Formaldehyde Levels and the Indoor Air Quality of Anatomy Dissection Hall with Different Ventilation Setups

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Nayak, Joseph Abraham This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3375113/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract During anatomy dissection, the release of formaldehyde (FA) from cadavers and embalming fluids can negatively affect the well-being of students and staff. To address this issue, a study measured the FA and air quality (CO2 and Total Volatile Organic Compounds- TVOC) in the breathing zone with different ventilation setups: natural, fan-based, and air-conditioned. The FA, CO2, and TVOC levels were estimated at the cadavers’ head and toe ends, in the pathway, and between the dissection tables. The levels were higher near the cadaver and lower in the pathway and between the tables, regardless of the type of ventilation. Fan-based ventilation had the lowest mean FA, CO2, and TVOC levels compared to AC and natural ventilation. However, there was no significant difference in these levels between the ventilation types, except for the toe-ends of the cadavers (p < 0.05), where the toe-end farther from the AC vents had higher levels. The study suggests that areas away from the source of ventilation are at risk of having lower air quality. Therefore, in addition to selecting an appropriate ventilation system, placing cadavers near the source of ventilation would help optimize FA levels and improve indoor air quality for better working conditions suitable for students and staff. Earth and environmental sciences/Environmental sciences Health sciences/Anatomy Health sciences/Health occupations Health sciences/Risk factors Formaldehyde ventilation system anatomy air quality Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Human cadaveric dissection is essential for learning Anatomy, either through demonstrating the specimens or through the dissection of cadavers. Though new teaching methods (like using models, virtual reality, etc.) exist, cadavers play a significant role in teaching anatomy [ 1 ]. For the preservation of the cadavers, durable (or long-lasting) and cost-effective formaldehyde (FA) is used as an embalming solution for the cadavers [ 2 ]. FA is a colorless, strong-smelling gas readily soluble in water. It is commonly used as a 37% aqueous solution, formalin, to preserve cadavers in medical schools. The sake of using formalin is its cost-effectiveness, preservation properties, availability, and suitable fixation properties. With water (1:10 ratio), formalin embalm the cadavers [ 2 ]. It is used due to its long-lasting feature and non-degenerative capacity [ 3 ]. The solution is routinely injected into the femoral or the carotid artery. FA also has bactericidal, fungicidal, and insecticidal properties, and it is widely used as a restoring and conserving agent; it has good disinfecting features and thereby blocks the entry of decomposers. FA also tans the tissue without ruining its fragile structures [ 2 ]. It is a productive fixative with rapid perforation of tissues and long-term conservative features [ 4 ]. Apart from its preservative properties, FA has several adverse health effects. During anatomy classes, evaporation of FA from cadavers and embalming fluids could adversely affect students and staff. The students, staff, and technicians in the dissection hall are frequently exposed to FA [ 5 ]. When exposed for a short time, FA will cause itchiness in the nose and irritation in the eyes, and on long-term exposure, it leads to changes in liver function and carcinoma [ 6 , 7 , 8 ]. The other symptoms are undesirable odor, profuse lacrimation, and some skin issues such as dryness of skin, eczema, allergic contact dermatitis, respiratory tract infection, and bronchial asthma [ 9 , 10 , 11 , 12 ]. General tiredness, burning eyes, and nose are also reported [ 13 ]. Exposure to FA has a wide range of adverse effects on health, ranging from allergic reactions to genetic damage [ 14 ]. It is also said to be carcinogenic [ 15 ]. Cancer risk assessment in Anatomy labs with FA exposure is estimated to be several thousand times higher than the limit recommended by the EPA (10 − 6 ) [ 16 ]. There are several standards set for the permissible limits of FA levels. The short exposure limit of 1ppm (1.2mg/m 3 ) for a period of 30min is recommended exposure limit (REL) by The National Institute for Occupational Safety and Health (NIOSH) [ 17 ]. The permissible exposure limit (PEL) is 2ppm, which is the maximum exposure limit during a 15min duration by The Occupational Safety Health Administration (OSHA) [ 18 ]. The American Conference of Government Industrial Hygienists (ACGIH, 1974) recommends a threshold limit value-ceiling (TLV-C) of 2ppm for formaldehyde [ 19 ]. However, the World Health Organization (WHO) has provided a short-term (30 minutes) exposure limit of 0.1 mg/m3 [ 20 ] The Sustainable Development Goal (SGD) 3.9 emphasizes reducing deaths and illnesses produced by hazardous chemicals and air [ 21 ]. NIOSH strongly recommends the evaluation of FA and indoor air quality assessment to protect the workers exposed to hazardous chemicals. Additionally, it emphasizes frequent checks of airflow at the workplace [ 17 ]. National Medical Council (NMC), India, had laid down guidelines on the dimensions and the requirements for the Anatomy dissection halls at medical schools [ 22 ]. Therefore, achieving a healthy indoor environment inside the dissection hall is imperative for the safety of the students and the staff. The ventilation set-ups and the floor area of the dissection hall influence the FA levels and the indoor air quality. FA levels monitored using a fan-based ventilation set-up have shown remarkably higher values emphasizing the need for an effective ventilation set-up and a larger floor area [ 23 ]. A local exhaust ventilation system has proven the most effective [ 24 ]. However, the effectiveness of such setup is not well understood for an Anatomy dissection hall with a large number of dissection tables and cadavers operational simultaneously. A computational fluid dynamics (CFD) approach revealed that an AC-based ventilation setup has benefits in optimizing FA levels compared to a simple fan-based setup [ 25 ]. However, evaluation of indoor air quality in a realistic set-up would be required to evaluate the indoor environment of the anatomy hall. The distribution of FA levels is influenced by the airflow rate and direction [ 20 ]. It is uncommon for the literature to evaluate the comprehensive air quality of an anatomy hall in terms of FA levels, carbon dioxide (CO2), and total volatile organic compounds (TVOC). Furthermore, the effect of frequently utilized ventilation systems, including air-conditioning (AC) and fan-based ventilation, on FA distribution is not commonly assessed. In order to ensure a safe and healthy environment in the anatomy hall, it is essential to evaluate the levels of FA and overall indoor air quality. This will help identify areas where hazardous compounds may be present and determine how ventilation systems can mitigate their impact. By analyzing FA levels and indoor air quality in different locations of the hall with varying ventilation setups, this study aims to provide information that can be used to identify the locations at risk with higher FA levels and poor air quality. 1.2 Aim and Objectives This study aimed to estimate the FA levels and evaluate the indoor air quality (CO2 and TVOC levels) at different locations of an Anatomy dissection hall and to find out how these values are influenced by the most commonly operating ventilation systems (natural, fan-based, and air-conditioned (AC). The objectives were, Estimation of FA levels at different locations (head-end and toe-end of the cadavers, between tables and pathway) in an anatomy dissection hall Comparison of FA levels with different ventilation systems (AC, fan-based and natural) in an anatomy dissection hall Comparison of TVOC levels and CO2 with different ventilation setups and different locations of an anatomy dissection hall 2. Materials and Methods This cross-sectional study was conducted at Kasturba Medical College, Manipal, India from January to March 2022. The Institutional Ethical Committee of Kasturba Medical College approved the study (IEC no. 614/2021). All methods were performed in accordance with the relevant guidelines and regulations. Written informed consent was obtained during the procurement of cadavers through the voluntary body donation program. The donor as well as the next of kin consented to utilize cadavers for research and medical education. 2.1 Description of the dissection hall involved The dissection hall used for the current study is designed to accommodate 250 students per the NMC guidelines [ 26 ]. The basic dimensions and infrastructure are described in Table 1 . Table 1 Description of the dissection hall used for the study Total floor area 925 m 2 Ventilation options available AC, fan, and natural ventilation AC The centralized operating capacity of 17,000cfm, vents situated at the height of 2.03m from the floor level Number of ceiling fans 40 Distance between the fans 0.96m Number of windows 18, 0.52m×0.75m in dimension Door One main door Number of cadavers utilized at a single time 10 There were ten dissection tables placed about 1.68m apart from each other. Ten cadavers were used at a time for one academic year. The cadavers were procured through the voluntary body donation program of the institute with written informed consent from the donor as well as the next of kin for their utilization for research and education. The cadavers were washed in water before placing them on the tables. Seven tables were continuous with distance in the dissection hall, and the other three were placed apart on the other side of the central pathway. Opposite every table were two windows situated 1.2m from the toe end of the cadavers. The AC vents were situated close to the head end at a distance of 0.96m. Forty ceiling fans were fixed at a height of 3.5m from the floor level. 2.2 Description of the embalming fluid used The embalming fluid at our institution constitutes 50% formalin (the composition is 37% formaldehyde and water in a 1:1 ratio). Arterial embalming is the preferred choice, where the femoral or carotid artery is chosen for injecting the embalming fluid. After embalming, the cadavers are immersed in 50% formalin (the same composition as the embalming fluid). 2.3 A detailed description of formaldehyde estimation and indoor air quality assessment The students and the staff are involved in dissection activity for two hours daily, four days a week. Hence, the short-term exposure limit by the WHO was considered the standard for the present study [ 27 ]. InkbirdPlus air quality monitor (Shenzhen, Guangdong, China) was used to measure CO2, FA, and TVOC. It has a measurement range: of 0.000–1.000mg/m3 of FA, 350–2000ppm of CO2, and 0.000–2.000mg/m3 of TVOC. Ten tables were set, each containing one formalin embalmed for regular dissection classes. The head end of the cadaver is placed near the AC vents, and the toe ends near the windows (Fig. 2 ). The FA levels and the indoor air quality at the breathing zone were estimated with AC, fan-based, and naturally ventilated setup. When the AC was operational, all windows were closed, and all the fans were switched off. Moreover, the naturally ventilated setup had all fans, AC switched off, and windows opened. AC was switched off in the fan-based setup, and the windows were kept open. With these three different types of ventilation setups, FA levels and the indoor air quality (CO2 and TVOC) were measured at the locations (or points) such as the head end (ten points) and the toe end of the cadavers (ten points), between two the dissection tables (eight points) and in the central pathway, (six points). The locations are represented in Fig. 3 . The readings were taken at the breathing zone, that is, at 3 feet (0.914m) from the floor level. At first, the cadavers were taken out from the formalin tanks, washed with tap water, and placed on the dissection tables. The ventilation setup was made operational at the same time. After 30 minutes, the values were measured at the defined points with a time interval of 15 minutes between two points. During the study period, the cadavers were utilized to dissection the head, neck, and abdominal regions. The readings are taken for four consecutive working days (Monday to Thursday) for each ventilation setup. All the levels were measured in the absence of students. 