although the song has not been released yet, it is expected to drop in 2022.
While the news about the new album is exciting, there is also plenty of speculation surrounding the relationship between Swift and Sheeran. The singer recently shared an Instagram photo of a new CD with the actress Taylor Swift. In the photo, Sheeran and Swift resembled a deck of cards. The ace and king are both sexy, and the queen has a queen-like appearance. She also added a caption saying "Keep an eye out."
Also Read: Rosalia Shares Motomami Cover Art and Reveals New Song Is Coming This Week
The two singers have previously teased "The Joker And The Queen" on social media. After the release of the album, Sheeran shared a clip of the song on Twitter. Run is the first track the two teamed up on. The other two songs, Everything Has Changed and Run, were released with the previous Red album. The duo recorded the songs again for the version with Taylor.
There are many rumors about a potential collaboration between Taylor Swift and Ed Sheeran. The British singer was coy about the rumours about the upcoming album, but the news about a Taylor Swift-Ed Sheeran re-recording are the most popular among his fans. The album has sold nearly five million copies in the US. It is the fifth song to achieve triple platinum in the 21st century.
Also Read: No Way Home's Big Death Scene Changed From the Original Plan
The news that Taylor Swift will be re-recording her song, "X," has been met with mixed reactions. The former's relationship with the pop singer is more than just a friendship. The singer have been spotted hanging out for years. A recent photo of the two was shared on YouTube, and the song was later released.
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There is much to consider when sourcing any bearing product which may be destined for use in a wide range of manufacturing applications. In view of the current economic climate, many budgets continue to be squeezed and some purchasing or production managers may be tempted to save a few pounds on lower quality bearings, but inevitably this will often prove to be a false economy in the long run.
In any plant and works situation, the bearing will usually be the most precise engineered component within a system. Some would say that bearings take on the importance of a highly engineered commodity with a myriad of requirements, needs and uses across the globe.
Today there are currently many sectors, especially in manufacturing, where the market continues to be challenging and production and operations managers and directors are increasingly under pressure to keep their spend to a minimum. It can be tempting to seek lower cost bearings, but this can come at a price and may cause premature failure during a vital process or operation with the obvious implications of plant shutdown, lost production and unscheduled maintenance costs.
So what should the specifier look for when selecting bearings? Potentially at the top of the list is the experience and knowledge of the supplier or distributor. Working with established companies who have an excellent reputation and proven track record with their customers and getting the right advice at the start of the selection process is something that cannot be underestimated for a successful outcome. As with most situations, good business relationships are usually built on trust in the quality of the product and service received.
It is important to work with a supplier that guarantees a high standard of product and has quality assurance systems in place to ensure standards are not compromised.
Close examination of the bearing specification and consideration of how it will perform to meet expectations, is vitally important at the outset.
Buyers should always go for the best quality their budget will allow and if working with distributors, ensure that they possess the right level of technical ability to support them and their product. High technical competence will also be invaluable throughout the selection process as under or over specification can cause a range of operational problems and may lead to inefficiency and even increased energy costs in some circumstances.
Choosing products from major brand manufacturers which carry ISO 9001 accreditation will demonstrate that they are committed to high quality as well as providing good value for money. This will pay dividends in the future and in line with this, it is also important to work with distributors who also carry the ISO 9001 standard. Again the same quality of products, knowledge and systems will run throughout the organisation to deliver a successful outcome.
Another important aspect of ensuring correct standards are held by the supplier is that of traceability. Most customers from a varied range of sectors these days will demand a bearing that has full traceability from where and when it was made, from the raw materials, right through to the component assembly of the final bearing. This should be a pre-requisite for many organisations when sourcing bearings.
Any apparent savings from lower cost, unbranded products will all too soon be eroded when any bearing failures have to be rectified. This will entail not only a replacement bearing and installation costs but will, as mentioned earlier, result in lost production and downtime. For those supplying manufacturing machinery, loss of reputation is also a potential outcome and is something that cannot easily be repaired and regained afterwards.
Bearings that are thoroughly and adequately tested will ensure the customers' confidence in what they are buying. For example, quality distributors will supply products from recognised manufacturers which have their own in-house metallurgy departments and research facilities where products are extensively tested, so that customers can have absolute confidence in the bearings they are purchasing.
Probably most important when selecting bearings is to carefully assess the application they are to be used for and this is where the bearing provider can make a big difference. Bearings can be used from something as small and simple as a skateboard to a highly complicated aerospace application and while the product principle will be the same, the actual demands of the application are worlds apart in their requirements Care needs to be taken to 'design in' a number of elements such as the overall size, speed and load it will need to handle as well as the direction of load.
The environment that a bearing has to run in will affect the selection significantly. Dirty and dusty applications will require adequate sealing, and applications in the food industry may require stainless steel bearings that cope better with aggressive wash down procedures. High temperatures create their own special challenges and these need to be factored into the selection process. These are just a few examples of many possible considerations that will need to be made.
When purchasing any type of bearing, confidence in the product, the manufacturer and distributor is key for complete peace of mind. If seeking a new bearing for a particular application, then working with those who have the experience and knowledge to help and advise in finding the best solution will be time and money well spent. When sourcing any bearing product, avoid the temptation to cut corners with lower cost products, as this could be an unwise move in the long run.
Nationwide specialist bearing distributor, INDUSTRIA BEARINGS & TRANSMISSIONS, reports it is highlighting its range of chain guide products from Murtfeldt, which are suitable for multiple industrial applications. Key products from the German manufacturer include chain guides, which are available for both roller and round link versions to provide quiet, smooth running protection for chains that operate on metal guides. Optimum running properties are combined with reliable and long term operation.
INDUSTRIA BEARINGS & TRANSMISSIONS reports it has been awarded an important internationally recognised accreditation for the products and services it provides to customers in the aerospace industry. The company says it has received the coveted EN 9120 Bureau Veritas Certification, which verifies its Quality Management Systems conform to both BS EN ISO 9001:2008 and EN 9120:2010, which is also technically equivalent to AS9120.
Uxbridge based INDUSTRIA BEARINGS & TRANSMISSIONS has confirmed it has been appointed as exclusive distributors of GMN high precision products for the UK.


