Department of Obstetrics, Gynecology, and Reproductive Sciences
University of Maryland School of Medicine
Baltimore, Maryland
The administration also announced Temporary Protected Status would expire for almost 400 depression symptoms vertigo buy zyban 150 mg amex,000 deeply-rooted immigrants from Sudan depression symptoms long term zyban 150mg low price, Haiti mood disorder other dis zyban 150mg, El Salvador depression after divorce zyban 150mg without prescription, Nicaragua, Honduras, and Nepal from late 2018 to early 2020, placing them at risk of deportation and separation from home and family. Arrests and deportations of undocumented people arrested in the interior of the United States mainly through minimal contact with the criminal justice system or in large-scale workplace raids continued to mount, without regard to their rights to home and family. Immigration authorities sought to detain more people-including vulnerable populations like children and pregnant women-in the already-sprawling immigration detention system. Immigration authorities sought to remove legal limits to detaining children in families indefinitely. Of 15 recent deaths in immigration detention, Human Rights Watch found that eight were linked to poor medical care. However, a tax reform eliminated the individual mandate penalties for not participating in the program required in the law. The Congressional Budget Office estimated this could leave 13 million people without insurance coverage. Many states with federal support have imposed work requirements, drug testing, and other barriers to Medicaid eligibility for low income individuals. In many states, criminal laws block expansion of proven public health interventions, such as syringe exchange programs and supervised consumption sites, which reduce transmission of infectious disease and prevent overdose. Reduced access to Medicaid threatens to put drug treatment out of reach for millions of Americans. Congress passed legislation in 2017 making it easier for states to restrict Title X grants by creating eligibility requirements that could exclude certain family planning providers, like Planned Parenthood. Title X is a national family planning program that funds services to more than 4 million Americans. However, several states adopted highly restrictive laws on abortion and reproductive health. Two states-Delaware and New Jersey-in 2018 banned all marriage before age 18, but child marriage remains legal in the remaining 48 states. This abusive practice remains widespread and can amount to cruel, inhumane or degrading treatment. Wisconsin and New York prohibit discrimination based on sexual orientation but not gender identity, and Utah only prohibits discrimination in employment and housing. Michigan, New York, and Pennsylvania interpret their statutory prohibition on sex discrimination to include discrimination based on sexual orientation and/or gender identity. During weeks of protests at the Gaza border with Israel, the United States celebrated its embassy relocation to West Jerusalem on May 14, 2018. The move coincided with one of the deadliest days of the protests, with more than 60 Palestinian demonstrators killed. In August, he met with Kenyan President Uhuru Kenyatta, only his second meeting with an African leader. Journalists also experienced deadly violence and threats, including the shooting of five staff of an Annapolis, Maryland, newspaper in June. Several police efforts to monitor protesters, including people of color, were reported or litigated during the year. In April, a new law aimed at curbing online sex trafficking made websites liable for what users say and do on their platforms. It also threatened to silence speech about consent-based sex work and other sexual activity. In March, the State Department approved a weapons sale of nearly $1 billion to Saudi Arabia, which was ultimately cleared by Congress. She defended Israeli abuses but pushed the Security Council to approve an arms embargo for South Sudan and kept pressure on the Democratic Republic of Congo. The United States continued to impose visa restrictions and asset freezes on perpetrators of grave human rights violations and corruption. At time of writing, according to the Treasury Department, the United States had sanctioned 101 people under Executive Order 13818 "Blocking the Property of Persons Involved in Serious Human Rights Abuse or Corruption," which expands upon the Global Magnitsky Human Rights Accountability Act, in addition to the numerous other designations under different sanctions programs. Using this authority, as well as others, the United States has expanded human rights sanctions against the Iranian government, Venezuelan officials, and a number of Myanmar military officials and entities. The State Department hosted its inaugural "Ministerial to Advance Religious Freedom" in Washington in July 2018-an event attend by foreign governments, civil society, and religious leaders, aimed at advancing religious liberties around the world. During 2018, a detained journalist and other long-serving political prisoners