Table_1_Quality criteria of nature-based interventions in healthcare facilities: a scoping review.XLSX

IntroductionImplementing integrated nature-based interventions that simultaneously serve human health and the restoration of biodiversity in healthcare facilities is considered a promising strategy. As an emerging field of research and practice in healthcare, identification of quality criteria is necessary to support desired outcomes related to biodiversity, human health and intervention processes. This study is part of a larger research project in collaboration with the Flemish Agency of Nature and Forest in Belgium.MethodsA scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, in PubMed, Medline, Web of Science and Scopus. A step-by-step tabular screening process was conducted to identify relevant studies and reviews of nature-based interventions, published in English between January 2005 and April 2023. A qualitative content analysis was conducted and the results were then presented to the project steering group and a panel of stakeholders for refinement.ResultsAfter filtering on the eligibility criteria, and with focus on healthcare facilities, 14 articles were included in this study. A preliminary nature-based interventions quality framework with a set of quality indicators has been developed.DiscussionWhen designing integrated nature-based interventions, a needs analysis of users and the outdoor environment should be conducted. Next, the integration of a One Health and biodiversity perspective and the application of a complex intervention framework, could support the quality of the design and implementation of nature-based interventions in healthcare facilities and facilitate their assessment. In future work, more rigorous research into the design and implementation of integrated nature-based interventions is needed to test and refine the quality criteria in practice.</p

Resource-Efficient Nitrogen Removal from Source-Separated Urine with Partial Nitritation/Anammox in a Membrane-Aerated Biofilm Reactor

Source separation and decentralized urine treatment can cut costs in centralized wastewater treatment by diverting 80% of the nitrogen load in sewage. One promising approach for nitrogen removal from source-separated urine is partial nitritation/anammox (PN/A), reducing the aeration demand by 67% and organic dosage by 100% compared to nitrification/denitrification. While previous studies with suspended biomass have encountered stability issues during PN/A treatment of urine, a PN/A biofilm was hypothesized to be more resilient. Its use for urine treatment has been pioneered here for maximum rates and efficiencies in an energy-efficient membrane-aerated biofilm reactor (MABR). Nitrogen removal rates of 1.0 g N L–1 d–1 and removal efficiencies of 80–95% were achieved during a 335-day operational period at 28 °C on stabilized (pH > 11.5), diluted urine (10%). A balance between N2 and NO3– formation was observed while optimizing the supply of O2 through intermittent aeration and was rate limiting for the conversion toward N2. A short-term operation on less- and undiluted urine yielded N removal rates of 0.6–0.8 g N L–1 d–1 and removal efficiencies of 93% on 66% urine and 85% on undiluted urine. Metataxonomic analysis and fluorescence in situ hybridization confirmed the presence in the biofilm of nitrifiers (Nitrosomonas, Nitrospira) at the membrane side and anammox bacteria (“Candidatus Brocadia”) at the anoxic bulk side. The findings suggest that a biofilm approach to PN/A treatment of urine overcomes stability issues and that a PN/A-MABR has significant potential for resource-efficient decentralized urine treatment. In human long-duration deep-space missions, this gravity-independent technology could produce N2 to compensate artificial atmosphere losses while facilitating water recovery from urine