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Living From Your Essence
Gloria Constantin, Human Design Counselor
ABOUT GLORIA
HUMAN DESIGN COACHING CONVERSATIONS
QUANTUM ASTROLOGY
QUANTUM DESIGN (ASTROLOGY + HUMAN DESIGN)
QUANTUM ALIGNMENT SESSIONS
Your Soul Role Profile
P A C K A G E S
Human Design Affordable Classes
Learn Human Design
Learn Human Design & Energy Tools
SESSIONS & FEES
Life Between Lives Regression Session
Notes from a life between lives regression session conducted by Gloria Constantin and used by permission.
Edmund was an extremely talented musician who had planned to spend his life composing epic works for orchestra and piano. However, that goal was short-circuited when family business matters unexpectedly demanded that he take the lead in running them, effectively thwarting his intentions. The past life as Edmund, a wealthy man in 1800's New York City, seems (for both Client and Edmund) to have been a pointless acquisition/ accumulation of wealth. Edmund is happy to be done with this life. The pursuits led nowhere; he feels he could have been better served doing something else. This was a lifetime devoted to maintaining the status quo and keeping up with the Joneses. There was so much time spent on pointless acquisition of wealth and status. This life did not nurture his soul, and he knew this, but he engaged in these pursuits because everyone else did. He felt removed from his family and other close connections because they were mere props in his play – a play that he did not really have much interest in. Edmund's only thought at dying, as a member of the wealthy elite, was "Well, that was a hash." He sees himself walking in another world (having already left the body) with much impatience – as if he is trying to slough off the debris of the old life as fast as he can.
Client as the current personality feels the residuals of the Edmund personality – these residuals include boredom, and some degree of revulsion at the life. It seems to both Client and Edmund to have been a pursuit of nothing. Edmund asks, "There. I've done that. Are you happy now? Can we move on, for Chrisakes?"
Moving on to another realm…away from the frustrated pacing.
Client's guides are keeping a safe distance from him. He is angry, and wants to know whose dumb idea it was for the Edmund life. There are three elderly gentlemen in white robes who left his immediate area because he chased them with Edmund's cane. Client/ Edmund is stuck in feeling anger and cynicism. He doesn't feel that this is the result of anything that was done to him; he is unhappy that he wasted his time.
I encourage him to connect with his guides to get their reflections on Edmund's life. I let him know that his guides are respectful of his wishes for them to stay away – that they are only interested in being of assistance. Client now sees that his guides are at a table, and he has been invited to join them. They seem to be dressed in the clothing of ancient Greece. The guides' names are Thor, Lazarus and Joshua. The guides are white in color, as are their gowns. They are wearing bowl-shaped haircuts. Their skin is sagging and lined, and their foreheads are lined.
We ask the guides for Client's soul name. It is something like Rueben or Romulus. We ask for Client's core soul color. It seems to be white.
(Note from the Client: This was confusing. I never really saw my soul color, but just guessed. I really don't have a picture in my mind of what it was. Not that it matters that much. But to clarify, the guides' robes were white, but their skin was flesh-colored, not white. When I described colors, I was usually referring to the clothes. )
We ask if Thor, Lazarus and Joshua are Client's original spirit guides as Client is at odds with them at times. He is not in agreement with the prescribed coursework. He'd rather do his own thing. Some of the assigned work seems unnecessary or redundant. He'd rather skip ahead. How do his guides feel about that? Client says it seems as if they feel that if Client is to be well-rounded, he needs to take a more comprehensive approach. That includes all facets of human experience. Client would rather pursue what interests him.
(Note from the Client: Although left unsaid, the general feeling was that my self-interests are geared toward experiences that feed the soul, rather than the body.)
We ask if Client's many past lives reflect the need to be comprehensive in his studies as well as time spent pursuing his interests. Client's guides indicate to him at this time that Client tends to be combative with them. He is not always willing to do what everyone else is doing. Client constantly wants to rewrite the rules, and teach them a thing or two.
Do Client's past lives reflect his need for independent study and/or his obedience to the request from his guides that he experience all facets of human life?
The guides indicate that Client has been a difficult student in that he's wanted to tailor his travels in a way that suits personal interests that don't necessarily reflect the interests of those that he has agreed to work with. Client is an independent party that came into this system as an equal, but once involved, Client has been hesitant to follow the course or suggested course, of his peers. He wants to do his own thing his own way. They only make suggestions that they feel are in his best interests, but it has often been felt that Client's interests were solely his, and not at all theirs. So, there's been some conflict between what Client feels is best vs the guide's directives.
(Note from the Client: The feeling I had here was that I've wanted to avoid painful experiences that I believed served no useful purpose. I'm sure most would want to do the same thing, but it felt like a sticking point with me to be defiant regarding the heavily karmic stuff. Obviously it doesn't work and my guides think I'm difficult. 😉
On behalf of Client, I address Client's guides, requesting information regarding the main objectives (goals) and lessons for the current incarnation, and to what extent he completed these. And if he is falling short of his goals, please comment on that.
Guides: All goes as planned. Client rarely falls short of anything he attempts to do. As he pieces together the parts of his life in a piecemeal fashion, similar to putting together the pieces of a giant jigsaw puzzle, the pieces not found in one lifetime may be found in another and then properly positioned in that lifetime. He doesn't care about what's left undone because it will all get done eventually. The big picture is the only concern.
We are now looking to see if Edmund also achieved his goals in that life.
Guides: They were lessons he did not wish to receive. There are certain elements of physical existence that have little bearing on Client's objectives, and perhaps rather stubbornly he would like to avoid them altogether. (Note from the Client: This is all about avoiding experiences that don't feed the soul. The feeling I had was that I've tried to fight against this. I didn't always agree with my guides that being comprehensive was in my best interests. Although they were probably right. ) But he agreed to participate in this journey even though it was foreign to him in many ways. It was a grand experiment that he undertook, coming from a background that didn't necessarily warrant needing to have this experience in the first place.
Facilitator: Are we referring to the life as Edmund or Client's incarnations, generally?
Guides: In general.
Facilitator asks the guides if there is any residual energy of Edmund's remaining with Client that can be cleared.
Guides: There is a residual of cynicism from that life having to do with the futility and the terrible monotony of it all. It was a largely pointless existence in Client's opinion, because although the endeavors were ultimately prolific from a societal point of view, the rewards were few. (Lazarus has offered this observation.) Client has a compelling fear of living a lifetime like that again. It simply did not feed the soul. It was senseless posturing and maneuvering, and he could just as well have skipped the entire experience. He does not feel that anything was gained or learned.
Facilitator: Thank you, Lazarus. I am wondering if this would be a good place to give Client healing energies to cleanse him of the residual debris of the life as Edmund.
