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James Cracknell is as popular on the water as he is on the screen and stage, a testament to not just his athletic skill, but his likeable nature too. The two time Olympic gold medal winner featured on 2019's Strictly Come Dancing, proving that though dancing may not be his strong point entertaining thousands of fans comes naturally to him.
James Cracknell is as popular on the water as he is on the screen and stage, a testament to not just his athletic skill, but his likeable nature too. The two time Olympic gold medal winner featured on 2019's Strictly Com
James won a gold medal in the 2019 Cambridge Boat Race, becoming the oldest rower ever to win the race in the process. Confident and Personable, his audience are enthralled by James' stories straight from the water in his Olympic speeches.
Specialising in the coxless four-team, James won gold medals at the 2000 Sydney Olympic Games and the 2004 Athens Olympic Games. His World Championships gold medals came in the coxless four in 1997, 1998 and 1999, the coxed pair in 2001 and the coxless pair in 2001 and 2002. However, James is far more than just an incredible Olympian and sportsperson. He is also well-known for pitching his skills against the elements, challenging his endurance capabilities against the odds, whether swimming, cycling, running and rowing.
James co-authored the novel The Crossing: Conquering the Atlantic in the World's Toughest Rowing Race alongside Ben Fogle, which depicted the pairs rowing race through the Atlantic. Other achievements include completing the inaugural Amundsen Omega3 South Pole Race, where James and a team travelled 473.6 miles, coming second in the race.
Not only has this enthralling Olympic speaker broken the record in crossing the USA from Los Angeles to New York, but he has also completed The Coldest Race on Earth – the Yukon Arctic Ultra. This is a gruelling 430-mile journey up the frozen Yukon River in Canada, which James made on a mountain bike.
In 2012, James became one of the fastest celebrities to run the London Marathon, with a time of under three hours. James is a key event host for fundraisers and charity events, due to his personal passion for fundraising. In 2009, James and Ben Fogle embarked on a 60-hour journey from Edinburgh to London via Rickshaw, to raise money for the SSAFA. Highly interesting and entertaining, James' Olympic speeches are famed for their insightful discussion of sport.
6 x World Rowing Championships Gold medallist
1 x The Boat Race Gold medallist
Videos of James Cracknell
"Excellent, natural. His talk was inspirational and really added a 'human' and emotional connection to our business-orientated agenda."
- Adobe Systems Europe Ltd
"We were all in awe that he could speak for over an hour in a thoroughly interesting, amusing and sometimes humble way."
- University of Surrey
Oliver James Associaties
"A great speaker. His presentation was excellent and inspiring. As a person, he was also incredibly approachable, warm and friendly."
- Oliver James Associates
The IT Service Management Forum
"Relaxed, self-deprecating style, the ideal light-hearted conclusion to a strenuous conference. Very amendable to book signings"
- The IT Service Management Forum
Adam Yates is one of Britain's leading road and track cyclists who rides for Mitchelton-Scott. In 2016, Yates became the first British rider to win the young rider classification at the Tour de France. A natural climber,
Ade Adepitan MBE is a British television presenter and elite wheelchair basketball player who is available as a Paralympic speaker through Champions. Having survived polio as a youngster, he went on to compete in wheelch
A bronze medal winner in rowing at the 2008 Paralympic Games in Beijing, Briton Alastair Mckean is an inspiration to everyone and a Paralympic speaker who never fails to leave his audience informed and entertained. Being
Aled Davies MBE is a leading British Paralympian who competes in both F42 Shot Put and F42 Discus. Since taking an interest in Paralympic sports in 2004, Davies has gone from strength to strength and is now one of the wo
Alex Partridge is a British rower who has won two medals at the Olympic Games. He was born in the United States but represented Great Britain throughout his rowing career. Although never winning gold at the Olympics, Par
Specialising in the 800-metre race, Andrew Osagie is famed for his performance at the World Indoor Athletics Championship in 2012 and 2014. At present, he represents the Harlow Athletic Club and his home country, Great B
British 400m and 4 x 400m relay runner Andrew Steele is an Olympic speaker who boasts fascinating family connections – his father is This Morning's Dr Chris Steele on ITV, while his brother Matthew is a professional musi
Andy Tennant is an English professional track and road racing cyclist and Olympic speaker. A world and European prize-winning cyclist, he applies his trade on the velodrome as well as the road, and was selected for the T


