becoming the first luger to win double gold at three consecutive Olympic Games She also became the sport's most decorated Olympian with seven medals - six golds and one bronze - at four Games Geisenberger grew up 50 kilometres away in the Bavarian mountain town of Miesbach A member of the local luge club from the age of 10 she went on to win 14 Junior World Cup events three overall Junior World Cup titles and six Junior World Championship crowns between 2004 and 2007: three in the singles and three in the team event she became European singles champion in 2008 in Cesana Pariol (ITA) where she also won an U-23 world title three years later Her first World Cup win came in the 2008/09 season when she was second in the overall standings behind Tatjana Hüfner she also took silver at the World Championships - where two-time reigning champion Hüfner came a disappointing sixth - and helped Germany to mixed team relay gold Torino 2006 bronze medallist Hüfner soon returned to form and beat Geisenberger to the next two World Cups series titles The youngster made her Olympic debut at Vancouver 2010 and took bronze behind Hüfner and Austria’s Nina Reithmayer After four consecutive years of finishing second to Hüfner in the World Cup Geisenberger finally dethroned the five-time reigning champion with six wins and three second places in the nine races of the 2012/13 season Hüfner took the season finale which doubled up as a test event for the Sochi 2014 Games winning seven of the first eight races to clinch the title enabling her to skip the final race of the season before the Olympic Winter Games Hüfner was no match for her at the Sanki Sliding Centre with Geisenberger the only woman to break 50 seconds something she achieved on each of the first three runs She was fastest on the fourth run as well to win by a massive 1.139 seconds from Hüfner with USA's Erin Hamlin who beat Geisenberger to the world title in 2009 “I knew by the time I’d reached the lower part of the course on my fourth run that I’d won the Olympic title and I was almost screaming with joy when I crossed the finishing line "I'm currently in my best form ever though it wasn’t easy to do as it’s pretty tricky after curves five and six The chance to win an Olympic title may not happen again and I’m really happy that I took this opportunity." her strong first leg helped Germany to mixed team relay gold repeating their 2013 world title triumph with Felix Loch and doubles kings Tobias Wendl and Tobias Arlt Geisenberger was simply unstoppable after her Sochi 2014 double and kicked on to complete six successive World Cup title wins by 2018 Further World Championship golds also came her way in both the singles and team relay (again with Loch Wendl and Arlt) in 2015 in Sigulda (LAT) and in 2016 in Königsee (GER) taking her collection of world titles to seven Geisenberger made her next objective clear posting a snap from the Olympic test event at the Alpensia Sliding Centre in February 2017 on her Facebook page and writing: “A year to go before PyeongChang 2018." While her victory - which came a week after she turned 30 - was not as emphatic as her Sochi triumph Geisenberger led from start to finish to retain her title by 0.367 seconds from teammate Dajana Eitberger with Canada’s Alex Gough edging out Hüfner for bronze "I came here having pretty much won everything there was to win Obviously I’ve been dreaming about winning the gold A second mixed team relay gold followed - this time with men's singles bronze medallist Johannes Ludwig after Loch's last-run error sent him down from first to fourth - to take her to five Olympic medals including four golds After claiming her seventh consecutive World Cup title in 2018/19 Geisenberger skipped the following season to have her first child and his mother was back in action six months later She finished second in each of her eighth races after her return with reigning champion Julia Taubitz taking the majority of them But victories in Oberhof (GER) and Innsbruck (AUT) helped Geisenberger secure her eighth World Cup series crown Taubitz exacted revenge in the World Championships at Königsee beating Geisenberger by just over a third of a second with Eitberger - also returning from childbirth - completing a German podium sweep The World Cup opener to the Olympic season was also a test event for Beijing 2022 at Yanqing National Sliding Centre Geisenberger lost control after the tricky Turn 13 on the Olympic track and not even a better second run could stop her finishing down in 26th place She had to wait until the third race of the season and it was not until the last weekend of the season - two weeks before Beijing - that she recorded her first win of the campaign at St Taubitz and Madeleine Egle were the form athletes from the season with the Austrian victorious in the Yanqing test event Turn 13 would play its part at the Games with Geisenberger admitting to sleeping badly after crashing there in training the veteran was fine with Egle crashing in the first heat and Taubitz wiping out in the second having set the track record earlier in the day "I wasn't nervous about the race - just about exiting that corner down there on the 13th I hope it will be better tonight and I get some sleep She took more than a tenth off the track record in heat three and was second quickest on the final run to beat fellow German Anna Berreiter by almost half a second with ROC's Tatiana Ivanova in third ahead of Egle "It's hard to compare Olympic medals because every one has its own history," Geisenberger said Five became six in the mixed team relay as she Ludwig and the Tobys reprised their PyeongChang success despite Geisenberger not having the best opening leg Geisenberger and the Tobys both completed triple-doubles in Beijing but the former's bronze at Vancouver means she stands alone as the most decorated luger in Olympic history Her total of seven is one clear of the Tobys and Italy's two-time men's singles champion Armin Zoeggeler Acino opened a new pharmaceutical manufacturing plant in Miesbach produces commercial quantities of transdermal rivastigmine patches The plant is owned and managed by Acino Holding and it produces commercial quantities of transdermal rivastigmine patches Acino received EU approval for the rivastigmine patch for the treatment of mild to moderate forms of Alzheimer dementia in March 2013 The patch was launched in the German market in partnership with Betapharm in April 2013 Acino also received the US Food and Drug Administration (FDA) approval for manufacturing the transdermal rivastigmine product at Miesbach facility in September 2013 The new facility was constructed with an investment of approximately €20m ($25.06m) and created employment for 40 highly skilled professionals The new facility at Miesbach features laboratories and modern storage spaces well-equipped with sophisticated pharmaceutical manufacturing equipment It is currently the second biggest manufacturer of transdermal patches in Europe The new plant began operations at the end of 2012 and has enough space to carry out future expansions The current production capacity of 37 million patches per year is planned to be doubled or tripled in the coming years Acino also plans to roll-out rivastigmine patches in other markets and supply license takers with the finished product The plant manufactures transdermal patches by employing better dosage forms compared to the oral delivery system The patches manufacturing method primarily involves mixing and weighing of all ingredients as liquid drug-containing adhesive solution The drug-in-adhesive layer is created by coating drying and lamination of liquid mass and the laminate is then sliced into daughter rolls The patch forms are punched and each patch is then sealed into pouches The foundation stone for the new manufacturing facility was laid down in July 2011 The foundation ceremony was attended by a number of dignitaries including the county commissioner of Miesbach Dr Jakob Kreidl the first mayor of the city Ingrid Pongratz the managing director of the investment promotion agency (SMG) of the county Miesbach Oliver Reitz and the CEO of the Acino Group Peter Burema a subsidiary of i+o Industrieplanung + Organisation site supervision and qualification of the facility The construction was completed on time and within the budget with the coordination of project management integrated building design and logistics of i+o Acino is a leading pharmaceutical company headquartered at Aesch, Basle, Switzerland. The company employs approximately 788 people across 80 countries worldwide. It is engaged in the development and manufacturing of generic and innovative pharmaceuticals by utilising advanced and patented drug delivery technologies The company focuses on the development of sophisticated oral dosage forms with modified release of the active ingredient transdermal therapeutic patches and biodegradable It generated annual revenues of €143m ($187m) in the first half of 2013 Boehringer Ingelheim microParts Atomisation Factory, GermanyBoehringer Ingelheim microParts a subsidiary of Boehringer Ingelheim Group invested $94m in a new atomisation factory in Dortmund as part of its expansion strategy Novartis Vaccine Manufacturing Facility, GermanyNovartis began production at its new vaccine manufacturing facility in Marburg Give your business an edge with our leading industry insights View all newsletters from across the GlobalData Media network This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page The Steelers signed linebacker Julius Welschof to the practice squad Welschof was signed originally signed by the team as an undrafted free agent following