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RESUMEN Introducción: La miopía es uno de los errores refractivos más prevalentes, a nivel global 28,3%. La apariencia morfológica del disco óptico en la miopía con las variaciones propias de la condición hacen del diagnóstico clínico y el monitoreo de la progresión del glaucoma muy difícil. Recientemente, nuevas modalidades de imagen de alta resolución se desarrollaron para darnos más información y ayudar en la detección de los cambios micro anatómicos de la cabeza del nervio óptico. Objetivo: Determinar la variabilidad del espesor de la capa de fibras nerviosas peripapilares (CFNR) medido con tomografía de coherencia óptica (OCT) entre los diferentes grupos según severidad de miopía y grupo control. Metodología: Se trata de un estudio observacional, descriptivo, de corte transversal. Muestreo no probabilístico de casos consecutivos. Con componente analítico. Resultados: Se analizaron un total de 144 ojos, de los sujetos estudiados aproximadamente dos tercios eran del sexo femenino (n: 97 ojos). La edad media de los sujetos estudiados fue de 30,68 +/- 11,58. Se estudiaron 50 (34,7%) ojos emétropes como grupo control, entre los diferentes grupos según severidad de la miopía se estudiaron 27 (18,8 %) ojos con miopía leve, 33 (22,9 %) con miopía moderada y 34 (23,6 %) ojos con miopía severa. La media de longitud axial encontrada fue de 23,12 +/- 0,81mm para el grupo control (emétropes); 23,72 +/- 0,76 para el grupo con miopía leve; 25,11+/-0.79mm para el grupo con miopía moderada y de 26,42 +/- 1,45mm para el grupo con miopía severa, encontrándose diferencias estadísticamente significativas entre estos grupos con una longitud axial mayor para el grupo con miopía severa. Se encontraron diferencias estadísticamente significativas entre los grupos estudiados, para diferencias encontradas en el espesor promedio y en el espesor de los cuadrantes superior, inferior y temporal. Las diferencias encontradas en el espesor del cuadrante nasal fueron no significativas. Conclusión: A pesar de las limitaciones, este estudio claramente demuestra que los ojos con miopía severa tienen un espesor menor en la CFNR peripapilares que los ojos emétropes en los cuadrantes superior e inferior. En el cuadrante temporal y nasal se encontró un aumento del espesor, siendo estadísticamente significativo en el cuadrante temporal. Por un lado este adelgazamiento podría ser un factor de riesgo para el desarrollo del glaucoma ya que las variaciones en la disposición de las fibras nerviosas de la cabeza del nervio óptico se postulan que hacen del ojo miope más susceptible al daño glaucomatoso. Para la relevancia clínica, debemos tener en cuenta las diferencias propias de la miopía para realizar el diagnóstico correcto en los casos de sospecha de glaucoma y evaluar progresión con OCT. Así también sería ideal agrupar según rango etario por las diferencias propias de esta variable que podría haber influenciado en la interpretación de los resultados. ABSTRACT Introduction: Myopia is one of the most prevalent refractive errors, globally 28.3%. The morphological appearance of the optic disc in myopia with the variations of the condition make clinical diagnosis and monitoring of glaucoma progression very difficult. Recently, new high resolution imaging modalities were developed to give us more information and help in the detection of micro anatomic changes of the optic nerve head. Objective: To determine the thickness variability of the peripapillary nerve fiber (RNFL) layer measured with optical coherence tomography (OCT) between the different groups according to myopia severity and control group. Methodology: This is an observational, descriptive, cross-sectional study. Non-probabilistic sampling of consecutive cases. With analytical component. Results: A total of 144 eyes were analyzed, approximately two thirds of the subjects studied were female (n: 97 eyes). The average age of the subjects studied was 30.68 +/- 11.58. 50 (34.7%) emmetropic eyes were studied as a control group, among the different groups according to severity of myopia 27 (18.8%) eyes with mild myopia were studied, 33 (22.9%) with moderate myopia and 34 (23.6%) eyes with severe myopia. The mean axial length found was 23.12 +/- 0.81mm for the control group (emétropes); 23.72 +/- 0.76mm for the group with mild myopia; 25.11 +/- 0.79mm for the group with moderate myopia and 26.42 +/- 1.45mm for the group with severe myopia, with statistically significant differences between these groups with a greater axial length for the group with severe myopia. Statistically significant differences were found between the groups studied, for differences found in the average thickness and in the thickness of the upper, lower and temporal quadrants. The differences found in the thickness of the nasal quadrant were not significant. Conclusion: Despite the limitations, this study clearly demonstrates that eyes with severe myopia have a smaller thickness in the peripapillary RNFL than the emmetropic eyes in the upper and lower quadrants. An increase in thickness was found in the temporal and nasal quadrant, being statistically significant in the temporal quadrant. On the one hand this thinning could be a risk factor for the development of glaucoma since variations in the arrangement of the nerve fibers of the optic nerve head are postulated that make the myopic eye more susceptible to glaucomatous damage. For clinical relevance, we must take into account the differences of myopia to make the correct diagnosis in cases of suspected glaucoma and evaluate progression with OCT. Thus it would also be ideal to group according to age range due to the differences of this variable that could have influenced the interpretation of the results.