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Posted on August 8, 2015 February 18, 2019 by Brown Pundits Archive
The Helper Boy
Today's horrific child abuse scandal from Punjab (the exact extent is disputed, with official inquiry reports saying the numbers are smaller and hinting that families in a property dispute may be making up some of the accusations; but of course those inquiries may well be part of the coverup too) reminded me of this short story by Pakistani-American writer Asif Ismael. It was originally published in viewpointonline but seems not to be on their site any more. So I am posting it here..
It's a very cold morning. Rustam wipes the fog off the windshield of the parked truck and looks out. It's dark except for a thin strip of light on the horizon. Not a soul in sight, except a dog hopping across the GT Road. Keeping one of its hind legs off the ground it lurches toward the parking lot of Hotel Paradise, the truck-drivers hotel. It wobbles across a dozen or so parked trucks, and heads over to the tea-stall located by the hotel's entrance, where behind the counter a cloaked figure moves in the dark.
It must be Ibrahim, the owner; he sleeps in his shop, in a room at the back. A flame leaps in the air behind the counter, a flickering glow of orange. Ibrahim is hunched over his stove.
Rustam wraps himself in his blanket, quietly unlatches the truck's door, and slips out into the cold. By the time he gets to the tea-stall his bones feel chilled. The dog, standing by the doorstep, wags its tail as if welcoming Rustam. It's a female dog, its shriveled teats hanging under her belly empty. She is so thin that he can see her ribs through her scarred brown coat.
The door squeaks as Rustam pushes it to enter the shop. Inside, Ibrahim squats by the fire, throwing crumpled papers into the flames. He turns his head, looks at Rustam, and nods with a smile. His face is swollen and wrinkly from sleep, his fingers combing his fist-length, bushy black beard, and his eyes wide and staring, reflecting the fire. Rustam walks over to the stove, sits beside him, and moves the end of a log.
"It's good to get up so early," Ibrahim says, as he winks at Rustam. "Everyone is asleep except the two of us." The flames have started to die. Rustam bends over, takes a deep breath, and blows on the logs till he runs out of breath. Ash swirls around his head, and gets in his eyes, making them teary. The wood catches fire. As he wipes his eyes with the back of his hand, he feels Ibrahim's hand on his shoulder. He freezes. The logs crackle, sparks fly out of the earthen stove. "I wish I've a boy like you to help me out with my shop," Ibrahim says, squeezing Rustam's shoulder. "Your Ustad is so lucky to have you."
Rustam blows on the fire as if he didn't hear what Ibrahim just said. "What would you say if I ask your Ustad to leave you with me for a few days?" Ibrahim says. Rustam keeps his eyes on the fire. He can sense, through his blanket, the heat of Ibrahim's hand over his shoulder. "You're not in a talking mood today," Ibrahim says. "Is everything okay?"
"Ustad will never let that happen, and even if he does, what makes you think that I'll stay?" Rustam says, keeping his eyes on the flames. "I'll take good care of you if you work for me," Ibrahim says. He slides closer to Rustam and pulls his shoulder. Rustam stiffens, shrugs to loosen Ibrahim's grip on him. "Alright! Alright! Keep the fire going," Ibrahim says, taking his hand off Rustam. "I'm leaving to say my fajr—when I'm back I'll make tea for you and your Ustad."
Ibrahim stands up, unwrapping and then quickly wrapping his woolen shawl around his stocky frame, and heads out the door. Outside as he passes by the dog she wags her tail, looking at Ibrahim. He throws a kick at her, but she's swift to move away, missing the point of his shoe. He bends down and picks up a rock. The dog, putting her tail between her legs, runs away.
"Mother-fuckers! Freeloaders! Can't even wait for the sun to rise!" Ibrahim shouts, throws the rock at the dog but misses. He resumes walking. The flames now leap in the air, their tongues licking the cold off the room. The wall behind the stove is black with smoke, except for the clear, white outline of two hands, their finger spread apart and pointing upward. The hands seem to tremble behind the flames.
Rustam remembers the wood-stove of his house, its blackened hearth of baked mud, where he and his younger brother, Ameer, etched with the point of stones, the sun, with its wiggly rays rising from behind the mountains, birds and trees, and a hut with a stream flowing by its side. The dog has come back, and standing at the threshold she stares at Rustam. He looks around for leftovers.
A rat moves along a crack on the floor, sniffing, its fearless eyes fixed on Rustam, its whiskers jerking. Rustam searches in his pockets for any remaining bit of the roasted peanuts Ustad bought for him yesterday from the outskirts of Multan. He finds a piece stuck within the seams of his front pocket. He tosses it towards the rat. The rat sniffs the peanut, and then putting in its mouth it draws nearer, wanting more. Rustam shoos it away by suddenly getting up.
The dog stands by the door and stares at Rustam, shifting her weight from one leg to the other. She does that several times. Rustam walks towards her, but as he gets to the door, she starts limping towards the road. He follows her. She looks back every few steps as if to make sure he's behind her. She crosses the GT Road and keeps walking, towards the line of massive Peepal trees over on a hillock.
The air is still and quiet During the day, the area around Paradise Hotel is crowded with truck drivers, hawkers, drug sellers, fruit vendors, the women holding babies begging; some crouching to touch the feet of the passersby for food or money; and once in a while a woman in a black burka shuffling nervously a few paces behind her pimp. Ustad, though he doesn't like girls, is quite good in telling apart a taxi from a regular woman.
The dog stands still for a moment, looks back, and then disappears behind the mound populated with the Peepal trees. Rustam quickens his pace. Upon reaching the trees he stops, his eyes searching for the dog. He spots her a few meters to his right, a shadow between two massive trunks. As he gets closer, she disappears from view again. On reaching the point where she has gone out of sight, Rustam finds himself looking into a triangular hollow at the base of a trunk. He bends over to take a peek. It's dark in there, but he's able to count six puppies crawling around on hay-covered ground. The dog sits down and the puppies cling to her, their eyes closed. What can possibly be in those withered sacs?
The dog stands up, and the puppies fall off her and roll on the ground. She looks at Rustam and he knows what she wants. He turns around and heads back to the shop—this time with a quicker pace. She follows him. Passing the front of his truck, he halts, and upon hearing the snores of Ustad, he resumes walking. Ustad is still asleep, tucked comfortably in the cozy sleeping cabin of his truck. On most days he doesn't get up unless Rustam shakes him up and hands him his cup of tea. After waking up, the first thing he'd do is to light up a cigarette. Some days Ustad pulls him inside the blanket, and after having him, he'll ask him to light a cigarette for him. He's been with Ustad for the last year and a half.
Rustam enters the shop. It's still warm in here, although the fire is beginning to die. The dog sits at the threshold. Ibrahim is still at the mosque, praying. Rustam squats on the floor, moves the logs, and throws a ball of crumpled papers in the fire. Behind the smoke, the hands look as if they are underwater. He looks around for a pan of milk, but he knows that Ibrahim keeps things, things which can be stolen, in his room at the back. He goes to the rear end of the shop, and, standing in front of a padlocked door, peers through a crack into Ibrahim's room. All he sees is darkness. A rustle on his back makes him turn around. Ibrahim stands right behind him, his lips quivering under his mustache, his eyes gleaming like coals.
Rustam marvels at his swiftness. How quietly he must have entered the shop and got all the way back here without making a sound? "What are you doing here?" Ibrahim whispers in his ear, his lips touching Rustam's earlobe. "Nothing." Rustam feels his heart begins to pound. Suddenly he feels very warm. "You want to come in?" Ibrahim leans forward and whispers in his ear, pressing his body against his.
"I need milk," Rustam says. He inches back and tries to stay calm, the ridges of the door dig into his back. "Anything for you!" Ibrahim's face is next to his. Rustam feels his warm breath on his cheeks. He smells of Nivea, the cold cream his Ustad also uses. "I need a lot of milk," Rustam says, taking a deep breath and holding it in his chest, as he watches the hairy, pointed swelling of Ibrahim's neck, an inch away from his face, moving up and down. "A lot of milk."
"How much do you need?" Ibrahim says swallowing his saliva.
"A kilo, may be."
"Do you have money?"
"I keep milk inside in my room," he says. "There I also keep butter—nothing tastes as good as pure, desi butter with a freshly made, hot prathaa."
Reaching above Rustam's head Ibrahim twists a key in the padlock and lowers the chain. The door flings open with Rustam's weight on it. Ibrahim pushes Rustam further inside the room, and once they are both inside the room, he shuts the door behind him. The room has no window; it smells of wax and cold cream.
Without turning the light on, Ibrahim moves his hand on Rustam's back, all the way down. There's no way out of this room for Rustam.
"I need a pan to carry milk," Rustam says.
"Hot or cold?" Ibrahim's voice is now shaking, as he massages Rustam's buttocks.
"How much would you pay?" Rustam says, feeling Ibrahim pressing himself against him, his hands fast undoing his waist-cord.
"Five hundred rupees."
"I can have a fifteen year old girl for that money."
"How about four," Rustam says. "Plus a kilo of milk."
"I'll give you enough to make you happy," Ibrahim says, pushing him towards the mattress. He's twice Rustam's size.
"But, first give me the milk. I promise I'll come back," Rustam says, but he knows further negotiations are futile.
"I will give you as much milk as you want, but after." Ibrahim lowers his shalwaar and pushes him on the mattress. Rustam lays on his stomach and looks back, clutching onto the bed-sheet. Ibrahim, tucking the end of his kurta under his chin, throws himself on Rustam's back. He is heavy and breaths like a mad bull. His beard feels like a sandpaper against Rustam's nape.
"I always think about you, even when you're not around." Ibrahim pinches Rustam's cheek, as he moves on top of him. "You've such dry skin. Let me rub some cold cream on you."
Ibrahim puts a dab of cold cream on Rustam's cheeks and some upon himself. It doesn't take long.
Ibrahim gets up and leaves the room. Rustam stays lying on his belly and thinks about the dog standing outside on her three legs, her six hungry pups waiting for their mother, and his Ustad: what if he finds out about what's just happened?
Rustam comes out of the room tying his waist cord. The morning light seems brighter after having dissolved the leftovers of the night. Squatting on the floor, in front of the fire, Ibrahim warms milk in a pan. Rustam sits down by his side, holds out his hands to the fire, and glances at Ibrahim. As if looking for something on the floor on the other side, Ibrahim turns away his face; his hands tremble as he tries to keep the blackened pan steady on the flames.
"I think it's quite warm now; do you need some sugar?"
"Where's the money?" Rustam says. Ibrahim takes out a bundle of crumpled ten-rupee notes. He wets his thumb with his saliva and starts counting. "I can only give you fifty for now." He holds five ten rupees notes out to Rustam.
"Why don't you keep it for yourself," Rustam says. "I don't need money."
He picks up the warm pan of milk from the ground.
"Don't be angry with me now. Next time I'll give you much more, I promise." From the weight of the pan Rustam can tell it's probably less than a kilo of milk.
"Do you want some sugar?" Ibrahim asks.
"I'll take it to my truck," Rustam says. The warm pan feels good against his belly. "I will bring your pan back. No, I don't want sugar."
"Promise me you won't ever tell your Ustad." Ibrahim moves the logs and stares at the flames. His beard shines as it reflects the glow of the fire. A log hisses, sparks fly out of the fire and disappear in midair. "You also don't tell him, that I've taken so much milk from you," Rustam says, walking towards the door.
At the threshold, the dog looks at Rustam curiously as he comes out of the shop holding the pan against his belly. She hops back towards her puppies, and he follows her. From the now crimson horizon, a beam of light shoots across the sky, flooding the air with a warm, golden hue.
Rustam's face breaks in a smile. Ustad has promised him a girl in Lahore, at their next stop. Ustad has made advanced arrangements for that. Since he's grown in size, he's begun to like girls. "Girls are expensive to get, but I'd get anything for you as long as it makes you happy," Ustad has told him.
Rustam knows deep inside that Ustad has been good to him; but he also knows that time has come to be on his own; he knows Ustad is not going to let him go that easy; only if he could get married. Rustam follows the dog, feeling the pleasant warmth spreading over his entire body. With the smile still on his face, he imagines himself lying on top of the naked back of a girl, moving.
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You are here: Home » » Current Issue » Progressive Supranuclear Palsy:
a Teaching Case Report
Progressive Supranuclear Palsy:
Julie Chao, OD, and Andrea Yiasemis, OD, FAAO
Progressive supranuclear palsy is a neurodegenerative parkinsonian syndrome with distinct clinical features including vertical supranuclear gaze palsy, frontal lobe cognitive decline, postural instability and progressive axial rigidity. Patients often present to their eyecare provider complaining of diplopia. Clinical examination typically reveals ocular motor dysfunction including restricted vertical gaze, slow vertical saccades and "eyelid opening apraxia" with intact vestibulo-ocular reflex. This teaching case report includes three cases of progressive supranuclear palsy and describes ocular findings, management and prognosis of the disease.
Key Words: progressive supranuclear palsy, parkinsonian disease, diplopia, vertical gaze palsy
