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Revista Cientı́fica Multidisciplinar
PLURALIDADE
Número 5, 2015
EDITOR-CHEFE
Dr. Odmir Andrade Aguiar
(SIMIODE, Alpharetta, GA - EUA)
EDITOR-ASSISTENTE
Dr. Ronald Stewart
(ICMMR, Gonzalez, TX - EUA)
EDITORES ASSOCIADOS
Dr. Chen Haoliang
(AkzoNobel, Singapura)
Dr. Marcos Paulo Bogossian
(Empresa de Planejamento e Logı́stica, Brası́lia, DF - Brasil)
Ed.S. Luciana Sacramento Aguiar
(Fundação Plural, São Vicente, SP - Brasil)
Dr. Ramasamy Manivanan
(CWPRS, Pune, MH - Índia)
Esp. Walter Trentadue
(Colégio Harper, Brodhead, WI - EUA)
1
c Fundação Plural, 2015
Copyright Capa: Detalhe de um Tubarão Galha-Branca, Triaenodon obesus (Ruppell,
1837), autor Andrej Gajić, Sharklab, Malta.
Preparação, Revisão e Editoração: Conselho Editorial, utilizando LATEX
O material apresentado neste suplemento não representam, necessariamente, as opiniões do editor ou do Conselho
Editorial da Revista Pluralidade ou os funcionários ou membros da Fundação Plural.
The material presented in this supplement does not necessarily represent the opinions of the Editor or Editorial Board
of the Pluralidade Journal, or the officers or members of Plural Foundation.
Revista Cientı́fica Multidisciplinar
PLURALIDADE
ISSN 2318-2156
CONTATOS:
Editor-Chefe
Odmir Andrade Aguiar, [email protected]
Diretora de Arte e Programação
Juliana Sacramento Aguiar, [email protected]
2015
Todos os direitos de publicação desta obra reservados à
FUNDAÇÃO PLURAL, Prefixo Editorial 66770
Av. Presidente Wilson 1.033 - Itararé
11320-001 - São Vicente - SP
Publicação on-line: www.pluralidade.info
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SUMÁRIO
THE RESEARCH METHODOLOGY FOR COMPARATIVE
ODONTOLOGY OF SELACHII, LABORATORY PROCEDURE
1
GLIESE 581D’S OBLIQUITY, NORTH AND SOUTH POLE
CONNECTIONS, MAY BE SIMILAR TO TITAN; AFFECTING
EXOPLANETARY NEOPROTEROZOIC LIKE WEATHER
PATTERN
18
AN INTRODUCTION TO DRY-BULK PORT TERMINAL
OPERATIONS
31
THE PSYCHOPEDAGOGICAL AND HOLISTIC APPROACH
- A PROPOSAL BEYOND HOSPITAL CLASSES
53
PRELIMINARY SITE INVESTIGATION OF THE LAKE
KENYIR WATERSHED
85
THE EBOLA VIRUS; PRELIMINARY THEORETICAL
MOLECULAR IMAGING CONSIDERATIONS GIVEN TO THE
POTENTIAL IMMUNOSTIMULATORY EFFECTS
- ALLOGENEIC LYMPHOCYTES
95
CRYPTOSPORIDIUM INFECTION IN PATIENTS WITH
ACUTE ON CHRONIC LIVER FAILURE (ACLF)
102
STRONG INTENSITY OF UNKENREFLEX DEFENCE
MECHANISM IN YELLOW-BELLIED TOAD, BOMBINA
VARIEGATA (LINNAEUS, 1758), FROM MT. PRENJ
(BOSNIA AND HERZEGOVINA)
116
USE OF SATELLITE TAGS TO REVEAL THE MOVEMENTS
AND INTERACTIONS OF SHARKS WITHIN THE NEUM
BAY AND THE REST OF ADRIATIC SEA
122
3
THE RESEARCH METHODOLOGY FOR
COMPARATIVE ODONTOLOGY OF
SELACHII, LABORATORY PROCEDURE
Gajić, A. ∗Romano, L.C. †Dautbegović, E. ‡Kahrić, A. §
Zaklan, H. ¶Jonić, L. kHamzić, E. ∗∗Avdibas̆ić, H. ††Aihodz̆ić, L.
July, 2014
Abstract: The Comparative Odontology of Selachians is an ongoing scientific research project coordinated by Gajić (Sharklab) with aim on better
understanding of morphology, morpho-taxonomy, anatomy, functional and
molecular biology of shark teeth and jaws. Besides original scientific studies
and field work, project aim to involve undergraduate students from chosen
University from Southern Europe in order to gain basic scientific research
methodology in the fields of comparative odontology of selachians. Through
this section student team (eight students) was included in writing a specific research morphology they used fro their own studies trough project and
graduate thesis, primarily in order to gain knowledge in publishing scientific papers and to gain references before graduation to motivate them on
scientific related work in future.
Key words: Odontology, Selachii, Shark, Jaw, Teeth.
∗
MSc, Department of Biology, University of Sarajevo (Sarajevo, Bosnia and
Herzegovina) and Researcher Scientist at SharkLab (Hamrun, Malta) e-mail:andrej [email protected]
†
B.Gen.Eng., University of Sarajevo (Sarajevo, Bosnia and Herzegovina)
‡
B.Eco.Eng., University of Sarajevo (Sarajevo, Bosnia and Herzegovina)
§
¶
B.Bio., Dz̆emal Bijedić University (Mostar, Bosnia and Herzegovina)
k
∗∗
††
‡‡
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1
‡‡
1
1.1
Fish Scales and Dermal Skeleton of Selachii
Fish Skin and Types of Scales
Fish have specifically built skin, which differs greatly from the skin of other
vertebrates. A large number of fish have slimy skin, which binds and breaks
sludge and in this way facilitates breathing of the fish. This mentioned mucus
is made from different mucopolysaccharides and immunoglobulins. Malpighi
cells that have retained their ability of division are scattered through the
epidermis. Beneath the epidermis is the dermis, in whose composition enter
the cell pigment, nerves, connective tissue and scales.
The dermis consists of two layers, the stratum spongiosum and stratum
compactum. Scales can be conditionally divide in two parts, upper part was
built of bone tissue, while the lower layer is built up of connective tissue permeated limestone. We distinguish four basic types scales specific for certain
groups of fish, such as: placoid (characteristic for most cartilaginous fish),
ganoid (Chondrostei ), cosmoid (fossil lungish and latimeria) and bone (most
bony fish).
1.2
Development Odd the Placoid Scales
Placoid scales (Fig. 1 and 2) represent the most primitive type of scales
and they are present only in cartilaginous fish, in form of the skin skeleton.
Each placoid scales presented one rhomboid plate that is embedded in the
dermis, with whose surface depart little teeth (usually three teeth), which
penetrate on the surface of the dermis. The emergence of the placoid scales
is carried out by following the way: in the dermis the cells with a large
nucleus are collected, which are native to the dermis, and they transform into
odontoblasts; beneath them the epidermis builds a conical wen. Odontoblasts
are deployed in a single, continuous layer, and secrete dentin, of which the
interior of teeth is made.
In contact with the dentin, the cells of the epidermis secrete vitrodentin.
In this way, the deeper part of the growth becomes covered with mineral
matter and placed into the dermis, which ossifies and build a base around
which the dentin layer is deposited. The small tooth stops growing, and after
a certain time it consumes, and drops, or else it damages and cracks. In the
interior of the scales, or the small tooth, there is a core of soft pulp, rich
of blood vessels. The scale is made of dentin, teeth bone, which represents
organic matter imbued lime salts. In the inside of the small tooth there is
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the nerve canal. On the surface is covered with a teeth canal. On the surface
is covered with dental enamel. Placoid scales of the cartilaginous fish are
homologous organs with the teeth of mammals, they have the same origin,
the same structure but different function.
Figure 1: Placoid scales of Squalus acanthias, taken under small microscopes
magnification (Source: Gajić, A.)
Figure 2: Placoid scales of Squalus acanthias, taken under small microscopes
magnification (Source: Gajić, A.).
We can conclude that the placoid scales are present on the cartilaginous
fish and cover the entire surface of the body, and have a support and hydrodynamic function, while in the jaw they develop in the form of sharp teeth.
Although Selachii (or Selachomorpha) have quite similar placoid scales is
necessary to stress that they are different from species to species, but in no
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way can not represent a reliable taxonomic character for species identification. Methodology of shark skin microscopic preparation is shown:
1. Carefully separate, using scalpel, a piece of skin measuring 3 cm x 3
cm from the fish;
2. Previously separated piece boil until crumbles;
3. Use pipette to take a drop of water from the pot that contain placoid
scales from the piece of skin and put it on glass;
4. Do not place cover glass;
5. Such preparation is ready for microscopy. The researcher should take
care of the fact that preparation is of a temporary nature and it dries
very quickly; and
6. If the drying occurs, pipette to add a bit of water on glass being careful
to not to split over scales.
Independently prepare the Selachii skins as described. Mentioned preparation, put under a small or medium magnification and observe; draw notable
results in a frame and mark the specific morphological parts.
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2.1
Shark Teeth
Basic Morphology of Shark Teeth
Shark teeth (Fig. 3 and 4) presents modified placoid scales, adapted for
cutting and tearing specific pray [2]; mentioned teeth are arranged in vertical
columns (rows) and horizontal bars (series). There are several series of teeth
in each shark jaws, of which the first series makes functional one. In addition
to the first, functional, series we can find several series of replacement teeth
(usually represented with three to five series). Those teeth replace continuously the first series in certain time (which grow on the relation to the age).
Mentioned teeth are not attached to jaw it self, but they are developed in the
gums and are fixes for dental membrane. The root and crown are constructed
of tooth bone, dentin, and are covered with enamel. Often, between the root
and crown lays layer of transition with thin layer of enamel called ”chevron”
[6] [2] [3] [4].
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Figure 3: Middle part of the lower jaw of Small spotted catshark (Scyliorhinus
canicula) (Source: Gajić, A.).
Figure 4: Two functional series of lower jaw of a Spiny dogfish shark (Squalus
acanthias) (Source: Gajić, A.).
2.2
Describing the Teeth Morphology
Morphologically viewed, shark teeth can be conditionally divided into one
or several ridges (cusps). Largest cusp is named as main cusp, while other
smaller cusp (if present) is named cusplet. The presence, number, and other
morphological characteristics of cusps vary within the species, but many also
vary within certain types of individuals of same species. Morphological characteristics of certain parts of the teeth are the basic taxonomic character
for species identification (morpho-taxonomical characters). When defining
the morphology of the teeth, we assume that the teeth are serrated laterally or not. Basis of morphological parts of the teeth of some Selachii are
schematically shown in Figure 5.
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5
Figure 5: The main morphological parts of the shark tooth. Legend: (A)
main cusp, (B) first pair of cusplets, (C) second pair of cusplets and (D) the
root. (Edition: Gajić, A.).
2.3
Detailed Morphological Analyses
During the more detailed morphological analysis of the cusps, we consider
curvature as well as the robustness of the tooth. By its curvature, cusp
can be moderately curved, highly curved and hooked; and by the robustness tooth can be: needle-shaped, moderately robust, extremely robust and
triangular/rhomboid.
Teeth root can be flat, slightly invaginated (slightly tucked in the direction of the tooth body) or extremely invaginated (drawn to the tooth body
to the extent that, viewed upside down, resembles the Latin letter ”U” or
”V”). Also, very important morpho-taxonomic character is root apartness,
the root can be complete (Fig. 5) or parted as is the case with the Squalus
acanthias (Fig. 4), where they are obvious two root parts. When describing the morphology of the teeth, as well as the conditional typification, it is
necessary to take account of all above mentioned tooth parts. While describing the morphology of individual tooth we are starting from lateral serration
(whether present or not), number and diversification of cusps and their full
description and in the end of the root characteristics. In describing several groups of teeth it is important to emphasize taxonomic characters that
clearly separates one group from another. While describing a group of teeth
we can take into consideration the position of observed teeth group in jaws.
Example of describing specific teeth group: Teeth of group fourth-pseudocuspid, species Scyliorhinus canicula are characterized by non-serrated lateral edges, the presence of main cusp surrounded by two pairs of cusplets
(first and second row) of which first is noticeably larger that the second pair.
Length of the main cusp is over three times greater than the length of the
first pair of cusplets. Root is whole (never separated), medium elongated,
and slightly invaginated.
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The morphologically division and details describe teeth presented in Figures 6 and 7.
Figure 6: Right side of the jaws of Bluntnose sixgill shark (Hexanchus
griseus). (Source: Bigelow and Schroeder, 1948).
Figure 7: Left side of the jaws of Spiny Dogfish (Squalus acanthias) (Source:
Bigelow and Schroeder, 1948).
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Morpho-Functional Teeth Differentiation [5]
Once we have mastered morphological division of teeth and jaws in previous exercises, we consider the basic functional division of the teeth. Gilbertson [5] have divided shark teeth into four functional groups, based primarily
on a specific diet conditioned by the morphology itself:
1. Flattened teeth adapted for crumbling the decapod crustaceans, ie
chitin cuticle (those teeth type is presented in most species of Genus
Mustelus (Linck, 1790);
2. Needle-like teeth for catching mid-sized and large pelagic fishes, for
example, teeth of Carcharias taurus (Rafinesque, 1810);
3. Needle-shaped teeth of the lowe jaw to capture and triangular, serrated,
teeth of the upper jaw for cutting, such as Carcharhinus longimanus
(Poey, 1861); and
4. Reduced teeth of the filter-feeding species, which feed on plankton and
have no real teeth function as Cetorhinus maximus (Gunnerus, 1765).
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As it’s seen from above examples, tooth morphology develops primarily
due to a specific type of pray which shark consumes. Its important to note
that there are a significant number of species whose teeth do not fit into the
either category described by Gilbertson.
4
Basic Anatomy of the Cranial Region of
Selachii
The muscular system includes a set of tissue structure with contractile,
hereditary traits. There are three types of muscles: striated (involved in
actively move of the organism and its individual components), smooth (which
form the walls of the internal organs and are not subject to the influence
of will) and cardiac muscle that stands out as a separate entity because
it contains elements of both mentioned groups. Muscles essential to the
movements of jaws belong to the group of striated muscles.
Striated muscles are built by muscle fibbers (myocytus striatus), which
are represented by relatively long, thin, cylindrical cells. Muscle fibbers are
properly aligned (parallel) and are surrounded by endomysium which wispy
layer of areolar connective tissue. The basic histological structure of each
muscle consists of bundles (fasciculi ), which forms a greater number of associated muscle fivers. Each bundle is surrounded by a specialized wrapper
called perimysium. The final structure of the muscles is formed by mutually
grouped bundles which are surrounded by a thick sheath of connective tissue,
called epimysium. Through all these aforementioned wrappers (endomysium,
perimysium and epimysium) blood vessels and nerves are passing, which van
be further branch out and maturing to each fibber. Length and diameter
of myocytes (muscle cells) varies considerably from muscle to muscle. The
average length of the myocytes is between one millimeter and twelve centimeters, while the average diameter ranges from 10 do 100 microns. When
we look at the transversely intersected histological preparation, we observe
oval or polygonal shapes.
4.1
Branchiomeric Muscles of Sharks
Branchiomeric muscles are mesenchymal origin and related primarily to
the elements of the visceral skeleton and together with the hypobranchial
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muscles its involved in rising the mouth then sliding down of the lower jaw,
as well as the expansion of gill pouches. In some recent groups of Selachii
that have uniformly built visceral arches, branchiomeric musculature of one
visceral arch is consist of the four muscle mass:
1. Dorsal and ventral constrictor muscles - there are exterior flat muscles
whose primary role is constriction of pharynx sacks during the active
phase of ventilation of gills;
2. Levator muscles - those muscles are connected to the dorsal parts of the
gill arches and actively participate in rising of the skeletal elements;
3. Adductor muscles - are set much deeper and they connecting the epibranchial and ceratobranchial parts of visceral arches and during contraction reduces the angle that creates among the mentioned skeletal
elements; and
4. Interradicular muscles - linked on the upper elements of visceral arches,
when contracted they bend them backwards.
For a proper understanding of the process of mastication, more precisely
movement of the upper and lower jaw, necessary is to know following muscles:
• musculus adductor mandibulae which is responsible for the closes of
jaw (in the descending of the lower jaw par of hypobranchial muscles
are involved, which starts from the shoulder belt and pulls the lower
jaw backward and downward);
• musculus intermandibularis is formed by ventral constrictor and hyoid
mandibular arch, lies between the lower jaw and during contraction
raises the lower jaw; and
• musculus levator palatoquadrati which raises the palatoquadrate cartilage, expect representative with autostylic skull type.
Muscles of other gill arches mostly are non-specialized; significant changes
involve only the levator muscles of latest arches that are powerfully developed
and forming musculus trapezius.
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4.2
Basic Anatomy of the Nervous System
The nervous system is basically composed of specific nerve cell called neurons, highly specialized that have lost their ability to continue dividing. Neurons have role of conductors of stimuli of receptors to the central nervous
system and from mentioned to the effector that will respond to a given stimulation. They also play a role in the transmission and storage of information
in the nervous system. So, the basic function of the nervous system is the
coordination of muscle activity, monitoring of internal organs and processing
information entered from the outside environment (by the senses). Sharks,
like all other vertebrates, possess a tubular nervous system, which consist of
two parts: the central nervous system (CNS) and peripheral nervous system
(PNS).
In order to better understand the function of the nervous system and its
impact on the innervation of jaws muscles, it is necessary first to explain the
basic of neuronal structure, as the basic unit of the nervous system. Neurons
have the ability of excitability; it is the ability of cells to respond to certain
stimulus by changing their membrane potential. When a neuron is idle, we
call it resting potential. Stimulation leads to depolarization of the membrane,
until the critical level occurs when an action potential is transmitted along
nerve fibbers, and it is always the same amplitude and duration.
Each neuron consists of two (or three) morphological units, the body
(soma) or perikaryon and two types of extensions that depart from the neuron body, such as: dendrites and axons. The body of neurons represents an
expanded part of nerve cell whose shape varies considerably. On the histological preparations, perikaryon are colored by Nissl method, after which we are
available to observe euchromatin, big, nucleus with very colored nucleolus,
after that Nissl bodies, comply grouping of tubes, vesicles and granules that
in fact match the rough endoplasmic reticulum and polyribosomes; also, in
the body we can observe visible elements of the cytoskeleton itself such as:
microtubules, micro and neurofilaments.
4.3
Innervation of the Jaw System
For innervation of jaw system are essential nn. craniales (cerebral nerves,
coming directly from the brain on the chondrocranium) which are an integral
part of the peripheral nervous system and are build from group of motor,
sensory and mixed nerve fibbers that innervates muscles and glands. Cranial
nerves of all vertebrates have similar names and perform similar functions.
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Fish have ten pairs of cranial nerves, unlike the humans that have thirteen
pairs. The most important cranial nerves of Selachii are:
• I - nervus olfactorius (olfactory nerve) sensory nerve which starts from
bipolar cells located in the olfactory epithelium of olfactory sack and
end up in olfactory bulb. They are associated with a sense of smell;
• II - nervus opticus (optical nerve) also represent a sensory nerve that is
build by axons of neurons that are located in the ganglionic layer of the
retina of the eye. The nerve start from the optical disc (the last part
of the eyeball) or the papilla of the optic nerve (discus nervi optici)
on the retina. It goes through the choroid and sclera and into the eye
socket. On its way through the eye socket, a nerve has a outer envelope
(vagina externa nervi optici) and inner envelope (vagina interna nervi
optici). Between the envelopes are located intervaginal areas;
• V - nervus trigeminus (branch nerve), which arises from the anterior
end of the medulla. Represents a mixed nerve with both motor and
sensory function. This nerve has three branches, inervation the muscles
of the face, eyes, mouth and jaws; and
• X - nervus vagus (the vagus nerve), which represents the longes, mixed,
cranial nerve which starts from the posterior end of the medulla and
innervates the gills, throat, oesophagus, stomach, intestines, etc.
For the innervation of the muscles of the mouth and jaws important is the
fifth pair of cerebral nerves, e.i., trigeminal nervous. This nerve directly affects on the jaw muscles mentioned in the previous section and provides opening, closing and moving the jaws, such as other cranial structures. A similar,
but more complex, function of this nerve is preforms at the higher vertebrates
and finally the human where it divides into three functional wholeness: ophthalmic, maxillary and mandibular (due to more complex construction of the
jaws itself).
4.4
Cranial Skeleton of Selachii
The skeleton (Greek, σκελετó ς = dry) is part of the body of progressive metazoans, whose main function is the support of body. We may distinguish two types
of skeleton: exoskeleton (external skeleton) and endoskeleton (represented with
internal skeleton). Lower vertebrates, which included jawless fish (the lampreys
and hagfishes) and cartilaginous fish have skeleton made from cartilage, while in
higher vertebrates (starting from the bony fishes) skeleton ossified. According to
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its composition, skeleton is very similar in all groups of vertebrates and it can be
divided into four basic sections:
• Axial skeleton;
• Skeleton of the limbs;
• Visceral skeleton; and
• Dermal skeleton (as its already pinted out, is some Selachii presented with
placoid scales).
Cranial skeleton is the most complex part of the axial skeleton, it includes two
sets of skeletal (protective-supporting) elements: skull (neurocranium, chondrocranium, cranium) skeletal shell that covers and protects the main sense organs,
together with the frontal part of the nervous tube and visceral skeleton (splanchnocranium). In some Selachii, as well as other cartilaginous fish, upper and lower
jaws are consist solely of visceral skeletal elements (Fig. 8).
The upper jaw is presented with palatoquadrate cartilage (palatoquadrate),
which is connected directly to the neurocranium via hyomandibular arch, and
indirectly with the lower jaws, which is presented with Meckel’s cartilage (Cartilago Meckelii ). Hyomandibular arch consist of three elements: hyomandibulare
(which is connected to the cranium and palatoquadrate), ceratohyale, which builds
on hyomandibulare and further build on bashyale (as the third part) and Cartilago Meckelii. Upper and lower jaw together forms the mandibular arch. During
the dissection researcher should be extremely careful when cutting hyoid arch (i.e.
removable jaws from the rest of the head) to avoid damage to the palatoquadrate
or Cavum Meckelii.
5
Types of Connection Between Cranium And
Jaws
There are several basic types of connection of the skull with the maxilla (upper
jaw), in the animal kingdom, which are supposed to have evolved from the primary
autostylic. In the most of extinct (fossil), and some recent, Selachii occurred amphistylic type of connection that is developed directly from the primary autostylic.
The about mentioned type present a double bond of the last part of the maxilla,
while the connection with the neurocranium is realized directly and throughout
the hyomandibular arch.
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Figure 8: Illustrated view of cranial skeleton of Selachii (Edition: Gajić, A.).
Legend: (1) Chondrocranium, (2) Mandibular arch, (C) Hyoid arch, (4) Palatoquadrate,
(5) Cartilago Meckelii, (6) Hyomandibulare, (7) Ceratohyale, and (8) Bashyal.
The vast majority of recent Selachii have hyostylic connection which have developed from amphistylic type, and its considered as more advanced. In the level
of the intraocular region, hyomandibulare is connected to the skull. On the lower
side its connected, either via ligaments (directly) or via symplecticum (indirectly),
on the last part of the palatoquadrate. In the previous described relation, hyomandibulare provides support for he jaws over the neurocranium (acts as jaw
carrier). Unlike sharks, chimaeras (Holocephali ) have autostylic connection between skull and maxilla.
6
6.1
Dissection of he Biological Material for Research Purposes
Required Laboratory Equipment
For a proper dissection, every researcher needs simple equipment, which consists
of six basic components: surgical scalpel, surgical scissors, two tweezers with a
different type of endings, pins and graphite pencils.
During the dissection, especially massive material, researcher should take care
that the blade of the scalpel losses cut and that it is necessary to change it from
time to time, sometimes more than over three times in the course of one dissection.
Duration of the dissection depends primarily on the experience of the researcher.
Jaws dissection of Mustelus mustelus measuring 14 x 12 cm (total head length 20
x 14 cm) takes in average 120 minutes (2 hours), or even more.
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6.2
Techniques of the Jaws Dissection
The process of dissection of the jaws from Smooth-hound Mustelus mustelus is
shown in photographs and is explained in the text.
Before the process of the dissection, it is necessary to palpate the ventral side
below the mouth, to the first gill set, for the locating a complete lower jaw.
Figure 9: First Step to Jaws Dissection (Edition: Gajić, A.).
Once you feel the position of the periphery of the lower jaw, you should sketch
jaw borders with pencil to outline the jaws and to cut easier (Fig. 9).
Figure 10: Second Step to Jaws Dissection (Edition: Gajić, A.).
