Environmentally sustainable practices in times of pandemic: Boroto Family's case, Garibaldi, RS, Brazil

The tourism sector has played an important role in the development of the world economy, mobility and globalization. Due to the Covid-19 pandemic, the sector needed to implement urgent measures and adaptations. This article aimed to identify which are the environmentally sustainable practices developed by a tourist enterprise of a rural property located in the municipality of Garibaldi-RS. In methodological terms, a single-type case study strategy was used with an exploratory and descriptive approach, operationalized with qualitative and quantitative research techniques. As data collection instruments, online interviews were used with the owner of the enterprise, respecting the recommendations of social isolation. The answers were recorded, tabulated and analyzed using the content analysis technique. Numerical data were tabulated using Excel software. The family responsible for the production unit, Familia Boroto, is fully dedicated to the organic production. The owner expressed concern about environmental sustainability and in this sense reported that the enterprise develops environmentally sustainable practices and, among them, they use solid waste management and recycling and he added that the health crisis brought a drop in revenue and little demand for organic products. In response, the producer made changes in management practices, such as process readaptation, innovation and entry into new markets. Thus, it was concluded that, even in the pandemic period, the venture had positive points and environmentally sustainable practices emerge as an opportunity to value products and services.

Metabolomic spittle analysis of post COVID-19 patients

Post COVID-19 patients have been suffering from persistent symptoms even after long periods. The physiopathology of these clinical manifestations still has a lack of knowledge. The objective was to evaluate the total expression of metabolites and spittle biological pathways in patients with 60 days post COVID-19. We included 30 post-hospital discharge patients and we compared seven non COVID-19 patients control. All COVID-19 patients were assessed by demographic characteristics, pulmonary function, exercise capacity, quality of life and body composition. The metabolomic analysis was performed in the patient's splits. From the total of post COVID-19 patients, 66% were male, 60+/-14 years. The lean body mass was 30+/-7kg and fat mass 34+/-13kg. Spirometry mean severity showed FVC of 4+/-1L, FEV1 3+/-1L. Pimax and Pemax values were 90+/-31(cmH2O) and 97+/-31(cmH2O), respectively. The quality of life evaluated by the SGRQ questionnaire showed a mean percentage of magnitude of symptoms 32+/-15, activities 41+/-25, impact 13+/-11 and total of 24+/-15. Physical capacity was measured by the distance in the 6MWT, and presented an average of 413+/-131. The metabolomic analysis showed 19 metabolites statistically significant difference between groups. We observed 3 metabolites overexpressed and 16 with lower expression in post COVID19 patients. From those metabolites, we can have attention to Sphinganine(p=0.03), Piperenol A triacetate(p=0.02) and 1-Monopalmitin(p=0.03) were lower expressed in control group. The creatin was one of the non-expressed metabolites in post hospital discharge COVID-19 patients compared to the control group. Thus, metabolomic analysis can demonstrate different metabolites in post COVID-19 patients to answer persistent symptoms.

Colchicine reduces the activation of NLRP3 inflammasome in COVID-19 patients.

OBJECTIVE: To evaluate whether colchicine treatment was associated with the inhibition of NLRP3 inflammasome activation in patients with COVID-19. METHODS: We present a post hoc analysis from a double-blinded placebo-controlled randomized clinical trial (RCT) on the effect of colchicine for the treatment of COVID-19. Serum levels of NOD-like receptor protein 3 (NLRP3) inflammasome products-active caspase-1 (Casp1p20), IL-1ß, and IL-18-were assessed at enrollment and after 48-72 h of treatment in patients receiving standard-of-care (SOC) plus placebo vs. those receiving SOC plus colchicine. The colchicine regimen was 0.5 mg tid for 5 days, followed by 0.5 mg bid for another 5 days. RESULTS: Thirty-six patients received SOC plus colchicine, and thirty-six received SOC plus placebo. Colchicine reduced the need for supplemental oxygen and the length of hospitalization. On Days 2-3, colchicine lowered the serum levels of Casp1p20 and IL-18, but not IL-1ß. CONCLUSION: Treatment with colchicine inhibited the activation of the NLRP3 inflammasome, an event triggering the 'cytokine storm' in COVID-19. TRIAL REGISTRATION NUMBERS: RBR-8jyhxh.