the 2024 NFL Draft He started at defensive end for Charlotte but had his 2023 season cut short due to injury He began his career at Michigan where he played in 35 games Bringing you the action: For fans who don't want to miss any of the action which means you can now watch the Steelers live and on the go Watch live local and primetime regular season games on mobile **Sign up today** The Steelers signed receiver Robert Woods to a one-year contract Jaylen Warren signed a one-year restricted free agent tender The Steelers signed offensive lineman Max Scharping to a one-year contract The Steelers signed offensive lineman Calvin Anderson to a two-year contract The Steelers signed linebacker Jeremiah Moon to a one-year contract The Steelers claimed offensive lineman Lecitus Smith off of waivers The Steelers signed cornerback James Pierre to a one-year contract  The Steelers signed defensive tackle Esezi Otomewo to a one-year contract The Steelers signed safety Juan Thornhill to a one-year contract The Steelers signed defensive tackle Daniel Ekuale to a one-year contract The Steelers signed defensive tackle Isaiahh Loudermilk to a one-year contract The Steelers signed receiver Ben Skowronek to a two-year contract Bos Dramatic footage showed the moment when life was cut short for many Jehovah's Witnesses in this church in Germany's northern city of Hamburg Gregor Miesbach filmed the gunman shooting through a first-floor window "I heard loud gunshots and went to the window to get a clear picture of the situation I saw a man with a firearm shooting through a window and filmed it," he told reporters.   A special police force was by chance in the neighbourhood and acted quickly after residents in Hamburg's GrossBorstel district heard a dozen shots There were 12 continuous shots," a witness said "I first thought it was at the construction site here But then I learned that it happened at the petrol station or next door at the Jehova's Witnesses." With continuous shootings regular police and special forces tried to save lives Officers had to break windows to enter the building where about 50 people had gathered "Police went into the building and quickly found people who some even fatally," recalls Hamburg police spokesman Holder Vehren Police said they soon discovered seven people A seven-month-old unborn baby was also hit in the womb A Ugandan and a Ukrainian were among the wounded The suspect - described as a "sports shooter" who had a gun license - reportedly fled to the first floor of the Jehovah's Witnesses center after the bloodshed Authorities explained that his "lifeless body" was found shortly afterwards Investigators believe he was a former member of the Jehovah's Witnesses who had "ill feelings" towards the religious sect his exact motives are still being investigated the Jehovah's Witnesses in Germany said they were "deeply saddened by the horrific attack on members at the Kingdom Hall in Hamburg after a religious service" attended by dozens of people German Chancellor Olaf Scholz has described the attack as a "brutal act of violence," saying his thoughts were with the victims and their relatives Jehovah's Witnesses are members of what they call a Christian-based religious movement founded in the U.S the sect says there are about 8.7 million Jehovah's Witnesses worldwide including about 170,000 in Germany.   In Hamburg there are believed to be nearly 4,000 Jehovah's Witnesses They are probably best known for their door-to-door preaching and offering of what they say is Bible literature Several mass shootings have rocked Germany in recent years a far-right extremist shot dead ten people and wounded five others in the central German city of Hanau two people were killed after a neo-Nazi tried to storm a synagogue in Halle on the Jewish holiday of Yom Kippur Thank you for reading our article. You can keep up-to-date by subscribing to our daily newsletter. Just click here We used fluorescence-activated cell sorting (FACS) with antibodies against CD61 for thrombocyte identification and CD62p or platelet activation complex-1 (PAC-1) to determine platelet activation. Aggregometry and automated platelet functioning analyzer (PFA-200) were employed to test thrombocyte reactivity. FACS and aggregometry samples were stimulated in vitro with arachidonic acid (AA) and adenosine diphosphate (ADP) to measure increase in CD62p-/PAC-1-expression or aggregation, respectively. In the clinical setting it is feasible to use differentiated platelet analytics to determine alterations caused by antiplatelet therapy. Among the tests under investigation, PFA-200 showed the highest sensitivity for the intake of ASA in stroke patients. FACS analysis on the other hand might be able to provide a more nuanced approach to altered platelet reactivity. Volume 15 - 2024 | https://doi.org/10.3389/fneur.2024.1361751 Background: The clinical course of ischemic and hemorrhagic strokes can be influenced by the coagulation status of individual patients The prior use of antiplatelet therapy (APT) such as acetylsalicylic acid (ASA) or P2Y12-antagonists has been inconsistently described as possibly increasing the risk of hemorrhagic transformation or expansion Since clinical studies describing prior use of antiplatelet medication are overwhelmingly lacking specific functional tests we aimed to implement testing in routine stroke care Methods: We used fluorescence-activated cell sorting (FACS) with antibodies against CD61 for thrombocyte identification and CD62p or platelet activation complex-1 (PAC-1) to determine platelet activation Aggregometry and automated platelet functioning analyzer (PFA-200) were employed to test thrombocyte reactivity FACS and aggregometry samples were stimulated in vitro with arachidonic acid (AA) and adenosine diphosphate (ADP) to measure increase in CD62p-/PAC-1-expression or aggregation 20 blood samples (n = 11 ischemic strokes; n = 7 hemorrhagic strokes; n = 2 controls) were acquired and analyzed within 24 h of symptom onset n = 8 patients no APT and n = 1 ASA+clopidogrel ASA intake compared to no APT was associated with lower CD62p expression after stimulation with AA on FACS analysis (median 15.8% [interquartile range {IQR} 12.6–37.2%] vs 40.1% [IQR 20.3–56.3%]; p = 0.020) lower platelet aggregation (9.0% [IQR 7.0–12.0%] vs 88.5% [IQR 11.8–92.0%]; p = 0.015) and longer time to plug formation with PFA-200 (248.0 s [IQR 157.0–297] vs 121.5 s [IQR 99.8–174.3]; p = 0.027) Significant correlations were noted between AA-induced CD62p expression and aggregometry analysis (n = 18; ρ = 0.714; p < 0.001) as well as a negative correlation between CD62p increase and PFA clot formation time (n = 18; ρ = −0.613; p = 0.007) Sensitivity for ASA intake was highest for PFA (81.8% for values ≥155.5 s) The combination of ASA + clopidogrel also affected ADP-induced CD62p and PAC-1 expression Conclusion: In the clinical setting it is feasible to use differentiated platelet analytics to determine alterations caused by antiplatelet therapy PFA-200 showed the highest sensitivity for the intake of ASA in stroke patients FACS analysis on the other hand might be able to provide a more nuanced approach to altered platelet reactivity the individual risk of hemorrhage is difficult to predict in cases of recurrent ischemic stroke or hemorrhagic stroke the literature on possibly deleterious effects of pre-treatment with single or dual antiplatelet medication yields heterogenous results In ischemic stroke, the use of thrombolysis for ischemic stroke patients on antiplatelet medication, especially in combination, has been suggested to increase the risk of symptomatic hemorrhage in some studies (5–7) whereas other authors have concluded that no significant difference in symptomatic hemorrhage can be observed, and more importantly, the outcome was independent of prior APT (8, 9) we aimed to evaluate the feasibility and comparability of different platelet functioning tests in patients with acute ischemic or hemorrhagic strokes presenting to a tertiary stroke center and correlate the results with prior intake of APT before stroke The samples were then incubated for 20 min at room temperature in the dark samples were fixed by adding 650 μl cold fixative solution (650 μl PBS containing 0.1% paraformaldehyde and 0.2% bovine serum albumin to a final volume of 720 μl) After incubation for 60 min at 2°C−8°C all samples were analyzed with a FACS Canto II device (BD Biosciences) within 5 h of venipuncture Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS The Kolmogorov-Smirnov-test was used to test for normal distribution Categorical data were assessed for significance by Pearson-χ2-tests continuous variables were analyzed using the Mann–Whitney–U-test for two independent samples The results of the different platelet test methods were compared calculating Pearson correlation coefficients A receiver-operator-characteristics (ROC) curve analysis was performed in order to obtain sensitivity values in regard to the presence of APT All tests were two-sided and statistical significance was set to p < 0.05 FACS data were analyzed with Flowjo (version 10.9.0 The study was conducted in accordance with the Declaration of Helsinki and approved by the local Ethics Committee of the Goethe University Frankfurt (2022-989). Written informed consent was provided by all patients before enrolment. The study was registered in the German Clinical Trials Register (ID DRKS00030574; https://www.drks.de) Between February and July 2023, 20 blood samples (n = 11 ischemic strokes; n = 7 hemorrhagic strokes; n = 2 controls) were acquired. N = 11 patients had taken ASA, n = 8 patients no APT and n = 1 ASA and clopidogrel. Mean