Nocturnal Cramps in Patients with Lumbar Spinal Canal Stenosis Treated Conservatively: A Prospective Study

Nishant,Harvinder Singh Chhabra,Kulwant Singh Kapoor 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.5

Study Design: Prospective cohort study with questionnaire. Purpose: To compare the treatment outcome of nocturnal leg cramps in lumbar spinal canal stenosis (LSCS) patients on conservative treatment with historical surgical cohorts and to determine the sensitivity and specificity as well as positive predictive value and negative predictive value of knee flexion test suggested for LSCS patient. Overview of Literature: True prevalence of nocturnal leg cramps in LSCS patients as well as the clinical outcome of its surgical treatment have been reported. Methods: A questionnaire suggested from previous study with minor modifications was used in this study. Clinical data was collected. Knee flexion test was performed in two groups. Results: The prevalence of nocturnal leg cramp was higher in the LSCS group compared to the control group (second group). In LSCS patients, 38 (88%) had improved leg cramps after the conservative treatment, 3 (6.97%) remained unchanged, and 2 (4.6%) had worsened leg cramps. Of the 43 patients, 21 (48.8%) had no disturbance to their activities of daily living. In the LSCS group, the sensitivity and specificity of the knee flexion test was 53.5% and 33.3%, respectively. The knee flexion test in the LSCS group had a positive predictive value and a negative predictive value of 65.71% and 23.1%, respectively. Conclusions: Our study demonstrated that nocturnal leg cramps were significantly more frequent in LSCS patients than in the control group.

New Modified English and Hindi Oswestry Disability Index in Low Back Pain Patients Treated Conservatively in Indian Population

Nishant,Harvinder Singh Chhabra,Kulwant Singh Kapoor 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.5

Study Design: Prospective cohort study along with questionnaire. Purpose: To measure the correlation of the visual analogue score (VAS), with (Oswestry disability Index [ODI], version 2.1a) in English, and modified ODI (English and Hindi version). To validate translated version of the modified ODI in English version to Hindi. Overview of Literature: Conflicting evidence in literature regarding the ability for existing ODI score to accurately measure the pain associated disability. Methods: One hundred and three patients conservatively treated for low back pain were enrolled in the study. The Pearson correlation coefficient for VAS and ODI along with the Cronbach α and test-retest reliability for Hindi version using the intraclass correlation coefficient was recorded. The new proposed translated Hindi version of ODI was carried out with established guidelines. Results: The mean age in English and Hindi version of ODI was 53.5 years and 58.5 years, respectively. The gender ration was 21:24 in the English version and 35:23 in the Hindi version. The mean follow-up in English and Hindi version of ODI was 3.4 months and 50.27 months, respectively. The Cronbach coefficient α=0.7541 for English ODI and 0.9913 for Hindi ODI was recorded for the both modified versions. Conclusions: The new modified ODI is time saving and accurate, and it avoids the need to measure other scores and has stronger correlation with VAS score compared to the previous scores. We recommend this version for both English and Hindi speaking population as an assessment tool to measure the disability related to pain.

DNN-Based Brain MRI Classification Using Fuzzy Clustering and Autoencoder Features

Nishant Chauhan,Byung-Jae Choi 한국지능시스템학회 2021 INTERNATIONAL JOURNAL of FUZZY LOGIC and INTELLIGE Vol.21 No.4

Worldwide interest has been noted in medical image analysis and classification using machine learning techniques. Magnetic resonance imaging (MRI) is one of the safe and painless procedures for human brain scanning. During the MRI procedure, magnetic fields and radio waves are used to scan and map the extended view of brain tissues for further pathological processes and analysis. For a qualitative and quantitative MRI analysis, the manual capability of radiologists and/or doctors is limited and time-consuming in complex and group-level diagnoses. Hence, the development of an intelligent, robust, and reliable support system for the diagnosis of brain-related diseases is a top priority. In this paper, a new deep neural network based MRI image classification approach is proposed that uses fuzzy c-mean (FCM) and an autoencoder to classify brain MRI as normal or abnormal, diminishing human error during the diagnosis of diseases in MRI scans. Here, FCM is utilized for abnormal tissue segmentation from brain MRI images, followed by an autoencoder, for extraction and dimensionality reduction of features. Finally, a deep neural network was used for the classification of brain MRI images that were trained using FCM-extracted features and sample data. Considering the availability of raw MRI data, data augmentation techniques have also been used to increase the number of data required to train a deep neural network. The experiment results achieved 96% accuracy and a 95% sensitivity rate for classification. The results demonstrate that the proposed well-trained deep learning technology has the potential to make solid predictions regarding brain abnormalities; therefore, it can be used as a prominent tool in clinical practice.

