Regulatory Action Center Review - October 7, 2019   


Welcome to FreedomWorks Foundation’s nineteenth regulatory review of 2019! Our Regulatory Action Center proudly updates you with our favorite tidbits from the swamp. We want to smash barriers between bureaucracy and the American people by delivering regulatory news straight to FreedomWorks activists. Check back in two weeks for the next edition.

1) Video of the Week: Unsurprisingly, the United States is not the first country to experience ballooning budgets and astronomical deficits. In the mid-1990’s, Canada’s debt grew to as high as 70% of GDP, similar to our current debt situation. In this weeks video, John Stossell sits down with Canadian economist David Henderson to discuss how Canada managed to tackle their debt problem by cutting government spending and reducing waste.

2) Why Is the CDC Still Fostering Potentially Deadly Confusion About Vaping and Lung Disease?: “Media outlets, following the lead of the U.S. Centers for Disease Control and Prevention (CDC), continue to blame recent cases of severe respiratory illnesses among vapers on "vaping" and "e-cigarettes" in general, falsely implying a link to legal nicotine products. This misinformation is fostering public confusion that may lead to more disease and death, both from smoking and from the black-market products that have been implicated in the lung disease cases.”

3) FBI using Facebook ads to gather Russian intelligence: report: “The FBI is reportedly using Facebook ads to gather intelligence on Russia, specifically targeting those who may be or know Russian spies. The FBI is running ads in the Washington, D.C., area, CNN reported on Wednesday, that direct to the FBI field office's website that describes its counterintelligence team and encourages visitors to meet "in person."

4) Federal Court Upholds FCC Decision to Roll Back Obama-Era Net Neutrality Rules: “Today, by a 2-1 vote, the United States Court of Appeals for the District of Columbia Circuit sided largely with the FCC, upholding the primary regulatory rollback as a valid exercise of its authority. In the nearly 200 page opinion, which is heavy on technical detail, the court wrote that while the challengers raised "numerous objections" aiming to show that the FCC's reclassification is "unreasonable," the judges found them "unconvincing."

5) Trump to issue executive order ‘protecting’ Americans from ‘Medicare for All’ campaign proposals pushed by Democrats: “The executive order, which he is scheduled to discuss at a speech in Florida later Thursday, is intended to bolster Medicare Advantage, private Medicare insurance for seniors that currently covers 22 million people, senior administration officials said on a call with reporters. The plan would also offer more affordable plan options, increase use of telehealth services and bring payments in Medicare fee-for-service program in line with payments for Medicare Advantage, officials said.”

6) Treasury to create tool to help people redeem billions in unclaimed savings bonds: “Sen. John Kennedy (R-La.) on Wednesday said that the Treasury Department will create an online tool to help people redeem billions of dollars in savings bonds. About $26 billion in matured savings bonds are in the U.S. Treasury and have yet to be redeemed. Using the department's forthcoming tool, people will be able to verify against Treasury Department records if they have any savings bonds dated after 1974 that can be redeemed, Kennedy's office said in a news release.”

7) Trump takes heat from right over vaping crackdown: “The Trump administration is under fire from conservative groups and some GOP lawmakers, who are pushing back over its planned crackdown on e-cigarette flavors. They say the administration is overreaching, and the flavor ban will harm small businesses, a violation of core Republican free market principles.”


Experienced staff - ExpertCare - Shelby Charter Township, MI   

Caregivers will work on goals such as using a fork to feed himself, social skills, some community outings etc. There is one dog and no smoking in the home.
From ExperTcare - Wed, 17 Oct 2018 15:55:23 GMT - View all Shelby Charter Township, MI jobs

Comment on The “new meat” debate is getting old by Guest    

Five reasons to eat meat: 1. It tastes good. 2. It makes you feel good. 3. It supports the nation’s farmers. 4. It’s a great Canadian tradition. 5. Your parents did it. ...then again, you can make the same argument for smoking cigarettes so maybe there’s a bit more to it than that.

There is the Trump smoking gun, and now what?   

But Hillary's emails.

Is the C# Party Over?   


Originally posted on:

After a month of a busy schedule, I finally have time to go though my blog aggregator today. I noticed a few people in my feed mentioned this interesting article. If you have not read it yet, go read it. I think this guy is smoking something, but you can be the judge.


Tom Ford collabora con Mr Porter per un'esclusiva capsule collection   


Tom Ford ha collaborato con Mr Porter per lanciare una capsule collection da 31 capi ready to wear, accessori e calzature.

La collezione comprende una giacca smoking zebrata in bronzo, rifinita in raso (3980 euro), gilet in pelle scamosciata trapuntata e pelle (4990 euro), giacca trucker in pelle effetto coccodrillo (8990 euro) e gemelli in oro bianco 18-carati con diamanti (11590 euro).

“Siamo entusiasti di presentare una nuova ed esclusiva collezione autunno inverno 2019 di Tom Ford ai nostri clienti in tutto il mondo ", ha sottolineato Fiona Firth, direttore acquisti di Mr Porter, a

Foto: Mr Porter, Facebook


Miss Fury   

I was going to write about music but an e-mail from Rassa was about Miss Fury and I had no idea who Miss Fury was.

MISS FURY was a comic book about the superhero Miss Fury.  June Tarpe Mills created the character and the comic book.   Who?  From TARPEMILLS.COM:

June Tarpe Mills, known professionally as Tarpe Mills, rose from obscurity to become the creator of the world's first female comic heroine with the publication of Miss Fury six months before the creation of Wonder Woman. Tarpe Mills’ tremendous artistic talent poured onto the print page with action, glamour and fashion, and sexiness that was unheard of until Miss Fury. Tarpe Mills and her work has been memorialized by her July 19, 2019, induction into the Eisner Comic Hall of Fame at ComicCon SanDiego.

From AMAZON, a look at Miss Fury:

From the visuals alone, you have to wonder why, in the '00s, someone didn't cast Annette Benning or Catharine Zeta Jones or Halle Berry or Michelle Pfeiffer as Miss Fury in a film of the same name?  Today, you could add Keira Knightly, Kerry Washington, Natalie Portman, Isabela Moner and Anne Hathaway to the list.  Some might argue that you'd have to set the film in the forties.  You wouldn't 'have to,' but even if you did, are you forgetting that both the Captain America film (2011) and the Wonder Woman film (2017) were set in that period and both were huge hits?