age was 63.4 ± 15.6 years and 30% were female (Table 1) The median time from symptom onset to hospital admission was 08 h 23 min ischemic and hemorrhagic strokes as well as healthy controls PAC-1 specificity of antibodies was confirmed with RGDS-inhibition (n = 7) leading to a complete suppression of PAC-1 expression despite ADP-stimulation No significant differences for PAC-1 expression were observed between unstimulated and AA-stimulated samples (median 7.18%; IQR 3.86–12.80% vs ADP-stimulation resulted in a significant increase of PAC-1 positive cells (median 47.30%; IQR 32.6–52.6% but no difference between the ASA-group and patients without APT was detected in this setting (median 48.0%; IQR 32.55–55.43% vs The exploratory use of thrombin to stimulate platelet activation resulted in an almost complete expression of CD62p-positive cells (n = 4; median 85.45% IQR 79.0–90.6%) and a majority of PAC-1-positive cells (median 70.55%; IQR 57.5–80.8%) as well as reaching 98% respectively in a subject with confirmed ASA-intake Fluorescence-activated cell sorting (FACS) analysis of CD62p and platelet activation complex-1 (PAC-1) expression as proportion of CD61-positive cells (all thrombocytes) signifying platelet activation in unstimulated samples (blue) and after stimulation (red) induced by arachidonic acid (AA) or adenosine diphosphate (ADP) The values were normalized to mode to facilitate comparability four patients are shown [control; hemorrhagic stroke (HS); ischemic stroke (IS)] with different antiplatelet therapy: none (control) Differences in AA-induced platelet reactivity were noted for ASA intake whereas CPG chiefly reduced ADP-induced platelet activation Median fluorescence intensity (MFI) in fluorescence-activated cell sorting (FACS) is depicted as box plots for CD62p-expression in unstimulated samples and after stimulation with arachidonic acid (AA) and adenosine diphosphate (ADP) for patients without (control) or with acetylsalicylic acid (ASA) pretreatment Multiple Mann–Whitney–U-tests for group differences revealed significant higher values for CD62p-MFI in the absence of antiplatelet therapy compared to the ASA group (mean ± standard deviation 2103 ± 734 vs the sensitivity and specificity for ASA intake was highest for PFA (cut-off value ≥ 155.5; sensitivity 81.8%; specificity 71.4%) The respective areas under the curve (AUC) were for FACS-CD62p 0.212 (95%-CI 0.000–0.424; p = 0.030) for LTA 0.232 (95%-CI 0.000–0.491; p = 0.044) and PFA 0.838 (95%-CI 0.661–1.000 Overview of fluorescence-activated cell sorting (FACS) and platelet-functioning analyzer (PFA-200) results for patients with and without acetylsalicylic acid (ASA) pretreatment Comparison of the effects of acetylsalicylic acid (ASA) on different platelet functioning parameters CD62-expression is demonstrated as percentage of all platelets (CD61-positive cells) after stimulation with arachidonic acid (AA; A) the difference between unstimulated and AA-stimulated CD62p-expression on CD61-positive cells is shown (B) Light transmission aggregometry (LTA) revealed the percentage of platelet aggregation after stimulation with AA (C) Platelet functioning analyzer (PFA-200) measurements show the time to plug formation after stimulation with epinephrine (D) Correlation between fluorescence-activated cell sorting (FACS)-analysis of platelet activation as measured by percentage of CD62p-positive cells and aggregometry (A) as well as platelet functioning analyzer (PFA-200) plug formation time (B) The significant correlation between FACS results and aggregometry as well as PFA highlights the clinical utility of the chosen methods Some outliers with unexpected low platelet reactivity despite no APT or high reactivity despite ASA intake were observed which point toward secondary effects on platelet reactivity such as preceding chemotherapy or non-compliance From our results it becomes evident why aggregometry is oftentimes considered the gold standard for the measurement of platelet function as it demonstrated the highest significance in detecting differences between patients with aspirin and without antiplatelet treatment PFA ultimately demonstrated the highest sensitivity to predict ASA pretreatment this finding should be regarded cautiously The positive correlation between FACS results and the routine diagnostic methods allows for the possibility of future implementation especially if a standardized approach for in-vitro platelet stimulation and FACS protocols can be established Strength of our study include the measurement of platelet activation as a percentage of circulating platelets antibody staining for PAC1 showed higher pre-activation and markedly less activation in response to AA compared to ADP suggesting different mechanisms in the recruitment of the glycoprotein (GP) IIb/IIIa complex in response to AA and ADP Further research could potentially elicit the underlying mechanisms if platelet reactivity after ASA intake is the focus of interest but is potentially more useful to evaluate the effectiveness of GP IIb/IIIa antagonists such as clopidogrel As the peak of CD62p-positive platelets was observed on day 1 it seems to be the most appropriate timepoint for measurement it remains unclear how fast changes occur in the immediate period within 24 h after stroke The results from this study are likely to guide future projects by providing estimates of the effect size of ASA on different platelet functioning tests as well as highlighting the feasibility and time frame of performing these tests in the setting of acute stroke By enrolling more patients with different subtypes of stroke a correlation of clinical outcomes with laboratory parameters can be envisaged these tests would also provide a basis for timely detection of non-responders of APT which might be at increased for thrombotic complications such as recurrent strokes it is feasible to use differentiated platelet analytics to determine alterations caused by antiplatelet therapy PFA showed the highest sensitivity for the intake of ASA in stroke patients particularly of CD62p-expression after in-vitro stimulation with arachidonic acid on the other hand might be able to provide a more nuanced approach to altered platelet reactivity and prove beneficial for clinical and preclinical research The raw data supporting the conclusions of this article will be made available by the authors The studies involving humans were approved by Ethics Committee of the Goethe University Frankfurt The studies were conducted in accordance with the local legislation and institutional requirements The participants provided their written informed consent to participate in this study The author(s) declare financial support was received for the research This study was supported by the junior scientist program of the Goethe University Frankfurt/Faculty of Medicine (research grant to JS) JS has received travel reimbursements by Bayer AG outside of the submitted work FB reports personal fees and grants from AstraZeneca WM reports institutional grants or contracts from Bayer Novo Nordisk and Pfizer; Consulting fees from Bayer Takeda/Shire and uniQure; Payment or honoraria for lectures manuscript writing or educational events from Bayer uniQure; Support for attending meetings and/or travel from Bayer Takeda/Shire and uniQure and Participation on a Data Safety Monitoring Board or Advisory Board with Octapharma The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher The The International Stroke Trial (IST): a randomised trial of aspirin subcutaneous heparin both or neither among 19435 patients with acute ischaemic stroke International Stroke Trial Collaborative Group Crossref Full Text | Google Scholar Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA Ischemic benefit and hemorrhage risk of ticagrelor-aspirin versus aspirin in patients with acute ischemic stroke or transient ischemic attack Factors associated with intracerebral hemorrhage after thrombolytic therapy for ischemic stroke: pooled analysis of placebo data from the Stroke-Acute Ischemic NXY Treatment (SAINT) I and SAINT II trials Safety of intravenous thrombolysis for acute ischemic stroke in patients receiving antiplatelet therapy at stroke onset Intravenous thrombolysis for acute ischemic stroke in patients receiving antiplatelet therapy: a systematic review and meta-analysis of 19 studies Intravenous thrombolysis for ischemic stroke patients on dual antiplatelets Safety and efficacy of dual antiplatelet pretreatment in patients with ischemic stroke treated with IV thrombolysis: a systematic review and meta-analysis Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review Antiplatelet therapy in primary spontaneous and oral anticoagulation-associated intracerebral hemorrhage Outcomes in antiplatelet-associated intracerebral hemorrhage in the TICH-2 randomized controlled trial Aspirin non-responder status and early neurological deterioration: a prospective study High on-clopidogrel platelet reactivity in ischaemic stroke or transient ischaemic attack: systematic review and meta-analysis doi: 10.1016/j.jstrokecerebrovasdis.2020.104877 Recommendations for the standardization of light transmission aggregometry: a consensus of the working party from the platelet physiology subcommittee of SSC/ISTH High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury Effects of aspirin and clopidogrel in healthy men measured by platelet aggregation and PFA-100 Assessing aspirin-induced attenuation of platelet reactivity by flow cytometry A novel flow cytometry-based platelet aggregation assay Harmonizing platelet function analyzer testing and reporting in a large laboratory network Platelet aggregation