Client comments that these guides seem to be rather expressionless and intellectually severe. Facilitator senses that they are sending him cleansing energies.
Facilitator asks if there are other guides that Client can dialogue with.
Client says there is another person that seems to be in the room now. This is an enormously tall individual, perhaps 100′ feet tall. The person seems to be only a huge robe. This robe being is a dark shade of gold, with patches of very dark blue inside of which are gold patches. He seems to be wearing a glowing hood or crown which appears to be gold in color. Client says he seems to recall this figure from a previous past life regression.
Facilitator asks for this being to identify itself in relation to Client.
Client says this being describes himself as Client's Emissary. He bridges the gap between this world and the world from which Client originally came.
Facilitator asks if the Emissary is referring to the world of 3rd density in both places.
Client says: No, this is a different system of experience.
Facilitator asks: What is the world that Client originally came from?
Guide: It is a place of existence that doesn't require physical expression.
Facilitator asks if it is a spiritual or physical world.
Guide says there is no physical at all in this world.
Facilitator asks if this world would be a place for incarnation, for the purposes of soul continuing to develop.
Guide says it is a place where there was evolution based on the accumulation of knowledge and that it can't be easily compared to the experiences we have in this locale.
Facilitator asks if this is Client's original home (after being cast from the Tao.)
We are told by the Emissary that this is one of Client's original homes, and it is also the place that he favors.
Does this favorite place have a name?
Emissary Guide: It does not have a name that can be readily defined in terms we would understand.
Facilitator asks if it is hard to give a sound to; if it is conveyed through telepathy.
Emissary Guide: It cannot be understood in our (Earth) terms.
Facilitator asks the Emissary – when you say that this is one of Client's original places, are you suggesting that Client spent many periods of existence in evolution on other realms prior to the Earth experience?
Emissary Guide: Client's experience in physical terms was never a requirement. He was invited.
Facilitator: Who invited him?
Emissary Guide: Other Elders who felt that Client's grasp of universal knowledge would be limited by not fully experiencing everything it (the universe?) had to offer.
Facilitator: Before we move on, is there other commentary or observations that Client's Guides or the Emissary would be interested in putting forth?
No answer.
Facilitator asks if this is a good time for Client to meet with his Council
Response is yes.
Facilitator asks who will volunteer to take Client to the Council.
Lazarus responds: I, Lazarus.
Client is getting an image of about 30 or 40 people. He wonders about the number.
Facilitator says that Council of Elders can be few or many. Facilitator asks Client to identify his current surroundings.
Client says the Council is sitting in a forum of benches that are connected in a circle.
Facilitator asks if there is a table.
Client says it reminds him of the Greek Senate, where benches wrapped around. Client is standing in their center.
Client says the Council was singing, and he interrupted them by showing up. One being was sitting at what looks like a pipe organ, playing. This person seemed to be in charge. They are sitting.
Facilitator wants an acknowledgement from the group that they are in fact Client's Council of Elders.
The Council (through Client) says that Client doesn't always listen, but yes, we are here on his behalf.
Facilitator asks what they look like.
Client is describing the Council. They are all wearing robes that appear to be dark purple. They are also wearing short haircuts, bowl-shaped. They all appear to be male.
(Note from the Client: Once again, the color pertains to the clothes. Their faces were flesh-colored. Thinking about this further, I felt like something of an outcast around most of these guides. If there's any truth to favoring a different system of existence, maybe I really don't fit in here. )
Facilitator asks the Council what percentage of soul energy Client brought into this life.
Answers: 2%, 9%, 20%.
Facilitator comments that 2 and 9 percent are very low.
Facilitator asks if they can make a decision – or are they all correct.
Answer: 20%
Facilitator asks if Client has some of his soul energy in other contemporaneous incarnations?
Council: Don't you know that Client is all over the place. He is quite the ubiquitous soul.
Facilitator asks if this means he has other incarnations that are current with Client?
Guide: Client had 9 incarnations. Two have already died. These are not 9 full incarnations; rather, a few are partial. They involve teaming up with other fragments.
Facilitator says it sounds like they are mixing soul energies from different fragments in one incarnation.
Client is not sure what they mean.
Facilitator asks if they want to say more or move on. We have other questions.
Move on.
Facilitator: As you are his Council, on Client's behalf we would like to know how Client's soul spends his time between lives, and if he is part of any specialty groups?
Council: Client works as an Ambassador to help connect other dimensional life forms that normally would not find themselves interacting with this plane of experience.
Facilitator: Or perhaps with each other?
Facilitator asks if Client is an emissary that becomes acquainted with these persons of other-dimensional existences and is able to introduce them to each other – by describing perceptions and environments?
Does he also bring them physically together or is this done telepathically, or both?
Council: Client was an other-dimensional being to start with, and he has no formal ties with this world. He is here (on Earth) by invitation. He has normally not sought out this experience, but given the nature of his work it was thought that becoming more acquainted, first-hand, with the nature of this realm would give him a greater understanding of the experience of the group with which he was attempting to connect.
Facilitator: When you say the nature of Client's work, you are referring to his work as Ambassador?
Facilitator: Would it be correct to say that Client is an interplanetary Ambassador as well as an intergalactic Ambassador?
Council: This is not correct. Client helps bridge the gap between interplanetary worlds and worlds not based on traditional planetary systems – worlds that have no physical dimension, that is, worlds that exist through the process of pure thought. These are worlds that cannot be readily defined with physical terms.
Facilitator says that this is quite an endeavor to bridge the gap between physical worlds and worlds that exist only as thought. What are the means by which Client is able to bridge this gap? Does it, for example, have anything to do with music?
Council: The mere existence of being is all that is required in some systems of experience. What you are requesting cannot be translated into physical terms unless most of the physical is experienced by those who have never been physical before.
Facilitator: And Client is one such being?
Facilitator: And this is why he can bridge the gap?
Council: He is attempting to be a pioneer in this regard.
Facilitator: And how is he doing?
Council: He is doing this with some reluctance but understands that it is necessary to be thorough.
Facilitator: Regarding the percentage of soul energy Client has – it is sufficient for the current life?
Council: He keeps his demands low for that reason.
Facilitator: May I ask if Client's current health issues are related to the low percentage of soul energy?
Council: His health issues are the result of poor choices by the personality.
Facilitator: What better choices can Client make?
Council: By actively engaging the reality that the body is finite. Individual choices can ultimately be a factor in the quality of life experience in the future.
Facilitator: So if Client makes better choices, his quality of life will be enhanced.
Facilitator: And speaking of other health issues, does Client have allergies to certain foods?
