Leadership 99. Interview by Terese Hudson.

Cost control, customer service and collaboration among health care sectors rank as top concerns with panelists in H&HN's annual Leadership Report. Efforts to improve community health are a priority, too, but are often frustrated by financial and other constraints. The 16 panelists represent managed care, physicians, and hospitals and health systems.

Residents' perspectives of their first 2 weeks in a long-term care facility.

This study investigated residents' perspectives of their first 2 weeks in a long-term care facility (LTCF). Twelve residents were interviewed to determine their experiences during the first 2 weeks, their needs, priorities and expectations, and their views about how relocation from home could be facilitated. The constant comparative method of qualitative analysis (Glaser & Strauss, 1967) was used. Qualitative analysis of the audiotaped interviews revealed four main categories: emotional reactions, transition activities, reflecting on their situation, and connecting with a personal philosophy. Residents' responses indicated that if they had actively participated in the decision to be admitted, the adjustments to the LTCF was easier. Connecting with a personal philosophy was also a significant factor. Nursing implications include recognition of the importance of preparing residents for admission, involving them in the decision, and listening to their perspectives throughout the relocation experience.

Sources of variation and prospects for improvement of productive efficiency in the dairy cow: a review.

In this review, "productive efficiency" in dairy cows is defined as the yield of milk obtained in ratio to the nutritional costs associated with maintenance, milk synthesis and loss of body condition during lactation. Improvements in efficiency could occur as a result of changes in digestion and nutrient absorption, maintenance requirement, utilization of metabolizable energy for production or nutrient partitioning. Digestibility can be greatly enhanced by appropriate dietary manipulation. Likewise, it may be possible to reduce maintenance requirements and improve the efficiency with which metabolizable energy is used for milk synthesis by manipulation of the pattern of nutrients presented to tissues. However, these factors apparently do not respond to selection for increased milk yield, and little variation is observed among cows. In contrast, individual cows differ substantially in feed intake and in the partitioning of nutrients among body tissues. Techniques associated with genetic engineering and the early prediction of genetic merit have the potential to improve productive efficiency by manipulation of these processes. However, changes in nutrient partitioning and feed intake during lactation are coordinated by a complex network of controls that accommodate the nutrient requirements of each tissue while maintaining homeostatic balance. Future improvements in productive efficiency will therefore depend on our ability to understand the manner in which these controls operate.