were released, there was an increasingly vibrant media environment, evidence the government was working to combat forced labor in the cotton sector, and several cases where local officials were held accountable for abusive or corrupt actions following vigorous online debate. At the same time, the Uzbek government remained authoritarian and many promising reforms have yet to be implemented. In May, following a trial observed by journalists and human rights monitors, a court conditionally released but still fined independent journalist Bobomurod Abdullaev, who had been detained in September 2017 and then allegedly tortured in pre-trial detention on charges of attempting to overthrow the government. He has also reported being subjected to surveillance by security services on several occasions since the trial. Thousands of individuals imprisoned on politically motivated charges remained behind bars. Some of them, including Kubatin, Fahriddinov, and Abdulhamid have been subjected to torture. In June, several security agency officers were sentenced for their role in the torture and death in custody of Ilhom Ibodov, a Bukhara entrepreneur, in 2015. Politically Motivated Imprisonment and Criminal Justice Authorities have released more than 30 people imprisoned on politically motivated charges since September 2016, including human rights activists Akzam Turgunov, Mehrinisso and Zulhumor Hamdamova, Isroiljon Kholdorov, Gaybullo Jalilov, Chuyan Mamatkulov, Fahriddin Tillaev and journalists Gayrat Mikhliboev, Yusuf Ruzimuradov, and Dilmurod Saidov. While the releases raised hopes that the Uzbek government was making efforts to reform, authorities did not provide people released on politically motivated charges with avenues for legal redress, including overturning unlawful convictions, nor access to adequate medical treatment. They have also reportedly Civil Society and Freedom of Expression Freedom of speech and of the press have improved under Mirziyoyev but remain restricted. The president has urged the media not to hold back in addressing urgent social issues. Some journalists are now covering sensitive issues, such as forced labor and corruption, which were previously taboo, helping bring to the fore cases of injustice or wrongdoing by officials. Much of the internet remains blocked, and several pioneering online outlets such as kun. In September, authorities detained at least eight conservative bloggers, allegedly for their views advocating a greater role for Islam in Uzbek society. Authorities denied several of them access to lawyers and sentenced some up to 15 days of administrative detention. Authorities have slightly relaxed restrictions on the holding of modest peaceful demonstrations. While able to freely visit the country and conduct research, Human Rights Watch remained unable to register due to a 2011 Supreme Court decision which remained in effect. In September, authorities fined rights activist Agzam Turgunov and refused him an exit visa, allegedly for filming police action during a peaceful protest. Key International Actors In February, following an earlier mission to Uzbekistan, Ahmed Shaheed, the United Nations special rapporteur on freedom of religion or belief, issued a report that expressed concerns over limits on religious freedom and "extreme surveillance" of all religious practices that lead to bogus charges of terrorism. He urged authorities to substantially revise the 1998 religion law, make registration of religious organizations optional, "respect the liberty of parents to provide a religious education to their children," and review the arbitrary jail sentences of alleged "religious extremists. Several delegations called on Uzbekistan to release wrongfully imprisoned persons, to address torture and ill-treatment in detention and to revise the criminal code to bring it in line with international standards, including by repealing the provision that criminalizes consensual sexual relations between men. The government took measures to enforce a public decree prohibiting the forced mobilization of public sector workers, including teachers and medical personnel. In October, the president dismissed the deputy prime minister Zoyir Mirzayev after an image appeared on social media of local officials and farmers apparently being forced to stand knee-deep in the cold water of an irrigation ditch. Mirzayev was present when an official punished the men for poor harvest results, prompting online anger at their humiliation. Mirzayev was reappointed to a lesser position of the head of a district in the Jizzak region several weeks later. Various authorities continued to mobilize some public sector workers, students, and employees of private businesses to pick cotton on threat of punishment or loss of employment. In various regions such as Khorezm, public sector workers were forced to sign forms that they would pick a minimum amount of cotton. The future agreement would also cover issues like rule of law, justice, and human rights. No independent government institutions remain today in Venezuela to act as a check on executive power.
