Histopathological maladaptive changes in the explanted human mitral leaflets correlate with changes in echocardiographic leaflet morphology and the severity of ischaemic mitral regurgitation.

peer reviewedAIMS: Several changes of the mitral valve (MV) morphology have been previously documented in ischaemic mitral regurgitation (IMR) upon macro and microscopic examination. This study aimed to correlate echocardiographic MV thickening with IMR severity and to delineate the histopathological basis of valve thickening from the explanted leaflets. METHODS AND RESULTS: Two hundred and fifty patients were included in the echo-group; of these, 48 patients (19.2%) underwent surgical mitral valve replacement (MVR), including them in the histology-group. By echocardiography, the thickness of the anterior and posterior leaflet was more extensive in moderate to severe IMR, P < 0.001. Histology-group: patients were divided into two groups based on the median thickness: those with cusp thickness <0.42 cm in Group 1, and ≥0.42 cm in Group 2. The thickness of the base and cusp was more significant in Group 2, P < 0.05 in both. Group 2 biopsies were characterized by involvement of the three leaflet segments, myxoid tissue, and fibrosis deposition. Thicker leaflets were associated with a greater degree of mitral regurgitation (MR), P < 0.0001. In the echo-group, a median leaflet thickness of 3.5 mm of the anterior and posterior MV was independently associated with moderate to severe ischaemic MR [odds ratio (OR) 2.88, P < 0.01] and (OR 10.8, P < 0.001), respectively. CONCLUSION: In ischaemic MR, the thicker the cusps, the worse the MR. Leaflet thickening was due to the myxoid and fibrosis deposition and was detected by echocardiography. Therefore, this method can be helpful in the evaluation of valve remodelling

Evaluación de la calidad en el servicio del subsector de restaurantes en la ciudad de Santiago de Cali

El presente trabajo de grado tiene como objetivo plantear un modelo de evaluación de la calidad del servicio para medir las percepciones de los usuarios que asisten a los restaurantes vinculados a la Mesa de Turismo del Grupo Multisectorial ubicados en la ciudad de Santiago de Cali, con el fin de implantar alternativas para mejorar la competitividad de los mismos. Este trabajo consta de tres objetivos específicos, los cuales se desarrollaron en cuatro etapas; la primera se basó en el análisis de validez del instrumento a partir de l validez de contenido, criterio y constructo; y de la confiabilidad a través del Alfa de Cronbach a una prueba piloto, se seleccionaron los datos de las encuestas sugeridas y adaptadas por Servperf y las Normas Técnicas de la Calidad para los restaurantes y, finalmente se realizó un estudio sociodemográfico. La segunda etapa se fundamentó en la evaluación de la calidad del servicio, llevando a cabo la toma de encuestas a los clientes para conocer sus percepciones ligeramente después de recibir el servicio. En la tercera etapa, se realizó un análisis estadístico de las percepciones de los usuarios y un análisis de criterios ponderados para la obtención del índice de calidad de servicio general percibido por dichos usuarios. Finalmente, en la cuarta etapa se plantearon estrategias de mejora con el fin de dar respuesta a las dimensiones con menor puntaje de percepción. Se hallaron como resultados que en los restaurantes los usuarios califican mejor la dimensión de seguridad seguido de la empatía, la capacidad de respuesta y la fiabilidad. No obstante, los usuarios se encuentran insatisfechos con la dimensión de tangibilidad. De la misma forma, se descubrió que los usuarios del restaurante La Galería Plaza se encuentran insatisfechos con la dimensión de tangibilidad, mientras que en el restaurante Jardín del Rio los usuarios se encuentran insatisfechos con las dimensiones de tangibilidad y fiabilidad. Por otro lado, el índice de calidad general para La Galería Plaza y Jardín del Rio es de 4,482 y 4,468 respectivamente, mientras que para el subsector en general es de 4,475. Como plan de mejora se planteó una estrategia para cada restaurante referida a los elementos tangibles e instalaciones físicas y dos adicionales para Jardín del Rio referentes a la disposición, proporción y rapidez del servicioThe purpose of this degree project is to propose a model for evaluating the quality of the service to measure the perceptions of the users who attend the restaurants linked to the Tourism Board of the Multisectoral Group located in the city of Santiago de Cali, with the in order to implement alternatives to improve their competitiveness. This work consists of three specific objectives, which were developed in four stages; the first was based on the analysis of the validity of the instrument based on the validity of content, criteria and construct; and from the reliability through Cronbach's Alpha to a pilot test, the data from the surveys suggested and adapted by Servperf and the Technical Quality Standards for restaurants were selected and finally a sociodemographic study was carried out. The second stage was based on the evaluation of the quality of the service, carrying out customer surveys to know their perceptions slightly after receiving the service. In the third stage, a statistical analysis of the perceptions of the users and an analysis of weighted criteria for obtaining the general service quality index perceived by said users was performed. Finally, in the fourth stage, improvement strategies were proposed in order to respond to the dimensions with the lowest perception score. The results were that in restaurants, users better rate the security dimension followed by empathy, responsiveness and reliability. However, users are dissatisfied with the dimension of tangibility. In the same way, it was discovered that users of the La Galería Plaza restaurant are dissatisfied with the tangibility dimension, while in the Jardín del Rio restaurant users are dissatisfied with the dimensions of tangibility and reliability. On the other hand, the general quality index for La Galería Plaza and Jardín del Rio is 4,482 and 4,468 respectively, while for the subsector in general it is 4,475. As an improvement plan, a strategy was proposed for each restaurant referring to the tangible elements and physical facilities and two additional ones for Jardín del Rio regarding the disposition, proportion and speed of the servicePasantía de investigación (Ingeniero Industrial)-- Universidad Autónoma de Occidente, 2020PregradoIngeniero(a) Industria