DiversityNursing Blog

By David McNamee

Recently, Medical News Today reported on a breakthrough in xenotransplantation - the science of transplanting functional organs from one species to another. Scientists from the Cardiothoracic Surgery Research Program of the National Heart, Lung and Blood Institute (NHLBI) demonstrated success in keeping genetically engineered piglet hearts alive in the abdomens of baboons for more than a year.

While that is a sentence that might sound absurd, or even nightmarish to some, xenotransplantation is a credible science involving the work of leading scientists and respected organizations like the NHLBI and the Mayo Clinic, as well as large private pharmaceutical firms such as United Therapeutics and Novartis.

What is more, xenotransplantation is not a new science, with experiments in cross-species blood transfusion dating as far back as the 17th century.

Why transplant the organs of animals into living humans?

The reason why xenotransplantation is a burning issue is very simple: because of a crippling shortage of available organs for patients who require transplants, many people are left to die.

US Government information on transplantation reports that an average of 79 people receive organ transplants every day, but that 18 people die each day because of a shortage of organs.

The number of people requiring an organ donation in the US has witnessed a more than five-fold increase in the past 2 decades - from 23,198 in 1991 to 121,272 in 2013. Over the same period, the number of people willing to donate has only doubled - 6,953 donors in 1991, compared with 14,257 donors in 2013.

Although some researchers are attempting to solve this shortage by developing mechanical components that could assist failing organs, these devices are considered to increase the risk of infection, blood clots and bleeding in the patient.

Stem cell research is also actively pursuing the goal of growing replacement organs, but despite regular news of breakthroughs, the reality of a functional lab-grown human organ fit for transplant is a long way off.

As the NHLBI's Dr. Muhammad M. Mohiuddin, who led the team responsible for the baboon trial, explained:

"Until we learn to grow organs via tissue engineering, which is unlikely in the near future, xenotransplantation seems to be a valid approach to supplement human organ availability. Despite many setbacks over the years, recent genetic and immunologic advancements have helped revitalized progress in the xenotransplantation field.

Xenotransplantation could help to compensate for the shortage of human organs available for transplant."

Xenotransplantation's eccentric history

The earliest known example of using animal body parts to replace diseased or faulty components of human bodies dates back to the 17th century, when Jean Baptiste Denis initiated the clinical practice of animal-to-human blood transfusion.

Perhaps predictably, the results were not successful and xenotransfusion was banned in Denis' native France.

Fast forward to the 19th century and a fairly unusual trend for skin xenotransplantation had emerged. Animals as varied as sheep, rabbits, dogs, cats, rats, chickens and pigeons were called upon to donate their skin, but the grafting process was not for the squeamish.

Medical records show that, in order for the xenosurgeons of the time to be satisfied that the donor skin had vascularized (developed capillaries), the living donor animal would usually have to be strapped to the patient for several days. However, the most popular skin donor - the frog - was typically skinned alive and then immediately grafted onto the patient.

Despite several reputed successes, modern physicians are skeptical that these skin grafts could have been in any way beneficial to the patient.

The first corneal xenotransplantation - where the cornea from a pig was implanted in a human patient - took place as early as 1838. However, scientists would not look seriously again at the potential for xenotransplantation until the 20th century and the first successes in human-to-human organ transplantation.

In 1907, the Nobel prize-winning surgeon Alexis Carrel - whose work on blood vessels made organ transplantation viable for the first time - wrote:

"The ideal method would be to transplant in man organs of animals easy to secure and operate on, such as hogs, for instance. But it would in all probability be necessary to immunize organs of the hog against the human serum. The future of transplantation of organs for therapeutic purposes depends on the feasibility of hetero [xeno] transplantation."

These words have been described as "prophetic" because Carrel is describing the exact line of research adopted by xenotransplantation scientists a century later.

A few years later, another leading scientist, Serge Voronoff, would also predict modern science's interest in using the pancreatic islets of pigs to treat severe type 1 diabetes in human patients. However, other xeno experiments by Voronoff have not endured critical reappraisal quite so well.

Voronoff's main scientific interest was in restoring the "zest for life" of elderly men. His attempt to reverse this element of the aging process was to transplant slices of chimpanzee or baboon testicle into the testicles of his elderly patients.

Incredibly, this surgery proved quite popular, with several hundred operations taking place during the 1920s in both the US and Europe.

By the 1960s, despite limited availability, the transplantation of kidneys from deceased to living humans had been established by French and American surgeons.