Council: Not that we can see, but Client's hypersensitivities tend to make him allergic to life in general.
Facilitator: Understandable. What can Client do to lower his sensitivities?
Council: By being more aware of the signals that his body is sending, keeping a log of these reactions, and then try to correlate them to choices in the lifestyle and make the corrections as needed.
Facilitator: Is Client able to continue this session? Is his body holding up?
Council: There is some mental fatigue.
Facilitator: I understand. Client, do you wish to proceed or end here?
Client: Let's end the session.
* ~ * ~ * ~ * ~ *
More Notes from another Client's Life Between Lives Session with Gloria Constantin as Facilitator
Client opens his past life door into the option of two lives – one as Edmund, seen in the last regression, and one as Luann, a woman who lived in Kansas in the early 1900's. Client sees Edmund walking the Victorian era streets on the way to a performance of the philharmonic orchestra, and Luann is driving a buggy that is pulled by a single horse. He chooses to enter the life as Luann. A summary of that life follows.
Luann, about 31 and petite, is driving the buggy along a dirt road in the country. She is wearing a plain black dress and a white scarf. The horse is a dark chestnut with red tones. She passes an old fence, which trails parallel to the road. The landscape is flat, but there are fields about with growing crops. She is in a hurry as a storm is coming. The sky is dark with rain clouds. She is carrying a small bottle of medicine that she obtained from a doctor. It is for her elderly father who is ill. She drives past a round barn to the house, and is greeted by a young teenager, her son, Eli. Apparently he takes care of the horse and buggy, and she enters her home. Her father, Elijah, is ill and in bed. She gives him several spoonfuls of the medicine.
Luann finds herself at her father's burial, out on the farm. Several farmhands are assisting with lowering the casket into the ground. It is raining out, and the grave and ground are extremely muddy. The farmhands' clothes are soiled and worn. Eli is weeping. Luann does not seem to feel much of anything.
In the next scene, Luann finds herself outside the home talking with a tall, gaunt man who appears to be a caricature of someone in the legal profession. He is formally dressed, and Luann is arguing with him about being forced out of her home. Apparently, it has been arranged for her to be displaced, and even though this seems inevitable, Luann is arguing with confidence and holding her own, and not showing much emotion.
In the next scene, Luann is living in a boarding house where she works to earn her keep, and her son's. She works long hours, washing, cooking, and cleaning. It is hard work, and though she is only 33, she is physically wearing down. Her son attends a one-room school where she wishes she could teach. Luann has an inventive mind, and enjoys reading and keeping a journal. Some of her journal entries comment on the lack of opportunities for women. Luann was also experimental with chicken farming, and her methods caused her unsophisticated neighbors to look upon her with suspicion. Luann had an interest in astronomy and owned a telescope. She and her father were not well-liked and seemed quite self-sufficient in a number of ways. They did not entertain the company of their neighbors, as they did not resonate with the community. She and her father were kindred spirits, and threatening to the others because they were different.
When Luann went into town on errands for the boarding house she moved quickly. The town was essentially lawless, and filled with danger. Men ogled her as she walked by, but they were base and ill-intentioned – an appropriate husband was not to be found among them, but then, she never sought to find another. She kept to herself and her interests, and her primary concern was caring for her son.
In the next scene she watched her son being hung in public for a crime he did not commit. It was a terrible and brutal act, deeply difficult to witness. The hostility of that community was not surprising, given that she and her son were never accepted, being seen as too eccentric. Shortly after, Client sees Luann's body, fully dressed in a bath tub filled with water – and blood. It appears that Luann has killed herself.
As Luann leaves her body, no guides are seen. She is about 100 feet up, and is seeing her son's dead body receive additional insults by being dragged on the ground by a horse his corpse has been tied to. The townspeople are jeering at him. She sees them as insects she could squash. The spirit of her son is not around.
Client comments: Another bad lifetime; more things to be angry about.
Facilitator: Perhaps Luann's guides will be able to shed some insights on why that particular life was chosen, and if the life turned out according to the original plan. They can also assist her with releasing the negative residual energy from that life.
Luann is not yet ready to leave. She is angry, and wants to set the town on fire. She is "stomping" on the townspeople. She is still above the town, but she is getting a great deal of satisfaction from it. Her form is much larger than it was in life. For the first time in her life, she is expressing intense emotion.
Luann has progressed to a gateway area. There are three elderly guides waiting – Thor, Lazarus and Joshua. She has taken on the form of a large male, and he is, as Edmund was, pacing back and forth angrily. He is very angry with the life just lived. It was harsh and brutal. He is having a heated exchange with the guides, and is throwing balls of fire at their faces. The guides are intimidated. The soul comments that these guides are useless.
Facilitator: Perhaps this would be a good time to summon a Guide who would be helpful. On Client's soul's behalf, the facilitator requests that a more powerful Guide appear. The "Robe" appears. This is the same Guide that was the Emissary in the first Between Lives Regression.
Client is observing that Client's soul is more attuned to this Guide. The soul is calming down. The Guide is showering the soul with light. It is likely a healing shower to remove the negative debris of the life as Luann. The soul is telling the Guide that he is extremely frustrated and wants to quit this perpetual game of pain and suffering. The Guide continues to shower him with light.
The Guide tells him: You are almost there; you don't have much farther to go.
There is reflection between the Facilitator and Client regarding the value of the three guides. The comment is made that perhaps these guides are not from the same spiritual realm that Client is from, but rather from the spiritual realm associated with earth plane incarnations. Since Client's soul is not from this realm, there may be some misalignment with the guides. However, these are the guides who seem to be needed to supervise the life in Client's earth incarnations.
Client: There's a feeling of being encouraged to try experiences that don't turn out the way they had been planned.
Facilitator: Did Luann's life go according to plan? Emissary Guide is asked for insights on the life of Luann.
Emissary Guide: Luann was to have an unusually active mind. One that was naturally geared towards the invention of things that could have positive impact on society, but the three guides thought that a greater challenge could be had if this task was undertaken in the body of a woman. There was frustration on the part of Luann that she had been given bad advice, that she had incarnated into an area where there was no chance of supporting the creative offspring of her soul [Note: Edmund's life review had similar complaints], and no chance of finding loving connections that would nurture her ambitions.
Facilitator: Were any agreements made prior to the life to provide support to Luann for her interests?
Emissary Guide: The father and son were of similar wavelengths as Luann. There was also a husband who was meant to have more impact in Luann's life, but he died in a war. The father, son and husband were the primary agreements for Luann's life. There were others, but they were not in the immediate area.
Facilitator: Had the husband lived and been able to provide Luann with his protection, would Luann have had an opportunity to meet those others?
Emissary Guide: It was a poorly conceived, ill-advised undertaking.
