Estudo de Matérias-Primas do Rio Grande do Norte para Uso em Revestimento Poroso: Influência do teor de dolomita e temperatura de calcinação nas propriedades físico-mecânicas

The state of Rio Grande do Norte presents a great potentiality for the production of ceramic tiles because of having natural raw material in quantity and quality making its economical exploration possible, beyond the great energetic differential of the state, the natural gás. This works aims to study the influence of the dolomite and granulometry concentration and calcinations temperature in the obtaining of formulations for porous coverings which have to be coherent to the project,s specifications. The experiments have involved the physical-chemical and mineralogical characterizations of raw materials and mechanical tests in the dry and burnt proof bodies preceding a mixture experiment planning with the use of the response surface methodology, in order to get the best raw materials combinations to produce a ceramic mass with specific properties. The twelve ceramic masses studied in this work were prepared by the via dry process, characterized, shaped by uniaxial pressing and sinterized in the temperatures of 940ºC, 1000ºC, 1060ºC, 1120ºC and 1180ºC, using a fast burning cycle. The crystalline phases formed during the sintering in the temperatures in study have revealed the presence of anorthite and diopside beyond quartz with a remaining phase. These phases were the main responsible ones by the physical- mechanical properties of the sinterized proof bodies. The proof bodies after the sintering stage have presented water absorption higher than 10% and a good dimensional stability in all studied temperatures. However, the flexural breaking strength results in the temperatures of 940ºC, 1000ºC and 1060ºC, under the temperature zone of the vitrification of ceramic whiteware do not reach the flexural breaking strength specific for the porous wall tile (15 MPa), but in the temperature of 1120ºC next to the vitrification temperature zone, some whiteware ceramic (formulations) has reached the specified value for the porous wall tile. The results of this work have showed that the studied raw materials have great importance for used in the production of porous wall tiles (BIII)

Contribuição da Geodésia ao monitoramento costeiro do Litoral Setentrional do Rio Grande do Norte, área de influência da indústria petrolífera

The general objective of this thesis has been seasonal monitoring (quarterly time scale) of coastal and estuarine areas of a section of the Northern Coast of Rio Grande do Norte, Brazil, environmentally sensitive and with intense sediment erosion in the oil activities to underpin the implementation of projects for containment of erosion and mitigate the impacts of coastal dynamics. In order to achieve the general objective, the work was done systematically in three stages which consisted the specific objectives. The first stage was the implementation of geodetic reference infrastructure for carrying out the geodetic survey of the study area. This process included the implementation of RGLS (Northern Coast of the RN GPS Network), consisting of stations with geodetic coordinates and orthometric heights of precision; positioning of Benchmarks and evaluation of the gravimetric geoid available, for use in GPS altimetry of precision; and development of software for GPS altimetry of precision. The second stage was the development and improvement of methodologies for collection, processing, representation, integration and analysis of CoastLine (CL) and Digital Elevation Models (DEM) obtained by geodetic positioning techniques. As part of this stage have been made since, the choice of equipment and positioning methods to be used, depending on the required precision and structure implanted, and the definition of the LC indicator and of the geodesic references best suited, to coastal monitoring of precision. The third step was the seasonal geodesic monitoring of the study area. It was defined the execution times of the geodetic surveys by analyzing the pattern of sediment dynamics of the study area; the performing of surveys in order to calculate and locate areas and volumes of erosion and accretion (sandy and volumetric sedimentary balance) occurred on CL and on the beaches and islands surfaces throughout the year, and study of correlations between the measured variations (in area and volume) between each survey and the action of the coastal dynamic agents. The results allowed an integrated study of spatial and temporal interrelationships of the causes and consequences of intensive coastal processes operating in the area, especially to the measurement of variability of erosion, transport, balance and supply sedimentary over the annual cycle of construction and destruction of beaches. In the analysis of the results, it was possible to identify the causes and consequences of severe coastal erosion occurred on beaches exposed, to analyze the recovery of beaches and the accretion occurring in tidal inlets and estuaries. From the optics of seasonal variations in the CL, human interventions to erosion contention have been proposed with the aim of restoring the previous situation of the beaches in the process of erosion.