From this edition, the Financial Stability Report will have fewer pages with some changes in its structure. The purpose of this change is to present the most relevant facts of the financial system and their implications on the financial stability. This allows displaying the analysis more concisely and clearly, as it will focus on describing the evolution of the variables that have the greatest impact on the performance of the financial system, for estimating then the effect of a possible materialization of these risks on the financial health of the institutions. The changing dynamics of the risks faced by the financial system implies that the content of the Report adopts this new structure; therefore, some analyses and series that were regularly included will not necessarily be in each issue. However, the statistical annex that accompanies the publication of the Report will continue to present the series that were traditionally included, regardless of whether or not they are part of the content of the Report. In this way we expect to contribute in a more comprehensive way to the study and analysis of the stability of the Colombian financial system. Executive Summary During the first half of 2015, the main advanced economies showed a slow recovery on their growth, while emerging economies continued with their slowdown trend. Domestic demand in the United States allowed for stabilization on its average growth for the first half of the year, while other developed economies such as the United Kingdom, the euro zone, and Japan showed a more gradual recovery. On the other hand, the Chinese economy exhibited the lowest growth rate in five years, which has resulted in lower global dynamism. This has led to a fall in prices of the main export goods of some Latin American economies, especially oil, whose price has also responded to a larger global supply. The decrease in the terms of trade of the Latin American economies has had an impact on national income, domestic demand, and growth. This scenario has been reflected in increases in sovereign risk spreads, devaluations of stock indices, and depreciation of the exchange rates of most countries in the region. For Colombia, the fall in oil prices has also led to a decline in the terms of trade, resulting in pressure on the dynamics of national income. Additionally, the lower demand for exports helped to widen the current account deficit. This affected the prospects and economic growth of the country during the first half of 2015. This economic context could have an impact on the payment capacity of debtors and on the valuation of investments, affecting the soundness of the financial system. However, the results of the analysis featured in this edition of the Report show that, facing an adverse scenario, the vulnerability of the financial system in terms of solvency and liquidity is low. The analysis of the current situation of credit institutions (CI) shows that growth of the gross loan portfolio remained relatively stable, as well as the loan portfolio quality indicators, except for microcredit, which showed a decrease in these indicators. Regarding liabilities, traditional sources of funding have lost market share versus non-traditional ones (bonds, money market operations and in the interbank market), but still represent more than 70%. Moreover, the solvency indicator remained relatively stable. As for non-banking financial institutions (NBFI), the slowdown observed during the first six months of 2015 in the real annual growth of the assets total, both in the proprietary and third party position, stands out. The analysis of the main debtors of the financial system shows that indebtedness of the private corporate sector has increased in the last year, mostly driven by an increase in the debt balance with domestic and foreign financial institutions. However, the increase in this latter source of funding has been influenced by the depreciation of the Colombian peso vis-à-vis the US dollar since mid-2014. The financial indicators reflected a favorable behavior with respect to the historical average, except for the profitability indicators; although they were below the average, they have shown improvement in the last year. By economic sector, it is noted that the firms focused on farming, mining and transportation activities recorded the highest levels of risk perception by credit institutions, and the largest increases in default levels with respect to those observed in December 2014. Meanwhile, households have shown an increase in the financial burden, mainly due to growth in the consumer loan portfolio, in which the modalities of credit card, payroll deductible loan, revolving and vehicle loan are those that have reported greater increases in risk indicators. On the side of investments that could be affected by the devaluation in the portfolio of credit institutions and non-banking financial institutions (NBFI), the largest share of public debt securities, variable-yield securities and domestic private debt securities is highlighted. The value of these portfolios fell between February and August 2015, driven by the devaluation in the market of these investments throughout the year. Furthermore, the analysis of the liquidity risk indicator (LRI) shows that all intermediaries showed adequate levels and exhibit a stable behavior. Likewise, the fragility analysis of the financial system associated with the increase in the use of non-traditional funding sources does not evidence a greater exposure to liquidity risk. Stress tests assess the impact of the possible joint materialization of credit and market risks, and reveal that neither the aggregate solvency indicator, nor the liquidity risk indicator (LRI) of the system would be below the established legal limits. The entities that result more individually affected have a low share in the total assets of the credit institutions; therefore, a risk to the financial system as a whole is not observed. José Darío Uribe Governor