Challenges and Perspectives of the Furniture Market in Brazil

Traditionally the furniture market in Brazil is owned by family businesses and of national origin, with few exceptions. Based on this premise and the high demand promoted, especially in the Covid-19 pandemic, the market has adapted to the growing demand for residential furniture. Therefore, a conceptual restructuring needs to be carried out due to the great variability of products in the same factory, driven by the target audience, which goes beyond the traditional concepts of factory standardization and enables a new way of thinking according to the demand for products offered by catalog and/or bespoke. In addition, as they are family businesses, there is an inherent risk of closing activities due to the lack of family motivation of the following generations linked to the lack of knowledge to update manufacturing processes. This article concludes that the variability of products offered in each factory is a high option. New concepts must be adopted from handcrafted to manual transition. And, with positional and functional factory configurations, ensuring high efficiency and quality concerning the degree of difficulty, associated with the characteristics of furniture dealerships. To get success, the companies must be directed towards the sustainable production chain to the companies involved. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Vaccine-Induced Immune Thrombotic Thrombocytopenia (Vitt) by a Third Dose of Chadox1 Ncov-19 (Astrazeneca) after Bnt162b2 (Pfizer-Biontech)

An atypical case of VITT was described resulting from a vaccination schedule where the third booster with ChAdOx1 nCoV-19 (AstraZeneca) was administered. The patient received a complete vaccination schedule with two doses of Pfizer-BioNTech (BNT162b2) without any complications before the third dose. However, the patient has developed an infrequent yet extreme prothrombotic;hypercoagulable state caused by platelet-activating anti-Platelet Factor 4 (PF4) antibodies. This phenomenon is typically triggered by the proximate administration of an adenoviral vector vaccine against COVID-19. The patient's symptoms began ten days after taking the third dose of the ChAdOx1 nCoV-19 vaccine (AstraZeneca). His main complaints when hospitalized were severe headaches and right abdominal pain. The blood tests and MRI scan imaging findings were very characteristic of VITT, and a rare cerebral venous sinus thrombosis was found. Also, a markedly elevated D-dimer and strong positive PF4-dependent enzyme-immunoassay test results were documented. Due to discerning clinical suspicion, this patient was rapidly treated with immunoglobulin infusion for two days and oral steroids for three days. Subsequently, he was anticoagulated with the new oral anticoagulant edoxaban after platelet numbers recovery. In a few days, platelets normalized, and D-dimer levels decreased, while anti- PF4-dependent enzyme-immunoassay test results showed a slow decline. He was discharged taking oral edoxaban without any sequeal. Copyright © 2022

Lives"Educativas Durante a Pandemia Do Covid-19 Direcionada Aos Pacientes Com Doenca Falciforme