2.4 Statistical analysis Mean, and standard deviations were calculated for each variable. The values measured at different points for each ventilation setup were compared using one-way ANOVA. The values at each point were also compared with the three different ventilation setups using one-way ANOVA. Furthermore, Tukey's Multiple Comparison Test was used for group-wise comparison. GraphPad Prism 5 software (Boston) was used for the statistical analysis. 3. Results 3.1 Comparison of FA levels at different locations We found that the levels of FA varied depending on the type of ventilation used. With AC, the levels ranged from 0.001 to 0.194 mg/m3, while with fans, they ranged from 0.002 to 0.059 mg/m3, and with natural ventilation, they ranged from 0.001 to 0.23 mg/m3. The fan-based ventilation setup had lower mean FA levels (0.01 ± 0.01mg/m 3 ) compared to the AC (0.04 ± 0.05mg/m 3 ) and natural ventilation (0.02 ± 0.03mg/m 3 ). However, the difference was not statistically significant. Additionally, we noticed that in a single ventilation setup, the FA levels were higher at the head and toe-ends of the cadavers compared to the pathway and between the dissection tables. This information can be found in Table 2 . Table 2 Mean and standard deviations of FA levels, TVOC, and CO2 at different locations and different ventilation setups Formaldehyde levels (mg/m 3 ) Head End Toe End Between tables Pathway AC setup 0.0579 ± 0.0544 0.0722 ± 0.0650 0.0078 ± 0.0054 0.01 ± 0.0086 Fan-based Setup 0.0207 ± 0.0203 0.0116 ± 0.0127 0.0048 ± 0.0046 0.013 ± 0.0057 Natural Ventilation 0.0175 ± 0.0113 0.0436 ± 0.0673 0.0042 ± 0.0024 0.0053 ± 0.0024 Air quality- TVOC levels (mg/m 3 ) Head End Toe End Between tables Pathway AC setup 0.321 ± 0.303 0.408 ± 0.407 0.0421 ± 0.0320 0.0541 ± 0.0494 Fan-based Setup 0.119 ± 0.109 0.0698 ± 0.0668 0.0305 ± 0.0208 0.065 ± 0.0434 Natural Ventilation 0.093 ± 0.067 0.126 ± 0.093 0.0195 ± 0.0053 0.0178 ± 0.0053 Air quality- CO2 levels (ppm) Head End Toe End Between tables Pathway AC setup 861.7 ± 486.5 999.1 ± 488.9 496.1 ± 60.63 519.33 ± 94.79 Fan-based Setup 618.4 ± 195.13 534.4 ± 132.34 458.75 ± 49.076 556.83 ± 60.963 Natural Ventilation 614.9 ± 134.64 655.7 ± 158.50 451.125 ± 27.0683 467.333 ± 25.2481 In the AC configuration, there was a notable contrast in the FA levels between the toe-end of the cadavers (0.072 ± 0.065 mg/m3) and the tables (0.0078 ± 0.0054 mg/m3) as determined by one-way ANOVA (p-value < 0.0001). However, in both the fan-based and natural ventilation setups, there was no significant difference in FA levels at various locations, suggesting a relatively even distribution of FA levels throughout the dissection hall. The levels of FA in the pathway and between the tables remained consistent regardless of the type of ventilation system. However, at the toe end, the FA levels were higher with AC than with fan-based ventilation (p = 0.06) and natural ventilation (p < 0.0001). Therefore, while comparing the FA levels at different ventilation setups and locations in the dissection hall, the AC setup showed unevenly distributed FA levels than the fan-based and natural ventilation setups. Figure 4 indicates the graphical comparison of FA levels with the ventilation systems. Additionally, in the present study, the FA levels were always within the standard limits provided for the short-term exposure limit by NIOSH with all three ventilation setups. 3.2 Comparison of TVOC and CO2 levels at different locations With AC, the CO2 levels ranged from 408-1839ppm, while with fans, they ranged from 405-971ppm, and with natural ventilation, they ranged from 409-932ppm. The fan-based ventilation setup had lower mean CO2 levels (545.26 ± 138.38ppm) compared to the AC (773.55 ± 397.5ppm) and natural ventilation (562.23 ± 139.9ppm). With AC, the TVOC levels ranged from 0.01-1.28mg/m 3 , while with fans, they ranged from 0.01–0.32 mg/m 3 , and with natural ventilation, they ranged from0.01-0.3 mg/m 3 . According to Table 2, the TVOC and CO2 levels were notably elevated at both the head-end and toe-end of the cadavers, in contrast to the pathway and the area between the tables for all three ventilation systems. The AC setup had significantly higher CO2 levels at the toe-end of the cadavers than the fan-based and natural ventilation methods (p<0.0001). Table 3 compares CO2 levels at different locations using the operating ventilation setup. Table 3: Comparison of the CO2 levels (ppm) at the different locations of the dissection hall with the ventilation setups Location Comparison between the ventilation setups Mean difference 95% confidence interval Significance* Head end of the cadaver AC vs. Fan-based 243.4 -103.4 to 590.1 No AC vs. Natural 246.9 -99.86 to 593.6 No Fan-based vs. Natural 3.500 -343.2 to 350.2 No Toe end of the cadaver AC vs. Fan-based 464.7 124.7 to 804.7 Yes (p<0.0001) AC vs. Natural 343.4 3.365 to 683.4 Yes (p<0.05) Fan-based vs. Natural -121.3 -461.3 to 218.7 No Between tables AC vs. Fan-based 37.38 -22.73 to 97.48 No AC vs. Natural 45.00 -15.11 to 105.1 No Fan-based vs. Natural 7.625 -52.48 to 67.73 No Pathway AC vs. Fan-based -37.50 -137.5 to 62.52 No AC vs. Natural 52.00 -48.02 to 152.0 No Fan-based vs. Natural 89.50 -10.52 to 189.5 No *Using Tukey's Multiple Comparison Test Regardless of the ventilation setup, the TVOC levels remained consistent between the tables and the pathway. However, at the toe-end of the cadaver, the TVOC levels were substantially higher with the AC setup than the natural and fan-based setups (p<0.001). A comprehensive comparison is given in Table 4. Table 4: Comparison of the TVOC levels (mg/m 3 ) at the different locations of the dissection hall with the ventilation setups Location Comparison between the ventilation setups Mean difference 95% confidence interval Significance* Head end of the cadaver AC vs. Fan-based 0.2022 -0.008893 to 0.4133 No AC vs. Natural 0.2288 0.01771 to 0.4399 Yes (p<0.05) Fan-based vs. Natural 0.0266 -0.1845 to 0.2377 No Toe end of the cadaver AC vs. Fan-based 0.3383 0.06718 to 0.6094 Yes (p<0.001) AC vs. Natural 0.2821 0.01098 to 0.5532 Yes (p<0.001) Fan-based vs. Natural -0.05620 -0.3273 to 0.2149 No Between tables AC vs. Fan-based 0.01163 0.01652 to 0.03977 No AC vs. Natural 0.02263 -0.005523 to 0.05077 No Fan-based vs. Natural 0.0110 -0.01715 to 0.03915 No Pathway AC vs. Fan-based -0.01083 -0.06801 to 0.04634 No AC vs. Natural 0.03633 -0.02084 to 0.09351 No Fan-based vs. Natural 0.04717 -0.01001 to 0.1043 No *Using Tukey's Multiple Comparison Test 4. Discussion In this study, we examined the FA, CO2, and TVOC levels in an anatomy dissection hall using various ventilation systems. We found that the toe-end of the cadavers had notably higher levels of these compounds in the AC setup, likely due to their distance from the vents. However, there were no significant differences in levels between the fan-based and natural ventilation setups at different points. Research in the anatomy hall evaluations has been documented in the literature, with studies comparing FA levels in different medical colleges. Bhat et al. found that the 8-hour TWA for FA was higher in a Private Medical College (ranging from 3.4 to 5ppm) compared to a Government Medical College (ranging from 1.64 to 2.02ppm) [ 6 ]. In this study, conducted at a private institute, FA levels were found to be within the acceptable limit of 1ppm for short-term exposure and did not exceed this limit regardless of ventilation setup. It is possible that the difference in FA levels between government and private colleges can be attributed to factors such as the number of cadavers, infrastructure, and the size of the dissection hall. However, the anatomy hall in this study meets NMC guidelines, indicating that the findings can be generalized to other medical institutes. In the study by Adamovic et al., FA levels were estimated at five locations inside the Department of Anatomy in Serbia in February, March, and May. Environmental factors, such as humidity and temperature, were also considered. In the cadaver storage room, the FA levels were as high as 1.76–2.90 ppm [ 28 ]. Similarly, in the present study, the FA levels were higher around the cadaver compared to the pathway and between tables. However, the present study did not include the storage room for FA level monitoring, considering that, inevitably, higher FA levels inside the storage room. At the same time, students and staff are exposed to FA in the dissection hall. Takayanagi et al. reported that FA levels ranged from 0.24 to 3.04 ppm during systemic musculoskeletal anatomy and neuroanatomy [ 29 ]. Kurose et al. measured FA levels in the indoor air of the anatomy dissection hall with 35 cadavers at the Faculty of Medicine of Hiroshima University and found levels between 0.25 and 0.55 ppm [ 30 ]. Our present study measured FA levels during the head, neck, and abdominal wall dissection. We observed a decrease in FA levels in the dissected region, which could be attributed to the smaller surface area compared to the higher values reported by Takayanagi et al [ 29 ]. According to a recent study by Norkaew et al., high levels of FA may contribute to skin-related issues among medical students [ 31 ]. Fortunately, research suggests that implementing a local ventilation system in the anatomy dissection hall can effectively lower FA levels [ 32 , 33 ]. However, due to the large number of students and cadavers, installing a complete ventilation setup may not be cost-effective. Instead, optimizing the existing ventilation system through regular FA and air quality monitoring could be a viable option. According to a study conducted by Zuber et al., the AC setup had lower FA levels than the fan-based and natural ventilation setups, as determined by the computational fluid dynamics approach [ 25 ]. However, our present study observed higher levels of FA with the AC setup, although there was no significant difference between the various ventilation setups. This difference could be attributed to the AC vents' high placement and the direction and circulation of the airflow within the dissection hall. According to Aung et al., the levels of FA in dissection rooms with a wall-mounted fan as ventilation showed remarkably high values with short-term exposure [ 34 ]. The study suggested that reducing the number of cadavers and increasing the area of the dissection hall could lower FA levels. The present study found that the FA levels were within expected limits for short-term exposure, which may be due to the larger floor area, more ceiling fans, and fewer cadavers. Studies have found that fan-based ventilation in dissection halls has resulted in higher levels of formaldehyde (FA) [ 35 ]. Other reports have shown that personal exposure to FA can be higher than indoor levels when using air conditioning in anatomy halls [ 36 , 37 , 38 ]. In this study, the air