Dialysis was not yet in practice and given that, in the absence of an available donor kidney, his renal failure patients were facing certain death, the Louisiana surgeon Keith Reemtsma took the unprecedented step of transplanting animal kidneys. He chose chimpanzees as the donor animals, due to their close evolutionary relationship with humans.

Although 12 of his 13 chimpanzee-to-human transplants resulted in either organ rejection or infectious complications within 2 months, one patient of Reemtsma continued to live and work in good health for 9 months, before dying suddenly from acute electrolyte disturbance. Autopsy showed that the chimpanzee kidneys had not been rejected and were working normally.

Experiments in the xenotransplantation of essential organs continued in living patients until the 1980s - without lasting success. However, the procedures attracted widespread publicity, with some attributing a subsequent rise in organ donation to the failed attempt to transplant a baboon heart into a baby girl in 1983.

Where does research currently stand?

Despite the more obvious similarities between humans and other primates, pigs are now considered to be the most viable donor animal for xenotransplantation.

Despite diverging from humans on the evolutionary scale about 80 million years ago, whole genome sequencing of the pig has shown that humans and pigs share similar DNA, while the pig's organs - in size and function - are anatomically comparable to humans.

However, perhaps the main advantage of the pig as donor is in its availability - potentially providing an "unlimited supply" of donor organs. If transplantation is viable, pig donors would provide an immediate solution for the organ shortage problem.

Xenotransplantation optimists also believe that the process can improve on the existing success rate of transplantation of human organs. By keeping the pigs healthy, regularly monitored for infection, and alive right until the point when the required organs are excised under anesthesia, the adverse effects associated with transplantation from deceased donors - such as non-function of organs or transmission of pathogens - would be much less likely, this group argues.

However, there are still significant scientific barriers to the successful implementation of xenotransplantation.

The company United Therapeutics - who moved into xenotransplantation research after the daughter of CEO Martine Rothblatt was diagnosed with pulmonary hypertension, a condition with a 90% shortage rate of available lung donors - claim to be making progress with eliminating these barriers.

MedIcal News Today spoke to Rothblatt, who once claimed that the company will have successfully transplanted a pig lung into a human patient "before the end of the decade."

"For a first clinical trial, which was my goal, I think we are on track," she told us. "I said our goal by end of decade is to transplant a xeno lung into a patient with end-stage lung disease and bring them safely back to health."

As well as pioneering lung xenotransplants, the company has ambitions of making pig kidneys, livers, hearts and corneas available for human transplant.

"All are years away, but lung may well be most difficult," admits Rothblatt. "We call it the canary in the coal mine."

In order to make pig lungs compatible with humans, Rothblatt has estimated that 12 modifications need to be made to the pig genome that will prevent rejection. She claims United Therapeutics have now succeeded in making six of these genome modifications.

Also, it was United Therapeutics' genetically modified piglets that provided the world record-beating pig hearts for the NHLBI study in baboons.

Opposition to xenotransplantation

However, science is not the only obstacle to xenotransplantation. Despite clearing all steps of the research with ethics committees at every step, Rothblatt - who has a doctorate in medical ethics - admits there will be unforeseeable regulatory dilemmas and ethics conversations before xenotransplantation can be accepted into clinical practice.

In 2004, the UK's Policy Studies Institute conducted the first major survey of public attitudes towards potential solutions for the organ shortage crisis. The public perception of xenotransplantation was shown to be overwhelmingly negative.

Indeed, response to animal-to-human transplantation was so hostile that some respondents demanded that it be removed as an option on the survey. Although many respondents considered xenotransplantation unethical, the major concern was that animal viruses could infect humans and spread into the population.

Following the survey, an intriguing debate over the ethics of xenotransplantation took place in the pages of Philosophy Now. Making the case against xenotransplantation, Laura Purdy - professor emerita of philosophy at Wells College in Aurora, NY - commented that "the xeno debate proceeds as if saving lives is our top moral priority." She argues that, from this perspective, it suggests that the lives lost down the line as a result of perfecting xenotransplantation do not count.

"What about the 11 million babies and children who die every year from diarrhea, malaria, measles, pneumonia, AIDS and malnutrition?" she questioned. "What about the half-million women who die every year during pregnancy and childbirth when simple measures could save most of them?"

We asked Prof. Purdy why the fact that people die from matters unrelated to transplantation issues would morally preclude science from attempting to also solve the issue of organ donor shortages.

"I agree that, other things being equal, saying that people are dying from other causes doesn't show why we should not also tackle this cause," she replied.

