No abstract

This study assessed changes in revolving-door (RD) mental health hospitalizations during the COVID-19 pandemic. A 5-year retrospective hospital chart review was performed, collecting revolving-door hospitalization, sociodemographic, and clinical data. Out of 1036 patients, 5.69% had RD hospitalizations, which accounted for 10.38% of all recorded hospitalizations. Further, a higher number of RD hospitalizations occurred following the pandemic outbreak, which is unlikely to have been a result of the confounding effect of trimester and month of hospitalization. Finally, several sociodemographic and clinical characteristics recurred more frequently in the context of RD hospitalizations, such as being younger, being compulsorily admitted, being an absconding patient, and being referred by a public service. Certain diagnostic categories occurred more frequently among RD hospitalizations, including psychotic, personality, and substance use disorders, as well as intellectual disability. Patients with specific characteristics are more likely to incur in RD hospitalizations, requiring the implementation of supportive treatment plans, especially following the pandemic outbreak.

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In this paper, a seasonal performance analysis of a hybrid ejector cooling system is carried-out, by considering a multi-ejector pack as expansion device. A 20 kW ejector-based chiller was sized to obtain the optimal tradeoff between performance and investment costs. The seasonal performance of the proposed solution was then evaluated through a dynamic simulation able to obtain the performance of the designed chiller with variable ambient temperatures for three different reference climates. The optimized multi-ejector system required three or four ejectors for any reference climate and was able to enhance the system performance at partial load, with a significant increase (up to 107%) of the seasonal energy efficiency ratio. The proposed system was then compared to conventional cooling technologies supplied by electric energy (electrical chillers EHP) or low-grade heat sources (absorption chillers AHP) by considering the total costs for a lifetime of 20 years and electric energy-specific costs for domestic applications from 0.10 to 0.50 €/kWhel. The optimized multi-ejector cooling system presented a significant convenience with respect to both conventional technologies. For warmer climates and with high electricity costs, the minimum lifetime for the multi-ejector system to achieve the economic break-even point could be as low as 1.9 years.