Estrutura da população de Coleodactylus natalensis Freire, 1999 (Squamata: Sphaerodactylidae) no Parque Estadual Dunas de Natal, Rio Grande do Norte, Brasil

Coleodactylus natalensis Freire, 1999, an endemic species of Atlantic Forest fragments around the Natal municipality, Rio Grande do Norte State, Brazil, has as type locality the Parque Estadual Dunas de Natal (05º48 S to 05º53 S and 35º09 W to 35º12 W), one of the largest restinga (herb and shrub association on sand dunes along the Brazilian coastline) associate fragment, surrounded by urban zone, placed on setentrional Atlantic Forest limits. We made estimates on populational density, spatial distribution, habitat and microhabitat preferences and feeding ecological aspects like sazonal and sexual variations on diet, prey electivities and niche breadth. We randomly sampled ninety-six 50m2 quadrants in each of the four habitats identified in the study area. Were collected 49 specimens and their stomach contents were analyzed; prey items found were correlated with leaf-litter invertebrates from habitat samples. We found a 98,5 ± 75,5 individuals/ha density, in grouped distribution pattern on densest habitats and random distribution on others habitats. This species lives mostly on leaf-litter in forest habitats, in higher humidity points, with lower temperatures, deeper leaf litter and lower sea level elevations than the randomly chosen points in the study area. Isopoda and Aranae were the most important prey categories in numeric, frequency and volumetric terms. Niche breadth has an intermediate value and was variable in sexual and in habitat terms. There was no correlation between morfometric measures and prey size on diet. The C. natalensis population studied seems to be diet opportunist, although selects larger prey items. The Parque Estadual das Dunas do Natal has several indications of anthropic pressure from the surrounding urban area that may affects the local C. natalensis population. Thus, the fragility of this species calls for urgent conservation efforts

Flebotomíneos (Diptera: Psychodidae) em um sistema agroflorestal da Região Metropolitana de Natal, Rio Grande do Norte, Brasil

Sandflies stand out as important vectors of leishmaniasis. The females need to ingest blood meals, enabling them to transmit protozoa of the genus Leishmania, which may give rise to visceral leishmaniasis (VL) or American tegumentary leishmaniasis (ATL), in addition to transmitting other parasites. Leishmaniasis are important infirmities, distributed worldwide, whose infection results from the interaction of reservoir animals, the vector insect, parasitic protozoa and the healthy host. In the state of Rio Grande do Norte (RN), Brazil, these insects are important transmitters of VL, which usually presents in the most serious form. It occurs mainly in metropolitan areas, with the dog as its main reservoir and Lutzomyia longipalpis as the vector. ATL is most present in the highland areas of the state. In addition to hematophagia, engaged in by the females, both sexes need to ingest carbohydrates, which are essential to the sand flies energy requirements and may interfere in the development of Leishmania. The aim of this study was to determine the occurrence and abundance of sand flies in different environments on the farm belonging to the Empresa de Pesquisas Agropecuárias do RN (Institute of Agricultural Research of RN), in the municipality of Parnamirim, in order to relate this occurrence with climatological and biological references and eating habits. Three consecutive monthly collections were carried out with CDC traps in a fragment of the Atlantic Forest, in a residence, on a goat breeding farm and on cashew, dwarf and giant coconut, mango, banana, eucalyptus, acacia and bean plantations. A total of 1241 sandflies from eight species (Lutzomyia evandroi, Lutzomyia longipalpis, Lutzomyia shannoni, Lutzomyia sordellii Lutzomyia walkeri, Lutzomyia wellcomei, Lutzomyia whitmani, and Lutzomyia intermedia) were collected, most in the forest environment. L. longipalpis, the main VL transmitter, was confirmed as a species adapted to anthropic environments, whereas others such as L. wellcomei, the vector of ATL, occurred predominantly in forests. Carbohydrate characterization of the sand flies and plants of the region demonstrated that a number of exotic plants such as hay and eucalyptus may play some role in the adaptation of these species to modified environments. Breeding in laboratory showed a mean biological cycle of 53.5 days from egg to adulthood for L. shannoni and the possibility of diapause behavior in L. wellcomei. This study serves as a source of information that may contribute to the epidemiological vigilance of tegumentary and visceral leishmaniasis in the state, given that it analyzes the bioecology of transmitting species, as well as their potential to adapt to new environments