This is from WIKIPEDIA:

Miss Fury[edit]

The Bell Syndicate first published the Miss Fury comic strip (then titled The Black Fury) on April 6, 1941, predating the first appearance of Wonder Woman by six months.[9] The strip "ran in full color in the Sunday comics pages for 351 consecutive weeks from 1942 through 1949, and was also collected in comic book form by Timely Comics."[10] Circulation included over 100 newspapers at its most popular stage.[11] As the Miss Fury strip became more popular, it eventually became public knowledge its creator was a woman.[12]
Miss Fury, the alter ego of socialite Marla Drake, was a character based loosely on Mills' own appearance.[12]
During World War II, "Miss Fury" was painted on the nose of three American warplanes in Europe and the South Pacific. Two of the recurring villains were the Nazi agents Erica Von Kampf and General Bruno. Mills' own white Persian cat Perri-Purr was introduced in the strip, and during World War II Perri-Purr became an unofficial mascot of the American troops.[6][13]


The artwork was created in a glamorous style with considerable attention placed on the heroine's outfits.[1][14] These outfits varied from lacy evening gowns and lingerie to bathing suits and athletic costumes.[15] Mills' attention to fashion in Miss Fury was mirrored in the work of her contemporary Dalia Messick's "Brenda Starr," and in this sense the women were ahead of their male counterparts who typically "dressed [their] heroines in plain red dresses."[16]
Cut-out paper fashion dolls were included for the first time in the comic-book reprints of Miss Fury, leading Trina Robbins to guess that these books were intended for a female audience.[15] Mills sent paper dolls to young women who had written fan mail requesting art.[9]


Miss Fury was notoriously full of "kinkiness," including “whips, spike heels, female-on-female violence, and lingerie scenes.”[2] One character's costume in a 1947 publication "was so daring that 37 newspapers cancelled the strip” that day.[15] A bathing scene from the tenth Miss Fury Sunday page on June 8, 1941 ran in newspapers at the time but was later excluded from the 1942 Timely Comics reprint.[17]
Trina Robbins said on Miss Fury:
“The only outrage I have seen were those newspapers that censored Mills’s strip in which she dressed her nightclub entertainer character, Era, in an outfit that would not bother us in the least today. But it obviously shocked the pants – yes, verbal joke intended – off some people."[9]


Mills' art in Miss Fury was modeled on the work of Milton Caniff.[18] Her portrayal of action across multiple panels, as well as the natural poses and facial expressions of her characters, has been described as "cinematic,"[19] echoing the film-noire style.[18][20] Mills' characters also possessed a "pinup quality."[19]
Dean Mullaney, editor and publisher behind Eclipse Enterprises, wrote that “[Mills’] art is drawn very traditionally—no surprises, no ah-ha moments.”[21]
Evie Nagy for The Los Angeles Review of Books remarked that “the flow of Mills’s sequential art feels completely organic."[19]


June Mills' legacy as the first woman to create a female action hero in comics was contextualized by Victoria Ingalls for the American Psychological Association. Out of a list of hundreds of female “superheroes” surveyed in her abstract, Ingalls identified only eleven as being created by a woman not working in a team with a male writer. Mills' Marla Drake is the chronological first of these eleven heroes.
According to Mike Madrid in his book The Supergirls, Marla Drake belongs to the “Debutante” caste of early comics female heroines, who include Sandra Knight (Phantom Lady), Dianne Grayton(Spider Widow), Diana Adams (Miss Masque), and Brenda Banks (Lady Luck). These characters form a ‘sorority’ of heiresses and socialites who had been forced into lives of propriety, submission, and “tedious leisure.” “Putting on a cape and mask liberated these women” to embrace their own identities, fight crime, and trade their “entitled boredom” for thrills.[22]
Madrid wrote, “Mills’ approach to a secret identity seemed more realistic, injected with a feminine practicality.”[22]

This is from an article at Australia's ABC:

Comics then and now tend to feature weak-kneed female characters who seem to exist for the sole purpose of being saved by a male hero — or, worse still, are "fridged", a contemporary comic book colloquialism that refers to the gruesome slaying of an undeveloped female character to deepen the hero's motivation and propel him on his journey.
But Mills believed there was room in comics for a different kind of female character, one who was able, level-headed and capable, mingling tough-minded complexity with Mills' own taste for risqué behaviour and haute couture gowns.
Where Wonder Woman's powers are "marvellous" — that is, not real or attainable — Miss Fury and her alter ego Marla Drake use their collective brains, resourcefulness and the odd stiletto heel in the face to bring the villains to justice.
And for a time they were wildly successful.
Miss Fury ran a full decade from April 1941 to December 1951, was syndicated in 100 different newspapers at the height of her wartime fame, and sold a million copies an issue in reprints released by Timely (now Marvel) comics.
Fighter pilots painted Miss Fury on the fuselage of bomber planes. Young girls played with paper doll cut outs featuring her extensive high fashion wardrobe.

From Australia's ABC -- emphasize.  Point being, Miss Fury was not known just in the US.  She had wide appeal.  So why isn't Miss Fury on the big screen?

"Iraq snapshot" (THE COMMON ILLS):
Friday, October 4, 2019.  Protests continue in Iraq while, in the US, Joe Biden continues to tarnish the legacy of Barack Obama.

Last week, Sarah Chayes, "Hunter Biden’s Perfectly Legal, Socially Acceptable Corruption" was published by THE ATLANTIC.  Yesterday on MORNING EDITION (NPR), Sarah spoke with David Green:

The impeachment inquiry into President Donald Trump is drawing attention to the questionable activities of more than one major political family. Former Vice President Joe Biden and his son Hunter are under scrutiny for Hunter's work in the Ukrainian energy industry.
The writer Sarah Chayes is the author of the book "Thieves Of The State: Why Corruption Threatens Global Security" (ph). And she argues this scrutiny is a good thing.

SARAH CHAYES: You know, when the son of a vice president gets a job in a field he knows nothing about while his father is vice president in a country that just had a revolution that, you know, typically, in that part of the world, post-revolution, all the oligarchs steal all the crown jewels, and the industry is one of the crown jewels - that is to say, gas - since when is that doing nothing wrong?

GREENE: Now, wrong does not necessarily mean illegal, Sarah Chayes told me. But she said too often these days, people with political ties or prominent political names are getting involved where they shouldn't be.