conditioning system resulted in higher levels of FA, particularly in the toe-end areas of the cadavers. Due to their distance from the AC vents, the heavier FA particles were not effectively cleared. However, the FA levels and indoor air quality were better with fan-based ventilation, suggesting that having four ceiling fans per cadaver effectively cleared the hazardous compounds near the cadavers. Previous studies have addressed monitoring formaldehyde (FA) levels in the dissection hall [ 6 , 39 ]. Gahukar et al. conducted a study that evaluated FA levels with and without exhaust fans operating and found higher FA values in the dissection hall [ 39 ]. Table 5 provides a comprehensive overview of indoor FA estimation based on various ventilation setups in previous studies. Table 5: Comparison of indoor FA levels with different dissection halls and ventilation settings Authors, Year, and Country Floor area of the dissection hall (m 2 ) Sampling locations Type of Ventilation setup Number of cadavers Average Indoor FA levels (ppm)* Kunugita et al. (2004) Japan 1400 Close to the cadavers General ventilation General ventilation with new filters Novel local ventilation for each dissection table 25 0.76 0.61 0.05 Ohmichi et al. (2006) Japan 1125 Center and the four corners of the lab 12 supply diffusor, four air conditioners, eight air return grills Not mentioned 0.23–1.03 Vohra (2011) Saudi Arabia 450 Center, close to the doors and four corners of the lab Central air conditioner, four exhaust fans 25 0.68 (week 4) 0.85 (week 10) 0.73 (week 14) Azari et al. (2012) Iran 339 Not specified Ventilation (supply-exhaust) system on Ventilation supply system on Ventilation system (supply and exhaust) off Not mentioned 0.306 ± 0.021 0.317 ± 0.026 0.698 ± 0.034 Gahukar et al. (2014) India 308 Aisle and corners of the hall; at about 2 feet height At about 5 feet height over dissection tables Windows with an exhaust fan 16 0.049–0.904 Homwutthiway and Ongwandee (2017) Thailand 380 Close to the cadaver At the corner Corridor Windows and four big pedestal fans 14 0.00925–0.01759 Aung et al. (2021) Myanmar Dissection room I, II-11,188m 3 Dissection room III- V- 9942 m 3 Center of the dissection hall, six feet above the ground Ten wall fans in each dissection room 10 (distributed in four dissection rooms) 0.09–1.22 The present study (2022) India 925 Head end, toe-end of the cadavers, between tables and pathway Air condition Fan-based natural ventilation 10 0.001–0.238 0.002–0.072 0.001–0.246 * Levels in mg/m 3 are converted into ppm for suitable comparability Footnote: Few of the contents of this table were adapted from Table 2 of Aung et al., 2021 This study uses ventilation systems to examine the various dissection hall locations for FA, CO2, and TVOC levels. Regardless of the ventilation type, the levels were notably higher around the cadaver, and the air quality was sometimes poor at specific points while using AC ventilation. As formaldehyde in ambient air quickly photo-oxidized to carbon dioxide, it is imperative to have higher FA and CO2 near the cadaver. The present study shows that fan-based ventilation can effectively remove FA, CO2, and TVOC from the air around cadavers in a dissection hall. To improve indoor air quality, it is recommended to have four ceiling fans per cadaver. Another effective measure is placing the cadavers near AC vents. However, more research is needed to compare different ventilation setups and assess their impact on indoor air quality in anatomy dissection halls. 4.1 Limitations The measurements were for a short exposure limit rather than a time-weighted average over an 8-hour interval. It is essential to consider furniture placement, such as stools and racks, as they may affect the airflow pattern. Additionally, climatic conditions can have an impact on the levels of FA, which were not taken into consideration. It should be noted that this study only measured the levels of FA at a single point in time. 4.2 Scope for further research FA levels and air quality assessment for a longer duration, over a while, can be considered to analyze the climatic influence and effect of ventilation setups. More studies with similar dissection hall setups would be required to compare the findings under different environmental conditions. 5. Conclusion When comparing the area around the tables and the pathway, it was found that the indoor FA levels near the cadaver were higher. This highlights the importance of a reliable ventilation system to clear FA levels. Additionally, the toe-end of the area, which was farther away from the AC vents, showed higher levels of FA, CO2, and TVOC. Despite the AC setup being considered the optimal ventilation system, it could not effectively clear the air in this more distant area. The current research indicates that fan-based ventilation results in lower mean FA levels than AC and natural ventilation. To enhance indoor air quality around cadavers in the anatomy dissection hall, it is recommended to position them near AC vents and operate multiple ceiling fans simultaneously. Additionally, selecting an appropriate ventilation system and placing the cadavers near the source of airflow can further optimize FA levels and create a healthier working environment for the students and faculty. Ensuring a safe and healthy workplace should be a top priority for everyone in the anatomy dissection hall. Declarations Acknowledgment The authors thank Dr. Prasanna L. C., Head of the Department of Anatomy, Kasturba Medical College, Manipal, for permitting this research and for the support during the research. The Department of Anatomy, Kasturba Medical College, Manipal, provided the logistics. The study was supported financially by Kasturba Medical College, Manipal, through the PG Research Grant-2021. Conference presentation GH presented a part of this study at the 68th National Conference of the Anatomical Society of India (NATCON), titled "Formaldehyde Levels at Breathing Zone in Anatomy Dissection Hall: A Pilot Study." The conference was organized by the Department of Anatomy at King George's Medical University UP, Lucknow, and held from January 28th to 30th, 2022, under the patronage of the Anatomical Society of India. Funding This study was supported by the PG Research Grant of Rs.10, 000/- with grant number PGR598. Ganesh received the grant from the Kasturba Medical College, Manipal, India Competing interests The authors have no relevant financial or non-financial interests to disclose. Author contributions All authors contributed to the study's conception and design. GH collected the data, analyzed and wrote the preliminary report. ADS and VSN reviewed the report. The final manuscript was prepared by GH and ADS, and JA and VSN reviewed the final version. Data availability The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request. Ethical approval The Institutional Ethical Committee of Kasturba Medical College approved the study (IEC no. 614/2021). Consent to Participate All the cadavers utilized for the study were procured through the voluntary body donation program. Written informed consent was obtained from the donors and the next of kin for their utilization in research and education. Consent to publish Not applicable References Hayashi S, Homma H, Naito M, Oda J, Nishiyama T, Kawamoto A, et al. Saturated salt solution method: a useful cadaver embalming for surgical skills training. Medicine (Baltimore). 2014;93(27):e196. Brenner E. 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Lakchayapakorn K. Formaldehyde exposure of medical students and instructors and clinical symptoms during gross anatomy laboratory in Thammasat University - PubMed [Internet]. 2010 [cited 2023 Aug 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/21294402/ D Souza A. Cytokinesis blocked micronucleus assay of peripheral lymphocytes revealing the genotoxic effect of formaldehyde exposure - PubMed [Internet]. 2014 [cited 2023 Aug 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/23893659/ IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Formaldehyde, 2-butoxyethanol and 1-tert-butoxypropan-2-ol. IARC Monogr Eval Carcinog Risks Hum. 2006;88:1–478. Adamović D, Čepić Z, Adamović S, Stošić M, Obrovski B, Morača S, et al. Occupational Exposure to Formaldehyde and Cancer Risk Assessment in an Anatomy Laboratory. Int J Environ Res Public Health. 2021;18(21):11198. Current intelligence bulletin 34 - formaldehyde: evidence of carcinogenicity (with reference package). 2020 Sep 28 [cited 2023 Aug 30]; Available from: https://www.cdc.gov/niosh/docs/81-111/default.html OSHA Formaldehyde Safety - PubMed [Internet]. [cited 2023 Aug 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/35593816/ National Research Council (US) Committee on Toxicology. Formaldehyde - An Assessment of Its Health Effects [Internet]. Washington (DC): National Academies Press (US); 1980 [cited 2023 Aug 30]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK217655/ Wu D, Yu L. Effects of airflow rate and plant species on formaldehyde removal by active green walls. Environ Sci Pollut Res Int. 2022;29(59):88812–22. The 2030 Agenda and the Sustainable Development Goals: An opportunity for Latin America and the Caribbean. Goals, Targets and Global Indicators [Internet]. [cited 2023 Aug 30]. Available from: https://repositorio.cepal.org/handle/11362/40156 Major step towards Medical Education reform [Internet]. [cited 2023 Aug 30]. Available from: https://pib.gov.in/pib.gov.in/Pressreleaseshare.aspx?PRID=1669118 Aung WY, Sakamoto H, Sato A, Yi EEPN, Thein ZL, Nwe MS, et al. Indoor Formaldehyde Concentration, Personal Formaldehyde Exposure and Clinical Symptoms during Anatomy Dissection Sessions, University of Medicine 1, Yangon. Int J Environ Res Public Health. 2021;18(2):712. Zdilla MJ. Local exhaust ventilation systems for the gross anatomy laboratory. Morphologie. 2021;105(350):237–46. Zuber M, Corda JV, Souza AD. Formaldehyde Concentration in An Anatomical Dissection Room with Three Different Ventilation Configurations Using Computational Fluid Dynamics. Engineered Science. 2022;Volume 18 (June 2022)(0):177–86. Minimum Requirements for Annual M.B.B.S Admissions Regulation,2020 | NMC [Internet]. [cited 2023 Jan 24]. Available from: https://www.nmc.org.in/rules-regulations/minimum-requirements-for-annual-m-b-b-s-admissions-regulation2020/ Weltgesundheitsorganisation. WHO guidelines for indoor air quality: selected pollutants. Copenhagen: WHO; 2010. 454 p. Adamović D, Čepić Z, Adamović S, Stošić M, Obrovski B, Morača S, et al. Occupational Exposure to Formaldehyde and Cancer Risk Assessment in an Anatomy Laboratory. Int J Environ Res Public Health. 2021;18(21):11198. Takayanagi M, Sakai M, Ishikawa Y, Murakami K, Kimura A, Kakuta S, et al. [Formaldehyde concentrations in the breathing zone of medical students during gross anatomy laboratory in Toho University]. Kaibogaku Zasshi. 2007;82(2):45–51. Kurose T, Kodera H, Aoyama H, Kawamata S. Formaldehyde concentration in the air and in cadavers at the gross anatomy laboratory in Hiroshima University. Hiroshima J Med Sci. 2004;53(3–4):33–7. Norkaew S, Thammabut P, Chaiyadej R, Changkaew K, Yamasamit N, Ketsakorn A. Indoor air quality and its associations with skin related syndrome among medical students during gross anatomy dissection. 2021; Kunugita N, Nakashima T, Kikuta A, Kawamoto T, Arashidani K. [Exposure to formaldehyde during an anatomy dissecting course]. J UOEH. 2004;26(3):337–48. Matsuda S. [The effects of a novel local ventilation system to reduce the health hazard to students during gross anatomy courses] - PubMed [Internet]. 