Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial

Background Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI. Methods This randomised, placebo-controlled trial was done in 175 hospitals in 29 countries. Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding were eligible. The time window for eligibility was originally 8 h but in 2016 the protocol was changed to limit recruitment to patients within 3 h of injury. This change was made blind to the trial data, in response to external evidence suggesting that delayed treatment is unlikely to be effective. We randomly assigned (1:1) patients to receive tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was head injury-related death in hospital within 28 days of injury in patients treated within 3 h of injury. We prespecified a sensitivity analysis that excluded patients with a GCS score of 3 and those with bilateral unreactive pupils at baseline. All analyses were done by intention to treat. This trial was registered with ISRCTN (ISRCTN15088122), ClinicalTrials.gov (NCT01402882), EudraCT (2011-003669-14), and the Pan African Clinical Trial Registry (PACTR20121000441277). Results Between July 20, 2012, and Jan 31, 2019, we randomly allocated 12 737 patients with TBI to receive tranexamic acid (6406 [50·3%] or placebo [6331 [49·7%], of whom 9202 (72·2%) patients were treated within 3 h of injury. Among patients treated within 3 h of injury, the risk of head injury-related death was 18·5% in the tranexamic acid group versus 19·8% in the placebo group (855 vs 892 events; risk ratio [RR] 0·94 [95% CI 0·86-1·02]). In the prespecified sensitivity analysis that excluded patients with a GCS score of 3 or bilateral unreactive pupils at baseline, the risk of head injury-related death was 12·5% in the tranexamic acid group versus 14·0% in the placebo group (485 vs 525 events; RR 0·89 [95% CI 0·80-1·00]). The risk of head injury-related death reduced with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64-0·95]) but not in patients with severe head injury (0·99 [95% CI 0·91-1·07]; p value for heterogeneity 0·030). Early treatment was more effective than was later treatment in patients with mild and moderate head injury (p=0·005) but time to treatment had no obvious effect in patients with severe head injury (p=0·73). The risk of vascular occlusive events was similar in the tranexamic acid and placebo groups (RR 0·98 (0·74-1·28). The risk of seizures was also similar between groups (1·09 [95% CI 0·90-1·33]). Interpretation Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury. Funding National Institute for Health Research Health Technology Assessment, JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and Wellcome Trust (Joint Global Health Trials scheme)

Sustainable architectural design studio towards the development of creative learning environment

The design studio has always been the key feature of architecture education. Unfortunately, the design studio in universities focused too much on cost and the uniformity of design throughout the whole campus and this leads to office-like layout which is designed without taking note on the psychological approach of the architecture students using the spaces. This paper intends to elucidate this problem and tries to find the best design solution for a sustainable architectural design studio towards an effective studio learning outcome vital for a creative learning environment. This study has found out that there are three key factors that contributed in the development of creative studio learning environment among occupants which are—the needs to have a transformable private and personal space, multi-functional interactive space and livable natural setting. This study is important because suitable architectural studio will not only provide a creative learning environment to the users but also established referential guideline for future architects

Evaluating the implementation of ‘Islamic built environment’ in the context of landscape components in public open spaces in Malaysia

The main purpose of this paper is to evaluate the implementation of ‘Islamic built environment’ (IBE) concept in public open spaces in Malaysia. Granting the development of IBE must be the basis in every concept of national development in Malaysia. Thus, this research believes that the adaptation of true Islamic concept is the very crucial in public open spaces that belong to the Malaysian community and for public use, besides being the focus of attraction and tourism assets. This research was conducted based on literatures on framework of indicators of truly Islamic environment. The evaluation was prepared through observation on ten indicators, namely (1) Tolerance, (2) Natural Environment, (3) Social Need and Human Comfort, (4) Religious Identity, (5) Order, (6) Economic, (7) Intellectual and Knowledge, (8) Hygiene, (9) Jannah, and (10) Safety in the selected open public spaces in Malaysia. This research employed a descriptive and survey-based research design rooted in quantitative and qualitative research paradigms. The procedure of research methodology is a combination of reviewing literature, data collection, and data analysis to determine the research finding. For data gathering, this research carried out a site survey for on-site observation confined to the context of landscape components in public open spaces. The findings of this research can benefit and guide Malaysian administrators and professionals in built environment industries to generate a better and more appropriate process of implementing an IBE in Muslim countries, particularly with regard to public open spaces

Elderly Care Centre

The demand for elderly centre has increased tremendously abreast with the world demographic change as the number of senior citizens rose in the 21st century. This has become one of the most crucial problems of today's era. As the world progress into modernity, more and more people are occupied with daily work causing the senior citizens to lose the care that they actually need. This paper seeks to elucidate the best possible design of an elderly care centre with new approach in order to provide the best service for them by analysing their needs and suitable activities that could elevate their quality of life. All these findings will then be incorporated into design solutions so as to enhance the living environment for the elderly especially in Malaysian context

A review on occupants' satisfaction and wellness level in low-cost housing in Malaysia

The purpose of this study is to ascertain how architecture could impede stress level among low-cost housing occupants in Malaysia based on design implementations. The home environment is one of the main contributing factors for the occurrence of stress among occupants as much of individuals' lives are spent indoor. Based on this, architecture plays a major role in minimizing the stress level among occupants of a building. This research analyses the wellness of low-cost housing owners and occupants through observation and questionnaires that were distributed to low-cost housing residents. This study found that there are four key factors that contributed to stress among occupants. It is, therefore, hoped that the findings of this paper help designers to design better low-cost houses in order to provide a better living environment to the occupants