CHAYES: Almost any senior name that I start researching, I run into practices like this. It is extraordinarily widespread. And that's my question. How did we all convince ourselves that this isn't corrupt? And it seems to me that we're not going to recover, you know, even an approximation of the ideals on which we were founded as a nation unless each of us, as citizens, begins to make it less comfortable for our political and economic leaders to behave this way.

GREENE: Well, let me ask you this, then. If it is not unusual, why focus on this case of Hunter Biden and Joe Biden specifically?

CHAYES: Because it's in the news and because of the word that I kept seeing apply in this context, which is, no wrongdoing, or, they didn't do anything wrong. And I'm looking at that, saying, what? And if we can say that now, in this context, then there's something awry.

From her article at THE ATLANTIC:

When allegations of ethical lapses or wrongdoing surface against people on one side of the aisle, they can always claim that someone on the other side has done far worse. But taken together, all of these examples have contributed to a toxic norm. Joe Biden is the man who, as a senator, walked out of a dinner with Afghan President Hamid Karzai. Biden was one of the most vocal champions of anticorruption efforts in the Obama administration. So when this same Biden takes his son with him to China aboard Air Force Two, and within days Hunter joins the board of an investment advisory firm with stakes in China, it does not matter what father and son discussed. Joe Biden has enabled this brand of practice, made it bipartisan orthodoxy. And the ethical standard in these cases—people’s basic understanding of right and wrong—becomes whatever federal law allows. Which is a lot.

To quote THELMA & LOUISE, "You get what you settle for."  Is that what we're willing to settle for as a society?  Corruption and lack of ethics?  Or do we have standards that we apply across the board?  Basic expectations from our public servants?

Situational ethics will never root out corruption.

Replying to 
Or is it this maybe?? Because let’s face it: Joe Biden’s son Hunter failed rehab 5 times, got kicked out of the Navy, dated his sister in law, and left a crack pipe in a rental car. The idea Hunter got a job getting paid $50,000 a month should strike everyone as suspicious.

The crack pipe?

That gets back to the Biden pass.  His niece Caroline physically attacks a police officer and is arrested.  She gets a pass, no time.  A few years later, the niece steals over $100,000 and, again, no time sentenced, no time served.  Hunter and his crack pipe?

Yea, because smoking crack isint a crime. "Prescott Police Department officials were unable to reach Hunter Biden and, after an investigation, declined to prosecute"

And, again, campaign staff insists Hunter is the father of the child that he's denying is hit, the one the mother is suing him for.  These are the values of the Biden family.  These are the values we want in the White House?

Two kinds of justice -- the ones for everyone else and the ones for the Bidens?

America deserves much better than that.


And what the media and the Joe-bots don't get, the American people do.  MEDIAITE notes:

Joe Biden’s third quarter fundraising numbers are out. And they are an ominous sign for the former vice president’s 2020 candidacy.
According to Bloomberg, Biden told donors at a fundraiser in Palo Alto, CA that his campaign raised $15 million in the period from July-September. That number is down markedly from the $21.5 million he brought in during the second quarter.
Biden’s third quarter haul also, notably, lags behind that of two of his rivals. Sen. Bernie Sanders (I-VT) brought in $25 million over the past three months, while South Bend, IN Mayor Pete Buttigieg raised $19.1 million. Sen. Elizabeth Warren (D-MA), who has emerged as the main threat to Biden’s long-held frontrunner status, has not yet reported her third quarter numbers.
The vice president also came in way behind President Donald Trump — whose coffers grew by a whopping $125 million in the third quarter.

It's time for Joe to go.

It's no longer just about him.

Corrupt Joe makes it that much harder to call Donald Trump out for any corruption.

Corrupt Joe is tainting Barack Obama's legacy with every day.

What Joe allowed his family to get away with while he was Vice President?

That reflects poorly on Joe.  It also reflects on Barack.  And there's a lot more to come on that issue.  Joe is harming Barack's legacy.

It's time for Joe to go.

He offers nothing that is needed and seems to believe it's 1996.  He's out of touch, he's out of date and he's corrupt.  He needs to go.

Turning to Iraq . . .

REUTERS notes:

The death toll from days of violent demonstrations across Iraq has risen to 44 as unrest rapidly spread across the country despite a plea for calm from the prime minister.
In an overnight TV address, Adel Abdul-Mahdi said he understood the frustration of the public but there was no “magic solution” to Iraq’s problems. He pledged to make reforms, but this drew a scornful response from demonstrators.

REUTERS plays 'even handed' and head up the ass.  Why?  Maybe so they can continue to cover Iraq.  It's not like the western press isn't intimidated and bullied by the Iraqi government.

That's been going on openly since 2006.

UN urges Iraq to probe protest deaths ‘transparently’ National News

Mahdi is so inept as a prime minister that the president of Iraq has dominated the news for over six months.  The presidency is a symbolic office in Iraq.  It has no real power, pure ceremony.  But that's how weak Mahdi is and how desperate the western press has been to ignore reality in Iraq.

A non-functioning prime minister?  Well, hey, just report on the doings of the president and pretend like he's the leader of the country.

Journalist Mustafa Habib reports the following:


Jason Statham & Guy Ritchie Reteam for New Action Thriller   

Guy Ritchie and Jason Statham previously worked together on Lock, Stock and Two Smoking Barrels and Snatch.


Fisioterapia respiratória nas doenças pulmonares obstrutivas crônicas   



As doenças obstrutivas pulmonares podem ser agudas ou crônicas. As doenças obstrutivas agudas, ao serem tratadas, não evoluem para alterações perniciosas e o paciente retorna a sua funcionalidade integral, sem prejuízo recorrente na qualidade de vida. As doenças obstrutivas pulmonares crônicas vêm apresentando alto índice de óbito de acordo com a Organização Mundial de Saúde (OMS)1 e, ainda segundo esta agência de saúde, as alterações das vias aéreas no decorrer do tempo mostram um maior nível de gravidade, refletindo na redução da atividade física, que interfere nas atividades da vida diária e no número de internações decorrentes do agravamento do quadro sintomatológico.2

As doenças pulmonares obstrutivas crônicas (DPOC) acometem homens e mulheres, sendo menor a prevalência em mulhres. Segundo o estudo de Lokke et al.,2 a DPOC não têm relação direta com o gênero mas, sim, com fatores como a idade e o tabagismo. Ainda segundo o autor, a doença ultrapassa o sistema pulmonar, expandindo-se com repercussões orgânicas, sendo analisada como uma condição sistêmica. A prescrição e o acompanhamento dos pacientes portadores de DPOC pela fisioterapia respiratória é, portanto, importante para reduzir o impacto das repercussões sistêmicas.1,3

A limitação crônica do fluxo expiratório da DPOC, normalmente relacionada aos sintomas de aumento da produção de muco, dispneia e tosse, é uma avaliação importante para caracterizar a gravidade da doença e direcionar a escolha do tratamento.