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The first cut can be performed in several places (mostly on the ventral side),
and specific method of dissection usually depends on it. In this exercise, we will
perform ventral dissection so that we may, as far as possible, avoid damages to
the other parts of the head. Carefully break the skin near the lowest edge of the
lower jaw, on the right side, then using surgical scissors make a cut on the skin to
the middle of jaws, as it is shown on the Fig. 10.
Figure 11: Third Step to Jaws Dissection (Edition: Gajić, A.).
Repeat the same procedure on the opposite side (Fig. 11).
Figure 12: Fourth Step to Jaws Dissection (Edition: Gajić, A.).
Use your fingers to peel the skin to see the lateral rim of the lower jaw (Fig. 12).
Using a scalpel gently remove as much of m. adductor mandibulae and surrounding
tissue on order to free up the space to the hyoid arch.
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Figure 13: Fifth Step to Jaws Dissection (Edition: Gajić, A.).
Particular attention should be taken to the separation of the jaws from the
cranium. The lower jar, presented with Cartilago Meckelii, is linked to the cranium
through hyoid arch, consisting of three parts: hyomandibulare, ceratohyale and
bashyal. Using scalpel carefully separate bashyal from one side of the Cartilago
Meckelii (Fig. 13), taking care not to damage the end of the jaw, then detach
bashyal from the other side.
Figure 14: Sixth Step to Jaws Dissection (Edition: Gajić, A.).
Separate hyomandibulare on both sides of the upper jaw, taking care not to
damage the cartilage itself. After you separate mentioned parts, use scissors or a
scalpel to remove surrounding tissue and remove jaws from the head (Fig. 14).
Once you have successfully separate the jaws from the head, it is necessary to
access detailed treatment and removal of excess skin and muscle. It is necessary
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to be extremely careful, when removing the skin (especially around the mouth), as
its already been pointed in chapter II, the teeth are not attached to the jaws itself,
but develop in the gums and are fixed to the dental membrane, which means that
if the surrounding skin remove improperly it may cause the destruction of a large
number o teeth and therefore entire material to be studied. It its needed, leave a
portion of the skin that is next to teeth (especially on the front of the lower jaw).
When removing tissue from the middle of the jaws be careful not to separate left
and right side.
After the processing of the jaws and removal of the remains of muscles and
connective tissues, wash jaws with a jet of fresh water and gently wipe try and
then blow dryer to dry for 5 - 10 minutes. Leave jaws, usually three to four days
to try completely (smaller species can be dried for 24 to 48 hours). When setting
the drying place, researcher should make the position in which he wants to prepare
jaws, it is usually accomplished by inserting a metal, wooden or glass rod between
the upper and lower jaw to open it. Once the jaws are placed for drying, avoid
touching until drying process is completed.
If its necessary, after drying, again to move jaws, soak them into hot water and
leave it for 15 to 30 minutes (be carefully that teeth do not fall of from jaws).
References
[1] BIGELOW, H.B., SHOROEDER, W.C., 1948. Sharks. Mem. Sears Found.
Mar. Res., (1):53-576, 1948.
[2] GAJIĆ, A., LELO, S. Promjenjivost zuba i zubala sitnopjegave morske
mačke bljedice Scyliorhinus canicula (Linnaeus, 1758) u vodama
Jadranskog mora. Rukopis, 2010.
[3] GAJIĆ, A. Slikovni ključ za determinaciju zuba i ralja ajkula
(Chondichthyes: Elasmobranchii ) u ihtiofauni Bosne i Hercegovine.
Priolozi fauni Bosne i Hercegovine, 8, pp. 61-71, 2012
[4] GAJIĆ, A. Comparative odontology of selachians (Chondichthyes:
Elasmobranch): development and morphological characteristics of
teeth. SymBiosE 2013. University of Sheffield, Department for Molecular
biology; England. Book of Abstracts, pp. 31-32, 2013.
[5] GILBERTSON, L. Zoology Laboratory Manual. New York: McGraw-Hill
Companies, Inc, 1999.
[6] HAMLETT, W.C. Sharks, Skates and Rays: The Biology of Elasmobranch Fishes. Johns Hopkins University Press, 1999.
17
17
GLIESE 581D’S OBLIQUITY, NORTH AND
SOUTH POLE CONNECTIONS, MAY BE
SIMILAR TO TITAN; AFFECTING
EXOPLANETARY NEOPROTEROZOIC
LIKE WEATHER PATTERN
Stewart, R.
∗
August, 2014
Abstract: The question of a neoproterozoic era is raised concerning the
potential habitability of Gliese 581d. There may be cause to believe that a
high neoproterozoic-like climate on Gliese 581d with also a high probability
having climate high obliquity is raised in the context of both exoplanet studies
raised in question by other scholarly papers mentioned in this paper and in
the references section of this paper as well. Previous papers discuss and
provide suitable (e.g. habitability) and paleo climates studies, producing
enough new data and evidence to strongly suggest that in all probability
Gliese 581d may also have similarities to its north and south poles and that an
unusual magnetic field presents and demonstrates evidence for low-latitude
glaciation during the neoproterozoic hypothesis. Therefore, because the poles
themselves may receive more infrared heat from the Gliese 581 star system
red sun coupled with a very high carbon dioxide gaseous based atmosphere
with substantial volcanic activity increases the warmth around the equator
around especially the equator of Gliese 581d since that is where possible most
of the volcanic activity produces masses of heat and a planet wide greenhouse
effect. This paper is to study this and the instability at the north and south
poles with a sustaining obliquity.
∗
Ph.D, Th.D., Editor-In-Chief of the International Journal of Astronomy, Astrophysics,
and Earth Sciences, and the International Journal of Interdisciplinary Science, CEO of
International Consortium On Microscopic-Macroscopic Research (Gonzalez, TX, USA).
E-mail: [email protected]
1
18
Key words:
planets, Titan.
1
Atmospheres, Atmospheric Dynamics, Habitability, Exo-
Gliese 581d Exoplanetary Obliquity
Interestingly, Ferreira [9], Armstrong [2], and Laskar [12] verifies and includes Gliese 581d as a suspected exoplanet that may have one or more bodies
of water/ oceans upon its surface, and needs to be included into the category
of exoplanets that although they may have liquid water on them does not
necessarily make them a good candidate for any type of proposed habitability. Whereas Armstrong [2] presents and demonstrates a good discussion and
reasons to believe that as is suspected in a range of currently thought possible habitable zone (HZ) related exoplanets that because they have water
(like liquid oceans for instance), may give them a better predisposition to be
suitable for habitability of some kind.
However, Ferreira [9] makes a case that in many of these exoplanetary
supposed alleged earth-like sizes HZ probable exoplanets have a range of
obliquities. The reasoning is based both on the range of obliquities of the
terrestrial planets of our own Solar System as well as predictions for exoplanets. The obliquity of Mars for example has been shown to vary chaotically,
ranging from zero to nearly sixty degrees as explained in Armstrong article
[2].
Armstrong [2] continues to explore the impact of obliquity variations on
planetary habitability in hypothetical systems with high mutual inclination.
Showing that large-amplitude, high-frequency obliquity oscillations on Earthlike exoplanets can suppress the ice-albedo feedback, increasing the outer
edge of the habitable zone. Arrange of modeling exoplanetary computer
models formulated exploration to hypothetical systems consisting of a solarmass star, an Earth-mass-like exoplanet. In this case which with similarities
could also incorporate Gliese 581d as well into the modeling hypotheses. Calculated differences in the outer edge of the habitable zone for planets with
rapid obliquity variations, were also taken into consideration. Calculates [2]
two primary factors as to why obliquity affects the potential for any habitability. Which are:
1. The full planetary spin and orbit; and
2. The eccentricity and obliquity fixed at their average values. According
to Laskar [12] recovered previous results that higher values of fixed
2
19
obliquity and eccentricity expand the habitable zone, but also found
that obliquity oscillations further expand habitable orbits in all cases.
However, Touma [22], Carpenter [4], and Shapiro [17] contend that exoplanet obliquity affects the HZ equation based upon such long term assessments and observations in the distorted and destabilized obliquity of for
example both mars and Venus. in our own solar system. Whereas Carter
[5], Correia [6], Cunha [7], Ferreira [10] [8], and Lewis [13] contend that exoplanetary habitability including exoplanets like Gliese 581d obliquity will be
affected by gravitational tides and thermal atmospheric tides, core-mantle
friction,and because of other disturbances like collisions with other planets.
Thus Ferreira[9] and Armstrong [2] provides evidence that for an exoplanet
including Gliese 581d to have the greatest possibility of habitability means;
that any such like exoplanet capable of habitability would also likely have to
have a close proximity of the same tilt on its axis that the earth does to have
the greatest chance of conditions prevailing for habitable conditions to even
begin to exist. This applies to Gliese 581d in like manner.
The tilt of this exoplanet much more than that of earth also causes a
warmer transcending condition along the equator as well. However, this is
also where the most frequent volcanic activity occurs as well. Making the
probability of Gliese 581d not as suitable for habitability as once thought. Especially with an accumulation of much of the densest part of its atmospheric
instability being concentrated up in around it enveloping the entire circumference around the north to south poles. Destabilizing any water/oceans on
its surface as well.
2
Gliese 581d Obliquity is a Sensitive Case in
Finding the Exact Earth-like Tilt of 23.5◦
Degrees to Ensue Potential Habitability
Hadhazy [11] depicts the image in Figure 1 and depicts how intricate and
exact the earth’s obliquity has to be to even support life. In retrospect
the article continues to discuss that just because an exoplanet Gliese 581d
included has more likely than not possible oceans-in this case caused by the
CO2 red radiation effect with the atmosphere and also take that the primary
volcanic action according to Stewart [18] discusses the foundational reasons
as to why the obliquity of Gliese 581d may affect its habitability.
3
20
Figure 1: The seasons are caused by Earth’s tilt. (Source: Starry Night apud
Hadhazy, A. [11])
Whereas Udry [23], Mayor [14], Wordsworth [25] adhere and lay down principles of research that allow the establishment for most likely dissolved ice
based oceans upon the surface of Gliese 581d. However, Stewart [21] includes
very detailed discussion and present a wealth of new data and evidence including imaging as well of possibly Gliese 581d itself and also depicts that
the influx of infrared radiation into the atmosphere not only comes from its
parent red dwarf star Gliese 581 but introduces additional evidence and images on other nearby stars that allow likely three to four times more infrared
radiation as a total influx to add to the already various amount of greenhouse
gases produced upon the surface of Gliese 581d.
This coupled with greater than known volcanic activity seems to be at
it’s greatest along the equator of Gliese 581d as well. All of these combined
factors with what also Hadrazy [11] brings to light in the aspect that the
obliquity is so important as to even the changing of the seasons even when
it comes to an exoplanet that just like on earth because everything known
about life on a planet has to seasonally change with the obliquity or the
chances of an exoplanet having realistic chances of habitability is put into
serious question and global temperature moderation.
4
21
Above and beyond this the systems are so inter balanced and depend
upon one another that the delicate issues and balances are further discussed
and intensely examined in Stewart [21] and Aguiar [1] examines the oceanic
conditions and how they are related to over all atmospheric, climate, and
constant un stabilized conditions of this exoplanet as well. Whereas Stewart
[19] provides an in depth examination of how all of the intricate systems of
such factors depend upon each other to make an exoplanet truly as earth-like
as possible in order to maintain its candidacy of being an exoplanet with
habitability possibilities. However, the supplemental material 1-6 go into
additional examination that the space restrictions in a paper cannot provide
to learn more about Gliese 581d.
However, the supplemental material 7-9, is in total agreement with Hadhazy [11] that not only the very intense gravitational conditions of Gliese
581d also allows and forces it to have no doubt a low obliquity of 0.4-0.8 or
less. Therefore, as provided and shown in figure 2 the atmospheric conditions of Gliese 581d is also not only causing this exoplanet to be more like
a neoproterozoic like (snowball earth) but that as Hadhazy [11] and supplemental material 7-9 are also consistent that the possibility that there may
be a closer by Gliese 581g exoplanet as well that the gravitation pull of these
two exoplanets comparatively as close to each other as they are causing this
exoplanet to be its warmest at the equator with likely a tremendous amount
of volcanic activity.
Whereas as shown in Figure 2 explains the disruptive intense erratic accumulation of the primary part of this exoplanet’s atmosphere concentrated
in the total circumference circle around the entire planet from its north to
south poles as well. These factors as aforementioned certainly affect pall of
these gravitational interactions of planets eventually erode a planet’s axial
tilt. The findings do not bode well for planets residing in the habitable, zones
around red dwarf stars smaller than the sun.
Figure 2 show the background from other space is a possibly alleged image
of Gliese 581d. The area in which the enlarged extreme close up of this
part of the surface of Gliese 581d depicted within the yellow rectangle is
where the approximate equator is located and red tinged landmass in the
background depicts more of a dryer Geomorphological condition of no ice
present as appears much everywhere else on these other fjord like vertical
cliff shelf landmasses. The green depicts like the warmer greener colored
ocean with a break up more of the ice because of warmer conditions along
5
22
Figure 2: Gliese 581d near equator image. (Source: Author)
the equator.
However in the blue are as is observed in the image the greatest concentration of this exoplanets atmosphere seems to be concentrated in around the
total circumference circle of the entire planet from its north to south poles.
These factors as aforementioned certainly affect all of these gravitational interactions of this exoplanet and its axial tilt. The findings do not bode well
for this exoplanets habitability factor.
3
North and South Poles of Gliese 581d May
Communicate With Each Other; Determining the Extent of How Much of It’s Neoproterozoic Like Planetary Conditions Affects Its Atmosphere and Entire Weather
Systems
In 2007 NASA’s AIM spacecraft was launched to study night-shining, or
noctilucent clouds, which form more than 50 miles (83 kilometers) above the
Earth’s surface, in a layer known as the mesosphere. The clouds, which glow
electric blue after dusk or before dawn, are composed of water ice crystals
that collect on ”meteor smoke,” the dust stripped from meteors as they streak
through the atmosphere.
6
23
Figure 3: Noctilucente and Aurora position in the atmosphere. (Source:
PHILLIPS, T, 2014 [16])
While studying these clouds (Figure 3), the researchers were surprised to
discover these teleconnections. Winds in the Northern Hemisphere’s stratosphere, the second layer of the Earth’s atmosphere, were affecting the Southern Hemisphere mesosphere, the layer above the stratosphere, a few weeks
later.
In like manner similar conditions may also be taking pace within out own
solar system and the communication of Gliese 581d’s north and south poles
may also be taking place much as discussed in Hdadhazy article [11]. In like
manner this could also be taking place on Titan as well.
4
The Obliquity of Titan in Comparison With
Gliese 581d May be a Factor to Consider
of Both Having Similarities Obliquities
Hadhazy[11], Bills & Nimmo [3] and NRAO [15] articles explains that he
obliquity of Titan is small, but certainly non-zero, and may be used to place
constraints on Titan’s internal structure. The measured gravity coefficients of
Titan imply that it is non-hydrostatic and thus the normal Radau approach
to determining internal structure cannot be applied.
7
24
However, if the obliquity is assumed to be tidally damped (that is, in a
Cassini state) then combining the obliquity with the measured gravity coefficients allows Titan’s moment of inertia to be determined without invoking
hydrostatic equilibrium. For polar moment values in the range , tidallydamped obliquity values result. If the inferred moment value exceeds 0.4,
this strongly suggests the presence of a near-surface ice shell decoupled from
the interior, probably by a subsurface ocean.
Figure 4: ALMA image of the distribution of the organic molecule HNC in
the upper atmosphere of Saturn’s moon Titan. (Source: NROA, 2014 [15])
Figure 5: ALMA image of the distribution of the organic molecule HC3 N in
the upper atmosphere of Saturn’s moon Titan. (Source: NROA, 2014 [15])
In Figure 4 the denser, brighter concentrations are shown near the moon’s
north and south poles. Their shifted, off-axis locations were unexpected and
8
25
Figure 6: ALMA image of the distribution of the organic molecule HC3 N at
intermediate-to-lower elevations in the atmosphere of Saturn’s moon Titan.
(Source: NROA, 2014 [15])
could help researchers better understand Titan’s complex atmospheric processes. The globe outline represents Titan’s orientation at the time of the
observations [15].
In Figure 5 the denser, brighter concentrations are shown near the moon’s
north and south poles. Their shifted, off-axis locations were unexpected and
could help researchers better understand Titan’s complex atmospheric processes. The globe outline represents Titan’s orientation at the time of the
observations [15].
In Figure 6 the denser, brighter concentrations are oriented more evenly
about the poles than is observed for HC3 N at higher elevations. The globe
outline represents Titan’s orientation at the time of the observations [15].
5
Organic Molecules in Titan’s Atmosphere
Are Intriguingly Skewed; Which May Also
be What’s Happening on Gliese 581d
While studying the atmosphere on Saturn’s moon Titan, scientists discovered intriguing zones of organic molecules unexpectedly shifted away from its
north and south poles. These misaligned features seem to defy conventional
thinking about Titan’s windy atmosphere, which should quickly smear out
9
26
such off-axis concentrations. This is an unexpected and potentially groundbreaking discovery. These kinds of east-to-west variations have never been
seen before in Titan’s atmospheric gases. Explaining their origin presents us
with a fascinating new problem.
6
Conclusion
In like manner, the circulatory concentration of atmospheric disturbance
as recorded by ALMA on the north-south poles on Titan has similarities to
the concentration of the intensified atmosphere in and around Gliese 581d’s
atmosphere as well. Which is likely according to the new data and evidence
presented and demonstrated in this paper is because of Gliese 581d’s obliquity. Making it less suitable to be classified as an exoplanet for possible
habitibility.
6.1
Acknowledgements
The author of this paper would like to thank any and all scientists and researchers for their contributions to astronomy and astrophysics. For without
the knowledge they provide papers like this one would not be possible.
6.2
Supplemental Material
1. 90 Seconds How The IMMI Technology Zooms into Gliese 581d.
https://www.youtube.com/watch?v=BPGJ21KsW8w
2. Gliese 581d - Extreme Close ups of Its Surface, Part 1.
https://www.youtube.com/watch?v= Uo46U0RBMg
https://www.youtube.com/watch?v=OviAmHu2nCw
https://www.youtube.com/watch?v=hyckDpTRRqw
https://www.youtube.com/watch?v=0iDKixBx-nQ
6. Gliese 581d - Extreme Close ups Zooming Down to Its Surface.
https://www.youtube.com/watch?v=GW6vEtQB4I4
7. Gliese 581g - Extreme Imaging Close ups, Part 1.
https://www.youtube.com/watch?v=k-QnnSxxhW8
10
27
https://www.youtube.com/watch?v=63g23OgWAKU
https://www.youtube.com/watch?v=WrYZL4nXHNk
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AN INTRODUCTION TO DRY-BULK
PORT TERMINAL OPERATIONS
UMA INTRODUÇÃO SOBRE
OPERAÇÕES DE TERMINAIS
PORTUÁRIOS DE GRANÉIS SECOS
Aguiar, O.A. ∗Bogossian, M. P.
†
Setembro de 2014
Abstract: All professional areas have their own vocabulary, this article
intends, in addition to presenting the vocabulary necessary for those who
intend to work in the port sector involving dry-bulk maritime transport,
mention the types of equipment used and other characteristics. This article
is intended for undergraduate students of oceanography and civil engineering
courses, and have interests in port engineering, and seek the expertise related
to the activity, beyond the jargon used in the port sector.
Key words: Bulk, Ship, Terminal, Ports, Port Engineering.
Resumo: Todas as áreas profissionais têm seu próprio vocabulário, este
artigo pretende, além de apresentar o vocabulário necessário para quem pretende atuar no setor portuário que envolva o transporte de granéis secos, citar
os tipos de equipamentos empregados e outras particularidades. Este artigo
é destinado a alunos de graduação dos cursos de oceanografia e engenharia
civil e que tenham interesse em engenharia portuária, e buscam os conhecimentos especı́ficos relacionados à atividade, além dos jargões utilizados no
setor portuário.
∗
D.Sc., Independent Researcher & SIMIODE member (Alpharetta, GA, USA). E-mail:
[email protected]
†
DSc, Analista da Empresa de Planejamento e Logı́stica S.A. (Brası́lia, Brasil)
1
31
Palavras-chaves: Granéis, Graneleiros, Terminais, Portos, Engenharia
Portuária.
1
Navios Graneleiros
O trigo, o granel sólido que deu inı́cio a este tipo de comércio, teve seu
transporte marı́timo relatado por Homero e Hesı́odo no século VIII A.C.,
esta commodity já era transportada pelos Fenı́cios e pelos Gregos desde o
século XI A.C. em rotas por todo o Mar Mediterrâneo, Mar do Norte e Mar
Cáspio. Em torno de 650 A.C., decorrente de ataques piratas foi introduzido
o nautikos tokos, um seguro para garantir prejuı́zos causados pela não entrega
da carga.
O comércio de grão em Atenas se diferenciava dos demais, pois somente
com uma autorização do estado os agentes (sitones) poderiam comercializar
a mercadoria. A partir de 470 A.C. as restrições sobre o a importação de
grãos foram abolidas, sendo mantida a restrição sobre a exportação de grãos,
cuja pena para os agentes que a realizassem sem autorização era a morte.
Durante os séculos seguintes pouco mudou, o transporte era feito em
quantidades reduzidas utilizando-se todos os navios disponı́veis, nos quais
os granéis tinham que ser colocados em tonéis ou sacos, sempre a mercê do
tempo e alvo de pirataria.
Os Navios Graneleiros, como entendemos hoje, têm sua origem em navios
que faziam o comércio nos Grandes Lagos em meados do século passado, o
comércio de minério de ferro, cimento e grãos iniciado no inı́cio daquele século
foi o propulsor de mudanças, e comprovou a necessidade de navios especı́ficos
para cada faixas de valor do fator de estiva. No final do Século XX foram
desenvolvidos Navios Graneleiros Combinados, que eram construı́dos a um
tipo bem especı́fico de comércio, como os OBO (ore/bulk/oil ) e os ConBulkers
(conteiner/bulk ), naquela época o modelo mais comum no Brasil era de navios
que saı́am do porto com minério de ferro e retornavam com petróleo cru, os
OO (ore/oil ).
A redução no custo de afretamento é o fator que é continuamente perseguido
ao longo dos anos e os desafios trazidos por essa tendência traduzem-se por
exigências cada vez maiores nos portos, com respeito à adoção de métodos
mais eficientes e rápidos de carga e descarga.
2
32
Não é um fato recente a tendência de crescimento exponencial do tamanho
dos navios, migrando-se do padrão Handymax, entre 1970 e 1980, para o
padrão Capesize, entre 1990 e 2000; depois para os Chinamax em 2005 e
agora para os Post Chinamax.
Table 1: Classificação de Navios Graneleiros [2]
Classificação
Very Small
Coastal
Small
Medium
Large 1
Capacidade [TPB]
... - 9.999
Nomenclaturas
10.000 - 29.999
30.000 - 49.999
50.000 - 59.999
60.000 - 79.999
80.000 - 119.999
Handysize - Lakesize
Handymax
Supramax - Panamax
Panamax
Over (Post) Panamax - Aframax
- Capesize
Post Panamax - Suezmax
- Capesize
Post Panamax Plus - New Suezmax
- Capesize
Chinamax - New Panamax
Malaccamax - Chinamax
- New Panamax
Chinamax
Post Chinamax - Valemax
Large 2
120.000 - 159.999
160.000 - 199.999
Very Large (1)
200.000 - 279.999
280.000 - 319.999
Ultra Large
(Very Large 2)
320.000 - 389.999
390.000 - 639.999
Para atender às necessidades dos mercados consumidores, foi iniciada uma
verdadeira corrida estratégica das empresas operadoras, buscando tecnologias mais eficientes e compatı́veis com as necessidades de conectividade entre
os mercados do mundo, melhorando o comércio e reduzindo os custos de
transporte por meio da melhoria das instalações portuárias. No caso dos
granéis secos (dry-bulk ) isso certamente levou a investimentos em infraestrutura, como proporcionar um melhor acesso ao porto, dragagem, alargar e
apoiar cais existente, silos e áreas de estocagem maiores e com mais controle
climático ou outras infraestruturas de acesso.
Em termos de superestrutura, os grandes portos investiram na melhoria da eficiência dos equipamentos de carga e descarga na uma busca pela
preservação da qualidade dos granéis secos. Para alcançar eficácia, esses
3
33
investimentos em infraestrutura portuária e superestrutura precisam ser entrelaçados por um sistema operacional eficaz e equilibrado. Conforme UNCTAD [10], o comércio marı́timo mundial é calcado em sua maioria em transporte de granéis, cerca de 77% da frota mundial (em TPB) é destinada a
este tipo de carga, sendo que a o granel seco atingiu a marca de 42,9% da
tonelagem de porte bruto no inı́cio de 2014.
