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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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The first control method is preventive and aims to eradicate the adult flies before they can cause any damage and is called vector control. The second control method is the treatment once the infestation is present, and concerns the infected animals (including humans).
The principal control method of adult populations of myiasis inducing flies involves insecticide applications in the environment where the target livestock is kept. Organophosphorus or organochlorine compounds may be used, usually in a spraying formulation. One alternative prevention method is the sterile insect technique (SIT) where a significant number of artificially reared sterilized (usually through irradiation) male flies are introduced. The male flies compete with wild breed males for females in order to copulate and thus cause females to lay batches of unfertilized eggs which cannot develop into the larval stage.
One prevention method involves removing the environment most favourable to the flies, such as by removal of the tail. Another example is the crutching of sheep, which involves the removal of wool from around the tail and between the rear legs, which is a favourable environment for the larvae. Another, more permanent, practice which is used in some countries is mulesing, where skin is removed from young animals to tighten remaining skin – leaving it less prone to fly attack.
To prevent myiasis in humans, there is a need for general improvement of sanitation, personal hygiene, and extermination of the flies by insecticides. Clothes should be washed thoroughly, preferably in hot water, dried away from flies, and ironed thoroughly. The heat of the iron kills the eggs of myiasis-causing flies.
This applies once an infestation is established. In many circles the first response to cutaneous myiasis once the breathing hole has formed, is to cover the air hole thickly with petroleum jelly. Lack of oxygen then forces the larva to the surface, where it can more easily be dealt with. In a clinical or veterinary setting there may not be time for such tentative approaches, and the treatment of choice might be more direct, with or without an incision. First the larva must be eliminated through pressure around the lesion and the use of forceps. Secondly the wound must be cleaned and disinfected. Further control is necessary to avoid further reinfestation.
Livestock may be treated prophylactically with slow release boluses containing ivermectin which can provide long-term protection against the development of the larvae.
Sheep also may be dipped, a process which involves drenching the animals in persistent insecticide to poison the larvae before they develop into a problem.
There are several preventative measures which are used to reduce the occurrence of flystrike in sheep flocks, these include:
- Controlling intestinal parasites to prevent scours and a suitable surface for flystrike
- Scheduled shearing and crutching
- Removing the tails of lambs at weaning
- Mulesing
- Preventative chemical treatments before fly infestation risk is high
- Breeding for traits that reduce the likelihood of infestation
- Removing or avoiding large maunure heaps or other sites attractive to the flies
- Using fly traps near the flock to attract and kill any local flies, helping to minimise the local populations. NB: Traps often emit a pungent smell and are best placed away from human activity.
None of these measures completely stop the occurrence of fly strike in sheep, and regular treatment is still necessary.
If infested, animals should be removed from the flock and all wool in and around roughly a 1 cm or larger radius of the discoloured area clipped. The area is treated with insecticide to kill the maggots. Soothing cream can also be applied to skin grazes or lesions caused by the maggots. Clippings should be collected after removal and placed in a maggot-proof bag and left closed in the sun, to ensure that no other animal is infected.
The following treatments, while once recommended, are considered of no use or harmful, including tourniquets, incisions, suction, application of cold, and application of electricity. Cases in which these treatments appear to work may be the result of dry bites.
- Application of a tourniquet to the bitten limb is generally not recommended. There is no convincing evidence that it is an effective first-aid tool as ordinarily applied. Tourniquets have been found to be completely ineffective in the treatment of "Crotalus durissus" bites, but some positive results have been seen with properly applied tourniquets for cobra venom in the Philippines. Uninformed tourniquet use is dangerous, since reducing or cutting off circulation can lead to gangrene, which can be fatal. The use of a compression bandage is generally as effective, and much safer.
- Cutting open the bitten area, an action often taken prior to suction, is not recommended since it causes further damage and increases the risk of infection; the subsequent cauterization of the area with fire or silver nitrate (also known as "infernal stone") is also potentially threatening.
- Sucking out venom, either by mouth or with a pump, does not work and may harm the affected area directly. Suction started after three minutes removes a clinically insignificant quantity—less than one-thousandth of the venom injected—as shown in a human study. In a study with pigs, suction not only caused no improvement but led to necrosis in the suctioned area. Suctioning by mouth presents a risk of further poisoning through the mouth's mucous tissues. The well-meaning family member or friend may also release bacteria into the person's wound, leading to infection.