testing on a routine coagulation analyzer: a method comparison study Anti-idiotypic antibodies against an antibody to the platelet glycoprotein (GP) IIb-IIIa complex mimic GP IIb-IIIa by recognizing fibrinogen Clinical and laboratory diagnosis of heritable platelet disorders in adults and children: a British Society for Haematology Guideline In vivo platelet activation in ischemic stroke patients Crossref Full Text | Google Scholar Course of platelet activation markers after ischemic stroke Guideline for reversal of antithrombotics in intracranial hemorrhage: a statement for healthcare professionals from the neurocritical care society and society of critical care medicine Thromboelastography as a predictor of functional outcome in acute ischemic stroke patients undergoing endovascular treatment Predicting functional outcomes after acute ischemic stroke - Is thrombelastography useful outside perioperative bleeding management Diagnostic utility of flow cytometry based coated-platelets assay as a biomarker to predict thrombotic or hemorrhagic phenotype in acute stroke Platelets in patients with acute ischemic stroke are exhausted and refractory to thrombin due to cleavage of the seven-transmembrane thrombin receptor (PAR-1) Measurement of platelet function in an experimental stroke model with aspirin and clopidogrel treatment Gatzke F and Miesbach W (2024) Feasibility and comparability of different platelet function tests in acute stroke with or without prior antiplatelet therapy Received: 26 December 2023; Accepted: 30 January 2024; Published: 12 February 2024 Copyright © 2024 Schaefer, Lieschke, Urban, Bohmann, Gatzke and Miesbach. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution or reproduction in other forums is permitted provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited in accordance with accepted academic practice distribution or reproduction is permitted which does not comply with these terms *Correspondence: Jan Hendrik Schaefer, amEuc2NoYWVmZXJAbWVkLnVuaS1mcmFua2Z1cnQuZGU= Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish. The disease burden and bleeding risk of patients with mild hemophilia may be underestimated. Their health-related quality of life (QoL) may be negatively impacted by insufficient treatment and bleed-related joint damage connected to a potentially delayed diagnosis. This study aims to gain information on the care reality and QoL of patients aged ≥12 years with mild hemophilia in Germany. An anonymous cross-sectional patient survey using standardized questionnaires was conducted in a validated electronic patient-reported outcome system. Medical specialists, hemophilia centers, patient organizations, and support groups across Germany invited the patients. Bleeding complications and joint bleeding, in particular, may be highly underestimated in patients with mild hemophilia, highlighting a medical need in this population. Patients with a potential benefit from prophylaxis need to be identified. Mild hemophilia has a negative impact on patients’ QoL. Hemophilia centers satisfied the patients’ needs. Further research is needed to address the current lack of awareness and improve adequate treatment in the future. Volume 11 - 2024 | https://doi.org/10.3389/fmed.2024.1347024 This article is part of the Research TopicAcute and Hereditary Coagulation DisordersView all 11 articles Introduction: The disease burden and bleeding risk of patients with mild hemophilia may be underestimated Their health-related quality of life (QoL) may be negatively impacted by insufficient treatment and bleed-related joint damage connected to a potentially delayed diagnosis Aim: This study aims to gain information on the care reality and QoL of patients aged ≥12 years with mild hemophilia in Germany Methods: An anonymous cross-sectional patient survey using standardized questionnaires was conducted in a validated electronic patient-reported outcome system and support groups across Germany invited the patients Results: A total of 43 patients (35 patients with hemophilia A and 3 patients for whom the information was missing) with a median age of 33 years were analyzed The median age at diagnosis was 6.0 years (interquartile range [IQR] 2.0–15.0) and the median factor activity was 14.0% (IQR 12.0–25.0) Nearly 85% of the patients received factor concentrates in the past and the most common reasons for the treatment were surgery or joint bleeding (each 65.6%) Half of the patients who provided feedback experienced complications during bleeding episodes Prophylactic treatment with factor concentrates was rare (10.3%) The patients had minor problems regarding their health status Conclusion: Bleeding complications and joint bleeding may be highly underestimated in patients with mild hemophilia highlighting a medical need in this population Patients with a potential benefit from prophylaxis need to be identified Mild hemophilia has a negative impact on patients’ QoL Hemophilia centers satisfied the patients’ needs Further research is needed to address the current lack of awareness and improve adequate treatment in the future Hemophilia refers to a rare congenital bleeding disorder (1) mainly affecting men (2). It is characterized by a coagulation factor deficiency of factor VIII (FVIII; hemophilia A, HA) or factor IX (FIX; hemophilia B, HB) (1) Unlike severe hemophilia, mild phenotypes are often diagnosed later in life (5, 7), usually as a result of extended bleeding episodes provoked by injury or medical interventions; however, recurrent spontaneous bleeding episodes are rare in mild hemophilia. Recently, patient age was reported to correlate with arthropathy, a most relevant factor negatively affecting the quality of life (QoL) (7) Exact numbers of patients with (mild) hemophilia are unknown (1) due to various reasons (2, 7), and the number of undiagnosed patients is likely to far exceed (1) than those reported (2): in 2020, 4,518 patients with HA (mild type: 738 patients) and 860 patients with HB (mild type: 152 patients) were newly registered in the German Hemophilia Registry (13) The current treatment of severe hemophilia aims to change its phenotype to that of moderate-to-mild hemophilia (1, 18) by prophylaxis (1). However, for patients with mild-to-moderate hemophilia, unmet needs (18), such as recommendations for physical activity (19) This survey aimed to investigate the care reality and QoL of patients with mild hemophilia, as daily problems and restraints may remain largely neglected (7) This cross-sectional survey was conducted to collect information on the care reality and the QoL of patients aged ≥12 years in Germany, diagnosed with mild HA or HB. The main objectives of this study were to assess the patient satisfaction with the therapy and support provided by hemophilia centers, the impact of hemophilia on daily life, QoL [EQ-5D-5L questionnaire (20)] The web-based survey collected anonymous data directly from patients in a single session using standardized electronic questionnaires filled out in the AMS-ePRO® tool a validated electronic patient-reported outcome system and support groups across Germany distributed invitations Distribution and individualized one-time QR codes on invitations were not tracked invitations were handed out to all eligible patients Patients accessed the survey using their own smartphones/tablets by scanning the QR code Internet connection via a standard web browser was secured by hypertext transfer protocol secure and the database server was hosted under controlled conditions in an off-site facility Easy-to-complete lay language questions focused on demographics It is important to note that drug-related adverse events were not collected questions could be answered in any order and ticked answers could be amended Logic and plausibility checks were implemented to ensure data quality and to minimize data inconsistencies Based on the number of patients and demographics in Germany 150–200 patients were expected to participate The sample size was based on the estimated number of suitable patients and was not formally calculated as this was an exploratory survey without formal hypothesis testing Statistical analyses were conducted using SAS® (v9.4 or later; SAS Institute Inc. The analysis set included all eligible patients who answered at least one question Continuous variables were represented using mean Categorical variables were represented as absolute and percentage frequencies of answers All available data were included in the analyses and summarized as far as possible The survey started in September 2021 and ended in July 2022 A total of 44 datasets were collected, and 43 were included in the final analysis set; one was excluded because it was a test input. The median age was 33.0 years (min–max 12–75; 41 answers; Table 1) The median age at the initial diagnosis of mild hemophilia was 6.0 years (min–max 0–37; 39 answers) Self-reported patient characteristics (full analysis set: N = 43) The majority of the patients (84.2%) had received the factor concentrate for hemophilia treatment in the past (38 answers, Table 2). The median age of first factor administration was 10.0 years (min–max 0–56; 27 answers; Table 2) Previous hemophilia treatment—type of treatment and age of first treatment administration (full analysis set: N = 43) Almost half of the patients with HA (43.6%) had not received desmopressin treatment in the past (39 answers) The median age at first desmopressin administration was 27.5 years (min–max 4–49); the mean age (SD) was 23.0 years (14.9 including three patients who could not recall) 38 answers) experienced complications due to untreated bleeding episodes in the past Patients