Deve-se ressaltar o fato de que as melhorias estão sendo realizadas de
forma constante em diversos portos do mundo, sempre com umas empresas
operadoras levando a outras a desenvolver estratégias de planejamento que
visem a aumentar a eficiência portuária dentro de uma perspectiva que atenda
à evolução do transporte marı́timo. Aqui se deve destacar que os avanços
tecnológicos estão ocorrendo de forma impressionante nos moldes descritos e
dentro das teorias evolucionárias de Rosemberg, Nelson e Winter [3].
Desde o Perı́odo Colonial no Brasil, quando se iniciou a exportação de
açúcar pelo Porto de São Vicente - SP, que posteriormente foi transferida para
o Porto de Santos em 1542, a mão-de-obra portuária (estiva) era alocada de
forma intensiva, o que perdurou até os anos de 1970, época em que se tornou
o principal componente dos custos das operações de carga e descarga.
No inı́cio, como os navios não possuı́am porões estanques nem carregadores,
os granéis não podiam ser acomodados diretamente no fundo dos porões ou
no piso inferior dos porões, e ainda tinham que ser ensacados ou colocados
em tonéis e cobertos com lona encerada para se tentar proteger a carga. Isto
fazia que o fator de estiva fosse extremamente reduzido e que o custo da mão
de obra fosse elevado.
Com o advento dos navios com casco duplo (top side tanks) e tampas
de porão estanques nos anos 1950, a capacidade de transporte de granéis
secos aumentou consideravelmente; em paralelo foram desenvolvidos os carregadores de esteira que agilizavam a operação de carregamento e barateavam
o custo, este carregadores foram adaptações de esteiras transportadores (conveyor belts) de carvão utilizadas na mineração (Fig. 3).
O primeiro Navio Graneleiro construı́do foi o Nichiryu Maru, em 1954
no Japão (Fig. 1), tinha 153 metros de comprimento e 15.368 TPB, foi
desenhado para o transporte de minério de ferro, logo seguido por outros
que eram destinados ao transporte de carvão e grãos. Esses navios proveram
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34
Figure 1: Nichiryu Maru entrando no Porto de Vancouver. (Autor: Paul
Wille, 1956)
uma das condições necessárias para que o Japão pudesse receber os insumos
necessários ao seu desenvolvimento industrial.
Granéis lı́quidos não são transportados em Navios Graneleiros, são transportados em Navios Tanques (lı́quido), Navios Tanques Quı́micos (lı́quidos
de alto risco) ou Navios Gaseiros (gás liquefeito).
2
Granéis
Neste artigo vamos focar ao comércio de granéis sólidos, mais especificamente soja em grão, e para podermos entender a diversidade do transporte de
granéis é importante saber que Navios Graneleiros se dividem em 4 (quatro)
grandes grupos:
1. Granéis de alta densidade (minérios) - Devido à alta densidade da
carga, os porões de carga são relativamente pequenos e os tanques
secundários laterais são grandes. Durante os anos 1970, havia muitos
portadores de combinação com tanques secundários laterais utilizados
como tanques de óleo, mas estes navios são raramente visto nos dias de
hoje (Fig. 2B);
2. Granéis de baixa densidade (carvão) - Devido à baixa densidade da
carga, os porões de carga são profundos e não há tanques secundários.
Os tanques de lastro do duplo fundo são susceptı́veis à corrosão, devido à temperatura relativamente mais elevada da carga. Este tipo de
5
35
arranjo foi considerado ineficiente, porém ganhou força com o aumento
do comércio de farelo de soja (Fig. 2A);
3. Granéis de grandes dimensões - Possui as anteparas do porão ali-nhadas
com os limites da escotilha visando melhorar a eficiência da movimentação de cargas por meio de guindastes, pode possuir tanques secundários laterais. é destinada a cargas de grandes dimensões, como estruturas pré-construı́das, celulose a granel, bobinas metálicas, plásticas
e de papel, podendo operar com contêineres; e
4. Granéis em geral - Devido à configuração semelhante a um casco duplo,
os porões de carga são relativamente grades, os tanques secundários
laterais são pequenos quando comparados com os tanques secundários
sob o convés e do fundo, podendo nem existir, este arranjo possibilita
que as cavernas não sejam necessariamente a estrutura dos tanques,
gerando um alto fator de estiva combinado para o navio com facilidade
de manobra da carga.
Figure 2: Arranjos de Navios Graneleiros: A - granel de baixa densidade, B
- granéis em geral. (Autor: [10])
O navio é o elemento da cadeia de transporte que requer menos atenção,
pois as tecnologias usadas têm mais de meio século de uso e se mostraram
confiáveis e seguras, a mais inovação que pode ser destacada é o controle ambiental das cargas por meio de um monitoramento constante de humidade e
6
36
temperatura em vários pontos do porão, buscando, como dito anteriormente,
a manutenção da qualidade do produto transportado.
Já na questão de logı́stica o comércio de granéis sólidos, em especial grãos
de soja, ainda mostra uma grande necessidade de investimentos, na melhoria dos acessos terrestres aos portos e na quantidade e qualidade dos locais
de armazenamento no porto, tendo tido uma grande evolução apenas na
metodologia de descarga do transportador terrestre (trem ou caminhão).
Já na virada do Século IXX para o Século XX buscava-se maneiras mais
eficientes de carga e descarga de granéis sólidos, tanto no modais terrestres
quanto no marı́timo.
Figure 3: Descarregador de carvão no modal ferroviário, Pittsburgh, PA USA. (Autor: Heyl & Patterson — Wikimedia Commons, 1895)
Sem dúvida a maior inovação foi a adaptação de esteiras transportadoras
(conveyor belt) associada a silos de armazenamento, fazendo com que houvesse uma reserva tanto do granel sólido quanto do espaço para armazenamento no porto possibilitando um carregamento dos navios de modo quase
que contı́nuo, ficando as paralisações quase que restritas a necessidade de
manobras de troca de porões.
Este fluxo quase contı́nuo se deve principalmente à caracterı́stica da carga
e aos volumes operados, até meados do Século XX não houve grande preocupação sobre possibilidade de misturada de um mesmo granel oriundo de
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37
diferente origens; a qualidade da carga, ainda hoje, é comumente atestada no
local de armazenamento do produtor e não no local de armazenamento da
instalação portuária, mesmo porque algumas descargas são feitas sem a utilização de um local de armazenamento no porto, porque o porto não dispõe
de local próprio, ou porque os volumes não são suficientes para a utilização
das instalações, ou ainda porque concorrem com outro tipo de granel no
mesmo porto.
A partir de meados do Século XX a questão de qualidade começou a ser
trabalhada, muito pelas restrições impostas por paı́ses importadores que exigiam, dentre outras coisas, a possibilidade de rastreio do produto desde sua
origem. O grão é transgênico? Qual o ı́ndice de umidade do minério? Onde
se originou o produto? Estas questões começaram a mudar as instalações
portuárias destinadas a granéis, tornando-as mais dedicadas e mais eficientes,
e ao mesmo tempo fez com que este tipo de instalação aumentasse em número.
Mesmo diante dos desafios da nova ordem, o transporte rodoviário no Brasil
se manteve o mesmo, gerando uma perda de cerca de 10% da produção nas
estradas e nos transbordos. Ineficaz e caro, o transporte rodoviário vem
perdendo terreno paras os modais ferroviário e hidroviário, grande empresas, como a Bunge Brasil S.A., fizeram investimentos no setor hidroviário e
tiveram uma melhora de eficiência em sua cadeia de exportação.
O trajeto percorrido pelo granel sólido é essencialmente o mesmo de qualquer tipo de carga, no quesito métodos de carga/descarga os granéis criaram
uma grande diversidade de equipamentos, estes desenvolvimentos foram fruto
do processo de modernização e especialização dos portos.
Vale destacar que granéis sólidos englobam alguns produtos ensacados
(sacarias) como o açúcar, café e cimento; o granel neste caso é o ”saco”
do produto e só deve ser considerado como granel sólido quando o navio
levar mais que 80% de um mesmo tipo de sacaria, em outra situação deve
ser considerado como carga geral.
3
Métodos e Equipamentos
As sacarias são divididas em 3 classes:
1. small bags - até 0,5 m3 (< 20 ft3 ), utilizados em carga e descarga
com estivadores, com sacarias menores embaladas em grupos, ou ainda
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utilizados para granéis sólidos de alta densidade, em especial no modal
ferroviário (Fig. 4);
2. bags - entre 0,6 m3 (≥ 20 ft3 ) até 1,1 m3 (< 40 ft3 ), esta classe é
a mais utilizada, seja no modelo de 20 ft3 devida a sua flexibilidade
intermodal, ou no modelo de 35 ft3 (≈ 1 m3 ) para granéis de baixa
densidade, em especial produtos agrı́colas (Fig. 5); e
3. big bags - maiores que 1,2 m3 (≥ 40 ft3 ), podendo chegar até 80 ft3 , os
modelos de big bags com base de 41” por 41” são os mais utilizados,
com altura variando de 34” (40 ft3 ) até 64” (80 ft3 ), pois servem melhor
ao modal ferroviário (Fig. 6).
Partindo do ponto onde os granéis sólidos (não ensacados) estão no local de armazenamento secundário, dentro do porto, durante a operação de
carregamento eles são elevados por um sistema de esteiras transportadoras
(conveyor belts), no caso de granéis sólidos de baixa densidade podem ser
utilizados dutos onde o granel é impulsionado por ar pressurizado, e são
efetivamente carregados utilizando-se uma das seguintes técnicas:
1. Descarga livre - os granéis sólidos são liberados por um tubo aberto
sem aparato nenhum, normalmente na altura da tampa do porão. Pode
causar dano à carga devido a velocidade que ela atinge o fundo do porão
ou o topo da pilha se o granel tem alta densidade, e pode espalhar a
carga no ambiente se o granel for de baixa densidade;
2. Cascata (Cascade Chute) - os granéis sólidos de média ou alta densidade
são carregados por uma série de ”baldes” sem fundo e desalinhados que
criam uma cascata e diminuem a energia cinética do granel fazendo com
que menos danos ocorram ao produto, normalmente é associada a um
bico distribuidor para melhor acomodação da carga no porão (Fig. 7);
3. Espiral (Spiral Chute) - os granéis sólidos de grande dimensões, incluindo as sacarias, são carregados por esteiras transportadoras até uma
rampa em espiral, evita completamente a queda do produto e preserva
a sua integridade fı́sica, a acomodação final da carga normalmente e
feita por estivadores (Fig. 8);
4. Tubo Telescópio (Telescopic Chute) - é semelhante à descarga livre
porém em vez da descarga ocorrer na altura da tampa do porão o tubo
telescópio faz com que a descarga seja inicialmente próxima ao fundo
do porão e acompanhe a altura pilha (Fig. 9); e
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Figure 4: Estiva de café no Porto de Santos, SP. (Autor: Marc Ferrez —
Wikimedia Commons, 1895)
Figure 5: Estiva de cimento no Porto de Málaga - Espanha. (Autor: FYM
Group, 2013)
Figure 6: Estiva de fertilizantes no Porto de Qingdao - China. (Autor:
Dawson Group, 2010)
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5. Distribuidor/Lançador (Jet-Slinger, Blower ) - os granéis sólidos de
média densidade, na maioria grãos, são carregados por esteiras transportadoras até um tubo telescópio com bico distribuidor e por meio
de ar seco pressurizado são lançados no porão, melhora bastante a distribuição de carga, porém se usados com carga de diminutas dimensões
pode criar uma ”nuvem de carga” no ambiente portuário (Fig. 10).
Existe ainda a técnica de carga, que também é utilizada na descarga, de
utilização de um guindaste com mandı́bulas articuladas (Clam Shell ), é muito
utilizada em cargas úmidas ou de alta densidade para as quais outras técnicas
apresentam uma produtividade muito pequena. Pode ainda ser utilizada para
embarque e desembarque de granéis cujo o contato com o sistema principal do
porto possa causar algum tipo de contaminação. O guindaste é um elemento
utilizado para carga e descarga de granéis ensacados ou paletizados.
No momento da descarga os granéis sólidos que estão no porão do navio
são retirados por um sistema de esteiras transportadoras ou aspirados, e são
efetivamente descarregados utilizando-se uma das seguintes técnicas:
1. Escavadeira (Bucket Elevator, Bucket Wheel ) - usada principalmente
para granéis sólidos secos de alta e média densidade, por vezes necessitam de manobras de lastro do navio para operarem (Fig. 11 e 12);
2. Parafuso Sem Fim (Screw ) - usada na maioria das vezes para granéis
sólidos úmidos, ou que possuam algum fator de agregação, são equipamentos versáteis porém não funcionam com granéis de alta densidade;
3. Esteira Móvel (Mobile Conveyor Belt) - Utilizada para sacarias soltas
e para granéis de grandes dimensões ou que requerem cuidado especial
na descarga, requer o emprego de estivadores no porão (Fig. 13); e
4. Aspirador (Negative Pressure) - Utilizada para granéis de média e baixa
densidade em especial aqueles de diminutas dimensões (farelos), é composto de duto (ou mangueira) de aspiração ou tubo telescópio (Fig. 14).
Alguns dos equipamentos aqui citados como de descarga de alguma forma
têm semelhança àqueles utilizados nos locais de armazenamento secundário
para alimentas as esteiras transportadoras na operação de carga.
Alguns navios possuem sistema de auto-descarregamento (self-unloading)
com a finalidade de operar em portos que não disponham equipamentos para
fazê-lo (Fig. 15).
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Figure 7: Carregador de cascata com bico, embarque de potássio no Porto
de Hamburgo - Alemanha. (Autor: Cleveland Cascades, 2012)
Figure 8: Carregador em espiral, embarque de cimento no Porto de
Bangladesh - ı́ndia. (Autor: ARI, 2012)
Figure 9: Carregador Móvel com Tubo Telescópio, embarque de minério de
ferro no Porto de Adelaide - Austrália. (Autor: AmyDos — Wikimedia
Commons, 2010)
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Figure 10: Distribuidor/Lançador (Jet-Slinger ), embarque de lascas de
madeira no Porto de Panama City, FL - EUA. (Autor: Samson Aumund
Group, 2013)
Figure 11: Escavadeira (Bucket Elevator ). (Autor: Jiangsu Fanzhou Shipping Co., 2007)
Figure 12: Escavadeira (Bucket Wheel ), desembarque de minério de ferro.
(Autor: Taiyuan Heavy Industry Co., 2008)
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Figure 13: Parafuso Sem Fim (Screw ), desembarque de fertilizantes no Porto
de Gresik - Indonésia. (Autor: Cargotec, 2012)
Figure 14: Aspirador (Negative Pressure), desembarque de grãos. (Autor:
Walinga, 2014)
Figure 15: Auto-Descarregamento (Self-Unloading Ship), desembarque de
calcário no Porto de Duluth, MI - EUA. (Autor: Jerry Bielicki, USACE —
Wikimedia Commons, 2008)
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44
As inovações no setor de granéis sólidos secos vêm sendo introduzidas no
mercado sempre buscando mais rapidez e eficiência, porém nos últimos vinte
anos as melhorias tem sido poucas pois a atenção está mais voltada para a
reconstrução dos setores de logı́stica e transporte, que afetam a convivência
do porto com as cidades e influenciam nos ı́ndices de eficiência das atividades
portuárias.
A preservação das qualidades e dos atributos das mercadorias movimentadas dentro dos padrões contratados tem se apresentado como um desafio
quando as quantidades vem aumentando e os tempos de viagem diminuindo
dentro das necessidades da logı́stica moderna.
4
Intalações e Operações Portuárias
De acordo com o Anuário Estatı́stico Portuário ANTAQ de 2013 [1], a
movimentação geral de cargas no Brasil em 2011-13, nas três naturezas da
carga (granel sólido, granel lı́quido e carga geral) assinalou expansão na comparação com 2012, o granel sólido teve um incremento de 2,6%, o granel
lı́quido de 1,2% e a carga geral de 7,3%, porém a exportação teve um aumento
de apenas 2,3%, contra um aumento de 4,3% na importação. É importante
destacar que estes números são referentes a um perı́odo de 3 anos.
O granel sólido, principal grupo de produtos das cargas representou, em
2013, 61,1% do total da movimentação, quase em sua totalidade como exportação; teve um crescimento em 2013 com relação a 2012, de aproximadamente 2,6%, possivelmente sendo o responsável pelo crescimento desta
parcela.
Em 2013 foram movimentadas cerca de 931 milhões de toneladas de carga,
desse total os portos públicos ficaram com cerca de 36% do total da movimentação, sendo que o Porto de Santos operou com 10,7%, seguido dos Portos
de Itaguaı́ (6,2%) e de Paranaguá (4,5%).
Os portos organizados foram responsáveis por 60% da movimentação total
de granéis sólidos do paı́s. Os demais 40% foram movimentados nos Terminais de Uso Privativo (TUP), sendo que, em 2004, a parcela dos TUP era
próxima a 60% da movimentação total do paı́s.
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45
Table 2: Principais Produtos Exportados pelo Brasil em 2012 [US$ Milhões]
(Autor: [4])
Produto
Minério
Petróleo e combustı́veis
Complexo de soja
Material de transporte
Produtos metalúrgicos
Quı́micos
Carnes
Açúcar e etanol
Máquinas e equipamentos
Papel e celulose
Café
Equipamentos elétricos
Fumo e sucedâneos
Calçados e couro
Têxteis
Valor
[Milhões US$]
33.244
30.986
26.122
24.594
15.556
15.189
15.266
15.031
10.573
6.656
6.439
4.599
3.257
3.467
3.385
Variação
2011/12 [%]
-24,8
-0,1
8,2
-2,1
-10,5
-6,4
-0,6
-8,5
1,1
-7,4
-26,0
-4,4
11,0
-5,3
12,4
Participação
[%]
13,7
12,8
10,8
10,1
6,4
6,3
6,3
6,2
4,4
2,7
2,7
1,9
1,3
1,4
1,4
Destaque especial ara o Porto de Santos teve um aumento de carga de
10% na comparação 2012-13, em sua maioria representada por granel sólido
(soja), cuja participação no total da movimentação deste porto alcançou
49,5%; muito em função do crescimento da safra, da saturação do Porto de
Paranaguá e custo de utilização da chamada saı́da norte (São Luiz - MA,
Itacoatiara - AM e Santarém - PA).
Essa situação pode ser atribuı́da a diversos fatores [4], tais como:
• A forma de gestão portuária;
• A ambiência local conscientizada, por tratar-se de mercadorias de exportação com menor interveniência das instituições de controle; e
• O desequilı́brio nos fluxos de granéis sólidos (importação exportação).
A avaliação destes aspectos será examinada adiante, principalmente em
relação ao estudo do caso do terminal dos Portos de Santos.
Deve-se flexibilizar e racionalizar os procedimentos de controle e de fiscalização atualmente utilizados nos terminais portuários de contêineres, além
de estabelecer procedimentos inteligentes para a liberação das mercadorias.
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46
Não se devem confundir os controles aduaneiros ou de insegurança ou fragilidade institucional descritos por North [9] com aqueles que visam à obtenção
de processos mais eficientes. Assim, eliminam-se entraves e monitoram-se as
causas de falhas na programação e no planejamento das operações que necessitam de ajuste ou reavaliação. Esse tipo de controle é virtuoso e pode proporcionar diagnósticos que possibilitem resultados de maior eficiência, identificando as causas dos entraves de maior relevância, eliminando os tempos
perdidos e possibilitando o refinamento dos procedimentos de programação
[4].
A capacidade total de armazenagem primária, no caso de grãos, é insuficiente para se manter um fluxo de mercadorias constante, não só por ser reduzida, mas principalmente porque a capacidade de armazenagem secundária
(no porto) não acompanhou o aumento da produção e o aumento das instalações de armazenamento primário. Este cenário faz com que os meios
de transporte (caminhões, vagões e chatas) seja utilizados como parte integrante do sistema de armazenagem, porém sem qualidade necessária. Esse é
um principal gargalo do comércio de grãos.
Medidas paliativas como a criação de pátios públicos de espera, não só
são ineficazes, como são um subsı́dio indireto do Governo Federal, que com
o dinheiro dos contribuintes tenta solucionar um problema na exportação de
grãos, que é exclusivamente do setor privado (produtores), com a justificativa
que as filas de caminhões perturbam o transito das cidades portuárias. A ineficácia logı́stica do setor produtivo chegou ao limite de levar agentes públicos
a organizar as filas de caminhões, que transferem a responsabilidade e custo
de armazenagem aos agentes transportadores.
Além da perda de volume no transporte rodoviário, estimado em 2% do
volume total transportado por este modal, o roubo de cargas no Brasil está
crescendo em proporções assustadoras, granéis não podem ser facilmente
identificados fazendo com que o produto do roubo seja virtualmente impossı́vel de se identificar.
O custos na operação de granéis, além dos elementos comuns do custo do
navio (Fig. 16), possuem caracterı́sticas particulares que são extremamente
significativas, com destaque para o item 5 Apoio Portuário, dos Custos da
Carga, engloba o custo e eficácia das instalações portuárias e podem representar até 30% do custo do navio, muito porque a estadia dos navios, embora programada, depende das condições climáticas locais (chuva, vento), os
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47
perı́odos de operação (Pop ) e de espera (Pea ), por vezes, crescem reduzindo
a eficiência das operações do navio e da carga (Fig. 17), Hummels [7] avalia
que o custo aumenta, por esse motivo, entre 0,6% e 2,3% por dia.
Reforçando o problema de aumento de custo o valor da carga diminui em
função da tempo decorrido entre a saı́da do local de armazenamento primário
e o efetivo embarque, isto pela perda de qualidade do produto. A necessidade
de transformar a safra colhida em dinheiro para saldar as dı́vidas contraı́das
pelo produtor andam em sentido contrário de impor esperas em qualquer
dos segmentos da logśtica de grãos. Este aspecto é agravado pela falta de
instalações regionais de armazenagem e pelas aleatoriedade dos ”preços teto”
fixados na Bolsa de Mercadoria de Chicago. Segundo Hummels o fator tempo
pode inviabilizar toda a empreitada [7].
Os Custos da Carga, ainda, são impactados pelo custo de operação do
sistema rodoviário (ou ferroviário, ou aquaviário) pelo qual se entrega a mercadoria no porto, que engloba:
• o custo, capacidade e qualidade dos meios de transporte; e
• o custo e capacidade de armazenagem primária.
• o custo do seguro da carga
Durante o perı́odo de operação, em navios graneleiros, há sempre a necessidade, antes do carregamento, de limpeza e preparação do pronto para o
recebimento da carga e, ao final do carregamento, de realizar o rechego (acomodação da carga); estas atividades realizadas por profissionais geridos pelo
OGMO (Órgão Gestor de Mão-de-Obra) acrescentam um custo que outros
tipos de carga não possuem. Quanto mais moderno o navio, menos pontos
cegos (difı́cil acesso) no porão, favorecendo os serviços de limpeza e rechego.
No outro sentido, o perı́odo de liberação (Pln ) para granéis é bem reduzido, em determinados casos a liberação é realizada durante do efetivo
carregamento, isto é possı́vel porque os produtos são commodities vendidas
a varejo e em grande quantidade.
Bogossian [4] destaca que:
”Hummels [8] avalia o tempo de transporte como uma das principais barreiras ao comércio, reconhecendo que alguns produtos
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48
Figure 16: Elementos do Custo do Navio. (Autor: [4])
são mais sensı́veis ao tempo de viagem do que outros. Estes, por
sua vez, estão correlacionados com uma data de entrega em uma
logı́stica previamente estabelecida. O autor avalia a magnitude
do tempo perdido em relação as oportunidade de negócios, bem
como os padrões do comércio e da Organização Internacional da
Produção.
Utilizando modelos econométricos, Hummels [8] determinou
parâmetros para relacionar o impacto médio que os produtos
manufaturados sofrem por dia de viagem em relação ao valor
da carga. Segundo Hummels, para cada dia de viagem, seria adicionado um custo de 0,8% em relação ao valor da mercadoria.
Assim, se um contêiner permanece durante 20 dias no porto, há
um adicional de custo de 16% sobre o valor da mercadoria. Para
matérias primas como soja e minério a granel, Hummels calculou
um adicional de 0,3% sobre o valor da mercadoria.
As oportunidades para as empresas são diferentes e em percentuais bem maiores em função do valor agregado ao produto.
Ou seja, para cada dia de demora adicional de trânsito terrestre
ou marı́timo para paı́ses distantes, a rotatividade do capital da
empresa e a oportunidade de lucro podem ter sua intensidade
19
49
Figure 17: Cronograma de Atividades do Navio. (Autor: [4])
reduzida à medida que aumenta o tempo de giro do capital na
atividade.