SUSTAINING RELATIONSHIPS WITH CLIENTS IN KNOWLEDGE-INTENSIVE SERVICES CASE : INDIAN KNOWLEDGE-INTENSIVE FIRMS

Nishant Kumar,Fredrik Nordin 글로벌지식마케팅경영학회 2014 Global Marketing Conference Vol.2014 No.7

The aim of this study is to examine how knowledge-intensive services firms sustain relationships with their clients in competitive international business environment and propose a framework of customer-relationship management strategy aligned with the entrepreneurial orientation of the firms under consideration. Developing, enhancing and sustaining relationships with customers has been one of the key areas of research in marketing, not least within knowledge-intensive service industries (Kalwani and Narayandas, 1995; Das and Rangan, 2004). Research has shown that retaining customers is a less expensive and less time-consuming process than attracting new customers (Rosenberg and Czepiel, 1984). Furthermore, building intimate relationships with customers is crucial for creating new knowledge, customer loyalty and increasing profitability (Mattila, 2001). Yet, the relationship between customers and service providers is a complex process. Significant efforts have been made by researchers to uncover the dynamics of the relationship, such as probing into such questions as explaining the types and levels of relationship, factors that determine the quality of a relationship, and the service quality and its effects on the relationships (Ruyter, Moorman, and Lemmink, 2001). Of crucial importance for understanding customer relationship is strategies firms deploy in building long-term relationships with customers in international markets (Salter, 2001; Narver et al., 2004; Kocak, and Abimbola, 2009). Furthermore, having customers involved in the production of the service as co-producers (Vargo and Lusch, 2006) creates a special relationship between customers and employees. However, what happens to the relationship when customer requirements changes due the changes in competition or technology. This question is important as little is known about how, in the face of disruptive technological changes and fierce market competition, firms can maintain strong relationships with their clients in international markets. The continuous changes in the technological and competitive landscape are making it harder for service firms to keep their customers satisfied and commend their commitment for long periods of time (Narver et al., 2004). Theoretical background: B2B customer relationship marketing literature (Jaworski and Kohili, 1993; Salter, 2001; Narver et al., 2004) dwells on the benefits of developing long-term partnerships, trust, commitment, and satisfaction, which are the parameters of relationship quality and long-term orientation in customer relationship (Macintosh, 2007; Skarmeas et al., 2008). Customer relationship is a key aspect of the competitive sustenance of knowledge-intensive service firms in international markets, yet, this has not received much attention in the literature. Customer relationships are unique, develop over time and may serve as a resource which will be difficult for competitors to imitate or purchase (Dyer and Singh, 1998). Such resources can be source of competitive advantage in international market (see Barney, 1991) particularly when the service firm is new to the market. To overcome the challenges of newness and foreignness firms need to build a level of cooperation, trust, and long-term relationship with the customers that reveal the quality of relationship (Lahiri and Kedia, 2011). In the context of business-to-business relationships, relationship quality has been suggested to be the binding factor between partnering firms, such that their relationship goes beyond mere exchange of goods, services, or capital. The resulting benefits would then include customer satisfaction, enhanced perception of fairness and justice, customer loyalty, relationship satisfaction, positive word-of-mouth publicity, repeat transactions, and business continuity (Wu et al., 2006; Kale and Singh, 2009). Unlike in the previous studies where the concern is mainly about sustaining ongoing relationships with the customers through understanding and meeting the current requirements, this study stress on anticipating and shaping customers’ future needs, and proactively investing in those relationships, accordingly.Building on these initial theoretical considerations, this paper suggests three important strategies that explain why knowledge-intensive firms in international markets can endure over time after their initial phase of internationalisation. These are: customer relationship quality management (Jaychandran et al., 2005; Payne and Frow, 