Objective:
We aimed to compare rates of hospital-onset secondary bacterial infections in patients with COVID-19 with rates in patients with influenza and controls, and to investigate reports of increased incidence of Enterococcus infections in patients with COVID-19.
Design:
Retrospective cohort study
Setting:
An academic quaternary care hospital in San Francisco, California
Patients:
Patients admitted between 10/1/2019 and 10/1/2020 with a positive SARS-CoV-2 PCR (N=314) or influenza PCR (N=82) within 2 weeks of admission were compared with inpatients without positive SARS-CoV-2 or influenza tests during the study period (N=14,332).
Methods:
National Healthcare Safety Network definitions were used to identify infection-related ventilator-associated complications (IVAC), probable ventilator-associated pneumonia (PVAP), bloodstream infections (BSI), and catheter-associated urinary tract infections (CAUTI). A multiple logistic regression model was used to control for likely confounders.
Results:
COVID-19 patients had significantly higher rates of IVAC and PVAP compared to controls, with adjusted odds ratios of 4.7 (1.7-13.9) and 10.4 (2.1-52.1), respectively. COVID-19 patients had higher incidence of BSI due to Enterococcus but not BSI generally, and whole genome sequencing of Enterococcus isolates demonstrated that nosocomial transmission did not explain the increased rate. Sub-analyses of patients admitted to the ICU and patients who required mechanical ventilation revealed similar findings.
Conclusions:
COVID-19 is associated with an increased risk of IVAC, PVAP and Enterococcus BSI compared with hospitalized controls, not fully explained by factors such as immunosuppressive treatments and duration of mechanical ventilation. The mechanism underlying increased rates of Enterococcus BSI in COVID-19 patients requires further investigation.
HTML5-based mobile applications are becoming more and more popular because they can run on different platforms. Several newly introduced mobile OS natively support HTML5-based applications. For those that do not provide native support, such as Android, iOS, and Windows Phone, developers can develop HTML5-based applications using middlewares, such as PhoneGap [17]. In these platforms, programs are loaded into a web component, called WebView, which can render HTML5 pages and execute JavaScript code. In order for the program to access the system resources, which are isolated from the content inside WebView due to its sandbox, bridges need to be built between JavaScript and the native code (e.g. Java code in Android). Unfortunately, such bridges break the existing protection that was originally built into WebView.In this paper, we study the potential risks of HTML5-based applications, and investigate how the existing mobile systems' access control supports these applications. We focus on Android and the PhoneGap middleware. However, our ideas can be applied to other platforms. Our studies indicate that Android does not provide an adequate access control for this kind of applications. We propose a finegrained access control mechanism for the bridge in Android system. We have implemented our scheme in Android and have evaluated its effectiveness and performance.
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