Além disso, devem ser também considerados os aspectos de
competitividade, que se tornam crı́ticos à medida que aumentam
os prazos de entrega, recebimento e programação de atividades
vinculadas ao just in time da produção, da distribuição e do oportunismo das inovações no produto. Atrasos logı́sticos na aquisição
de insumos ou na comercialização do produto fazem com que o
turnover e o risco da empresa sejam maiores, reduzindo a oportunidade do seu produto no mercado e tornando o negócio mais
vulnerável.
A fim de dirimir questionamentos quanto à aplicabilidade do
método proposto por Hummels, vale acrescentar que esse pro20
50
cedimento foi utilizado em estudo contratado pela Agência dos
Estados Unidos para o Desenvolvimento Internacional (USAID)
em 2006, ela empregou esses parâmetros e critérios para determinar a significância dos entraves nos diversos modais de transporte
do Paraguai [11].
Hummels [8] será a referência para avaliar e comparar os entraves no âmbito das instalações portuárias. O sistema de custos
será utilizado como instrumento para medir e comparar a significância desses entraves para os agentes envolvidos nas operações.”
References
[1] AGÊNCIA NACIONAL DE TRANSPORTE AQUAVIÁRIO (ANTAQ).
Anuário Estatı́stico Portuário 2013. Brası́lia: ANTAQ, 2014.
[2] AGUIAR, O.A. Dragagem por Resultados. São Vicente: Fundação
Plural, 2013.
[3] BOGOSSIAN, M.P. Modelo de análise para a operação portuária
de carga geral. Tese de Mestrado. Rio de Janeiro: UFRJ, 1983.
[4] BOGOSSIAN, M.P., AGUIAR, O.A. Gestão e competitividade
portuária - Terminais de contêineres. São Vicente: Fundação Plural, 2014.
[5] BOGOSSIAN, M.P., AGUIAR, O.A. Panorama do escoamento da
safra de grãos. Pluralidade, 3:19-38, 2013.
[6] CHRISTENSEN, C.M., KAUFMANN H.H. Spoilage of corn in ship
transport. Feedstuffs Feb.:28-32, 1978.
[7] HUMMELS, D. SCHAUR, G. Time as a trade Barrier. American
Economic Review, 103: 1-27, 2013.
[8] HUMMELS, D. Have International Transportation Costs Declined? Chicago: UChicago, 2001.
[9] NORTH, D.C. Instituciones, cambio institucional y desempeño
económico. México, DF: Ed. FCE, 1990.
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[10] UNITED NATIONS CONFERENCE ON TRADE AN DEVELOPMENT (UNCTAD). Review of maritime transport. New York:
UNCTAD, 2014.
[11] SGUT, M., SCHACHT, D. BENEGAS, G., TORRONTEGUI, A., PEDRETTI, L., GARCIA, A. Impactos del Transporte y de La
Logı́stica em El Comércio Internacional Del Paraguay. Arlington, VA: USAID/CNCSP, 2006.
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52
THE PSYCHOPEDAGOGICAL AND
HOLISTIC APPROACH - A PROPOSAL
BEYOND HOSPITAL CLASSES
ABORDAGEM PSICOPEDAGÓGICA E
HOLÍSTICA - UMA PROPOSTA PARA
ALÉM DAS CLASSES HOSPITALARES
Aguiar, L. S.
∗
Dezembro de 2014
Abstract: The Hospital Pedagogy service in Brazil has been growing
slowly and basically under the light of two proposals: hospital classes, intended for school support of children undergoing prolonged hospitalization,
and toy libraries, for the development of recreational activities as a coping strategy to pathology and hospitalization, both restricted to pediatric
wards. These two different models are called pedagogical-school and ludictherapeutic, the first with the premise of taking care of the cognitive needs
of children, and the second to take care of the affective needs, when analyzed
it is observed that both ignore the subject learning is involved in all levels
and indivisible way: organism, body, cognition and emotion. The goal of
this study is to describe and analyze these two traditional models of care in
hospital class and introduce a third model, the psychopedagogical and holistic approach, developed in Neurological Rehabilitation Program of the Sarah
Network of Rehabilitation Hospitals as an alternative to hospital pedagogical
work.
Key words: Psychopedagogy, Rehabilitation, Hospital Pedagogy, Educational Therapy.
∗
MSc, Private Practice Educational Therapist (Atlanta, GA, USA) e-mail:
[email protected]
lu-
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Resumo: O atendimento pedagógico hospitalar no Brasil vem se desenvolvendo lentamente e basicamente à luz de duas propostas: as classes hospitalares que visam acompanhamento escolar de crianças submetidas a longos
perı́odos de internação, e as brinquedotecas voltadas para o desenvolvimento
de atividades lúdicas como estratégia de enfrentamento à patologia e à internação, ambas restritas as enfermarias pediátricas. Esses dois modelos
distintos são denominados educativo-escolar e lúdico-terapêutico, o primeiro
tendo como premissa o atendimento as necessidades cognitivas das crianças, e
o segundo o atendimento as necessidades afetivas, quando analisadas observase que ambas ignoram que o sujeito que aprende está implicado em todos os
seus nı́veis e de forma indivisı́vel: organismo, corpo, cognição e emoção. O
objetivo desse estudo é descrever e analisar esses dois modelos tradicionais de
atendimento em classes hospitalares e apresenta um terceiro modelo, a abordagem psicopedagógica e holı́stica, desenvolvido no Programa de Reabilitação
Neurológica da Rede Sarah de Hospitais como uma alternativa ao trabalho
pedagógico hospitalar.
Palavras-chave: Psicopedagogia, Reabilitação, Classe Hospitalar.
1
Introdução
Tradicionalmente o modelo da classe hospitalar está voltado para o atendimento em enfermarias pediátricas visando o acompanhamento escolar de
crianças submetidas a longos perı́odos de internação, ou o desenvolvimento
de atividades lúdicas nas brinquedotecas como estratégia de enfrentamento
à patologia.
O atendimento pedagógico hospitalar vem se desenvolvendo lentamente
no paı́s basicamente a luz dessas duas propostas. É verdade que crianças e
jovens que permaneçam por um longo tempo internados e distantes das suas
escolas, necessitam de atendimento que lhes garanta o direito à educação e ao
desenvolvimento integral. É também incontestável que o ambiente hospitalar
é adverso a experiência infantil, onde a criança é submetida a procedimentos
desconhecidos e muitas vezes invasivos. A questão é que esses modelos são
difundidos como fórmulas prontas para o atendimento pedagógico hospitalar.
Por se tratar de um novo campo de atuação é indispensável o desenvolvimento
de pesquisas e de novas propostas de atuação do pedagogo no contexto hospitalar.
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Esse trabalho tem como objetivo, descrever e analisar os modelos de atendimento pedagógico hospitalar que são largamente difundidos no Brasil, e apresentar o modelo de atendimento desenvolvido na Rede Sarah de Hospitais.
Para o desenvolvimento desse trabalho buscou-se a concepção e organização de uma pesquisa social orientada de acordo com os princı́pios da
pesquisa-ação. Não pretende torná-lo um roteiro único, pois sabe-se que
pela própria natureza da pesquisa-ação, requer um planejamento flexı́vel,
que vai se delineando em função das circunstâncias e da dinâmica instituı́da
entre pesquisadores e a situação investigada. Nesta perspectiva, a pesquisaação não pretende fixar limites estreitos para controlar totalmente a situação
experimental.
Para Kurt [6], uma das grandes vantagens da pesquisa-ação, é permitir
aos cientistas estudar os fenômenos sociais sem transformá-los em fenômenos
quantificáveis de ações e reações fı́sicas, podem estudar as intersubjetividades, os jogos e seus significados, as normas e valores, fora de ambientes
controlados, ambientes de laboratório.
Thiollent [18] ressalta que todas as ”ações investigativas envolvem produção
e circulação de informação, elucidação e tomada de decisões, e outros aspectos
supondo uma capacidade de aprendizagem dos participantes.” [18], estabelecendo uma relação de dependência, colocando a aprendizagem em um ponto
central do processo.
A capacidade de aprendizagem está diretamente ligada ao processo de
investigação. Alguns pesquisadores chegam a considerar que as aprendizagens construı́das no processo de pesquisa-ação são suficientes para marcar o
sucesso do trabalho.
A preocupação com a produção de conhecimento sobre situações práticas
nos leva a conceber a pesquisa-ação como uma proposta de articulação entre
teoria e prática.
Dentro desse processo de construção metodológica será realizada uma analise qualitativa dos modelos de atendimento pedagógico hospitalar a fim de
identificar e discutir pontos fundamentais da práxis psicopedagógica nesse
ambiente.
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55
A apresentação dos modelos de atendimento será realizada a partir de
revisão bibliográfica de publicações sobre as classes hospitalares brasileiras,
e por relato de experiência.
A experiência relatada será a do Programa de Reabilitação Neurológica do
Hospital Sarah, como um exercı́cio de reflexão sobre a prática e teorização.
Como coloca Alicia Fernández [3]:
”Um espaço importante de gestação do saber psicopedagógico é o
trabalho de auto-análise das próprias dificuldades e possibilidades
de aprender, pois a formação do psicopedagogo, assim como requer a transmissão de conhecimentos e teorias, também requer
um espaço para a construção de um olhar e uma escuta psicopedagógicos a partir de uma análise de seu próprio aprender.”
Os dados contidos no relato de experiência, são fruto de observação da
pesquisadora que esteve imbricada durante todo o processo, no ir e vir da
prática e da reflexão teórica. Também será realizada a análise de documentos
construı́dos nas inúmeras reuniões e sessões clı́nicas, que envolveram toda a
equipe de profissionais do Programa de Reabilitação, que constituı́ram um
material fundamental para o desenvolvimento dessa pesquisa.
Como premissa para a análise é preciso entender que o hospital é outro sistema, bem diferente da escola, e a atividade do pedagogo hospitalar não pode
ser organizada como uma extensão da sala de aula, voltando-se unicamente
para o suporte pedagógico nas classes hospitalares ignorando o contexto da
internação.
Não se pode pensar que as questões de enfrentamento à patologia e à
internação, que muitas vezes para o paciente são tão difı́ceis de transpor,
sejam abordadas apenas com elementos distratores, como jogos e brincadeiras
que tirem o foco da doença. Apesar de o lúdico ter reconhecidamente um
lugar importante nas atividades pedagógicas com crianças.
As questões de enfretamento, as dificuldades cognitivas relacionadas às
patologias ou as dificuldades de aprendizagens apresentadas por aqueles que
sofrem por continuas internações merecem a avaliação e intervenção psicopedagógica adequada.
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56
Também é preciso entender que para garantir o atendimento integral ao
sujeito é preciso que o pedagogo esteja integrado à equipe de saúde, que
pertença ao sistema ao qual aquele sujeito está inserido, mesmo que temporariamente, promovendo a troca de informações e a construção de uma
abordagem multidisciplinar em benefı́cio do paciente.
Essas são algumas questões que esse estudo pretende discutir com a finalidade de contribuir para a reflexão e construção de conhecimento na érea da
psicopedagogia hospitalar.
2
2.1
As Classes Hospitalares
Um Breve Histórico das Classes Hospitalares
O registro da primeira classe escolar dentro de um hospital que iniciou
oficialmente suas atividades, data de 14 de agosto de 1950, no Hospital Municipal Menino Jesus no Estado do Rio de Janeiro [11].
Mas foi a partir da década de 90 que se iniciou a expansão das classes
hospitalares no Brasil, apesar de ocorrer com grande lentidão. Segundo Fonseca [4], este fato ocorreu pelo redimensionamento do discurso social sobre a
infância e a adolescência que acarretou na aprovação do Estatuto da Criança
e do Adolescente e seus posteriores desdobramentos.
A partir da década de 90 a legislação brasileira volta-se mais claramente
para o atendimento às crianças hospitalizadas, esta modalidade de atendimento denomina-se Classe Hospitalar, segundo terminologia estabelecida em
1994 pela Secretaria de Educação Especial (SEESP) do Ministério da Educação (MEC) [7].
Até então, as poucas iniciativas de atendimento pedagógico hospitalar eram
regidas pela Constituição Federal de 1988 que assegura a educação como direito de todos, mais precisamente no Tı́tulo VIII - Da Ordem Social, Capı́tulo
III, Da Educação, da Cultura e do Desporto, Seção I, artigo 205:
”[...] a educação é direito de todos e dever do Estado e da famı́lia,
será promovida e incentivada com a colaboração da sociedade,
visando ao pleno desenvolvimento da pessoa, seu preparo para
exercı́cio da cidadania e sua qualificação para o trabalho.”
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57
Em 1995, o Estatuto da Criança e do Adolescente, em especial, o artigo
9◦ , que trata do direito à educação, aborda o atendimento a criança hospitalizada:
”[...] Direito a desfrutar de alguma forma de recreação, programa
de educação para a saúde, acompanhamento do currı́culo escolar,
durante sua permanência hospitalar.”
A Classe Hospitalar está inserida na Lei de Diretrizes e Bases (LDB), Lei
n 9.394/96 [8], como educação especial, em uma visão de educação inclusiva
(artigos 5◦ , 23, 58, 59 e 60).
◦
Em 1999 havia um total de 30 Classes Hospitalares no Brasil para o atendimento pedagógico-educacional de crianças e jovens hospitalizados.
A Resolução do Conselho Nacional de Educação (CNE) n◦ 002/2001, define
mais claramente o atendimento em Classes Hospitalares:
”Art. 13. Os sistemas de ensino, mediante ação integrada com os
sistemas de saúde, devem organizar o atendimento educacional
especializado a alunos impossibilitados de frequentar as aulas
em razão de tratamento de saúde que implique internação hospitalar, atendimento ambulatorial ou permanência prolongada em
domicı́lio.
§ 1◦ As classes hospitalares e o atendimento em ambiente domiciliar devem dar continuidade ao processo de desenvolvimento e ao
processo de aprendizagem de alunos matriculados em escolas da
Educação Básica, contribuindo para seu retorno e reintegração ao
grupo escolar, e desenvolver currı́culo flexibilizado com crianças,
jovens e adultos não matriculados no sistema educacional local,
facilitando seu posterior acesso à escola regular.
§ 2◦ Nos casos de que trata este Artigo, a certificação de frequência
deve ser realizada com base no relatório elaborado pelo professor
especializado que atende o aluno.”
Os primeiros documentos são pouco claros sobre as estratégias a serem adotadas pelas Classes Hospitalares, só o documento da SEESP/MEC de 2002
[9], definiu a Classe Hospitalar como atendimento pedagógico-educacional
que ocorre em ambientes de tratamento de saúde, seja sob internação, ou no
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atendimento em hospital-dia e hospital-semana, ou em serviços de atenção
integral à saúde mental.
”Elaborar estratégias e orientações para possibilitar o acompanhamento pedagógico-educacional do processo de desenvolvimento
e construção do conhecimento de crianças, jovens e adultos, matriculados ou não nos sistemas de ensino regular, no âmbito da
educação básica e que se encontram impossibilitados de frequentar a escola, temporária ou permanentemente e, garantir a manutenção do vı́nculo com as escolas por meio de currı́culo flexibilizado e/ou adaptado, favorecendo seu ingresso, retorno ou adequada reintegração ao seu grupo escolar correspondente, como
parte do direito de atenção integral.” [9]
2.2
A Prática Pedagógica Hospitalar
A legislação em vigor, aponta para o desenvolvimento de práticas pedagógicas no ambiente hospitalar que deem continuidade ao processo de aprendizagem e desenvolvimento da criança com o objetivo de facilitar seu retorno ao
ambiente escolar, pontuando a preocupação com a continuidade da aprendizagem dos conteúdos escolares e a manutenção dos vı́nculos escolares.
Durante as duas últimas décadas pôde-se observar o crescimento do atendimento pedagógico hospitalar. Essa modalidade de atendimento, porém, vem
se configurando em modelos diferentes, seguindo diferentes abordagens, que
são permeadas por crenças e valores próprios sobre o atendimento ao sujeito
hospitalizado.
A prática do pedagogo hospitalar está normalmente voltada para o atendimento de pacientes pediátricos (crianças e jovens), sendo que quase a totalidade é atendida no modelo de Classe Hospitalar, salvo algumas poucas iniciativas de atendimento ambulatorial de crianças com queixas relacionadas
à aprendizagem, visando à avaliação e a intervenção psicopedagógica.
Ricardo Ceccim [2] destaca dois modelos de abordagens da pedagogia hospitalar que vêm se consolidando no Brasil, todas com práticas e referenciais
teóricos distintos.
O primeiro deles Ceccim [2] classifica como lúdico-terapêutica vinculadas
às atividades de recreação ou terapia ocupacional. Essa abordagem busca o
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59
oferecimento de assistência e atendimento emocional e humanı́stico para o
paciente e para a famı́lia, que podem apresentar dificuldades de adaptação
ao ambiente hospitalar.
Nesse sentido a prática pedagógica se dará através de atividades lúdicas, e
recreativas. As práticas mais comuns são desenhos, pinturas, contar histórias,
brincadeiras, jogos e dramatizações.
Essa abordagem caracteriza, por exemplo, os atendimentos das Salas de
Recreação, das Brinquedotecas, e dos Movimentos de Humanização Hospitalar pela Alegria ou Projetos Brincar é Saúde.
Autores como Regiane Fontes [5] defendem essa abordagem como uma boa
estratégia de intervenção para dificuldades de enfrentamento.
”Primeiro, porque este tipo de atividade, ao acionar o lúdico
como canal de comunicação com a criança hospitalizada, procura
fazê-la esquecer, durante alguns instantes, do ambiente agressivo
no qual se encontra, resgatando sensações da infância vivida anteriormente à entrada no hospital. Segundo, porque ao conhecer
e desmistificar o ambiente hospitalar, resignificando suas práticas
e rotinas, que é uma das propostas de atendimento pedagógico
em hospital, o medo que paralisa as ações e cria resistência, tende
a desaparecer, surgindo em seu lugar a intimidade com o espaço
e a confiança naqueles que cuidam dela.”[5]
Como alternativa ao modelo de abordagem anterior, Ceccim [2] defende
uma proposta educativo-escolar que objetiva atender às necessidades pedagógico-educacionais da criança hospitalizada, operando com os condicionamentos do desenvolvimento psı́quico e cognitivo representados pelo adoecimento
e pelo referenciamento hospitalar na produção de aprendizados.
Essa proposta visa dar continuidade do ensino de conteúdos da escola
de origem da criança e/ou trabalho educativo possibilitando a aquisição de
conteúdos, com a preocupação de intervir sobre as dificuldades de aprendizagem.
”[...] em sua prática pedagógico-educacional diária, as classes
hospitalares visam a dar continuidade ao ensino dos conteúdos
da escola de origem da criança ou adolescente e/ou operam com
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60
conteúdos programáticos próprios à faixa etária das crianças e
jovens hospitalizados o que os leva a sanar dificuldades de aprendizagem e/ou à oportunidade de aquisição de novos conteúdos
intelectivos.” [2]
Fonseca [4] refere que a Classe Hospitalar, além de manter as atividades
escolares, sustenta o retorno e a reintegração de seus alunos ao seu grupo
escolar e social. Além disso, pode servir como instrumento ao acesso escolar,
pois algumas crianças hospitalizadas não estão formalmente matriculadas na
rede de ensino devido à quantidade de internações durante o ano, o que acaba
prejudicando o desempenho nas atividades previstas para seu grau escolar.
Esse modelo de Classe Hospitalar é o que mais se aproxima das diretrizes do
Conselho Nacional de Educação.
O contato com as atividades pedagógicas dentro da escola ajudam a famı́lia
a compreender as possibilidades de escolarização da criança, servindo de incentivo para a posterior matrı́cula em uma escola regular.
Segundo Wolf [17], independente da abordagem a pedagogia hospitalar
busca modificar situações e atitudes junto ao enfermo, as quais não podem
ser confundidas com o atendimento á sua enfermidade. As atividades devem
ser organizadas de modo que ajudem na adaptação do organismo (paciente)
às circunstâncias que se impõem no ambiente. A implantação da Classe Hospitalar nos hospitais pretende integrar a criança doente no seu novo modo de
vida tão rápido quanto possı́vel dentro de um ambiente acolhedor e humanizado, mantendo contato com seu mundo exterior, privilegiando suas relações
sociais e familiares, sendo assim o seu principal objetivo diminuir o impacto
da internação na vida da criança.
Após revisão de literatura de relatos de experiências de classes hospitalares
foi possı́vel levantar algumas informações acerca da situação dos profissionais
que nela atuam como os Pedagogos e os Psicopedagogos.
Em todas as experiências relatadas os profissionais da área da Pedagogia
são contratados por instituições ligadas ao ensino, Universidades e Secretarias
de Educação, e atuam nos hospitais por meio de convênios ou estágios. Assim, o suporte pedagógico e material, além do corpo docente, ficam a cargo
da área da educação.
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Como a maior parte dos atendimentos das classes hospitalares são fruto de
convênio com Universidades, grande parte dos profissionais que atuam são
Pedagogos em formação supervisionados por professores pesquisadores das
instituições de ensino. Quando o contrato se dá por meio das Secretarias
de Educação encontramos professores com formação variada entre o antigo
Curso Normal e Pós-Graduação.
A área da saúde é encarregada de fornecer o espaço fı́sico aos professores
para a atuação pedagógico-educacional no ambiente hospitalar.
Em geral a atuação do profissional de educação é realizada de forma independente dos profissionais das equipes de saúde, algumas experiências relatam reunião com a equipe de saúde para discutir questões administrativas
e receber orientações sobre as patologias.
Constata-se também que as Classes Hospitalares são multisseriadas e organizadas em salas de aula dentro do hospital, em alguns casos os atendimentos
são realizados dentro das enfermarias, devido à infraestrutura do hospital ou
às condições clı́nicas do paciente.
3
Contextualizando a Rede Sarah de Hospitais de Reabilitação
A rede é composta por hospitais públicos, atualmente constituı́da por
unidades que possibilitam o atendimento nas seguintes cidades: Brası́lia
(DF), Rio de Janeiro (RJ), Belo Horizonte (MG), Salvador (BA) , Fortaleza
(CE), São Luı́s (MA), Macapá (AP) e Belém (PA).
Os hospitais são administrados pela Associação das Pioneiras Sociais (APS),
entidade de serviço social autônomo, de direito privado e sem fins lucrativos.
A APS foi criada pela Lei n◦ 8.246, de 22 de outubro de 1991, e tem como
objetivo retornar o imposto pago por qualquer cidadão, prestando-lhe assistência médica qualificada e gratuita, formando e qualificando profissionais
de saúde, desenvolvendo pesquisa cientı́fica e gerando tecnologia.
O caráter autônomo da gestão desse serviço público de saúde faz da APS
a primeira instituição pública não-estatal brasileira.
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A APS administra a Rede SARAH por meio de um Contrato de Gestão,
firmado em 1991 com a União, o qual explicita os objetivos, as metas e os
prazos a serem cumpridos.
O programa de trabalho plurianual da Associação tem os seguintes objetivos gerais:
1. Prestar serviço médico público e qualificado na área da medicina do
aparelho locomotor;
2. Formar recursos humanos e promover a produção de conhecimento
cientı́fico;
3. Gerar informações nas áreas de epidemiologia, gestão hospitalar, controle de qualidade e de custos dos serviços prestados;
4. Exercer ação educacional e preventiva visando à redução das causas
das principais patologias atendidas pela Rede.
5. Construir e implantar novas unidades hospitalares, expandindo o modelo gerencial e os serviços da rede para outras regiões do paı́s.
6. Desenvolver tecnologia nas áreas de construção hospitalar equipamentos e reabilitação.
O controle é feito pelo Tribunal de Contas da União (TCU), com ênfase
na avaliação dos resultados finais dos investimentos garantidos por recursos
públicos. A qualidade dos serviços é aferida pelo Centro Nacional de Controle de Qualidade (CNCQ), com padrões universais nas áreas ambulatorial
e hospitalar.
Os recursos financeiros que mantêm todas as unidades da Rede SARAH
provêm exclusivamente do Orçamento Geral da União, em rubrica especı́fica
para manutenção do Contrato de Gestão.
A Rede SARAH não recebe recursos proporcionais ao número e à complexidade dos serviços prestados, diferentemente do que ocorre com instituições
de saúde subordinadas ao Sistema Único de Saúde (SUS). A Rede SARAH
é uma instituição dedicada à reabilitação e ao tratamento de deformidades,
traumas, doenças do aparelho locomotor e problemas neurológicos. Destinase, portanto, à prestação de serviços especializados nas áreas de reabilitação,
indiscriminadamente a todos os nı́veis da população.
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A admissão de todos os profissionais é realizada por meio de seleção pública,
sendo contratados pelo regime da Consolidação das Leis do Trabalho (CLT).