could provide multiple answers regarding the reasons for previous treatments (ranging from 11 to 32 answers). There were multiple reasons for the treatment with the factor concentrate (Table 3) with the most common being joint bleeding and/or a perioperative setting (21; 65.6% each) The most common reasons for using desmopressin were medical procedures (dental treatments and surgery) or accidents (11 answers) Spontaneous or joint bleeding was less frequently treated with desmopressin The most common reasons for complications due to untreated bleeding episodes—19 patients (50%) who answered that they had experienced complications—were due to medical procedures such as dental treatment (10/19 patients; 52.6%) and joint bleeding (10/19 patients; 52/69%) Patients could provide multiple answers to this question Reasons for previous hemophilia treatments and for complications due to untreated bleeding episodes (full analysis set: N = 43) Patients could provide multiple answers regarding their current treatment/the use of prophylaxis (39 answers). Most patients (69.2%) received the factor concentrate on-demand. One-quarter of the patients used medications other than factor concentrates, such as tranexamic acid or desmopressin. Furthermore, 59% of the patients received non-medicinal treatment or no medication for the treatment of bleeding episodes (Table 4) and used Current hemophilia treatment of bleeding episodes and reasons for choosing prophylaxis with factor concentrate (full analysis set: N = 43) Additionally, four patients (10.3%), two with HA and two with HB, currently used prophylaxis with factor concentrate. They indicated multiple reasons for choosing prophylaxis (Table 4) The three most frequent reasons were a desire for better control of bleeding episodes even in the case of non-apparent bleeding (100%) a reduction of bleeding episode frequency (100%) The desire for more safety in daily life or a more carefree life was not in focus (0%) Concentrates with an extended half-life were rarely used in this patient population (27 answers; Table 4) and most patients (63%) were unaware of whether they were receiving them Patients visited hemophilia centers only when needed (55.3%) or on a regular basis, i.e., more often than every six months and every 6 or 12 months (44.7%; 38 answers). Half of those patients (nine, 52.9%) who needed regular visits (17 patients) attended the hemophilia center about every six months or only about once a year (seven, 41.2%). One patient required more frequent visits (Table 5) Frequency of visits to the hemophilia center and patient diaries (full analysis set N = 43) A bar chart depicting patient satisfaction with the support and therapy for the treatment of bleeding episodes at the hemophilia center This chart is based on the information provided by 37 patients; the answers for six patients per topic were missing The bars show the patient numbers at the inside end of the bars; the corresponding percentages are shown on top of the bars Percentages relate to the number of patients who provided answers The majority of the patients (73.7%) did not seek medical care from other physicians other than their hemophilia center while approximately one-quarter of patients (26.3%) sought another medical opinion (38 answers) A bar chart representing the impact of mild hemophilia on daily life; this chart is based on the information provided by 37 patients; the answers for six patients were missing (A) The majority of patients can always or usually detect bleeding episodes and assess when they need treatment; (B) Hemophilia is sometimes a burden on the patients or during leisure time; (C) The majority of patients always or usually needs support from the hemophilia center if bleeding occurs which is sometimes the case for seven patients EQ-5D-5L includes the dimensions “mobility”, “self-care”, “usual activities”, “pain/discomfort”, and “anxiety/depression”, with the ratings ranging from “no problems” to “unable” and “no” to “extreme” (20) The number of answers varied in different dimensions: Information was missing for eight patients regarding self-care and nine patients each for usual activities A bar chart representing the health of patients with mild hemophilia at the day of the survey; this chart is based on the information provided by 34 with missing information for six patients in mobility and nine patients each in their usual activities The bars show the patient numbers in the center of the respective bar section Most patients experienced no limitations due to their condition in all five dimensions except for the pain/discomfort dimension where nearly half of the patients experienced slight impairment The EQ-VAS scale allows patients to self-report their health status on a scale from 0 (“worst imaginable health”) to 100 (“best imaginable health”) The median EQ-VAS was 80.0 (range 30–100; based on 33 answers) This survey aimed to shed light on the reality of care for patients with mild hemophilia, as daily problems and restrains may remain largely neglected (7) which were detected by coincidence in another patient with FVIII deficiency Both patients were included in the analysis as local laboratory standards on categorization levels for hemophilia slightly differ Most patients (69.2%) received the factor concentrate on-demand as a current treatment option, which was lower than that reported in the DYNAMO study (98%), an international multicenter study including men aged 12 to 55 years with non-severe hemophilia (residual FVIII/IX activity: 2 to 35%) (21) Other patients (59.0%) chose non-medicinal treatment or no medication for the treatment of bleeding episodes and used plasters or dressings or other medications except the factor concentrate (25.6%; see below) Approximately 60% of patients chose non-medicinal treatment or no medication for the treatment of bleeding episodes as compressions, a procedure applied by others for small bleeds or cuts, that is following the standard RICE (rest, ice, compression, and elevate) principle (30) The generally (very) high satisfaction of the patients in our survey with the support from their hemophilia center and the treatment of bleeding episodes was also reported in another, yet small, survey from the United Kingdom, (30) and a larger study from the United States comprised patients with all severities (mild 32.8%), females patients with hemophilia, and patients with other bleeding disorders, such as von Willebrand disease (38) Most patients (73.0%) always/usually needed support from the hemophilia center, indicating the need for adequate treatment (10). However, patients may choose a wait-and-see approach before seeking healthcare services, depending on the severity of bleeding episodes and pain (30). Improved patient education may lead to earlier intervention and, thereby, timely treatment (7, 9) In this study, the median patient self-rated health, as reported by the EQ-VAS scale, was 80.0, ranging from 30 to 100, with a score of 100 equaling “best imaginable health”. This score was higher than that in the B-HERO-S study (41) and was similar to the P-FiQ study, which included both patients with HA and HB (19) Increasing these through supportive measures Results may not be representative of all patients with mild hemophilia as only those with smartphone/tablet access and the ability to scan QR codes could participate Motivation/approaches in filling out questionnaires may differ but retrospective verification is impossible due to anonymized data capture Captured data were patient-reported and were not validated by a physician reviewing unclear/incorrect information was impossible While automated measures reduced the possibility of implausible data it is important to note that missing/implausible data may still exist The generation of irrelevant/double/fake datasets cannot be completely ruled out some data may be missing due to accidental or purposeful premature survey termination The definition “mild” based on the residual factor activity may not result in an actual perception of a mild disease by the affected patients especially regarding joint problems/hemophilic arthropathy and lowering the patients’ QoL such as longitudinal studies to track the progression of clinical outcomes or a study to determine whether individuals with higher factor activity have fewer emergency visits or scheduled appointments might be useful in this patient population Increased awareness of mild hemophilia is needed to improve diagnosis and treatment for these patients The original contributions presented in the study are included in the article/supplementary material further inquiries can be directed to the corresponding author The authors thank all the participants of this survey and the members of the DHG Medical writing support was provided by Ina Heppel and Hanna Neymeyer and the decision to publish by the authors RA has acted as a paid consultant to CSL Behring and has received funding for research carried out in this work and Novartis and meeting/congress support from Takeda GG reports receiving honoraria for lectures from Bayer and reimbursement for travel expenses from Biotest SH reports grants or contracts from Bayer Healthcare SH has received honoraria from Bayer Healthcare Roche Pharma; Swedish Orphan Biovitrum and consulting fees from Bayer Healthcare KH reports grants for research or clinical studies (to institution): Bayer and honoraria for lectures or consultancy (to person): Bayer She has received meeting/congress support from Pfizer Novo Nordisk and has served as a speaker for the Haemophilia Board of the GTH and is a member of the Ärztlicher Beirat of the Deutsche Hämophiliegesellschaft e.V (DGH; Medical Advisory Board of the German Haemophilia Society e.V.) CK has received consulting fees or honoraria for lectures and meeting/congress support from BFSH CK’s institution has received grants from Bayer Vital GmbH and the European Union (H2020) and federal funding He is a member of the German Paediatric AIDS Society and Head of the German Haemophilia PUP Registry WM has acted as a paid consultant to Bayer uniQure and has received research funding form Bayer WM has received honoraria for lectures from Bayer and Takeda/Shire and has received meeting/congress support from Bayer CP reports grants for studies and research from Chugai and Takeda; and personal fees for lectures or consultancy from Alexion MO has received honoraria or consulting fees from Bayer MO has participated in DSMB/advisory boards from Bayer Sobi and Takeda and has received meeting/travel support from Bayer This study received funding from CSL Behring The funder had the following involvement with the study: study design the writing of this article (funding of medical writing support) and the decision to submit it for publication Deutsche Hämophiliegesellschaft e.V.; IGH Interessengemeinschaft Hämophiler e.V The WFH guidelines for the Management of Hemophilia panelists and co-authors WFH guidelines for the management of hemophilia Google Scholar Crossref Full Text | Google Scholar Definitions in hemophilia: communication from the SSC of the ISTH Mild and moderate hemophilia a: neglected conditions Recent advances in musculoskeletal physiotherapy for haemophilia Diagnosis and care of patients with mild haemophilia: practical recommendations for clinical management Factor VIII gene (F8) mutation and risk of inhibitor development in nonsevere hemophilia a Challenges in the diagnosis and management of non-severe hemophilia Crossref Full Text | Google Scholar International consensus recommendations on the management of people with haemophilia B Deutsches Hämophilieregister (DHR) Google Scholar 1-Deamino-8-d-arginine vasopressin: a new pharmacological approach to the management of haemophilia and von Willebrands’ diseases Cellular mechanisms of the hemostatic effects of desmopressin (DDAVP) Crossref Full Text | Google Scholar Desmopressin for bleeding in non-severe hemophilia a: suboptimal use in a real-world setting The factor VIII treatment history of non-severe hemophilia a: COMMENT Joint damage in adult patients with mild or moderate hemophilia a evaluated with the HEAD-US system Current challenges for men and women with mild-to-moderate haemophilia Impact of haemophilia on patients with mild-to-moderate disease: results from the P-FiQ and B-HERO-S studies EuroQol--a new facility for the measurement of health-related quality of life Crossref Full Text | Google Scholar The bleeding phenotype in people with nonsevere hemophilia What factors influence the age at diagnosis of hemophilia Mild haemophilia: a disease with many faces and many unexpected pitfalls The factor VIII treatment history of non-severe hemophilia a Burden of mild haemophilia a: systematic literature review Gentherapie der Hämophilie: Empfehlung der Gesellschaft für Thrombose- und Hämostaseforschung (GTH) Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten Google Scholar Living with mild haemophilia and care after a bleed – a qualitative study Crossref Full Text | Google Scholar Quality of life in a large multinational haemophilia B cohort (the B-natural study) - unmet needs remain Identified unmet needs and proposed solutions in mild-to-moderate haemophilia: a summary of opinions from a roundtable of haemophilia experts Analysis of low frequency bleeding data: the association of joint bleeds according to baseline FVIII activity levels The frequency of joint hemorrhages and procedures in nonsevere hemophilia a vs B Hemophilia without prophylaxis: assessment of joint range of motion and factor activity Crossref Full Text | Google Scholar Leitlinie der Gesellschaft für Thrombose- und Hämostaseforschung (GTH) zur Struktur- und Prozessqualität von Hämophilie-Zentren Patient satisfaction with US hemophilia treatment center care teams and services: the first National Survey Impact of mild to severe hemophilia on education and work by US men and caregivers of children with hemophilia B: the bridging hemophilia B experiences results and opportunities into solutions (B-HERO-S) study Clinical outcome of moderate haemophilia compared with severe and mild haemophilia Impact of hemophilia B on quality of life in affected men and caregivers-assessment of patient-reported outcomes in the B-HERO-S study Improving survey response rates in online panels:effects of low-cost incentives and cost-free text appeal interventions Crossref Full Text | Google Scholar Patient-reported experiences with general practitioners: a randomised study of mail and web-based approaches following a national survey Pfrepper C and Olivieri M (2024) Patient perspective on living with mild hemophilia in Germany: results from a nationwide survey Received: 30 November 2023; Accepted: 15 January 2024; Published: 05 February 2024 Copyright © 2024 Alesci, Goldmann, Halimeh, Holstein, Königs, Miesbach, Pfrepper and Olivieri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) *Correspondence: Rosa Sonja Alesci, cy5hbGVzY2lAZ2VyaW5udW5nc3plbnRydW0taG9jaHRhdW51cy5kZQ== Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish Natalie Geisenberger's ASV Miesbach club in Bavaria erupted in celebration on Tuesday night as the German luge legend became the first to win the women's singles competition three times would like to see his mother on a big TV screen blowing kisses to him with tears of joy running down her face The little boy might not have spotted the gold medal hanging around his mother's neck Geisenberger's victory at the 2022 Beijing Winter Olympic Games was her third consecutive women's single luge Olympic gold after winning in Sochi in 2014 and in Pyeongchang in 2018 Another two golds in the team luge event in Sochi and Pyeongchang and a bronze from 2010 in Vancouver make Geisenberger the winningest luge Olympian of all time cheered her on from Germany surrounded by friends and family Scheer and Helmut have traveled with Geisenberger on the luge circuit from event to event to allow for a normal family life alongside top-level competition Together with German national team member Dajana Eitberger the 34-year-old set up an interest group on social media called "Mum's special training." The 2018 Olympic luge silver medal winner Eitberger gave birth to her child in 2020 as well and returned to the sport shortly after he will come to understand the details behind his mother's concerns about leaving her family behind for the 2022 Games addressing the rules of the Olympics in times of a pandemic She may tell him about the nerve-wracking two days when she had to face four runs down Beijing's fierce and fast luge track She may tell him about a restless night after the first two runs with her having taken the lead Geisenberger was having a lackluster 2021/22 season with some pundits speculating she might retire While on average almost 80 people lose their lives to the pandemic every day in Germany  and a new COVID wave is gathering pace the federal and state governments are dismantling the last remaining measures and promoting a “live with the virus” strategy The Oktoberfest—a super-spreading event par excellence—is only the most disturbing example of this policy the Oktoberfest has been taking place in Munich where millions of people from countries around the world meet in tents without any COVID protection measures The fact that this would lead to a mass spread of the virus was beyond question from the outset head of the Miesbach health office in Upper Bavaria “One thing is clear: a beer tent cannot be adequately ventilated And it is an international meeting place—the best conditions for the virus to spread this will lead to an increase in the number of cases,” said Johannes Bogner senior consultant at the LMU Clinic at the University of Munich And Munich virologist Oliver Keppler told regional public broadcaster BR the probability of SARS-CoV-2 exposure after several hours in the tent is This coincides with the catastrophic consequences of similar festivals which were celebrated in various parts of Bavaria without COVID restrictions the seven-day infection rate rose there to over 1,000 infections per 100,000 inhabitants approximately one-and-a-half weeks after the start of the Oktoberfest the seven-day incidence has risen from 225 per 100,000 inhabitants to over 695 within 10 days more than 10,000 new COVID cases were reported where the second highest number of cases were registered in the last seven days PCR test samples have shown that 2 percent of Oktoberfest visitors are already infected at the event The federal and state governments are not only aware of this development Numerous politicians of all parties have published pictures of themselves without a mask at the festival According to the new Infection Protection Act Bavarian Prime Minister Markus Söder (Christian Social Union CSU) stated before the start of the Oktoberfest “The number of infections will probably increase that is the experience of previous festivals.” The organisation of huge festivals without any protection serves above all one goal: “living” or rather “dying with the virus” is to be normalised President Biden recently described the pandemic as “over,” an increasing number of politicians in Germany are calling for the last remaining measures to be lifted the spokesman for health policy of the Christian Democratic Union/CSU parliamentary group in the Bundestag the state of