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder with distinct clinical features including vertical supranuclear gaze palsy, frontal lobe cognitive decline, postural instability and progressive axial rigidity. First described in 1964 by Steele et al., PSP had been referred to historically as Steele-Richardson-Olszewski syndrome. They reported nine cases with the aforementioned findings, which veered from the typical presentation of idiopathic Parkinson's disease.1 Since its initial characterization, PSP has been further categorized into different phenotypes with notable overlap with other neurodegenerative disorders. Early in the onset of the disease, patients with PSP are often misdiagnosed as having idiopathic Parkinson's disease.2 Given that the average life expectancy following diagnosis is 5-10 years, it is imperative for practitioners to identify and manage the disease appropriately.3,4 The three cases presented here highlight common ocular features of PSP and considerations for ophthalmologic management. The intended audience is third- and fourth-year optometry students, optometry residents and practicing optometrists.
Case Descriptions
A 78-year-old man residing at a community living center presented to the eye clinic reporting that his vision in both eyes seemed to have slowly worsened over time. The patient's ocular history included toxic, nutritional optic neuropathy OD>OS secondary to long-term cocaine and alcohol abuse. His medical history included type 2 diabetes mellitus, osteopenia, liver steatosis, malignant prostatic tumor, hypertension, hyperlipidemia, spastic paraparesis, spinal stenosis and post-traumatic stress disorder. Medications included acetaminophen 650 mg, bicalutamide 50 mg, cholecalciferol, gabapentin 900 mg, simvastatin 40 mg, tamsulosin 0.4 mg and venlafaxine 150 mg.
Figure 1. MRI T-1 weighted images, sagittal view. Left: Initial study eight years prior with greater midbrain and colliculus volume. Right: Current study demonstrating "hummingbird sign" (midbrain atrophy). Click to enlarge
Best-corrected visual acuities (BCVAs) were hand-motion OD and 20/50-1 OS. An afferent pupillary defect was noted OD. Evaluation of the patient's extraocular muscle motility exhibited a complete restriction of inferior gaze and a moderate restriction of vertical gaze. Of particular note, the vestibulo-ocular reflex (VOR), or "doll's head" reflex, was intact. The patient's low phonation and mild dysphagia made it difficult to acquire a proper history to ascertain whether he had been symptomatic for his restriction of gaze.
Pre-dilated intraocular pressures (IOPs) were measured as 15 mmHg OD and 19 mmHg OS. Slit-lamp biomicroscopy revealed interpalpebral corneal punctate epithelial erosions OU, grade 2+ nuclear and anterior cortical cataracts OU with cortical spokes within the visual axis OD. Dilated fundus exam revealed cup-to-disk ratios of 0.6 OD and 0.4 OS with diffuse disc pallor OD and temporal disc pallor OS. The peripheral fundus exam was unremarkable OU. The patient had difficulty comprehending instructions for confrontational or kinetic visual fields.
The patient's acquired oculomotor apraxia with intact VOR warranted further investigation to determine the presence or absence of a supranuclear palsy or degeneration. Magnetic resonance imaging (MRI) with and without contrast was ordered and revealed a classic "hummingbird sign" showing midbrain atrophy, as well as atrophy of the superior colliculus, which were not noted in the initial MRI study eight years prior (Figure 1). The patient's primary care provider (PCP) was notified of the results, and a consultation to the neurology clinic for further evaluation of "possible PSP" was placed.
A 61-year-old man presented for an eye examination reporting vertical binocular diplopia when reading for the past few weeks. The patient's medical history included type 2 diabetes mellitus, hyperlipidemia, psoriasis and recently diagnosed PSP. Prior to the diagnosis of PSP, the patient had experienced frequent falls and generalized muscle weakness over the course of three years. Within the course of the three years, the patient had been prescribed carbidopa-levodopa (Sinemet) and his condition was treated as atypical Parkinson's disease. At the time of his eye exam, he had discontinued carbidopa-levodopa due to a change in diagnosis from Parkinson's disease to PSP. The patient's ataxia had significantly progressed, and he was wheelchair-bound shortly before his eye examination. His most recent MRI demonstrated characteristic midbrain atrophy compared to prior studies (Figure 2). Current medications included acetaminophen 650 mg, aspirin 81 mg, atorvastatin 40mg, gabapentin 300 mg qam and 600 mg qhs, lorazepam 1 mg, metformin 500 mg, sertraline 150 mg and tizanidine 2 mg.
Figure 2. MRI, T-1 weighted images, sagittal view. Left: Initial study three years prior with robust midbrain. Right: Most recent study demonstrating significant midbrain atrophy. Click to enlarge
BCVAs were 20/20 OD and 20/20 OS. Pupils were equal, round and reactive to light with no afferent pupillary defect present. Confrontational fields were full to finger counting OD and OS. Pre-dilated IOPs were 16 mmHg and 14 mmHg. Slit-lamp biomicroscopy findings revealed unremarkable eyelid and eyelash findings, small nasal pterygium minimally encroaching on the cornea, flat and avascular iridis and deep and quiet angles OU. Dilated fundus exam revealed 1+ nuclear cataract OS, cup-to-disc ratios of 0.45 round and 0.5 round OD, OS, respectively, and otherwise unremarkable posterior pole and peripheral retinal findings. Based on evaluation of the patient's vergences, exophoria greater at near than distance and a reduced near point of convergence were noted. Given the patient's symptom of diplopia at near, he was diagnosed with convergence insufficiency secondary to PSP. He was prescribed 2.5 prism diopters base out in single-vision near glasses for greater comfort when reading.
Four months after the initial eye examination, the patient was admitted to a nursing home and was examined at bedside at the request of the PCP and charge nurse due to a reported increase of falls. The patient reported that he preferred to use previously prescribed progressive addition lenses despite having diplopia at near. Evaluation of the extraocular muscles revealed normal lateral gaze and intact VOR but limited superior and inferior movement. Due to these concerns, the patient was educated on the importance of protecting his eyes given his unstable gait and re-prescribed single-vision distance and single-vision near glasses with Fresnel prism to adjust for changes in severity of his diplopia.
A 75-year-old male referred for an eye exam by his neurologist presented to the eye clinic for a preoperative cataract evaluation. Doctors were unable to elicit any verbal complaints from the patient, as he had severe aphasia rooting from his diagnosis of PSP. His wife stated he had been less interactive with the family, and she was concerned he was unable to see their faces as well as he used to. The patient's neurologist had noted that improved vision may help reduce the possibility of agitation and delirium in demented patients. The patient's medical history included chronic cough (from pooled airway secretions), chronic microaspirations and previous cerebral vascular accident with right arm contracture. His medications included levothyroxine 0.15 mg, memantine 5 mg, ferrous sulfate 300 mg/mL, omeprazole 40 mg, albuterol 05% 2.5 mg/0.5mL, bisacodyl 10 mg, ascorbic acid 250 mg, cholecalciferol 1,000 units, acetaminophen 650 mg, levetiracetam solution 125 mg/1.25mL and glycopyrrolate 1 mg.
BCVAs were unobtainable due to the patient's poor cognitive state. Pupils were observed to be equal, round and reactive to light with no afferent pupillary defect present. The patient was unable to understand confrontational visual field testing. Upon extraocular muscle testing, he was noted to have restricted superior and inferior vertical gaze but intact VOR movement. Slit-lamp biomicroscopy findings revealed unremarkable eyelid and eyelash findings, flat and avascular iridis and deep and quiet angles OU. The lenses showed 3-4+ milky nuclear sclerotic cataracts OU. Dilated views by fundoscopy were poor and fleeting due to the patient's tendency to squeeze his eyelids shut with light exposure. The retina was grossly normal with optic nerve cup-to-disc ratios possibly larger than average but difficult to ascertain.
The ophthalmologists gathered from the limited data that the patient would be able to cautiously proceed with cataract extraction pending presurgical medical evaluation. Evaluation by the patient's pulmonologist determined that rhonchi, or low-pitched rattling sounds from the lungs, were present and suggested possible aspiration or respiratory infection. Given the patient's demented mental status, general anesthesia would need to be administered, necessitating prolonged intubation and risking respiratory failure. Additionally, there was concern that coughing could disrupt postoperative sutures and result in a poor surgical outcome. The cataract surgery was thus postponed.
Understand neurodegenerative diseases as they relate to ocular health
Become familiar with the ocular manifestations of PSP
Understand possible complications of general anesthesia when considering ocular procedures in patients with PSP or other neurodegenerative disease affecting motor function
Fundamental pathophysiology of PSP
Ocular effects of PSP and the optometrist's role in diagnosis
Management of patients with PSP
What is the pathophysiology of saccades and PSP?
What causes PSP?
How is PSP diagnosed?
What are the ocular signs and symptoms of PSP?
What are some differential diagnoses that should be considered in cases of suspected PSP?
What is the appropriate management of patients with PSP?
What is the prognosis of patients with PSP?
PSP is the most common degenerative, atypical parkinsonian disorder, with a prevalence of 6.4 per 100,000 according to Schrag et al.5,13 The incidence is reported to increase with age from 1.7 cases per 100,000 at 50-59 years to 14.7 per 100,000 per year at 80-99 years.6,7 The mean age of diagnosis is approximately 65 years, with no racial or sex predilection. No significant risk factors for developing PSP have been identified.3
Teaching instructions: Participants should read each question and consider how they would respond, then read the information provided in the text. Participants may work together in small groups or individually, either in real time or as part of a homework assignment. If working in groups, participants may split into three groups with each group focusing on one case or each group working on all three cases. Learning objectives can be assessed by comparing participants' responses to the questions provided. This case may also be presented as a PowerPoint presentation detailing the case presentation, learning objectives, key concepts, literature review and discussion points.
For horizontal and vertical saccades to be initiated, excitatory burst neurons (EBNs) in the brainstem generate a burst of neuronal discharge known as the pulse. The EBNs for horizontal saccades are located in the paramedian pontine reticular formation. The EBNs for vertical and torsional saccades are located in the rostral interstitial medial longitudinal fasciculus (RIMLF) and interstitial nucleus of Cajal. Once the pulse fires to the intended agonist muscle, antagonist muscles are relaxed.8
PSP results from an aggregation of abnormally phosphorylated tau proteins. Tau proteins aid in axonal transport and support neuronal microtubules. Localized accumulation of the irregular tau proteins form what are known as neurofibrillary tangles.9 In addition to the tauopathy, PSP degenerates dopaminergic neurons and cholinergic neurons, lending to loss of basal ganglia, cerebral cortex and, most clinically characteristic, brainstem structures. Structures within the brainstem that atrophy are the dorsal midbrain, notably the midbrain tegmentum and pedunculopontine nucleus, which lends to postural stability, and the motor nuclei of the cranial nerves in advanced stages of the disease. Given the atrophy of the midbrain tegmentum, the RIMLF is greatly affected, which decreases the presence of vertical EBNs, and an inability to initiate vertical saccades ensues.8
Although no definitive genetic factors have been identified, recent studies suggest there may be a genetic susceptibility in patients with mutations of the tau gene. PSP is currently considered a "tauopathy."10
The diagnostic criteria for PSP, which were revised in 2017 by the International Parkinson and Movement Disorder Society, must include all "basic features": sporadic occurrence, age 40 years or older at onset of first PSP-related symptom, and gradual progression of PSP-related symptoms.11,12 PSP-related symptoms include ocular motor dysfunction, postural instability, akinesia and cognitive dysfunction. The category of ocular motor dysfunction is further stratified to include vertical supranuclear gaze palsy, slow vertical saccades and frequent macro square wave jerks or "eyelid opening apraxia." In this delineated criterion, the highest level of certainty for each category is defined as vertical supranuclear gaze palsy, repeated unprovoked falls within three years, progressive freezing of gait within three years, and speech or language disorder that presents as some variant of primary progressive aphasia, respectively. Supportive features that may increase diagnostic confidence, but do not alone suggest a diagnosis, include levodopa resistance, dysphagia, photophobia, and hypokinetic, spastic dysarthria.
Clinical forms of PSP have arisen since its original description in 1964. The original cases presented by Steele-Richardson-Olszewski have been classified as Richardson Syndrome (PSP-RS), which is characterized by postural instability, vertical gaze palsy and cognitive dysfunction. Eight other clinical variants have been described based on the severity and nature of their neurological signs.11
The gold standard for diagnosing PSP is a comprehensive, post-mortem neuropathological examination to identify the presence of neurofibrillary tangles. Because a definitive diagnosis requires a post-mortem exam, it is crucial for an eyecare provider to be able to identify oculomotor restrictions and make appropriate clinical recommendations for the patient's systemic care.12
Patients with PSP typically present with horizontal or vertical diplopia or asthenopia while reading secondary to convergence insufficiency, horizontal or vertical gaze palsy.13 Patients may also exhibit impaired slow phase responses of their vertical optokinetic response, as well as slowed volitional saccades.14 In a few studies, abnormal acoustic-startling reflex (orbicularis oculi response to high-intensity stimulation of the median nerve) and apraxia of eyelid opening have been observed in patients diagnosed with PSP.15-18 A decrease in blink frequency may cause symptoms of dry eye, including blurred vision, foreign body sensation, burning or irritation. Appropriate evaluation of extraocular muscle motility and near point of convergence as well as slit-lamp examination to evaluate the tear film and corneal integrity are of particular importance.