No que diz respeito aos sintomas, foi publicado um estudo de coorte estável, em 20114, no qual 298 pacientes responderam a um questionário sobre qual sintoma os levou a buscar atendimento médico. O resultado indicou que a dispneia prevalece, seguida da tosse seca e com expectoração.

O diagnóstico e a gravidade da DPOC são definidos a partir dos parâmetros de função pulmonar, de acordo com as orientações da Global Initiative for Chronic Obstructive Lung Disease (GOLD). Apesar das caracterizações clínicas estarem estabelecidas, ainda é necessário um maior conhecimento dos vários estágios da doença.3-5

As doenças obstrutivas agudas ou crônicas apresentam alterações patológicas que impedem/limitam o fluxo aéreo de forma leve, moderada ou grave. Podem estar relacionadas com: a) estreitamento das vias aéreas por broncoespasmo (contração da musculatura lisa) e inflamação e edema da mucosa (bronquite); b) presença de material intrabrônquico, como secreções e tumores; c) compressão extrínseca (tumores), alterando a função pulmonar do paciente.6

Para caracterizar as alterações patológicas do sistema respiratório, vale ressaltar as suas funções fisiológicas. O aparelho respiratório, isento de doenças, apresenta mecanismos de defesa importantes e eficientes para a manutenção da sua funcionalidade. As defesas são divididas em imunológica (natural e adquirida) e mecânica (relativa à estrutura pulmonar). São elas que mantêm íntegras as condições para a troca gasosa, a filtração aerodinâmica - que está relacionada ao tamanho do material inalado, concorrendo para a sua deposição na mucosa - e o transporte mucociliar, responsável pela eliminação do muco em direção a orofaringe.6,7

Estes mecanismos de defesa, nas doenças obstrutivas, podem estar gravemente comprometidos, propiciando infecções respiratórias, agudizando a doença e piorando a função pulmonar já comprometida.

A prevenção, a partir da supressão dos fatores de risco e o controle da progressão da doença obstrutiva podem ser imprescindíveis no impacto (positivo) da qualidade de vida, através de programa de tratamento integral. Aqui inclui-se a fisioterapia respiratória, de acordo com diversos autores como Bellamy et al., Gulini e Kunikoshita et al.8-10

O objetivo deste texto, com base na revisão de literatura, será demonstrar a intervenção da fisioterapia respiratória nas alterações patológicas da obstrução brônquica e sua consequente otimização na ventilação pulmonar.


A indicação da fisioterapia respiratória deve estar pautada no tempo e gravidade da doença, na relação do paciente com a mesma e nas comorbidades apresentadas, assim como a frequência e a duração do tratamento. Porém, deve ser levado em conta que a intervenção fisioterapêutica - iniciada imediatamente após o diagnóstico da doença obstrutiva e realizada regularmente pelo paciente - minimiza os efeitos deletérios da obstrução.11

As vias áreas obstruídas não são ventiladas e prejudicam as trocas gasosas, provocando hipoxemia e infecções por crescimento de micro-organismos. As consequentes alterações sistêmicas incluem complicações musculoesqueléticas e queda da endurance, prejudicando a qualidade de vida do portador de DPOC.10-13

A fisioterapia respiratória nas doenças obstrutivas tem como objetivo tratar o paciente proporcionando a melhora da sua funcionalidade pulmonar através da limpeza brônquica, estimulando a eliminação das secreções, relaxando a musculatura brônquica, otimizando a ventilação pulmonar e melhorando o condicionamento cardiopulmonar do paciente.14-16

Os métodos de avaliação da fisioterapia respiratória serão os parâmetros de evolução da doença. São eles: a anamnese, o exame físico, a oximetria, a análise do condicionamento cardiopulmonar, assim como os testes de função pulmonar, gasometria e radiografia de tórax. Dados subjetivos - como a percepção de dispneia, fadiga e dor, avaliados pelas escalas de Borg e visual analógica - são importantes para avaliação qualitativa.17-19 Os exames ergométricos, como o teste de caminhada em seis minutos e o teste do degrau, também são avaliações importantes para determinar o condicionamento cardiopulmonar dos pacientes.20,17


Em relação às técnicas intervencionistas, a aerossolterapia (com substâncias diluentes como a água e soluções salinas) é indicada quando a secreção se apresenta hiperviscosa e hiperaderente, visando facilitar a sua eliminação com o menor gasto energético.21,22

A aerossolterapia medicamentosa, indicada pelo médico assistente, atua nos processos inflamatórios e broncoespasmos. Para seu melhor aproveitamento, o paciente deve ser orientado a realizar um exercício respiratório de redução da velocidade de fluxo, tanto inspiratório - que otimiza a deposição das partículas de substâncias veiculadas -, quanto expiratório - que minimiza a velocidade de saída das partículas inaladas -, mantendo-as por mais tempo no ducto brônquico. Desta maneira, a filtração aerodinâmica é utilizada a favor do tratamento por aerossol.21

A desobstrução brônquica é um dos principais objetivos da intervenção fisioterapêutica nestas doenças. Atualmente, as técnicas são divididas em convencionais e atuais.


As técnicas convencionais da fisioterapia são a drenagem postural, percussões, expiração forçada e técnicas de tosse (tosse explosiva e huffing).

Drenagem postural e percussões

A drenagem postural pode ser associada à percussão. A drenagem, através das modificações da postura do paciente obedece a estrutura das vias aéreas em relação à ventilação dependente e não dependente. Isto estabelece o diâmetro do alvéolo sob atuação da força da gravidade, facilitando a drenagem.23-27

Os níveis de postura relativos aos decúbitos além de 0º são o Fowler, em que o paciente é colocado com o tórax elevado acima de 0º até 45º, e o Trendelemburg, que posiciona o paciente com o tórax rebaixado menor que 0º, no máximo. Esta técnica exige monitorização constante, em todos os níveis, pois há predisposição a alterações ventilatórias pela ação da força da gravidade no sistema cardiopulmonar e pelo deslocamento do muco, que pode se organizar em quantidade maior em determinada região e promover dispneia por bloqueio momentâneo da passagem do fluxo aéreo.