- Immersion in warm water or sour milk, followed by the application of snake-stones (also known as "la Pierre Noire"), which are believed to draw off the poison in much the way a sponge soaks up water.
- Application of a one-percent solution of potassium permanganate or chromic acid to the cut, exposed area. The latter substance is notably toxic and carcinogenic.
- Drinking abundant quantities of alcohol following the cauterization or disinfection of the wound area.
- Use of electroshock therapy in animal tests has shown this treatment to be useless and potentially dangerous.
In extreme cases, in remote areas, all of these misguided attempts at treatment have resulted in injuries far worse than an otherwise mild to moderate snakebite. In worst-case scenarios, thoroughly constricting tourniquets have been applied to bitten limbs, completely shutting off blood flow to the area. By the time the person finally reached appropriate medical facilities their limbs had to be amputated.
Snakes are most likely to bite when they feel threatened, are startled, are provoked, or when they have been cornered.
Snakes are likely to approach residential areas when attracted by prey, such as rodents. Regular pest control can reduce the threat of snakes considerably. It is beneficial to know the species of snake that are common in local areas, or while travelling or hiking. Africa, Australia, the Neotropics, and southern Asia in particular are populated by many dangerous species of snake. Being aware of—and ultimately avoiding—areas known to be heavily populated by dangerous snakes is strongly recommended.
When in the wilderness, treading heavily creates ground vibrations and noise, which will often cause snakes to flee from the area. However, this generally only applies to vipers, as some larger and more aggressive snakes in other parts of the world, such as mambas and cobras, will respond more aggressively. When dealing with direct encounters it is best to remain silent and motionless. If the snake has not yet fled it is important to step away slowly and cautiously.
The use of a flashlight when engaged in camping activities, such as gathering firewood at night, can be helpful. Snakes may also be unusually active during especially warm nights when ambient temperatures exceed . It is advised not to reach blindly into hollow logs, flip over large rocks, and enter old cabins or other potential snake hiding-places. When rock climbing, it is not safe to grab ledges or crevices without examining them first, as snakes are cold-blooded and often sunbathe atop rock ledges.
In the United States, more than 40 percent of people bitten by snake intentionally put themselves in harm's way by attempting to capture wild snakes or by carelessly handling their dangerous pets—40 percent of that number had a blood alcohol level of 0.1 percent or more.
It is also important to avoid snakes that appear to be dead, as some species will actually roll over on their backs and stick out their tongue to fool potential threats. A snake's detached head can immediately act by reflex and potentially bite. The induced bite can be just as severe as that of a live snake.
Dead snakes are also incapable of regulating the venom they inject, so a bite from a dead snake can often contain large amounts of venom.
One recommended method of removal is using a fingernail or other flat, blunt object to break the seal of the oral sucker at the anterior end of the leech, repeating with the posterior end, then flicking the leech away. As the fingernail is pushed along the person's skin against the leech, the suction of the sucker's seal is broken, at which point the leech will detach its jaws.
Common, but medically inadvisable, techniques to remove a leech are to apply a flame, a lit cigarette, salt, soap, or a chemical such as alcohol, vinegar, lemon juice, insect repellent, heat rub, or certain carbonated drinks. These will cause the leech to quickly detach; however, it will also regurgitate its stomach contents into the wound. The vomit may carry disease, and thus increase the risk of infection.
An externally attached leech will detach and fall off on its own when it is satiated on blood, which may be anywhere from 20 minutes to two hours or more. After feeding, the leech will detach and depart. Internal attachments, such as inside the nasal passage or vaginal attachments, are more likely to require medical intervention.
After removal or detachment, the wound should be cleaned with soap and water, and bandaged. Bleeding may continue for some time, due to the leech's hirudin. Bleeding time will vary, with location, from a few hours to three days. This is a function of the hirudin and other compounds that reduce the surface tension of the blood. Anticlotting medications also affect the bleeding time. Applying pressure can reduce bleeding, although blood loss from a single bite is not dangerous. The wound normally itches as it heals, but should not be scratched, as this may complicate healing and introduce other infections. An antihistamine can reduce itching, and applying a cold pack can reduce pain or swelling.