"But once one has taken on board the larger risks to society, both from the research as well as the deployment of the technology, as well as the probability that this is merely a bridge technology that, hopefully will be made obsolete by future developments (such as partial or whole artificial hearts) or advances in public health (making headway against diabetes) and the probability that both research and implementation will be very expensive, that seriously erodes the case for proceeding.

Resources for health are far from infinite. There is a great deal that we could be doing now to advance human health that does not have these downsides - why not focus more there?"

Whether public attitudes toward xenotransplantation have mellowed in the decade since the Policy Studies Institute's survey is not currently known.

However, as the technology advances and the likelihood of implementation draws closer, so too must the public conversation over the perceived rights and wrongs of animal organ transplantation advance in order to hold the science accountable.

Do you have a view on this issue? If so, use our comments box to join the debate.

Source: http://www.medicalnewstoday.com

By Dr. Chethan Sathya

Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.

This is the dream of the surgical "black box." Operations could become flawless. Post-operative complications could be significantly reduced. Surgeons could review the footage to improve their technique and prep for the next big case.

Such a device isn't far from reality.

Researchers in Canada are working on a surgical tracking box -- like the ones placed in airplanes -- that records surgeons' movements and identifies errors during an operation.

By pinpointing mistakes and telling surgeons when they're veering "off course," a black box could prevent future slip-ups, says Dr. Teodor Grantcharov, a minimally invasive surgeon at St. Michael's Hospital in Toronto. Unlike the so-called black boxes in aviation, which are used after disasters occur, the surgical black box Grantcharov is creating will be used proactively to prevent major patient complications.

A number of hospitals have already expressed interest in using the device, Grantcharov says.

But the litigious medical environment may make its implementation problematic. If the recordings were used in court, they could open the floodgates to a new wave of malpractice concerns, which would be counterproductive to surgeons and patients, Grantcharov says.

"We have to ensure the black box is used as an educational tool to help surgeons evaluate their performance and improve," he says.

A work in progress

Grantcharov's black box is a multifaceted system. In addition to the actual box, it includes operating room microphones and cameras that record the surgery, the surgeon's movements and details about team dynamics.

It will allow surgeons to hone in on exactly what went wrong and why.

The black box will eventually assess everything from how surgeons stitch to how delicately they handle organs and communicate with nurses during high-stress situations. Error-analysis software within the black box will help surgeons identify when they are "deviating" from the norm or using techniques linked to higher rates of complications.

So far, Grantcharov's black box has been tested on about 40 patients undergoing laparoscopic weight-loss surgery.

"At this initial stage, we are analyzing surgeries to determine how many errors occur and which ones actually lead to bad results for patients," Grantcharov says. Not every error will result in a patient complication.

Grantcharov's initial research has shown that surgeons recognize few of their mistakes, and, on average, make about 20 errors per surgery -- regardless of experience level. Once Grantcharov's team determines which errors affect patient safety, it hopes to be able to provide this information to surgeons in real time. The team has also developed software that can synthesize the recorded data into user-friendly and interpretable information for surgeons.

The concept of using a black box in surgery isn't new. But until now, the technology never made it out of the laboratory because it lacked comprehensiveness, Grantcharov says. Earlier surgical black boxes didn't record all the important elements of the operating room, he says, leaving pieces of the puzzle missing.

"To truly understand what causes an error, you need to know all the factors that may come into play."

Recording mistakes

Grantcharov was inspired to develop the surgical black box after years of witnessing how patient complications affected surgeons.

"The feeling of not knowing what causes a complication, whether it's surgical technique, communication in the operating room or the patient's condition itself, is tormenting," Grantcharov says.

Many surgeons, however, may be uncomfortable with using a black box in the operating room, says Dr. Teodoro Forcht Dagi with the American College of Surgeons Perioperative Care Committee.

"If there was a legal requirement to record every operation, then many surgeons would be resistant," Forcht Dagi says. He says he believes doing so would create a sense of nervousness that would paralyze a surgeon's ability to operate and end up ultimately harming patients.

"The black box needs to be used solely by surgeons for their own education, in which case I think it's a great idea," Forcht Dagi says.

Errors during surgery have generally been dealt with after the fact, and only once a complication during the patient's recovery occurs. Weeks after surgery, cases with complications are presented to a panel of experts, who weigh in on what may have gone wrong during the operation.

Yet in many cases nothing is recorded apart from an audio transcript of the operation, making it tough to identify what caused each complication. The black box would add much needed context.