Rubiaceae em um remanescente de floresta atlântica no Rio Grande do Norte, Brasil

Empresa de Pesquisa Agropecuária do Rio Grande do Norte

Biologia reprodutiva da |Tainha, Mugil curema valencientes, 1836 (osteichthyes: mugilidade) nas águas costeiras do Rio Grande do Norte

The marine fish white mullet, Mugil curema Valenciennes, 1836 (Osteichthyes: Mugilidae) exhibits a wide geographical distribution, being common in the Brazilian coast and is an important component of the artisanal fisheries. The objective of this study was to investigate the reproductive biology of M. curema in the coastal waters of Rio Grande do Norte. Fish samples were captured on a monthly basis during August, 2008 to July, 2009. The fish specimens were numbered, weighed, measured, dissected and their gonads were removed, weighed, their sex and gonadal development were identified. The length-weight relationship was determined for males and females. The sex ratio, the size at first gonadal maturation and gonadosomatic index (GSI) were calculated and ovarian development was investigated using macroscopic and histological techniques. The fecundity, spawning type and the reproductive period of the species were determined. A total of 366 specimens (186 males and 180 females) were captured. The sex ratio was 1:1 and the females were heavier than males. The estimated values of the angular coefficient for both sexes suggest that the species has isometric growth. The size at which 50% of the population began the process of maturation was 25.9 cm of total length for grouped sex. The macroscopic characteristics of the ovaries showed four stages of development: immature, maturing, mature and spent. However, the microscopic characteristics of the ovaries showed five stages of development: immature, early maturing, late maturing, mature and spent. The development of oocytes indicated five phases: Chromatin-nucleolus (phase I), initial perinucleolar (phase II), final perinuclear (phase II), formation of vitelline vesicle or yolk (phase III), vitellogenic (phase IV) and complete vitellogenesis (phase V). The species has a prolonged spawning period, with two peaks coinciding with the rainy season.

Ecologia do fitoplâncton impactado por cultivo de tilápia do Nilo, oreochromis niloticus, em tanques-rede no açude Ministro João Alves, Parelhas, Rio Grande do Norte

The dams are limnic ecosystems of great importance for its multiple uses, among them, water supply for the public and to culture of artisanal fish are most relevant. The aim of the present study is to evaluate the physical-chemical characteristics and the phytoplankton community in two chosen sites (Point 1 littoral zone of point source; Point 2 pelagic zone of non-point source) of the Minister João Alves dam, which is also known as Boqueirão de Parelhas/RN. This represents the spatial distribution of the phytoplankton species in order to understand any possible alterations of the water quality and the phytoplankton composition in relation to the water quality originating from the impact of the tilapia, Oreochromis niloticus, culture. The study period also encompasses temporal variations exhibited in two seasons of an annual cycle, one during the dry season (Oct, Nov and Dec of 2008 and Jan of 2009), and the other rainy season (Mar, Apr, May and June of 2008) to extend the observation. The physicalchemical parameters, such as pH, temperature, electrical conductivity, concentration of dissolved oxygen were measured in situ and the values of the inorganic nutrients (nitrate, ammonium and orto-phosfato) and chlorophyll in the laboratory. The quali-quantitative analyses of the phytoplankton had been carried through sedimentation technique and the enumeration of the random of 400 cells, colonies and filaments counted using Sedgwick-Rafter counting chamber. The results of pH varied widely from the acidic to alkaline range with the minimum of 5.8 (± 0.8) and the maximum of 9.2 (± 0.7-0.8), at point 1 and 2. The dissolved oxygen content was higher in the rainy period than that in the dry period. The maximum electrical conductivity was of 1409 μScm-1 in point 1 and 431 minim of μScm-1, in point 2. There was a considerable alteration in the levels of inorganic nutrients such as nitrate-nitrogen, ammoniacal nitrogen and orthophosphate during the two cycles of study period. Phytoplankton assemblages presented a picture of alternate dominance among species Cyanobacteria, Bacillariophyceae and Chlorophyceae. The trophic state index diagnosed to the category of mesotrophic, which is based on the values of chlorophyll, total phosphorus and Secchi-disc measurements. The wind driven turbulence of the water column and the fresh inflow of water (flushing and dilution) during rainy season acted as constraint and did-not allow an exaggerated growth of the species of cyanobacteria. On the basis of the present we conclude that the culture of tilapias in cage-culture fails to produce pollution load that could compromise the quality of the water of the dam, probably be due to small dimension of the culture in relation to the size, volume of the water and the reservoir capacity support its own environment