Facilitator: Whose advice was responsible for this? Did the soul desire this experience, or was he encouraged?
Emissary Guide: The guides played their role, but the soul made this choice.
Facilitator: Does this suggest that Client's soul is particularly adventurous?
Emissary Guide: He was willing to cooperate against his better judgment.
Facilitator: Who encouraged him?
Emissary Guide: The three guides (Thor, Lazarus and Joshua).
Facilitator: Is it valid (a good idea) for Client's soul to be advised by these three guides?
Emissary Guide: There are a gamut of experiences that are considered as essential on this plane, and part of the challenge of life is for the soul to forge a path through these obstacles and find a way to navigate a course for the most positive outcome. We are encouraged to never fear the unpredictability of the way a life can unfold. Much growth and wisdom may be gained when the life is not as heavily bland. (Note from Facilitator: I wonder if this is a reference to Edmund's life.) It is true that this soul has had more painful experiences than others, but this [his experience] is more about the unpredictable nature of this planet and the choices of the souls he has encountered, rather than the overall intention of his life plans.
Facilitator, commenting: The observations from the Emissary seem to indicate that, even though a better structure was planned for Luann so that she could pursue the interests of her active mind, the overall value of the life as Luann was essentially found in its challenges and unpredictability.
Facilitator: Is Client's soul in agreement with the unpredictability and difficulties?
Emissary Guide: Begrudgingly.
Facilitator, observing: It is almost as if this soul is taking on these experiences not so much for its own development as for the development of the collective. The Council stated in an earlier session that this soul was invited to do this experience in order to acquire a deeply comprehensive experience of physical plane life so that he could do his work of creating a bridge of communication between non-physical and physical experiences of sentience. It was not a requirement for him to incarnate here, so it seems that this information-gathering by the soul is also being done on behalf of many others.
Client commenting on his soul in the life as Luann: He just never realized it would entail so much suffering.
Facilitator: Was Edmund's life a disappointment because it was so bland?
Emissary Guide: Edmund's was a life ruled by responsibilities to his family. There was a lineage or dynasty that he was obligated to. Edmund had no interest in supporting this, but did so out of loyalty to his family.
Facilitator: What was the primary goal for the life as Edmund?
Emissary Guide: The goal was to create magnificent musical compositions. Edmund played piano and he had studied with some of the best piano teachers that money could buy. The life was chosen to provide the freedom an ordinary survival life could not have supported. Therefore, Edmund's creative pursuits would have been enabled. The life became stifled by the demands and expectations of running the family business.
Facilitator: In addition to the demands of running the family business, did Edmund's soul bring into that life any beliefs that could have created impediments to realizing his initial plan to create music?
Emissary Guide: Edmund's loyalty to the expectations of his family was perhaps over-exceeded. But he did what was expected of him and did not really see there was another course of action available to him without hurting those that he loved. He accepted his obligations rather stoically on the outside but often was dying on the inside.
Facilitator: Because he could not do his music?
Emissary Guide: Because he felt obligated to do those things in life that did not feed the soul.
Facilitator: Thank you for these insights. They are much appreciated. We would now like to invite Client's Council to be present to assist Client with further exploration and understanding of his soul purpose.
(Council appears. Client observes that there seem to be more than 40 in number – similar to last time.)
Facilitator: On behalf of Client, I'd like to address the Council. We were just looking at the life of Edmund and how his obligations to his family diminished his ability to become the composer. It seems he very vigorously took on the role of family business supervisor. We are wondering if, in the current life, Client is also playing a caretaker role for his parents by previous agreement.
Council: We thank you for your concern and openness in asking for guidance on this soul's behalf. In this lifetime, Client specifically sought to shelter himself from the pain and suffering that he had experienced in so many lifetimes before. There has been some reluctance on his part to even engage in normal experiences for fear that things would all go bad again. This is primarily a lifetime of rest, and also a way to regain his footing in a world that has so frequently kept him off balance.
Facilitator: So Client does not have an official caretaker agreement with his parents.
Council: The agreement with his parents was for them to provide him with a safe harbor.
Facilitator: Thank you. I very much appreciate your assistance. It is helpful for Client's continued journey. Client has some questions regarding his loyalty to and involvement with the Michael Teachings. His first question is what is the nature of his involvement with these Teachings?
Council: The Michael Teachings are much in alignment with the inner directives of Client's soul to better understand the often quirky and unpredictable nature of the human condition. The Teachings have provided Client with a shortcut to his understanding of why people are the way that they are. For that reason, Client has actively sought to help others find the Teachings – so that they too can enjoy the benefits that he has derived from their study.
Facilitator: So the study of the Michael Teachings for Client is very much in alignment with his pioneering of physical plane existence with regard to achieving a more comprehensive understanding of it?
Council: It has provided him with an easier template to sort out the often difficult incongruities in the human personality.
Facilitator: Are these conflicting incongruities of the human personality experienced in the world where Client is from?
Council: No.
Facilitator: How can Client establish a greater rapport with the community of Michael Teachings students?
Council: One obstacle that has presented a conflict in achieving a greater rapport has been his own protective need to shelter himself from those that he feels will hurt him. There is some justification here in that Client has experienced an unusually long series of lifetimes that have been more unpleasant than most souls usually encounter.
Facilitator: Despite this, is there a way that Client can increase his rapport with the other students?
Council: Client can come to an understanding that opening himself to trusting another individual does not automatically mean that he will be maimed or killed. Client feels strongly justified in protecting himself from further suffering.
Facilitator: I understand. Would you comment on the past lives or [between life] soul connections that he has with the soul currently embodied as Facilitator Constantin?
Council: These two souls are from similar origins. They share many commonalities and pursuits, although the work that they do is different.
Facilitator: I assume that by work you mean the work that Client does with [connecting] the physical and non-physical worlds and that soul that is now Facilitator does not do the same work.
Council: The work that Facilitator does largely involves healing, whereas Client is more focused on creating new avenues of communication between different systems of existence.
Facilitator: Is Facilitator's healing work for the soul rather than the body, or both?
Council: Facilitator often heals on a case-by-case basis, but primarily works with the healing of larger groups.
Due to Client's fatigue, we end the session here.
Back to Life Between Lives
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text:
Jacques Le Rider (Atenas, 20 de febrero de 1954) es un germanista e historiador francés, especialista en la cultura vienesa de inicios del siglo XX.

