Digital Money & Central Bank Digital Currency (CBDC) – New Opportunity, New Challenge

The power of new technology may, nevertheless, now lead to a fundamental restructuring of banking and financial markets themselves, particularly with the emergence of new private and public digital coins and digital market platforms.1 Markets have been subject to massive continuing changes and advances, which have substantially reformed banking and financial services and products.2 Centrally controlled government, or central bank, markets can now enjoy the technological capability to replace more traditional legacy private markets and services.3 The advent of digital systems has had a major impact on all aspects of banking and finance. Almost 30,000 private digital coins have since been created.9 The value of this market exceeded $1 trillion in the first quarter of 2021 and then grew to $2.06 trillion later in the year.10 Similarly, the valuation of large technology firms, such as BigTech leaders, including Apple and Microsoft, also rose to over $2 trillion.11 While the value of these coins has suffered from substantial variability and volatility, this suffering can be limited or managed through the use of stablecoins, which tie their value to another cryptocurrency, fiat currency, or commodity, with the most notable example being Facebook's Libra coin (now known as Diem), which was launched in June 2019.12 New forms of digital payment systems have also emerged, with over three billion account holders now using different forms of payment applications and electronic wallets.13 Private "CoinTech" has then evolved in competition with PayTech and other forms of financial technology (FinTech) applications (AppTech), including decentralised finance (DeFi), decentralised exchanges (DEXs), and most recently non-fungible tokens (NFTs).14 The most dramatic innovation within these markets may, nevertheless, be the adoption of new forms of official central bank digital currency (CBDC) or digital government coin (GovCoin or StateCoin).15 This has been referred to as the "new incarnation of money," which could lead to a major switch in power from individuals to the state, geopolitical disruption, and adjustment of capital allocation.16 This has to be treated with a combination of "optimism[ ] and humility," with central banks described as moving from being "the aristocrats of finance to its labourers. Central banks had to support the financial system over a decade ago in the wreckage of the global financial crisis beginning in 2008-2009 and then following the coronavirus crisis in 2020-2021.24 This intervention could be taken further forward with central banks effectively nationalising private money and banking systems through a process of highly centralised technological transformation and metamorphosis.25 This could be partly driven by efficiency and stability arguments and accompanied by a decline in physical coin and banknote use, although probably more simply due to the potential perceived loss of control over markets and market function and stability either to private operators or other governments that could otherwise ensue.26 This could result in fundamental change and adjustment. Metal coinage was introduced with the Lydian Stater around 650 BC, which was made from an alloy of gold and silver, with a large number of different types of metal coinage having been created subsequently, especially in new Greek city-states.33 The Persians would introduce gold Darics and silver Sigloi, with the Romans developing the gold Aureus, silver Denarius, and copper Sestertius.34 The Chinese created early forms of knife and tool coins around 1,122-221 BC during the Zhou dynasty,35 with later paper Feiqian (618-907), or "flying cash," during the Tang dynasty,36 and Jiaozi notes (960-1279) during the Song Dynasty.37 The Carolingian Pound was introduced around 742-814 by Charlemagne or Charles the Great (748814).38 The English silver penny and pound sterling date from around 757796.39 The Florence Florin and the Venetian Ducal were introduced around 1252 and 1284.40 The Spanish Real and Peso date from 1350 and 1366.41 The Dutch Guilder and then Thaler, Mark, and Franc emerged between 1252 and 1360.42 The United States dollar was created between 1776 and 1792,43 with the European Euro between 1999 and 2 002.44 The modern Chinese Renminbi dates from 1948.45 Aristotle explained the functions of money in terms of acting as a unit of account, medium of exchange, and store of value, which has remained the principal formulation in economics over time.46 Aristotle, nevertheless, separately highlighted the importance of valuation in his Nicomachean Ethics.41 The two core functions of money, for the purposes of this text, are restated in terms of valuation and value, with care having to be exercised in considering the three economic functions of money in law.48 This division is also reflected in Joseph Schumpeter's distinction between money acting as both a mensuratum (means of measurement) and mensura (the thing measured).49 Because money is a universal item of financial value, the principal uses or applications of money can be explained in terms of valuation, savings or deposit, lending or credit, payment or exchange, investment or return, and risk or loss management.50 A massive edifice of writing has subsequently been erected to examine the subject of money over