Introducao: Quando a Pandemia do COVID-19 chegou ao Brasil, pacientes com doenca falciforme foram considerados uma populacao de alto risco. Ware et al. (2017), em seu estudo, levantou algumas questoes que contribuiam com essa hipotese. A Sociedade Americana de Doenca Falciforme produziu um guia de orientacoes para esses pacientes durante a pandemia., (Sickle Cell Society, 2020). Isso fez com que nossa equipe elaborasse uma estrategia para fornecer informacoes a esses pacientes de maneira remota. Aproveitando a tecnologia e a colaboracao de varios profissionais de diferentes areas, gravamos sete "lives" que, na linguagem da internet, sao transmissoes ao vivo feitas por meio de redes sociais. Objetivo: Transmitir informacoes sobre cuidados em saude durante a pandemia do COVID-19 para pacientes com Doenca Falciforme. Metodologia: Os profissionais da saude foram convidados pela coordenadora da plataforma digital @melhoreviversemdor para realizacao das "lives" com temas especificos de suas areas de atuacao. Foram convidados dez profissionais, porem apenas nove puderam participar. As "lives" aconteceram entre os meses de junho e junho do corrente ano, em horarios previamente combinados e dentro da unidade de saude, no caso o Instituto Estadual de Hematologia Arthur de Siqueira Cavalcante (HEMORIO). Ao termino, as "lives" foram salvas e adicionadas a rede social Instagram no endereco @melhoreviversemdor. Resultados: Abaixo relacionamos os temas das "lives", os profissionais que realizaram a mesma e numero de visualizacoes obtidas no dia da postagem. Essas visualizacoes foram registradas no Instagram. 1) Tratamento domiciliar da dor na Doenca Falciforme - Enfermeira Elvira Carvalho - 233 visualizacoes. 2) Direitos e Beneficios Sociais no contexto da Pandemia do COVID-19 - Assistente Social Marcia Pereira - 299 visualizacoes. 3) Orientacoes de Atividade para a memoria durante a Pandemia do COVID-19 - fonoaudiologa Marcia Baima - 162 visualizacoes. 4) O fantasma do coronavirus no Universo Infantil - psicologas Daniella Gouget e Joanna D'Arc Bastos - 282 visualizacoes. 5) Cuidados com o seu bebe durante a Pandemia do COVID-19 - Enfermeira Disleine Xavier - 200 visualizacoes. 6) Orientacoes do armazenamento de medicamentos durante a Pandemia do COVID-19 - 263 visualizacoes. 7) Aspectos juridicos do doente cronico durante a Pandemia do COVID-19 - Com a advogada e enfermeira Delaine Fidlarczyk e o advogado Andre Baiseredo - 169 visualizacoes. 8) Abordagem odontologica nas gestantes com Doenca Falciforem - Destistas Larissa Melo e Thais Xavier - 198 visualizacoes. 9) A Importancia da boa alimentacao na Doenca Falciforme em tempos de pandemia do COVID-19 - Nutricionista Karen Cordovil - 236 visualizacoes. Conclusao: A educacao em saude e um processo continuo que envolve o fornecimento de informacoes nao apenas aos profissionais de saude, mas tambem aos pacientes. Esse trabalho teve o objetivo de transmitir conhecimentos de boas praticas em saude para pessoas que vivem com Doenca Falciforme. Todas as "lives" obtiveram mais de 100 visualizacoes, o que consideramos um resultado positivo, ja que foi a primeira vez que a plataforma @melhoreviversemdor executou esse tipo de proposta como veiculo de informacao. Seguir tendencias atuais como o uso de ferramentas virtuais e apostar na modernizacao da assistencia sem perder o profissionalismo e a constante preocupacao na melhoria da assistencia. Copyright © 2022

Sala De Espera: Projeto De Entretenimento Durante a Pandemia Do Covid-19

Introducao: A COVID-19 e uma patologia causada pelo Coronavirus SARS-CoV-2 caracterizada pelo comprometimento pulmonar, com evolucao para insuficiencia respiratoria. Apesar dos esforcos para realizacao do isolamento social, alguns pacientes necessitam comparecer ao hospital para realizar alguns procedimentos que nao podem ser adiados, como quimioterapia, transfusao de sangue, troca e consultas medicas. A fim de diminuir este tempo de espera criamos passatempos com orientacoes sobre a COVID-19. Objetivo: Disseminar informacoes acerca da pandemia do COVID-19. Materiais e Metodos: Estudo prospectivo de uma coorte na sala de espera do ambulatorio do HEMORIO, durante os meses de marco e abril de 2020, incluidos adultos (pacientes e acompanhantes) a partir de 18 anos e de ambos os sexos. O passatempo consistia de uma atividade de caca-palavras, uma atividade de palavras-cruzadas, uma atividade de labirinto e uma com frases para responder: verdadeiro ou falso. Todas as atividades abordavam o tema "cuidados relacionados ao Coronavirus". O passatempo foi entregue aos pacientes e acompanhantes juntamente com uma caneta. As analises foram feitas a partir da aceitacao do material, da opiniao emitida sobre o tema e se houve melhor tolerancia do tempo de espera com o uso de um passatempo. Resultados: A iniciativa do projeto obteve uma boa aceitacao dos pacientes e acompanhantes pois, foram distribuidos 50 passatempos com 99% de aceitacao, 98% de interesse pelo tema, 70% relataram diminuicao subjetiva do tempo de espera. Conclusoes: Orientacoes educacionais foram fundamentais na epoca de pandemia. A espera diante do alto grau de ansiedade dos pacientes foi relativamente amenizada por este projeto de entretenimento. Esperamos que o trabalho inspire outros servicos de saude a criarem formas de passatempo em suas salas de esperas. Copyright © 2022

