The port system is immersed in a process of digital transformation towards the concept of Ports 4.0, under the new regulatory and connectivity requirements that are expected of them. As a result of the changes that the industrial revolution 4.0 is imposing, based on new information technologies and the change of energy model, the electrification of modes of transport from alternative energies and the total digitalization of the processes is occurring. This conversion to digital, intelligent, and green ports requires the implementation of the new technologies offered by the market. The inclusion of these enabling tools has allowed the development of automated terminals under a functional approach. This article aims to offer the responsible entities a new methodology (BOT) that allows them to successfully undertake the automation of terminals, taking into account the reality of the conditions of the environment in which they are developed. By quantifying the factors that facilitate or impede implementation, it will be possible to determine the strategy to be followed and the necessary measures to be adopted in the project; constituting, therefore, a novel management and planning tool.

BackgroundOptimal immunosuppressive treatment for membranous nephropathy is still a matter of controversy. Current recommendations include oral cyclophosphamide combined with steroids (modified Ponticelli regimen) as first-line treatment in patients who are high risk. However, concerns about the cumulative toxicity of oral cyclophosphamide persist. In the last 30 years, a protocol based on low-dose intravenous cyclophosphamide plus steroids has been used to treat membranous nephropathy in Uruguay. We aimed to assess the efficacy of this regimen to induce clinical remission in patients with membranous nephropathy.MethodsIn this retrospective, observational cohort study, we analyzed the outcome of 55 patients with membranous nephropathy treated between 1990 and 2017 with a 6-month course of alternating steroids (months 1, 3, and 5) plus intravenous cyclophosphamide (single dose of 15 mg/kg on the first day of months 2, 4, and 6).ResultsAt 24 months, 39 (71%) patients achieved clinical response with complete remission observed in 23 patients (42%) and partial remission in 16 (29%). Median time to achieve partial and complete remission was 5.9 and 11.5 months, respectively. Absence of response was observed in 16 patients (29%), five of whom started chronic RRT after a median follow-up of 3.5 years. Clinical relapse occurred in nine of 33 (27%) patients at a median of 34 months after treatment discontinuation.ConclusionsReplacement of oral cyclophosphamide with a single intravenous pulse on months 2, 4, and 6 of the modified Ponticelli regimen can be an effective and safe alternative for treatment of membranous nephropathy.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_09_24_KID0002802020.mp3

The Spanish port system is subjected to a Data Envelopment Analysis (DEA)-Bootstrapping analysis of its operational and financial efficiency to be compared to two other scenarios. One of these presents a port cluster based on the grouping of ports because of their proximity, and the second scenario proposes a port cluster based on seafronts. The analysis is made up of a DEA-Bootstrapping of two inputs and two outputs for both the operational and financial efficiency analyses. The results of the DEA-Bootstrapping analysis show a series of results that favour these two scenarios against the present situation, as both the operational and financial efficiency are improved in relation to the current scenario or scenario 0.