Endogenous, Exogenous And Existential Risk – New Global Solutions

Countries can be assisted through a separate 'Financial Investment, Regulatory, Social and Technology' (FIRST) agenda with emerging markets benefiting from a dedicated 'Sustainable Assistance Finance and Engagement' (SAFE) program with climate protection secured through a parallel 'Sustainable Assistance and Value Enterprise' (SAVE) agenda. The purpose would be to create a set of essential global minimum measures or key 'Global Objectives and Absolute Living Standards' (GOALS) based on a 'Core Objectives, Directions, Ethics' (CODE) statement or primary set of 'Conduct Objectives Regulations and Ethics' (CORE). Financial markets are core components within any modern economy and society with market risk and exposures and other internal (endogenous) and external (exogenous) threats having to be built into any larger new systems examination and architecture.10 This also requires the adoption of a longer, and inter-generational11 or monumental approach,12 rather than short-term planning perspective to respond to emergent threats and continuing larger global problems. Financial markets and financial regulation have been developed to manage specific forms of identifiable risk as well as more peripheral exposures that may impact on market function and market stability.13 Financial institutions attempt to identify a full range of possible exposures, and to deal with these either directly through risk management systems and controls, including with capital, liquidity, and leverage constraints;or indirectly through the maintenance of appropriate continuity and support management systems.14 These include new Recovery and Resolution Programs (RRPs) and Special Resolution Regimes (SRRs).15 Financial regulation has traditionally been either micro, market and sector specific, or macro focused, which assesses the financial system as a whole.16 Other more subtle forms of exposure can be identified between these with new additional forms of prudential, or subprudential, regulation being developed.17 A number of recommendations can be made to construct new, more effective and efficient types of market regulation and control.

SPORTS AND PHYSICAL ACTIVITY ATTENUATE THE EMOTIONAL TOLL OF THE COVID-19 PANDEMIC

Background: The COVID-19 pandemic resulted in the alterations or restrictions of youth sports and physical activity. These changes may have had negative ramifications on anxiety and both physical and psychological readiness to return to sport in youth athletes. Hypothesis/Purpose: Our purpose was to investigate the relationships between the physical and mental health ramifications on youth athletes during restricted sport activities that resulted from COVID-19 stay-at-home orders. Our hypothesis was that youth athletes who participated in a similar or greater volume of organized sports would have less anxiety during the COVID-19 stay-at-home orders compared with those who reported a decrease in organized sport volume. Methods: Our cross-sectional study evaluated male and female athletes who competed in club sports (e.g., non-school sponsored) at the time of questionnaire completion. All participants completed an online questionnaire between July 15, 2020 and August 10, 2020. We asked participants to report the average hours/week they spent in organized sports or physical activity unrelated to their sport prior to COVID-19 and currently. We grouped participants on whether they had a decrease or increase/no change in their reported activity level. Participants also completed the Generalized Anxiety Disorder-7 questionnaire. Results: A total of 192 participants (13.0±2.2 years of age;range= 6-18 years, 56% female) completed the study. On average, participants reported 2.3 (SD+5.2) fewer hours of sport training per week during the COVID-19 stay-at-home orders compared to prior. Over half (56%) of participants reported a decreased training volume during stay-at-home orders, and 44% reported a similar or increased training volume (Table 1). The respondents reporting decreased training volumes had significantly greater anxiety scores than those who reported similar training volumes (Figure 1). After adjusting for the potential confounders of age, sex, and body size, decreased training volumes during stay-at-home orders were significantly associated with higher anxiety levels (β coefficient = 2.02;95% confidence interval = 0.64, 3.41;p = 0.005). Those with decreased training volumes were more likely to report feeling undertrained (72% vs 30%, p<0.001) and less physically ready to return to sport (56% vs 88%, p<0.001) compared to those with similar/increased training volumes (Table 1). Conclusion: The COVID-19 pandemic resulted in decreased training volumes and higher anxiety scores (mean difference= 1.9 GAD-7 points, 95% confidence interval= 0.6, 3.2) compared with athletes who reported similar/increased training volumes. Lastly, those in the decreased training cohort felt both under-trained and less physically ready to return to sports.