O gênero geastrum pers. (phallomycetidae, basidiomycota) em algumas áreas de Mata Atlântica e Caatinga no Rio Grande do Norte, Brasil

A taxonomic survey of representatives of the genus Geastrum took place during the rainy season from 2006 to 2009 in four districts in the state of Rio Grande do Norte: Parque Estadual Dunas do Natal (Atlantic Forest), Mata do Jiqui EMPARN (Atlantic Forest) and Estação Ecológica do Seridó (Caatinga). Fourteen species were recorded: G. entomophilum, G. fimbriatum, G. hirsutum, G. javanicum, G. lageniforme, G. lloydianum, G. minimum, G. morganii, G. ovalisporum, G. pectinatum, G. saccatum, G. schweinitzii, G. setiferum and G. triplex. Of these species, eleven occurred in the Atlantic Forest and six in the Caatinga. A new species has been recorded to science, G. entomophilum, other as a first record for Brazil, G. morganii, six new records for the Northeast, and ten new records for Rio Grande do Norte. The material was tumbled in the Herbarium UFRN. Additionally, a survey of the species of the genus deposited in the Herbarium UFRN was accomplished, resulting in 244 herbarium specimens belonging to thirty-three species. Of these ones, twenty-three were collected in Brazil and ten are from Czech Republic, Europe, as donation from the VZ Herbarium

Ocorrência da infecção por Toxoplasma gondii e avaliação da imunização em caprinos do sertão do cabugi, Rio Grande do Norte

Toxoplasmosis is one zoonosis caused by Toxoplasma gondii protozoan. Goats, amongst the production animals, are one of the species most susceptible to this parasite, being one them main involved agents in ovine and goat abortions, determining great economic losses and implications for public health, since the presence it parasite in the products of goat origin, consist in one of the main sources of infection for the man. In this study 244 blood samples in 8 farms situated in 4 cities from the Sertão do Cabugi region, Rio Grande do Norte State, northeast of Brazil and, tested by ELISA assay. The results had shown a prevalence of 47.13% for anti- T. gondii antibodies and a significant association between positivity and variable evaluated as age, locality and property. The IgG avidity assay evaluated in 115 positive samples was carried to discriminate acute and chronic infection. Twelve samples (10.4%) had presented antibodies of low avidity while 103 (89.6%) presented high avidity antibodies; indicating that most of the animals was precocious exposure to the parasite. Significant difference was verified only for the variable sex. We also evaluate the capacity of recombinant adenoviruses codifying SAG1, SAG2, SAG3 and CMV in inducing activation of specific immune response in goat. These 109 animals received 109 pfu of the AdSAG1, AdSAG2, AdSAG3, AdCMV or PBS in vaccine protocol with 3 immunizations. Serum samples of the each animal, before and after mmunization, had been submitted to the ELISA. The results demonstrate that the immunizations had induced the production of IgG antibodies specific against T. gondii proteins

Estudo comparativo da variação temporal da comunidade fitoplanctônica do açude Cruzeta inserido no bioma caatinga, Rio Grande do Norte

