Distinguishing benign from malignant breast tissue can be difficult, even for trained experts. But, surprisingly, pigeons can learn to tell the two apart on mammogram images, according to a new study.

In more bird-related news, researchers wanted to see if turkey vultures can react quickly enough to avoid oncoming cars. In fact they can, but sometimes only with moments to spare.

Improbable Research has been tracking bizarre patents. One patent, filed in 2009, is for "six God toilet water itching," which appears to be an insect repellent.

More on the butcher's tongue illusion: Now you can purchase a fake tongue and try the experiments for yourself.

That's Improbable! is MedPage Today's weekly roundup of clinically, um, relevant finds at Improbable Research, which awards the Ig Nobel Prizes.

Burnout is typically not a rapid onset condition and for many there are signs of the condition as early as medical school or post-graduate training.

In recognition of this, some medical schools and residency programs are taking steps to address burnout as an early career issue. "You might not be able to change the clinical environment, but you can change their response and the choices they make," said Vineet Arora, MD, a faculty physician and assistant dean at the University of Chicago Pritzker School of Medicine.

A New Curriculum

One way to do this is to induce a greater resiliency in physicians in training. The Association of American Medical Colleges is now encouraging schools and residency programs to cultivate resilience in young physicians. Among its "intrapersonal competencies" for entering residents the AAMC includes "resilience and adaptability." That is, a doctor who can demonstrate tolerance of stressful or changing environments or situations and adapt effectively to them.

"While most of us would say that medicine is the most gratifying, stimulating, and noble career a person can pursue, many of our colleagues are in genuine distress," said AAMC President Darrell G. Kirch, MD, last year. "Resilience is what drives us forward and inspires us to take on difficult challenges and to keep trying in the face of doubt and failure."

Studies show that about a quarter of medical students are depressed, half of them experience burnout, and most of them report quality of life substantially worse than the same-age general population. To screen for distress among medical students Lotte N. Dyrbye, MD, and colleagues at the Mayo Clinic developed a Medical Student Well-Being Index. The index correlates with quality of life, fatigue, recent suicidal ideation, burnout, and the likelihood of seriously considering dropping out of medical school.

It is easy and convenient to think that people who go into medicine have a certain kind of perfectionist personality that predisposes them toward burnout, Dyrbye said. Her research into what kind of person enters medical school convinced her the opposite was true. "When they come in the door, medical students have better or similar levels of mental health than others," with lower prevalence of depression and a higher quality of life reported in most arenas, she said.

Wellness and Resilience

The University of Chicago has incorporated wellness and resilience into the undergraduate and graduate medical curricula. Wei Wei Lee, MD, is assistant dean of students and directs the wellness program at Pritzker. "One of the domains of competency is professionalism," she told MedPage Today. Medical students need to recognize personal and professional development as a skill. That means they must acquire healthy coping mechanisms, become aware of stress, and learn to be flexible and mature and adjust to change.

She has assembled a student committee on wellness, with four representatives from each class, that meets monthly. The committee develops programs to address burnout and holds social events to build student camaraderie. The school is building a portfolio for the students on teamwork and leadership skills as well.

Students do a self-assessment twice a year of their physical well-being, mental well-being, and health-seeking behaviors. They set specific goals they want to work on in the next 6 months. This becomes part of their personal and professional development portfolio. The committee then develops events around the themes that the students are interested in.

"Out of these self assessments, we're now putting together mandatory session on mental health in the medical profession," Lee said. The school wants to destigmatize issues around mental health, and talk about it in an open atmosphere. "We want to normalize that health seeking is not punitive, that there is a supportive community of faculty staff and peers out there." Since the program started in the 2014-15 academic year, student engagement has been high, she said.

The program on resiliency for residents at Chicago was led by Amber-Nicole Bird, MD, now an assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine. A survey of residents at the University of Chicago Medical Center revealed that all of them had experienced it in their training but the majority felt they had no outlet to discuss the issue.

"We felt like there were plenty of interventions available that focused on wellness: healthy eating, sleep management, taking care of yourself," Bird said. But residents didn't think those worked. "We thought, what if we could look at a different marker, say, resilience? Those individuals with lower resilience look at it in a different way, or have more downstream consequences. Maybe we could train them to be more resilient."

The team leaders used the Connor-Davidson Resilience Scale to quantify resilience in residents. They divided the scores between low, intermediate, and high. The average was 70 out of 100. Those who scored lower than 40 were deemed to be at high risk in managing stress. A program was created emphasizing setting realistic goals, managing expectations, processing and letting go after stressful clinical events, and finding gratitude.

From August to March of the 2014-15 school year, small group sessions were held to introduce the main skill, for example, managing and letting go after stressful clinical events. Students were invited to discuss why it was stressful, what it felt like, how they managed it.


Then came a skill building exercise for letting go, including a systems analysis of medical error. "We would have the residents write a narrative of an episode they were involved in that was stressful," Bird said. "We would then have them rewrite the story, remove the 'I', tell the story from the third person as it occurred. Then we asked them to identify where there were other actors at play that contributed to the error."

A similar exercise was created around finding gratitude.