Diseases
Generalized torsion dystonia
Oculocerebrorenal syndrome
Cataract, total congenital
Hip dysplasia (human)
Blepharospasm
Achalasia alacrimia syndrome
Swyer James and McLeod Syndrome
Essential fatty acid deficiency
The bronchioles finally divide within the acinus into smaller respiratory bronchioles that have alveoli arising from the surface anxiety 5-htp buy generic zyban 150 mg online. Alveoli are not completely airtight; many have holes in the alveolar wall depression types cheap zyban 150 mg with visa, allowing communicationbetweenalveoliofadjoininglobules(poresofKohn) anxiety depression zyban 150mg otc. Theyarefoundgenerallyinthebordersofthealveolusandcontaindistinctive lamellar vacuoles anxiety reddit 150 mg zyban amex, which are the source of surfactant. Each lobe is further subdivided into bronchopulmonary segments by fibrous septa that extendinwardsfromthepleuralsurface. Thepleura the pleura is a layer of connective tissue covered by a simple squamous epithelium. Atthehilum,the visceral pleura continues alongside the branching bronchial tree for some distance before reflectingbacktojointheparietalpleura. Motorandsensorynervefibresgo separately to each half of the diaphragm via the phrenic nerves. Fifty per cent of the muscle fibresareoftheslow-twitchtypewithalowglycolyticcapacity;theyarerelativelyresistant tofatigue. The arterioles accompanying the respiratory bronchioles are thin-walled and contain little smooth muscle. The pulmonary venules drain laterally to the periphery of the lobules, pass centrally in the interlobular and intersegmentalsepta,andeventuallyjointoformthefourmainpulmonaryveins. Thesebronchialarteriessupply tissues down to the level of the respiratory bronchiole. The bronchial veins drain into the pulmonaryveins,formingpartofthenormalphysiologicalshunt. The tracheobronchial lymph nodes are arranged in five main groups: pulmonary, bronchopulmonary, subcarinal, superior tracheobronchial and paratracheal. Inaddition,theciliaofthenasalepitheliummove the mucous gel layer rapidly back to the oropharynx, where it is swallowed. Mucociliary protection is less effective against viral infectionsbecausevirusesbindtoreceptorsonepithelialcells. Themechanicalprocess Thelungshaveaninherentelasticpropertythatcausesthemtotendtocollapseawayfromthe thoracic wall, generating a negative pressure within the pleural space. Lungcomplianceisameasure of the relationship between this retractive force and lung volume. At the end of a quiet expiration,theretractiveforceexertedbythelungsisbalancedbythetendencyofthethoracic wall to spring outwards. Duringtidalbreathinginhealthyindividuals,inspirationisalmost entirely due to contraction of the diaphragm. More vigorous inspiration requires the use of accessory muscles of ventilation (sternomastoid and scalene muscles). At rest or during low-level exercise, expiration is passive and results from the natural tendencyofthelungtocollapse. Thecontrolofrespiration Coordinated respiratory movements result from rhythmical discharges arising in an anatomically ill-defined group of interconnected neurones in the reticular substance of the brainstem,knownastherespiratorycentre. Although breathlessness is a very common symptom, the sensory and neural mechanismsunderlyingitremainobscure. Overall, the cross-sectional area available for airflow increases as the total number of airways increases. The airflow rate is greatest in the trachea and slows progressively towards the periphery(sincethevelocityofairflowdependsonthecross-sectionalarea). Adrenoceptors on the surface of bronchial muscles respond to circulating catecholamines; there is no direct sympathetic innervation. Airway responsiveness to these stimuli increases following respiratory tract infections, even in healthy subjects. In asthma, the airways are very irritable and as the circadian rhythm remains the same, asthmatic symptoms are usually worse in the early morning. Airflow Movementofairthroughtheairwaysresultsfromadifferencebetweenatmosphericpressure and the pressure in the alveoli; alveolar