The Cruzeta impoundment, situated in the city of Cruzeta, hinterland of the state of the Rio Grande do Norte state has significant importance to the municipality as it represents the only source of supplying water to the region. It was hypothesized that the regional consequence of the global warming and the warming of surface water could substantially contribute the significant growth of the aquatic macrophytes in the years 2008-2009. The growth of these vegetation believed to be improved the degree of water transparency and as a consequence of the improved growth of phytoplankton species and chlorophyll biomass. At the same time the aquatic macrophyte could interact and compete potentially for the dissolved inorganic nutrients resources and the phytoplankton community. This study presents a comparison of years 2004-2005 when it did not have the expressive presence of the aquatic macrophyte community or restricted to the littoral region. In contrast, the years 2008-2009 showed a significant growth of the aquatic macrophyte in the Cruzeta/RN impoundments. The present study is an attempt to elucidate the significant presence of the aquatic macrophyte, Eichhornia crassipes, Ceratophyllum submersum, Nymphea sp and Pistia sp, and its interference on the ecology of phytoplankton. The samplings had been carried out from September of 2008 to April of 2009 and consistently between 10:00 h and 12:00 h with the aid of Van Dorn bottle and the plankton net of mesh size 20 Qm. The collections were made in three depths ie., surface, mid-column and bottom. The Physical-Chemical parameters such as pH, temperature, electrical conductivity and dissolved oxygen had been analyzed in situ. The samples for analysis of nutrients and chlorophyll were kept under refrigeration for posterior analysis in the laboratory. Phytoplankton samples were preserved in Lugol-iodine and kept for sedimentation for quali-quantitative analysis of phytoplankton. Enumeration of cells, colonies and filaments was done with the aid of Sedgwick-Rafter counting chamber and expressed as numbers/ml. Chlorophyll a was analyzed as a functional component of phytoplankton biomass and extracted with cold 90% acetone. The results indicate that the chlorophyll concentration varied between 5,65-8,08 Qg.L-1 for the dry period and 5,09-6,23 Qg.L-1 for the rainy period and showed considerable reduction when compared to the values to the 2004-2005 study period. The temperature was always presented higher in relation to the 2004-2005 study. Phytoplankton species showed a relative abundance of the Cyanophyceae for both the period of dry and rainy. The predominance species are filamentous Leptolymbya geophila Borzi (Planctolyngbya sp), Anabaena plankctônica Brunnthaler, Oscillatória limosa Ag. and Cylindrospermopsis raciborskii (Wolosz). The concentration of the nutrients such as nitrate and orto-phosfato had always presented higher values during the rainy period and the ammoniacal nitrogen retained moderate values in the dry period and a slight increase in rainy season. The main conclusions are the reduction of the concentration of chlorophyll, diversity of phytoplankton, and the increase in temperature and transparency of the water during the period of the study

Periurbanização da leishmaniose visceral e emergência da coinfecção HIV/leishimania, no Rio Grande do Norte

Visceral leishmaniasis (VL) has undergone changes in terms of clinical and epidemiological presentation worldwide. Urbanization has been described in different regions of Brazil and the world, as well as in the state of Rio Grande do Norte. These changes have impacted in the clinical outcome of Leishmania infection. A new clinical entity called co-infection of HIV/Leishmania has been described as a consequence of overlapping areas of occurrence of VL and HIV / AIDS in different countries including Brazil. The aim of this study was to define the process of periurbanization of the LV and describe a case series of co-infection HIV / Leishmania in Rio Grande do Norte. A new demographic pattern of VL was detected, with an increase in the number VL adult male subjects. Analysis of spatial distribution of VL in the state of Rio Grande do Norte showed that in the past 20 years VL tends to occur in larger cities and therefore the highest risk disease is greater in the eastern and western regions. The first region included Natal, the state capital, where the process of suburbanization began in 1990, and more recently the city of Mossoró, the second largest state, where periurbanization began in the last five years. In 1990, the emergence of co-infection HIV/Leishmania in the state was observed. Case-control study revealed that the new clinical entity affects adult males, who acquired HIV through sexual intercourse, 40% of those with a preivous history of leishmania infection Relapse and death from LV is increased in HIV positive compared with HIV-negative patients matched by sex and age. This pattern is similar to the observed in Europe, except of the route of transmission, where in Europe occured concomitantly, by parenteral route in drug users. Analysis of spatial distribution identified overlapping new areas of occurrence of HIV / AIDS and LV potentially signaling to increased risk of this new clinical entity as described above. Therefore, epidemiological surveillance for co-infection HIV / Leishmania should be adopted in all areas of risk of VL. At the same time, it is necessary to evaluate drug resistance currently used in the treatment of VL, as well as parenteral transmission of L infantum/ chagasi in areas where drug dependence is a risk factor for HIV acquisition

Intervenção dietoterápica em portadores de lipodistrofia generalizada congênita do Rio Grande do Norte