In the face of the multiple shocks currently experienced by the domestic economy (resulting from the drop in oil prices and the appearance of a global pandemic), the Colombian financial system is in a position of sound solvency and adequate liquidity. At the same time, credit quality has been recovering and the exposure of credit institutions to firms with currency mismatches has declined relative to previous episodes of sudden drops in oil prices. These trends are reflected in the recent fading of red and blue tonalities in the performance and credit risk segments of the risk heatmaps in Graphs A and B.1 Naturally, the sudden, unanticipated change in macroeconomic conditions has caused the appearance of vulnerabilities for short-term financial stability. These vulnerabilities require close and continuous monitoring on the part of economic authorities. The main vulnerability is the response of credit and credit risk to a potential, temporarily extreme macroeconomic situation in the context of: (i) recently increased exposure of some banks to household sector, and (ii) reductions in net interest income that have led to a decline in the profitability of the banking business in the recent past. Furthermore, as a consequence of greater uncertainty and risk aversion, occasional problems may arise in the distribution of liquidity between agents and financial markets. With regards to local markets, spikes have been registered in the volatility of public and private fixed income securities in recent weeks that are consistent with the behavior of the international markets and have had a significant impact on the liquidity of those instruments (red portions in the most recent past of some market risk items on the map in Graph A). In order to adopt a forward-looking approach to those vulnerabilities, this Report presents a stress test that evaluates the resilience of credit institutions in the event of a hypothetical scenario thatseeks to simulate an extreme version of current macroeconomic conditions. The scenario assumes a hypothetical negative growth that is temporarily strong but recovers going into the middle of the coming year and has extreme effects on credit quality. The results suggest that credit institutions have the ability to withstand a significant deterioration in economic conditions in the short term. Even though there could be a strong impact on credit, liquidity, and profitability under the scenario being considered, aggregate capital ratios would probably remain at above their regulatory limits over the horizon of a year. In this context, the recent measures taken by both Banco de la República and the Office of the Financial Superintendent of Colombia that are intended to help preserve the financial stability of the Colombian economy become highly relevant. In compliance with its constitutional objectives and in coordination with the financial system’s security network, Banco de la República will continue to closely monitor the outlook for financial stability at this juncture and will make the decisions that are necessary to ensure the proper functioning of the economy, facilitate the flow of sufficient credit and liquidity resources, and further the smooth functioning of the payment system. Juan José Echavarría Governor

With its annual Payment Systems Report, Banco de la Republica offers a complete overview of the infrastructure of Colombia’s financial market. Each edition of the report has four objectives: 1) to publicize a consolidated account of how the figures for payment infrastructures have evolved with respect to both financial assets and goods and services; 2) to summarize the issues that are being debated internationally and are of interest to the industry that provides payment clearing and settlement services; 3) to offer the public an explanation of the ideas and concepts behind retail-value payment processes and the trends in retail payments within the circuit of individuals and companies; and 4) to familiarize the public, the industry, and all other financial authorities with the methodological progress that has been achieved through applied research to analyze the stability of payment systems. This edition introduces changes that have been made in the structure of the report, which are intended to make it easier and more enjoyable to read. The initial sections in this edition, which is the eleventh, contain an analysis of the statistics on the evolution and performance of financial market infrastructures. These are understood as multilateral systems wherein the participating entities clear, settle and register payments, securities, derivatives and other financial assets. The large-value payment system (CUD) saw less momentum in 2019 than it did the year before, mainly because of a decline in the amount of secondary market operations for government bonds, both in cash and sell/buy-backs, which was offset by an increase in operations with collective investment funds (CIFs) and Banco de la Republica’s operations to increase the money supply (repos). Consequently, the Central Securities Depository (DCV) registered less activity, due to fewer negotiations on the secondary market for public debt. This trend was also observed in the private debt market, as evidenced by the decline in the average amounts cleared and settled through the Central Securities Depository of Colombia (Deceval) and in the value of operations with financial derivatives cleared and settled through the Central Counterparty of Colombia (CRCC). Section three offers a comprehensive look at the market for retail-value