pressure is negative in inspiration and positive in expiration. During quiet breathing, the pleural pressure is negative throughout the breathing cycle. This compresses the central airways, but the smaller airways do not close off becausethedrivingpressureforexpiratoryflow(alveolarpressure)isalsoincreased. In forced expiration, as mentioned above, the driving pressure raises both the alveolar pressureandtheintrapleuralpressure. To increase ventilation, these patients have to breatheathigherlungvolumesandallowmoretimeforexpiration,bothofwhichreducethe tendency for airway collapse. To compensate, they increase flow rates during inspiration, wherethereisrelativelylessflowlimitation. Theonlyexceptiontothisoccurswhenthereissignificantobstructionto the airways outside the thorax, such as tracheal tumour or retrosternal goitre. Expiratory airway narrowing is prevented by tracheal resistance and expiratory airflow becomes more effort-dependent. During forced inspiration, this same resistance causes such negative intraluminalpressurethatthetracheaiscompressedbythesurroundingatmosphericpressure. Inthenormallung,bothventilationandperfusionaregreateratthe bases than at the apices, but the gradient for perfusion is steeper, so the net effect is that ventilation exceeds perfusion towards the apices, while perfusion exceeds ventilation at the bases. Othercauses of mismatch include direct shunting of deoxygenated blood through thelungwithoutpassingthroughalveoli. An increased physiological shunt results in arterial hypoxaemia since it is not possible to compensate for some of the blood being under-oxygenated by increasing ventilation of the well-perfused areas. An increased physiological deadspace just increases the work of breathing and has less impact on blood gases since the normally perfused alveoli are well ventilated. Oxygen is carried in chemical combination with haemoglobinintheredbloodcells,withanon-linearrelationshipbetweenthevolumecarried andthepartialpressure(seeFig. These can be divided into physical, physiological, humoral and cellularmechanisms. Respiratorytractsecretions the mucus of the respiratory tract is a gelatinous substance consisting of water and highly glycosylatedproteins(mucins). Themucusformsathickgelthatisrelativelyimpermeableto water and floats on a liquid or sol layer found around the cilia of the epithelial cells. In addition to the mucins, the gel contains various antimicrobial molecules (lysozyme, defensins),specificantibodies(IgA)andcytokines,whicharesecretedbycellsinairwaysand areincorporated intothemucusgel. Under normal conditions, the tips of the cilia engage with the undersurface of the gel phaseand by coordinated movement they push the mucus blanket upwards and outwards to the pharynx, whereitiseitherswallowedorcoughedup. One of the major long-term effects of cigarette smoking is a reduction in mucociliary transport. This contributes to recurrent infection and prolongs contact with carcinogenicmaterial. Congenital defects in mucociliary transport lead to recurrent infections and eventually to bronchiectasis. Therespiratorymicrobiome It has always been thought that the lower respiratory tract is sterile. Recent evidence has shown that there is a resident bacterial flora that is very similar to that of the mouth. Thisrespiratorytractdysbiosiscausesadisregulationofthe localimmuneresponseandfavoursthegrowthofbacteria:forexample,intheexacerbationof chronic diseases in which inflammation is perpetuated. Innateandadaptiveimmunity Thesemechanismsactas adefenceagainstmicrobes,inorganic substancessuchasasbestos, particulate matter such as dust, and other antigens. They act by aiding opsonization so that macrophagescanbetteringestforeignmaterial. With infection, neutrophils migrate out of pulmonary capillaries into the air spaces and phagocytose and kill microbes with, for example, antimicrobial proteins (lactoferrin), degradativeenzymes(elastase)andoxidantradicals. Microbes are detected by host cells by pattern recognition receptors, such as toll-like receptors.