"I would rush (a black box) into service immediately," says Richard Epstein, professor of law at New York University's School of Law. Since most medical lawsuits end up being "he said, she said" arguments, not knowing exactly what happened in the operating room just adds to the level of distrust, Epstein says.

In the United States, the Healthcare Quality Improvement Act prevents courts from using data that doctors and hospitals use for peer review, a self-regulation process in which experts or "peers" evaluate one another. The law allows doctors to assess each other openly and identify areas for improvement without fear of litigation.

But there are exceptions to this rule, says William McMurry, president of the American Board of Professional Liability Attorneys. For instance, cases where surgeries are recorded but don't receive any peer review can be used in court.

While McMurry says that "keeping patients in the dark about the details of their surgery is never OK," he points out that litigation concerns should not derail use of the black box. It will be an asset to the health care system regardless of whether it can be used in court, he says.

"We care about better health care, and the black box will provide surgeons with the information they need to avoid mistakes," McMurry says. "It's a win-win situation."

The surgical black box will be tested in hospitals in Canada, Denmark and parts of South America in the next few months. Talks are also under way with a number of American hospitals.

If doctors accept it, implementation in U.S. hospitals could happen quickly since the surgical black box isn't considered a medical device and doesn't require approval from the U.S. Food and Drug Administration.

Bottom line, Grantcharov says, is that even after years of practicing medicine, the black box "made me a safer surgeon and a better teacher."

Source: http://www.cnn.com

By MNT

"People tend to think that happiness in schizophrenia is an oxymoron," says senior author Dr. Dilip V. Jeste, distinguished professor of Psychiatry and Neurosciences at the University of California, San Diego School of Medicine.

"Without discounting the suffering this disease inflicts on people, our study shows that happiness is an attainable goal for at least some schizophrenia patients," he adds. "This means we can help make these individuals' lives happier."

Dr. Jeste's team surveyed 72 schizophrenia outpatients in the San Diego area - all but nine of whom were taking at least one anti-psychotic medication. Just over half of the respondents were residents in assisted-living facilities.

A comparison group was comprised of 64 healthy men and women who did not currently use alcohol or illegal drugs and who had not been diagnosed with dementia or other neurological illnesses.

The mean age for both groups was 50 years.

In the survey, the respondents answered questions on their happiness over the previous week. They were asked to rate statements such as "I was happy" and "I enjoyed life" on a scale from "never or rarely" to "all or most of the time."

The results reveal that about 37% of the schizophrenia patients were happy most or all of the time, compared with about 83% of respondents in the comparison group.

However, about 15% of people in the schizophrenia group reported being rarely or never happy, but no one in the comparison group reported such a low level of happiness.

'Patients' happiness was unrelated to the severity or duration of their illness'

The researchers compared the self-reported happiness of the respondents with other factors including age, gender, education, living situation, medication status, mental health, physical health, cognitive function, stress, attitude toward aging, spirituality, optimism, resilience and personal mastery.

The study - which is published in the journal Schizophrenia Research - suggests that the patients' levels of happiness were unrelated to the severity or duration of their illness, cognitive or physical function, age or education. This is clinically significant because, among healthy adults, all of these factors are associated with a greater sense of well-being.

Lead author Barton W. Palmer, PhD, professor in the UC San Diego Department of Psychiatry summarizes the study's findings:

"People with schizophrenia are clearly less happy than those in the general population at large, but this is not surprising.

What is impressive is that almost 40% of these patients are reporting happiness and that their happiness is associated with positive psychosocial attributes that can be potentially enhanced."

Source: http://www.medicalnewstoday.com

BY JULIANNE PEPITONE

Google mapped the world's streets and developed self-driving cars to roam them. Now, the company wants to map something much larger: perfect human health.

Google Baseline, announced last week, will collect molecular and genetic information from an initial 175 volunteers and later thousands more. The philosophy is to focus on the genetics of health itself, rather than focus on disease.

"We want to understand what it means to be healthy, down to the molecular and cellular level," Google said in a press release. Google repeated the phrase "what it means to be healthy" a few times -- and that's what worries one expert.

"My immediate question is, what does Google mean by that? Healthy for a six-year-old boy, or a 75-year-old woman? You're injecting values about the range of humanity, right off the bat," said Arthur Caplan, the director of the division of medical ethics at the NYU Langone Medical Center and an NBC News contributor.