Trayectoria
Jacques Le Rider estudió en la École Normale Supérieure, de la calle Ulm de París, entre 1973 y 1977. Lograda la agregación en alemán (1976), se diplomó en el Instituto de estudios políticos de París (1977), se doctoró en 1982. Más tarde, en 1989, obtuvo el doctorado de Estado en Letras.

Fue asistente en la Universidad París IV-Sorbonne (1977-1981), 'maître de conférences' en la Universidad Paris XII-Val de Marne en Créteil (1981-1990), profesor de Universidad en París VIII, en Saint-Denis (1990-1999). Desde el año 1999 es director de estudios de la 'École pratique des hautes études' en la cátedra «Europa y el mundo germánico moderno y contemporáneo».

Ha dado cursos en Tubinga, Graz, Viena (fue director del Instituto Francés), Ginebra, São Paulo, Mannheim (dos veces), Berlín, Münster y Colonia. Desde abril de 2105, es miembro correspondiente en el extranjero de la 'Academia austriaca de las Ciencias (Österreichische Akademie der Wissenschaften).

Le Rider ha hecho ediciones de Friedrich Nietzsche, Hugo von Hofmannsthal y Goethe. Y ha traducido a Lou Andreas-Salomé, Richard Beer-Hofmann, Hugo von Hofmannsthal, Theodor W. Adorno, Fritz Mauthner y Stefan Zweig.