Pediatric patients with COVID-19 admitted to a PICU in Southern Brazil, excluding MIS-C

Objective: To describe pediatric patients admitted to a PICU with a diagnosis of COVID-19 and to compare some variables in relation to severely ill patients and critically ill children, excluding patients with MIS-C. Method: Retrospective case series of patients aged 24 days to 15 years with a diagnosis of COVID-19 admitted to a PICU from April 1, 2020, to April 1, 2021. We describe data regarding epidemiological characteristics, clinical manifestations, laboratory, and imaging tests, treatment, and outcome. We also divided the patients into two groups: severely ill patients and critically ill patients (those who required invasive mechanical ventilation (IMV), non-invasive ventilation or shock), and we compared some variables to determine possible predictors of greater severity. Results: 32 children were admitted with severe COVID-19;20 of them were considered critical. The median age was 2 years. Of the patients, 50% were male and 81% had comorbidities, and 44% had 3 or more comorbidities. Respiratory failure was the main cause of hospitalization. Fifty-six percent required IMV, and 37% used vasoactive drugs. Bacterial or viral co-infection occurred in 41%. A total of 81% of our patients received antimicrobials, 53% patients received low-dose corticoids, and 25% received enoxaparin. Patients with 3 or more comorbidities were significantly more frequent in the critically ill group. Conclusion: Most of the children admitted to PICU had comorbidities, and children under 1 year of age made up almost half of the sample. In our study, the presence of three or more comorbidities was more frequent in pediatric patients with critical COVID-19. © 2021

Challenges and Perspectives of the Furniture Market in Brazil

Traditionally the furniture market in Brazil is owned by family businesses and of national origin, with few exceptions. Based on this premise and the high demand promoted, especially in the Covid-19 pandemic, the market has adapted to the growing demand for residential furniture. Therefore, a conceptual restructuring needs to be carried out due to the great variability of products in the same factory, driven by the target audience, which goes beyond the traditional concepts of factory standardization and enables a new way of thinking according to the demand for products offered by catalog and/or bespoke. In addition, as they are family businesses, there is an inherent risk of closing activities due to the lack of family motivation of the following generations linked to the lack of knowledge to update manufacturing processes. This article concludes that the variability of products offered in each factory is a high option. New concepts must be adopted from handcrafted to manual transition. And, with positional and functional factory configurations, ensuring high efficiency and quality concerning the degree of difficulty, associated with the characteristics of furniture dealerships. To get success, the companies must be directed towards the sustainable production chain to the companies involved. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Randomized controlled trial comparing holmium laser en-bloc resection with monopolar transurethral resection in patients with large bladder tumors

Introduction & Objectives: The HoLERBT (Holmium Laser En-bloc Resection) has emerged as an alternative to classical TURBT (Transurethral Resection of Bladder Tumor) by using the en-bloc tumor resection technique. So far, the tumors in previous studies were mostly <3cm. We performed a previous pilot study with tumors >3cm (3-8cm) submitted to HoLERBT in 2019. All samples had detrusor muscle present and there were no peri-operative complications. These results support the present study to establish the best approach to endoscopic treatment of large bladder tumors. The objectives are to analyze differences between HoLERBT and TURBT in terms of presence of detrusor muscle in the histopathological analysis, intra-operative and peri-operative complications and oncological outcomes in large bladder tumors. Materials & Methods: This is a single-institution, randomized, single-blinded, prospective, controlled trial (RCT). The expected duration is of 24 months. The sample size calculated is 47 patients per group (n = 94). The study was approved by the Institutional Ethical Board and was submitted to the Brazilian Registry of Clinical Trials (ReBEC). Inclusion criteria is bladder tumor >3cm by CT or MRI. The exclusion criteria are diagnosis of invasive tumor on image examination (CT, MRI), urethral stenosis, systemic or intra-vesical chemotherapy or previous radiotherapy. The outcomes analyzed are quality of detrusor muscle, intra-operative and immediate post-operative complications, length of hospital stay (LOS);clinical progression, recurrence-free, overall and cancer-specific survival at 24 months. Results: This is an ongoing trial that began in January 2020, was suspended for 5 months due to Covid-19, restarted recruitment in September 2020 and currently has 9 patients in the group HoLERBT and 11 patients in the group TURBT. The first surgery was in 01/21/20. The current data represents 22% of the estimated sample and the analysis is partial. The median age (years) was 55.8 (29-83) and 65.5 (46-84), the median tumor size (cm) was 3.4 (2.1-5.4) and 3.1 (2.1-5.7), the median time of surgery (min) was 29 (16-49) and 37.6 (13-60), the LOS (days) was 1.25 (1-3) and 2.0 (1-4), complications rates Clavien I was 11% and 36% and Clavien >I was 0% and 9% for HoLERBT and TURBT. The presence of detrusor was 80% in both groups. The interim analysis will be made with 50% of the sample estimated to occur in June 2021 and the final analysis with 2 years of follow up is estimated to occur in January 2023. Conclusions: This is a RCT comparing HoLERBT and TURBT evolving large tumors, with a 2-year follow-up proposal. The initial analysis give support to continue the study in order to assess the real role of laser resection in high volume bladder tumor.