Google isn't purporting to develop a model of the singular perfect human. The goal is to analyze participants' data from to uncover "biomarkers," or patterns, that can be used to detect disease earlier.

"It's a perfectly reasonable approach, but I wouldn't do it under the 'what it means to be healthy' mission statement," Caplan said. "Those are fighting words. The mother of a child with Down's syndrome may consider her child perfectly healthy."

What's more, genetics alone doesn't provide a full picture of health or of disease, pointed out Kedar Mate, M.D., the vice president of the Institute for Healthcare Improvement, a Massachusetts-based not-for-profit.

"Genes are about 15 to 40 percent, behavioral patterns 30 to 40, socioeconomic factors 20 to 30, etc.," Mate told NBC News. "So even a wonderful genetic model is not a total picture of health."

What makes Baseline different, Google argues, is that it will "try to connect traditional clinical observations of health" like diet and other habits with genetic information.

But while Google (nor anyone) can't create the full model of perfect health, the company still brings two major advantages to the field: technological power and an outsider perspective.

"Anyone can collect 175 DNA samples," Caplan said. "But Google is a very, very powerful computational company. That's what makes it exciting."

Google's trove of technology resources and know-how could create a faster, smarter process for analyzing the links between genes and disease.

But not everyone in the field considers Google's computational power a major boost. Some genomics experts scoffed online at Google's assertion that Baseline is a "clinical research study that has never been done before."

"Frankly, anything Google does gets attention," Mate said.

"What would make it really different is Google's knowledge of so much of our behavior," he added. "If Google could take all of that and combine it with genetic information -- no other organization can offer us that."

But given what little we know about Baseline, it doesn't sound like Google is planning to do that -- at least not now. It's not clear they could, even if they wanted to.

Whether Google would -- or even could -- move to combine health data with the rest of the information it knows about our behavior, Mate insisted the nature of Google's business adds a unique element to the pursuit of health.

"You wonder if they’ll bring a fresh and different perspective, because this isn’t a stodgy academic project," Mate said. "The entry of a player like Google has the ability to stimulate the space -- and break it out of the way things have always been done."

Source: www.nbcnews.com

By Cornell University

In a forthcoming Cornell study published in the journal Health Environments Research and Design, Rana Zadeh, assistant professor of design and environmental analysis, discovered nurses who had access to natural light enjoyed significantly lower blood pressure, communicated more often with their colleagues, laughed more and served their patients in better moods than nurses who settled for large doses of artificial light.

Letting natural light into the nurses’ workstations offered improved alertness and mood restoration effects. “The increase in positive sociability, as measured by the occurrence of frequent laughter, was … significant,” noted Zadeh in the paper.

Nurses work long shifts, during non-standardized hours. They work on demanding and sensitive tasks and their alertness is connected to both staff and patient safety. Past evidence indicates natural light and views have restorative effects on people both physiologically and psychologically. Maximizing access to natural daylight and providing quality lighting design in nursing areas may be an opportunity to improve safety though environmental design and enable staff to manage sleepiness, work in a better mood and stay alert, according to Zadeh.

“Nurses save lives and deal with complications every day. It can be a very intense and stressful work environment, which is why humor and a good mood are integral to the nursing profession,” Zadeh said. “As a nurse, it’s an art to keep your smile – which helps ensure an excellent connection to patients. A smart and affordable way to bring positive mood – and laughter – into the workplace, is designing the right workspace for it.”

Access to natural daylight, and a nice view to outside, should be provided for clinical workspace design, said Zadeh. In situations where natural light is not possible, she suggests optimizing electric lighting in terms of spectrum, intensity and variability to support circadian rhythms and work performance.

“The physical environment in which the caregivers work on critical tasks should be designed to support a high-performing and healthy clinical staff,” she said “ improving the physiological and psychological wellbeing of healthcare staff, by designing the right workspace, can directly benefit the organization’s outcomes”.

In addition to Zadeh, this study, “The Impact of Windows and Daylight on Acute-Care Nurses’ Physiological, Psychological, and Behavioral Health,” was authored by Mardelle Shepley, Texas A&M University; Cornell doctoral candidate Susan Sung Eun Chung; and Gary Williams, MSN, RN. The research was supported by the Center for Health Design Research Coalition’s New Investigator Award.

Source: www.sciencedaily.com

By Serusha Govender and Sara Cheshire

(CNN) -- Do you tend to forget things when you're stressed? Like when you're late for a meeting and can't remember where you left your car keys? Or when you have to give a big presentation and suddenly forget all your talking points seconds before you start?