Congenital generalized lipodystrophy is a rare genetic disease with autosomal recessive inheritance characterized by the generalized absence of subcutaneous adipose tissue and insulin resistance. The aim of our study was to determine the profile of patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome) through their clinical history, eating habits, and socioeconomic and cultural aspects; assess food consumption and nutritional status of the study group; propose and evaluate a diet therapy model associated to oral supplementation with zinc to help in the control and prevention of metabolic complications associated to the pathology. Initial assessment of food consumption indicated a voracious appetite in all the patients studied. The introduction of zinc reduced appetite, contributing to patient adherence to the food plan proposed. It was also observed that the proposed diet contributed mainly to glycidic control, specifically with respect to HbA1c. The nutritional status of the patients investigated was adequate in terms of body mass index (BMI), arm muscle circumference (AMC), arm muscle area AMA, but triceps skinfold (TSF) indicated serious malnutrition. Our study is unique in the literature and provides important information to the field of nutrition and to individuals with this pathology. Furthermore, it contemplates the interdisciplinary and multidisciplinary requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte (UFRN), Natal, Brazil

Financiamento e gasto público em saúde: o caso do Rio Grande do Norte

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Aspectos clínicos e imunológicos da infecção por Leishmania Infantum Chagasi em cães do Rio Grande do Norte / Paula Vivianne Souza de Queiroz. Natal/RN

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Qualidade de vida do servidor da Universidade Federal do Rio Grande do Norte em condição crônica de saúde

The study aimed to analyze the influence of chronic health conditions (CHC) on quality of life (QOL) of UFRN servers assaulted by CHC. It is a descriptive and cross-sectional study with prospective data and quantitative approach, accomplished in the ambulatory clinic of the Department of Server Assistance (DSA) of the Pro-Rectory of Human Resources, during three months. The sample was composed by accessibility, totaling 215 people, being 153 active and 62 inactive servers, in chronic health condition. The data were collected through the application of the sociodemographic characterization, health, environmental and laboral form, the Medical Outcome Study 36-Item Short Form (SF-36). The study was evaluated by the HUOL Ethics Committee (CAAE no. 0046.0.294.000.10), obtaining assent. The results were analyzed in the SPSS 15.0 program through the descriptive and inferential statistics. It was identified servants predominantly male (59,1%), under 60 years old, married or in stable union, Catholics, brown color, living in the capital and residents in own home. Regarding labor issues, there was a predominance of active servers technical-administrative with intermediate and medium level positions and small proportion of docents. Among the CHC, the non-communicable diseases - NCDs (95.8%) had a higher frequency, followed by persistent mental disorders - PMDs (18.6%) and, finally, the continuous and structural physical deficiency - CSPD (16.9 %). The QOL of servers was considered good, with a mean score of 72.5 points in the total score, with the most affected domains: physical (59.1), general health (66.2), bodily pain (66.3) and functional aspects (72.0). The mental health dimension (76.5) had a better average than the physical dimension (68.0 points). It was found that the decrease in QOL scores is significant statistically related to higher number of CHC (ρ <0.001), with no statistical significance regarding the functional situation (p = 0.259). The administrative technicians of elementary, primary, secondary levels and docents had the worst QOL scores. After the correlation analysis of CHC with the domains and dimensions of the SF-36, there was statistically significant, negative and weak correlation of the domains: functional aspect (ρ = 0.002, r = -0.207), physical aspects (ρ = 0.007; r = -0.183), vitality (ρ = 0.002, r = -0.213), social function (ρ = 0.000, r = -0.313), emotional aspects (ρ = 0.000, r = -0.293), mental health (ρ = 0.000 , r = -0.238), physical health dimension (ρ = 0.002, r = -0.210) and mental health dimension (ρ = 0.000, r = -0.298). The presence of PMD isolated or together, contributed to a lower SF-36 scores, being the domains variation of mean significant, except for bodily pain, general health and physical aspects. By correlating the categories of CHC and QOL, there was a weak correlation (r ≤ -0.376) and significant (ρ ≤ 0.011), mainly related to the NCD, PMDs and NCD + PMD, affecting the mental health, social function, emotional aspects, vitality and functional aspect domains. Front of the results, it was concludes that the servers quality of life is influenced by the CHC. Thus, it was inferred that the presence of CHC causes a negative effect on quality of life, leading the active and inactive servers to exposure their overall life activities and work over the years, due to the morbidity affected, mainly related to NCDs and PMDs. Descriptors: Quality of life. Chronic disease. Occupational Health. Nursing