Protótipo de um microgerador termoelétrico de estado sólido: cogeração a gás

The thermoelectric energy conversion can be performed directly on generators without moving parts, using the principle of SEEBECK effect, obtained in junctions of drivers' thermocouples and most recently in semiconductor junctions type p-n which have increased efficiency of conversion. When termogenerators are exposed to the temperature difference (thermal gradient) eletromotriz a force is generated inducing the appearance of an electric current in the circuit. Thus, it is possible to convert the heat of combustion of a gas through a burner in power, being a thermoelectric generator. The development of infrared burners, using porous ceramic plate, is possible to improve the efficiency of heating, and reduce harmful emissions such as CO, CO2, NOx, etc.. In recent years the meliorate of thermoelectric modules semiconductor (TEG's) has stimulated the development of devices generating and recovery of thermal irreversibility of thermal machines and processes, improving energy efficiency and exergy these systems, especially processes that enable the cogeneration of energy. This work is based on the construction and evaluation of a prototype in a pilot scale, for energy generation to specific applications. The unit uses a fuel gas (LPG) as a primary energy source. The prototype consists of a porous plate burner infrared, an adapter to the module generator, a set of semiconductor modules purchased from Hi-Z Inc. and a heat exchanger to be used as cold source. The prototype was mounted on a test bench, using a system of acquisition of temperature, a system of application of load and instrumentation to assess its functioning and performance. The prototype had an efficiency of chemical conversion of 0.31% for electrical and heat recovery for cogeneration of about 33.2%, resulting in an overall efficiency of 33.51%. The efficiency of energy exergy next shows that the use of primary energy to useful fuel was satisfactory, although the proposed mechanism has also has a low performance due to underuse of the area heated by the small number of modules, as well as a thermal gradient below the ideal informed by the manufacturer, and other factors. The test methodology adopted proved to be suitable for evaluating the prototype

Imagem corporal e fatores de risco em praticantes de caminhada da cidade do Natal-RN

Body image is the figure of our bodies built in our minds and the degree of dissatisfaction is often associated with risk factors identified by anthropometric measures. The purpose of this descriptive study was to evaluate the risk factors associated to morphological and functional variables associate to the perception of auto-image in middle-aged walkers of the south zone of the city of Natal. A hundred and thirty volunteers had been evaluated in four groups in function of the gender and age group. As measurement evaluations were used an auto-image perception questionnaire proposed by Stunkart of nine silhouettes numbered for both gender was applied; a weighing machine equipped with stadiometer for the body mass (kg) and stature (m) and the body mass index (kg/m2) that was calculated with base in measures of the body weight and stature and classified according to norms of the National Institute of Health (2000) as well as the systolic and diastolic blood pressure by a electronic digital device (DIGITRONIC). A metal anthropometric tape was used for the waist to hip ratio (WHR). It was used Analyses of variance (ANOVA) one-way, post hoc of Tukey and correlation of Spearman for the nonparametric data adopting the level of ρ≤ 0,05 for rejection of the null hypothesis. The body mass index indicated high factors of risk in the consisting groups. In all the groups were registered the desire to reduce their silhouettes. The body weight shows reduced when compared with the younger group in the male group of superior age group, while in the female group the inverse one occurs. The autoimage perception is associated with the classification of the waist to hip ratio in the female gender in the age group of the 50 to the 59 years and in the classification of the body mass index of all constituted groups. Significant associations had not been found for classification of the systolic and diastolic blood pressure in relation to the auto-image 41 perception. This thesis presents relation of interdisciplinarity and its contents have application in the fields of Physical Education, Medicine, Physiotherapy and Nursing

Análise cintilográfica da deposição pulmonar de radioaerossol após associação da nebulização através dos dispositivos mesh e jato com a ventilação não invasiva em indivíduos normais e com pneumopatias obstrutivas crônicas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Digestibilidade e balanço de nitrogênio em ovinos alimentados à base de dietas com elevado teor de concentrado e níveis crescentes de polpa cítrica peletizada