payments; that is, transactions made by individuals and companies. During 2019, electronic transfers increased, and payments made with debit and credit cards continued to trend upward. In contrast, payments by check continued to decline, although the average daily value was almost four times the value of debit and credit card purchases. The same section contains the results of the fourth survey on how the use of retail-value payment instruments (for usual payments) is perceived. Conducted at the end of 2019, the main purpose of the survey was to identify the availability of these payment instruments, the public’s preferences for them, and their acceptance by merchants. It is worth noting that cash continues to be the instrument most used by the population for usual monthly payments (88.1% with respect to the number of payments and 87.4% in value). However, its use in terms of value has declined, having registered 89.6% in the 2017 survey. In turn, the level of acceptance by merchants of payment instruments other than cash is 14.1% for debit cards, 13.4% for credit cards, 8.2% for electronic transfers of funds and 1.8% for checks. The main reason for the use of cash is the absence of point-of-sale terminals at commercial establishments. Considering that the retail-payment market worldwide is influenced by constant innovation in payment services, by the modernization of clearing and settlement systems, and by the efforts of regulators to redefine the payment industry for the future, these trends are addressed in the fourth section of the report. There is an account of how innovations in technology-based financial payment services have developed, and it shows that while this topic is not new, it has evolved, particularly in terms of origin and vocation. One of the boxes that accompanies the fourth section deals with certain payment aspects of open banking and international experience in that regard, which has given the customers of a financial entity sovereignty over their data, allowing them, under transparent and secure conditions, to authorize a third party, other than their financial entity, to request information on their accounts with financial entities, thus enabling the third party to offer various financial services or initiate payments. Innovation also has sparked interest among international organizations, central banks, and research groups concerning the creation of digital currencies. Accordingly, the last box deals with the recent international debate on issuance of central bank digital currencies. In terms of the methodological progress that has been made, it is important to underscore the work that has been done on the role of central counterparties (CCPs) in mitigating liquidity and counterparty risk. The fifth section of the report offers an explanation of a document in which the work of CCPs in financial markets is analyzed and corroborated through an exercise that was built around the Central Counterparty of Colombia (CRCC) in the Colombian market for non-delivery peso-dollar forward exchange transactions, using the methodology of network topology. The results provide empirical support for the different theoretical models developed to study the effect of CCPs on financial markets. Finally, the results of research using artificial intelligence with information from the large-value payment system are presented. Based on the payments made among financial institutions in the large-value payment system, a methodology is used to compare different payment networks, as well as to determine which ones can be considered abnormal. The methodology shows signs that indicate when a network moves away from its historical trend, so it can be studied and monitored. A methodology similar to the one applied to classify images is used to make this comparison, the idea being to extract the main characteristics of the networks and use them as a parameter for comparison. Juan Jose Echavarria Governor

The addition of oxygenated fuels to petrochemical gasoline and diesel reduces the formation of contaminants during combustion, including soot, CO, hydrocarbons, and NOx. The net reduction of these emissions and greenhouse gases, particularly CO2, CH4, and N2O, is a more complex and controversial issue, since it involves the entire production chain, including agricultural emissions, about which he knows very little. Similar volumes of oil palm biodiesel are produced in Colombia (1261 ton / day in 2017) and sugar cane bioethanol (1005 m3 / day in 2017). The geographic valley of the Cauca River (VRC), in which it is possible to grow cane throughout the year, produces almost 80% of Colombia's sugar cane. The pre-harvest burning of sugarcane (QPA) is still a common practice, given its advantages in terms of yield and production, compared with the green harvest, that is, without pre-harvest burning. Despite its importance, very little is yet known about the impact on air pollution of this practice. This research is part of the CACIQUE project and measurement campaign (CAuca river valley sugarCane pre-harvest burning aIr QUality Effects), which seeks to quantify and attribute sources to the air quality measured in the center of the VRC. Based on detailed information for 2018, in this presentation we will present a detailed analysis of the spatiotemporal distribution of the QPA in the VRC, and a first estimate of the associated atmospheric emissions. In 2018, 66% of the area was harvested green, 26% by controlled burning, and 8% by fires, or unintentional burning. The analysis also revealed that the majority of the burns take place in the 4-8 pm period, and a considerable reduction in burns and fires in the rainiest months (May and November). Additional details will be presented, including geostatistical analysis results.