Erratum: Covid-19 Through Brazilian Courts: The Deserving and the Undeserving Vulnerable (German Law Journal (2021) 22: 6 (1098–1114) DOI: 10.1017/glj.2021.55)

The authors apologise that upon publication of this article, the paragraphs below (from the section A. Vulnerability Theory as a General Legal Principle, p. 1101) refer twice to the name of Freeman when they should in fact refer to Fineman: As proposed by Freeman, vulnerability is a human condition beyond identity, departing from a discrimination approach to formal equality, in a universalism that transcends categories such as race and class.12 This section argues that the post-identity stance of vulnerability theory is both helpful and limiting in the pandemic and while it can free policies of a set category of vulnerable groups, it can be misunderstood and dilute identity-based claims. In brief, for Finemans vulnerability theory, what distinguishes each person is the resources and effective capacity to endure adversity. Freeman argues for a responsive State to allocate resources according to the levels of resilience needed to compensate for the vulnerability strengthened by institutions and society.13 This view attempts to steer clear of identity concepts by referring to complexity-how different factors converge to each individual embodied or embedded forms of vulnerability-and particularity-how this complexity materializes individually. Complexity and particularity could be easily taken as identity, but Fineman wants to use vulnerability foremost as a universal principle. © 2021 The authors.

Association of coronary calcification with prognosis of Covid-19 patients without known heart disease.

Risk factors that determine the severity of Covid-19 have not been fully elucidated. The aim of this study was to evaluate the role of coronary artery calcification (CAC) as a risk factor for death or mechanical ventilation (MV) of patients without known heart disease infected with Covid-19. We analyzed 283 consecutive in-patients with acute respiratory symptoms with chest computed tomography (chest-CT), without previous heart disease, and criteria for Covid-19 (RT-PCR positive and/or typical clinical and chest-CT findings). CAC was classified by the number of coronary segments affected as absent (0), mild (1-3), and severe calcification (more than 3). The association between CAC, CAC severity, and death or MV due to severe respiratory failure was assessed by logistic regression. The mean age was 58.7±15.7 years and 54.1% were men. Patients with CAC were older, more likely to have hypertension, and less likely to be obese. CAC was present in 75 patients (26.5%), of which 42 had a mild calcification and 33 had severe calcification, and was associated with death (OR=2.35, 95%CI: 1.01-5.48) or MV (OR=2.72, 95%CI: 1.20-6.20) adjusted for multiple confounders, with significant and increased odds ratio for the severe form of CAC (death: OR=3.70, 95%CI: 1.20-11.42; MV: OR=3.30, 95%CI: 1.09-9.95). We concluded that CAC was an independent risk factor for death or MV in Covid-19 patients without previous heart disease, particularly for those with severe calcification. CAC can be easily visualized on common chest-CT, widely used in evaluation of moderate to severe Covid-19.

IMPLEMENTATION OF ACTIVE METHODOLOGIES AS AN ASSESSMENT TOOL IN THE PLANT PHYSIOLOGY DISCIPLINE IN PANDEMIC TIMES: EXPERIENCES AND CHALLENGES

In view of the pandemic scenario of the new coronavirus, SARS-CoV2, educational units invested in remote education by adapting and reinventing the teaching-learning process amid uncertainties and limitations of different orders. The present study aimed to evaluate the use of some alternative methodologies such as Google forms, Conceptual map, Kahoot and Short film. It was observed that the Google forms form as well as the Short film had an acceptance of 90% of the students, 60% stated that the concept map improved the understanding of the content energy metabolism and 90,9% scored above the average 7 during the Kahoot. Therefore, the implementation of alternative methodologies as an evaluation method in order to stimulate student protagonism during remote teaching proved to be positive, allowing undergraduates to exercise autonomy in the elaboration and execution of activities in the construction of their knowledge and that of other colleagues, thus providing the experience teaching practice during graduation.