A indicação de determinada postura é relativa à área estrutural da árvore brônquica a ser tratada. As contraindicações à técnica são: edema pulmonar, insuficiência cardíaca congestiva, embolia pulmonar, hemoptise ativa, pressão intracraniana acima de 20 mmHg, hemorragia ativa, instabilidade hemodinâmica, infarto do miocárdio, derrames pleurais volumosos, lesões e cirurgias medulares, além de pós-operatórios imediatos.

A drenagem postural, no caso da DPOC, deve ser indicada de acordo com a gravidade da doença; os casos moderados e graves limitam a utilização desta técnica.

A percussão pulmonar mais utilizada é a tapotagem, que gera vibrações intrapulmonares, descolando e mobilizando, através do fluxo expiratório, as secreções na direção da traqueia e, ao entrar em contato com os receptores reflexos, estimulam a tosse e a consequente eliminação da secreção. Paralelamente, a vibração manual tem o mesmo objetivo da tapotagem e, ambas, deve(m) ser executada(s) na fase da expiração, o que otimiza a expectoração.

Por serem manobras (principalmente a tapotagem) realizadas na superfície externa do tórax, possuem contraindicações: lesões pulmonares, fraturas de costelas, osteoporose, hemoptise ativa, edema agudo, tumores, metástase pulmonar e broncoespasmo.23-26

A vibração manual na DPOC deve ser utilizada sob monitorização auscultatória e a tapotagem no enfisema deve ser evitada, pois pode estimular a musculatura brônquica e provocar broncoespasmos.

Técnica de expiração forçada

A técnica de expiração forçada pode ser realizada com pequeno, médio e grande esforço, sendo dependente da força dos músculos respiratórios empreendida para expirar um determinado volume pulmonar em uma velocidade de fluxo. Também conhecida como huffing, esta técnica tem o objetivo de deslocar a secreção brônquica e direcioná-la à orofaringe para ser expectorada, com a menor alteração da pressão pleural e reduzido gasto de energia. No caso da DPOC, deve ser orientada para ser feita com redução da velocidade de fluxo, minimizando o estimulo brônquico ao broncoespasmo.10,28,27

Técnicas de tosse (explosiva e huffing)

A tosse explosiva provoca um grande gasto energético, aumentando a dispneia e a percepção subjetiva de fadiga, o que - sabe-se - é prejudicial ao paciente com DPOC. Para minimizar os efeitos deletérios da tosse explosiva, o paciente deve ser orientado a realizar tosse a partir do conhecimento das suas fases, reduzindo a velocidade do fluxo, como o huffing (técnica de expiração forçada), e com a tosse controlada, minimizando seus efeitos.14,29,27


As técnicas desobstrutivas conhecidas como atuais são: drenagem autógena, ciclo ativo da respiração, aceleração do fluxo expiratório (AFE), associação de aparelhos como o sistema de pressão expiratória positiva (PEP) e o Flutter® ou Shaker® (pressão positiva oscilatória). Porém, no enfisema, algumas técnicas estão contraindicadas por estimularem a musculatura lisa brônquica e provocar broncoespasmos, como a AFE.12,14, ,23,25,27, 28

Drenagem autógena

Realizada em três fases, a drenagem autógena tem o objetivo de remover o muco das paredes brônquicas passando pelas fases de "descolar", coletar e eliminar o muco, através da respiração com diferentes volumes pulmonares. Para doenças que apresentam probabilidade de desenvolver broncoespasmo, a velocidade do fluxo deve ser controlada, inclusive com relação à tosse.

Ciclo ativo da respiração

Também realizada em três fases, a técnica consiste em ciclos respiratórios repetidos, através de respirações predominantemente diafragmáticas, seguidas de inspirações profundas com velocidade de fluxo lento, tanto na inspiração quanto na expiração e, por fim, a eliminação da secreção através do huffing, otimizando o transporte mucociliar. Esta técnica é indicada para os portadores de DPOC que podem desenvolver broncoespasmo.

AFE (aceleração do fluxo expiratório)

Esta técnica tem como objetivo aumentar a velocidade do fluxo expiratório e, assim, permitir o deslocamento do muco no ducto brônquico. É realizada através da manobra de compressão torácica associada ao fluxo expiratório. É contraindicada para as situações que podem desencadear broncoespasmo, por estimular a musculatura brônquica.


Indicada para reduzir o aprisionamento aéreo, reverter atelectasias e mobilizar secreções através da resistência ao fluxo respiratório. Presume-se que previne o colapso das vias aéreas e desloca as secreções em direção aos brônquios de maior calibre, facilitando a sua eliminação. De acordo com a indicação, pode ser utilizada na DPOC.

Flutter® ou Shaker®

Instrumento que associa a fisiologia da PEP à oscilações de alta frequência com o mesmo objetivo da PEP. A velocidade do fluxo expiratório pode ser controlada pelo paciente, sendo também indicada para a DPOC.


Os pacientes em esforço respiratório - seja por estarem na fase aguda ou na agudização da cronicidade, seja na fase da doença de moderada a grave - podem apresentar redução da incursão funcional da musculatura respiratória por excesso de uso, tornando-se hipertrofiada e em estado de retração. Essas alterações diminuem o movimento torácico e prejudica a ventilação pulmonar.30,27

Pacientes que ainda não apresentam tórax em tonel com alterações musculares estruturadas se beneficiam integralmente dos exercícios de alongamento e relaxamento muscular. Isto melhora a elasticidade muscular e, assim, permite a incursão funcional mais adequada da musculatura respiratória. Desta maneira, os movimentos torácicos são otimizados, o que permite a melhor expansão do tórax.

Os pacientes que apresentam quadro moderado ou grave da doença se beneficiam desta técnica de forma limitada, porém melhora a percepção subjetiva do esforço.


Os padrões respiratórios utilizados objetivam conscientizar os movimentos toracoabdominais da respiração, melhorar o movimento da caixa torácica, otimizar a funcionalidade da musculatura respiratória e promover a melhora da ventilação pulmonar e a consequente oxigenação. A cinesioterapia respiratória melhora o desempenho muscular, assim como estimula a endurance, propiciando um maior condicionamento cardiopulmonar.30,27


A intervenção da fisioterapia respiratória nas doenças obstrutivas pulmonares e, principalmente, na DPOC promove evidente benefício relativo à ventilação pulmonar. Apesar da ausência de estudos randomizados e ensaios clínicos controlados e, também, da pouca quantidade de dados disponíveis na literatura para algumas das técnicas desobstrutivas utilizadas o tratamento fisioterapêutico resulta em maior medida de secreção eliminada e melhora da perfusão e função pulmonar observada nos exames complementares pertinentes. Após a intervenção fisioterapêutica com desobstrução brônquica, relaxamento muscular e exercícios respiratórios, ocorre a melhora dos valores gasométricos, da ausculta pulmonar, da radiografia de tórax, dos testes de função pulmonar e da percepção subjetiva de dispneia, podendo, desta maneira, ser considerada relevante no tratamento do paciente com doenças obstrutivas.