O experimento foi realizado com o objetivo de determinar os coeficientes de digestibilidade, a ingestão de nutrientes e o balanço de nitrogênio de dietas com 20% de silagem de milho e 80% de concentrado e 0, 25, 40 e 55% de polpa cítrica na matéria seca total, substituindo o milho em grão. em delineamento de blocos ao acaso, foram utilizados oito cordeiros mestiços, com nove meses de idade e 34 kg de peso, mantidos em gaiolas individuais com dispositivo para separação de fezes e urina. O período de coleta de alimento, sobras, fezes e urina foi de seis dias e a quantidade de alimento oferecido correspondeu à média do consumido nos três últimos dias do período de adaptação. O experimento foi desenvolvido em duas fases, utilizando-se os mesmos animais, que foram distribuídos em blocos pelo peso. Os resultados foram analisados por regressão polinomial. Houve aumento linear nos coeficientes de digestibilidade aparente da proteína bruta e da fibra em detergente ácido, com o aumento da participação da polpa cítrica na dieta. Os demais coeficientes de digestibilidade não diferiram entre si e foram, respectivamente: 71,8; 73,3; 77,2; 63,5; e 72,2%; para matéria seca, matéria orgânica, extrato etéreo, fibra em detergente neutro e hemicelulose. O teor médio de nutrientes digestíveis totais foi de 72,39%. Houve aumento linear da ingestão de matéria seca e de nutrientes digestíveis totais por dia e por peso metabólico, com o aumento de polpa cítrica na dieta. O mesmo ocorreu com a quantidade de nitrogênio ingerido, absorvido, urinário e retido. O aumento da participação da polpa cítrica peletizada até 55% da matéria seca da dieta, substituindo o grão de milho, implicou em melhor aproveitamento da fibra e eficiência no metabolismo do nitrogênio.

Ethopoiésis e Heavy Metal: Subjetivação e consumo na cena de Natal-RN

Our research intends to comprehend the configuration of the resistance (Foucault) as the stylization of life in the contemporary world, taking Heavy Metal as the specific object of study. We believe that Heavy Metal is an ethopoietical device which admits practices of freedom withstanding the reified moral habits since the beginning of the socialization. This is reflected, mainly, in the creation of new individual and communal ways to stylize the life. We also suggest an expansion of Foucault s concept of resistance, considering the idea of consumer society described by Zygmunt Bauman. Our hypothesis understands that the contact with the underground of Heavy Metal provides new ethical manners (Foucault), where the individual take the Heavy Metal as a way of life. At this point, the consumption becomes a key-word since the participation in the underground of Heavy Metal is a way of consumption out of the rules of marketing a practice of freedom, a way of particular existence , being different in both mode and duration

Instâncias da representação imagética hiper-real

The approach that undertakes this work revolves around the emergence of iconic structures on reflecting about the meaning of different methods of image representation through which the contemporaneity reveals itself. At baseline, three aspects are considered looking for an analytical ontology of the act of representation and imagery: the transition of representation in the oral culture of societies for writing, from these to typography, and finally the creation of a representation device. Resorted to, therefore, the argument by some genealogy reference points that technological instances such as writing, printing and photography, the evolution of this process, correspond, in itself, a consequent shift technique, for each representation precedent. In the area of the image, the most salient aspect of this change in foward process is the emergence of hyper-reality: the instances of hyper-realistic representation. In the Western context, the 'simulation of the world' - essential idea of mimesis is the work of an autonomous an conventional system. It should be noted, then the fact that under unreflective of the post-industrial societies, the mass-media image is coating with natural or fake code including - according to Baudrillard - tends to replace the real world in the "perpetuation of a large chain of simulacra." Hence in modern times, in the postindustrial society, during the crisis of the representation regimen and perception, centered in the referent. In this limit, new settings are established by aesthetic representations of imagery in contemporary culture: establishing spaces of simulation [Jean Baudrillard] the spectacle [Guy Debord] and hypermodernity [Gilles Lipovetsky] in which they operate. In these assemblages, saps the emergence of Hyper-reality Representation Instances - as seen in this study aesthetic events to configure itineraries of a new sensibility. It is the nature of this practice sign-iconic, ingrained in the creation of current artistic expression, which this research engaged in peering: the hyper-realistic setting, taking empirical support central to contemporary imagery production, diverse formats of analog representation.