As principais patologias atendidas na Rede SARAH são: paralisia cerebral,
acidente vascular cerebral, espinha bı́fida, doenças metabólicas que afetam
o cérebro, doenças genéticas, atrofia muscular espinhal, traumatismo cranioencefálico, malformações cerebrais, lesão medular, paralisia facial periférica,
paralisia braquial obstétrica, distrofia muscular progressiva, artrogripose, pé
torto congênito, sı́ndrome de Guillain-Barré e miopatias congênitas entre
outras.
Os atendimentos são realizados por acompanhamento ambulatorial ou internações dependendo de cada caso. Os pacientes são acompanhados integralmente nos programas de reabilitação, sendo eles: Programa de Reabilitação
Infantil, Programa de Reabilitação Neurológica, Programa de Reabilitação
Ortopédica e Programa de Reabilitação Medular. A Rede SARAH conta
ainda com atendimento oncológico de pacientes com tumores ósseos e cerebrais.
3.1
O Serviço de Pedagogia Hospitalar na Rede Sarah
de Hospitais
Na Rede SARAH o serviço de Pedagogia Hospitalar é na verdade desenvolvido com o tı́tulo de Psicopedagogia Hospitalar, o que já diferencia a
natureza da abordagem proposta pelo hospital, e pertence ao Núcleo Neuropsicopedagógico, que também é composto por outros profissionais como
fonoaudiólogos, psicólogos e assistentes sociais.
Todos os programas de reabilitação, citados anteriormente, contam com
no mı́nimo um profissional da área da Psicopedagogia Hospitalar.
O psicopedagogo é contratado pelo hospital mediante processo seletivo
público, assim como os demais profissionais, para exercer a função. O psicopedagogo é membro da equipe de saúde e deve participar de todas as
atividades do setor.
Na Rede Sarah o psicopedagogo hospitalar participa de atividades de
formação continuada, que se iniciam logo após a aprovação no concurso, com
a participação no treinamento em cursos e estudos de conteúdos necessários
à formação do profissional de reabilitação, como neuropsicologia, anatomia
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e neuroanatomia, patologias ortopédicas e estudos avançados em psicologia,
entre outros.
É nesse contexto de reabilitação que é desenvolvido o trabalho que será
descrito, mas especificamente a atuação da Psicopedagogia Hospitalar no
Programa de Reabilitação Neurológica do Hospital Sarah de Brası́lia - DF.
4
O Programa de Reabilitação Neurológica
de Pacientes Adultos com Lesão Cerebral
Adquirida
O Programa de Reabilitação Neurológica do Hospital Sarah de Brası́lia
atende pacientes com sequelas de Acidente Vascular Cerebral (AVC), Traumatismo Cranioencefálico (TCE), Anóxia Cerebral e Ressecção de Tumor
Cerebral, entre outras.
O Programa de Reabilitação Neurológica visa promover o máximo de independência possı́vel, de acordo com o potencial motor e cognitivo de cada
paciente. Paciente e familiares acompanhantes recebem orientações quanto
à patologia, educação nutricional, cuidados com a saúde, qualidade de vida
e reinserção social, profissional e educacional. Diversas atividades são realizadas conforme as necessidades especı́ficas do paciente, dentre elas, estimulação cognitiva, treino de atividades de vida diária, treino de habilidades
manuais, atividades de reintegração à sociedade e atividades recreativas e
esportivas.
No atendimento aos pacientes com sequelas graves, a equipe de profissionais do programa ensina à famı́lia a prestar cuidados especı́ficos e gerais ao
paciente, visando facilitar a continuidade dos cuidados recebidos no hospital. Os principais objetivos são: treinar quem cuida a prestar cuidados ao
paciente; capacitar quem cuida a repassar informações a outros membros
da famı́lia; orientar a famı́lia sobre barreiras que dificultam a locomoção e
possı́veis adaptações na residência; e promover atividades das quais participam quem cuida do paciente e a famı́lia.
Essas atividades são realizadas por uma equipe multidisciplinar, composta
por: 7 Neurologistas, 12 Enfermeiras, 5 Auxiliares de Enfermagem, 2 Psicopedagogas, 2 Psicólogas, 2 Fonoaudiólogas, 2 Assistentes Sociais, 2 Pro-
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fessores de Educação Fı́sica, 7 Fisioterapeutas, 1 Terapeuta Ocupacional e 2
Nutricionistas, além do pessoal de apoio.
O Programa conta com 50 leitos divididos em duas enfermarias e o perı́odo
de internação dos pacientes é programado de acordo com as demandas do
tratamento, mas a média de tempo de internação é de 4 semanas.
O perfil dos pacientes internados é composto por adultos (a partir dos 16
anos) com sequelas de lesão cerebral adquiridas, de diferentes classes sociais
e oriundos de diferentes Estados da Federação.
As sequelas dos pacientes com lesão cerebral podem ser variadas dependendo da extensão da lesão. As sequelas podem ser motoras, cognitivas, de
linguagem ou comportamentais.
Para melhor compreensão da atuação do pedagogo no Programa de Reabilitação Neurológica é preciso nos deter um instante na caracterização de
algumas dessas sequelas, pois a proposta de reabilitação visa o trabalho de
estimulação, reeducação e compensação das habilidades afetadas pela lesão
cerebral, buscando a reintegração do sujeito na sociedade e melhora da qualidade de vida.
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5.1
A Psicopedagogia Hospitalar no Contexto
da Reabilitação
Atuação do Psicopedagogo Hospitalar no Programa
de Reabilitação Neurológica
No Programa de Reabilitação Neurológica do Hospital Sarah de Brası́lia a
Psicopedagogia Hospitalar atua com os demais profissionais como membro da
equipe de reabilitação, e objetiva contribuir para o processo de reabilitação,
atuando na estimulação e reeducação do paciente por meio de atividades
psicopedagógicas.
Assim como as bases filosóficas de um hospital de reabilitação se diferenciam de um hospital geral em alguns aspectos, a prática da psicopedagogia
hospitalar também apresenta caracterı́sticas diferenciadas dos demais. A
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atuação do psicopedagogo no hospital de reabilitação visa o atendimento integral ao paciente, incluindo aı́ o tratamento das sequelas da patologia de
base, como membro da equipe de saúde.
Dessa forma a prática do psicopedagogo na Rede SARAH considera que:
”[...] o psicopedagogo tem como função identificar a estrutura do
sujeito, suas transformações no tempo, influências do seu meio
nestas transformações e seu relacionamento como aprender. Este
saber exige do psicopedagogo o conhecimento do processo de
aprendizagem e todas as suas inter-relações com outros fatores
que podem influenciá-los; das influências emocionais, sociais, pedagógicas e orgânicas.” [1]
A prática do psicopedagogo no hospital de reabilitação encontra sua sustentação teórica na interlocução de diversas áreas do conhecimento, assim
como o psicopedagogo que constrói seu saber agregando diferentes contribuições: da pedagogia, psicologia do desenvolvimento, psicologia social, neuropsicologia, neurologia, psicolinguı́stica, filosofia e psicanálise entre outros.
Alves [1] indica que a importância dessas áreas de estudo para a psicopedagogia se traduzem na observação de diferentes dimensões no processo de
aprendizagem: orgânico, cognitivo, emocional, social e pedagógico. Para a
psicopedagogia a interligação desses aspectos ajudará a construir uma visão
da pluricausalidade do fenômeno, possibilitando uma abordagem global do
sujeito em suas múltiplas facetas.
Dadas as caracterı́sticas dos pacientes com lesão cerebral do Programa de
Reabilitação Neurológica e os objetivos de reinserção social, o psicopedagogo
nesse contexto deve desenvolver uma abordagem holı́stica. Essa abordagem
no contexto de reabilitação preconiza que os aspectos cognitivos, psiquiátricos
e funcionais sejam abordados juntamente com as emoções, sentimentos e
autoestima [14].
É preciso considerar que os pacientes que sofreram um acidente vascular
cerebral ou um traumatismo crânio encefálico, quase que em sua maioria,
ficam com sequelas cognitivas e comportamentais de uma lesão cerebral que
causam mudanças drásticas e súbitas na vida em suas vidas e de seus familiares, impondo limitações acadêmicas, profissionais, aos planos pessoais, às
relações sociais e afetivas.
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Assim, embora as atividades do psicopedagogo no hospital de reabilitação
estejam muito voltadas para os déficits cognitivos, os problemas emocionais
e psicossociais decorrentes das lesões cerebrais devem ser abordados nas intervenções psicopedagógicas, pois sabe-se que estes problemas estão intimamente relacionados.
As emoções podem interferir no pensamento e no comportamento, e os
déficits cognitivos podem ser exacerbados pela angustia e sofrimento psı́quico
e podem causar alterações comportamentais. As dificuldades psicossociais
também podem ocasionar problemas emocionais e comportamentais, e a ansiedade pode reduzir a efetividade dos programas de reabilitação neurológica.
Portanto, existe uma forte interação entre todos estes aspectos do funcionamento humano, interação esta, reconhecida por aqueles que utilizam a abordagem holı́stica [16].
A reabilitação é um processo fundamentalmente de aprendizagem, nele
o paciente vai reaprender sobre seu corpo suas potencialidades e limites.
Um programa de reabilitação tem o objetivo de organizar atividades contextualizadas e significativas, melhorar a qualidade de vida dos pacientes
e dos familiares através do melhor aproveitamento das funções preservadas
ou parcialmente preservadas, estimulando-as, desenvolvendo e ensinando estratégias compensatórias, e a aquisição de novas habilidades visando o retorno ao convı́vio social.
Durante todo o processo o paciente e a famı́lia participam ativamente do
processo decisório, traçando junto com a equipe suas metas, o que ajuda
a construção de uma percepção de si cada vez mais próxima do real e o
planejamento de objetivos viáveis, diminuindo o sentimento de desvalia e
frustração.
Para isso é importante que o paciente e a famı́lia estabeleçam uma relação
de confiança com a equipe / ou um membro da equipe. Nessa perspectiva o
psicopedagogo busca desenvolver uma escuta empática que na proposta vai
além do paciente, englobando a famı́lia, ”tentando apreender o sistema de
referência interno desses sujeitos , preocupando-se sobretudo com a autopercepção e a percepção do mundo próprias desses sujeitos” [13], ajudando-os
como orientador nessa caminhada.
A participação da famı́lia também garante o apoio social e emocional ao
paciente, assim como, a possibilidade de generalização das atividades reali16
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zadas no ambiente de reabilitação para as situações de vida no retorno ao
lar.
Todos os atendimentos realizados pela psicopedagogia são acompanhados
por um membro da famı́lia ou cuidador que aprende sobre os déficits apresentados, as estratégias de estimulação e compensação.
A intervenção do psicopedagogo nos hospitais da Rede SARAH não se
restringe ao paciente, mas a todos os sistemas que ele está inserido, sua
famı́lia, ambiente escolar/acadêmico e trabalho, ampliando os contatos para
orientação sempre que for necessário.
Com relação aos aspectos cognitivos o psicopedagogo nos hospitais da Rede
SARAH atua na avaliação, estimulação e desenvolvimento de estratégias
compensatórias das sequelas apresentadas após a lesão cerebral.
As habilidades cognitivas envolvidas na intervenção psicopedagógica não
só aquelas ligadas aos conteúdos escolares, mas todas as habilidades estruturantes do funcionamento cerebral que envolvem: atenção, memória,
linguagem, percepção e funções executivas (habilidades que possibilitam a
criação de novos de metas, planos, estratégias, decisões, realização dessas
metas ,monitoração, detecção, e resolução de problemas, flexibilidade mental, inibição, iniciativa e capacidade de memória operacional).
Dentre os modelos de intervenção para o tratamento de problemas especı́ficos, o psicopedagogo pode utilizar no processo de reabilitação algumas
abordagens retiradas como contribuição da psicolinguı́stica [10]: a reativação
(ou restauração), a reorganização (ou reconstituição da função) e a substituição (facilitação).
A reativação consiste em ensinar novamente a informação, as regras ou
procedimentos perdidos. A reativação leva em consideração o sprouting, ou
seja, um desenvolvimento neural rápido de outras áreas circundantes que
mediante estimulação podem realizar a função. É mais aplicada em casos de
lesões menores onde ainda há tecido neural para recuperar a função como
antes.
A reorganização consiste em ensinar um modo diferente para realizar a
mesma tarefa, utilizando habilidades remanescentes. As funções são tomadas
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por áreas que não estavam diretamente ligadas a função, a função recuperada
não e igual a perdida.
E por último, a substituição, consiste na facilitação de acesso as habilidades
prejudicadas por meio de estratégias compensatórias funcionais ou recursos
materiais para acessibilidade (órteses, próteses, comunicadores, etc...)
É importante ressaltar que as atividades de cognitivas também são planejadas e organizadas de acordo com o contexto do paciente e suas metas reais
de reabilitação. Assim, se uma das metas traçadas durante o programa de
reabilitação é o retorno às atividades acadêmicas, ou o retorno às atividades
laborais, ou ainda o desenvolvimento de atividades ocupacionais; todo o trabalho da pedagogia será desenvolvido nesse sentido, visando a desenvolvimento das habilidades cognitivas necessárias para sua reintegração social e o
desenvolvimento desse projeto pessoal.
Os objetivos dos atendimentos psicopedagógicos são determinados pelo
resultado das avaliações em consonância com as expectativas do paciente e
da famı́lia. Para cada paciente é organizado um programa de reabilitação,
com atividades pensadas especificamente para atender suas demandas.
As atividades podem ser desenvolvidas individualmente ou em grupo, sendo
que sempre objetiva-se o planejamento de atividades significativas e contextuais, para que a partir da vivência as famı́lias possam ser orientadas pelos
profissionais.
5.2
A Prática Psicopedagógica - Descrição das Atividades
A partir de agora serão descritas as atividades desempenhadas pelo Psicopedagogo Hospitalar no Programa de Reabilitação Neurológica do Hospital
Sarah de Brası́lia.
Como já foi dito anteriormente, o Psicopedagogo Hospitalar faz parte da
equipe de reabilitação, assim, muitas dessas atividades são realizadas em conjunto com outros profissionais da equipe de reabilitação. Embora participe
de um grande número de atividades, o Psicopedagogo Hospitalar não está
presente em todas elas. Assim, por opção, serão descritas apenas as que
contam com sua atuação direta.
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As atividades são realizadas em diferentes espaços do hospital, dependendo
da natureza da atividade, do número de participantes e dos profissionais
envolvidos.
5.2.1
Admissão em Equipe
Todos os pacientes que chegam ao hospital para internação participam da
admissão em equipe na enfermaria. Durante esse atendimento é realizada
a anamnese e questionadas as expectativas do paciente e da famı́lia sobre o
perı́odo de internação. Essas informações ajudaram a equipe a construir a
proposta de reabilitação junto com o paciente e a famı́lia. Na admissão estão
presentes todos os profissionais de reabilitação.
5.2.2
Avaliação Psicopedagógica
Busca-se avaliar o raciocı́nio lógico-verbal e matemático, linguagem, e alterações neuropsicológicas para traçar o programa de reeducação do paciente.
Esta atividade é realizada a partir de instrumentos padronizados produzidos
na Rede SARAH, da avaliação qualitativa, da entrevista de admissão e da
observação do paciente.
A impressão diagnóstica é construı́da por toda a equipe multidisciplinar
que discute em reuniões os resultados das avaliações dos diferentes profissionais. A equipe, em conjunto, traça o plano de tratamento e reabilitação.
Os resultados da avaliação são repassados para a famı́lia e para o paciente,
assim como a proposta de reabilitação e orientações em reuniões com toda a
equipe.
5.2.3
Reunião de Equipe / Processo Decisório
Após a admissão e avaliação do paciente, por todos os profissionais da
equipe de reabilitação, é realizada a discussão de caso e são traçados os
objetivos e a proposta de reabilitação. Os objetivos da reabilitação envolvem
metas reais e individuais para cada paciente, baseadas na percepção de todos
os profissionais e nas expectativas da famı́lia e do paciente. Nesta reunião
estão presentes todos os profissionais de reabilitação.
5.2.4
Reunião de Orientação / Repasse
Objetiva discutir com a famı́lia e com o paciente o programa de reabilitação,
esclarecer possı́veis duvidas sobre o processo, as estratégias de estimulação,
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duvidas sobre a patologia de base e terapia medicamentosa, traçar novos objetivos, planejar alta e retorno para acompanhamento. Nesta reunião estão
presentes todos os profissionais de reabilitação.
5.2.5
Programa de Comunicação Suplementar e Alternativa
Atuação do Pedagogo Hospitalar no programa de comunicação alternativa
e tecnologia assistiva, tem o objetivo de avaliar as melhores estratégias compensatórias (temporárias ou permanentes) para pacientes com desordens de
expressão seja através da fala e/ou escrita. Comprometimentos que envolvem
a linguagem como afasia e comprometimentos motores como apraxia, disartria e anartria, que envolvem a fala , ou ainda comprometimentos motores que
envolvem a escrita manual, como a tetraparesia, distonias e espasticidade.
A avaliação objetiva a escolha da forma de comunicação complementar
mais adequada ao quadro de cada paciente, levando em consideração não só
suas alterações de linguagem ou motoras, mas todo o seu contexto sócio-cultural e emocional.
A partir dessa avaliação pode-se escolher os recursos materiais, entre eles:
pranchas de comunicação pictográficas, alfabéticas ou com palavras; uso de
comunicação por sı́mbolos; computador (software e hardware especı́ficos); ou
comunicadores. E também as interfaces de acessibilidade: teclas de acionamento, órteses, teclados adaptados.
O Hospital Sarah de Brası́lia conta com o Setor de Bioengenharia, no qual
Engenheiros e Desenhistas, juntamente com o Psicopedagogo Hospitalar, projetam soluções de acessibilidade para pacientes do programa de comunicação
suplementar e alternativa.
5.2.6
Orientação Profissional
Como o processo de reabilitação está voltado para a contexto do sujeito a
orientação profissional voltada para reintegração social e qualidade de vida
deve ser abordada como um dos objetivos da Psicopedagogia Hospitalar.
As atividades de orientação são realizadas a partir da concepção dinâmica
de desenvolvimento profissional no confronto com a diversidade das experiências, papéis desempenhados nos contextos de vida, investimentos pessoais ao
nı́vel da cidadania e interação com a comunidade, combinação entre pessoal
e vocacional.
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Durante o processo de reabilitação observam-se as formas pelas quais os
indivı́duos elaboram o seu problema vocacional, identificam seus limites e
constrangimentos, e facilitam a exploração de outras possı́veis histórias profissionais.
Esse é um processo de co-construção e de autoconhecimento que envolve
interesses, competências investimentos, motivação e autorealização.
Negociam-se objetivos e etapas a percorrer, analisam-se as necessidades de
investimento profissional.
As decisões progressivamente tornam-se mais autônomas realistas e experienciadas como metas para o projeto de vida.
O sucesso vocacional tem sido uma das mais importantes medidas para o
processo de reabilitação.
5.2.7
Grupo de Acompanhantes/Famı́lia
Esse é um grupo que tem como objetivo proporcionar momentos de escuta
aos cuidadores, favorecer a identificação e reflexão de estratégias de enfrentamento, oferecendo suporte emocional e convı́vio entre pessoas que vivenciam
situações semelhantes, promovendo a troca de experiências e informações.
5.2.8
Grupo de Temas
Esse grupo visa oportunizar a troca de experiência e reflexões acerca de
estratégias de enfrentamento entre os pacientes.
A cada encontro os temas discutidos são propostos pelos próprios pacientes,
que podem variar no enfrentamento a patologia ou a própria situação de
internação e tratamento.
Durante o grupo são observadas as estratégias utilizadas por cada paciente
que podem ser: adaptativas e focalizadas no problema, que se caracterizam
por um enfrentamento mais ativo, com a busca de informações sobre a patologia, apoio social e reestruturação cognitiva; ou estratégias evitativas e
focalizadas na emoção, associado ao fatalismo, a negação ao desamparo e ao
isolamento, comportamentos relacionados aos sujeitos deprimidos [15].
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5.2.9
Grupo de Comunicação
O grupo tem como objetivo identificar e praticar estratégias para favorecer
a comunicação. Desenvolvendo a iniciativa, adequação dos turnos comunicativos e a organização do discurso de pacientes com diagnóstico de afasia,
disartria ou apraxia de fala.
Durante as atividades os pacientes têm a possibilidade de experimentar
em situações de comunicação os recursos de comunicação suplementar e alternativa caso tenha indicação.
5.2.10
Grupo de Planejamento do Cotidiano
Esse grupo tem o objetivo de promover uma reflexão sobre a rotina domiciliar anterior a participação no Programa de Reabilitação Neurológica. A
partir da descrição da rotina dos pacientes alguns temas são discutidos como
medicalização (excesso de atividades voltadas para tratamento clı́nico na
rotina), ociosidade, prevalência de atividades restritas ao lar e isolamento
social.
Visando ampliar a percepção das possibilidades de generalização das atividades e das orientações realizadas durante o processo de reabilitação, cada
participante do grupo tem a tarefa de reorganizar suas atividades a partir
das vivências no perı́odo de internação e da avaliação da rotina anterior,
verificando o que é possı́vel modificar e incorporar a sua rotina.
5.2.11
Socialização
Esta atividade pode ser interna ou externa. Envolve atividades culturais e
lúdicas entre outras, visando favorecer a integração do paciente com a equipe,
com a famı́lia e com os outros pacientes, bem como promover um contato
com a realidade e sua participação social (barreiras arquitetônicas, estigma,
etc.).
Muitas pessoas depois de uma lesão apresentam dificuldades de se perceber dentro de contextos que anteriormente faziam parte de suas vidas, assim essa atividade visa favorecer a percepção da possibilidade de participação em atividades de lazer, apesar das limitações adquiridas, auxiliando
na readaptação à vida quotidiana.
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5.2.12
Visitas Domiciliares e/ou Institucionais
Visa a orientar a famı́lia e/ou instituições sobre o desenvolvimento global
do paciente, acerca da patologia, e meios alternativos que podem favorecer
a sua reeducação e integração social. Verificar as necessidades do paciente
no seu ambiente domiciliar, profissional ou escolar; verificando as barreiras
arquitetônicas, as necessidades de adaptação do ambiente, assim como as
necessidades de manejo comportamental e cognitivo quando necessário.
5.2.13
Ludoteca
Essa atividade visa proporcionar a interação em grupo, motivação, estimulação cognitiva através de jogos de tabuleiro/lúdicos/populares/cooperativos.
5.2.14
Grupo de Leitura e Escrita
Objetiva, através de estratégias psicopedagógicas, a estimulação das habilidades cognitivas inerentes à leitura e escrita de pacientes com diagnóstico de
afasia, dislexias adquiridas, disgrafias, assim como o treino de escrita manual
em pacientes com alterações motoras.
5.2.15
Grupo de Raciocı́nio Lógico
Objetiva, através de estratégias psicopedagógicas alternativas, favorecer a
construção e/ou reconstrução de rotas cognitivas para a resolução de problemas numéricos e não numéricos voltados às necessidades reais do paciente,
tratamento numérico e cálculo, facilitando a reinserção social do paciente.
5.2.16
Grupos de Artesanato, Culinária e Jardinagem
Esses grupos oferecem atividades diversificadas, cuja a participação do
paciente é determinada pelo seu interesse, suas habilidades prévias e suas
possibilidades atuais (cognitivas e motoras).
Esses grupos realizam atividades para estimulação contextualizada visando
o desenvolvimento das habilidades de planejamento, resolução de problemas,
linguagem, viso-construção e habilidades manuais; assim como o resgate da
autoestima e competência. Em alguns casos os grupos também apresentam
possibilidades de reinserção laboral ou ocupacional para os pacientes.
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5.2.17
Atividade de Vida Prática
Um indivı́duo com diferentes graus de comprometimento gerados por uma
doença, deve retornar ao convı́vio familiar e social. Das atividades realizadas
em um programa de reabilitação, a reinserção comunitária é uma das mais
importantes. Ela se relaciona com a aquisição de materiais necessários no cotidiano (alimentos, roupas, utensı́lios domésticos, medicamentos) e serviços.
É iniciada após avaliação e abordagem das diferentes funções do indivı́duo
- fı́sica, cognitiva, psı́quica e social - realizadas pelos profissionais da equipe
de reabilitação.
As atividades são realizadas em ambientes comunitários mais próximos
ao contexto do paciente como bancos, supermercados, museus, shoppings
e parques, conforme o contexto de vida do indivı́duo. A equipe avalia a
indicação para participação nestas atividades, considerando a situação clı́nica
e funcional do paciente, e objetivos especı́ficos a serem alcançados como:
1. Treinar a mobilidade na comunidade, através da marcha, com ou sem
auxı́lio-locomoção e/ou órtese de membros inferiores, ou utilização de
cadeira de rodas, manual ou motorizada. Isso envolve percorrer terrenos acidentados, subir e descer meio-fio, rampa ou escada rolante,
utilizar transporte coletivo, e percorrer ambientes de maior circulação
de pessoas.