There's nothing like stress to make your memory go a little spotty. A 2010 study found that chronic stress reduces spatial memory: the memory that helps you recall locations and relate objects.

Hence, your missing car keys.

University of Iowa researchers recently found a connection between the stress hormone cortisol and short-term memory loss in older rats. Their findings, published in the Journal of Neuroscience this week, showed that cortisol reduced synapses -- connections between neurons -- in the animals' pre-frontal cortex, the area of the brain that houses short-term memory.

But there's a difference between how your brain processes long-term job stress, for example, and the stress of getting into a car accident. Research suggests low levels of anxiety can affect your ability to recall memories; acute or high-anxiety situations, on the other hand, can actually reinforce the learning process.

Acute stress increases your brain's ability to encode and recall traumatic events, according to studies. These memories get stored in the part of the brain responsible for survival, and serve as a warning and defense mechanism against future trauma.

If the stress you're experiencing is ongoing, however, there can be devastating effects.

Neuroscientists from the University of California, Berkeley,found that chronic stress can create long-term changes in the brain. Stress increases the development of white matter, which helps send messages across the brain, but decreases the number of neurons that assist with information processing.

The neuroscientists say the resulting imbalance can affect your brain's ability to communicate with itself, and make you more vulnerable to developing a mental illness.

Defects in white matter have been associated with schizophrenia, chronic depression, bipolar disorder, obsessive-compulsive disorder and post-traumatic stress disorder. Research on post-traumatic stress disorder further shows that it can reduce the amount of gray matter in the brain.

The Berkeley researchers believe their findings could explain why young people who are exposed to chronic stress early in life are prone to learning difficulties, anxiety and other mood disorders.

To reduce the effects of stress, the Mayo Clinic recommends identifying and reducing stress triggers. Eating a healthy diet, exercising, getting enough sleep and participating in a stress-reduction activity such as deep breathing, massage or yoga, can also help.

Stress may harm the brain, but it recovers.

Source: www.cnn.com

About a month after passing his state licensing exam, Arthur Greenbank was cashing a paycheck in his field.

The University of Akron graduate is not alone: Of all the majors that students can choose, it is nursing that offers the best chance for employment.

“I tell graduates not to worry, that they almost certainly will land a job within a few months of graduating,” UA nursing administrator Cheryl Buchanan said. “If they would go to Florida or Michigan, they would find a job immediately.”

Researchers at the Georgetown University Center on Education and the Workforce examined 2009 and 2010 census data to determine what college majors are most likely to lead to jobs.

“People need to pay attention to this,” center director Tony Carnevale said. “It tells you that if you really want to be an architect, that's fine, but you're going to have to think more about what your plan is.”

“Hard Times, College Majors, Unemployment and Earnings 2013: Not All College Degrees are Created Equal” notes that the unemployment rate for recent nursing graduates is 4 percent. Meanwhile, the typical unemployment rate for majors in many liberal arts fields is double that, and that of architecture and fine arts graduates is more than triple at 13.9 and 11.1 percent, respectively.

What the researchers don't know is whether the graduates were working in their major. Some college majors don't have clear career paths.

That was reflected in the unemployment rates for area ethnic and civilization studies (10.1 percent) and philosophy and religious studies (10.8 percent).

Other majors, such as architecture, have suffered in the economic downturn, although their unemployment rate is gradually improving, Carnevale said.

Only 50 to 54 percent of recent college graduates are working in their majors, Carnevale said.

That means that some “employed” college graduates really might be working in fields once reserved for high school graduates: the proverbial English major driving a cab, for instance.

That can be an expensive outcome, given the cost of college.

“There is lots of pressure now to find out what the value of the college major is,” Carnevale said.

He said that graduates with certificates in heating and air conditioning from a community college can make more than typical graduates with bachelor's degrees.

“It's all about the field of study,” he said.

Buchanan, the UA nursing administrator, said all 55 of the spring 2012 nursing graduates who responded to a UA survey are working in their field or are attending graduate school.

Although nursing might be the fastest route to a paycheck, other majors can eclipse it in salary, according to the Georgetown study.

Electrical engineering ($57,000), mechanical engineering ($58,000) and civil engineering ($50,000) pay more at the start than nursing ($48,000). Same with graduate degrees: Those in nursing earn $81,000 compared with $107,000 for majors in pharmaceutical sciences and administration, $96,000 for chemistry majors and $101,000 for economics majors.

Source: TribLive