Ya desde eu primer trabajo —El caso Otto Weininger. Raíces del antifeminismo y del antisemitismp (1982)—, se ocupó de los antisemitas germánicos. Destacó su serie de trabajos reunicos en Hugo von Hofmannsthal. Historicismo y modernidad, de 1995.

En 2013 ha publicado Los judíos vieneses en la Belle Époque, una notable síntesis sobre el entorno histórico-social de los autores que más ha estudiado, la Viena entre 1867 y 1914 y deteniéndose luego en los casos de Sigmund Freud, Arthur Schnitzler, Hugo von Hofmannsthal, Richard Beer-Hofmann, Karl Kraus, Felix Salten, Stefan Zweig, Gustav Mahler y Arnold Schönberg.

Obras
 Le cas Otto Weininger. Racines de l'antiféminisme et de l'antisémitisme, París, PUF, 1982.
 Modernité viennoise et crises de l'identité, PUF, 1990, reed. en Quadrige, 2000.
 La Mitteleuropa, PUF, Que sais-je? 1994.
 Hugo von Hofmannsthal. Historicisme et modernité, PUF, 1995.
 Les couleurs et les mots, PUF, 1997.
 Nietzsche en France, de la fin du XIXe siècle au temps présent, PUF, 1999 (antes, en alemán, 1997).
 Journaux intimes viennois, PUF, 2000.
 Freud, de l'Acropole au Sinaï. Le retour à l'antique des modernes viennois, PUF, 2002.
 Arthur Schnitzler ou la Belle Époque viennoise, Belin, 2003.
 Malwida von Meysenbug. Une Européenne du XIXe siècle, Bartillat, 2005.
 L'Allemagne au temps du réalisme. De l'espoir au désenchantement (1848-1890), Albin Michel, 2008.
 Faust, le vertige de la science, Larousse, 2010, con Paul-Jean Franceschini
 Fritz Mauthner: Scepticisme linguistique et modernité. Une biographie intellectuelle, Bartillat, 2012.
 Les Juifs viennois à la belle époque, Albin Michel, 2013. Trad. esp.: Los judíos vieneses en la Belle Époque, Ediciones del subsuelo, 2016.
 La censure à l'œuvre. Freud, Karl Kraus, Arthur Schnitzler, Hermann, 2015.
 Karl Kraus. Phare et brûlot de la modernité, Le Seuil, 2018.

Notas

 Parcialmente traducido del artículo correspondiente de la Wikipedia francesa.