2. Treinar atividades tais como fazer compras, pesquisar preços de produtos, efetuar operações financeiras em bancos ou comércio.
3. Treinar funções cognitivas como orientação temporal e espacial, memória,
comunicação, organização e planejamento de atividades.
4. Treinar enfrentamento, ou seja, habilidade de se adaptar ao contexto
dentro da situação atual.
5. Identificar e trabalhar estratégias de enfrentamento referente a barreiras arquitetônicas e atitudinais.
5.2.18
Acompanhamento Pedagógico e Orientação Acadêmica
Visa acompanhar e orientar o desenvolvimento de atividades acadêmicas
/ escolares de pacientes internados que estão cursando educação regular em
qualquer nı́vel. Realizar todas as adaptações curriculares e metodológicas
necessárias para facilitar o processo de aprendizagem, mantendo contato
com as instituições de ensino e fazendo as orientações necessárias a equipe
pedagógica a fim de promover a reinserção após a alta hospitalar.
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5.2.19
Ambulatório Externo Psicopedagógico
Ambulatório destinado ao acompanhamento de pacientes que não necessitam de internação e apresentam demandas especificas de acompanhamento
psicopedagógico.
5.2.20
Ambulatório em Equipe
Acompanhamento de pacientes em atendimentos com toda a equipe. Esse
ambulatório é destinado à revisão de pacientes que já passaram pela internação e participaram do Programa de Reabilitação Neurológica.
5.2.21
Sessão Clı́nica
Essa atividade é destinada a formação continuada, onde semanalmente são
apresentados estudos realizados pela equipe de temas relacionados com as patologias atendidas, ressaltando os aspectos neurológicos e neuropsicológicos.
5.2.22
Discussão e Estudo de Caso
Esta atividade ocorre em reuniões da equipe e visitas à enfermaria, nas
quais se discute a participação do paciente no Programa de Reabilitação
Neurológica. Esta atividade favorece a troca interprofissional essencial a
uma abordagem holı́stica do paciente.
5.2.23
Atividades Administrativas
Estas têm por finalidade dar suporte às atividades de produção. As atividades mais frequentes são reuniões administrativas, aperfeiçoamento, formação
de novos profissionais, planejamento, elaboração de relatórios e registro em
prontuário.
O prontuário médico é constituı́do de um conjunto de documentos padronizados, contendo informações geradas a partir de fatos, acontecimentos e
situações sobre a saúde do paciente e a assistência prestada a ele, de caráter
legal, sigiloso e cientı́fico, que possibilita a comunicação entre membros da
equipe multiprofissional e a continuidade da assistência prestada ao indivı́duo.
Na Rede SARAH o Psicopedagogo Hospitalar realiza evoluções de todas as
atividades realizadas, suas impressões do diagnóstico psicopedagógico e observações de alta no prontuário, assim como todos os demais profissionais de
saúde.
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5.2.24
Pesquisa
Tem como finalidade a produção cientı́fica e o aprimoramento profissional
na área de Reabilitação.
6
Analisando as Diferentes Propostas
Para realizar essa análise é preciso inicialmente revisitar pressupostos da
abordagem psicopedagógica e holı́stica, que considera que o sujeito que aprende
está implicado em todos os seus nı́veis e de forma indivisı́vel: organismo,
corpo, cognição e emoção [3].
Nessa concepção o atendimento integral ao sujeito hospitalizado só se dará
se todos esses aspectos forem considerados e abordados em uma proposta de
intervenção psicopedagógica.
Esse trabalho descreveu inicialmente dois modelos de abordagem desenvolvidos nas classes hospitalares brasileiras, que como vimos apresentam referenciais práticos e teóricos bem distintos, o lúdico-terapêutico e o educativoescolar.
O que se observa nesses modelos é que eles se distinguem pelos tipos
de atividades que são propostas aos alunos-pacientes. Enquanto o modelo
educativo-escolar prioriza as atividades escolares, contemplando os conteúdos
do currı́culo formal, dando ênfase aos aspectos cognitivos; o lúdico-terapêutico
dedica-se ao desenvolvimento de atividades que envolvam necessariamente
conteúdos afetivos e de enfrentamento à hospitalização.
À luz dos pressupostos teóricos da psicopedagogia as duas propostas apresentam concepções de um sujeito fragmentado, dissociado-o em duas dimensões a cognitiva e a afetiva.
As atividades escolares e lúdicas são muito importantes no contexto hospitalar, e como estratégias de enfretamento são eficazes, mas momentâneas. A
experiência de doenças crônicas, longas internações, medo da morte, talvez
exija outras estratégias de intervenção que vão além daquelas que pretendem
tirar o foco da doença ou familiarizar o paciente com o ambiente hospitalar
diminuindo alguns elementos estressores. Ir além da proposta de se construir
um ambiente humanizado é preciso lembrar que esses conteúdos emocionais
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vão interferir diretamente na aprendizagem, não só durante a internação mas
também poderá se estender no retorno ao ambiente escolar.
Com relação ao modelo de acompanhamento educativo-escolar, muitas
vezes a prioridade daquele paciente internado são os cuidados com a saúde e
sua recuperação. Pacientes que estejam passando por tratamentos quimioterápicos, ou em recuperação de lesões cerebrais, podem no momento da internação ainda não estar preparados para entrar em contato com conteúdos
escolares, por questões cognitivas, emocionais ou até mesmo incapacitados
pelo uso de fortes medicamentos. Lidar com esses conteúdos no momento
errado podem, na verdade, produzir sensações de frustração e incapacidade.
O desenvolvimento de estratégias psicopedagógicas, que levem em consideração o momento de cada indivı́duo é uma forte ferramenta para o sucesso
do trabalho.
É preciso também reconhecer que muitos pacientes irão carregar sequelas fı́sicas ou cognitivas que poderão interferir na sua vida fora do hospital,
inclusive na escola, assim o perı́odo de internação deve servir para a implementação de recursos alternativos e adaptativos para que essa criança saia
habilitada para integrar-se a escola, muitas crianças precisam reaprender
como aprender. É também importante que o psicopedagogo hospitalar seja
capaz de estabelecer um ponte com a escola, relatando o caso e orientando
no que for necessário a equipe pedagógica escolar.
Dois outros aspectos que merecem atenção, primeiramente o distanciamento do pedagogo da equipe de hospitalar que não permite a troca de
informações e experiências. A equipe de saúde pode contribuir com informações acerca da patologia como do desenvolvimento do tratamento, que
podem interferir no processo de aprendizagem e assim permitir ao pedagogo a
implantação de estratégias de trabalho mais adequadas; assim como o pedagogo pode dar um feedback sobre o desenvolvimento do paciente, eventuais
diferenças detectadas no comportamento ou no processo de aprendizagem,
como também auxiliar na compreensão do paciente e da famı́lia sobre a patologia e as orientações da equipe de saúde. Outro aspecto é com relação
a formação do pedagogo hospitalar, como foi observado nos relatos a maior
parte dos profissionais não apresentam formação adequada para o trabalho
no ambiente hospitalar. Esse trabalho exige uma formação especı́fica que
englobe tanto conteúdos especı́ficos da educação especial e psicopedagogia,
quanto conhecimentos sobre as patologias.
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7
Considerações Finais
O modelo a descrito na experiência da Rede SARAH busca superar algumas dessas questões levantadas nesse trabalho, e se apresenta como uma
alternativa às Classes Hospitalares. É importante pontuar que a intensão não
foi apresentar um novo modelo que possa ser implementado em outros hospitais, mas compartilhar a ideia que o espaço de intervenção psicopedagógica
no ambiente hospitalar é muito mais amplo do que se vem apresentando na
maioria das classes hospitalares. A experiência aqui apresentada, retratou
o modelo desenvolvido dentro do Programa de Reabilitação Neurológica de
Adultos, e mesmo dentro do Hospital Sarah a proposta de atendimento psicopedagógico se difere dentro dos vários setores, atendendo a especificidade
de cada programa e de seus pacientes.
As atividades na Rede SARAH são movidas por uma busca contı́nua da
melhoria da qualidade do atendimento, para tanto, a flexibilidade é fundamental nesse processo. As atividades de reabilitação são constantemente
avaliadas e replanejadas pela equipe, que está pronta para pensar novas formas de atuação diante de novos desafios apresentados pelos pacientes.
O Hospital fez a opção pelo atendimento com enfoque psicopedagógico
e holı́stico, por entender que o atendimento a cada indivı́duo deve ser realizado de maneira integral considerando seus aspectos cognitivos, afetivos,
fı́sicos e orgânicos, e a complexidade das suas relações nos diferentes sistemas
(hospital, famı́lia, escola, sociedade). Sendo assim, também não restringe o
trabalho psicopedagógico ao atendimento de crianças e adolescentes, pois
reconhece a importância do acompanhamento de pacientes adultos.
Na Rede SARAH o Psicopedagogo Hospitalar faz parte da equipe multidisciplinar, onde constrói em conjunto com os outros profissionais um saber
teórico e prático, que favorece o entendimento do paciente e de sua patologia. A troca de informações e a possibilidade de atendimento em conjunto
permitem ao Psicopedagogo Hospitalar atuar em outro nı́vel, ajudando diretamente na recuperação do paciente.
A construção do conhecimento transdiciplinar permite uma atuação mais
assertiva do Psicopedagogo Hospitalar, que com maior sensibilidade e preparo
e capaz de definir a melhor conduta para cada caso. ”O compromisso com
a pessoa e não com a profissão, ou o profissional, seja ele quem for, sempre
me marcou muito. Paguei preço muito alto por isso, mas, por outro lado,
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consegui fazer o que é a prática do SARAH, em que se dá o mesmo valor ao
médico, às enfermeiras, aos terapeutas e aos psicólogos. Em que outras instituições, no mundo inteiro, se adota esse princı́pio do SARAH? Essa é uma
das formas mais objetivas de desmistificar a perigosa sacralização do médico
e reconhecer a fragmentação de saberes e as contribuições multidisciplinares
à prática da medicina.” [12]
O principio da individualização do Programa de Reabilitação Neurológica
considera que os pacientes não são todos iguais, na manifestação de sua
patologia, nas suas crenças, na sua bagagem cultural ou nas suas necessidades afetivas. Cada sujeito é único e assim não pode existir uma ”formula”
pré-definida para o seu atendimento, cada caso é pensado em conjunto pela
equipe de reabilitação, e são estabelecidas as metas e o planejamento das
atividades para atingi-las.
Escutar a famı́lia e o paciente é essencial para a construção de um proposta
de atendimento psicopedagógico hospitalar. A abordagem psicopedagógica
na Rede SARAH visa à reconstrução de projetos de vida e sua reintegração na
sociedade, assim o direcionamento de nossa ação deve ser sensı́vel o suficiente
para ajudar o paciente a lidar com situações adversas na sua vida. Muitas
vezes ele precisa de ajuda para definir se há condição de retorno às atividades
laborais, ou se é necessário o redirecionamento de suas atividades.
Outras vezes projetos acadêmicos são interrompidos, jovens estudantes que
após TCE apresentam sequelas cognitivas irreversı́veis que impossibilitam o
seu retorno à universidade, precisam de ajuda para descobrir novas possibilidades. Ou ainda, trabalhadores com baixa escolaridade, que tinham na sua
condição fı́sica toda sua capacidade de atividade profissional, com sequelas
motoras causadas por um AVC, podem ficar impossibilitados de retornar a
sua antiga atividade, mas com as funções cognitivas preservadas podem ser
incentivados a voltar para os estudos e qualificar-se profissionalmente.
Na rotina dos hospitais da Rede SARAH os pacientes realizam várias atividades com a mediação do Psicopedagogo Hospitalar, e cada uma das atividades são planejadas com objetivos e estratégias próprias.
São realizadas abordagens em grupo e individualmente, pela equipe de
psicopedagogia, visando o enfrentamento a patologia e da situação de internação, tanto com os pacientes quanto com os seus acompanhantes, para
proporcionar momentos de troca e reflexão sobre sua condição na tentativa
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de construir formas positivas de lidar, na maioria de nossos pacientes, com
grandes mudanças em suas vidas.
Da mesma forma são realizadas atividades de intervenção psicopedagógica
em grupo e individualmente visando a estimulação, a reeducação e a compensação de aspectos cognitivos e motores.
O trabalho rompe as barreiras do hospital, quando se realizam atividades
educativas em outros contextos, muito mais próximos da realidade do paciente, promovendo à interlocução desses espaços com a equipe de saúde. A
orientação é fundamental para aqueles que convivem com um paciente em
processo de reintegração, permite conhecer suas possibilidades e limites, entendê-lo como um sujeito cheio de possibilidades apesar de realizar algumas
atividades de uma forma diferente, visando diminuir o preconceito e vencer
algumas barreiras sociais. Visitar a sua casa, conversar com seus vizinhos,
orientar os professores de sua escola ou universidade, pode abrir grandes
possibilidades no seu retorno.
Nessa perspectiva a intervenção psicopedagógica em um hospital pode ir
muito além das Classes Hospitalares, que como vimos, tendem a tratar os
pacientes como iguais, enquadrando-os em uma proposta única e fechada,
sem considerar suas diferenças e seus desejos.
Sem o enrijecimento que as Classes Hospitalares impõem, restringindo o
trabalho ao acompanhamento escolar ou as atividades lúdico-terapêuticas, o
Psicopedagogo Hospitalar pode descobrir que possui um papel importante na
recuperação desses pacientes, realizando atividades que os ajudem a transpor
suas limitações sejam elas quais forem.
É importante fomentar a troca de experiências e a pesquisa para o desenvolvimento de um saber especı́fico para a área da pedagogia hospitalar, que
ajude na superação dos obstáculos e na melhoria de qualidade no atendimento daqueles que precisam de nossa ajuda.
References
[1] ALVES, D. Psicopedagogia: Avaliação e Diagnóstico. Vila Velha:
ESAB, 2007.
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[2] CECCIM, R. Classe Hospitalar : encontros da educação e saúde
no ambiente hospitalar. São Paulo: Rev. Pátio, 10: 41- 44, 1999.
[3] FERNÁNDEZ, A. A inteligência aprisionada. Porto Alegre: Ed.
Artes Médicas,1990.
[4] FONSECA, E. A situação brasileira do atendimento
pedagógico-educacional hospitalar. Educação e pesquisa SP:
25(1): 117-129, 1999.
[5] FONTES, R. A Educação no Hospital: repensando a formação e
a prática de professores para a atuação em hospitais. Anais do
XII ENDIPE. Curitiba: ENDIPE, 2.540 - 2.554, 2004.
[6] KURT, L. Teoria de campo en ciência social. São Paulo: Ed. Pioneira, 1995.
[7] MINISTÉRIO DA EDUCAÇÃO E DO DESPORTO (MEC). Polı́tica
de Educação Especial, livro 1. Brası́lia: MEC, 1994.
[8] MINISTÉRIO DA EDUCAÇÃO E DO DESPORTO (MEC). Lei de
Diretrizes e Bases da Educação Nacional, n◦ 9.394/96. Brası́lia:
MEC, 1996.
[9] MINISTÉRIO DA EDUCAÇÃO (MEC). Classe Hospitalar e
Atendimento Pedagógico Domiciliar: estratégias e orientações.
Brası́lia: MEC, 2002.
[10] ORTIZ, K. Distúrbios Neurológicos Adquiridos: linguagem e
cognição. Barueri: Manole, 2005.
[11] ORTIZ, L. & FREITAS, S. Classe Hospitalar :um olhar sobre sua
práxis educacional. R. Bras. Est. Pedag., 82(200/201/202): 70-77,
2007.
[12] PAZ, A. Tratando doentes e não doenças. Brası́lia: Sarah Letras,
2002.
[13] PINEL, H. Intervenções Psicológicas na Ótica da Psicanálise.
Vila Velha: ESAB, 2007.
[14] PRIGATANO, G. Learning from our successes and failures: reflections and comments in Cognitive Rehabilitation: How it is and
how it might be. Journal of the international Neuropsychological Society,
3: 497-499, 1997.
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[15] STRAUB, R. Psicologia da Saúde. Porto Alegre: Artmed, 2005.
[16] WILSON, B. Avanços recentes em reabilitação neuropsicológica,
in Neuropsicologia e as interfaces com as Neurociências. São Paulo: Casa
do Psicólogo, 2007.
[17] WOLF, R. Pedagogia Hospitalar: a prática do pedagogo em instituição não-escolar. Disponı́vel no site htpp://WWW.uepg.br/revistaconexão/revista/edição03/artigo11pdf. Acessado em 10 de dez.
2014.
[18] THIOLLENT, M. Concepção e organização da pesquisa, in
Metodologia da pesquisa-ação. São Paulo: Cortez Editora, 1994.
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PRELIMINARY SITE INVESTIGATION OF
THE LAKE KENYIR WATERSHED
(Letter)
Resnick, J. A.
∗
February, 2015
Abstract:
These are the first steps of water contamination studies
in Lake Kenyir, Malaysia, took by the survey team of Universiti Malaysia
Terengganu.
Key words:
limnology.
1
Lake Kenyir, Tasik Kenyir, contamination, water quality,
Introduction
Tasik Kenyir1 , or Kenyir Lake, is an artificial lake located in the state
of Terengganu in northeast Malaysia. The lake was created in 1985 by the
damming of the Kenyir River in order to create the Sultan Mahmud Power
Station. Kenyir Lake is the largest man-made lake in South East Asia.
Kenyir Lake borders Kelantan, in the west, Pahang, in the south, and
Terengganu, to the east. This immense lake also serves as another gateway
to Taman Negara and is part of the King George V National Park that is
encompassed within the states of Pahang, Kelantan and Terengganu. The
lake covers 260 km2 and contains some 340 small islands which used to be
hilltops or buttes. There are more than 14 (known) waterfalls with numerous
rapids and rivers throughout the lake region. Because the lake is a reservoir,
the water levels can vary depending upon rainfall, seasonal weather trends
and the month of the year. Water levels in the lake are highest in March and
April after the Monsoon Season.
∗
PhD, Principal Research Fellow at Institute of Biology, Universiti Malaysia Terengganu (Terengganu, Malaysia) e-mail: [email protected]
1
See: http://en.wikipedia.org/wiki/Kenyir Lake
1
85
2
Preliminary Site investigation
Figure 1: Preliminary Site Coordinates: 05◦ 00’ 00” N, 102◦ 47’ 59” E
(Source: Google Earth)
3
Potential Contaminating Activities
1. Deposition of raw sewage directly into open waters from stationary
(huts) mobile platforms (houseboats);
2. Decay of sunken vessels and flotsam in Gawi Cove area;
3. Possible leakage of motor oil directly into lake by watercraft;
4. Debris, plastic bottles, paper, aluminum cans, tires.
2
86
4
Potential Contamination Types
1. Raw Sewage (human waste)
2. Decaying portage/flotsam
3. Leaking motor oil
4. Debris, plastic bottles, paper, aluminum cans, tires
5
Discussion of the Site
The main potential contamination (area) site is located at Pengkalan Gawi
(Fig. 2), Hulu Terengganu 21700 Kuala Berang, Terengganu Darul Iman,
Malaysia. Other potential contamination areas (sites) include permanent
(moored lodgings), movable platforms (houseboats) and make-shift housing
located on the lake (Fig. 3).
Upon arrival and initial observation at the Pengkalan Gawi location, immediately apparent was the presence of assorted flotsam and jetsam strewn
about the ramps and dock areas as shown in Figure 2. This photo was obtained providing an overhead view from the parking area observation deck at
the Pengkalan Gawi arrival center, adjacent to rest rooms and maintenance
storage lockers. Noted, as shown in the Figure 2, is assorted debris strewn
about the beach area 2 . No apparent ”sheen”3 , indicative of release of free
product, was noted in this area nor at this location.
6
Additional Concerns and Potential Problem Sites
Additional areas (sites) of possible concern are the numerous permanenttype, but make- shift, dwellings erected in and around Lake Kenyir as shown
in Figure 4. No on-board inspection was made by this investigator of those
platforms. However, upon interview of a person claiming to be a ”part-time
resident” on Lake Kenyir (houseboats) it was reported that ”no toilets were
2
This area could be cleaned very easily, requiring expense of fewer than eight (8)
man-hours.
3
The absence of free product (sic., ”sheen”) at this location is a positive indicator that
no immediate remedial action is required at this location and that a detailed P-CAR is
not necessary at this time.
3
87
Figure 2: The Pengkalan Gawi Public Access Facility (Source: Resnick, J.A.)
Figure 3: Flotilla Community (Source: Resnick, J.A.)
used”4 on such platforms and that inhabitants would routinely ”melegakan
diri sendiri” (evacuate) directly into the waters.
It should be noted, again, that this investigator did not undertake an
actual, physical inspection of the facilities and conditions said to exist by an
un-known third party. Therefore, this information can only be relied-upon
as ”Hearsay Evidence”. On-site inspection(s) undertaken by duly authorized
personnel may be necessary in the future should physical test parameters for
4
The interviewee reported that, although some houseboats did, in fact, have conventional marine-type toilet facilities, that in the ”make-shift-type” platforms residents had
constructed an ”out-house” type closet in these platforms where human waste was deposited directly into the waters underneath the houseboat platform.
4
88
Figure 4: Lake Huts/Platforms (Source: Resnick, J.A.)
water samples become elevated, fall outside normal ranges or fish die-off.
7
Observations
The practice of defecating and urinating directly into the waters is a very
dangerous proposition. Such practices lead to increases in bacterial levels
in the lake, overall. Increases in deposition of fecal matter and urine could
lead to detrimental elevations and increases in both the levels of fecal E.coli,
coliform and physical parameters of overall water chemistries.
Continuation of such practices could lead to detrimental deterioration and
alteration of water chemistry throughout the surrounding habitats. Of particular concern to Stakeholders should be the certain probability that at
times when water temperatures increase (e.g., Summer months) and when
additional bio-stressors (e.g., ”tourists”) or bioloading (occurring during the
tourist season as a result of human encroachment) resultant bacterial levels
will rise in the lake waters. The combination of i.) depositing human waste
directly into this watershed, along with ii.) unusually high (and sustained)
increases in temperature, iii.) decrease in water levels, and iv.) reduction in
the frequency or adequacy of flushing cycles throughout Lake Kenyir, could
result in spontaneous and sporadic outbreaks and occurrence of a variety
of water-borne diseases. If left un- checked, ultimately, this condition could
have a profound effect not only to inhabitants and visitors to the Lake Kenyir
watershed, but also, due to the size of the lake, to visitors at other areas
5
89
Figure 5: The Pengkalan Gawi Public Access Facility (Source: Resnick, J.A.)
throughout the King George V National Park, affecting the populations in
the three states (Pahang, Terengganu and Kelantan) adjoining Tasik Kenyir.
8
Other Sites Observed
A cursory inspection of the Sultan Mahmud Dam was undertaken from
a remote location accessible to visitor traffic only. No formal inspection of
the dam facilities upstream of the outfall was undertaken at the site. A
water sample was drawn in the tributary outflow accessible via access road
below the dam. During sample collection it was noted that some debris and
flotsam was present in the waters traversing the dam and outfalls. The debris
consisted mainly of plastic bottles, construction debris, aluminum cans and
tree trimmings. The debris had a tendency to agglomerate at the base of the
outfall without restricting water flows downstream. No fish or wildlife of any
other kind was noted.
Where contaminating (Resnick, 20015 ) activities are suspected or known
to have occurred, or if the site history is incomplete and the Primary Responsible Party (”PRP”) has not been determined, it may be necessary to
undertake a preliminary sampling and analysis in order to determine the
5
Dr. Resnick’s lecture on ”Fundamentals of Preliminary Contamination Assessment
Methods and Protocols”, January, 14, 1990, Florida Department of Environmental Protection, Tallahassee, FL Proceedings.
6
90
Figure 6: Outfall-spillway at Sultan Mahmud Dam (Source: Resnick, J.A.)
need for a more detailed environmental investigation. Since the major concern and, in the opinion of this investigator, the most likely problematic
areas6 are:
1. the Pengkalan Gawi public access facility (quay and boat docks shown
in Figures 2 and 5;
2. the flotilla community (Figure 3); and
3. the sporadic lake huts/platforms (Figure 4).
It should be noted that minor pollutants, e.g., plastic bottles, assorted
flotsam, automobile tires and aluminum cans, although a health concern and
potential breeding source for mosquitoes, are unsightly and pose potential
hazards to wildlife, are relatively inconsequential in the overall assessment.