2009 [cited 2023 Aug 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/20030181/ Aung WY. Indoor Formaldehyde Concentration, Personal Formaldehyde Exposure and Clinical Symptoms during Anatomy Dissection Sessions, University of Medicine 1, Yangon - PMC [Internet]. 2021 [cited 2023 Aug 30]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830549/ Homwutthiwong K, Ongwandee M. Investigation of Formaldehyde in Gross Anatomy Laboratory: Area-Based and Exposure Levels, Ventilation, Health Risk and Clinical Symptoms. Applied Environmental Research. 2017;39(3):77–90. Azari MR. Occupational exposure of a medical school staff to formaldehyde in tehran - PubMed [Internet]. 2012 [cited 2023 Aug 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/25191427/ Ohmichi K. Formaldehyde exposure in a gross anatomy laboratory–personal exposure level is higher than indoor concentration - PubMed [Internet]. 2006 [cited 2023 Aug 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/16612901/ Vohra MS. Personal formaldehyde exposure level in the gross anatomy dissecting room at College of Medicine King Saud University Riyadh - PubMed [Internet]. 2011 [cited 2023 Aug 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/21468908/ Gahukar S, Ramteke U, Majumdar D, Malviya R, Patil D, Trivedi J, et al. Prevalence of formaldehyde in the indoor air of gross anatomy laboratory and cadaver storage room of a medical college. Journal of Environmental and Occupational Science. 2014;3:1. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3375113","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":240068511,"identity":"9d90a259-9a92-439b-b3d8-cffad90cfbe9","order_by":0,"name":"Ganesh Handady","email":"","orcid":"","institution":"Kasturba Medical College, Manipal Manipal Academy of Higher Education","correspondingAuthor":false,"prefix":"","firstName":"Ganesh","middleName":"","lastName":"Handady","suffix":""},{"id":240068512,"identity":"6fb1a941-2385-4066-9b8c-e6ce2fbba413","order_by":1,"name":"Anne DSouza","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYNACNjDJ+ABI8DAwMDfARAhqYTaAaGEkXgubBIRHQAv/7N6DDxjK6uQMzh9+VnWj5o6MOfvBBoYPZYdxapG4cy7ZgOHcYWODA8fMbucce8Zj2ZPYwDjjHG4tDDdyzCQY2w4kbjjYANTCdpjH4EBiAzNvG24t8jdyzH8wttUlbjjM/q045x9Qy/mHDcx/8WgxANrCwNjGnLjhGI8Zc24bUMsNoC2MeLQY3sgxlkgA+kXyDE+xdG7fYR7LGQ8bDvacS8epRe5GjuGHD8AQ4zt/fOPnnG+H7c35kw8++FFmjdv7IJCA4lQgPoBfPTowIE35KBgFo2AUjAAAAEoQWfmfg/3OAAAAAElFTkSuQmCC","orcid":"","institution":"Kasturba Medical College, Manipal Manipal Academy of Higher Education","correspondingAuthor":true,"prefix":"","firstName":"Anne","middleName":"","lastName":"DSouza","suffix":""},{"id":240068513,"identity":"6b916b08-9412-4819-8ece-0416dc0b1731","order_by":2,"name":"Vanishri S. Nayak","email":"","orcid":"","institution":"Kasturba Medical College, Manipal Manipal Academy of Higher Education","correspondingAuthor":false,"prefix":"","firstName":"Vanishri","middleName":"S.","lastName":"Nayak","suffix":""},{"id":240068514,"identity":"4408d27e-aca3-4797-b714-67016bb8ac7c","order_by":3,"name":"Joseph Abraham","email":"","orcid":"","institution":"Kasturba Medical College, Manipal Manipal Academy of Higher Education","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Abraham","suffix":""}],"badges":[],"createdAt":"2023-09-21 07:59:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3375113/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3375113/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":44796885,"identity":"eb883e9e-6e82-4d61-8d68-099dc1a849b0","added_by":"auto","created_at":"2023-10-17 15:38:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":196387,"visible":true,"origin":"","legend":"\u003cp\u003eA two-dimensional pictorial representation of the dissection hall.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3375113/v1/f8c5846d6d1e54495f567541.png"},{"id":44798234,"identity":"d9b8cd99-61ce-4def-8ff2-7b43766f43c8","added_by":"auto","created_at":"2023-10-17 15:46:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94774,"visible":true,"origin":"","legend":"\u003cp\u003ePictorial representation of the placement of one cadaver on a dissection table\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3375113/v1/f3ea09ef41631294425237de.png"},{"id":44796883,"identity":"4ea8db86-d44c-4491-bade-40624f632091","added_by":"auto","created_at":"2023-10-17 15:38:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":227409,"visible":true,"origin":"","legend":"\u003cp\u003eTwo-dimensional pictorial representation of the points at which the FA levels and the air quality readings were measured.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3375113/v1/ee85008468a3f89d853e1124.png"},{"id":44796886,"identity":"321f9b4a-4ffc-4d52-b79c-f3fa5a532d22","added_by":"auto","created_at":"2023-10-17 15:38:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":145619,"visible":true,"origin":"","legend":"\u003cp\u003eGraphical representation of the distribution of FA levels at different locations of the anatomy hall with different ventilation setups\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-3375113/v1/68daa15ed2b1209cabfdfcdf.png"},{"id":45788243,"identity":"fa6a1586-b0fe-458c-ba10-9db3c01bf9d4","added_by":"auto","created_at":"2023-11-03 06:10:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1229286,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3375113/v1/e31606bd-216a-48f5-8990-c35d12e4a150.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Formaldehyde Levels and the Indoor Air Quality of Anatomy Dissection Hall with Different Ventilation Setups","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHuman cadaveric dissection is essential for learning Anatomy, either through demonstrating the specimens or through the dissection of cadavers. Though new teaching methods (like using models, virtual reality, etc.) exist, cadavers play a significant role in teaching anatomy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. For the preservation of the cadavers, durable (or long-lasting) and cost-effective formaldehyde (FA) is used as an embalming solution for the cadavers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFA is a colorless, strong-smelling gas readily soluble in water. It is commonly used as a 37% aqueous solution, formalin, to preserve cadavers in medical schools. The sake of using formalin is its cost-effectiveness, preservation properties, availability, and suitable fixation properties. With water (1:10 ratio), formalin embalm the cadavers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is used due to its long-lasting feature and non-degenerative capacity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The solution is routinely injected into the femoral or the carotid artery. FA also has bactericidal, fungicidal, and insecticidal properties, and it is widely used as a restoring and conserving agent; it has good disinfecting features and thereby blocks the entry of decomposers. FA also tans the tissue without ruining its fragile structures [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is a productive fixative with rapid perforation of tissues and long-term conservative features [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eApart from its preservative properties, FA has several adverse health effects. During anatomy classes, evaporation of FA from cadavers and embalming fluids could adversely affect students and staff. The students, staff, and technicians in the dissection hall are frequently exposed to FA [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. When exposed for a short time, FA will cause itchiness in the nose and irritation in the eyes, and on long-term exposure, it leads to changes in liver function and carcinoma [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The other symptoms are undesirable odor, profuse lacrimation, and some skin issues such as dryness of skin, eczema, allergic contact dermatitis, respiratory tract infection, and bronchial asthma [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. General tiredness, burning eyes, and nose are also reported [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Exposure to FA has a wide range of adverse effects on health, ranging from allergic reactions to genetic damage [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It is also said to be carcinogenic [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Cancer risk assessment in Anatomy labs with FA exposure is estimated to be several thousand times higher than the limit recommended by the EPA (10\u003csup\u003e\u0026minus;\u0026thinsp;6\u003c/sup\u003e) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are several standards set for the permissible limits of FA levels. The short exposure limit of 1ppm (1.2mg/m\u003csup\u003e3\u003c/sup\u003e) for a period of 30min is recommended exposure limit (REL) by The National Institute for Occupational Safety and Health (NIOSH) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The permissible exposure limit (PEL) is 2ppm, which is the maximum exposure limit during a 15min duration by The Occupational Safety Health Administration (OSHA) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The American Conference of Government Industrial Hygienists (ACGIH, 1974) recommends a threshold limit value-ceiling (TLV-C) of 2ppm for formaldehyde [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, the World Health Organization (WHO) has provided a short-term (30 minutes) exposure limit of 0.1 mg/m3 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe Sustainable Development Goal (SGD) 3.9 emphasizes reducing deaths and illnesses produced by hazardous chemicals and air [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. NIOSH strongly recommends the evaluation of FA and indoor air quality assessment to protect the workers exposed to hazardous chemicals. Additionally, it emphasizes frequent checks of airflow at the workplace [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. National Medical Council (NMC), India, had laid down guidelines on the dimensions and the requirements for the Anatomy dissection halls at medical schools [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, achieving a healthy indoor environment inside the dissection hall is imperative for the safety of the students and the staff.\u003c/p\u003e \u003cp\u003eThe ventilation set-ups and the floor area of the dissection hall influence the FA levels and the indoor air quality. FA levels monitored using a fan-based ventilation set-up have shown remarkably higher values emphasizing the need for an effective ventilation set-up and a larger floor area [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A local exhaust ventilation system has proven the most effective [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, the effectiveness of such setup is not well understood for an Anatomy dissection hall with a large number of dissection tables and cadavers operational simultaneously. A computational fluid dynamics (CFD) approach revealed that an AC-based ventilation setup has benefits in optimizing FA levels compared to a simple fan-based setup [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, evaluation of indoor air quality in a realistic set-up would be required to evaluate the indoor environment of the anatomy hall. The distribution of FA levels is influenced by the airflow rate and direction [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is uncommon for the literature to evaluate the comprehensive air quality of an anatomy hall in terms of FA levels, carbon dioxide (CO2), and total volatile organic compounds (TVOC). Furthermore, the effect of frequently utilized ventilation systems, including air-conditioning (AC) and fan-based ventilation, on FA distribution is not commonly assessed.