Enlaces
  en el sitio de la EPHE.
  en la Encyclopaedia Universalis (en la red).
 Reseña del Jacques Le Rider, Los judíos vieneses en la Belle Époque.

Historiadores de Francia
Miembros de la Academia Austríaca de Ciencias
Nacidos en Atenas

redpajama_set_name: RedPajamaWikipedia


Astros reliever Joe Smith will throw another inning for Class AA Corpus Christi on Sunday, the final hurdle he will clear before rejoining the team in Arlington.
ST. PETERSBURG, Fla. — Astros reliever Joe Smith threw another scoreless inning for Class AA Corpus Christi on Sunday, the final hurdle to clear before rejoining the club in Arlington.
Smith has been on the disabled list since June 10 with right elbow soreness. He threw a 19-pitch inning in Corpus Christi's game on Friday, allowing three singles before notching a strikeout to strand the bases loaded. Sunday, he threw 14 pitches — eight for strikes — and allowed one hit.
Smith's impending return was the impetus for the Astros' roster move on Sunday, optioning Cionel Perez back to Class AA after Yuli Gurriel returned from paternity leave. It meant, for one game, the Astros are back to a seven-man bullpen with an extra position player — AJ Reed — on the bench.
"We've got a couple things going on with position players that I didn't know today or this morning how it was going to go when I showed up," manager A.J. Hinch said Sunday. "Having an extra bat on the bench, assuming (the Rays) go with most of their righthanded relievers today, the lefthanded pinch-hit at-bat out of Reed made a little bit of sense. It's a matter of how to play with one day, knowing that Joe will be here after today."


text:
Q: Looping through squares sequentially I have a grid of squares as shown below and I am trying to figure out how to loop through each row (from bottom to top or vice versa), select a random square and simulate a press (scale it down then up). I have created each row as an array of 5 SKShapeNodes with the code below:
Row of Squares:
//Row Seven
        for var i = -2; i < 3; i++ {

            firstSquare = SKShapeNode(rectOfSize: CGSize(width: self.view!.frame.size.width * (1/5), height: self.view!.frame.size.width * (1/5)))
            firstSquare.fillColor = SKColor(hue: 225.0/360.0, saturation: 0.1176, brightness: 0.2667, alpha: 1.0)
            firstSquare.strokeColor = SKColor.clearColor()
            firstSquare.position = CGPoint(
                x: CGRectGetMidX(self.frame) + ((firstSquare.frame.size.width + CGFloat(2)) * CGFloat(i)),
                y: (CGRectGetMidY(self.frame) + self.frame.size.height / 4) - (firstSquare.frame.size.width + CGFloat(2)) * CGFloat(6))
            rowSeven.append(firstSquare)
            addChild(firstSquare)

        }

Each of the seven rows is added to an array (gameLayers) that holds all the rows.
gameLayers = [rowOne, rowTwo, rowThree, rowFour, rowFive, rowSix, rowSeven]

I have the following code to loop through the gameLayers Array to and pick eachRow, select a random element and run the animation of a press.
private func randomIntergerInRange(low:Int, high: Int) -> Int {
        let randomGeneratedNumber = low + Int(arc4random()) % (high - low);
        return Int(randomGeneratedNumber)
    }

func loopThrough() {

for eachRow in gameLayers {

    let selectedSquare = eachRow[randomIntergerInRange(0, high: eachRow.count)]

    let delay = dispatch_time(DISPATCH_TIME_NOW, Int64(Double(2) * Double(NSEC_PER_SEC)))
        dispatch_after(delay, dispatch_get_main_queue()) {

            let scaleDown = SKAction.scaleTo(0.85, duration: 0.3)
            let scaleUp = SKAction.scaleTo(1.0, duration: 0.3)
            let scalingSequence = SKAction.sequence([scaleDown, scaleUp])

            selectedSquare.runAction(scalingSequence)

    }
}

}

On trying this out, a square is selected in each row but all of the selected square run the animation simultaneously and not sequentially as I would wish.
Any ideas what could be the cause. I thought the for loop would run the animation for each element sequentially.

A: I figured the problem can be used through a recursive loop. After running the animation on a square on one row, call the same function and update the row on with to fire the animation.
var selectedRowIndex = 0

    func loopThrough() {
            let rowSelected = gameLayers[selectedRowIndex] //Select a row from the gameLayers

            let selectedNumber = self.randomIntergerInRange(0, high: rowSelected.count)
            let squareSelected = rowSelected[selectedNumber] //Select a square from the selected Row.

            //Run the animation on that square
            let scaleDown = SKAction.scaleTo(0.9, duration: 0.2)
            let scaleUp = SKAction.scaleTo(1.0, duration: 0.2)
            let scalingSequence = SKAction.sequence([scaleDown,
                    scaleUp])

            squareSelected.runAction(scalingSequence)

            let delay = dispatch_time(DISPATCH_TIME_NOW, Int64(Double(1.3) * Double(NSEC_PER_SEC)))
                dispatch_after(delay, dispatch_get_main_queue()) {

//Delay for 1.3 seconds and call the function again. Increase the index of the selected row to select the next
                    if self.selectedRowIndex != self.gameLayers.count - 1 {
                        self.selectedRowIndex++
                        self. loopThrough()
                    }
            }
     }

redpajama_set_name: RedPajamaStackExchange