Some people have severe allergic or anaphylactic reactions from leech bites and require urgent medical care. Symptoms include red blotches or an itchy rash over the body, swelling around the lips or eyes, feeling faint or dizzy, and difficulty breathing.
The European medical leech "Hirudo medicinalis" and some congeners, as well as some other species, have been used for clinical bloodletting for thousands of years. The use of leeches in medicine dates as far back as 2,500 years ago, when they were used for bloodletting in ancient India. Leech therapy is explained in ancient Ayurvedic texts. Many ancient civilizations practiced bloodletting, including Indian and Greek civilizations. In ancient Greek history, bloodletting was practiced according to the humoral theory, which proposed that, when the human body's four "humors" — blood, phlegm, and black and yellow bile — were in balance, good health was guaranteed. An imbalance in the proportions of these humors was believed to be the cause of ill health. Records of this theory were found in the Greek philosopher Hippocrates' collection in the fifth century BC. Bloodletting using leeches was one method used by physicians to balance the humors and to rid the body of the plethora.
The use of leeches in modern medicine made a small-scale comeback in the 1980s after years of decline, with the advent of microsurgeries, such as plastic and reconstructive surgeries. In operations such as these, problematic venous congestion can arise due to inefficient venous drainage. Sometimes, because of the technical difficulties in forming an anastomosis of a vein, no attempt is made to reattach a venous supply to a flap at all. This condition is known as venous insufficiency. If this congestion is not cleared up quickly, the blood will clot, arteries that bring the tissues their necessary nourishment will become plugged, and the tissues will die. To prevent this, leeches are applied to a congested flap, and a certain amount of excess blood is consumed before the leech falls away. The wound will also continue to bleed for a while due to the anticoagulant hirudin in the leech's saliva. The combined effect is to reduce the swelling in the tissues and to promote healing by allowing fresh, oxygenated blood to reach the area.
The active anticoagulant component of leech saliva is a small protein, hirudin. Discovery and isolation of this protein led to a method of producing it by recombinant technology. Recombinant hirudin is available to physicians as an intravenous anticoagulant preparation for injection, particularly useful for patients who are allergic to or cannot tolerate heparin.
Resuscitation begins with the assessment and stabilization of the person's airway, breathing and circulation. If inhalation injury is suspected, early intubation may be required. This is followed by care of the burn wound itself. People with extensive burns may be wrapped in clean sheets until they arrive at a hospital. As burn wounds are prone to infection, a tetanus booster shot should be given if an individual has not been immunized within the last five years. In the United States, 95% of burns that present to the emergency department are treated and discharged; 5% require hospital admission. With major burns, early feeding is important. Hyperbaric oxygenation may be useful in addition to traditional treatments.
Honey has been used since ancient times to aid wound healing and may be beneficial in first- and second-degree burns. There is tentative evidence that honey helps heal partial thickness burns. The evidence for aloe vera is of poor quality. While it might be beneficial in reducing pain, and a review from 2007 found tentative evidence of improved healing times, a subsequent review from 2012 did not find improved healing over silver sulfadiazine. There were only three randomized controlled trials for the use of plants for burns, two for aloe vera and one for oatmeal.
There is little evidence that vitamin E helps with keloids or scarring. Butter is not recommended. In low income countries, burns are treated up to one-third of the time with traditional medicine, which may include applications of eggs, mud, leaves or cow dung. Surgical management is limited in some cases due to insufficient financial resources and availability. There are a number of other methods that may be used in addition to medications to reduce procedural pain and anxiety including: virtual reality therapy, hypnosis, and behavioral approaches such as distraction techniques.
A related condition, bisphosphonate-associated osteonecrosis of the jaw (BON), has been described as a side-effect of amino-bisphosphonates, a class of phosphorus-based drugs that inhibit bone resorption and are used widely for treating osteoporosis, bone disease in cancer and some other conditions.
BON, sometimes called "bis-phossy jaw",
is primarily associated with the use of intravenous bisphosphonates in the treatment of cancer. The percentage incidence of BON from this use is approximately 1000 times higher than the incidence of BON caused by the use of oral bisphosphonates.