From an ocular standpoint, it is important to determine the etiology of a patient's presenting symptoms of double vision when reading or limitation of gaze rather than assuming such presentations are idiopathic or, as observed in case 2 reported above, presbyopia-associated convergence insufficiency. In assessing these complaints, the clinician must elicit a thorough case history including recent falls or postural changes and memory changes. Additionally, it is critical to carefully assess extraocular muscle movement, saccades, phorias and vergences at distance and near. Forced duction evaluation is particularly valuable in differentiating a mechanical vs. a neurodegenerative or vascular cause. The posterior thalamo-subthalamic paramedian artery, which stems from the posterior cerebral artery, supplies the RIMLF. Thus, an infarction of this artery may result in a superior gaze palsy.19 Neoplasms, particularly pineal gland tumors, may also lead to vertical gaze palsies.19 Other vertical gaze palsy conditions include Neimann-Pick type C, an autosomal-recessive condition in which cholesterol and lipids accumulate, dorsal midbrain syndrome, Whipple disease, and midbrain infarction.19
As previously noted, PSP is often misdiagnosed early in its course as Parkinson's disease. It shows similar symptoms to Parkinson's, dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). Parkinson's disease is a neurodegenerative disorder with characteristic skeletal muscle tremor, rigidity and akinesia, all of which are features observed in PSP.20 However, PSP typically involves greater cognitive dysfunction and speech disturbance than Parkinson's disease. A study by Song et al. assessed patients with MSA, Parkinson's disease and PSP. Results showed that 73% of patients with PSP had gaze abnormalities, a characteristic that was absent in Parkinson's disease and MSA.21 Song also found that patients with PSP and MSA had a poorer response to levodopa, which is a staple treatment for Parkinson's disease.
MSA is defined as an "adult-onset, sporadic, progressive neurodegenerative disease" with "parkinsonian features, cerebellar ataxia, autonomic failure, urogenital dysfunction, and corticospinal disorders" by the Second Consensus Statement on the Diagnosis of MSA.22,23 Although difficult to definitively differentiate from PSP, any sign of autonomic dysfunction would steer the diagnosis towards MSA.
DLB is defined by the 2017 Dementia with Lewy Bodies Consortium as a disease of "progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational functions, or with usual daily activities." In DLB, patients have "recurrent visual hallucinations that are typically well-formed and detailed," rapid eye movement (REM) sleep behavior disorder, and "features of parkinsonianism."24 Gait abnormalities, gaze apraxia and saccadic dysfunction may be present in both PSP and DLB, but visual hallucinations are a hallmark feature of DLB.25,26
Various presenting signs and symptoms overlap between PSP and other neurodegenerative disorders, which makes PSP diagnosis reliant on the clinical findings centered around the 2017 Movement Disorder Society criteria. Neuroimaging such as MRI may be a helpful supplement for diagnosis. Various studies report abnormalities on MRI demonstrating midbrain atrophy, third ventricle dilation, T2-periaqueductal hyperintensities and frontal and temporal atrophy. One hallmark feature of PSP on MRI is the "hummingbird sign" or "penguin sign" demonstrating midbrain atrophy. Most useful for differentiating PSP from Parkinson's disease or other atypical Parkinson's diseases are the midbrain-to-pontine area ratio, which tends to be lower in PSP patients, and the magnetic resonance parkinsonism index (MRPI), which is greater in PSP patients. The MRPI is a value calculated by determining atrophy of the midbrain, superior cerebellar peduncle, pons and middle cerebellar peduncle.27,28 Another promising diagnostic method is utilizing positron emission tomography scanning to track the tau protein THK5351 and determine the presence of tau aggregates specific to PSP.29 This diagnostic tool, however, is predominantly used in research and often not clinically performed due to cost constraints.
Eyecare providers are crucial in determining the presence or absence of gaze palsies, which aids in the differentiation of PSP. Once an abnormality is determined, a referral to the patient's PCP and neurologist should be made.
Patients with PSP often have limited benefit from levodopa therapy, as opposed to patients with Parkinson's disease. In a study by Williams et al. investigating 91 pathologically confirmed cases of PSP, 32% of patients presented with a response to levodopa, defined as a 30% or greater improvement in symptoms.30 There are no successful pharmacological treatment options targeting the disease process, and management centers around symptomatic care. A few case reports have demonstrated some efficacy of botulinum toxin injected into the orbicularis oculi for apraxia of eyelid opening, into upper limbs to improve rigidity and into cricopharyngeal muscle for dysphagia.31-34 Additional intervention from an interdisciplinary care team consisting of speech, physical and occupational therapists is necessary to facilitate greater independent activities of daily living.
Following diagnosis of PSP, the optometrist may play a role in the patient's care, particularly to address diplopia and dry eye symptoms. A study by Reddy et al. found that corneal sensitivity was reduced in patients with PSP, with 71% reporting they did not have dry eyes. However, evaluation of the tear firm revealed reduced tear break-up time compared to the control group.35 Even without patent report of dry eye symptoms, it is important for the optometrist to manage the patient's dry eyes with artificial tears and lubricating ointment or gel formulations for severe exposure keratopathy. Although few reports demonstrate alleviation of double vision when reading with "mirror prism," we found that Fresnel prisms were particularly useful for alleviating the progressive double vision experienced by the patient in case 2.36,37
What is the prognosis for patients with PSP?
PSP is a rapidly neurodegenerative condition with a poor prognosis. A study by Cosseddu et al. evaluated 100 patients with PSP and found that the average disease duration following diagnosis was 8.25 years.3 Cosseddu found that patients with dementia at the time of diagnosis had a shorter survival time than those without dementia, with no other significant predictors.3 The most common causes of death for patients with PSP are respiratory-related, with the most frequent complication being aspiration pneumonia.38 Given the high frequency of respiration complications, surgery requiring general anesthesia should be given significant consideration due to the potential for respiratory failure.
Optometrists may play a critical role in recognizing characteristic features of PSP and managing concomitant ocular symptoms that may arise. Although no pharmacologic therapy halts progression of the disease, a multidisciplinary team can provide patients and their caretakers with the tools to maximize quality of life and minimize debilitating symptoms.
Steele JC, Richardson JC, Olszewski J. Progressive supranuclear palsy. A heterogeneous degeneration involving the brain stem, basal ganglia and cerebellum with vertical gaze and pseudobulbar palsy, nuchal dystonia and dementia. Arch Neurol. 1964 Apr;10:333-59.
Joutsa J, Gardberg M, Röyttä M, Kaasinen V. Diagnostic accuracy of Parkinsonism syndromes by general neurologists. Parkinsonism Relat Disord. 2014 Aug;20(8):840-4.
Cosseddu M, Benussi A, Gazzina S, et al. Natural history and predictors of survival in progressive supranuclear palsy. J Neurol Sci. 2017 Nov 15;382:105-107.
Glasmacher SA, Leigh PN, Saha RA. Predictors of survival in progressive supranuclear palsy and multiple system atrophy: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2017 May;88(5):402-411.
Schrag A, Ben-Shlomo Y, Quinn NP. Prevalence of progressive supranuclear palsy and multiple system atrophy: a cross-sectional study. Lancet. 1999 Nov 20;354(9192):1771-5.
Bower JH, Maraganore DM, McDonnell SK, Rocca WA. Incidence of progressive supranuclear palsy and multiple system atrophy in Olmsted County, Minnesota, 1976 to 1990. Neurology. 1997 Nov;49(5):1284-8.
Chiu WZ, Kaat LD, Seelaar H, et al. Survival in progressive supranuclear palsy and frontotemporal dementia. J Neurol Neurosurg Psychiatry. 2010 Apr;81(4):441-5.
Kato N, Arai K, Hattori T. Study of the rostral midbrain atrophy in progressive supranuclear palsy. J Neurol Sci. 2003;210(1-2):57-60.
Bancher C, Lassmann H, Budka H, et al. Neurofibrillary tangles in Alzheimer's disease and progressive supranuclear palsy: antigenic similarities and differences. Microtubule-associated protein tau antigenicity is prominent in all types of tangles. Acta Neuropathol. 1987;74(1):39-46.
Stanford PM, Halliday GM, Brooks WS, et al. Progressive supranuclear palsy pathology caused by a novel silent mutation in exon 10 of the tau gene: expansion of the disease phenotype caused by the tau gene mutations. Brain. 2000 May;123 (Pt 5):880-93.
Höglinger GU, Respondek G, Stamelou M, et al. Clinical diagnosis of progressive supranuclear palsy: the movement disorder society criteria. Mov Disord. 2017 Jun;32(6):853-864.
Litvan I, Agid Y, Calne D, et al. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology. 1996 Jul;47(1):1-9.
Williams DR, Lees AJ. Progressive supranuclear palsy: clinicopathological concepts and diagnostic challenges. Lancet Neurol. 2009 Mar;8(3):270-9.
Chen AL, Riley DE, King SA, et al. The disturbance of gaze in progressive supranuclear palsy: implications for pathogenesis. Front Neurol. 2010 Dec 3;1:147.
Shaikh AG, Factor SA, Juncos J. Saccades in progressive supranuclear palsy–maladapted, irregular, curved, and slow. Mov Disord Clin Pract. Sep-Oct 2017;4(5):671-681.
Gironell A, Kulisevsky J, Roig C, Pascual-Sedano B, Rodríguez-Fornells A, Otermin P. Diagnostic potential of acoustic startle reflex, acoustic blink reflex, and electro‐oculography in progressive supranuclear palsy: a prospective study. Mov Disord. 2003 Nov;18(11):1273-9.
Valls-Solé J, Valldeoriola F, Tolosa E, Marti MJ. Distinctive abnormalities of facial reflexes in patients with progressive supranuclear palsy. Brain. 1997 Oct;120 (Pt 10):1877-83.
Grandas F, Esteban A. Eyelid motor abnormalities in progressive supranuclear palsy. In: Tolosa E, Duvoisin R, Cruz-Sanchez FF, editors. Progressive supranuclear palsy: diagnosis, pathology, and therapy. Vienna: Springer;1994. p.33-41.
Lloyd-Smith Sequeira A, Rizzo JR, Rucker JC. Clinical approach to supranuclear brainstem saccadic gaze palsies. Front Neurol. 2017 Aug 23;8:429.
Lopez G, Bayulkem K, Hallett M. Progressive supranuclear palsy (PSP): Richardson syndrome and other PSP variants. Acta Neurol Scand. 2016 Oct;134(4):242-9.
Pasternak JJ, Lanier WL. Diseases affecting the brain. In: Hines RL, Marschall KE, editors. Stoelting's anesthesia and co-existing disease. Philadelphia: Elsevier; 2018. p. 265-303.
Williams DR, Warren JD, Lees AJ. Using the presence of visual hallucinations to differentiate Parkinson's disease from atypical parkinsonism. J Neurol Neurosurg Psychiatry. 2008 Jun;79(6):652-5.
Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008 Aug 26;71(9):670-6.
Liscic RM, Srulijes K, Gröger A, Maetzler W, Berg D. Differentiation of progressive supranuclear palsy: clinical, imaging and laboratory tools. Acta Neurol Scand. 2013 May;127(5):362-70.
Song YJ, Huang Y, Halliday GM. Clinical correlates of similar pathologies in parkinsonian syndromes. Mov Disord. 2011 Feb 15;26(3):499-506.
McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium. Neurology. 2017 Jul 4;89(1):88-100.
Hussl A, Mahlknecht P, Scherfler C, et al. Diagnostic accuracy of the magnetic resonance parkinsonism index and the midbrain‐to‐pontine area ratio to differentiate progressive supranuclear palsy from Parkinson's disease and the Parkinson variant of multiple system atrophy. Mov Disord. 2010 Oct 30;25(14):2444-9.
Massey LA, Jager HR, Paviour DC, et al. The midbrain to pons ratio: a simple and specific MRI sign of progressive supranuclear palsy. Neurology. 2013 May 14;80(20):1856-61.
Respondek G, Levin J, Höglinger GU. Progressive supranuclear palsy and multiple system atrophy: clinicopathological concepts and therapeutic challenges. Curr Opin Neurol. 2018 Aug;31(4):448-454.
Williams DR, Silva R, Paviour DC, et al. Characteristics of two distinct clinical phenotypes in pathologically proven progressive supranuclear palsy: Richardson's syndrome and PSP-parkinsonism, Brain. 2005 Jun;128 (Pt 6):1247-58.
Lepore V, Defazio G, Acquistapace D, et al. Botulinum a toxin for the so‐called apraxia of lid opening. Mov Disord. 1995 Jul;10(4):525-6.
Piccione F, Mancini E, Tonin P, Bizzarini M. Botulinum toxin treatment of apraxia of eyelid opening in progressive supranuclear palsy: report of two cases. Arch Phys Med Rehabil. 1997 May;78(5):525-9.
Polo KB, Jabbari B. Botulinum toxin‐A improves the rigidity of progressive supranuclear palsy. Ann Neurol. 1994 Feb;35(2):237-9.
Alfonsi E, Merlo IM, Ponzio M, et al. An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment. J Neurol Neurosurg Psychiatry. 2010 Jan;81(1):54-60.
Reddy VC, Patel SV, Hodge DO, Leavitt JA. Corneal sensitivity, blink rate, and corneal nerve density in progressive supranuclear palsy and Parkinson disease. Cornea. 2013 May;32(5):631-5.
Krohel GB, Tobin DR, Hartnett ME, Barrows NA. Divergence paralysis. Am J Ophthalmol. 1982 Oct;94(4):506-10.
Weisz RR, Richer SP, Jordan M, Tucker EG. Case report: prismatic redirection of vision for progressive supranuclear palsy. J Am Optom Assoc. 1991 Jul;62(7):537-9.
Litvan I, Mangone CA, McKee A, et al. Natural history of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome) and clinical predictors of survival: a clinicopathological study. J Neurol Neurosurg Psychiatry. 1996 Jun;60(6):615-20.
Dr. Chao is a 2018 graduate of the Western University of Health Sciences College of Optometry. She completed her residency in geriatrics/ocular disease optometry at the West Los Angeles Veterans Affairs Health Care Center in 2019.
Dr. Yiasemis [Andrea.Yiasemis@va.gov] is Chief of Optometry at the Greater Los Angeles Veterans Affairs Health Care Center and an Assistant Professor at Southern California College of Optometry at Marshall B. Ketchum University. A 2007 graduate of the University of California – Berkeley School of Optometry, she completed her residency training at the San Francisco Veterans Affairs Medical Center.
An Inquiry-Based Approach
to Teaching Sphero-Cylindrical Ametropia
Is Educational Theory of Use in Optometric Education?
SCCOMBKU Graduate is Winner
of 2020 Student Award in Clinical Ethics
The Idea of Teaching as a Way to "Give Back"
Diversity and Cultural Competence in Optometry