PREPARE-IBD: Physician responses to disease flares and patient adaptation in relation to events in inflammatory bowel disease during the COVID-19 pandemic: A multicentre cohort analysis

Background: The COVID-19 pandemic continues to pose complex problems across Europe and the world, with rising numbers of infections and the ongoing need for drastic public health interventions. This is difficult for patients with immune-mediated disorders like Inflammatory Bowel Disease (IBD), where immunosuppressive medications may affect susceptibility to serious infection. It was particularly challenging for physicians and patients during the first wave of the pandemic, when it was unclear whether anti-inflammatory flare treatment should be adapted to reduce infection risk, whilst trying to ensure symptomatic control and avoid admission to overwhelmed hospitals. Despite the development of various IBD / COVID-19 databases, the treatment adaptations and outcomes of patients experiencing IBD flares during the COVID-19 pandemic remain undefined. We aimed to compare IBD management and outcomes between pandemic and prepandemic cohorts. Methods: An observational cohort study was performed, comprising patients who contacted IBD teams for a symptom flare between March - June, 2020 in, 60 National Health Service trusts in the United Kingdom. Data were compared to a pre-pandemic cohort after propensity- matching for age and disease severity. Statistical analyses were performed using R (version, 4.1.0, Vienna, Austria). Results: In total, 3728 patients in the pandemic (n=1864) and pre-pandemic (n=1864) cohorts were included. The principal findings were reduced systemic corticosteroid prescription during the pandemic in both Crohn's disease (prednisolone: pandemic, 199/752, 26.5% vs, 263/708, 37.1%;p<0.001) and ulcerative colitis (UC) (prednisolone: pandemic, 372/1112, 33.5% vs, 470/1156, 40.7%, p<0.001), with increases in poorly bioavailable oral corticosteroids in Crohn's (pandemic, 117/752, 15.6% vs, 48/708, 6.8%;p<0.001) and UC (pandemic, 131/1112, 11.8% vs, 60/1156, 5.2%;p<0.001). Ustekinumab (Crohn's and UC) and vedolizumab (UC) treatment also significantly increased during the pandemic. Three-month steroid-free remission was similar in both Crohn's (pandemic, 175/616, 28.4% vs, 195/608, 32.1%;p=0.17) and UC (pandemic, 312/858, 36.4% vs, 404/1006, 40.2%;p=0.095). The, 65 patients experiencing a flare and COVID-19 were more likely to have moderate-to-severely active disease at three months compared to those with a flare alone. Conclusion: Despite several treatment adaptations during the pandemic, steroid-free outcomes were comparable to pre-pandemic levels, though patients with a flare and COVID-19 experienced worse outcomes. These findings have implications for IBD management during future waves or pandemics.