Another human health issue caused by animal hoarding is the risk of zoonotic diseases. Defined as "human diseases acquired from or transmitted to any other vertebrate animal", zoonotic diseases can often be lethal and in all cases constitute a serious public health concern. Examples of well-known zoonotic diseases include bubonic plague, influenza, and rabies. Common domesticated animals constitute a large portion of animals carrying zoonoses, and as a result, humans involved in animal hoarding situations are at particular risk of contracting disease. Zoonoses that may arise in hoarding situations—through vectors such as dog, cat, or rat bites—include rabies, salmonellosis, catscratch fever, hookworm, and ringworm. One zoonosis of special concern is toxoplasmosis, which can be transmitted to humans through cat feces or badly-prepared meat, and is known to cause severe birth defects or stillbirth in the case of infected pregnant women. The risk of zoonotic diseases is amplified by the possibility of community epidemics.
Contrary to a widespread misconception, only 3 species of bats feed on blood, and these species only live in Latin America. Common ignorance often leads to misidentification.
At the same time, the fear of bats may be naturally reinforced by the natural startle response experienced by an unsuspecting person, e.g., when a disturbed colony of bats dashes out of a cave. In fact, the majority of bats, specifically the microbats which make up the majority of species, are terrified of humans and see man as a potential predator; bats disturbed in their roost instinctively flee as fast as they can, with maternity colonies sometimes abandoning their babies since they are desperate to escape.
Often, people fear bats due to the possibility of contracting rabies, but only 0.5% of vampire bats carry rabies.
As is common with specific phobias, an occasional fright may give rise to abnormal anxiety that requires treatment. An abnormal fear of bats may be treated by any standard treatment for specific phobias. Due to the fact that the fear is not life altering, it can usually just be left untreated.
White phosphorus was the active ingredient of most matches from the 1840s to the 1910s and exposure to the vapour from this caused a deposition of phosphorus in the jaw bones of workers in the industry. Concern over phossy jaw contributed to the London matchgirls strike of 1888, and although this strike did not end the use of white phosphorus, William Booth and The Salvation Army opened a match-making factory in 1891 which used the much safer, though more expensive, red phosphorus. The Salvation Army also campaigned with local retailers to get them to sell only red phosphorus matches.
However it was not until the use of white phosphorus was prohibited by the international Berne Convention in 1906, and these provisions were implemented in national laws over the next few years, that industrial use ceased.
Poor sanitation practices, a general characteristic of hoarding households, pose health risks to both animals and humans. In typical hoarding residences, animal waste is found coating interior surfaces, including beds, countertops, and cupboards. In one case, floors and other surfaces were found to be covered in a six-inch layer of feces and garbage.
In addition to severe odors which may pose a nuisance to neighbors, animal waste poses serious health risks through both the spread of parasites and the presence of noxious ammonia levels. OSHA, the United States agency regulating air quality standards in work-related environments, has identified an ammonia level of 300 parts per million as life-threatening for humans; in many hoarding cases the atmospheric ammonia level in the housing space approaches this number, requiring the use of protective clothing and breathing apparati during inspections or interventions. In an extreme case, the ammonia level in the hoarder's house was 152 parts per million even after ventilation.
The presence of animal waste also prevents sanitary storage and preparation of food, which puts residents at risk of contracting food-related illnesses and parasites. Insect and rodent infestation can both follow and worsen hoarding conditions, and can potentially spread to the surrounding environment including to nearby buildings. In one case, an elementary school had to be shut down due to a flea infestation that had spread from a nearby dog hoarder residence.
Hoarders are frequently found to collect large numbers of inanimate objects in addition to animals, giving rise to clutter as well. Hoarded objects can include newspapers, trash, clothing, and food; the clutter inhibits normal movement around the house, hampering household maintenance and sanitary food preparation, heightening the risk of accidents, and contributing to the overall level of squalor. A lack of functioning toilets, sinks, electricity, or proper heating (often due to hoarders not paying bills, though poor maintenance may also be a cause) further exacerbates the problem. Fire hazards comprise yet another health issue tied to poor sanitation; the clutter found in many hoarding households prevents workable fire escape plans and serves as possible fuel when located close to heat sources. The risk is amplified when hoarders, due to inoperative heating systems, seek alternate heating methods such as fireplaces, stoves, or kerosene heaters.