Utilização intracoágulo de espuma fibrinolítica - preparação, caracterização e atividade in vitro de uma espuma de estreptoquinase e proposta de uma nova abordagem terapêutica

Foam was developed as a novel vehicle for streptokinase with the purpose of increasing the contact time and area between the fibrinolytic and the target thrombus, which would lead to a greater therapeutic efficacy at lower doses, decreasing the drug s potential to cause bleeding. Fibrinolytic foams were prepared using CO2 and human albumin (at different v:v ratios), as the gas and liquid phases, respectively, and streptokinase at a low total dose (100,000 IU) was used as fibrinolytic agent conveyed in 1 mL of foam and in isotonic saline solution. The foams were characterized as foam stability and apparent viscosity. The thrombolytic effect of the streptokinase foam was determined in vitro as thrombus lysis and the results were compared to those of a fibrinolytic solution (prepared using the same dose of streptokinase) and foam without the fibrinolytic. In vitro tests were conducted using fresh clots were weighed and placed in test tubes kept at 37 ° C. All the samples were injected intrathrombus using a multiperforated catheter. The results showed that both foam stability and apparent viscosity increased with the increase in the CO2:albumin solution ratio and therefore, the ratio of 3:1 was used for the incorporation of streptokinase. The results of thrombus lysis showed that the streptokinase foam presented the highest thrombolytic activity (44.78 ± 9.97%) when compared to those of the streptokinase solution (32.07 ± 3.41%) and the foam without the drug (19.2 ± 7.19%). We conclude that fibrinolytic foam showed statistically significant results regarding the enhancement of the lytic activity of streptokinase compared to the effect of the prepared saline solution, thus it can be a promising alternative in the treatment of thrombosis. However, in vivo studies are needed in order to corroborate the results obtained in vitro

Desenvolvimento e efetivação da garantia a duração razoável do processo civil

The present paper aims at analysing the constitutional principle which foretells lawsuit s rational run warranty. We came from a principle standard-constitutional analysis, showing its historical descent, its position and hermeneutical extent which can be given to the dispositive text. Being based on the institute standard examination, we then went to infraconstitutional analysis of the rules related. We noticed that there are specks of legal and practical advancements, however there are also some clear limitations for the lawsuit s rational run judicial development and accomplishment. In short, it is about a principle-logical constitutional standard which must be more and more compacted

Os antagonismos da integração sul-americana na ordem jurídica brasileira

The economic regional integration is a phenomenon observed in numerous occasions inside the global economic reality. Watchful to that phenomenon, the 1988 s Brazilian constitutional order establish in its 4th article, single paragraph, the commitment to seek for the Latin- American integration, as a Fundamental Principle to the Brazilian Federative Republic. Regarding the mentioned constitutional disposition s realization, the Brazilian State celebrated, specially, the 1980 s Montevideo Treaty, creating the Latin-American Integration Association, and the 1991 s Asuncion Treaty, performing the duty to establish a common market, in sub regional level, with Argentina, Paraguay and Uruguay, called Mercado Comum do Sul. However, due to an addiction to a wrong comprehension of State s Sovereignty Principle, the Constitution imposes to the international rules an incorporation process, without providing any privilege to those ones regarding the integration constitutional disposition s realization, whether original or derived. The Brazilian s Supreme Court, as matter of fact, affirmed that it is not possible, facing the actual constitutional order, to grant any character of preference. Also in the controversies solution mechanism, responsible for the law s execution in case of its noncompliance, where found malfunctions, most notably the system s open character and its excessive procedural flexibility, in addiction to restricting the access of individuals. It follows from these findings, then, the lack of legal certainty provided by the Mercosul s legal system, considering its effects both international and within the Brazilian state. Among the possible solutions to reduce or eliminate the problem are using the practice of the so-called executive agreements in the Mercosul s original rules incorporation to the Brazilian state, the creation of a Mercosul s court of law and/or a constitutional reform

Reserva de cargos e empregos públicos a pessoas com deficiência: instituições federais de ensino no RN

