Landscape fires in Indonesia during the 2015 resulted in large-scale emissions of airborne particulate matter (PM) that degraded ambient air quality of several countries in Southeast Asia (SEA) including Singapore. During this transboundary haze episode, the general public was advised to remain indoors as much as possible in order to mitigate their exposure to high concentrations of PM in the outdoor environment. To understand the quantitative relationship between outdoor and indoor air quality, we measured PM 2.5 as well as the size-fractionated PM (coarse, accumulation and quasi-ultrafine (q-UF) particles) simultaneously inside and outside a naturally ventilated apartment and studied the potential health risk associated with exposure to PM of different sizes under the three levels of smoke haze (light, moderate and severe). PM mass concentrations increased with a decrease in particle size, and the q-UF particles (diameter ≤ 250 nm) were observed to be as high as 80 to 85 µg m -3 both indoors and outdoors. Estimation of PM deposition patterns along the human respiratory tract revealed that q-UF particles were mainly deposited in the deeper alveolar region, thereby posing severe health threats. Potential human health risk assessment results based on bioavailable concentrations of toxic elements in PM raised further concerns about health impacts of q-UF particles deposited in the alveolar region. Moreover, uncertainty analysis of exposure parameters used in potential carcinogenic health risk assessment model indicated much higher exceedance of potential health risk than the threshold limit for 95 th percentile values of the health risk (11.5 times higher for PM 2.5 ) during severe-haze episodes. The potential health risk estimated in this study indicates the need to conduct further studies focused upon mitigation of human exposure to achieve health benefits during haze episodes.

Objective To study the frequency a diagnosis is made in children with early developmental impairment (EDI), and the contribution made to diagnosis by specific investigations. Design Retrospective case note review. setting Community, neurodisability and neurology department at a UK tertiary centre. Participants Children referred to determine the aetiology of EDI where a cause was not evident on history and examination. Participants were divided into two groups: EDI and no additional features (EDI−) and EDI with additional features (EDI+). Main outcome measures The frequency a cause was found for the child's EDI and which tests contributed to a diagnosis. results 699 participants, 68.8% boys, median age at investigation 2 years 8 months (range 3 months to 11 years 5 months). 61 (8.7%) of participants had no investigations, and children with EDI− were less likely to be investigated (χ 2 =12.5, p<0.05). A diagnosis was made in 166 children (23.7%) and was more frequent in EDI+ (EDI− 9.9%, EDI+ 27.3%, χ 2 =19.0; p<0.05). Full blood count, zinc protoporphyrin, renal or liver function, bone profile, biotinidase, creatine kinase or lead level revealed no diagnoses. The following investigations found causes for EDI: MRI (23.1%), microarray (11.5%), Fragile X (0.9%), plasma amino acids (1.2%), urine organic acids (0.9%) and thyroid function tests (0.5%). Conclusions The majority of 'screening' investigations for EDI do not contribute to a diagnosis, highlighting an area of cost saving for the NHS and reduced burden for patients and families. We propose a streamlined guideline for the investigation of EDI based on our data.

The 2015 smoke haze episode was one of the most severe and prolonged transboundary air pollution events ever seen in Southeast Asia (SEA), affecting the air quality of several countries within the region including Indonesia, Malaysia and Singapore. The 24 h mean outdoor PM 2.5 (particulate matter (PM) with aerodynamic diameter ≤ 2.5 m) concentrations ranged from 72-157 g m −3 in Singapore during this episode, exceeding the WHO 24 h mean PM 2.5 guidelines (25 g m −3 ) several times over. The smoke haze episode not only affected ambient air quality, but also indoor air quality due to the migration of PM of different sizes from the outdoor to the indoor environment. Despite the frequent occurrence of smoke haze episodes over the years, their potential health impacts on indoor building occupants remain largely unknown in SEA due to the lack of systematic investigations and observational data. The current work was carried out in Singapore to assess human exposure to size-resolved PM during the 2015 smoke haze episode, and to evaluate the effectiveness of exposure mitigation measures in smoke-haze-impacted naturally ventilated indoor environments. The potential health risks associated with exposure to PM 2.5 were assessed based on the concentrations of redox active particulate-bound trace elements, which are known to be harmful to human health, with and without exposure mitigation. Overall, it was observed that human health exposure to PM 2.5 and its carcinogenic chemical components was reduced substantially by 62% (p < 0.05) while using an air cleaner. However, extremely small hazardous particles were only partially removed by the air cleaner and remain a matter of concern for public health.

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