Allergic disorders include allergic rhinitis (hay fever) bipolar depression 311 buy zyban 150mg on-line, allergic eczema depression symptoms shortness of breath buy zyban 150mg amex, bee andwaspvenomallergy depression extended definition order zyban 150 mg on line,someformsoffoodallergy depression test beyond blue cheap zyban 150 mg line,urticariaandangio-oedema. Diagnosis of allergic disease is usually made on the history and backed up by skin-prick testing(insertionofatinyquantityofallergenundertheskinandmeasurementofthesizeofthe weal) and/or measurement of serum allergen-specific IgE. To provoke anaphylaxis, the allergen must be systemically absorbed, after either ingestion or parenteral injection. More serious sequelae are hypotension, bronchospasm, laryngealoedemaandcardiacarrhythmiaorinfarction. Avoidance of triggering foods, particularly nuts and shellfish, may require almost obsessive self-discipline. Patient education is necessary and manyareinstructedintheself-administrationofadrenaline(epinephrine)andcarrypre-loaded syringes. Desensitization has a well-established place in the management of this disorder, particularlyifexposureisunavoidableorunpredictable,asininsectstings. Indeed, in a rare group of patients who develop multiple autoimmune disorders affecting the adrenal and parathyroid glands (autoimmune polyglandular syndrome type1;seep. When the gene malfunctions, there is reduced expressionofselfproteinsinthethymusandautoimmunediseaseisaconsequence. Failureofcheckpoint2,regulatoryTlymphocytes An example of Treg failure is the defect in the gene encoding Foxp3, a critical transcription factorinTregs(seep. Laboratorystudiesinthisarea are revealing subtle Treg defects in several autoimmune diseases. Individuals develop multiple cytopenias, organ-specific autoimmunity, and lymphoproliferation that may mimic lymphoma. IgG4disease IgG4 disease is a fibro-inflammatory condition with the formation of swellings at multiple sitesinfiltratedwithIgG4-producingplasmacellsandatendencytohighcirculatinglevelsof IgG4. Unlike many autoimmune disorders, IgG4-related disease is driven by Th2 T cells in association with high numbers of FoxP3+ T cells. The first recognized form of this disorder was autoimmune pancreatitis, but lesions in the biliary tree, salivary glands, periorbital tissues, kidneys, lungs, lymph nodes, meninges, aorta, breast, prostate, thyroid, pericardium and skin are recognized (Box 8. The current hypothesis is that Th2 cells drive the activation of macrophages and myofibroblasts, leading to fibrosis and IgG4 plasma cell proliferation. Autoantibodies can also bind their antigen in the circulation to form immune complexes. Immune complexes preferentially deposit in sites such as the kidney glomerulus, leadingtochronickidneydisease. With modern tissue-matching approaches, hyperacute rejection is rare and acute rejectioncanusuallybepreventedortreatedwithimmunosuppression. Immune-BasedTherapies Manipulating the immune response in a therapeutic setting has seen many successes, as evidenced by the control of organ rejection in clinical transplantation through targeted immunosuppression(Box8. Monoclonalantibodiesoffertheopportunitytoneutralizethe unwanted effects of cytokines, or to direct immune responses, drugs, toxins or irradiation againstaspecifictarget,whetheritbeatumourcelloranimmunecellinvolvedinadamaging autoimmune response. Naturalantiviral mediators, such as the interferons, are already in the clinicastherapiesforchronicviralinfection,amongstotherthings. Since integrins are essential for the migrationofTcellsintotissues,theblockadepreventsegressintoinflammatorysites,butalso reducesimmunesurveillanceofinfection. Cytokinesandanticytokines Cytokines are pleiotropic agents with powerful pro-inflammatory and immunosuppressive effects, and are attractive targets for therapies that inhibit or enhance their function. Nonetheless, the good safety profile of anakinra has prompted its use in other diseases, and a beneficial effecthasbeenshownintype2diabetes,whichmayhaveaninnateinflammatorycomponent. Restoringtoleranceinautoimmunediseasesandallergy Oneofthegoalsforimmune-basedtherapiesforautoimmunediseaseisnotsimplytoachieve immunosuppression, but also to restore immunological tolerance against the relevant autoantigens. In animal models, an effective means of achieving this is to administer the autoantigenitself,orkeypeptideepitopesfromit. For example, administration of cocktails of peptides of the cat allergen Fel d 1 has led