With a focus on the need for effectiveness of fundamental rights of persons with disabilities, this dissertation held a scientific research to analyze the degree of implementation of reservation of positions and public jobs to people with disabilities in the Brazilian State, because the 1988 Federal Constitution expressly determined such a reservation in your article 37, VIII. Highlight that this subject is enough evidence, given the large number of open public competition in recent years in Brazil, as well as recent proposals to grant equal rights to blacks (Bill nº 6,738/2013). In addition, the wording the constitutional device comes fomenting heated discussions on the subject, which are flowing on the doors of the judiciary and are spicy because such protection Microsystem vulnerable group has several gaps in the regulation of this policy. However, the research produced, unlike other related theme, does not address the problem of inefficiency in its constitutional theory, that is, abstractly, but also focuses on a specific analysis of this ineffectiveness within Brazilian society, so that research based on a bibliographical analysis, plus a study case law, at the national level, as well as in field research, while case study, focusing on the technique of the analysis of everyday life, because it was believed that the degree of realization of the constitutional norm debated is not yet a satisfactory degree of effectiveness. Soon, the methodological procedures chosen confirmed such a hypothesis and contributed to the study of realization of the fundamental right to work of people with disabilities in Brazil, the light of a Constitutional State, proposing a constitutionally appropriate model the greater effectiveness of the constitutional norm studied

Histórias do corpo negado: uma reflexão educacional sobre gênero e violência feminina

This research has been implanted on thematic area education, politic and culture, based on line research and cultures practices aducatives histories approaches and literaries. on this situations, be involved around the kind of relations investigating about history cultural perspective, the thematic: woman, violence, body and education in women s daily victims of fisic, sexual and psychological violence. The research period happens end of 20th century beginning of 21th, specially between the 1999 until 2002. The survey shows influence of sexually device above body to reveal the root of violence in kinds of relations, be present in lifehistory of women aggressors the prisoners women and the women who permits aggressions the victims who accuse in the police station of woman. to preserv her privacy, i have been utilized in my register book pseudonym by flowers, to everyone. i have been defended my theory by familyrelations, be constitued in micro powerspaces and learn about sex, under the influence of violence in kinds of relations, creating negative bodywoman. shows bodyconceptions and sexuality by light thinking of the French philosopher Mr. Foucault Michel, in his opinion sexuality is a mechanisms by power, it is present on circular form at the society from all the institutions. I have been run over of Erich Fromm s lover theory. Those are fontain of newspapers, Police Protests, the prisoners women statement and the women who permits aggressions that them accuse aggressors of hers. I also utilize as fontain the Brazilian Penal Coole. At last I have decide about the flowers-women´s history, they have discourse who divulge the really importance of body as privileged by wisdom and truths, it was translated by own subjectivity, learned educations relacions, repetead in family breast and be responsible of the actions at signature in the presence of society. These relacions, were twice think and was problematic, their will be bring seeds of social transformations

O memorial autobiográfico: uma tradição acadêmica do ensino superior no Brasil

The thesis has as object of study the autobiographical memmorials. The general objective is to describe the history of the memmorial as an academic tradition of higher education in Brazil. Considered a hybrid genre, memmorials are known for focusing on life stories from a scientific perspective. The investigation revolves around three intertwined branches: History of Education, educational practices and language usages, which allow us to conduct a dialogue with multiple theoretical-methodological references with a view to supporting our analyses. The corpus used for the analysis was made up of 40 autobiographical memmorials, distributed as follows: 16 academic memmorials, dated from 1935 to 1970; 07 academic memmorials, dated from 1980 to 2007; and 17 formation memmorials, dated from 1995 to 2000. In this corpus, we also included official documents, which relate to legislation contained in edicts, resolutions, ordinances, regulations, which we used with a view to: 1) getting to know and understanding the big picture of higher education regulation in Brazil and the aspects related to the higher education teaching career; 2) investigating the text of memmorials in the light of the injunctive discourse characteristic of the edicts and resolutions in which they were based. The analysis of the memmorial supported by the legislation which regulates it allowed us to reconstitute the image of the professor throughout 80 years in the Brazilian public university. For this purpose, the study was conducted in the theoretical-methodological perspective of the (auto)biographical research in Education and of the sociolinguistic studies on discourse genres and discursive traditions. The investigations reveal the memmorial as an academic genre in which the professor's academic-professional history and the history of the higher education teaching career in Brazil intertwine. Anchored in the Bakhtinian perspective on discourse genres, according to which the memmorials evolve and become more complex as their contexts of usage also evolve and become more complex themselves, the results of our analyses allowed us to correlate genre changes to the sociohistorical context and to its usage as an educational practice in the university, in the decades under study. Therefore, the analyses showed that these self-writings: go from latent subjectivity to pure objectivity from the 1930s to 1960s; they show total annulment of the subject from the 1960s to the 1970s; they reappear in the 1980s, having Professor Magda Soares' memmorial as perspective; they expand and diversify from the 1990s onwards, taking on a formative role and a perspective of future as well. So far as language usages are concerned, we investigated the relationship of the subject with the language, especifically the manifestation of alterity on the discursive tissue of the memmorials. In this branch, the analyses pointed to the influence of the authoritative discourse on the formation of the professor and of the injunction and reinventing discourses on the authorship process. Therefore, the autobiographical memmorial reveals itself as a specific expression of the Brazilian academy's cultural sphere and allows us to confirm the hypothesis that each memorial tackles a singular-plural situation, by presenting a dialectical articulation between private and public, according to the institutional structures, in which and with which the professor has already formed him/herself and with which he/she dialogues