DISEASE ACTIVITY IS ASSOCIATED WITH COVID-19 OUTCOMES IN IBD PATIENTS WITH EFFECT MODIFICATION BY AGE

Background: Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is an international database that monitors COVID-19 outcomes in IBD patients. We examined the influence of IBD disease activity on COVID-19 severity, while accounting for confounders and exploring the modifying effect of age. Methods: This was a retrospective analysis of all cases reported to SECURE-IBD with complete Physician Global Assessment (PGA) of IBD activity and age data (N=3028). PGA was categorized as remission/mild (reference) vs moderate vs severe. Outcomes used as surrogates of severe SARS-CoV2 infection were hospitalization and a composite of ICU/ ventilation/death. We compared cohort characteristics across PGA categories using the Chisquare and Kruskal-Wallis test. Using logistic regression, we determined the unadjusted association between disease activity and COVID-19 outcomes, overall and by age decade. Multivariable logistic regression models included PGA, age, sex, IBD type, comorbidities (0, 1, ≥2) and systemic corticosteroids (CS) a priori and additional confounders if they changed the estimate by ≥10% (we tested BMI, race, and medications). Risk estimates were expressed as crude and adjusted odds ratios (OR) with 95% CI. We also built models stratified by age (≤50 vs >50 years). Results: Race, IBD type, BMI and current medications (CS, anti-TNF, thiopurine monotherapy, aminosalicylates, ustekinumab and tofacitinib) differed across PGA categories (p<0.05). COVID-19 was more severe in patients with more active IBD: hospitalization rates 19% (remission/mild), 26% (moderate) and 45% (severe);ICU/ventilation/death rates 5% (remission/ mild), 6% (moderate) and 12% (severe) (p<0.05 for both outcomes). In unadjusted analyses, higher PGA was associated with an increased risk of hospitalization (moderate: OR 1.52, 95% CI 1.21-1.92;severe: OR 3.57, 95% CI 2.56-4.98) and ICU/ventilation/death (moderate: OR 1.40, 95% CI 0.94-2.10;severe: OR 2.72, 95% CI 1.63-4.55). Figure 1 illustrates the OR for hospitalization and ICU/ventilation/death for severe PGA vs remission/ mild by decade;effect sizes are greatest in patients ≤50 years. In multivariable analyses, PGA remained significantly associated with hospitalization, but not ICU/ventilation/death (effect lost after adjusting for CS) (Table 1). However, in analyses stratified by age, PGA remained significantly associated with both hospitalization and ICU/ventilation/death, even after adjusting for medications, in patients ≤50 but not >50 years (Table 1).Conclusions: The association between IBD activity and severe COVID-19 varied with age. The association was stronger in younger patients and, after adjusting for the confounding effect of medications, particularly CS, disease activity was significantly associated with severe outcomes only in younger (≤50 years) patients.(Figure Presented)Odds Ratios for A) hospitalization and B) ICU/ventilation/death for severe PGA vs remission/mild by decade (Table Presented)Adjusted Odds Ratios for Hospitalization and ICU/ventilation/death by Disease Activity, Overall and Stratified by Age

Psychological defence mechanisms during the COVID-19 pandemic: A case series.

BACKGROUND AND OBJECTIVES: COVID-19 has had a negative effect on mental health across the world's population. Healthcare workers in particular have experienced increased levels of psychological distress, depression and anxiety. Any perceived stress to an individual can provoke psychological defence mechanisms. Using psychoanalytic theory, a defence mechanism is described as an unconscious psychological strategy, with or without resulting behaviour, which aims to reduce or eliminate anxiety arising from unacceptable or potentially harmful stimuli. This paper aims to describe a range of psychological defence mechanisms encountered within colleagues in relation to the COVID-19 pandemic. METHODS: Using the methodology of a case series, specific defence mechanisms are explored with reference to further literature in the field. RESULTS: The author has encountered varying psychological defence mechanisms, both within himself and in other members of the multidisciplinary team. These have been illustrated in the attached clinical vignettes, relating to the specific psychological coping mechanisms of; denial, hypochondriasis, altruism, sublimation and humour. CONCLUSION: We encourage acknowledgement of psychological defence mechanisms and their implications on day to day practice. Whilst defence mechanisms can have a number of negative consequences as described in this article, they also have an important role, particularly in the case of mature defence mechanisms, as protective factors against psychological distress and symptom formation. Deeper understanding of the gold-standard hierarchical organisation of defence mechanisms could help increase utilisation of specific therapeutic interventions for enhancing changes from immature to mature defensive responses to stressful experiences as the COVID-19 pandemic progresses.