to a reductionindetectableskin-prickresponsesandimprovedclinicalscores. However,whenusedfor inflammatory conditions, there is also a therapeutic benefit, although randomized placebocontrolled studies are few. These include: immune-mediated thrombocytopenia, Kawasaki syndrome, chronic inflammatory demyelinating polyneuropathy andpost-transfusionpurpura. The intracellular and interstitial fluids are separated by the cell membrane; the interstitial fluidandplasmaareseparatedbythecapillarywall(Fig. However, if solutes are added to one side of the membrane, the intermolecular cohesiveforcesreducetheactivityofthewatermolecules. Asaresult,watertendstostayin the solute-containing compartment because there is less free diffusion across the membrane. Regulationoftheplasmavolumeissomewhatmorecomplicatedbecauseofthetendencyof the plasma proteins to hold water in the vascular space by an oncotic effect that is partly counterbalanced by the hydrostatic pressure in the capillaries that is generated by cardiac contraction(Fig. Bycontrast,Na+ freely crosses the capillary wall and achieves similar concentrations in the interstitium and plasma; as a result, it does not contribute to fluid distribution between these compartments. Similarly, urea crosses both the capillary wall and the cell membrane, and is osmotically inactive. For example, if Na+ intake is increased, the extra Na+ will initiallybeaddedtotheextracellularfluid. Thus,1Lofwatergivenintravenouslyas5%glucose (whichisrapidlymetabolizedtoenergy,waterandcarbondioxide)isdistributedequallyinto all compartments, whereas the same amount of 0. The addition of 1L of colloid with its high oncotic pressure stays in the vascular compartment and was a treatment for hypovolaemia, but 0. In general, it is changes in tubular reabsorption that constitutethemainadaptiveresponsetofluctuationsintheeffectivecirculatingvolume. Although the loop of Henle and distal tubules make a major overall contribution to net Na+ handling, transport in these segments primarily varies with the amount of Na+ delivered; that is, reabsorption is flow-dependent. In comparison, the neurohumoral regulation of Na+ reabsorptionaccordingtobodyneedsoccursprimarilyintheproximaltubulesandcollecting ducts. High-pressure arterial receptors (carotid, aortic arch, juxtaglomerular apparatus) predominate over low-pressure volume receptors in volume control in mammals. The lowpressure volume receptors are distributed in thoracic tissues (cardiac atria, right ventricle, thoracicveins,pulmonaryvessels)andtheirroleinthevolumeregulatorysystemismarginal. The pressure natriuresis phenomenon may be the final defence against changes in the effective circulating volume. Marked persistent hypovolaemia leads to systemic hypotension and increased salt and water absorption in the proximaltubulesandascendinglimbofHenle. Thisprocessispartlymediatedbychangesin renal interstitial hydrostatic pressure and local prostaglandin and nitric oxide production. Thisconditionisseeninyoungtomiddle-agedmaleagricultural workers along the Pacific coast in Central America, where strenuous work in high temperaturesisthoughttobeacause. Volumeregulationinoedematousconditions Sodium and water are retained despite increased extracellular volume in oedematous conditionssuchascardiacfailure,hepaticcirrhosisandhypoalbuminaemia. Heretheprincipal mediatorofsaltandwaterretentionistheconceptofarterialunderfillingduetoeitherreduced cardiac output or diminished peripheral arterial resistance. In normal subjects, high doses of mineralocorticoids initially increase renal sodium retention so that the extracellular volume is increased by 1. However, renal sodium retention then ceases, sodium balance is re-established, and there is no detectable oedema. Inpatientswiththeaboveoedematousconditions,suchasheartfailure,escapefromthe sodium-retaining actions of aldosterone does not occur and therefore they continue to retain sodiuminresponsetoaldosterone. Sodiumdeliverytothedistalportionofthenephron, and thus the collecting duct, is reduced. This process, which is the primary step in the counter-current mechanism, has two effects: it makes the tubularfluiddiluteandthemedullaryinterstitiumconcentrated. This leads to protein kinase activationandtopre-formedcytoplasmicvesiclesthatcontainuniquewaterchannels(called aquaporins) moving to and then being inserted into the luminal membrane. The water channels span the luminal membrane and permit water movement into the cells down a favourable osmotic gradient.