2005; Kim et al., 2011); customer relationship proactiveness (Sharma, 1994; Slater and Narver, 1998; Johannessen et al., 1999); and customer-focused innovativeness (Lumpkin and Dess, 1996; Zahra et al., 2000). Research design/methodology – Following Yin (1994), a multiple case studies approach is used. We draw on case study material gleaned from four Indian knowledge-intensive service firms, two are old firms, being in existence for more than 20 years, and two new firms, which we consider as particularly revelatory cases (Eisenhardt & Graebner, 2007: 27), because the old firms have sustained long term relationships with their clients in international market and new ones are trying to develop such relationships (Nasscom, 2010). Data was collected through personal interviews and from company websites and it was analysed abductively.Findings: The findings suggest that it is the entrepreneurial orientation (Lumpkin and Dess, 1996- innovativeness, proactivness, and risk-taking) of knowledge-intensive B2B firms in combination with other capabilities, such as marketing capability, service delivery capability, that explains their continued relationship with clients in international markets. Entrepreneurial orientation focuses on knowing the customers’ present and latent needs so as to cater for them in a proactive, innovative and unique way. Their focus on knowing the customer intimately helps the firms to lock in their customers and to retain them over long periods of time, thereby insuring their sustenance and continued development. Findings reveal that customers also play an active role in developing the intimate relationships and the transfer of intimate knowledge. This is mainly because of the high cost associated with the replacement of the knowledge that the partners have developed of each other and the mutual trust and commitment the partners invest in. Customers understand the risk and cost associate with the replacement of provider and, thus, are careful in the selection of service providers. The relationship normally begins with small projects that do not have serious cost and risk implications. As the relationship solidifies, and as each party learns more about the other party’s systems and processes, trust between the partners increases. Trust between top managers as well as between people on an operative level are equally important, thereby making relationship-building the responsibility and concern of everybody in the company. The intimate knowledge of the customer provides ample opportunity to the service firms to develop the required capabilities for meeting current and future needs of the customers. To the extent that the relationship is a long-term commitment, the cases under consideration witness how, in order to retain clients, they have to proactively anticipate their clients’ needs, as these are always changing. Being proactive helps the firm to keep abreast of their clients’ business thrust. Furthermore, firm has to be innovation-driven, and on the lookout for new technological trends. Leveraging its unique knowledge of its customers, these firms are more able than competitors to identify what future solutions would be relevant to the businesses of the clients. Both sensing and scanning the environment, on the one hand, and watching the customer’s evolving requirements, on the other. In summary, earlier studies have indicated that intimate knowledge of customers and good relationship are critical to market success, but have failed to how such intimacy can be developed and sustained over a period of time. The findings of this study provide insights into the factors underlying customer intimacy, such as customer relationship quality, a proactive approach, and the pursuit of innovativeness. In this sense, the current study fills an important gap in the literature on knowledge-intensive services. The study also has practical relevance relating to firms and managers operating in an knowledge-intensive industry.

Electroencephalographic Abnormalities in Clozapine-Treated Patients: A Cross-Sectional Study

Nishant Goyal,Samir Kumar Praharaj,Pushpal Desarkar,Haque Nizamie 대한신경정신의학회 2011 PSYCHIATRY INVESTIGATION Vol.8 No.4

The objective of our study was to examine the electroencephalogram (EEG) abnormalities associated with clozapine treatment. It was a cross-sectional study on 87 psychiatric patients on clozapine treatment. 32 channel digital EEG was recorded and analysed visually for abnormalities. EEG abnormalities were observed in 63.2% of patients. Both slowing and epileptiform activities were noted in 41.4% of patients. The EEG abnormalities were not associated with dose or duration of clozapine exposure.