Clinical progression of SARS-CoV-2 infection in people with cystic fibrosis: a global observational study

Objectives: As the novel coronavirus (SARS-CoV-2) pandemic continues, people with cystic fibrosis (CF) have been identified as being a vulnerable group. It is essential that people with CF, their families and their clinical teams have the most up-to-date information on the impact of SARS-CoV-2 on their health. This study aims to characterise the impact of SARS-CoV-2 infection in people with CF throughout 2020, identify factors that predict clinical progression of COVID-19, and to describe medium-term follow-up of people who have been infected. Methods: The ‘Cystic Fibrosis Registry Global Harmonization Group’ is a worldwide network of CF Registries that each contributed data on people with CF diagnosed with SARS-CoV-2 infection. In this analysis, we will report on cases contributed from 22 countries diagnosed between 1st February and 13th December 2020. We will present demographic, pre-infection clinical characteristics, symptoms, infection management and outcomes. We will use multivariable logistic regression to assess predictors for hospitalisation with respiratory support and intensive care admission as the outcomes of interest representing clinical progression of COVID-19. Descriptive analysis of medium-term follow-up BMI and FEV1% predicted values will also be undertaken. Results: Results pending. Expected cohort size >1,000, including the 181 previously reported in our paper “The global impact of SARS-CoV-2 in 181 people with cystic fibrosis.” Conclusion: It is expected that the findings of this study will have important implications for shielding advice, clinical care and vaccine prioritisation for people with CF.

Heterocyclic compounds as antiviral drugs: Synthesis, structure–activity relationship and traditional applications

A virus outbreak challenges the economic, medical, and public health infrastructure worldwide. More than one virus capable of triggering diseases have been identified per year since 1972, which requires the development of new ways of treatment and prevention, however, such processes are not rapid and easy. With the pandemic scenario experienced since early 2020, several drugs with well-known purposes have gained prominence, due to speculation of their use in the treatment against the new coronavirus. Among the main drugs studied, the vast majority contain a heterocyclic structure. In this review, we presented the traditional and efficient synthesis of 15 drugs that have been studied for the COVID-19 treatment, containing in their structure heterocycles like indole, quinoline, pyrimidone, tetrahydrofuran, pyrrolidine, triazole, pyridazine, pyrazole, pyrrolopyrimidine, azetidine, pyrrolotriazine, pyrazine, tetrahydropyran, benzofuran, spiroketal, and thiazole. Furthermore, we have shown the original applications, as well as their structure–activity relationship and what is their situation as a drug candidate against COVID-19. Thus, the objective was to consolidate the main synthetic and pharmacological aspects involving clinically developed heterocycles that at some point were presented as promising against SARS-CoV-2. © 2021 Wiley Periodicals LLC.

Review of Ultraviolet-C Light Against Coronavirus

Severe acute respiratory syndrome coronavirus (SARS-CoV2) is a new highly pathogenic virus that has induced the COVID-19 disease in over 27.6 million patients and caused over 900 thousand deaths around the world by September 8th, 2020, nine months after the first reported case in China, according to the World Health Organization. Through the realization of the research, it is implied that Ultraviolet-C (UVC) light is an efficient method for tackling the spread of coronavirus. This work comprises a systematic study of state-of-art scientific articles concerned with the application of UVC for tackling different viruses, including those from the coronavirus family and its impact on human health. While the most common germicidal wavelength, 254 nm, is harmful to humans, studies demonstrated the germicidal effect of the wavelength of 222 nm and indicated it could be safe to humans under certain exposure conditions. Also, different conditions of virus exposure to UVC light were considered and the UVC dose required for n-log reduction compared. Data from analyzed studies demonstrated that some factors such as temperature, incident wavelength, and virus family have been shown to be important to determine the inactivation dose. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.