Building communal values for quality sustainable living in traditional madrassa—the case of Madrassa Quran Kubang Bujuk, Trengganu

Madrassa is deemed referred as a religious education center for the Muslim community. Due to its well acceptance and establishment in the Muslim society, madrassa not only acts as scholarly center but also as a place that promotes goodwill and unity. However, many scholars are of opinion that traditional madrassa is considerably significant as it has an important role in reshaping Islamic education towards the development of communal values. This paper aims to identify and elucidate the importance of the traditional design of madrassa towards the development of communal values. Madrassa Quran Kubang Bujuk in Trengganu was analyzed as case study due to its significant establishment and dominant role in reshaping the local Muslim society. In addition, the architectural madrassa design is distinctive, and its multifunctional purpose considers the well-being of occupants towards the development of communal values. Semiotic as research method is used to reveal the communal values that are embedded in the architectural design of a madrassa. The findings will benefits future designers and scholars on the importance of communal values and the propagation of Islamic teaching through the representation of madrassa as built form

The effectiveness of public park management and design for sustainable livelihood in Malaysian context

Public Park is an important element for societal development because it can offer a wide range of recreational activities to reduce stress for free. In other words, it may also function as an open communal center that can build integrity and sense of belonging among the people since it acts to define the shape and ambience of a city and its neighborhood. Nonetheless, the design of public parks, especially in current urban areas are facing many problems due to factors such as unavailability of proper monitoring and management system to identify the level and trend of consumerism of public parks. Till present, there is no detailed study conducted to elucidate on the appropriateness of public parks design to meet the needs of local context. Henceforth, the objective of this paper is to study the context of existing public park in Malaysia and identify problems relating to design, management and effectiveness from user’s perception. To conduct this study, the research will adopt case study method as research strategy. Since the focus of this study is on social physical phenomenon and to understand how human social culture correlates with the design and management of public parks-two research paradigms which are interpretivism (hermeneutics) that translates human ideology and structuralism (semiotic) to read any physical structure or architectural design are adopted as research methodology. Data collection method will be from site observation, recorded documentation and questionnaires are used to gather all the evidences on the selected public parks design. Findings indicate that the design of local public parks failed to fulfill user satisfaction due to design imperfections and poor management. Therefore, this study will propose a suitable guideline as future reference to design a better and sustainable management for public park in the Malaysian context

Contextual responsive designed administrative buildings in Malaysia

The purpose of this study is to elucidate on the regional design approach of two modern administrative buildings in Malaysia; former Prime Minister’s Office (1967) and Parliament Malaysia (1963) that was built during the post independence era in a comparative manner. This is to explicate the relationship of design and adaptation towards the regional context by focussing on the environmental aspects. Using structuralism paradigm and semiotic methodological approach, the relationship between building design and sustainable aspects were observed. It is evident that indoor comfort plays a major role in designing administrative building alike. This paper is of value to practicing architects and the society as it offers new insights by formulating design approaches in designing public architecture in Malaysia

Peripheral Eye Length Evaluation in Myopic Children Undergoing Orthokeratology Treatment for 12 Months Using MRI

Yu Chen Low,1 Bariah Mohd-Ali,1 Mizhanim Mohamad Shahimin,1 Norhani Mohidin,1 Hamzaini Abdul-Hamid,2 Siti Salasiah Mokri3 1Optometry and Vision Science Program and Research Centre for Community Health (REACH), Faculty of Health Sciences, UKM Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia; 2Department of Radiology, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia; 3Department of Electrical, Electronics and Systems, Faculty of Engineering and Built, UKM, Bangi, Selangor, MalaysiaCorrespondence: Bariah Mohd-Ali, Optometry and Vision Science Program and Research Centre for Community Health (REACH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, Tel +603-92897602, Email [email protected]: To investigate changes in peripheral eye length (PEL) in myopic children undergoing orthokeratology (Ortho-K) treatment for 12 months using MRI. The results were compared to single vision spectacle wearers (SVS).Patients and Methods: A total of 70 children with myopia (aged 8– 9 years old) were recruited. A total of 45 children were fitted with Ortho-K, and 25 were fitted with SVS. The PEL and axial length (AL) were measured by using MRI 3-Tesla, whereas central and peripheral refraction (PR) measurements were conducted at ± 30 degrees horizontally with nasal (N) and temporal (T) intervals of 10°, 20°, and 30° and with an open field autorefractometer (WAM-5500 Grand Seiko). All the measurements were conducted at the baseline and 12 months.Results: The MRI analysis indicates that at 12 months, the SVS group showed more elongation of the PEL and AL at all eccentricities than the Ortho-K group did (p < 0.05). The Ortho-K group only showed significant PEL elongation beyond 20 degrees at N20, N30, T20, and T30 (p < 0.05); however, a significant reduction in the AL was detected in the center AL, N10, and T10 (p < 0.05). All eccentricities in the relative PR of the Ortho-K group were significantly more myopic than at the baseline (p < 0.05), whereas in the SVS group, all eccentricities in the relative PR were shown to be significantly more hyperopic than at the baseline (p < 0.05). The PEL and PR showed negative correlations at 12 months in the Ortho-K group.Conclusion: MRI analysis can be utilized to describe changes in PEL in myopic children. It appears that as myopia progressed in Ortho-K lens wearers, the PEL increased by a greater amount than the AL did; thus, the retina was reshaped to become increasingly oblate and to display peripheral myopic defocus.Keywords: myopia, peripheral eye length, peripheral refraction, childre