\u003c/p\u003e \u003cp\u003eIn order to ensure a safe and healthy environment in the anatomy hall, it is essential to evaluate the levels of FA and overall indoor air quality. This will help identify areas where hazardous compounds may be present and determine how ventilation systems can mitigate their impact. By analyzing FA levels and indoor air quality in different locations of the hall with varying ventilation setups, this study aims to provide information that can be used to identify the locations at risk with higher FA levels and poor air quality.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Aim and Objectives\u003c/h2\u003e \u003cp\u003eThis study aimed to estimate the FA levels and evaluate the indoor air quality (CO2 and TVOC levels) at different locations of an Anatomy dissection hall and to find out how these values are influenced by the most commonly operating ventilation systems (natural, fan-based, and air-conditioned (AC).\u003c/p\u003e \u003cp\u003eThe objectives were,\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEstimation of FA levels at different locations (head-end and toe-end of the cadavers, between tables and pathway) in an anatomy dissection hall\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eComparison of FA levels with different ventilation systems (AC, fan-based and natural) in an anatomy dissection hall\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eComparison of TVOC levels and CO2 with different ventilation setups and different locations of an anatomy dissection hall\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis cross-sectional study was conducted at Kasturba Medical College, Manipal, India from January to March 2022. The Institutional Ethical Committee of Kasturba Medical College approved the study (IEC no. 614/2021). All methods were performed in accordance with the relevant guidelines and regulations. Written informed consent was obtained during the procurement of cadavers through the voluntary body donation program. The donor as well as the next of kin consented to utilize cadavers for research and medical education.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Description of the dissection hall involved\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe dissection hall used for the current study is designed to accommodate 250 students per the NMC guidelines [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The basic dimensions and infrastructure are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of the dissection hall used for the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal floor area\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e925 m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentilation options available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAC, fan, and natural ventilation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe centralized operating capacity of 17,000cfm, vents situated at the height of 2.03m from the floor level\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of ceiling fans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance between the fans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of windows\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18, 0.52m\u0026times;0.75m in dimension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne main door\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of cadavers utilized at a single time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were ten dissection tables placed about 1.68m apart from each other. Ten cadavers were used at a time for one academic year. The cadavers were procured through the voluntary body donation program of the institute with written informed consent from the donor as well as the next of kin for their utilization for research and education. The cadavers were washed in water before placing them on the tables. Seven tables were continuous with distance in the dissection hall, and the other three were placed apart on the other side of the central pathway. Opposite every table were two windows situated 1.2m from the toe end of the cadavers. The AC vents were situated close to the head end at a distance of 0.96m. Forty ceiling fans were fixed at a height of 3.5m from the floor level.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Description of the embalming fluid used\u003c/h2\u003e \u003cp\u003eThe embalming fluid at our institution constitutes 50% formalin (the composition is 37% formaldehyde and water in a 1:1 ratio). Arterial embalming is the preferred choice, where the femoral or carotid artery is chosen for injecting the embalming fluid. After embalming, the cadavers are immersed in 50% formalin (the same composition as the embalming fluid).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.3 A detailed description of formaldehyde estimation and indoor air quality assessment\u003c/h2\u003e \u003cp\u003eThe students and the staff are involved in dissection activity for two hours daily, four days a week. Hence, the short-term exposure limit by the WHO was considered the standard for the present study [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. InkbirdPlus air quality monitor (Shenzhen, Guangdong, China) was used to measure CO2, FA, and TVOC. It has a measurement range: of 0.000\u0026ndash;1.000mg/m3 of FA, 350\u0026ndash;2000ppm of CO2, and 0.000\u0026ndash;2.000mg/m3 of TVOC.\u003c/p\u003e \u003cp\u003eTen tables were set, each containing one formalin embalmed for regular dissection classes. The head end of the cadaver is placed near the AC vents, and the toe ends near the windows (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe FA levels and the indoor air quality at the breathing zone were estimated with AC, fan-based, and naturally ventilated setup. When the AC was operational, all windows were closed, and all the fans were switched off. Moreover, the naturally ventilated setup had all fans, AC switched off, and windows opened. AC was switched off in the fan-based setup, and the windows were kept open. With these three different types of ventilation setups, FA levels and the indoor air quality (CO2 and TVOC) were measured at the locations (or points) such as the head end (ten points) and the toe end of the cadavers (ten points), between two the dissection tables (eight points) and in the central pathway, (six points). The locations are represented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The readings were taken at the breathing zone, that is, at 3 feet (0.914m) from the floor level. At first, the cadavers were taken out from the formalin tanks, washed with tap water, and placed on the dissection tables. The ventilation setup was made operational at the same time. After 30 minutes, the values were measured at the defined points with a time interval of 15 minutes between two points.\u003c/p\u003e \u003cp\u003eDuring the study period, the cadavers were utilized to dissection the head, neck, and abdominal regions. The readings are taken for four consecutive working days (Monday to Thursday) for each ventilation setup. All the levels were measured in the absence of students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMean, and standard deviations were calculated for each variable. The values measured at different points for each ventilation setup were compared using one-way ANOVA. The values at each point were also compared with the three different ventilation setups using one-way ANOVA. Furthermore, Tukey's Multiple Comparison Test was used for group-wise comparison. GraphPad Prism 5 software (Boston) was used for the statistical analysis.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparison of FA levels at different locations\u003c/h2\u003e \u003cp\u003eWe found that the levels of FA varied depending on the type of ventilation used. With AC, the levels ranged from 0.001 to 0.194 mg/m3, while with fans, they ranged from 0.002 to 0.059 mg/m3, and with natural ventilation, they ranged from 0.001 to 0.23 mg/m3. The fan-based ventilation setup had lower mean FA levels (0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01mg/m\u003csup\u003e3\u003c/sup\u003e) compared to the AC (0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05mg/m\u003csup\u003e3\u003c/sup\u003e) and natural ventilation (0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03mg/m\u003csup\u003e3\u003c/sup\u003e). However, the difference was not statistically significant. Additionally, we noticed that in a single ventilation setup, the FA levels were higher at the head and toe-ends of the cadavers compared to the pathway and between the dissection tables. This information can be found in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean and standard deviations of FA levels, TVOC, and CO2 at different locations and different ventilation setups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eFormaldehyde levels (mg/m\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead End\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eToe End\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBetween tables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePathway\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAC setup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0579\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0722\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0078\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFan-based Setup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0207\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0116\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0048\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.013\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatural Ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0175\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0436\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0042\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0053\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAir quality- TVOC levels (mg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHead End\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eToe End\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBetween tables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ePathway\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAC setup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.321\u0026thinsp;\u0026plusmn;\u0026thinsp;0.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.408\u0026thinsp;\u0026plusmn;\u0026thinsp;0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0421\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0541\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFan-based Setup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.119\u0026thinsp;\u0026plusmn;\u0026thinsp;0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0698\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0305\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.065\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0434\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatural Ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.093\u0026thinsp;\u0026plusmn;\u0026thinsp;0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.126\u0026thinsp;\u0026plusmn;\u0026thinsp;0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0195\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0178\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAir quality- CO2 levels (ppm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHead End\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eToe End\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBetween tables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ePathway\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAC setup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e861.7\u0026thinsp;\u0026plusmn;\u0026thinsp;486.