Contar no caminho: escritas de si, percursos de formação e inserção institucional de professores da infância

El trabajo tiene como objeto de estudio la percepción de profesores de la infancia respecto sus itinerarios de formación y proyectos de inserción institucional, y como objetivo analizar como los participantes de la investigación articulan, narrativamente, sus itinerarios de formación y proyectos de actuación profesional para inserción institucional en un Colegio de Aplicación. Adopta principios epistemológicos y métodos de la investigación (auto)biográfica: Ferrarotti 2010); Delory-Momberger (2008, 2011, 2012); Josso (2010); Nóvoa (2007); Nóvoa y Finger (2010); Dosse (2009); Passeggi (2011, 2012, 2013); Souza (2004, 2010, 2013). El corpus está constituido por diez memoriales académicos; diez proyectos de actuación profesional; la transcripción de entrevistas realizadas en dos grupos de discusión y el diario de campo de la investigadora. Las analises se basan en las contribuciones de Jovchelovitch y Bauer (2010), Schütze (2010) y Weller (2006). Los resultados de la investigación permitiran concluir que el proceso de biografización y el proyecto de actuación profesional introduce una doble función: constituirse en una herramienta de evaluación y como dispositivo de formación, permitiendo a los profesores la reflexión sobre las particularidades del proceso de biografización en el contexto de injunción institucional y el conocimiento de las potencialidades de sus percursos de formación. Permitiran, todavia, la definición de tres eixos organizadores de una cartografía de formación, tomando lo que Nóvoa (2007) sugiere sobre los procesos de Adesión, Acción y Autoconsciencia en la constitución de la identidad docente. Ao relatar sus percursos de formación los profesores reconstituyen adesiones a los principios, valores y proyectos en diferentes contextos de formación, revisitan acciones desarrolladas en el ejercicio de la profesión y elaboran reflexiones que resultan en la autoconciencia de potencialidades y limitaciones de sus acciones en la institución. El trabajo contribuye para pensar la producción de memoriales y proyectos académicos de experiencia profesional como espacio fundador de reflexión sobre la formación del profesorado de la infancia

Uma intervenção educativa para profissionais de saúde na prevenção de pneumonia associada à ventilação mecânica