Central Library, KUET catalog › Details for: Engineering Quantum Mechanics.
Details for: Engineering Quantum Mechanics.
Cover -- CONTENTS -- Preface -- PART I: Fundamentals -- 1: Basic Quantum Mechanics -- 1.1 MEASUREMENTS AND PROBABILITY -- 1.2 DIRAC FORMULATION -- 1.3 BRIEF DETOUR TO CLASSICAL MECHANICS -- 1.4 A ROAD TO QUANTUM MECHANICS -- 1.5 THE UNCERTAINTY PRINCIPLE -- 1.6 THE HARMONIC OSCILLATOR -- 1.7 ANGULAR MOMENTUM EIGENSTATES -- 1.8 QUANTIZATION OF ELECTROMAGNETIC FIELDS -- 1.9 PERTURBATION THEORY -- PROBLEMS -- REFERENCES -- 2: Basic Quantum Statistical Mechanics -- 2.1 ELEMENTARY STATISTICAL MECHANICS -- 2.2 SECOND QUANTIZATION -- 2.3 DENSITY OPERATORS -- 2.4 THE COHERENT STATE -- 2.5 THE SQUEEZED STATE -- 2.6 COHERENT INTERACTIONS BETWEEN ATOMS AND FIELDS -- 2.7 THE JAYNES8211;CUMMINGS MODEL -- PROBLEMS -- REFERENCES -- 3: Elementary Theory of Electronic Band Structure in Semiconductors -- 3.1 BLOCH THEOREM AND EFFECTIVE MASS THEORY -- 3.2 THE LUTTINGER8211;KOHN HAMILTONIAN -- 3.3 THE ZINC BLENDE HAMILTONIAN -- 3.4 THE WURTZITE HAMILTONIAN -- 3.5 BAND STRUCTURE OF ZINC BLENDE AND WURTZITE SEMICONDUCTORS -- 3.6 CRYSTAL ORIENTATION EFFECTS ON A ZINC BLENDE HAMILTONIAN -- 3.7 CRYSTAL ORIENTATION EFFECTS ON A WURTZITE HAMILTONIAN -- PROBLEMS -- REFERENCES -- PART II: Modern Applications -- 4: Quantum Information Science -- 4.1 QUANTUM BITS AND TENSOR PRODUCTS -- 4.2 QUANTUM ENTANGLEMENT -- 4.3 QUANTUM TELEPORTATION -- 4.4 EVOLUTION OF THE QUANTUM STATE: QUANTUM INFORMATION PROCESSING -- 4.5 A MEASURE OF INFORMATION -- 4.6 QUANTUM BLACK HOLES -- APPENDIX A: DERIVATION OF EQUATION (4.82) -- APPENDIX B: DERIVATION OF EQUATIONS (4.93) AND (4.106) -- PROBLEMS -- REFERENCES -- 5: Modern Semiconductor Laser Theory -- 5.1 DENSITY OPERATOR DESCRIPTION OF OPTICAL INTERACTIONS -- 5.2 THE TIME-CONVOLUTIONLESS EQUATION -- 5.3 THE THEORY OF NON-MARKOVIAN OPTICAL GAIN IN SEMICONDUCTOR LASERS -- 5.4 OPTICAL GAIN OF A QUANTUM WELL LASER WITH NON-MARKOVIAN RELAXATION AND MANY-BODY EFFECTS -- 5.5 NUMERICAL METHODS FOR VALENCE BAND STRUCTURE IN NANOSTRUCTURES -- 5.6 ZINC BLENDE BULK AND QUANTUM WELL STRUCTURES -- 5.7 WURTZITE BULK AND QUANTUM WELL STRUCTURES -- 5.8 QUANTUM WIRES AND QUANTUM DOTS -- PROBLEMS -- REFERENCES -- INDEX.
Summary: A clear introduction to quantum mechanics concepts Quantum mechanics has become an essential tool for modern engineering, particularly due to the recent developments in quantum computing as well as the rapid progress in optoelectronic devices. Engineering Quantum Mechanics explains the fundamentals of this exciting field, providing broad coverage of both traditional areas such as semiconductor and laser physics as well as relatively new yet fast-growing areas such as quantum computation and quantum information technology. The book begins with basic quantum mechanics, reviewing measurements and probability, Dirac formulation, the uncertainty principle, harmonic oscillator, angular momentum eigenstates, and perturbation theory. Then, quantum statistical mechanics is explored, from second quantization and density operators to coherent and squeezed states, coherent interactions between atoms and fields, and the Jaynes-Cummings model. From there, the book moves into elementary and modern applications, discussing such topics as Bloch theorem and effective mass theory, crystal orientation effects for zinc-blend and wurtzite Hamiltonian, and quantum entanglements and teleportation. There has been growing interest in the model of semiconductor lasers with non-Markovian relaxation. This book develops a non-Markovian model for the optical gain in semiconductor materials, taking into account the rigorous electronic band-structure and the non-Markovian relaxation using the quantum statistical reduced-density operator formalism. Many-body effects are taken into account within the time-dependent Hartree-Fock equations, and example programs based on Fortran 77 are provided for band-structures of zinc-blend quantum wells. Engineering Quantum Mechanics is intended for advanced undergraduate and graduate students in electrical engineering, physics, and materials science. It also provides the necessary theoretical background for researchers in optoelectronics or semiconductor devices.
A clear introduction to quantum mechanics concepts Quantum mechanics has become an essential tool for modern engineering, particularly due to the recent developments in quantum computing as well as the rapid progress in optoelectronic devices. Engineering Quantum Mechanics explains the fundamentals of this exciting field, providing broad coverage of both traditional areas such as semiconductor and laser physics as well as relatively new yet fast-growing areas such as quantum computation and quantum information technology. The book begins with basic quantum mechanics, reviewing measurements and probability, Dirac formulation, the uncertainty principle, harmonic oscillator, angular momentum eigenstates, and perturbation theory. Then, quantum statistical mechanics is explored, from second quantization and density operators to coherent and squeezed states, coherent interactions between atoms and fields, and the Jaynes-Cummings model. From there, the book moves into elementary and modern applications, discussing such topics as Bloch theorem and effective mass theory, crystal orientation effects for zinc-blend and wurtzite Hamiltonian, and quantum entanglements and teleportation. There has been growing interest in the model of semiconductor lasers with non-Markovian relaxation. This book develops a non-Markovian model for the optical gain in semiconductor materials, taking into account the rigorous electronic band-structure and the non-Markovian relaxation using the quantum statistical reduced-density operator formalism. Many-body effects are taken into account within the time-dependent Hartree-Fock equations, and example programs based on Fortran 77 are provided for band-structures of zinc-blend quantum wells. Engineering Quantum Mechanics is intended for advanced undergraduate and graduate students in electrical engineering, physics, and materials science. It also provides the necessary theoretical background for researchers in optoelectronics or semiconductor devices.