These concerns are addressed later in the section entitled, ”Recommendations”, presented later in this pre-investigation report.
9
Water Sampling of Physical Parameters at
Lake Kenyir
Two water samples were collected by this investigator at two locations at
the Lake Kenyir site on Saturday, September 20, 2014. The two sites selected
6
Dr. Resnick’s opinion is that the most likely areas to result in on-going problems at
Lake Kenyir are a direct result of deposition of human waste into the watershed.
7
91
for physical parameter testing were:
1. The Pengkalan Gawi public access facility shown in Figure 2; and
2. Outfall-spillway at Sultan Mahmud Dam shown in Figure 6.
10
Physical Parameter Test Results
The water samples were collected by Dr. Resnick using conventional sterile
collection methods. Samples were held by Dr. Resnick (under refrigeration
at 4◦ C.) until Sunday, September 21, 2014 at which time these were provided
to Dr. Hon Jung, Kenyir Research Institute, for physical parameter analysis
by Mr. Haniff of UMT’s Akuatrop testing laboratory. Results are shown in
the following tables.
Table 1: Current water sample - Analyzed by Haniff (Akuatrop)
Parameter
DO (dissolved oxygen) [µg/l]
pH
Conductivity [mS/m]
Turbidity [NFU]
TDS (total dissolved solids) [mg/l]
P (Phosphorous) [µg/l]
Location A
(Gawi)
6.80
7.17
26.9
2.2
0.173
< 0.02
Location B
(SM-Dam)
6.86
7.20
26.6
1.6
0.169
0.04
Table 2: In situ sampling data set (April 2014) - Chomo River (for comparison)
Parameter
DO (dissolved oxygen) [µg/l]
pH
Conductivity [mS/m]
Temperature [◦ C]
Surface
5.68
5.62
26
26.28
Depth
1m
5.80
5.64
26
26.23
2m
5.28
5.77
26
26.02
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11
Interpretation of Data
The above data set and parameters are well within normal physical parameters for lake waters. As such, indicators pointing to need for further
investigation and/or biological testing and monitoring are absent.
12
Recommendations
1. Initiate informal investigation of stationary and mobile platforms in order to determine compliance with pre-established sanitation guidelines;
2. Undertake cleanup of shoreline facilities and stations at Pengkalan Gawi
arrival center. This is a relatively ”quick-fix” and should be easily
accomplished as part of the contractor’s routine maintenance protocols
and could be done with expense of fewer than eight (8) man-hours;
3. Install portable lavatory stations on all boat docks, at quays, and at
boat landing stations, such as those shown at:
http://www.toitoi.com.my/ or, http://www.eatoilet.com.my/#!for-rent
;
4. Consider requiring persons whom have established living quarters or
have erected huts, lean-to’s or other temporary housing units, to install
sanitary collection appliances, such as chemical toilets
(see: http://tinyurl.com/pgrzgwk);
5. Mandate that operators of concessions, hotels, resorts, boat tour operators, etc., be required to have on-hand and to give access to use of
toilet facilities for both men and women;
6. Licensing agencies, e.g., Department of Health, Department of Fisheries, etc., could contract to purchase a number of the stand-alone
toilets and require campers, and other parties remaining on the lake
for more than 24 hours, to ”rent” one of the lightweight, portable units
for use during their stay and use of the Lake Kenyir facilities. The
agency, or vendor, could charge a rental fee to users that would, over
time, offset the initial expense of lease-purchase of the toilet appliance,
eventually leading to profitability; and
7. Undertake a ”Pilot Study” (i.e., project) in collaboration with the
Malaysian EHS (see: https://www.e-ehs.doe.gov.my/app/webroot/portal/ ), the Malaysian Ministry of Health ( http://www.moh.gov.my/ ),
9
93
UMT and The Kenyir Research Institute to initiate a program such as
that described in Item 6., above.
10
94
THE EBOLA VIRUS; PRELIMINARY
THEORETICAL MOLECULAR IMAGING
CONSIDERATIONS GIVEN TO THE
POTENTIAL IMMUNOSTIMULATORY
EFFECTS - ALLOGENEIC
LYMPHOCYTES
(Letter)
Stewart, R.
∗
January, 2015
Abstract: There is no known therapy for EHF. Late in the epidemic,
this fact motivated a clinical experience with blood transfusions from survivors However, this is no guarantee that this solves the problem if not possibly making it worse. Comparison with the bulk of patients in the outbreak,
taking into account the patient’s age and sex, the day of treatment, and the
stage of the epidemic, did not suggest any real benefit to the therapy. In
addition, virologic analysis of the incomplete specimen set that was available
did not lend support for efficacy. It is questionable whether antibodies would
have had much effect. However, in theory, in the event the activated Allogeneic lymphocytes and the added volume of platelets, erythrocytes, were
probably beneficial. Whereas current examination of the Ebola virus under current microscopy instrumentation has failed to be able to examine the
Ebola Virus, and examine it at small enough microscopic levels in order to
understand its molecular biological activity. Therefore, this paper incorporates a microscopic imaging study at the molecular level in order so that the
Ebola virus may be studied to see how in has interaction between molecules
∗
Ph.D, Th.D., Editor-In-Chief of the International Journal of Astronomy, Astrophysics,
and Earth Sciences, and the International Journal of Interdisciplinary Science, CEO of
International Consortium on Microscopic-Macroscopic Research (Gonzalez, TX, USA) Email: [email protected]
1
95
kin order to understand it better. In hopes to lead to better future treatments. If therapeutic studies are undertaken in patients in the future, it will
be important to have randomized control serial laboratory samples and some
consideration given to the potential immunostimulatory effects of Allogeneic
lymphocytes.
Key words: Ebola, EHF, Infectious Diseases, CDC.
1
Ebola: The Virus and the Disease
Sanchez [9] brings to the readers attention that the introduction to the
Ebola virus that there are very little if next to none known or in place
maintenance strategies employed in nature by the agents, and we know much
less about the resulting diseases, their pathogenesis, and detailed virology.
The Ebola first known family of the only known virus family, and in the
past their was a profound ignorance about it about which we have such
profound ignorance. However, continued progressive research in the resulting
diseases, their pathogenesis, and detailed virology, allowed much progress to
be made in the progressive treatment of this disease over the years. Whereas
during such efforts recent epidemics has provided considerable fundamental
information about filoviruses. The fundamentals of this disease and their
progress may be better understood and explained in Figures 1-3.
There are 4 distinguishable Ebola related subtypes, whose phylogenetic
tree in which the resulting affects are shown in Figure 2. However, Sanchez
[9], Peters [7] and Georges-Coubot [3] examines and goes into in depth comprehensive range of discussions and clinical trials in which experimental treatments and past medicines were examined to see if they could be improved
to not only address the initial onset of this horrific disease, but to also help
determine what could be done to help control the onset and control of these
diseases as well. Because the subtypes, which may even be different virus
species, have differing properties. Some of these may be traced through past
experience several different and varying Ebola outbreaks over the last several
decades. Some of these are as follows:
1. Ebola outbreaks of 1976; and
2. 1994-1996 as described under Figure 1.
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96
Figure 1: Signs and symptoms. (Source: WHO)
2
The Ebola Epidemics of 1994-1996
After Ebola hemorrhagic fever (EHF) appeared in Africa in 1976-1979, it
was not seen again until 1994. The virus causing sporadic human infections
that remained undetected because the patients never contaminated hospitals to produce the savage nosocomial epidemics. Careful and scrutinizing
surveillance may have identified several cases and estimated the findings are
subject to caveats because of problems with the validity of laboratory tests
[5]. Serosurveillance in 1995 also suggested that human infections may have
occurred from time to time [1]. Additional data and new evidence lead to
the development of better understandings and treatment as discussed.
During 1994-1996, no less than five independent active sites of Ebola virus
transmission were identified: Côte d’Ivoire in 1994 [1]; D.R. of Congo in
1995 [2]; and Gabon in 1994, 1995, and 1996 [4] [6] [8]. The previously
known Zaire subtype of Ebola virus (EBO-Z) and the newly discovered Côte
d’Ivoire subtype (EBO-CI) were both involved, and as in previous African
Ebola virus transmissions, the sites were in or near tropical forests.
Which was followed by renewed human transmission, reflects actual Ebola
virus activity or rather publicity combined with fortuitous entry of the virus
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97
Figure 2: Facts about Ebola Virus. (Source: WHO)
into medical facilities (leading to recognition) is unknown. Which other published papers trace the current outbreaks of allegedly some similar of the
Ebola virus that had taken place in 2013-2014 as well.
EBO-Z was also circulating in Gabon [6], and at least 3 separate outbreaks
in humans and nonhuman primates occurred. Thus, Gabon may well provide
another site where the search for risk factors of human infection and the
natural reservoir could be carried out. Notable among the epidemics were
features such as the important role of a dead, naturally infected chimpanzee
in bridging the virus to humans, the rapid control of human transmission
when barrier-nursing measures were instituted and the continued circulation
of virus without these precautions, and the deep forest exposures of index
cases also discussed and assessed in Rowe article [8].
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98
3
Preliminary Methodological Theoretical
Molecular Investigation Using the Angstrom
Microscope (AM)
A very limited fundamental imaging study on the above micrograph was
accomplished to attain a greater examination of the molecular level of this
disease. It was preliminarily determined at the pre-molecular level that the
digenesis of this disease is more accelerated in theory than previously given
the correct deterioration sequence digenesis situations and circumstances,
past the onset of digenesis to where it appears that even the application
of anti-bodies would not be a treatable option past a certain deterioration
point. The first preliminary study was able to minimally study the virus
at approximate 100.0 nm (nanometers). Therefore a much more durational
study is needed at even smaller microscopic measurement scale levels. Which
hopefully eventually would lead into potential important randomized control serial laboratory samples and some consideration given to the potential
immunostimulatory effects of allogeneic lymphocytes could be an option in
theory. However, more of this cannot be determined until a more advanced
study is ensued with due diligence.
Figure 3: Ebola virus at 108,000 magnification. (Source: Fuse — Thinkstock)
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99
4
Acknowledgements
The author of this paper would like to thank International Consortium On
Microscopic-Macroscopic Research (ICOMMR) for their generous help, and
for the use of their Angstrom-Microscope (AM) in the first initial preliminary
molecular imaging investigation into this deadly disease.
References
[1] BUSICO, K.M., MARSHALL, K.L., KSIAZEK, T.G., ROELS, T.H.,
FLEERACKERS, Y., FELDMANN, H., KHAN, A.S., PETERS, C.J.
Prevalence of IgG antibodies to Ebola virus in individuals during an Ebola outbreak, Democratic Republic of the Congo. J
Infect Dis 179(1):S102-S107, 1999.
[2] BWAKA, M.A., BONNET, M.J., CALAIN, P., COLEBUNDERS, R.,
DE ROO, A., GUIMARD, Y., JATWIKI, K.R., KIBADI, K., KIPASA,
M.A., KUVULA, K.J., et al. Ebola hemorrhagic fever in Kikwit,
Democratic Republic of the Congo: clinical observations in 103
patients. J Infect Dis 1999;179 (1):S1-S7. 1999.
[3] GEORGES-COURBOT, M.C., SANCHEZ, A., LU, C.Y., BAIZE,
S., LEROY, E., LANSOUT-SOUKATE, J., TÉVI-BÉNISSAN, C.,
GEORGES, A.J., TRAPPIER, S.G., ZAKI, S.R., et al. Isolation and
phylogenetic characterization of Ebola viruses causing different
outbreaks in Gabon. Emerg Infect Dis 3(1):59-62. 1997.
[4] KIBADI, K., MUPAPA, K., KUVULA, K., MASSAMBA, M., NDABEREY, D., MUYEMBE-TAMFUM, J.J., BWAKA, M.A., DE ROO,
A., COLEBUNDERS, R. Late ophthalmologic manifestations in
survivors of the 1995 Ebola virus epidemic in Kikwit, Democratic Republic of the Congo. J Infect Dis 179 (1):S13-S14, 1999.
[5] KSIAZEK, T.G., WEST, C.P., ROLLIN, P.E., JAHRLING, P.B., PETERS, C.J. ELISA for the detection of antibodies to Ebola
viruses. J Infect Dis 179(1):S192-S198, 1999.
[6] MUPAPA, K., MUKUNDU, W., BWAKA, M.A., KIPASA, M., DE
ROO, A., KUVULA, K., KIBADI, K., MASSAMBA, M., NDABEREY,
D., COLEBUNDERS, R., et al. Ebola hemorrhagic fever and pregnancy. J Infect Dis 179(1):S11-S12, 1999
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[7] PETERS, C.J., SANCHEZ, A., FELDMAN, H., ROLLIN, P.E.,
NICHOL, S., KSIAZEK, T.G. Filoviruses as emerging pathogens.
Seminars in Virololgy, 5:147-154. 1994.
[8] ROWE, A.K., BERNOULLI, J., KHAN, A.S., MUKUNU, R.,
MUYEMBE-TAMFUM, J.J., BRESSLER, D., WILLIAMS, A.J., PETERS, C.J., RODRIGUEZ, L., FELDMANN, H., et al. Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit,
Democratic Republic of the Congo. J Infect Dis 179(1):S28-S35,
1999.
[9] SANCHEZ, A., TRAPPIER, S.G., MAHY, B.W., PETERS, C.J.,
NICOL, S.T. The virion glycoproteins of Ebola viruses are encoded in two reading frames and are expressed through transcriptional editing. Proc Natl Acad Sci USA, 93(8):3602-3607, 1996.
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CRYPTOSPORIDIUM INFECTION IN
PATIENTS WITH ACUTE ON CHRONIC
LIVER FAILURE (ACLF)
Ramadan, M. E. ∗Ramadan, M. E. E. †Yousef, M. S. M.
‡
February, 2015
Abstract: Acute on chronic liver failure (ACLF) patients had reduced
cellular immunity could contribute to an increased susceptibility to infection
in subjects with ACLF, including infection with Cryptosporidium. This study
was carried out to investigate the prevalence and clinical significance of Cryptosporidium infection in patients with hepatitis B virus (HBV)-associated
ACLF in Ahmed Maher Teaching Hospital, Cairo, Egypt. Fecal samples
from patients with HBV-associated ACLF, chronic hepatitis B (CHB) and
children with diarrhea were collected; Modified acid fast Ziehl-Neelsen staining (MZN), coproantigen ELISA were used. The prevalence of Cryptosporidium infection in the HBV-associated ACLF patients was 9.5%, although was
2.5% and 5% in CHB and children with diarrhea respectively. No watery
diarrhea present in Cryptosporidium-positive ACLF patients. Among all 220
ACLF patients, 60 had diarrhea, ten of them were Cryptosporidium-positive,
which is significantly higher than the Cryptosporidium-positive rate in patients without diarrhea.
Key words:
Cryptosporidiosis, Chronic Hepatitis B (CHB), Acute
on Chronic Liver Failure (ACLF), Modified acid fast Ziehl-Neelsen staining
(MZN), Coproantigen ELISA.
∗
MD, Medical Parasitological Fellow at Department of Parasitology, National Hepatology and Tropical Medicine Research Institute (Cairo, Egypt) e-mail: manarezz98@yahoo.
com
†
MD, Gastroentrology and Hepatology Fellow at Department of Hepatology, Ahmed
Maher Teaching Hospital (Cairo, Egypt)
‡
MD, Professor of Chemical and Clinical Pathology at Department of Chemical and
Clinical Pathology, Ain Shams University (Cairo, Egypt)
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102
1
Introduction & Background
Cryptosporidiosis is a parasitic disease caused by Cryptosporidium spp.,
These are enteric protozoan parasite with worldwide distribution which may
inhabit the gastrointestinal tract of a wide variety of animals including humans [33]. The infectious stages of the parasite (oocysts) are shed in the
feaces of infected individuals; they survive in adverse environmental conditions and are spread by direct contact or through contaminants (food and
water) [16].
In immunocompetent individuals, Cryptosporidium causes acute diarrhea,
usually self-limited, nausea, vomiting, loss of appetite, weight loss and fever
[2] [15]. Mostly affecting people with immunodeficiency and, in some cases,
can be deadly, and is an important cause of morbidity and mortality in
immunosuppressed individuals [20].
Cryptosporidium infection has been reported in various populations with
severe impairments of immune status, such as those with acquired immune
deficiency syndrome (AIDS) [17] [23] acute leukemia [26] and other hematological disorders, [10] interferon deficiencies, [27] graft transplants, [1] and
malnourished children [18]. In a study of human immunodeficiency virus
(HIV) infected patients, over 37.3% of AIDS patients with diarrhea were
found to have a Cryptosporidium infection, which often worsened the prognosis of the disease [6].
Chronic hepatitis B virus (HBV) infection affects over 240 million people
worldwide and about a half million people die every year due to the acute or
chronic consequences leading to liver failure and liver cancer [32].
Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity
encompassing an acute deterioration of liver function in patients with cirrhosis, either secondary to superimposed liver injury or due to extrahepatic precipitating factors such as infection culminating in the end-organ dysfunction.
A characteristic feature of ACLF is its rapid progression, the requirement for
multiple organ supports and a high incidence of short and medium term
mortality of 50-90% [14]. Abundant evidence has indicated that the immune
status is impaired in patients with ACLF, who are often highly susceptible
to microbial infection [29] [36] cite[18].
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103
The purpose of this study was to determine the prevalence and potentially
clinical significance of Cryptosporidium infection in patients with hepatitis B
virus HBV-associated ACLF.
2
Materials and Methods
2.1
Ethical declaration
Ethical approval was obtained from the Committee of Research, Publications and Ethics of Ahmed Maher Teaching hospital, Cairo, Egypt. Informed
consent was obtained from each patient who voluntarily participated after
a clear explanation of the research objectives. Parents or guardians signed
consent on behalf of the children enrolled in this study. The inclusion criteria
of participation was: cases of ACLF associated with hepatitis B and chronic
hepatitis B (CHB) regardless of age, gender, whereas the exclusion criteria
were cases who did not give consent to participate in the study, in addition
to Individuals with concurrent hepatitis C virus (HCV), hepatitis E virus
(HEV), hepatitis A virus (HAV), or HIV infections or who had autoimmune
liver diseases were excluded or children with diarrhea who their ages are more
than 2 years old. Clinical data were obtained from patient’s medical record
with patient’s consent and permission from the hospital.
2.2
Subjects
This study was conducted between September 2012 and November 2014.
It was carried out on three groups, attending outpatient clinics of Ahmed
Maher Teaching Hospital, Cairo, Egypt.
• GROUP 1: 220 patients with acute-on-chronic liver failure (ACLF);
• GROUP 2: 120 patients with chronic hepatitis B (CHB); and
• GROUP 3: 140 children aged less than 2 years with diarrhea.
2.3
Clinical examination
It was done to all adult patients, patients with HBV-associated ACLF and
CHB were diagnosed according to previously described criteria by Zhang
et al. [35]. Late-stage ACLF was defined in the presence of more than
grade II hepatic encephalopathy and/or other complications (such as severe
hemorrhage, ascites, etc ...).
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104
Recovery in patients with ACLF was defined as [34]:
1. Liver function with normal alanine aminotransferase (ALT) and total
bilirubin (TBIL) for 6 months; and
2. Disappearance of clinical manifestations of liver failure after routine
treatment for 6 months.
Patients with ACLF other than those who had recovered or died were
defined as intractable cases. All patients with ACLF and CHB were followed
for 6 months, and fecal samples were collected on days 10, 20, and 30 after
the diagnosis of ACLF or CHB; additional fecal samples were collected if
diarrhea occurred.
Diarrhea was defined as three or more unformed stools in a 24 hours period. A patient was considered to be infected with Cryptosporidium if it was
detected positively by Modified acid fast Ziehl-Neelsen staining (MZN) and
or coproantigen detection by ELISA.
2.4
Stool specimens and processing
Fresh fecal samples were collected from all patients, into a dry, clean, wide
mouth plastic container containing no preservatives, with tight fitting lids.
Macroscopic examination was conducted at first regarding several aspects:
consistency, presence of blood and mucus and macroscopic parasitic elements.
Microscopic examination was then done using direct wet smear technique for
the presence of cysts of parasitic protozoa.
All samples were subjected to formalin-ether concentration (centrifugation
at 500 g for 10 min) and examined as wet saline and iodine preparation for
the detection of parasites. A 0.01 ml sediment sample was thinly spread on
two glass slides and air dried. Two dried smears were prepared from fecal
concentrate for special staining of Cryptosporidium spp. Slides were immediately fixed in methanol for 5 min. [12] A portion of unconcentrated stool
samples was stored at -20◦ C without any preservative for antigen detection.
2.5
Modified Acid Fast Ziehl-Neelsen Staining (MZN)
[25] [3]
Is classically performed by staining a methanol fixed thin smear of fecal material with undiluted carbol-fuchsine solution for at least 15 minutes.
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105
Subsequently, the slide is rinsed in tap water and placed in an acid-alcohol
solution to remove the stain, while acid-fast structures will resist to the acidalcohol’s destaining action. After rinsing again, the slide is placed for a
short period of time in a counter-staining product, such as methylene blue,
providing contrast between background material and acid-fast structures.
The slide is rinsed once more and after the slide has been air-dried, The
slides were screened under 10X, 40X and 100X of light microscope for identification of Cryptosporidium. Cryptosporidium oocysts will appear as pink
stained, round to oval structures of about 3 to 6 µm in diameter, containing
distinct internal structures. The intensity of infection was estimated semiquantitatively according to the average number of oocysts at 1000 magnification, and the categories established were: negative (absence of oocysts),
slight (1-5 oocysts), moderate (6-10 oocysts), and severe (> 10 oocysts) [19].
3
Cryptosporidium Antigen detection
It was detected by using a commercial RIDASCREENr, R-Biopharm AG,
Germany. Cryptosporidium coproantigen detection is an enzyme immunoassay for the qualitative determination of Cryptosporidium parvum in stool
samples. This Cryptosporidium antigen ELISA described here is of high sensitivity 100%, negative predictive value (NPV) 100.0% [5] and requires no
special personnel trained in parasitology to perform it, is quick and simple
to use and does not rely on the presence of intact organisms in the stool
sample.
The samples were centrifuged at 5,000 rpm (approx. 2,300 g - 2,500 g) for 5
minutes as the test procedure is carried out in an automated ELISA system.
High positive patient samples may cause the substrate to precipitate as a
black sediment. Samples are considered positive if their extinction is more
than 10% above the calculated cut off. Samples are considered equivocal and
must be repeated if their extinction is within ±10% of the cut-off.
4
Statistical Analysis
The results of the study were analyzed using SPSS software v. 11.0. The
Chi-square test was used to determine the relationships. The Student’s t-test
was used to compare groups with continuous data measurement.
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106
Table 1: Age and sex distribution among the studied groups
Studied group
ACLF
CHB
Infants with Diarrhea
Number of
Cases
220
120
140
Age range
[years]
25-50
30-50
0.3-2
Male
Female
25
13
32
195
107
108
Cases detected by coproantigen ELISA for Cryptosporidium were including
the cases detected by MZN. The Frequency of Cryptosporidium infection in
patients with HBV-associated ACLF was 9.5% (21/220), in CHB patients
was 2.5% (3/120), and in children with diarrhea was 5.0% (7/140) (Table
3). Results showed that the rate of positive Cryptosporidium infection in
HBV-associated ACLF patients was significantly higher than that in CHB
patients and that in diarrheic children (p < 0.01 for both). ACLF patients
with Cryptosporidium infection showed no severe or watery diarrhea.
Table 2: Some liver functions tests in the studied groups
Studied
Group
ACLF
CHB
Infants with
Diarrhea
Alanine
Aminotransferase
(ALT) [U/L]
Range
Median
50-13,350
320
90-1,890
650
7-34
20
Prothrombin
Activity
(PTA) [%]
Range
Median
22.0-36.5
33
72.0-123.0
92
93.0-120.0
102
Total
Bilirubin
(TBIL) [µmol/l]
Range
Median
180.0-765.5
353.0
10.5-36.3
25.8
7.0-34.0
9.0
Table 3: Detection of Cryptosporidium infection by Modified acid fast ZiehlNeelsen (MZN) staining and coproantigen detection in stool
Studied
Group
ACLF
CHB
Infants with Diarrhea
Patients
[un]
220
120
140
MZN Stain
positive (+ve)
[un]
[%]
15
6.8
0
0.0
5
3.5
Coproantigen Detection
positive (+ve)
[un]
[%]
21
9.5
3
2.5
7
5.0
6
107
No significant relation, p > 0.05
Table 4: Prevalence of Cryptosporidium in late and non late stage of liver
failure
ACLF
Late-Stage Liver Failure
Non Late-Stage Liver Failure
Patients
[un]
88
132
Cryptosporidium
positive (+ve) negative (-ve)
[un]
[%]
[un]
[%]
7
7.9
81
92.1
6
4.5
126
95.5
All positive samples detected in ACLF and CHB patients by MZN (n = 15)
or coproantigen detection (n = 21) only showed mild to moderate infection
(1-5 oocysts/field of magnification), moderate (6-10 oocysts). However, one
diarrheic child had a severe infection (> 10 oocysts/field of magnification).