Recomenda-se que estudos randomizados e de evidência clínica sejam realizados para proporcionar embasamento científico às técnicas utilizadas pela fisioterapia respiratória.


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2. Lokke A, Lange P, Scharling H, Fabricius P, Vestbo J. Developing COPD: a 25 year follow up study of de general population. Thorax. 2006;61(11):935-9.

3. Silvestre MV, Lima WC, Steidle LJM, Garcia RCB. Comparação da percepção subjetiva de esforço e da dispnéia em pacientes com DPOC estável durante o teste de caminhada de seis minutos e o teste do degrau de cadencia livre. Rev Fisioter Ser. 2011;6(4):218-22.

4. Bárbara C, Moita J, Cardoso J, Costa R, Redondeiro R, Gaspar M.. A Importância da Dispneia no diagnóstico da Doença Pulmonar Obstrutiva Crónica - uma análise descritiva de uma Coorte Estável em Portugal (Ensaio Clínico SAFE). Rev Port Pneumol. 2011;17(3):131-138.

5. Pauwels RA, Buist AS, Calverley PMA, Jenkins CR, Hurd SS, GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am J Respir Crit Care Med. 2001;163(5):1256-76.

6. Terra Filho, J. Avaliação laboratorial da Função Pulmonar. Doenças Pulmonares. Medicina. 1998;31:191-207.

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9. Gulini JEHMB. Exercício Físico em pacientes portadores de diferentes níveis de DPOC [Dissertação de Mestrado]. Florianópolis (SC): UDESC; 2006.

10. Kunikoshita LN et al. Efeito de três programas de fisioterapia respiratória (PFR) em portadores de DPOC. Rev Bras Fisioter. 2006;10(4):449-55.

11. Laizo A. Doença Pulmonar Obstrutiva Crônica - uma revisão. Rev Port Pneumol. 2009;XV(6):1157-66.

12. Roceto LS, Takara LS, Machado L, Zambom L, Saad IAB. Eficácia da reabilitação pulmonar uma vez na semana em portadores de doença pulmonar obstrutiva. Rev Bras Fisioter. 2007;11(6):475-480.

13. Lapperre TS, Sont JK, Schadewijk A, Gosman MME, Postma DS, Bajema IM, et al. Smoking cessation and bronchial epithelial remodeling in COPD: a cross-sectional study. RespirRes 2007;26(8):85.

14. Kris I, Dick V, De Backer L, Leemans G, De Backer W. Airway Clearance in COPD: Need for a Breath of Fresh Air? A Systematic Review. Chronic Obstruct Pulmon Disease J.2011;8(3):196-205.

15. Moreno J, Dal Corso S, Malaguti C. Análise descritiva do uso de ventilação mecânica não invasiva durante exercício em paciente com DPOC. Conscientiae Saúde. 2007;6(2):295-303.

16. Santos RS, Donadio MVF. Efeitos da suplementação de oxigênio no exercício em pacientes com doença pulmonar obstrutiva crónica não-hipoxemicos. Rev Cien & Saude. 2008;1(1):43-48.

17. Vilaró J, Resqueti VR, Fregonezi GAF. Avaliação clínica da capacidade de exercício em pacientes com doença pulmonar obstrutiva crônica. Rev Bras Fisioter. 2008;12(4):249-59.

18. Domingues PW, Almeida AF. Fisioterapia como Tratamento Complementar em Portadores de Doenças Respiratórias Obstrutivas. Rev Saúde e Pesquisa. 2010;3(2):173-179.

19. Weintraub M, Hawlitschek P, Amado JSM. Jogo educacional sobre avaliação em fisioterapia: uma nova abordagem acadêmica. Fisioter Pesq. [Internet] 2011 Set;18(3):280-286. Disponível em:

20. Rodrigues SL, Fonseca e Mendes H, Viegas CAA. Teste de caminhada de seis minutos: estudo do efeito do aprendizado em portadores de doença pulmonar obstrutiva crónica. J Bras Pneumol. 2004;30(2):121-125.

21. Martins ALP, Jamami M, Costa D. Estudo das Propriedades Reológicas do Muco Brônquico de Pacientes Submetidos a Técnicas de Fisioterapia Respiratória. Rev Bras Fisioter. 2005;9(1):33-39.

22. Ramos D, Ramos EM, Jardim JR, Faresin SM, Saldiva PH, Macchione M, Tigre E, et al. Efeitos da aerossolterapia nas propriedades físico-quimicas do muco brônquico. Rev Bras Fisioter. 2004;8(1):61-66.

23. Ramos D, Ramos EM, Jardim JR, Faresin SM, Saldiva PH, Macchione M, Tigre E et al. Drenagem postural x tapotagem x tecnica de expiração forçada: análise da transportabilidade do muco brônquico. Rev Bras Fisioter. 2003;7(3):223-228.

24. Lamari NM, Martins ALQ, Oliveira JV, Marino LC, Valerio N. Bronquiectasia e fisioterapia desobstrutiva: ênfase em drenagem postural e percussão. Braz J Cardiovasc Surg. 2006;21(2):206-210.

25. Tang CY, Taylor NF, Blackstock FC. Chest physiotherapy for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD): a systematic review. Physiotherapy. 2010 mar;96(1):1-13.

26. Dourado VZ, Godoy I. Recondicionamento muscular na DPOC: Principais intervenções e novas tendências. Rev Bras Med Esporte. 2004;10(4):331-334.

27. Liebano RE, Hassen MAS, Racy HHMJ, Corrêa JB. Principais manobras cinesioterapêuticas manuais utilizadas na fisioterapia respiratória: descrição das técnicas. Rev Ciênc Méd. Campinas. 2009;18(1):35-45.