Residents at first were skeptical of the program's value, Bird recalled, but that evaporated as the year progressed. "At the end, we had great feedback. Just under 70 percent of the residents who went through the program wanted it to be continued," she said.

The qualitative feedback showed that the program fostered a sense of shared experience. That was important for the residents, because it "gave them time to process an experience where they felt alone," Bird said. "It was therapeutic."

Chances are, you are feeling a bit hefty after the Thanksgiving period; the average American consumes an average of 4,500 calories and 229 g of fat during a typical holiday get-together. But this overindulgence take its toll not only on the waistline, it could also play havoc with the brain, according to a new study.
[A woman eating a burger]
Researchers find weight gain induced by a high-fat diet may destroy synapses in the brain, impairing cognitive functioning.

Published in the journal Brain, Behavior and Immunity, the study suggests a high-fat diet destroys synapses - connections that aid communication between neurons, or brain cells - in the hippocampus of the brain, which may impair learning and memory.

But it is not all bad news; the research also suggests that switching to a low-fat diet for 2 months can counteract the brain-damaging effects of a high-fat diet.

High-fat diets are a main contributor to obesity, which has become a major public health concern in the US. More than a third of adults in the US are obese, meaning they are at greater risk of heart disease, stroke, type 2 diabetes and some types of cancer.

Aside from weight gain, however, there is increasing evidence that a high-fat diet can harm the brain. Dr. Alexis M. Stranahan - of the Department of Neuroscience and Regenerative Medicine at the Medical College of Georgia at Georgia Regents University - and colleagues decided to investigate this association further.

Brain effects of high- and low-fat diets compared in mice

To reach their findings, the team randomized male mice to one of two diet groups: one group was fed a diet in which around 10% of calories came from saturated fat, while the other group was fed chow that contained 60% fat.

According to the researchers, the diets the mice were fed represented a healthy diet versus a fast-food diet in humans. Each diet contained similar amounts macronutrients and protein, the team notes.

The weight, food intake, insulin levels and blood glucose levels of the mice were assessed at 4, 8 and 12 weeks after diet initiation.

Additionally, the researchers analyzed the hippocampi of the mice - the brain region associated with learning and memory. Specifically, they measured levels of synaptic markers in the hippocampus - proteins that represent the number of synapses in the brain - and cytokine levels, which are markers of inflammation.

Excess fat triggers autoimmune response that destroys synapses

At 4 and 8 weeks, the team found the levels of synaptic markers were the same for both groups of mice, though the mice on a high-fat diet had gained weight.

Fast facts about obesity

  • Around 17% of children and teenagers aged 2-19 in the US are obese
  • An adult is defined as obese if they have a body mass index (BMI) of 30 or more
  • The medical cost of obesity in the US totals around $147 billion a year.
  • Learn more about obesity

By 12 weeks, however, the mice fed a high-fat diet had not only become obese, but they also had reduced levels of synaptic markers and increased cytokine levels, indicating that synapses were being destroyed in the hippocampus.

The researchers explain that when there is too much fat in the body, this leads to chronic inflammation, triggering an autoimmune response from microglia - glial cells that form the primary immune defense in the central nervous system.

Microglia usually help rid the brain of harmful agents, which helps to protect and strengthen neurons, but it appears that too much fat in the body impairs this process.

"Normally in the brain, microglia are constantly moving around. They are always moving around their little fingers and processes. What happens in obesity is they stop moving," explains Dr. Stranahan. "They draw in all their processes; they basically just sit there and start eating synapses. When microglia start eating synapses, the mice don't learn as effectively."

Switching to low-fat diet reversed synaptic loss and function

Next, the team swapped half of the mice on the high-fat diet to the low-fat diet to see how this affected their brains.

They found that the weight of these mice returned to normal within around 2 months, though they did have a larger "fat pad" - a layer of fat that simplifies future weight gain - than mice fed a low-fat diet that did not gain weight.

What is more, while the mice that remained on the high-fat diet continued to gain weight, experience more inflammation and lose more synapses, synaptic loss and function were restored among those that switched to the low-fat diet. This suggests swapping to a low-fat diet may offset neurological damage caused by a high-fat diet.

Commenting on the overall findings, Dr. Stranahan says:

"Microglia eating synapses is contributing to synapse loss and cognitive impairment in obesity. On the one hand, that is very scary, but it's also reversible, meaning that if you go back on a low-fat diet that does not even completely wipe out the adiposity, you can completely reverse these cellular processes in the brain and maintain cognition."

Dr. Stranahan notes that the findings suggest medications currently used to treat Crohn's disease and rheumatoid arthritis - which work by blocking certain inflammatory cytokines, some of which were present in the brains of mice fed a high-fat diet - may show promise for neurological conditions involving synaptic loss, though further research is required.

In the meantime, if you have overindulged these past few days, think about eating a bit healthier - your brain may thank you for it.

Medical News Today recently reported on a study in which researchers identified a type of fatty acid in the medium-chain triglyceride (MCT) ketogenic diet that could help reduce seizures for people with epilepsy.

Written by Honor Whiteman