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e999.1\u0026thinsp;\u0026plusmn;\u0026thinsp;488.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e496.1\u0026thinsp;\u0026plusmn;\u0026thinsp;60.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e519.33\u0026thinsp;\u0026plusmn;\u0026thinsp;94.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFan-based Setup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e618.4\u0026thinsp;\u0026plusmn;\u0026thinsp;195.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e534.4\u0026thinsp;\u0026plusmn;\u0026thinsp;132.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e458.75\u0026thinsp;\u0026plusmn;\u0026thinsp;49.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e556.83\u0026thinsp;\u0026plusmn;\u0026thinsp;60.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatural Ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e614.9\u0026thinsp;\u0026plusmn;\u0026thinsp;134.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e655.7\u0026thinsp;\u0026plusmn;\u0026thinsp;158.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e451.125\u0026thinsp;\u0026plusmn;\u0026thinsp;27.0683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e467.333\u0026thinsp;\u0026plusmn;\u0026thinsp;25.2481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the AC configuration, there was a notable contrast in the FA levels between the toe-end of the cadavers (0.072\u0026thinsp;\u0026plusmn;\u0026thinsp;0.065 mg/m3) and the tables (0.0078\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0054 mg/m3) as determined by one-way ANOVA (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). However, in both the fan-based and natural ventilation setups, there was no significant difference in FA levels at various locations, suggesting a relatively even distribution of FA levels throughout the dissection hall.\u003c/p\u003e \u003cp\u003eThe levels of FA in the pathway and between the tables remained consistent regardless of the type of ventilation system. However, at the toe end, the FA levels were higher with AC than with fan-based ventilation (p\u0026thinsp;=\u0026thinsp;0.06) and natural ventilation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e \u003cp\u003eTherefore, while comparing the FA levels at different ventilation setups and locations in the dissection hall, the AC setup showed unevenly distributed FA levels than the fan-based and natural ventilation setups. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicates the graphical comparison of FA levels with the ventilation systems. Additionally, in the present study, the FA levels were always within the standard limits provided for the short-term exposure limit by NIOSH with all three ventilation setups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of TVOC and CO2 levels at different locations\u003c/h2\u003e \u003cp\u003eWith AC, the CO2 levels ranged from 408-1839ppm, while with fans, they ranged from 405-971ppm, and with natural ventilation, they ranged from 409-932ppm. The fan-based ventilation setup had lower mean CO2 levels (545.26\u0026thinsp;\u0026plusmn;\u0026thinsp;138.38ppm) compared to the AC (773.55\u0026thinsp;\u0026plusmn;\u0026thinsp;397.5ppm) and natural ventilation (562.23\u0026thinsp;\u0026plusmn;\u0026thinsp;139.9ppm). With AC, the TVOC levels ranged from 0.01-1.28mg/m\u003csup\u003e3\u003c/sup\u003e, while with fans, they ranged from 0.01\u0026ndash;0.32 mg/m\u003csup\u003e3\u003c/sup\u003e, and with natural ventilation, they ranged from0.01-0.3 mg/m\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e \n\u003cp\u003eAccording to Table 2, the TVOC and CO2 levels were notably elevated at both the head-end and toe-end of the cadavers, in contrast to the pathway and the area between the tables for all three ventilation systems. The AC setup had significantly higher CO2 levels at the toe-end of the cadavers than the fan-based and natural ventilation methods (p\u0026lt;0.0001). Table 3 compares CO2 levels at different locations using the operating ventilation setup.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Comparison of the CO2 levels (ppm) at the different locations of the dissection hall with the ventilation setups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparison between the ventilation setups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean difference\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% confidence interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.218543046357617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificance*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.072847682119205%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHead end of the cadaver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Fan-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e243.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e-103.4 to 590.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.218543046357617%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Natural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.772639691714836%\" valign=\"top\"\u003e\n \u003cp\u003e246.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003e-99.86 to 593.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.038535645472063%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003eFan-based vs. Natural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.772639691714836%\" valign=\"top\"\u003e\n \u003cp\u003e3.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003e-343.2 to 350.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.038535645472063%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.072847682119205%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eToe end of the cadaver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Fan-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e464.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e124.7 to 804.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.218543046357617%\" valign=\"top\"\u003e\n \u003cp\u003eYes (p\u0026lt;0.0001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Natural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.772639691714836%\" valign=\"top\"\u003e\n \u003cp\u003e343.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003e3.365 to 683.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.038535645472063%\" valign=\"top\"\u003e\n \u003cp\u003eYes (p\u0026lt;0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003eFan-based vs. Natural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.772639691714836%\" valign=\"top\"\u003e\n \u003cp\u003e-121.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003e-461.3 to 218.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.038535645472063%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.072847682119205%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eBetween tables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Fan-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e37.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e-22.73 to 97.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.218543046357617%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Natural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.772639691714836%\" valign=\"top\"\u003e\n \u003cp\u003e45.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003e-15.11 to 105.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.038535645472063%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003eFan-based vs. Natural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.772639691714836%\" valign=\"top\"\u003e\n \u003cp\u003e7.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003e-52.48 to 67.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.038535645472063%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.072847682119205%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePathway\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Fan-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e-37.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e-137.5 to 62.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.218543046357617%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Natural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.772639691714836%\" valign=\"top\"\u003e\n \u003cp\u003e52.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003e-48.02 to 152.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.038535645472063%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003eFan-based vs. Natural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.772639691714836%\" valign=\"top\"\u003e\n \u003cp\u003e89.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.094412331406552%\" valign=\"top\"\u003e\n \u003cp\u003e-10.52 to 189.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.038535645472063%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Using Tukey\u0026apos;s Multiple Comparison Test\u003c/p\u003e\n\u003cp\u003eRegardless of the ventilation setup, the TVOC levels remained consistent between the tables and the pathway. However, at the toe-end of the cadaver, the TVOC levels were substantially higher with the AC setup than the natural and fan-based setups (p\u0026lt;0.001). A comprehensive comparison is given in Table 4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Comparison of the TVOC levels (mg/m\u003csup\u003e3\u003c/sup\u003e) at the different locations of the dissection hall with the ventilation setups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.3044925124792%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.795341098169718%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparison between the ventilation setups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.472545757071547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean difference\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46089850249584%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% confidence interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.966722129783694%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificance*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.3044925124792%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHead end of the cadaver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.795341098169718%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Fan-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.472545757071547%\" valign=\"top\"\u003e\n \u003cp\u003e0.2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46089850249584%\" valign=\"top\"\u003e\n \u003cp\u003e-0.008893 to 0.4133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.966722129783694%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.56539235412475%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Natural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.919517102615693%\" valign=\"top\"\u003e\n \u003cp\u003e0.2288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.37022132796781%\" valign=\"top\"\u003e\n \u003cp\u003e0.01771 to 0.4399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.14486921529175%\" valign=\"top\"\u003e\n \u003cp\u003eYes (p\u0026lt;0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.56539235412475%\" valign=\"top\"\u003e\n \u003cp\u003eFan-based vs. Natural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.919517102615693%\" valign=\"top\"\u003e\n \u003cp\u003e0.0266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.37022132796781%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1845 to 