Calidad de servicio y lealtad de compra del consumidor en supermercados real plaza y metro de la ciudad de Huánuco. 2013-2014

Service quality is a complex concept that includes both tangible and intangible elements thatconsumers perceive to receive a service. Similarly, represents one of the most important variables informulating marketing strategies, which helps improve the competitiveness of the company. Loyaltyis another complex concept that allows knowing the intention or decision that takes the consumerto the service quality stimulus.Both concepts are closely related, as shown Heskett (1997) in their model of the Service ProfitChain, which is part of the essential information of companies, mainly services, to design strategiesand quality of service customer loyalty, which ultimately impact on its financial results. The research focused on establishing the partnership between the two concepts, quality of service and loyalty inHuanuco supermarket customers, considering their perceptions and behavioral intention.The methodology applied research corresponded to a quantitative cross-sectional study of descriptivecorrelational. The survey method was used to obtain information through a structured and validatedbased on the measuring of the questionnaire CALSUPER questionnaire. This was applied to a randomsample of 400 customers.The results of the research helped establish that there is a strong relationship between perceivedservice quality and customer loyalty purchase. Consumers in Huanuco supermarkets showed afavorable perception towards quality of service received, and high levels of loyalty, considering thewide range of these businesses. Service quality was measured in dimensions, physical evidence,political, personal interaction and reliability. Of these, the first two are the ones that are more relatedto loyalty as measured behavioral intention.Finally, it is recommended that management of supermarkets put greater emphasis on these twodimensions when defining aimed at improving service quality strategies, which will result in higherlevels of loyalty of existing and new customers.La calidad de servicio es un concepto complejo que comprende tanto a los elementos tangiblescomo intangibles que perciben los consumidores al recibirlo. De igual manera, representa una delas variables más importantes en la formulación de las estrategias de marketing, la cual ayuda amejorar la competitividad de la empresa. La lealtad es otro concepto complejo que permite conocerla intención o decisión que asume el consumidor ante el estímulo calidad de servicio.Ambos conceptos se encuentran estrechamente relacionados, según lo muestra Heskett (1997) ensu modelo del Service Profit Chain, el cual forma parte de la información esencial de las empresas,principalmente las de servicios, para el diseño de sus estrategias de calidad de servicio y fidelizaciónde sus clientes, que, finalmente, impactará en sus resultados financieros. La investigación se enfocóen establecer la asociación entre ambos conceptos, calidad de servicio y la lealtad, en clientes desupermercados de Huánuco, considerando su percepción e intención de comportamiento.La metodología de investigación aplicada correspondió a un estudio cuantitativo de corte transversaldel tipo descriptivo-correlacional. Se utilizó el método de encuestas para obtener la informacióna través de un cuestionario estructurado y validado, basado en el instrumento de medición delcuestionario CALSUPER. Este se aplicó a una muestra aleatoria de 400 clientes.Los resultados de la investigación permitieron establecer que hay una fuerte relación entre la calidadde servicio percibida por el cliente y su lealtad de compra. Los consumidores de los supermercadoshuanuqueños mostraron una percepción favorable hacia la calidad de servicio recibida, así como altosniveles de lealtad, considerando la amplia oferta existente de este tipo de empresas. La calidad deservicio fue medida en las dimensiones, evidencias físicas, políticas, interacción personal y fiabilidad.De estas, las dos primeras son las que se encuentran más relacionadas con la lealtad medida comointención de comportamiento.Finalmente, se recomienda que las gerencias de los supermercados pongan mayor énfasis a estasdos dimensiones al momento de definir estrategias orientadas a mejorar la calidad de servicio, lo quetraerá como consecuencia mayores niveles de fidelización de los actuales y nuevos clientes

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

EFECTO DE LOS FACTORES CLIMÁTICOS DETERMINANTES SOBRE LA PRODUCCIÓN DE Myrciaria dubia (Kunth) McVaught EN UCAYALI, PERÚ, 2009 – 2029

Agricultural production is sensitive to climatic factors and the study of their relationships is essential to understand their behavior in the future; for this reason, the objective of this study was to determine the effect of the determining climatic factors on the production of Myrciaria dubia (Kunth) McVaugh, in Ucayali - Peru, 2009-2019; to do this, through the production function, the effect of climatic factors (temperature and rainfall) determining the production of camu-camu in Ucayali was quantified; considering for this, as dimensions of production: yield per hectare, harvested area and the gross value of production for the period 2009 - 2019 and its projection until 2029, using the ordinary least square method (OLS). It was possible to determine that rainfall is the most important climatic factor on yield with 48.79%; and, by 2029, the yield trend is negative, with a reduction of 1.12 t.ha-1. On the other hand, the maximum temperature is the determining climatic factor on the harvested area of camu-camu in 68.82%; by 2029 its projection is positive with an increase of 835.50 ha. Likewise, the maximum temperature is the determining climatic factor on the gross value of camu-camu production at 82.62% and by 2029, its projection will be positive with an increase of 3,546,843.95 PENLa producción agrícola es sensible a los factores climáticos y el estudio de sus relaciones es fundamental para comprender su comportamiento a futuro; por ello, el objetivo de este estudio fue determinar el efecto de los factores climáticos determinantes en la producción de Myrciaria dubia (Kunth) McVaugh, en Ucayali – Perú, 2009-2019; para ello, mediante la función de producción se cuantificó el efecto de los factores climáticos (temperatura y precipitación pluvial) determinantes sobre la producción del camu-camu en Ucayali; considerando para ello, como dimensiones de la producción: rendimiento por hectárea (t.ha-1), superficie cosechada (ha) y el valor bruto de la producción (soles) del periodo 2009 – 2019 y su proyección hasta el 2029, utilizando el método de Mínimos Cuadrados Ordinarios (MCO). Se pudo determinar que la precipitación pluvial es el factor climático con mayor importancia sobre el rendimiento con un 48,79%; y que, al 2029 la tendencia de su rendimiento es negativo, con una reducción de 1,12 t.ha-1. Por otro lado, la temperatura máxima es el factor climático determinante sobre la superficie cosechada del camu-camu en 68,82%; al 2029 su proyección es positiva con un incremento de 835,50 ha. Así también, la temperatura máxima es el factor climático determinante sobre el valor bruto de la producción de camu-camu a un 82,62% y al 2029, su proyección será positiva con un incremento de 3 546 843,95 soles

First scientific observations with MEGARA at GTC

On June 25th 2017, the new intermediate-resolution optical IFU and MOS of the 10.4-m GTC had its first light. As part of the tests carried out to verify the performance of the instrument in its two modes (IFU and MOS) and 18 spectral setups (identical number of VPHs with resolutions R=6000-20000 from 0.36 to 1 micron) a number of astronomical objects were observed. These observations show that MEGARA@GTC is called to fill a niche of high-throughput, intermediateresolution IFU and MOS observations of extremely-faint narrow-lined objects. Lyman-α absorbers, star-forming dwarfs or even weak absorptions in stellar spectra in our Galaxy or in the Local Group can now be explored to a new level. Thus, the versatility of MEGARA in terms of observing modes and spectral resolution and coverage will allow GTC to go beyond current observational limits in either depth or precision for all these objects. The results to be presented in this talk clearly demonstrate the potential of MEGARA in this regard

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old