In September depression symptoms treatment and causes discount zyban 150 mg with amex, ethnic violence displaced an estimated 15 mood disorder hk zyban 150mg sale,000 people from the outskirts of Addis Ababa bipolar depression for a year hoping for mania buy 150 mg zyban with visa. Despite signs of possible clashes depression yeast infection generic 150 mg zyban mastercard, the government failed to prevent attacks, resulting in further displacement. Except for humanitarian aid, Human Rights Watch is not aware of sustainable federal government efforts to address internal displacement and inter-ethnic violence. He underlined the importance of making greater efforts to ensure the independence of the government-affiliated human rights commission. Migration and Asylum Despite arrivals of migrants and asylum seekers decreasing to pre-2015 levels, the often- opportunistic hardline approach of anti-immigrant European Union governments, including those of Italy, Hungary, and Austria, dominated the migration debate throughout the year. By mid-November, 107,900 arrivals were registered by sea (the vast majority) and over land, compared to 172,300 in 2017. With Malta following suit, there were numerous incidents when hundreds of people had to remain aboard rescue ships until ad hoc disembarkation agreements could be reached. There were concerns that the actions could deter merchant vessels from carrying out rescues. Egypt, Tunisia, and other North Africa states, and Albania were proposed as possible partners despite concerns about conditions, treatment, and meaningful access to asylum. Belgium moved forward with plans to resume family immigration detention, completing the construction of new detention units for migrant families with children in mid-2018. It had abandoned immigration detention of children, whether unaccompanied or with families, in early 2016. Discrimination and Intolerance Populist extremist parties and ideas again exercised an outsize influence over European politics during the year. Parties aligned with radical right populism won re-election in Hungary, joined ruling coalitions in Italy and Austria, and gained ground in elections in Sweden and Slovenia, and in state elections in Germany. Danish authorities introduced a series of measures during the year to enforce "Danish values," designating certain areas as "ghettos" based on a high proportion of residents with ethnic minority or immigrant backgrounds, and low social status. Children in those areas would be subject to mandatory daycare in the name of integration. In Ireland, a referendum in May overturned a near-total abortion ban; at time of writing, legislation legalizing access to abortion was pending before parliament. In Poland, a bill introduced in January to "stop abortion" was still pending at time of writing. The initiative aimed to restrict legal abortions carried out in situations of severe fetal anomaly, the grounds for over 95 percent of legal abortions performed in Poland. In September, the European Parliament decided by a two-thirds majority to activate article 7 over the situation in Hungary. The parliament expressed concerns on a wide range of issues, including judicial independence, freedom of expression, freedom of association, academic freedom, and the rights of migrants and asylum seekers. Terrorism and Counterterrorism In March, the European Commission announced a series of non-binding "operational measures" for states and internet companies to remove online content deemed terrorism-related or otherwise illegal, raising concerns about privacy and freedom of expression. In September, the commission published a draft regulation that, if passed, would turn these measures into law, including large fines for internet companies that failed promptly to remove content deemed illegal. The court also determined that national investigations in both countries were ineffective, calling for a renewal of the investigations to identify and punish responsible officials. The directive contains provisions that undermine free expression and freedom of movement. Between January and September 2018, there were 14 war crimes cases before courts in Croatia. In the same period, courts convicted only four people for warrelated crimes and the prosecution of other cases moved slowly. The law failed to ban detention of migrant children, despite six European Court of Human Rights rulings that such detention by France violated their rights. Living conditions for migrants and asylum seekers in the Calais area remain squalid and harassment of aid workers there by police continued. Child protection authorities in Paris continued to use flawed age assessment procedures for unaccompanied migrant children, excluding many from care they need and are entitled to , leaving hundreds homeless. In July, the Constitutional Council ruled that solidarity was among the highest values of the French republic and that