Clinical characteristics of Cryptosporidium infection in patients with ACLF
(Table 4), of the 220 patients with HBV-associated ACLF, 88 cases were defined as late-stage liver failure. The rate of positive Cryptosporidium infection in patients with late-stage liver failure (7.9%, 7/88) showed no significant
difference to that in patients not in the late stage (4.5%, 6/132) (p > 0.05).
Of the 88 patients with late stage ACLF (Table 4), 25 cases died or had
intractable disease and 63 cases recovered. The rate of positive Cryptosporidium infection in the recovered ACLF patients with late-stage liver failure
(7.9%, 5/63) showed no significant difference compared with that in patients
without recovery (8.0%, 2/25) (p > 0.05), suggesting that the severity of
HBV-associated ACLF was not associated with Cryptosporidium infection
in this study.
In addition, the Cryptosporidium-positive rate in ACLF patients complicated with infection (9%, 12/133) was significantly higher compared with
that in patients without signs or symptoms of infection (2.3%, 2/87) (p <
0.01), suggesting that Cryptosporidium caused infection in ACLF patients.
Among all 220 ACLF patients, 60 had diarrhea, ten of them were Cryptosporidium-positive (16.6%, 10/60), which is significantly higher than the
Cryptosporidium-positive rate in patients without diarrhea (3.1%, 5/160) (p
< 0.01). In addition, none of the 20 CHB (n=120) patients with diarrhea
7
108
were Cryptosporidium-positive. So this study data strongly suggest that
Cryptosporidium infection may be the cause of diarrhea in patients with
HBV-associated ACLF.
5
Discussion
Cryptosporidium parvum is an opportunistic parasite capable of causing
gastrointestinal illness in both immunocompetent and immunocompromised
patients as well as in children particularly in developing countries [21]. It
is now well known that immunosuppressed individuals are at higher risk for
Cryptosporidium infections, and that carriage of the parasite is associated
with diarrheal disease in most cases. Furthermore, in compromised individuals with diarrhea, the disease is much more severe and prolonged than in
otherwise healthy individuals [29].
Despite the consensus of opinion regarding the seriousness of Cryptosporidium infection in immunocompromised patients and the importance of protecting such patients from infection, there are insufficient valid data to allow
an accurate assessment of the prevalence of this infection in this group [13].
Gastrointestinal infections and symptoms of diarrhea often occur in patients
with HBV-associated ACLF, however whether Cryptosporidium infection is
involved in these cases remains unknown [33].
Screening of stool sediment smears by MZN, Modified Ziehl-Neelsen staining is a sensitive and specific approach for the identification of Cryptosporidium oocysts in stools [11]. In the present study, MZN stain was at the end
in ranking as compared to ELISA In spite of low cost, more time in preparation, staining, reading and interpretation of the smear. Additionally, it
requires considerable expertise to identify the oocysts and not to confuse it
with other ingredients of stool like yeast spores. In addition, it is not enabling to bulk processing which in accord with [7] and [9] however Weitzel
et al. [30], reported that coproantigen assays were less time-consuming and
easier to perform, but were less sensitive than conventional microscopical
methods reported by evaluation of seven commercial antigen detection tests
for Cryptosporidium in stool samples.
A positive rate of 5% was determined for Cryptosporidium infection in children with diarrhea aged younger than 2 years, this is consistent with initial
testing of stool samples in a study done in Egypt, 2012 by El-Mohammady et
al. [8] . These results were not consistent with the findings in other Chinese
8
109
reports (0.82-3.90%) [34] [4] [28]. Others reported a high percentage 41% of
the studied children less than 1 year old have Cryptosporidium in a research
done by Sánchez-Vega et al. in Mexico in 2006 [24].
Previous studies demonstrated that severe liver injury and liver failure are
closely associated with reduced cellular immunity [22]. Reduced cellular immune function could contribute to an increased susceptibility to infection in
subjects with chronic liver diseases, including infection with Cryptosporidium
[35].
Many reports have indicated that patients with ACLF and CHB have different immune statuses [29] [31] which may explain the significant difference
in the prevalence of Cryptosporidium infection between these two groups of
patients.
Clinical findings in this study indicated that the rate of positive Cryptosporidium infection in the recovered ACLF patients showed no marked
difference to the rate in patients who did not recover. So no marked difference between those with late-stage disease and those with early, or middle,
stage disease, this suggested by Yu et al. [34].
In AIDS patients, Cryptosporidium infection can promote disease progression and worsen the prognosis of the disease [6]. Our investigation
showed Cryptosporidium infection was not correlated with the progression
or severity of ACLF. Nevertheless, Cryptosporidium infection occurred in
ACLF patients with signs or symptoms of infection. Furthermore, Among
all 220 ACLF patients, 60 had diarrhea and ten of them were Cryptosporidium-positive (13.8%, 10/60), which is significantly higher than the Cryptosporidium-positive rate in patients without diarrhea (3.1%, 5/160) (p <0.
01). These results indicate that Cryptosporidium infection might be a significant cause of diarrhea in patients with HBV-associated ACLF was coincided
with Yu et al. in a study done in China [34].
In our study, all positively stained fecal sample slides from ACLF patients,
detected by MZN, contained only a few oocysts (1-5 oocysts/field of magnification) and none of 21 ACLF patients with Cryptosporidium infection
suffered intractable diarrhea or watery diarrhea. These results indicate that
the clinical significance of Cryptosporidium infection in these patients needs
to be further investigated. ACLF patients with Cryptosporidium infection
9
110
received no specific anti-Cryptosporidium treatment; it is necessary to evaluate whether early treatment of Cryptosporidium infection can shorten the
hospitalization time and promote improvements in liver function.
6
Conclusion
The prevalence of Cryptosporidium infection in patients with HBV-associated
ACLF was markedly high compared with the prevalence in CHB patients and
in children with diarrhea. Cryptosporidium infection does not appear to be
problematic in patients with HVB-associated ACLF Unlike the negative effect Cryptosporidium infection has on AIDS patients; However, Cryptosporidium infection might be a significant cause of diarrhea in patients with HBVassociated ACLF. The clinical significance of this parasitic infection needs to
be further studied.
6.1
Conflict of Interests
The authors declare that there is no conflict of interests regarding the
publication of this paper.
6.2
Acknowledgements
We are grateful for the generous cooperation of authorities and staff from
Ahmed Maher Teaching Hospital and Ain Shams University Hospital throughout sampling.
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STRONG INTENSITY OF UNKENREFLEX
DEFENCE MECHANISM IN
YELLOW-BELLIED TOAD, BOMBINA
VARIEGATA (LINNAEUS, 1758), FROM
MT. PRENJ (BOSNIA AND
HERZEGOVINA)
(Letter)
ZIMIĆ, A.
∗
January, 2015
Abstract: The article presents one etiological observation of strong
intensity of defense mechanism know as unkenreflex in Yellow-bellied toad.
The behavior was noticed in the alpine area of Mountain Prenj.
Key words: Etiology, Behavior, Dinaric Alpes, Amphibians.
1
Background and Preliminary Observational
Study
Yellow-bellied toads protect themselves from predators by four know mechanisms: cryptic coloration, fleeing, unkenreflex (personal observation) and
production of noxious secretions [10]. The most common (apart from fleeing) is unkenreflex [2], which is also one of the rarest defensive mechanisms
in anurans [17].
Observations were carried out in an alpine area on Mountain Prenj, in a
place named ”Jezerce” (small pond), on altitude of 1,602 m, on August, 28th ,
∗
BSc, Scientist and Researcher at Herpetological Association in Bosnia and Herzegovina
(ATRA) (Sarajevo, Bosnia and Herzegovina) E-mail: [email protected]
1
116
Figure 1: Habitat of Bombina variegata on the Mountain Prenj, and location
of preliminary observational behavioral study. (Source: BHHU Atra
2013, between 8:30pm to 9:00pm. This habitat is place for an additional four
species: Ichthyosaura alpestris larvae, Bufo bufo and Bufotes viridis tadpoles,
and Natrix natrix [16]. The pond is very shallow, about 5-10 cm depending
on weather conditions, and almost without aquatic vegetation (Fig. 1).Unkenreflex was deliberately provoked by dropping toads from height 10-20 cm
above the ground on the rock (1), mud (2) and water (3) (stimulating effect
of birds of prey), birds often drop their prey during an attack [5].
First, individual immediately made a full unkenreflex (Fig. 2.1) and began
to roll over, under the influence of gravity force, towards the water body (fig.
2.2 to 2.5). Finally, stopped in the water and turned on his back, the toads
weren’t moving about 10 to 20 seconds (Fig. 2.6).
However, in the second and third observations, were made by motivating
the third Bombina variegata to move toward deeper water and into again the
mud. In both cases toad’s behavioral patterns were observed to instinctively
made a full unkenreflex again, for about 10 seconds. However, reformulated
and then switched to partial movements in about 10 seconds and fled.
In like manner, this behavior tells us about the preferences of defensive
mechanisms in yellow-bellied toads, unkenreflex is most likely used in some
individuals, even when toad is at the place where it can do other defense
mechanisms like fleeing. It is known that yellow-bellied toads flee into the
water and hide in the mud with circular movements of extremities, which
2
117
Figure 2: Rolling unkenreflex (sequence 2.1 to 2.6). (Source: Author)
aims to blur the water in which they are located [3]. But, this mechanism
is not very effective because the yellow-bellied toads can’t stay long under
water (personal observation).
However, in the second and third observations, were made by motivating
the third Bombina variegata to move toward deeper water (Fig. 3A) and
into again the mud (Fig. 3B).
Rolling unkenreflex should not be treated as a new defensive mechanism,
nor new type of unkenreflex. It is only a result of strong will of the toads to
do unkenreflex and impact factors (dropping, gravity, gradient) that led to
3
118
Figure 3: Unkenreflex in the deeper water (3A), and into the mud (3B).
(Source: Author)
this case. Even though, there are known instances of similar conduct known
as rolling escape or balling behavior [7] [12].
It is also important to say that yellow-bellied toads don’t make the mechanism of ”flipping onto the back”, as it can be shown in many pictures. That
pose can be a result of accidental rotation of individuals (like in this case) or
deliberate rotation by humans.
”Flipping onto the back” mechanism is defining as an ability of deliberately jumping-rotation by animals [18] [17], it is useful to know that many
described unkenreflexes in anurans [9] [6] [8] [11] [14] [1] [4] [15] [19] should
be also treated as different defensive mechanism called ”eye-protection” [17].
This mechanism may function as a protection that allows a frog to be
swallowed without much harm after regurgitation [13].
In the end the question arises: Can fire-bellied toads learn to stop using
unkenreflex, that is, do they use it strongly in places where harassments are
rare?
References
[1] ANDREONE, F. Boophis albilabris (NCN). Defensive behavior.
Herpetological Review, 33(4): 299-300, 2002.
[2] BAJGER, J. Diversity of Defensive Responses in Populations
of Fire Toads (Bombina bombina and Bombina variegata).
Herpetologica, 36: 133-137, 1980.
[3] BOLKAY, S. Amphibien und Reptilien von Sarajevo. Glasnik Zemaljskog muzeja Bosne i Hercegovine, 41: 57-78, 1929.
4
119
[4] CARRETERO, M.A., SILLERO, N., CORTI, C., JORGE, F., FREITAS, S., ARAKELYAN, M. Unkenreflex in Rana macrocnemis
from Armenia. Herpetology Notes, 4: 067-069, 2011.
[5] DODD, C.K., BRODIE, E.D. Defensive mechanisms of Neotropical salamanders with an experimental analysis of immobility
and the effect of temperature on immobility. Herpetologica, 32(3):
269-290, 1976.
[6] GARCÍA-PARÍS, M., ESTEBAN, M. Nouvelles données sur la
réaction de défense reflexe (Unken-reflex) chez Rana temporaria, Linnaeus, 1758 (Anura; Ranidae). Bulletin de la Société
Herpétologique de France, 51: 33-36, 1989.
[7] GARCÍA-PARÍS, M., DEBAN, S.M. A novel antipredator mechanism in salamanders: rolling escape in Hydromantes platycephalus. Journal of Herpetology, 29(1), 149-151, 1995.
[8] HARBE, W., WILKINSON, J.W. A note on the unkenreflex and
similar defensive postures in Rana temporaria (Anura, Amphibia). British Herpetological Society Bulletin, 61: 16-20, 1997.
[9] HINSCHE, G. Vergleichende untersuchungen zum sogenannten
unkenreflex. Biol. Zentralbl., 46, 296-305, 1926.
[10] KISS, G., MICHI, H. Uber das Giftsekret der Gelbbauchunke,
Bombina variegata L.. Toxicon, 1(1): 33-34, 1982.
[11] McCALLUM, M.L. Acris crepitans (Northern Cricket Frog)
death feigning. Herpetological Review, 30(2): 90, 1990.
[12] McDIARMID, R.W., GORZULA, S. Aspects of the reproductive
ecology and behavior of the Tepui toads, genus Oreophrynella
(Amphibia, Bufonidae). Copeia, 445-451, 1989.
[13] SAZIMA, I. Experimental predation on the leaf-frog Phyllomedusa rohdei by the water snake Liophis miliaris. Journal of
Herpetology, 8(4): 376-377, 1974.
[14] SCHLŬPMANN, M. Schreckruf und unkenreflex beim Grasfrosch
(Rana temporaria) sowie Anmerkungen zu Schrecreaktionen
bei Amphibien. Z. f. Feldherpetologie, 7: 29-35, 2000.
[15] STOJANOV, A. Ein ungewŏhnliches Verhalten bei Rana dalmatina, Bonaparte, 1840. ŎGH-Aktuell, 16: 11-12, 2005.
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120
[16] S̆UNJE, E., ZIMIĆ, A., STJEPANOVIĆ, B., JUSIĆ, B., C̆ENGIĆ, M.,
BRADARIĆ, M., MERDAN, S. Biodiversity of herpetofauna of
Prenj and C̆vrsnica Mts. (Bosnia and Herzegovina). Hyla, 4(2):
4-19, 2014.
[17] TOLEDO, L.F., SAZIMA, I., HADDAD, C.F.B. Behavioural defences of anurans: an overview. Ethol. Ecol. Evol. 23: 1-25, 2011.
[18] WILLIAMS, C.R., BRODIE, E.D., TYLER, M.J., WALKER, S.J. Antipredator mechanisms of Australian frogs. Journal of Herpetology, 34(3); 431-443, 2000.
[19] ZIMIĆ, A., C̆ENGIĆ, M., MERDAN, S., JELIĆ, D. Nivo istraz̆enosti faune vodozemaca (Amphibia) i gmizavaca (Reptilia) Spomenika prirode ”Tajan” (BiH). Hyla herpetolos̆ki bilten,
2013(1): 22-45, 2013.
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USE OF SATELLITE TAGS TO REVEAL
THE MOVEMENTS AND INTERACTIONS
OF SHARKS WITHIN THE NEUM BAY
AND THE REST OF ADRIATIC SEA
Swisher, A. ∗Gajić, A.
†
January, 2015
Abstract: The Neum Bay presents the largest section of the marine
part of Bosnia and Herzegovina; which present the most unexplored area in
the entire Adriatic sea. According to the actual checklist, there are seven
registered species of sharks in Bosnia and Herzegovina [2], with no data
about movements and populations. In this paper authors present methods
that can bring scientific data about movements of the sharks through the
Neum Bay and their interactions with Malostonski Bay and the rest of the
Adriatic Sea. This will help to discover the actual state of sharks in Bosnia
and Herzegovina.
Key words: Shark, Tagging, Neum, Migrations, Biodiversity.
1
Introduction
Historical date shows that Neum Bay has been researched only twice in
last two centuries. The first major research was held in the late 1970’s by
Dr. Tonko S̆oljan and his team from Institute of Oceanography and Fisheries from Split (former republic of Yugoslavia, today republic Croatia). The
second research was held in September 2011 by Andrej Gajić and his team
from Sharklab (Hamrun, Malta) and Society for animal protection and inventory (Sarajevo, Bosnia and Herzegovina). Both researches had inventory
caught and have not dealt with any detail about population of sharks; and
∗
†
MSc, Researcher Scientist at SharkLab (Hamrun, Malta) e-mail: [email protected]
MSc, Researcher Scientist at SharkLab (Hamrun, Malta)
1
122
did not explain whether sharks occur in Neum Bay or whether there is a
stable population of sharks smooth-hound inhabit in marine part of Bosnia
and Herzegovina. There have not been any satellite tagging projects in the
Adriatic Sea thus far.
Tagging species is an extremely efficient way of collecting vast amounts
of data, both over a large period of time and short period of time. There
are many different tagging methods, all depending on the source of data
desired as well as the specie’s environment and size. M-tags (Figure 1 & 2),
Spaghetti tags and Roto-tags (Figure 3 & 4) are an efficient way of collecting
continuous data for a long period of time. Most of these tags are composed
of plastic, and positioned at the base of the dorsal fin of a shark. These
conventional tags display an ID number as well as a contact number.
Figure 1: M-tag, used predominately in larger shark species.
Swisher, A.)
(Source:
Figure 2: Detail of the newer M-tag (Source: NOAA [2])
Various data is recorded at the time of attachment including measurements, location, sex, identifying marks, etc... Therefore, when a tagged
shark is recovered, one can refer back to its original data and detect a pattern as well as learn the growth and its straight-line movement patterns.
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123
Unfortunately, this method of tagging only provides the net distance travelled and time elapsed between the tagging and the recatch site, and it does
not provide any temperature, depth or actual path. These plastic tag devices
are good for a majority of shark species and very reliable and require easy
attachment for low amounts of stress. These conventional tags also give way
to a continuous amount of data collecting.
Figure 3: Attaching the Roto-tag on large tiger shark. (Source: Geary, D.)
To attain a large amount of precise data over a short period of time,
it is best to use a satellite tag. There is a large assortment of satellite
tags including SPLAH tags, Pop-up tags, SPOT tags, and TDR tags. Each
one measures a precise objective and is fit to suit the size of the species.
Furthermore, satellite tags eliminate the need for physical recovery. Recently,
there have been developments of small pop-up satellite tags, which are very
effective in tagging species that were previously too small to have been fixed
with a satellite tag.
2
Material and Methods
This paper is based on personal experience of the Authors in different
types of shark tagging programs in the Gulf of Mexico with blacktip sharks
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Figure 4: Roto-tag is beeing attached on large black tip shark. (Source:
Swisher, A.)
(Carcharhinus limbatus (J. P. Mŭller & Henle, 1839)) and the Bahamas,
with several shark species including tiger sharks (Galeocerdo cuvier Péron &
Lesueur, 1822), nurse sharks (Ginglymostoma cirratum (Bonnaterre, 1788)),
lemon sharks (Negaprion brevirostris (Poey, 1868)), and some other species;
and personal experience of Gajić in researching of biodiversity and ecology
of Neum Bay, in September 2011 and different series of studying biology and
ecology on sharks, some of which occurs in the Adriatic Sea, and marine part
of Bosnia and Herzegovina, which include Neum Bay.
With personal experience in different types of shark biology of authors and
after consulting available literature, we are suggesting a best method of shark
tagging for Neum Bay.
3
Results ans Discussion
According to actual check-list, there are seven registered and eleven possible, shark species in the waters of Bosnia and Herzegovina [2].
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125
To this date, there have been no records of shark tagging in the Adriatic Sea, and therefore there is very little information about the sharks that
inhabit these waters. With such a huge lack of data we are not able to understand the sharks movements inside the Neum Bay, and their interactions
with other parts of Adriatic and Mediterranean Sea. The two most prevalent species of shark that reside in the Adriatic Sea, and can be particularly
found off the coastal waters of Bosnia and Herzegovina, are the leser-spotted
cat shark (Scyliorhinus canicula (L.)) and common smooth-hound (Mustelus
mustelus (L.)) These are generally a small species only reaching on average approximately 45-200 cm in total length. In order to understand these
species, including the subpopulations, distribution, and migration patterns,
it is important to implement a plan on gaining this knowledge. The most
appropriate tag for either S. canicula or M. mustelus, would be a popup
satellite archival transmitting tag (PSAT), specifically a MiniPAT or X-tag
(Figure 5).
Figure 5: MiniPAT, pop-up Archival Transmittig Tags which are best to use
for small species that are most common in the Neum Bay (Source: Wildlife
Computers)
The size of these tags are considerably smaller than other commercially
available satellite tags, thus permitting the use of advanced tagging technology to track the movements of these relatively small species. Attached
tags on small-spotted cat shark and common smooth-hound can be seen at
Figures 4 and 5. The MiniPAT records depth, temperature, and light-level
data while being towed by the animal. At a user-specified date and time,
the MiniPAT actively corrodes the pin to which the tether is attached, thus
releasing the MiniPAT from the animal. The MiniPAT then floats to the surface and transmits summarized information via the Argos system (Wildlife
Computer 2011). Argos also uses the transmitted messages to provide the
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126
position of the tag at the time of release. The transmitted data are sent to
the researcher by Service Argos.
Figure 6: PTT-100 X Pop-up Tag on the first dorsal fin of the smooth-hound
shark (Mustelus mustelus). (Source: NFRDI, adapted by: Gajić, A.)
The data can be analyzed further by the researcher using Wildlife Computers PC-based WC-DAP software. The results provide the migration path
taken by the study animal, depth and temperature preferences of the study
animal, as well as oceanographic data in the form of depth-temperature
profiles (Wildlife Computers 2011). The X-tag works generally the same.
The generated data collected may provide sufficient information to present
an overall and consistent trend in the horizontal movement patterns of this
species. The information will then give way to possible distribution of these
species as well as detailed migratory patterns. Along with the satellite tag, it
would be necessary to create an ongoing data base with data collected from
plastic tags, particularly M-tags and Roto-tags. These will be fixed onto
both the primary species of study, and any by-catch of other shark species
in order to gain a broad knowledge of these fish, and determine distribution,
sub populations, and growth patterns. This will also allow for a continuous
recovery of field data.
4
Conclusion
Historical date shows that Neum Bay has been researched only twice in
last two centuries. According to actual check-list, there are seven registered
and eleven possible, shark species in the waters of Bosnia and Herzegovina
[2].
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127
Tagging species is an extremely efficient way of collecting vast amounts
of data, both over a large period of time and short period of time. There
are several methods used in shark tagging program, which mostly depends
of the size and environment of the species that you want to track. M-tags,
Roto-tags and Spaghetti tags are an efficient way of collecting continuous
data for a long period of time.
To this date, there have been no records of shark tagging in the Adriatic Sea, and therefore there is very little information about the sharks that
inhabit these waters. With such a huge lack of data we are not able to understand the sharks movements inside the Neum Bay, and their interactions
with other parts of Adriatic and Mediterranean Sea. The two most prevalent species of shark that reside in the Adriatic Sea, and can be particularly
found off the coastal waters of Bosnia and Herzegovina, are the leser-spotted
cat shark (Scyliorhinus canicula (L.)) and common smooth-hound (Mustelus
mustelus (L.)) These are generally a small species only reaching on average approximately 45-200 cm in total length. In order to understand these
species, including the subpopulations, distribution, and migration patterns,
it is important to implement a plan on gaining this knowledge. It is recommended to use a popup satellite archival transmitting tag (PSAT), specifically a MiniPAT or X-tag; which are the most appropriate tag for either S.
canicula or M. mustelus.
The MiniPAT records depth, temperature, and light-level data while being
towed by the animal. Along with the satellite tag, it would be necessary to
create an ongoing data base with data collected from plastic tags, particularly
M-tags and Roto-tags. These will be fixed onto both the primary species of
study, and any by-catch of other shark species in order to gain a broad
knowledge of these fish, and determine distribution, sub populations, and
growth patterns. This will also allow for a continuous recovery of field data.
Various data is recorded at the time of attachment including measurements,
location, sex, identifying marks, etcetera.
References
[1] GAJIĆ, A., & LELO, S. Promjenjivost zuba i zubala morske
mac̆ke bljedice Scyliorhinus canicula (Linnaeus 1758) (Elasmobranchii: Carcharhiniformes, Scyliorhinidae). U Jadranskom moru, Rukopis, 2010.
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128
[2] NATIONAL
OCEANOGRAPHIC
AND
ATMOSPHERIC
AGENCY (NOAA). Shark Tagging Program. Available at
http://www.sefsc.noaa.gov/labs/panama/species/shark/sharktag.htm.
Accessed in Jan. 6th, 2015.
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