0.2377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.14486921529175%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.3044925124792%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eToe end of the cadaver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.795341098169718%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Fan-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.472545757071547%\" valign=\"top\"\u003e\n \u003cp\u003e0.3383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46089850249584%\" valign=\"top\"\u003e\n \u003cp\u003e0.06718 to 0.6094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.966722129783694%\" valign=\"top\"\u003e\n \u003cp\u003eYes (p\u0026lt;0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.56539235412475%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Natural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.919517102615693%\" valign=\"top\"\u003e\n \u003cp\u003e0.2821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.37022132796781%\" valign=\"top\"\u003e\n \u003cp\u003e0.01098 to 0.5532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.14486921529175%\" valign=\"top\"\u003e\n \u003cp\u003eYes (p\u0026lt;0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.56539235412475%\" valign=\"top\"\u003e\n \u003cp\u003eFan-based vs. Natural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.919517102615693%\" valign=\"top\"\u003e\n \u003cp\u003e-0.05620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.37022132796781%\" valign=\"top\"\u003e\n \u003cp\u003e-0.3273 to 0.2149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.14486921529175%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.3044925124792%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eBetween tables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.795341098169718%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Fan-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.472545757071547%\" valign=\"top\"\u003e\n \u003cp\u003e0.01163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46089850249584%\" valign=\"top\"\u003e\n \u003cp\u003e0.01652 to 0.03977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.966722129783694%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.56539235412475%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Natural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.919517102615693%\" valign=\"top\"\u003e\n \u003cp\u003e0.02263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.37022132796781%\" valign=\"top\"\u003e\n \u003cp\u003e-0.005523 to 0.05077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.14486921529175%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.56539235412475%\" valign=\"top\"\u003e\n \u003cp\u003eFan-based vs. Natural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.919517102615693%\" valign=\"top\"\u003e\n \u003cp\u003e0.0110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.37022132796781%\" valign=\"top\"\u003e\n \u003cp\u003e-0.01715 to 0.03915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.14486921529175%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.3044925124792%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePathway\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.795341098169718%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Fan-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.472545757071547%\" valign=\"top\"\u003e\n \u003cp\u003e-0.01083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46089850249584%\" valign=\"top\"\u003e\n \u003cp\u003e-0.06801 to 0.04634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.966722129783694%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.56539235412475%\" valign=\"top\"\u003e\n \u003cp\u003eAC vs. Natural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.919517102615693%\" valign=\"top\"\u003e\n \u003cp\u003e0.03633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.37022132796781%\" valign=\"top\"\u003e\n \u003cp\u003e-0.02084 to 0.09351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.14486921529175%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.56539235412475%\" valign=\"top\"\u003e\n \u003cp\u003eFan-based vs. Natural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.919517102615693%\" valign=\"top\"\u003e\n \u003cp\u003e0.04717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.37022132796781%\" valign=\"top\"\u003e\n \u003cp\u003e-0.01001 to 0.1043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.14486921529175%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Using Tukey\u0026apos;s Multiple Comparison Test\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study, we examined the FA, CO2, and TVOC levels in an anatomy dissection hall using various ventilation systems. We found that the toe-end of the cadavers had notably higher levels of these compounds in the AC setup, likely due to their distance from the vents. However, there were no significant differences in levels between the fan-based and natural ventilation setups at different points.\u003c/p\u003e \u003cp\u003eResearch in the anatomy hall evaluations has been documented in the literature, with studies comparing FA levels in different medical colleges. Bhat et al. found that the 8-hour TWA for FA was higher in a Private Medical College (ranging from 3.4 to 5ppm) compared to a Government Medical College (ranging from 1.64 to 2.02ppm) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In this study, conducted at a private institute, FA levels were found to be within the acceptable limit of 1ppm for short-term exposure and did not exceed this limit regardless of ventilation setup. It is possible that the difference in FA levels between government and private colleges can be attributed to factors such as the number of cadavers, infrastructure, and the size of the dissection hall. However, the anatomy hall in this study meets NMC guidelines, indicating that the findings can be generalized to other medical institutes.\u003c/p\u003e \u003cp\u003eIn the study by Adamovic et al., FA levels were estimated at five locations inside the Department of Anatomy in Serbia in February, March, and May. Environmental factors, such as humidity and temperature, were also considered. In the cadaver storage room, the FA levels were as high as 1.76\u0026ndash;2.90 ppm [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similarly, in the present study, the FA levels were higher around the cadaver compared to the pathway and between tables. However, the present study did not include the storage room for FA level monitoring, considering that, inevitably, higher FA levels inside the storage room. At the same time, students and staff are exposed to FA in the dissection hall.\u003c/p\u003e \u003cp\u003eTakayanagi et al. reported that FA levels ranged from 0.24 to 3.04 ppm during systemic musculoskeletal anatomy and neuroanatomy [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Kurose et al. measured FA levels in the indoor air of the anatomy dissection hall with 35 cadavers at the Faculty of Medicine of Hiroshima University and found levels between 0.25 and 0.55 ppm [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Our present study measured FA levels during the head, neck, and abdominal wall dissection. We observed a decrease in FA levels in the dissected region, which could be attributed to the smaller surface area compared to the higher values reported by Takayanagi et al [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to a recent study by Norkaew et al., high levels of FA may contribute to skin-related issues among medical students [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Fortunately, research suggests that implementing a local ventilation system in the anatomy dissection hall can effectively lower FA levels [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, due to the large number of students and cadavers, installing a complete ventilation setup may not be cost-effective. Instead, optimizing the existing ventilation system through regular FA and air quality monitoring could be a viable option.\u003c/p\u003e \u003cp\u003eAccording to a study conducted by Zuber et al., the AC setup had lower FA levels than the fan-based and natural ventilation setups, as determined by the computational fluid dynamics approach [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, our present study observed higher levels of FA with the AC setup, although there was no significant difference between the various ventilation setups. This difference could be attributed to the AC vents' high placement and the direction and circulation of the airflow within the dissection hall.\u003c/p\u003e \u003cp\u003eAccording to Aung et al., the levels of FA in dissection rooms with a wall-mounted fan as ventilation showed remarkably high values with short-term exposure [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The study suggested that reducing the number of cadavers and increasing the area of the dissection hall could lower FA levels. The present study found that the FA levels were within expected limits for short-term exposure, which may be due to the larger floor area, more ceiling fans, and fewer cadavers.\u003c/p\u003e \u003cp\u003eStudies have found that fan-based ventilation in dissection halls has resulted in higher levels of formaldehyde (FA) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Other reports have shown that personal exposure to FA can be higher than indoor levels when using air conditioning in anatomy halls [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In this study, the air conditioning system resulted in higher levels of FA, particularly in the toe-end areas of the cadavers. Due to their distance from the AC vents, the heavier FA particles were not effectively cleared. However, the FA levels and indoor air quality were better with fan-based ventilation, suggesting that having four ceiling fans per cadaver effectively cleared the hazardous compounds near the cadavers.\u003c/p\u003e \u003cp\u003ePrevious studies have addressed monitoring formaldehyde (FA) levels in the dissection hall [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Gahukar et al. conducted a study that evaluated FA levels with and without exhaust fans operating and found higher FA values in the dissection hall [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Table\u0026nbsp;5 provides a comprehensive overview of indoor FA estimation based on various ventilation setups in previous studies.