text:
is a 2010 action video game developed by Sandlot and published by Nintendo for the Wii; it was only released in Japan. The story, based on Norse mythology, follows the divine warriors Freyr and Freyja in their war against the Jötunn, which heralds the coming of Ragnarok. Gameplay is mission-based, following one of the two protagonists as they fight hordes of enemies. Missions can be completed either in single-playing or in four-player co-op. Along with standard controls, the game supported the Wii MotionPlus expansion.

Development of Zangeki no Reginleiv began in 2006, though the concept was pitched to Nintendo before the Wii's launch. The world and characters' Norse origins were chosen due to that system's uncertain visual identity. The last year of production was turbulent due to requests from Nintendo about the controls and inclusion of co-op. It was the first Nintendo-published game given the "D" rating by Japan's CERO rating system. The game was among the best-selling Wii titles of the year in Japan, but met with mixed reviews in both Japan and overseas.

Gameplay

Zangeki no Reginleiv is an action video game set in a world inspired by Norse mythology. Players take on the role of sibling deities Freyr and Freyja, completing missions that involve defeating waves of enemy troops. The game has two control options; the Classic Controller, and the Wii Remote and Nunchuk. The latter also incorporates use of the Wii MotionPlus expansion, allowing players to use weapons by miming appropriate actions, such as slashing with a sword or drawing a bow. There are five difficulty settings; Easy, Normal, Hard, Hardest, and Inferno. Each ascending difficulty is unlocked upon clearing a mission on their next lowest.

The game is divided into missions, with some capped by story cutscenes. Gameplay takes place in open areas populated by enemies. The two characters have different skills; Freyr is a melee-based character who primarily uses swords, while Freyja is strong with ranged weapons and magic. Before each of the game's 63 missions, the player selects up to two weapons for the character to use, and is given a story summary and win conditions. Some missions lock the player to one character, but others allow either Freyr or Freyja to be used. The player character is also outfitted with armour, and has two metres for characters: health (HP) and magic points (MP).

When moving, the characters move at a standard walking pace, with a dash move for speed or dodging attacks triggered by shaking the Nunchuk. During battle, players use their equipped weapon to destroy enemies and boss characters that appear on the field, with each of the five different weapon types being more or less effective on enemies. One of the core elements of combat is dismembering enemies, with this being a key tactic for killing some larger types. Up to 300 weapons are unlocked by collecting crystals dropped by enemies when they are killed and some body parts severed. Weapons range from standard swords and axes, to bows, to magic staves which fire explosive projectiles that can damage both enemies and allied units. Weapons also have a skill tree, which requires further crystals to unlock new abilities. Using some weapons drains MP, which can be replenished with specific crystal types in missions alongside HP.

The game can be played either in single-player with the assistance of non-playable characters, or online-exclusive co-op multiplayer. The multiplayer host can tweak the mission type to narrow which players will be joining. There are checks to ensure participants have equivalent weapons and armour to the host to prevent mismatching, and story missions are marked for players who have yet to reach them in their version of the game. In the game's co-op mode, up to four players connect through the Wii's wi-fi system, and can prepare for missions together using an in-game lobby. During gameplay, players coordinate and communicate through shouts triggered using the Wii Remote's D-pad, and in-game alerts if a character is low on health. Once the mission ends, the multiplayer host can set up another mission.

Synopsis
In the world of Midgard, humanity comes under attack from the Jötunn, a race imprisoned by the gods of Asgard after a prolonged war. In response to this attack, Asgard dispatches the twin deities Freyr and Freyja to aid humanity in defeating the giants. As the battles escalate, it becomes clear that the apocalypse Ragnarok is immanent. Despite their best efforts, Freyr and Freyja cannot stop the Jötunn's advance. The situation is worsened by the emerging armies of Niflheim and Muspelheim, and the release of three demonic weapons created by Loki during an earlier war with the giants. Asgard itself is eventually assaulted leading to the death of all the gods except Freyr and Freyja, followed by the final emergence of the Fire Jötunn Surtr. The world is left in ruin after Surtr's defeat, but Freyja uses her powers to restore the world and humanity. The post-credits scene shows a modern world, where the gods have reincarnated as humans.

Development
Sandlot, best known for their work on the Earth Defense Force series, first pitched the concept of Zangeki no Reginleiv to Nintendo in 2004 alongside a project for the Nintendo DS called Chōsōjū Mecha MG. Nintendo producer Hitoshi Yamagami was wary of such a large pitch, so he agreed that the developer would make Chōsōjū Mecha MG and then go on to Zangeki no Reginleiv. When production of Chōsōjū Mecha MG finished in 2006, the team were given the go-ahead to work on Zangeki no Reginleiv, though both sides were wary of its scale. Originally the plan was for only 100 weapons to feature, but as the team became familiar with the Wii hardware, the number tripled. In 2009, a year before the planned release, Nintendo asked Sandlot to include online co-op—which the team had never tried before—then control options for the Classic Controller and the Wii MotionPlus. These additional elements put a lot of strain on the team, with Yamagami describing it as a "dark year" for the team. A point of contention with Nintendo during the final six months was allowing a player to dismember enemies. Instead of cutting it altogether, Sandlot and Nintendo rationalised that since the violence was against hostile supernatural beings, it did not go against Nintendo's policy of not showing excessive violence against people.

The early concept focused simply on making a fun game where players could slash at enemies, with the setting being a secondary consideration. Writer and director Takehiro Homma initially considered ancient Japan and a modern-day setting, but settled on a mythological setting to better explain the fantastic feats on display. Norse mythology was chosen as the world's base due to lacking a distinct visual identity when compared to Greek mythology. With this in mind, levels were designed to reflect the topography of the mythos as much as possible. The main characters were designed by Haccan. Art director Masatsugu Igarashi brought Haccan onto the project due to liking his human character designs. Character model design was assisted by Optimo Graphico, an outsourcing company also working on Xenoblade Chronicles. The music was composed by Masafumi Takada. Different voice clips were recorded for different battle situations, with the number and harshness causing the actors' voices to become hoarse by the end of recording.

Release
The game was first announced at a special Nintendo press event in 2008 under the provisional title Dynamic Zan, with a planned release for the following year. It was re-introduced under its official title in November 2009, releasing in Japan on February 11, 2010. To promote the game, Nintendo partnered with media retailer Tsutaya to loan trial versions to customers from January 21 until release. This was the first time Nintendo ever released a demo or trail version of a game. It was later reissued for Wii U through the Virtual Console on February 18, 2015. Zangeki no Reginleiv was not localised for Western territories, remaining exclusive to Japan. While no official reasons were given, it was speculated to be due to the high violence and Sandlot's niche Western market.

Zangeki no Reginleiv was the first Nintendo-published game to be rated "D" by Japan's CERO rating body, equivalent to the North American ESRB "Mature" rating. By this point, Nintendo had several third-party developers and publishers creating mature games for the Wii, but Zangeki no Reginleiv was their first self-published work. In response to this growing number of mature titles, Nintendo decided to create new black-edged packaging for such titles so as to help consumers identify more mature titles in the store at a glance. Zangeki no Reginleiv was the first title to feature this black design.

Reception

During its first week on sale, Zangeki no Reginleiv reached ninth place in sales charts, with initial sales of nearly 23,000 units and a high sale ratio. During that time, it was one of the most played titles on the Wii, earning a "Platinum" rank from players. The game was the fourteenth highest-selling Wii release of 2010, with sales of over 53,000 units.

Japanese gaming magazine Famitsu praised the implementation of the Wii MotionPlus and the general flow of gameplay, but the four reviewers each faulted the game for camera and control issues, and growing repetition. Japanese website Game Watch Impress praised the gameplay, but noted a lack of depth and frequent control problems. Keza MacDonald of Eurogamer was fairly mixed, enjoying the gameplay style despite control issues, but finding the story flimsy and criticizing the graphics and cutscenes.

The magazine NGamer found there was not enough in the game to justify its use of the Wii MotionPlus, but referred to it as mindless fun for people able to import it. Siliconeras Spencer Yip found the controls difficult to handle, but praised the coop multiplayer and enjoyed the gameplay style. In a list of anticipated Wii titles, Cubed 3 lauded the game's potential and felt that players would enjoy it due to its style and combat system.

Notes

References

External links

2010 video games
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Cooperative video games
Fantasy video games
Japan-exclusive video games
Multiplayer and single-player video games
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Sandlot games
Video games based on Norse mythology
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Video games scored by Masafumi Takada
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redpajama_set_name: RedPajamaWikipedia