Quasi-experimental study, prospective with quantitative approach, performed at the Hospital do Coração in Natal, aimed at verified the existence of difference between the care given by health professionals to the patients under mechanical ventilation (MV) in the Intensive Care Unit, before and after an educative intervention. The population was of 31 professionals, with data collected between november 05 of 2007 to march 27 of 2008. The results show a yong population, female gender, middle level of education, nursing technique, working between 05 and 09 years on nursing profession, and 01 to 04 years on Intensive Care Unit; almost all, never had an kind of training over prevent pneumonia associated to mechanical ventilation; from those that had training, occur on the work place with duration from 12 to 24 hours. About endotracheal intubation, the cuff was tested with a sterilized syringe had a positive change after a educative intervention, increased from 75,0% to 100,0%; the sterile guide was used on 75,0% before and 100,0% after an educative intervention. Regarding endotracheal suction procedure, was not informed to the patient on 72,7% before, however was informed on 56,7% after; the hands was not previously washed 68,5% before, however was 63,3% after the procedure; mask was used on 74,2 % opportunities before and 76,7% after; the aspiration catheter had adequated size on 98,9% observation before and 100,0% after; the gaze was sterilized on 95,7% before and 100,0% after; the ventilator was connected to the patient during the aspiration intervals on 94,4% observation before and 100,0% after; the ambu bag was clean and protected on 76,1% before and 85,7% after; the aspiration catheter was discarded after be used on 98,9% before and 100,0% after; FIO2 was turned to the begging value on 32,9% observation before and 12,0% after; before the procedure 71,9% professions washed their hands and 73,3% after; before, notes of aspiration results were performed on 70,8% observation and 86,7% after. Regarding devices used on respiratory tract, aspirator flasks were not swapped on 84,6% observations before and 71,0% after; daily látex extention change was not performed on 93,6% observation before and 87,1% after; the ambu bag change was not performed on 50,0% observation before even if was duty or unprotected and on 75,8% opportunities was changed, after; nebulization was not prepared with sterile fluids or manipulated aseptically on 65,2% observation before, perhaps was on 71,7% after; before nebulizers were not changed on 65,2% observations, perhaps were on 60,9% after. Concerning ventilator breathing circuits, condense fluids cumulated on circuits were removed on 55,0% opportunities before, and 64,0% after; moisturizer was not filled with sterile water when already had small amount of liquid inside on 78,4% observations before, and 90,2% after; MV circuits were changed on 97,0% observations on presence of visible duty or when presents some kind of failure, before and 98,4% after. About body position, on 51,3% observations the decubitus position change were done before and 78,2% after; fowler position was maitened on 95,5% observations before and 98,2% after; Regarding respiratory physiotherapy, enteral diet was not interrupted before respiratory physiotherapy on 94,9% before and 90,0% after; respiratory physiotherapy devices were not disinfected or sterile on 69,6% observations before but they re on 60,0% after; before the cateter was not tested before introduction enteral diet or medications on 100,0% but after was done on 15,2%. About enteral feeding, intestine motility and measure of stomach contents were not done on 100,0% observations before, but was 15,2% after. We conclude that 05 of 07 valuated procedures in relation to MV, had a significant improvement on quality of care given after educative intervention, when compared before intervention

Protocolo de avaliação do cuidado de enfermagem e da segurança do paciente em unidades de terapia intensiva

The reports of adverse events date from 1990 up to the present day. Conceptually, these adverse events are unintentional injuries unrelated to the underlying disease, causing measurable lesions in patients, extending the period of hospitalization, or leading to death. These issues require discussions with regard to patient safety, improved quality of service, and preventing medical errors. In the Intensive Care Units, this concern is greater because these are sectors of intensive care to individuals with hemodynamic changes and imminent risk of death. Therefore, it is essential to conduct evaluation processes to investigate aspects of quality of nursing care and patient safety in these spaces. For that reason, we aimed to propose the Evaluation protocol of nursing care and patient safety in Intensive Care Units. For its achievement, we needed to: 1) analyze the evolution of the patient safety concept used in scientific productions, under Rodgers evolutionary concept; 2) identify the necessary items to build the evaluation protocol of nursing care and patient safety in the Intensive Care Unit, from the available evidence in literature; 3) construct an instrument for content validation of the evaluation protocol of nursing care and patient safety in the Intensive Care Unit; and 4) describe and evaluate the appropriateness of the content for an evaluation protocol of nursing care and patient safety in the Intensive Care Unit. This is a methodological study for the content validation of the abovementioned protocol. To meet the first three specific objectives, we used the integrative literature review in Theses Database of the Coordination for the Improvement of Higher Education Personnel and the portal of the Collaborating Centre for Quality of Care and Patient Safety. The fourth specific objective happened through the participation of judges, located from the Lattes curricula, in the content validation process developed in two stages: Delphi 1 and Delphi 2. As instrument, we used the electronic form of Google docs. We present in tables the answers from the evaluation instruments by Delphi consensus and Content Validity Index (CVI) of the entire protocol. We summarized the results in articles entitled Analysis of the patient safety concept: Rodgers evolutionary concept ; Scientific evidence regarding patient safety in the Intensive Care Unit ; Technological device for the content validation process: experience report ; and Evaluation protocol of nursing care and patient safety in Intensive Care Units. The Embodied Opinion of the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte, No. 461,246, under CAAE 19586813.2.0000.5537, approved the study. Thus, we conclude the protocol valid in its content, constituting an important tool for evaluating the quality of nursing care and patient safety in Intensive Care Units