emergency must not become a permanent state Our federal government will also have to explain to people how long we will be in pandemic mode.” spokesman for health policy for the Free Democratic Party group “I can absolutely understand what Joe Biden means I would argue that the pandemic is not over yet Baden-Württemberg’s Green Party Minister President Winfried Kretschmann sees Germany in the “transition from the pandemic to endemic disease” and declared that he does not consider any further protective measures necessary Hesse and Schleswig-Holstein demanded in a joint letter that the obligation to isolate people infected with COVID be abandoned Baden-Württemberg’s Minister of Health Manne Lucha (Greens) said “We should gradually come into the mode of treating a coronavirus infection like another infectious disease in which the rule is: If you are ill the Baden-Württemberg state government abolished compulsory isolation for children and young people after a coronavirus infection Students can therefore return to school infected and spread the virus among their classmates who was infected with the coronavirus a few days ago has concentrated on sending the message that infected people can work Scholz “isolated himself” in the Chancellery because he could “do a good job from here.” In order to recover quickly he took Paxlovid on the advice of his doctors this coronavirus treatment is virtually unavailable Federal Health Minister Karl Lauterbach (Social Democrats) is busy downplaying the situation and agitating against serious measures He only reckons with a 'medium-sized wave in autumn,” he explained in an interview with the Rheinische Post Lockdowns were “no longer justifiable” and “closures of schools or the hospitality industry” would no longer be considered A compilation of the World Socialist Web Site's coverage of this global crisis the situation is more serious than at the same time in recent years After a slight decline in infections in recent weeks The official 7-day incidence was 410 infections per 100,000 inhabitants on Thursday This means that the 7-day incidence has increased by 46 percent within a week The number of current new infections is about four times as high as a year ago at the same time the true number of infections is much higher as a large part of the test infrastructure has been dismantled and only PCR tests are included in the statistics The enormous test positivity rate of 33.9 percent also illustrates the high number of unreported cases A growing number of infections occur in hospitals and nursing homes Last week there were 51 outbreaks in medical treatment facilities (49 in the previous week) and 178 in retirement and nursing homes (120 in the previous week) at least 24 people have died in medical treatment facilities and 99 in retirement and nursing homes the number of severe outcomes following a COVID infection is increasing sharply again Around 6,000 people are hospitalized every week while 705 people are currently in intensive care units and around 80 people die every day This is almost twice as high as a year ago at the same time Particularly concerning is the spread of the Omicron subvariant BA 2.75.2 which exhibits an unprecedented ability to evade immunity According to assistant professor Ben Murell at the Karolinska Institute in Stockholm both the Evusheld and sotrovimab COVID drug treatments show no significant effect on isolated samples of the mutation According to a study by a research group at the University of Beijing the subvariant also easily prevails against the drug bebtelovimab All three drugs consist of isolated antibodies which are intended to trigger an immediate effect in the infected patient The emergence of new mutations illustrates the total bankruptcy of the official pandemic policy the mass infection of the population does not lead to more harmless mutations but to the emergence of more infectious and resistant variants The only strategy to end the pandemic is to eliminate the virus But since this is incompatible with the economic interests of the ruling class it is necessary to build a socialist movement of the working class which prioritises the life and health of the population over the profits of the capitalists Someone from the Socialist Equality Party or the WSWS in your region will contact you promptly You are using an outdated browser. Please upgrade your browser or activate Google Chrome Frame to improve your experience Memorial services for Wilhelm “Bill” Fritsch Visitation will be one hour prior to the service at the church John’s Lutheran Home after a courageous battle with colon/brain cancer Wilhelm Fritsch (He preferred “Bill”) was born on Nov to parents Franz Xaver Fritsch and Ursala Eibach Fritsch Bill had an adventurous pioneering spirit and immigrated to America at age 15 He lived with Cecelia and Ruben Peterson and their two daughters He attended ALHS and graduated with the Class of 1957 He enlisted in United States Marine Corps in 1958 became a naturalized citizen in 1961 and was honorably discharged in 1964 after serving in Okinawa Bill was employed as warehouse manager at and retired from Interstate Power Company in Albert Lea He is a past president of the Eagles Club in Albert Lea was active in the “JC’s” and a member of New Life Christian Church in Albert Lea He loved to cook and for many years cooked Torsk for the annual dinner at Trinity Lutheran Church Bill loved making authentic Bavarian dishes and sauerkraut for family and friends He loved to learn new things and help friends and family He especially enjoyed nature and experiencing new things with his grandson Bill will be greatly missed by family and friends He had strong faith in Jesus and knew Jesus would take him home and soon we will be reunited of Albert Lea; Bill’s pride and joy his grandson Lori (Bill) Bagley; nieces in America: Jennifer Bagley and Rebecca Bagley; adopted sisters: Maxine (Arliss) Bachtle and family and Janice Peterson and family; adopted brother Anna “Bobby” (Willi) Weindel and Karin and Petra and families in Forst; Dorathea wife to brother Franz Fritsch in Ludenscheid Ingrid wife to brother Hans Fritsch and daughter Claudia and family in Miesbach; brother-in-law Erich husband to sister Rosie (Fritsch) Pisch and daughters Gitti and Evi in Miesbach; cousin Marlene Schober and family in Miesbach Bill was preceded in death by his biological parents: Franz and Ursula Fritsch; step-father Alfred Muschke; adopted parents: Cecelia and Ruben Peterson and Emily and Mathew Michels; siblings: Rosie Pisch in 1992 Franz Fritsch in 1998 and Hans Fritschin 2009; and aunt The Minnesota Timberwolves (33-29) are home in Northwest Division play versus the Utah Jazz (15-45) on Sunday which includes the Tampa Bay Lightning versus the Florida Panthers Top 25 teams will take the court across two games on Monday’s college basketball schedule The college basketball schedule on Monday should provide some fireworks Our computer model has provided picks against the… Ranked teams are on Monday’s college basketball schedule for two games including the Kansas Jayhawks squaring off against… Germany (AP) — Georg Schoettl’s workout routine is intense That — plus a high tolerance for pain — is all he needs to compete in the unique sport of “Fingerhakeln,” or finger wrestling Schoettl’s training regimen consists of using his middle finger to lift a weight and pull a rubber band over and over again The preparation serves the 56-year-old farmer from southern Germany well when he arrives at the 40th Alpine Country Championship where he is one of more than 50 competitors Hundreds of people in traditional Bavarian clothes come together in a big tent in the picturesque village of Woernsmuehl near Miesbach in Upper Bavaria to drink beer and watch the crowning of new champions Fingerhakeln is now a serious competitive sport in the Alpine region of southern Germany and neighboring Austria but it was originally used to settle disputes competitors sit on opposite sides of a solid table cushioned with leather to soften the impact They hook their fingers through opposite sides of a small leather loop and wait for the referee to signal the start The winner is whoever can pull his opponent across the table first Von: Sebastian Grauvogl um am Wochenende Scharen an Skitourengehern zu locken Doch Experten mahnen zur Vorsicht.","url":"https://www.merkur.de/lokales/region-miesbach/schliersee-ort29415/warnen-tourengeher-vor-unvernunft-tiefschneewunder-am-spitzingsee-experten-93303777.html"};c&&a.navigator.canShare(d)&&(c.style.display="",c.addEventListener("click",b=>{b.preventDefault(),a.setTimeout(function(){a.navigator.share(d)},0)}))}})(window,document); Der heftige Wintereinbruch am Spitzingsee reichte um am Wochenende Scharen an Skitourengehern zur vorzeitigen Saisoneröffnung zu locken Spitzingsee – In Tagen wie diesen muss man schnell sein Was Gela Allmann schon der Alpenblick aus dem heimischen Fenster in Aurach suggerierte bestätigte ihr eine Freundin dann am Samstag Ein Meter frischer Neuschnee sei am Sonntagmorgen (15 September) in den Bergen rund um den Spitzingsee gelegen wie die Alpenbahnen Spitzingsee auf ihrer Homepage mitteilten Das schien der Schneebegeisterung Mitte September keinen Abbruch zu tun Wie der stellvertretende Bereitschaftsleiter der Bergwacht Schliersee waren nicht nur Skitourengeher am Spitzing unterwegs Auch Wanderer – wahlweise mit Schnee- oder Bergschuhen – und sogar Schlittenfahrer habe die Bergwacht angetroffen Die eingeschneiten Fahrwege zur Diensthütte an der Schönfeldalm aber waren schon eine in dieser Heftigkeit und vor allem zu dieser Jahreszeit ungewohnte Herausforderung Und die dürfte trotz des Tauwetters samt Regen am Montag noch ein paar Tage anhalten nasse Schnee könne auf den noch mit langem Gras bewachsenen Hängen plötzlich ins Rutschen kommen und dadurch auch Lawinen auslösen Vor allem im steilen Gelände sei hier Vorsicht geboten Ferner seien viele Wanderwege schneebedeckt und vereist und damit äußerst rutschig Gerade nordseitig dürfte sich daran trotz höherer Temperaturen im Verlauf der Woche noch nicht viel ändern Grödl einzupacken und – sofern vorhanden – auch ein Lawinenverschüttetensuch(LVS)-Gerät eingeschaltet am Körper zu tragen Fast noch wichtiger: vernünftiges Verhalten und rechtzeitig umkehren Das sei am Sonntagmorgen tatsächlich der Fall gewesen Einheimischen falle es da natürlich leichter die Bedingungen abzuschätzen und im schlimmsten Fall einfach wieder umzukehren „Aber eine weitere Anfahrt lohnt sich aktuell sowieso nicht“ das konnte sie am Sonntagnachmittag nach ihrer Skitour gleich selbst noch feststellen „Wir sind mit den Kindern noch mal hochgefahren“ Da sei der Schnee dann schon schwer und nass gewesen Was dem Nachwuchs für eine Schneeballschlacht gerade recht kam dass sich das Zeitfenster fürs Auffellen am Spitzingsee schon wieder geschlossen hatte Allmann nimmt‘s im wahrsten Sinne sportlich: „Dann geh ich wieder Rennradfahren.