Alessio Shostak is a fourth-year undergraduate student studying Economics at the University of St Andrews in Scotland.
The fundraising efforts of the Islamic State of Iraq and Syria (ISIS) have impressed academics, journalists, and government officials alike. The literature has thus far explored the methods via which ISIS acquire funds and transfer their proceeds across international borders. This article aims to expand upon these entries by analysing the failures of EU and US policy to counter terrorist financing since the 9/11 attacks, particularly with regards to the inability of both entities to adjust to digital transfer methods. The value of military operations will also be discussed within the context of halting the Islamic State's fundraising capabilities.
Recent terrorist attacks across the Western world have placed the spotlight on the threat of terrorism as a whole, and the Islamic State in Iraq and Syria (ISIS) in particular. ISIS has been described by David Cohen (2014), a leading official in the US Department of the Treasury, as "the best funded terrorist organisation we have come across". Indeed, in 2015 their estimated asset pool was valued at $2 billion; greater than the GDP of many small nations (Fowler, 2015). Media outlets have dedicated countless hours to covering the ongoing military struggle waged by the international community against ISIS. However, to date there has been relatively scant coverage of the group's ability to raise and move funds in order to finance their terrorist activities and maintain an infrastructure necessary to sustain their caliphate. Terrorist financing has been coined by Raphaeli (2003) as "an octopus with tentacles spreading across vast territories" (p.59), and a key portion of this paper will be dedicated to analysing ISIS's sources of revenue. It will also discuss ISIS's methods of transferring funds, with an emphasis placed on what the Financial Action Task Force (FATF) refer to as "emerging terrorist financing risks" such as virtual currencies and prepaid cards (FATF 2015: 4). The bulk of this paper will then be reserved for addressing (a) the measures the international community – particularly the EU and the United States – has taken to counter the financing of terrorism (CFT) since the 9/11 terrorist attacks, (b) whether these measures have been successful, and (c) what measures and approaches should be taken in the future. Finally, this paper will adopt a broader focus by outlining the indispensable role of private-public sector cooperation to combatting terrorist financing while stressing the interconnectedness of military and non-military measures in the fight against ISIS.
Terrorists require funds for a myriad of purposes. The most evident use of funding is for 'operational costs' in order to directly plan and carry out terrorist attacks; this includes the potential costs associated with the falsification of documents, the purchasing of weapons, and the use of vehicles for transportation. However, Biersteker and Eckert (2008) note that only approximately 10% of funds are allocated to operational costs (p.8). Indeed, the direct expenses of conducting terrorist attacks tend to be quite low; for instance, the cost of the 2004 Madrid bombings for Al Qaeda was approximately $100,000 (Gomez, 2010: 4). The vast majority of funds are allocated by terrorist groups towards what Biersteker and Eckert (2008) describe as "infrastructure" (p.8) in order to sustain and expand the organisation. These include paying members' salaries, providing ideological and military training, and recruitment and propaganda costs. ISIS additionally fund social welfare programs in their occupied territories in order to create the perception that their rule is legitimate. This involves the creation of police forces, the subsidizing of schools and the provisioning of basic necessities such as food and electricity. ISIS have also overseen numerous "state-building activities" such as the establishment of a "court of grievances", a body empowered to process civilian complaints against ISIS officials (Stergiou, 2016: 198). Overall, terrorist organisations must incur substantial costs in order to function, irrespective of their vast network of fundraising sources.
ISIS have utilized their territorial control to develop self-sufficient fundraising methods which would be, in Cronin's (2015) words, "unthinkable for most terrorist groups". Chief among these is revenue from the sale of 'domestic' petroleum and refined petroleum products to individuals in ISIS-held territory and several entities abroad, ranging from the Syrian government to criminal elements in Turkey. The US Treasury (2015) estimates that ISIS accrued $100 million in revenue from petroleum and petroleum-related products in 2014. Despite this, numerous sources indicate that the rate of oil extraction has declined precipitously in recent years, dropping from 80,000 barrels per day (bpd) in August 2014 to 20,000 bpd in November 2014 (Levitt, 2014). This has mainly been attributed to the persistent effects of US-led coalition airstrikes on mobile oil refineries. Most significantly, revenues from petroleum and petroleum products have also plummeted, with some positing as much as an 80% decrease between October 2014 and April 2015 (Bahney and Johnston, 2014). This has largely been due to (a) the aforementioned airstrikes, (b) Turkey's enhanced border security measures, and (c) the recent fall in oil prices. Several authors have suggested that these revenues have reached a peak, and that from now on ISIS will rely more heavily on other sources of funding.
One such base of funds is the extortion racket run by the Islamic State within their territory. Involuntary taxation is derived from all manner of sources, some of which include a 5-10% tax on all cash withdrawals, customs taxes on vehicles entering and exiting ISIS territory, and so-called 'jizya' taxes on religious minorities. Another key fundraising source is the sale of cultural artefacts on the black market. ISIS have occupied over 4,500 archaeological sites, and some sources estimate that sales of artefacts have garnered "tens of millions of USD" from Syria alone (FATF, 2015: 16). Despite only contributing to 5% of ISIS's total revenue, Stergiou (2016) projects that external contributions from wealthy patrons – particularly from Gulf States such as Qatar and Kuwait–are projected to increase in importance given the dwindling fundraising potential of oil reserves in ISIS-held territory (p.204).
The use of standard wire transfers via the formal financial system has become troublesome for terrorists–and particularly for ISIS–due to the policies enacted by the international community in order to identify and freeze suspicious transactions. Consequently, terrorist groups have shifted to unconventional methods to transfer funds across their vast networks. Chief among these is the use of informal value transfer systems (IVTS), most notably of 'hawala' networks. These networks are characterized by their ability to transfer funds across borders without the physical movement of these funds via a complex process involving several intermediaries. Hawalas play a key role in the economy, having traditionally served as remittance systems for migrants to transfer money back to their families residing in developing nations without a reliable banking system. However, as Berti (2008) claims, "the very characteristics that account for hawala's success have made it an impenetrable haven for illicit and criminal transactions" (17). Chief among these is the lack of a transparent audit trail, as hawala operators are unlikely to keep extensive transaction records or to verify customer identity. The key policy challenge for lawmakers and regulators has been to strike a balance between mitigating TF risks while also preventing excessive compliance regulation. However, the severe lack of recent documented cases involving hawalas suggests that terrorist organisations such as ISIS have transitioned away from these traditional transfer methods towards novel, 'emerging' methods in order to globally transfer their funds.
Financial innovation has produced a wide variety of payment methods and services. Although it is indisputable that each of these advances has had positive ramifications on society as a whole, they have unfortunately raised numerous potential anti-money laundering (AML)/CFT vulnerabilities which policymakers ought to address. At the outset, it is important to note that concrete examples of these systems being used to finance terrorist activities are few and far between; indeed, in a recent report the FATF (2015) claimed that "the actual prevalence and level of exploitation of these technologies by terrorist groups and their supporters is not clear at this time and remains an ongoing information gap to be explored" (p.6). However, the FATF also stressed the probability of terrorists having adapted to using these services after heightened AML/CFT regulations elsewhere. The subsequently outlined threats should therefore be placed highly on any nation's counter-terrorism agenda.
Cryptocurrencies are one of the novel methods of transferring funds that are subject to TF risks. Cryptocurrencies are virtual currencies, which are defined as "digital sources of value that can be digitally traded" (FATF, 2014: 4). On one hand, virtual currencies such as Bitcoin have various legitimate uses; for instance, experts claim that bitcoin could reduce transaction costs and facilitate micro-transactions (FATF, 2014). However, the TF risks associated with these currencies are substantial, not least among which is the greater anonymity offered by cryptocurrencies relative to other non-cash methods of money transfer; browser extensions such as Dark Wallet obscure the source of Bitcoin transactions, while Bitcoin accounts do not require identity verification. The decentralized nature of cryptocurrencies implies the lack of a central administrator to monitor transactions – this increases the difficulty of any potential enforcement efforts by eliminating the focal point of any asset seizing measures that might be implemented. Policy solutions must counterweigh the benefits and drawbacks of these cryptocurrencies. In the absence of a central administrator, the IMF have advocated for the imposition of AML/CFT regulations (such as customer due diligence requirements) on the institutions – known as 'covered entities'–facilitating the exchange of Bitcoin into fiat currency (IMF, 2016). However, legislation to this effect is in its infancy in most jurisdictions; indeed, the EU has no regulations in place whatsoever with respect to virtual currencies.
Prepaid cards – cards "preloaded with a fixed amount of electronic value" – are another 'emerging' method of money transfer among terrorists (Kim-Kwang, 2008: 12). As cryptocurrencies, the positive aspects of prepaid cards are not in doubt; they are an essential component of the distribution of disaster assistance, in addition to providing an invaluable method for disadvantaged individuals to purchase goods online. However, prepaid cards pose serious TF risks; for instance, the lack of reporting requirements on international transfers of prepaid cards is a key loophole that could be used by terrorists to avoid restrictions on cash smuggling (FATF, 2015). On a broader note, a key barrier in the fight against the use of prepaid cards for nefarious purposes is the vast differences in legislation across jurisdictions, particularly with regard to regulations applied to small to medium sized card providers. This gives terrorists the freedom to purchase prepaid cards in areas where AML/CFT legislation is weakest before freely transferring these cards across international borders (FATF, 2015). The use of prepaid cards by terrorist organisations is less abstract than other methods that have hitherto been discussed; indeed, they were most notably found in the apartments of the perpetrators of the Charlie Hebdo attacks in Paris. Some legislative proposals have been brought forward to tackle the vulnerabilities associated with these cards; for instance, one recent EU Communication (2016) called for amending the 4th EU AML Directive to introduce regulations on pre-paid card issuers. However, significantly more progress must be made in order to overcome the TF risks posed by this emerging method of transferring funds.
Prior to 9/11, international CFT regulations have been widely viewed as having been insufficient; by 9/11 the 'International Convention on the Suppressing of the Financing of Terrorism' – the first ever UN resolution explicitly prohibiting the financial or material support of terrorist groups – had only been ratified by four nations (Biersteker and Eckert, 2008). Despite its creation in 1989, the FATF's sole focus prior to 9/11 was on AML legislation. Following the attacks, the FATF expanded its mandate to include the battle against terrorist financing, releasing eight 'Special CFT Recommendations'. These recommendations highlighted several key issues, including the mandatory issuance of suspicious transaction reports (STRs) to "competent authorities" in suspected TF cases (FATF, 2001: 2). These eight guidelines – expanded to nine in 2004 – also endorsed UN Resolutions 1267 and 1373, two crucial CFT measures advocating for the freezing of assets belonging to designated terrorists and terrorist affiliates. These Recommendations, and all subsequent work by the FATF, have been adopted by the international community as the "international standards in the fight against terrorist finances" (Bures, 2012: 715). It is important to note, however that the success of these standards is – and will continue to be–incumbent upon the ability of legislative bodies such as the EU and US to implement these standards into law, and of regulatory agencies to enforce these laws.
The European Union's two-pronged AML/CFT approach has been viewed by many as being strongly "in parallel with international developments in the field, in particular initiatives by the FATF" (Gilmore and Mitsilegas, 2007: 120). One aspect of this effort is the 'smart sanctions model', which calls for the full implementation of UNSCRs 1267 and 1373 (Bures, 2015). This resulted in the transposition of the terrorist blacklist developed by the 1267 Sanctions Committee into EU law. The second strand of the Union's CFT efforts has been the 'AML FATF Model', whereby EU legislation – in the form of 'AML Directives'–has adapted over time in order to match FATF AML/CFT Recommendations (Ibid). The Third AML Directive (2005) was the first to explicitly prohibit the financing of terrorist organisations, aiming to adopt the nine Special FATF Recommendations into law. Among other measures, this Directive gave Financial Intelligence Units (FIUs)–the key CFT regulators on a national scale – full access to various nationwide databases including police records, while also expanding customer identity verification requirements via the banning of anonymous bank accounts (Gilmore and Mitsilegas, 2007). In 2015, the Fourth Directive was adopted in order to align with the revised 2012 FATF AML/CFT Recommendations. This was done primarily by increasing the flexibility of FI due diligence obligations depending on the 'risk' posed by the client.