\u003c/p\u003e \n\u003cp\u003e \u003cb\u003eTable\u0026nbsp;5: Comparison of indoor FA levels with different dissection halls and ventilation settings\u003c/b\u003e \u003c/p\u003e \n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthors, Year, and Country\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFloor area of the dissection hall (m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSampling locations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eType of Ventilation setup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNumber of cadavers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAverage Indoor FA levels (ppm)*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKunugita et al. (2004)\u003c/p\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClose to the cadavers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGeneral ventilation\u003c/p\u003e \u003cp\u003eGeneral ventilation with new filters\u003c/p\u003e \u003cp\u003eNovel local ventilation for each dissection table\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003cp\u003e0.61\u003c/p\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOhmichi et al. (2006)\u003c/p\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCenter and the four corners of the lab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 supply diffusor, four air conditioners, eight air return grills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot mentioned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.23\u0026ndash;1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVohra (2011)\u003c/p\u003e \u003cp\u003eSaudi Arabia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCenter, close to the doors and four corners of the lab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCentral air conditioner, four exhaust fans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.68 (week 4)\u003c/p\u003e \u003cp\u003e0.85 (week 10)\u003c/p\u003e \u003cp\u003e0.73 (week 14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzari et al. (2012)\u003c/p\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVentilation (supply-exhaust) system on\u003c/p\u003e \u003cp\u003eVentilation supply system on\u003c/p\u003e \u003cp\u003eVentilation system (supply and exhaust) off\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot mentioned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.306\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003cp\u003e0.317\u0026thinsp;\u0026plusmn;\u0026thinsp;0.026\u003c/p\u003e \u003cp\u003e0.698\u0026thinsp;\u0026plusmn;\u0026thinsp;0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGahukar et al. (2014)\u003c/p\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAisle and corners of the hall; at about 2 feet height\u003c/p\u003e \u003cp\u003eAt about 5 feet height over dissection tables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWindows with an exhaust fan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.049\u0026ndash;0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHomwutthiway and Ongwandee (2017)\u003c/p\u003e \u003cp\u003eThailand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClose to the cadaver\u003c/p\u003e \u003cp\u003eAt the corner\u003c/p\u003e \u003cp\u003eCorridor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWindows and four big pedestal fans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00925\u0026ndash;0.01759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAung et al. (2021)\u003c/p\u003e \u003cp\u003eMyanmar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDissection room I, II-11,188m\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDissection room III- V- 9942 m\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCenter of the dissection hall, six feet above the ground\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTen wall fans in each dissection room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (distributed in four dissection rooms)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.09\u0026ndash;1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe present study\u003c/p\u003e \u003cp\u003e(2022)\u003c/p\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHead end, toe-end of the cadavers, between tables and pathway\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAir condition\u003c/p\u003e \u003cp\u003eFan-based\u003c/p\u003e \u003cp\u003enatural ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u0026ndash;0.238\u003c/p\u003e \u003cp\u003e0.002\u0026ndash;0.072\u003c/p\u003e \u003cp\u003e0.001\u0026ndash;0.246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*\u003c/b\u003eLevels in mg/m\u003csup\u003e3\u003c/sup\u003e are converted into ppm for suitable comparability\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFootnote: Few of the contents of this table were adapted from Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e of Aung et al., 2021\u003c/p\u003e \u003cp\u003eThis study uses ventilation systems to examine the various dissection hall locations for FA, CO2, and TVOC levels. Regardless of the ventilation type, the levels were notably higher around the cadaver, and the air quality was sometimes poor at specific points while using AC ventilation. As formaldehyde in ambient air quickly photo-oxidized to carbon dioxide, it is imperative to have higher FA and CO2 near the cadaver. The present study shows that fan-based ventilation can effectively remove FA, CO2, and TVOC from the air around cadavers in a dissection hall. To improve indoor air quality, it is recommended to have four ceiling fans per cadaver. Another effective measure is placing the cadavers near AC vents. However, more research is needed to compare different ventilation setups and assess their impact on indoor air quality in anatomy dissection halls.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Limitations\u003c/h2\u003e \u003cp\u003eThe measurements were for a short exposure limit rather than a time-weighted average over an 8-hour interval. It is essential to consider furniture placement, such as stools and racks, as they may affect the airflow pattern. Additionally, climatic conditions can have an impact on the levels of FA, which were not taken into consideration. It should be noted that this study only measured the levels of FA at a single point in time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Scope for further research\u003c/h2\u003e \u003cp\u003eFA levels and air quality assessment for a longer duration, over a while, can be considered to analyze the climatic influence and effect of ventilation setups. More studies with similar dissection hall setups would be required to compare the findings under different environmental conditions.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eWhen comparing the area around the tables and the pathway, it was found that the indoor FA levels near the cadaver were higher. This highlights the importance of a reliable ventilation system to clear FA levels. Additionally, the toe-end of the area, which was farther away from the AC vents, showed higher levels of FA, CO2, and TVOC. Despite the AC setup being considered the optimal ventilation system, it could not effectively clear the air in this more distant area. The current research indicates that fan-based ventilation results in lower mean FA levels than AC and natural ventilation. To enhance indoor air quality around cadavers in the anatomy dissection hall, it is recommended to position them near AC vents and operate multiple ceiling fans simultaneously. Additionally, selecting an appropriate ventilation system and placing the cadavers near the source of airflow can further optimize FA levels and create a healthier working environment for the students and faculty. Ensuring a safe and healthy workplace should be a top priority for everyone in the anatomy dissection hall.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Dr. Prasanna L. C., Head of the Department of Anatomy, Kasturba Medical College, Manipal, for permitting this research and for the support during the research. The Department of Anatomy, Kasturba Medical College, Manipal, provided the logistics. The study was supported financially by Kasturba Medical College, Manipal, through the PG Research Grant-2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConference presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGH presented a part of this study at the 68th National Conference of the Anatomical Society of India (NATCON), titled \u0026quot;Formaldehyde Levels at Breathing Zone in Anatomy Dissection Hall: A Pilot Study.\u0026quot; The conference was organized by the Department of Anatomy at King George\u0026apos;s Medical University UP, Lucknow, and held from January 28th to 30th, 2022, under the patronage of the Anatomical Society of India.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the PG Research Grant of Rs.10, 000/- with grant number PGR598. Ganesh received the grant from the Kasturba Medical College, Manipal, India\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll authors contributed to the study\u0026apos;s conception and design. GH\u003c/em\u003e collected the data, analyzed and wrote the preliminary report. ADS and VSN reviewed the report. The final manuscript was prepared by GH and ADS, and JA and VSN reviewed the final version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Institutional Ethical Committee of Kasturba Medical College approved the study (IEC no. 614/2021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the cadavers utilized for the study were procured through the voluntary body donation program. Written informed consent was obtained from the donors and the next of kin for their utilization in research and education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHayashi S, Homma H, Naito M, Oda J, Nishiyama T, Kawamoto A, et al. Saturated salt solution method: a useful cadaver embalming for surgical skills training. Medicine (Baltimore). 2014;93(27):e196.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrenner E. Human body preservation - old and new techniques. J Anat. 2014;224(3):316\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMusiał A, Gryglewski RW, Kielczewski S, Loukas M, Wajda J. Formalin use in anatomical and histological science in the 19th and 20th centuries. 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Journal of Environmental and Occupational Science. 2014;3:1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Formaldehyde, ventilation system, anatomy, air quality","lastPublishedDoi":"10.21203/rs.3.rs-3375113/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3375113/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDuring anatomy dissection, the release of formaldehyde (FA) from cadavers and embalming fluids can negatively affect the well-being of students and staff. To address this issue, a study measured the FA and air quality (CO2 and Total Volatile Organic Compounds- TVOC) in the breathing zone with different ventilation setups: natural, fan-based, and air-conditioned. The FA, CO2, and TVOC levels were estimated at the cadavers\u0026rsquo; head and toe ends, in the pathway, and between the dissection tables. The levels were higher near the cadaver and lower in the pathway and between the tables, regardless of the type of ventilation. Fan-based ventilation had the lowest mean FA, CO2, and TVOC levels compared to AC and natural ventilation. However, there was no significant difference in these levels between the ventilation types, except for the toe-ends of the cadavers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), where the toe-end farther from the AC vents had higher levels. The study suggests that areas away from the source of ventilation are at risk of having lower air quality. Therefore, in addition to selecting an appropriate ventilation system, placing cadavers near the source of ventilation would help optimize FA levels and improve indoor air quality for better working conditions suitable for students and staff.\u003c/p\u003e","manuscriptTitle":"Formaldehyde Levels and the Indoor Air Quality of Anatomy Dissection Hall with Different Ventilation Setups","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-17 15:38:08","doi":"10.21203/rs.3.rs-3375113/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"96340a01-1294-4d5b-8408-f8695450ed69","owner":[],"postedDate":"October 17th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":25378682,"name":"Earth and environmental sciences/Environmental sciences"},{"id":25378683,"name":"Health sciences/Anatomy"},{"id":25378684,"name":"Health sciences/Health occupations"},{"id":25378685,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2023-11-03T06:02:18+00:00","versionOfRecord":[],"versionCreatedAt":"2023-10-17 15:38:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3375113","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3375113","identity":"rs-3375113","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}