28. Morsch ALBC, Amorim MM, Barbieri A, Santoro IL, Fernandes ALG. Influência da técnica de pressão expiratória positiva oscilante e da técnica de expiração forçada na contagem de células e quantidade do escarro induzido em portadores de asma ou doença pulmonar obstrutiva crônica. J Bras Pneumol. 2008;34(12):1026-1032.

29. Santos CISS, Ribeiro MAGO, Morcillo AM. Técnicas de depuração mucociliar: o que o pneumologista precisa saber? História, evidências e revisão da literatura. Pulmão. 2009;Supl 1:S54-S60.

30. Sonehara E, Cruz MSL, Fernandes PR, Policarpo F, Fernandes Filho J. Efeitos de um programa de reabilitação pulmonar sobre mecânica respiratória e qualidade de vida de mulheres obesas. Fisioter. mov. (Impr.) [Internet]. 2011 Mar [acesso em fev 2012];24(1):13-21. Disponível em


Kênia M. da Silva
Adalgisa I. M. Bromerschenckel

Programa de Pós-graduação Stricto Sensu em Ciências Médicas. Faculdade de Ciências Médicas. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.


Trans Smoking 65   

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There it is: Two men arrested for smoking during a ‘Joker’ screening in Chicago   


No word on if the two men caught smoking during "Joker" were incels.

The post There it is: Two men arrested for smoking during a ‘Joker’ screening in Chicago appeared first on




Français Partage Campagne Djerbienne Le bureau de mon père "presque vingt ans" Jaligny-sur-besbre Confession 11 janvier 1996 Voleur de poche Tribune libre à... Claudio J'aime le golf Ma première grève Une expérience Lo zio Gigi Le marchand de couleurs Un bouquet de tulipes jaunes La Camerata (la chambrée) "La Casa" La base américaine "La Galaxie des Ecrivains" Nous étions trop payés Mes 68 Pour la fin du monde Le sport et moi

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Joaquin Phoenix Is Trying to Quit Smoking with Hypnosis   

Joaquin Phoenix talks about his new effort to quit smoking and why he doesn’t enjoy talk shows. Subscribe NOW to The Tonight Show Starring Jimmy Fallon: …

Little bit of heaven adoption referral   

C is 29yrs old. This is her third pregnancy. She has a 2 and 9 yr old. They live with dad who is also father of this baby. She is in jail rt now for failing to pay court cost and failing to appear for drugs test and community services.  She may or may not get out of jail soon.  She is clean from heroin 30 days. That's the time she has been in jail. She admits to smoking weed and the heroin addiction.  She is not on anything at this time but one must assume unless she gets in a treatment program she will go back to what she knows. She states she has ADHD and Bipolar. No meds for this.

She use to smoke but does not alcohol during her pregnancy. She will probably go early because with her last children she had preeclampsia.  Both children are fine. The first was c section the last was natural birth but early.

Need Christian couple that can sign statement of faith. I need you to be sure your fine with drug use and fees. Est fee is $35,000 plus our fee. 

Need to know soon. They want to show her ASAP email me

Grundy County VAC in Morris to offer assistance for veterans to quit smoking   

The Veterans Health Administration (VHA) will be implementing two new policies eliminating smoking on the grounds of health care facilities by patients, visitors, volunteers, contractors, vendors and employees starting this month.

These new policies allow VA to ensure the health and wellness of patients, VA staff and the public.

“We are not alone in recognizing the importance of creating a smoke-free campus,” said VA Secretary Robert Wilkie. “As of 2014, 4,000 health care facilities and four national health care systems in the U.S. have implemented smoke-free grounds.”

The new smoke-free policy applies to cigarettes, cigars, pipes, any other combustion of tobacco, and e-cigarettes, vape pens and e-cigars.

VA has collaborated with key stakeholders to update and re-certify the policy to be consistent with VA’s commitment to Veterans and the community.

There is overwhelming evidence that smoking and exposure to secondhand smoke creates significant medical risks, as well as a growing body of evidence that exposure to third hand smoke creates additional risks to safety and direct patient care.

VA has extensive resources and programs to assist Veterans and employees in their smoke-free journey.

During October, the Hines Community Outreach Team will be sharing information and resources to help veterans stop smoking during the following dates:    

• Monday, Oct. 7 at the Morris American Legion 212 W Washington St., Morris from 9 a.m. to 2 p.m.

• Wednesday, Oct. 9 in Minooka at the Minooka Village Hall Community Room, 121 E. McEvilly Rd. Minooka from 9 a.m. to 2 p.m.

• Monday Oct. 21 in Coal City at the Coal City American Legion, 1752 E. Division St. in Diamond from 9 a.m. to 2 p.m.

Flu shots will also be available at these events.


United States gets its first cannabis cafe   

Representative image

Washington D.C [USA], Oct 8 (ANI): In a first, the United States on Tuesday opened the doors of its maiden cannabis cafe.
Named 'Lowell Farms: A Cannabis Cafe,' the eatery will be the first farm-to-table restaurant that highlights cuisine and cannabis.
The authorities of West Hollywood created eight cannabis consumption licenses and of more than 300 applicants, however, Lowell Farms was granted the first one, the restaurant said.
The restaurant will be the first cafe in the United States to be granted a fully legal cannabis consumption license, reported CNN.
At the cafe, head Chef Andrea Drummer has created a special menu that will be reflected Californian flavors, and it will feature seasonal dishes. Because of current cannabis legislation, the restaurant said that its dishes will not be infused with cannabis.
"In harmony with the West Hollywood community, the restaurant will offer a first-of-its-kind nightlife experience," a spokeswoman told CNN.
"Lowell Farms: A Cannabis Cafe will serve as a welcoming and safe environment for all to enjoy and learn about consumption in the newly legal world of cannabis," the spokesperson added.
The guests will have the opportunity to smoke marijuana at the cafe using joints, pipes, and bongs. With the area of the 5,900-square foot, the cafe will have both a smoking and non-smoking patio, and the entire indoor space is a designated smoking area.
"Lowell Farms: A Cannabis Cafe' was created because we believed there needed to be a destination for everyone to openly enjoy cannabis in the community," the cafe said in a statement.
"It is a welcoming space for those who are cannabis connoisseurs and those who are canna-curious and looking to experience cannabis in a welcoming atmosphere," the statement added. (ANI)