“ Die Alpenbahnen sind derweil am Montag wieder in Betrieb gegangen Die Taubensteinbahn wegen Schneedruckschäden laut Internetseite allerdings erst gegen Mittag Noch geschlossen bleibe die Mountaincart-Strecke am Stümpfling Doch auch das dürfte angesichts der angekündigten Wärmerückkehr nur eine Momentaufnahme sein Dieser Inhalt"+t(a)+"kann aufgrund Ihrer Datenschutz-Einstellungen nicht geladen werden Munich has been named the best place to live in Germany according to a study published by public broadcaster ZDF Munich also has the lowest poverty rates and crime rates nationwide The study ranked every town in Germany based on three categories: work and living conditions; free time and nature; and health and security followed by the wealthiest town per capita in Germany Starnberg and the UNESCO World Heritage town of Potsdam Following the UNESCO World Heritage town of Potsdam – in fifth sixth and seventh place are all Bavarian cities and districts: Garmisch-Partenkirchen and 10th place are the district of Oberallgäu; the Bad Tölz-Wolfsratshausen district; and the Baden-Württemberg city of Ulm Ulm is also known for being the birthplace of Albert Einstein These Are The 10 Best Places To Live In Germany CEOWORLD and ‘CEOWORLD magazine’ are trademarks of The CEOWORLD magazine LTD Freizeit-Tipp: Auf den Spuren des Münchner Trinkwassers hochwertige Komponenten & kostenfreie Beratung Besondere Erlebnisse in der Sauna genießen Ökologischer Landbau zum Schutz des Münchner Trinkwassers Mit der Initiative „Ökobauern“ fördern die SWM den ökologischen Landbau im Wassergewinnungsgebiet Mangfalltal Mit der boden- und gewässerschonenden Bewirtschaftung schützen die SWM gemeinsam mit den Ökobauern vor Ort die Natur und erhalten die Qualität des Münchner Trinkwassers Ein „Zusatznutzen” der artgerechten Tierhaltung im Mangfalltal: die gute Fleisch- und Milchqualität Die SWM unterstützen zusammen mit Öko-Verbänden wie Bioland und Naturland ihre Partnerbetriebe bei der Vermarktung der Bio-Erzeugnisse Wer sich nachhaltig ernähren und gleichzeitig zur Reinhaltung des Münchner Trinkwassers beitragen möchte indem er Produkte aus dem Mangfalltal kauft nachhaltige Forstwirtschaft: Die SWM schützen die Qualität des Münchner Trinkwassers in den Gewinnungsgebieten Durch eine boden- und gewässerschonende Bewirtschaftung der Flächen in den Wasserschutzgebieten lassen sich Lebensraum und Vielfalt zahlreicher Pflanzen- und Tierarten bewahren Das Münchner Trinkwasser ist eines der besten Trinkwasser Europas dass es bei Ihnen quellfrisch aus der Leitung kommt © 2010 – 2025 Stadtwerke München GmbH Unter den Gästen waren auch einige bekannte Gesichter.","url":"https://www.merkur.de/lokales/region-miesbach/schliersee-ort29415/natalie-geisenberger-hat-geheiratet-fotos-im-brautkleid-9917312.html"};c&&a.navigator.canShare(d)&&(c.style.display="",c.addEventListener("click",b=>{b.preventDefault(),a.setTimeout(function(){a.navigator.share(d)},0)}))}})(window,document); Im Schlierseer Rathaus gaben sich Rennrodlerin Natalie Geisenberger und ihr langjähriger Partner Markus Scheer das Ja-Wort Unter den Gästen waren auch einige bekannte Gesichter Schliersee – Ganz gespannt warteten einige Hochzeitsgäste am Freitag schon auf dem Rathausbalkon in Schliersee Pünktlich um 14 Uhr fuhren sie dann im schwarzen Oldtimer vor: Rennrodlerin Natalie Geisenberger und ihr langjähriger Freund Markus Scheer – das Brautpaar an diesem Tag Den Rennanzug hat die 30-jährige Rekord-Olympiasiegerin vom SV Miesbach gegen ein langes Ihre Haare waren – passend zum Blumenstrauß in ihrer Hand – mit rosa Blüten geschmückt Nachdem sich die beiden im Standesamt das Ja-Wort gaben wurden sie von ihrer Familie und den engsten Freunden vor dem Rathaus mit Blütenblättern und Seifenblasen in Empfang genommen Unter den Gästen waren unter anderem auch Rodellegende Georg Hackl sowie die Olympiasieger und Trainingspartner Felix Loch und Tobias Wendl Bundestrainer Norbert Loch öffnete dem frisch vermählten Paar sogar die Tür auf den Rathausplatz entschied sich das Paar für eine Trauung in Schliersee.  Nachdem sich das Meer aus Seifenblasen schön langsam auflöste und zahlreiche Bilder geknipst wurden ging es im BMW-Oldtimer zur Hochzeitsfeier mit allen Gästen Richtung Sudelfeld – natürlich hupend im Auto-Corso Rosenheimer Radmarathons kam es zu einem schweren Sturz Die verletzte Hamburgerin ist im Krankenhaus verstorben.","url":"https://www.merkur.de/lokales/region-miesbach/dasgelbeblatt/polizei-sturz-mit-fahrrad-bei-rosenheimer-radmarathon-sudelfeld-91631951.html"};c&&a.navigator.canShare(d)&&(c.style.display="",c.addEventListener("click",b=>{b.preventDefault(),a.setTimeout(function(){a.navigator.share(d)},0)}))}})(window,document); Die verletzte Hamburgerin ist im Krankenhaus verstorben Wie die Polizeiinspektion Miesbach mitteilt ereignete sich ein schwerer Fahrradsturz am Sudelfeld auf der Bundesstraße B307 in Fahrtrichtung Bayrischzell „Eine 46-jährige Hamburgerin fuhr dabei im Rahmen des 29 Rosenheimer Radmarathons talabwärts mit ihrem Rennrad und stürzte nach einer Kurve alleinbeteiligt“ Dabei zog sie sich trotz getragenen Fahrradhelms schwerste Kopfverletzungen zu und wurde durch einen Rettungshubschrauber abtransportiert Die B307 musste während der ärztlichen Versorgung und zur Unfallaufnahme kurzzeitig komplett gesperrt werden Die Freiwillige Feuerwehr Bayrischzell regelte dabei den Verkehr und befand sich mit 21 Einsatzkräften vor Ort Aufgrund der Vollsperrung kam es laut Polizei zu leichten Verkehrsbehinderungen Rottach-Egern - Am Donnerstagmittag geriet in Rottach-Egern ein nagelneuer Mercedes in Brand. Warum, ist noch unklar, der entstandene Schaden ist jedenfalls immens. Der Mercedes S-Klasse, der laut des Polizeipräsidiums Oberbayern Süd gerade einmal zwei Wochen alt ist, geriet gegen 10.30 Uhr in der Ulrich-Stöckl-Straße während der Fahrt in Brand. Drinnen saß ein Rentnerehepaar aus Nordrhein-Westfalen, das das Auto noch rechtzeitg parken und verlassen konnte. Mitarbeiter eines nahegelegenen Geschäfts und Passanten eilten herbei und löschten die Flammen, die aus dem Motorraum des Autos schlugen. Die Rottacher Feuerwehr war laut Kommandant Josef Stadler mit 18 Einsatzkräften und drei Fahrzeugen vor Ort, musste aber aufgrund des Einsatzes der Passanten nur noch Nachlöscharbeiten leisten. An dem Fahrzeug entstand ein wirtschaftlicher Totalschaden in Höhe von rund 100.000 Euro. Der Grund: Der gesamte Motorraum ist ausgebrannt, außerdem wurde die Frontscheibe in Mitleidenschaft gezogen und es drang jede Menge Rauch in das Fahrzeuginnere ein. Beamte der Kriminalpolizei Miesbach haben Spuren an dem Auto gesichert, die klären sollen, warum es in Brand geriet. Außerdem soll ein Gutachter den Schaden inspizieren. Auch der Hersteller habe wohl ein Interesse an der Ursachenforschung, so Polizeisprecher Jürgen Thalmeier. "Ein Brand im Motorraum eines neuen Autos ist sehr ungewöhnlich", so Thalmeier. Vermutlich handele es sich aber um einen technischen Defekt. Die Feuerwehrler hatten laut Kommandant Stadler außerdem damit zu kämpfen, dass die Batterie, die bei ihrem Eintreffen heftig funkte, im Motorraum zu finden. "Bei einem alten Auto weiß man halt, wo was ist", so der Feuerwehrkommandant. Dieser Inhalt"+t(a)+"kann aufgrund Ihrer Datenschutz-Einstellungen nicht geladen werden. (Falls dieser Link nicht funktioniert, m\xFCssen Sie ggf. Ihre Adblocker-Einstellungen anpassen.) 2009 19 WAVERLY HIGH SCHOOL LINCOLN EAST Flute Mariah Atteberry Trevor Rolofson; Drumline: snare Sam Bohac Jana Wentzel; Pit: Brandon Cassell; Avery Curtis mallets; Calynn Gowin; Justin Minchow; Robert Posont elec bass; Adrienne Strode; baritone: Sarah Campbell Kensly Schuelke; Bass Clarinet Taylor Neth Haley Lawrence LINCOLN NORTH STAR Roster: Shatice Archie Samantha Zwiebel; Percussion Davis Anderson More band coverage next week The marching band report from Lincoln Northeast High School arrived past the deadline to be included in this section Look for the Rockets' report in next week's Neighborhood Extra 2009 Waverly Must have any driving permit to register NEBRASKAnesafetycouncil.org 483-2511 SAFETY Nebraska Safety Council Inc COUNCIL INC 3243 Cornhusker Highway Chapter National Safety Concil 483-2511 LINCOLN Seniors: Carolyn Butler 26 Papillion-LaVista Tournament of Bands Oct 10 Central States Marching Festival at Kansas State University 24 Nebraska State Bandmasters Association State Marching Contest