assisting undocumented migrants should not therefore be criminalized "when these acts are carried out for humanitarian purposes. Croatia According to the minister of interior, 3,200 migrants and asylum seekers crossed into Croatia between January and August, with 852 claiming asylum. Authorities granted 140 people asylum and 21 subsidiary protection during the same period. A government funded study published in July found that almost all Roma in the country live in poverty and less than a third finish primary school. In November, Prime Minister Edouard Philippe announced a 69 percent increase in antisemitic attacks in the first nine months of 2018 compared to 2017. The National Commission on Human Rights reported in March that violent anti-Muslim acts had increased in 2017 by 8 percent compared to 2016. The welcome decision to include access to inclusive education in the national strategy for autism launched in April stood in contrast to a housing law adopted in October that would reduce the obligation to ensure that new housing is wheelchair accessible. In August, France adopted a new sexual violence law aimed at tackling sexual harassment and sexual violence against children. The law makes street harassment an offense, raises the statute of limitation on sex crimes against children from 20 to 30 years, and gives judges the power to rule on a case by case basis that sex by an adult with a child under 15 is rape but falls short of criminalizing all such sex with a child under 15 as rape. In September, a man was convicted of sexual harassment for the first time under the new law and fined 300 euros (approximately $340). France accepted recommendations to stop ethnic profiling in identity checks but failed to take legislative steps to end such practices. Arrivals of asylum-seekers and migrants fell for the third year in a row, and federal authorities made significant progress clearing a backlog of asylum claims during the year. By the end of July, 96,644 new asylum-seekers had been registered, decreasing by a sixth from the previous year. In July, the government granted admission to up to 300 refugees evacuated to Niger from Libya. Although fewer than in previous years, attacks on refugees and asylum seekers remained a matter of concern. In the first half of 2018, police recorded 627 attacks on refugees and asylum seekers outside their home, and 77 attacks on refugee shelters. Xenophobic demonstrations in the city of Chemnitz triggered by the killing of a German man, allegedly by two foreign nationals, in August and the exploitation of the killing by the far-right, saw violent scenes, including attacks on people perceived as "non-German. In July, a Munich judge found a man guilty of murder, terror offenses, and arson in a case relating to a series of murders carried out by a neo-Nazi group between 2000 and 2006. It compels social media companies to take down hate speech and other illegal content or face large fines. German judicial authorities continued their work investigating serious international crimes committed abroad, including in Syria. Greece Although Greece continued to host large number of asylum seekers, it failed to protect their rights. Deficiencies in the reception and asylum system escalated with severe overcrowding, unsanitary, unhygienic conditions, and lack of sufficient specialized care, including medical care, trauma counseling, and psychosocial support. Most unaccompanied children continued to be placed in camps with adults, in so-called protective police custody or detention or risked homelessness, with authorities failing to resolve a shortage of juvenile shelters or foster care. On Lesbos, a regional authority inspection in September concluded that the Moria camp, the largest of its kind, presented a danger to public health and the environment, and called on the government to address acute shortcomings or close the camp. Greece did not address reception needs of newly arriving asylum seekers in the region, despite an increase in arrivals starting in April. As a result, women and girls were housed with unrelated men in sites for reception or detention of asylum seekers and lacked access to essential services. Less than 15 percent of asylum-seeking children had access to education on the islands, and only one in two on the mainland were enrolled in public schools. Far-right groups continued to campaign against asylum seekers on the islands, and there were media reports of attacks across the country on persons perceived to be migrants or Muslims. Police statistics for hate crimes for 2017 released in March showed a marked increase compared to the previous year. In June, parliament approved government-proposed amendments to the constitution and other legislation, criminalizing services, advice, and support to migrants and asylum seekers, punishable by up to one-year imprisonment.
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