Mild iron deficiency can be prevented or corrected by eating iron-rich foods and by cooking in an iron skillet. Because iron is a requirement for most plants and animals, a wide range of foods provide iron. Good sources of dietary iron have heme-iron, as this is most easily absorbed and is not inhibited by medication or other dietary components. Three examples are red meat, poultry, and insects. Non-heme sources do contain iron, though it has reduced bioavailability. Examples are lentils, beans, leafy vegetables, pistachios, tofu, fortified bread, and fortified breakfast cereals.
Iron from different foods is absorbed and processed differently by the body; for instance, iron in meat (heme-iron source) is more easily absorbed than iron in grains and vegetables ("non-heme" iron sources). Minerals and chemicals in one type of food may also inhibit absorption of iron from another type of food eaten at the same time. For example, oxalates and phytic acid form insoluble complexes which bind iron in the gut before it can be absorbed.
Because iron from plant sources is less easily absorbed than the heme-bound iron of animal sources, vegetarians and vegans should have a somewhat higher total daily iron intake than those who eat meat, fish or poultry. Legumes and dark-green leafy vegetables like broccoli, kale and oriental greens are especially good sources of iron for vegetarians and vegans. However, spinach and Swiss chard contain oxalates which bind iron, making it almost entirely unavailable for absorption. Iron from non-heme sources is more readily absorbed if consumed with foods that contain either heme-bound iron or vitamin C. This is due to a hypothesised "meat factor" which enhances iron absorption.
Following are two tables showing the richest foods in heme and non-heme iron.
In both tables, food serving sizes may differ from the usual 100g quantity for relevancy reasons. Arbitrarily, the guideline is set at 18 mg, which is the USDA Recommended Dietary Allowance for women aged between 19 and 50.
Iron deficiency can have serious health consequences that diet may not be able to quickly correct; hence, an iron supplement is often necessary if the iron deficiency has become symptomatic.
Iron is needed for bacterial growth making its bioavailability an important factor in controlling infection. Blood plasma as a result carries iron tightly bound to transferrin, which is taken up by cells by endocytosing transferrin, thus preventing its access to bacteria. Between 15 and 20 percent of the protein content in human milk consists of lactoferrin that binds iron. As a comparison, in cow's milk, this is only 2 percent. As a result, breast fed babies have fewer infections. Lactoferrin is also concentrated in tears, saliva and at wounds to bind iron to limit bacterial growth. Egg white contains 12% conalbumin to withhold it from bacteria that get through the egg shell (for this reason, prior to antibiotics, egg white was used to treat infections).
To reduce bacterial growth, plasma concentrations of iron are lowered in a variety of systemic inflammatory states due to increased production of hepcidin which is mainly released by the liver in response to increased production of pro-inflammatory cytokines such as Interleukin-6. This functional iron deficiency will resolve once the source of inflammation is rectified; however, if not resolved, it can progress to Anaemia of Chronic Inflammation. The underlying inflammation can be caused by fever, inflammatory bowel disease, infections, Chronic Heart Failure (CHF), carcinomas, or following surgery.
Reflecting this link between iron bioavailability and bacterial growth, the taking of oral iron supplements in excess of 200 mg/day causes a relative overabundance of iron that can alter the types of bacteria that are present within the gut. There have been concerns regarding parenteral iron being administered whilst bacteremia is present, although this has not been borne out in clinical practice. A moderate iron deficiency, in contrast, can provide protection against acute infection, especially against organisms that reside within hepatocytes and macrophages, such as malaria and tuberculosis. This is mainly beneficial in regions with a high prevalence of these diseases and where standard treatment is unavailable.
The cause should be identified and, where possible, the treatment should be directed to that cause. A last resort form of treatment is heart transplant.
While ITBS pain can be acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. Massage therapy, and many of its modalities, can offer relief if symptoms arise.
The underlying disorder must be treated. For example, if a spinal disc herniation in the low back is impinging on the nerve that goes to the leg and causing symptoms of foot drop, then the herniated disc should be treated. If the foot drop is the result of a peripheral nerve injury, a window for recovery of 18 months to 2 years is often advised. If it is apparent that no recovery of nerve function takes place, surgical intervention to repair or graft the nerve can be considered, although results from this type of intervention are mixed.