Resumen Introducción. En Colombia, la tamización para cáncer de mama, de acuerdo con las normativas del Ministerio de Protección Social, se hace mediante el examen clínico anual de la mama a partir de los 40 años y la mamografía bienal entre los 50 y los 69 años. Se presenta la experiencia en tamización con mamografía y examen clínico de la mama en el departamento del Huila de Colombia. Materiales y métodos. El departamento del Huila, al sur de Colombia, tiene una población de 1’097.615 habitantes, y se seleccionaron 15 municipios para este estudio. La tamización se llevó a cabo entre junio de 2011 y diciembre de 2013, y se adaptó un vehículo que permanecía en cada uno de los municipios durante un tiempo establecido. Dicha unidad móvil contaba con recepción, consultorio médico y unidad de mamografía digitalizada. Se hizo una ronda de tamización con el examen clínico de la mama y la mamografía de dos proyecciones. Resultados. Se valoraron 5.212 mujeres, 4.995 de las cuales contaban con información completa. De estas, 100 (2 %) tenían hallazgos positivos en el examen clínico de la mama. El 51,9 % de las mamografías fueron caracterizadas como BI-RADS 3 y el 1,12 %, como BI-RADS 4 o 5. Se confirmó el diagnóstico de cáncer en 29 pacientes, 9 con carcinoma in situ y 20 con carcinoma infiltrante, de las cuales 17 (59 %) tenían tumores en los estadios clínicos tempranos. Discusión. Se muestra que es posible hacer tamización para cáncer de mama con mamografía y examen clínico de la mama en municipios alejados de los grandes centros urbanos de Colombia, si se cuenta con una infraestructura básica y médicos generales o enfermeras con entrenamiento en la detección temprana del cáncer de mama. Abstract Introduction: Breast cancer screening in Colombia is performed following the “Ministerio de Salud y Protección Social” guidelines, through annual clinical examination starting with women 40 years old and biennial mammography in women between 50 and 69 years old. The article shows the experience in screening with mammography and breast clinical examination in the state of Huila, Colombia. Methods and materials: The state of Huila, located in southern Colombia, has a population of 1,097,615. Fifteen townships were selected for the study. Screening was carried out between June 2011 and December 2013. A customized vehicle stayed in every single township during an stablished period of time. This mobile unit was equipped with a reception area, a doctor´s office and a digitalized mammography unit. Screening was performed by breast clinical examination and a two-projection mammography. Results: 5,212 patients were screened, of which 4,995 had complete information. 100 women (2%) had positive clinical breast examination findings; 51.9% of the mammographies were BI-RADS 3, and 56 (1.12%) were BI-RADS 4 or 5. Diagnosis of cancer was confirmed in 29 patients, 9 of them with carcinoma in situ, and 20 with infiltrating carcinoma, of which 17 (59%) had early stage tumors. Discussion: This work shows that it is possible to screen for mammary cancer with mammography and breast clinical examination in townships away from the large urban centers of Colombia, provided there are a basic infrastructure and general physicians or nurses with training in early detection of breast cancer.

Macroprudential policy in Colombia is described along with a discussion of the main challenges faced by the authorities in implementing it and a review of episodes in which macroprudential measures were taken. An overview and some estimates of their effectiveness in preventing the buildup of imbalances, increasing buffers and cushioning downswings are presented.