SUSTAINING RELATIONSHIPS WITH CLIENTS IN KNOWLEDGE-INTENSIVE SERVICES CASE : INDIAN KNOWLEDGE-INTENSIVE FIRMS

Nishant Kumar,Fredrik Nordin 글로벌지식마케팅경영학회 2014 Global Marketing Conference Vol.2014 No.1

Thermodynamic and Economic Contrast of an Ionic Solution Operated Solar Absorption Cooling System with LiBr + H_2O Pair for a Business Building in India

Nishant Modi,Bhargav Pandya,Jovad Hosseinpour,Majid Amidpour 대한설비공학회 2019 International Journal of Air-Conditioning and Refr Vol.27 No.4

The current study assesses the thermo-economic performance of a H2O+[EMIM][DMP] (1-ethyl-3-methylimidazolium dimethyl phosphate) working fluid-based absorption machine coupled with various solar collectors to cater the cooling load to business building at Gandhinagar city, India. H2O+[EMIM][DMP] could be an alternative to conventional LiBr+ H2O working fluid pair of absorption machines as it can operate without problem of crystallization which is perquisite for the continuous operation of the system. A mathematical model is developed to simulate the proposed system with 10kW cooling capacity at 5∘C. The sensitivity assessment is carried out to find the effect of various parameters including heat source temperature on the coefficient of performance (COP) and exergetic efficiency for each collector case. The optimum SCOP of parabolic trough collector (PTC)-based system is 11.43% higher compared to ETC-based system, whereas the ETC-based system is 25.10% economical than the PTC-based system. Furthermore, payback period for ETC-based system is only one month higher than FPC-based system, which altogether exhibits the superiority of ETC-coupled H2O+[EMIM][DMP] absorption refrigeration system over FPC-based system.

Electrical Properties of Complex Perovskite Samarium Nickel Titanate

Nishant Kumar,Alo Dutta,S. Prasad,T. P. Sinha 대한금속·재료학회 2013 ELECTRONIC MATERIALS LETTERS Vol.9 No.5

The complex perovskite oxide samarium nickel titanate, Sm(Ni1/2Ti1/2)O3 (SNT) is synthesized by solid-state reaction technique. The x-ray diffraction pattern of the sample at room temperature shows monoclinic phase. The microstructure analysis of the sample is performed using scanning electron microscope. Alternating current impedance spectroscopy is used to investigate the electrical properties of SNT in a temperature range from 313 K to 673 K and in a frequency range from 100 Hz to 1 MHz. A peak is observed in the frequency dependence of imaginary part of electric modulus (M''(ω)) indicating a non-Debye type of relaxation. The relaxation peak of M''(ω) moves towards higher frequencies with the increase of temperature showing the thermally activated nature of the relaxation time. The relaxation times for M''(ω) at different temperatures are found to obey Arrhenius law with an activation energy of 0.57 eV. The scaling behaviour of M''(ω)shows that the relaxation describes the same mechanism at various temperatures. The complex impedance plane plots show that the relaxation mechanism in SNT is purely a bulk effect arising from the semiconductive grains of the sample. The frequency dependent conductivity is found to obey the power law.

Design and Optimization of Rectangular Microstrip Antenna for UWB Applications

Nishant Aggarwal,Jyoteesh Malhotra 보안공학연구지원센터 2015 International Journal of Signal Processing, Image Vol.8 No.9

A novel rectangular microstrip antenna for ultrawideband applications is proposed. The ultrawide frequency response is achieved by determining the dimensions of the radiating patch of antenna .The simulated reflection coefficient is smaller than -10 dB for fractional bandwidth greater than 20%. The fractional bandwidth is further enhanced by providing improvements in the proposed design. Besides a directive radiation pattern, high efficiency and a constant gain is achieved in the operating bandwidth.

Nuances in the management of acquired hemophilia A in an elderly patient with large granular lymphocytic leukemia

Nishant R. Tiwari,Kaustubh S. Chaudhari,Vrushab Rao,Vivek R. Sharma 대한혈액학회 2020 Blood Research Vol.55 No.3