Despite the success of the directives at transposing UN resolutions and FATF Recommendations into EU legislation, evidence suggests that the implementation of these laws has occurred slowly and is, as yet, incomplete. This slow implementation has primarily been linked to the differences in the perceived threats of a terrorist attack among member states, as nations who view an attack as unlikely are susceptible to become 'free-riders' in order to avoid bearing the costs of implementation (Clunan, 2006). One instance of this is the lack of asset freezing arrangements within certain EU member states. Moreover, a recent EU Communication (2016) outlined the necessity of amending the 4th EU AML Directive to monitor virtual exchanges and increase regulations on pre-paid card issuers; in my view, the slow speed at which this issue is being addressed could potentially be due to the 'free-rider' problem, particularly because of the high suspected costs of implementing these high-tech solutions. Overall, a key issue for the EU to consider should be the uniform implementation across all member states of the global CFT standards endorsed by the international community; as the aforementioned discussion regarding prepaid cards indicates, the success of terrorists in financing their operations is likely to be determined by "the weakest link in the international cooperation frameworks" (Bures, 2015: 209).
The effectiveness of the EU's efforts has been historically difficult to measure; indeed, the EU Commission has itself claimed that "it is rather difficult to establish whether the aforementioned measures have had 'a significant impact on terrorists' ability to carry out attacks'" (Ibid: 224). The reasoning behind this is that each of the candidates which could be used as the criteria for success are imperfect measurements. Firstly, the amount of terrorist funds frozen cannot be used as a proxy for success; on one hand, a high value of frozen assets could nevertheless coexist with the fact that several terrorist attacks – such as the 2004 Madrid bombings–have been carried out using small sums of money which would not have been frozen under existing legislation. Inversely, a lack of frozen funds might imply that terrorists have shifted their focus away from formal financial institutions towards transferring their proceeds using informal channels. The quantity of STRs filed by financial and non-financial institutions is another misleading barometer of success. One of the key themes of the recent literature is the lack of public-private sector communication regarding the exact AML/CFT measures that private institutions must follow. Due to their lack of knowledge regarding the exact measures they must implement, and because of the heavy penalties they face for non-compliance, private actors tend to file an excessive amount of STRs. Therefore, a high amount of STRs does not necessarily indicate any sort of success; on the contrary, the dilution of legitimate and frivolous reports increases the difficulties faced by FIUs in determining which transactions pose a serious threat (Bures, 2012). Indeed, evidence suggests that the number of STRs resulting in TF prosecutions are negligible at best, and that most terrorist financing investigations come to light during unrelated investigations.
A key branch of US CFT regulations stems from the pre-9/11 US sanctions regime. The 1977 International Emergency Economic Powers Act enabled the Treasury to place financial sanctions on nations which threatened US national interests, freezing their assets and thus impeding them from using the international financial system. The 1996 'Anti-terrorism and Effective Death Penalty Act' expanded the targets of these sanctions to include terrorist groups and their financial supporters. However, Eckert claims that until the 9/11 attacks, these asset freezing measures were a "little known and understood tool of policy-makers" which had effectively "done little or nothing against terrorist financing" due to the low priority placed upon financial intelligence gathering by the US government (Eckert, 2008: 214). This changed after 9/11 with the issuance of Executive Order 13224, which greatly expanded the US Treasury's ability to strategically freeze the assets of terrorist organisations and their financiers, whist prohibiting US individuals from transacting with these designated parties. Ryder (2015) estimates that $135m worth of assets have been frozen from the bank accounts of approximately 1439 suspected terrorists as a result of this order (Ryder, 2015: 82). Despite this, several authors question the effectiveness of the US sanctions regime in combatting TF; firstly, evidence shows that the rate of asset freezes greatly diminished following the first months after 9/11 (Ibid). Furthermore, Eckert (2008) notes that the "evidentiary foundations" (p.215) for several designations were "quite weak" (p.215), and that many terrorism charges were dismissed due to a lack of evidence. Most crucially, terrorists have perfected other means of transferring funds without the use of the formal financial system.
Another regulation that has garnered much attention is the 2001 USA PATRIOT Act, which greatly enhanced the administrative CFT burden placed on both formal and informal financial institutions. This act required them to enact know your customer mechanisms and establish minimum due diligence procedures, while empowering the Treasury to sanction foreign FIs if they are suspected of having participated in ML/TF. The PATRIOT Act also facilitated increased sharing of financial intelligence between the public and private sectors regarding suspicious individuals. Despite these overarching measures, however, there are several reasons to doubt the effectiveness of the PATRIOT Act in curbing the transfer of terrorist funds. Primary among these is the difficulties of AML measures such as the PATRIOT Act to take into account the differences between the mechanisms involved in money laundering versus terrorist financing. As a result, several authors have called for alternative measures for focusing on CFT apart from the AML extensions which have hitherto been adopted (Ibid). One potential flaw is the high minimum requirement for currency transaction report (CTR) filings, which has led many to suggest that terrorists could simply break up their transactions into several smaller increments in order to evade these measures (Ibid). Moreover,–similarly to the European situation outlined above – various authors point to the failed communication between the private and public sectors as a key factor in the failure of CFT efforts (Ibid). Revealingly, Ryder (2015) and Bures (2012) both claim that 9/11 would not have been prevented even if these new regulations had been in place, while Ryder (2015) notes that these measures did not prevent the 2013 Boston Marathon terrorist attacks from occurring. Finally, new technologies such as cryptocurrencies and prepaid cards also threaten to allow terrorists to circumvent many of the existing AML/CFT provisions.
As per Cohen (2014), the US is implementing a three-pronged strategy to counter ISIS's financial network. Firstly, the Islamic State's access to the international financial system has been slowed due to a ban on wire transfers to and from bank branches within ISIS-held territory in Iraq, while banks in Syria have been subject to harsh reporting requirements. This tactic possesses several limitations; firstly – as Bahney and Johnston (2014) state – the weakness of the current Iraqi government potentially precludes the effective enforcement of this ban. Furthermore, this strategy does not take into account alternative, 'emerging' transfer methods that ISIS could employ which are more difficult for authorities to monitor and regulate. Secondly, the US are working with Kurdish and Iraqi forces to proverbially strike ISIS at their core and disrupt the revenue gained from their sources of funding. This has involved coalition airstrikes against ISIS oil refineries, which have already proved successful in reducing oil extraction rates and revenues, particularly in Syria (Humud, Pirog, and Rosen, 2015). However, the impact of these airstrikes in Iraq has been tempered by the necessity of retaining vital oil infrastructure in order to repower the region once the government regains control (Bahney and Johnston, 2014). On a broader note, US efforts to tackle ISIS's sources of funding will never succeed without military intervention given the inescapable link between ISIS's territorial possessions and their fundraising capabilities. The US Treasury (2014) has indeed claimed that their methods are "not particularly suited to this task", and that military engagement is a necessity if the international community wishes to scale back ISIS's fundraising operations. The final weapon in America's arsenal is targeted sanctions against ISIS operators and foreign financiers. Although these donations currently constitute only 5% of ISIS revenues, the following hypothesis suggests that in the long run, these donations will grow in importance as the economic and military capacity of ISIS both decline precipitously.
Military force is crucial to financially crippling ISIS in the long run. The core of ISIS revenues have been derived from the selling of petroleum-based products. However, numerous factors are contributing to the decreased revenues ISIS have been able to glean from this funding source; firstly, ISIS have been unable to repair extraction infrastructure due to a lack of skilled technicians within ISIS territory. Indeed, data has shown that the productivity of oil extraction has been markedly decreasing since March 2012 (Lewis and Shapiro, 2015: 144). Rapidly declining oil prices along with coalition airstrikes have also reduced potential revenue streams. All in all, oil revenues and production possibilities are low in the long run. Moreover, ISIS's economic policies – or lack thereof – have been criticized as not being conducive to long-run growth; the excessive taxes on cash withdrawals, agriculture machinery, and fuel are typically modelled as reducing consumer incentives to save and invest, imperilling long-run growth. The lack of access to credit and private insurance markets is likely to discourage entrepreneurship, while ISIS's lack of human capital investment in the form of education and healthcare will also reduce long-term labour productivity and growth (Ibid). ISIS's long-run military prospects are also expected to be bleak. Luminosity data indicates that ISIS GDP equalled approximately $30bn in 2014 (Ibid: 148). However, Iraqi and Saudi defence spending in 2014 totalled $80bn and $9.5bn respectively – far beyond what ISIS can realistically afford (Ibid: 148). This disparity is likely to increase given ISIS's aforementioned economic difficulties. ISIS will therefore be unable to territorially expand, trapping the organisation in an area with diminishing resources. This will increase its reliance on foreign donors, enabling the international community – and especially the US Treasury – to use its sanctions regime to thwart the transfer of these funds and proverbially starve ISIS out. This long-run outlook crystallises the inextricable link between financial and military measures necessary for defunding ISIS. Evidence suggests that military action is already depleting ISIS's financial portfolio; in January 2016 it was widely reported by news outlets that ISIS had reduced their fighters' salaries by 50% as a result of coalition airstrikes (Pagliery, 2016). It is therefore essential that nations continue to coordinate military manoeuvres and share military intelligence in order to "degrade and ultimately destroy ISIL" (Obama, 2014).
The 9/11 attacks moved terrorist financing to the forefront of global counter-terrorism efforts, as has been reflected by the innumerable strides that have made on both the national and international stages to combat TF. The FATF and the UN have been the key standard-setters with regards to CFT legislation, and the EU and the US have diligently attempted to transpose these standards into law in addition to crafting their own unique legislation to deal with this perilous threat. Despite this, several factors have conspired to thwart significant progress; for instance, the lack of communication between the private and public sectors with regards to compliance requirements has inhibited the effectiveness of increased financial sector regulations in halting the transfer of terrorist funds. Moreover, the efficacy of current regulations has been notoriously difficult to gauge due to the inadequacies of several potential proxies for success. Most importantly, tools that have hitherto been indispensable in the fight against terrorist financing are unlikely to feature as prominently against the Islamic State due to (a) the unique nature of ISIS's fundraising streams and (b) ISIS's recent shift away from traditional transfer methods in favour of 'emerging' technologies such as cryptocurrencies. It is therefore essential that nations enact legislative measures to ensure that these novel technologies are not exploited for nefarious purposes. It is also paramount that the US and EU continue to share financial and military intelligence with local forces on the ground in order to continue choking off the Islamic State's fundraising potential, in addition to cooperating on military ventures to accelerate the group's long-run decline. Overall, although CFT measures have rapidly advanced since 2001, more must be done to effectively drain the financial resources of terrorist organisations and limit their ability to wage war on their victims.
I would like to thank my supervisor Dr. William Vlcek for giving me the crucial advice and inspiration that I needed to pursue this paper. The scholarship provided by Lord Laidlaw – which allowed me to pursue the Laidlaw Undergraduate Internship in Research and Leadership – also proved invaluable.
Alessio Shostak is a fourth-year undergraduate student studying Economics at the University of St Andrews in Scotland. He has lived a relatively nomadic lifestyle, having residing in several nations including Australia, Switzerland, and Italy.
Fowler, Jennifer (2015). U.S. Efforts to Counter the Financing of ISIL. In: Washington Institute for Near East Policy. Taking the Fight to ISIL: Operationalizing CT Lines of Effort Against the Islamic State Group. Washington D.C., United States of America. February 2, 2015.