Non-surgical treatments for spinal stenosis include a suitable exercise program developed by a physical therapist, activity modification (avoiding activities that cause advanced symptoms of spinal stenosis), epidural injections, and anti-inflammatory medications like ibuprofen or aspirin. If necessary, a decompression surgery that is minimally destructive of normal structures may be used to treat spinal stenosis.
Non-surgical treatments for this condition are very similar to the non-surgical methods described above for spinal stenosis. Spinal fusion surgery may be required to treat this condition, with many patients improving their function and experiencing less pain.
Nearly half of all vertebral fractures occur without any significant back pain. If pain medication, progressive activity, or a brace or support does not help with the fracture, two minimally invasive procedures - vertebroplasty or kyphoplasty - may be options.
Ankles can be stabilized by lightweight orthoses, available in molded plastics as well as softer materials that use elastic properties to prevent foot drop. Additionally, shoes can be fitted with traditional spring-loaded braces to prevent foot drop while walking. Regular exercise is usually prescribed.
Functional electrical stimulation (FES) is a technique that uses electrical currents to activate nerves innervating extremities affected by paralysis resulting from spinal cord injury (SCI), head injury, stroke and other neurological disorders. FES is primarily used to restore function in people with disabilities. It is sometimes referred to as Neuromuscular electrical stimulation (NMES)
The latest treatments include stimulation of the peroneal nerve, which lifts the foot when you step. Many stroke and multiple sclerosis patients with foot drop have had success with it. Often, individuals with foot drop prefer to use a compensatory technique like steppage gait or hip hiking as opposed to a brace or splint.
Treatment for some can be as easy as an underside "L" shaped foot-up ankle support (ankle-foot orthoses). Another method uses a cuff placed around the patient's ankle, and a topside spring and hook installed under the shoelaces. The hook connects to the ankle cuff and lifts the shoe up when the patient walks.
Coxsackie B virus is spread by contact and epidemics usually occur during warm weather in temperate regions and at any time in the tropics.
The illness lasts about a week and is rarely fatal. Treatment includes the administration of nonsteroidal anti-inflammatory agents or the application of heat to the affected muscles. Relapses during the weeks following the initial episode are a characteristic feature of this disease.
Recurrence rate is higher in aspirated cysts than in excised ones. Ganglion cysts have been found to recur following surgery in 12% to 41% of patients.
A six-year outcome study of the treatment of ganglion cysts on the dorsum (back) of the wrist compared excision, aspiration, and no treatment. Neither excision nor aspiration provided long-term benefit better than no treatment. Of the untreated ganglion cysts, 58% resolved spontaneously; the post-surgery recurrence rate in this study was 39%. A similar study in 2003 of ganglion cysts occurring on the palmar surface of the wrist states: "At 2 and 5 year follow-up, regardless of treatment, no difference in symptoms was found, regardless of whether the palmar wrist ganglion was excised, aspirated or left alone."
Medications can be used to prevent cancer in a few circumstances. In the general population, NSAIDs reduce the risk of colorectal cancer; however, due to cardiovascular and gastrointestinal side effects, they cause overall harm when used for prevention. Aspirin has been found to reduce the risk of death from cancer by about 7%. COX-2 inhibitors may decrease the rate of polyp formation in people with familial adenomatous polyposis; however, it is associated with the same adverse effects as NSAIDs. Daily use of tamoxifen or raloxifene reduce the risk of breast cancer in high-risk women. The benefit versus harm for 5-alpha-reductase inhibitor such as finasteride is not clear.
Vitamin supplementation does not appear to be effective at preventing cancer. While low blood levels of vitamin D are correlated with increased cancer risk, whether this relationship is causal and vitamin D supplementation is protective is not determined. One 2014 review found that supplements had no significant effect on cancer risk. Another 2014 review concluded that vitamin D may decrease the risk of death from cancer (one fewer death in 150 people treated over 5 years), but concerns with the quality of the data were noted.
Beta-carotene supplementation increases lung cancer rates in those who are high risk. Folic acid supplementation is not effective in preventing colon cancer and may increase colon polyps. It is unclear if selenium supplementation has an effect.