Income drop can take a toll on brain   

Representative image

Washington D.C. [USA], Oct 8 (ANI): A drop in your salary does not only affect your pocket and budget but can trouble the mind too.
Young adults who experience annual income drops of 25 per cent or more may be prone to thinking problems and reduced brain health in middle age, states a new study published in the Journal Neurology.
"Our results provide evidence that higher income volatility during peak earning years are associated with worse brain aging in middle age," said senior author Adina Zeki Al Hazzouri, PhD, assistant professor of epidemiology at Columbia Mailman School of Public Health.
The study involved 3,287 people who were 23 to 35 years old at the start of the study and were enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study.
Participants reported their annual pre-tax household income every three to five years for 20 years, from 1990 to 2010.
Researchers examined how often income dropped as well as the percentage of change in income between 1990 and 2010.
Based on a number of income drops, participants fell into three groups: 1,780 people who did not have an income drop; 1,108 who had one drop of 25 per cent or more from the previously reported income; and 399 people who had two or more such drops.
Participants were given thinking and memory tests that measured how well they completed tasks and how much time it took to complete them.
Researchers found that people with two or more income drops had worse performances in completing tasks than people with no income drops. On average, they scored worse by 3.74 points or 2.8 per cent.
"For reference, this poor performance is greater than what is normally seen due to one year in aging, which is equivalent to scoring worse by only 0.71 points on average or 0.53 per cent," said first author Leslie Grasset, PhD, of the Inserm Research Center in Bordeaux, France.
Participants with more income drops also scored worse on how much time it took to complete some tasks.
Of the study group, 707 participants also had brain scans with magnetic resonance imaging (MRI) at the beginning of the study and 20 years later to measure their total brain volume as well as the volumes of various areas of the brain.
When compared to people with no income drops, people with two or more income drops had smaller total brain volume. People with one or more income drops also had reduced connectivity in the brain.
One of the reasons according to researchers could be that people with lower or unstable income may have reduced access to high-quality health care which may result in worse management of diseases like diabetes, or management of unhealthy behaviours such as smoking and drinking. (ANI)


Figures reveal more women smoking during pregnancy in Wiltshire   

MORE women are smoking during pregnancy in Wiltshire, figures reveal.

Edgware Road, Colindale, London NW9   

Established pub/bar prominently situated in corner premises with wrap around frontage and rear outdoor terrace (smoking area). Arranged over 2 floors with late licence until 3am. Bar is fully fitted with bar area, several function rooms, kitchen,...
Thu, 03 Oct 2019 16:45:25 +0200

Free meals and passive smoking - the truth about appearing on television   

Well, we have all hung onto the wreckage for another week and so again we venture down Memory Lane. This week I am reflecting on my television appearances over the decades.

E-cigarette vapor linked to lung cancer in mice   

A new study is yet more evidence that vaping isn’t the completely safe alternative to smoking it was once thought to be.

Comment on Beat the Tweet: Impeachment Inquiry Has Trump Off Balance by Jim Thomas    

I am not a member of the "hard right". I am a progressive and former supporter of the thoroughly corrupt Democratic Party. I disagree that the transcript of the telephone conversation between Trump and Zelensky confirms any wrongdoing on the part of Trump. In fact I think a good lawyer can make Trump actually look pretty good by taking the position (whether in good faith or bad) that Trump was genuinely concerned about apparent wrongdoing by Biden and his son (for the receipt of large sums of money by the son for no apparent benefit to the company making the payments) and by the Democratic Party (for generating what appears to be false information in connection with its phony Russiagate accusations). In fact, I want those two matters to be investigated. Honest people need to understand how completely corrupt our electoral/political system has become. Elections are a bad joke on the people. When we go the polls (if we bother to do so at all) we are faced with the choice between two corporate candidates, already vetted and approved by the 1%. There is no one on the ballot who represents our interests. All the while, the elites of both parties are getting rich by serving the interests of the 1%. There is no functioning democracy in this Country. Trump, of course, is a terrible person and unfit to hold the office of President. The same is true of Hillary Clinton. I did not vote for either of them in the 2016 Presidential election. If the supporters of both of the principal political parties continue to just play the game like the 1% wants them to do, i.e. cheering on their respective parties, we will never effect any meaningful change. We must insist that all wrongdoing by all wrongdoers, regardless of party affiliation, be investigated and, if the investigation supports the charges, prosecuted to the full extent of the law. There have been good and sufficient grounds for the impeachment of Trump for the last 2 years. The Democrats were not interested in impeachment until the alleged "smoking gun" telephone call was revealed. What a joke. That is the weakest reason I can think of to support impeachment. If the telephone call is the best evidence of wrongdoing by Trump, I would not vote for impeachment. But I would deeply regret that the Democrats did not fulfill their duty of bringing impeachment charges for all the multiple crimes committed by Trump, including war crimes, violations of the emolument law and violations of the civil rights of immigrants, including putting children in cages. He is a loathsome and despicable person. He is incompetent and ignorant. And the reason he occupies the White House is that people are fed up with both of the principal political parties, both of which serve the interests of the 1% and care not a whit about the interests of the people.

Voyeur watching her smoking hot body   

Watch voyeur watching her smoking hot body on Pornvideoq!

Fortnite: Epic faces lawsuit due to addictive game   


Fortnite: Epic faces lawsuit due to addictive game

A legal firm is seeking a class action lawsuit against Epic Games because its popular Fortnite game is too addictive.

Calex Légal is representing the parents of two children in arguing that Fortnite is designed to be addictive, and that Epic Games did not warn customers about the dangers. The firm, based in Montreal, is seeking authorization for a class-action lawsuit and inviting parents concerned about their children's dependence on the video game to come forward.

"We dug into it and we realized there was a strong case for it," said Alessandra Esposito Chartrand, a Calex Légal attorney, reports the CBC.

The suit cites a decision made by the Quebec Superior Court in 2015 that determined tobacco companies had not warned customers about the dangers of smoking their product. This duty to inform is what Calex Légal is focusing on. Furthermore, Chartrand claims that the game is actually made purposely to be as addictive as possible.

"Epic Games, when they created Fortnite, for years and years, hired psychologists -- they really dug into the human brain and they really made the effort to make it as addictive as possible," she said. "They knowingly put on the market a very, very addictive game which was also geared toward youth."

Also cited by the lawsuit is the classification of video game addiction as a mental disorder in the World Health Organization's international disease classification manual. It was amended to reflect the change in 2018.

While the terms of service for Fortnite require users to give up the right to go to court individually or as part of a class action lawsuit, Chartrand said this will not stand up in court in Quebec. The Consumer Protection Act there requires that companies clearly disclose risks associated with products.

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