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Using data collected in routine care delivery to inform treatment is a key feature of a learning health system (LHS). In this study, we explored the experiences of service users and providers adopting measurement-based care (MBC) in early psychosis (EP) specialty care settings. Qualitative interviews were conducted with 32 providers and 12 service users across 18 programs in the Early Psychosis Intervention Network of California (EPI-CAL). These findings were compared with quantitative data from Beehive, EPI-CAL's data collection and review application. Regarding the clinical benefits of MBC in EP, three broad themes were identified - supporting safety monitoring and response, the assessment process, and delivery of psychotherapy. Outside of direct clinical care, Beehive was considered to support clinical supervision and external reporting, while service users reported data collection facilitated self-reflection. In the quantitative Beehive application data collected from 23 EP programs, high utilization of the safety alert system was evident (349 alerts in total, of which 338 [96.85 %] were resolved at a median of 2.03 days). However, service users' key survey data was only reviewed by assigned providers in 32.22 % (142 of 441) of cases. While providers and service users saw many benefits to Beehive, utilization was highly inconsistent outside of the alert system. Going forward, further consideration of how best to support EP providers to consistently use data in care is necessary to maximize the utility of the LHS approach and positively impact outcomes., Competing Interests: Declaration of competing interest Tara A. Niendam is a cofounder and shareholder in Safari Health, Inc. No other authors disclosed any competing interests., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

The objective of this study was to examine the effect of stage of lactation (early, mid, and late) and proportion of pasture in the cow's diet (high: GRS, medium: PMR, and no: TMR) on the composition and quality of Cheddar cheese. Triplicate trials were carried out in each stage of lactation, and milk protein and fat contents were standardized for Cheddar cheese manufacture at pilot scale. Because cheese milks were standardized for milk fat and protein contents, gross composition did not differ as a result of diet. Fatty acid profiles of GRS cheese were significantly different from TMR, while PMR profiles were less distinct and more similar to both GRS and TMR profiles, as illustrated by partial least squares discriminatory analysis. Fatty acids including CLA C18:2 cis-9,trans-11, C22:1 n-9, and C18:3 n-3 were most influential in this separation of profiles. Fatty acid profiling revealed that GRS-derived cheese contained higher proportions of nutrients considered beneficial for human health including higher proportions of unsaturated fatty acids and omega-3 fatty acids. A biomarker model utilizing the proportions of 5 fatty acids was constructed and was effective at distinguishing between cheese of GRS, TMR, and PMR feeding systems. Proportions of ρ-κ-CN, α s2 -CN and α s1 -CN in cheese also differed among diets while proportions of ρ-κ-CN, α s1 -CN, and β-CN were lowest in late lactation cheese. The effect of diet was less influential compared with that of stage of lactation on the ripening characteristics of cheese. An index of primary proteolysis was highest in late lactation cheese. The peptides derived from the proteolysis of κ-CN and β-CN and levels of secondary proteolysis, in particular, the proportions of 12 free AA were most influenced by stage of lactation. Overall this study demonstrated the effects of increasing pasture allowance and wstage of lactation on the nutritional quality and ripening properties of Cheddar cheese., (© 2024, The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Background: A prolonged first episode of psychosis (FEP) without adequate treatment is a predictor of poor clinical, functional, and health outcomes and significant economic burden. Team-based "coordinated specialty care" (CSC) for early psychosis (EP) has established effectiveness in promoting clinical and functional recovery. However, California's CSC program implementation has been unsystematic and could benefit from standardizing its processes and data collection infrastructure. To address this, we established a consortium of EP clinics across the state via a Learning Health Care Network (LHCN) framework to develop the Early Psychosis Intervention Network of California (EPI-CAL). EPI-CAL's LHCN developed a core battery of evidence-based measures for service users and family members and linked them together using a unique data collection and visualization application, Beehive., Methods and Objectives: EPI-CAL's LHCN collects, visualizes, and aggregates data at the individual and clinic level for EP programs across California via Beehive. Beehive was designed to: (1) collect outcomes data from service users receiving care at EP programs and their support persons, (2) provide the data to providers on a secure web-based dashboard to support measurement-based care, and (3) allow data to be used for program or research analysis. We will (1) determine the feasibility of implementing an LHCN across a diverse, decentralized network of early psychosis programs, (2) determine if the implementation of an LHCN increases the delivery of measurement-based care, and (3) determine if the implementation of measurement-based care is associated with significant improvements in key service user outcomes. EPI-CAL's network will contribute data to the Early Psychosis Intervention Network (EPINET) program., Discussion: The current study aims to establish an LHCN of EP clinics in California that implements harmonized data collection using Beehive and assesses the feasibility of establishing such a network. Our goal is for this harmonized data collection approach to be used to inform decisions and develop learning opportunities for service users, staff, and administrators, and to improve outcomes for service users and their supporters in CSC care. Further, the data will enable programs and research teams to examine what elements of care lead to program success and improved treatment outcomes for service users., Clinical Trials Registration: www., Clinicaltrials: gov , identifier NCT04007510; registered 07/05/2019., Competing Interests: Declarations Ethics approval and consent to participate The University of California, Davis Institutional Review Board approved the study (1403828-21, California Collaborative Network to Promote Data-Driven Care and Improve Outcomes in Early Psychosis [CORE]). Additionally, several of the counties and universities with a program participating in EPI-CAL required a separate review and approval of the project by their institutional review board (e.g., Los Angeles County Department of Mental Health Human Subjects Research Committee; San Mateo County Behavioral Health and Recovery Services Institutional Review Board; Sacramento County Department of Health and Human Services Research Review Committee; Napa County Institutional Review Board; County of San Diego Behavioral Health Services Research Review Board; and Orange County Health Care Agency Human Subjects Review Committee) or compliance or oversight departments. Multisite/single IRB with reliance from UCSD and UCSF on UC Davis IRB. Associated IRB protocols include 1411596-5 (UCD), 1411602-2 (UCSD), 1411601-5 (UCSF). Competing interests Tara A. Niendam is a cofounder and shareholder in Safari Health, Inc. No other authors disclosed any competing interests., (© 2024. The Author(s).)

There is an increasing consumer desire for pasture-derived dairy products, as outdoor pasture-based feeding systems are perceived as a natural environment for animals. Despite this, the number of grazing animals globally has declined as a result of the higher milk yields achieved by indoor TMR feeding systems, in addition to the changing climatic conditions and lower grazing knowledge and infrastructure. This has led to the development of pasture-fed standards, stipulating the necessity of pasture and its minimum requirements as the primary feed source for products advertising such claims, with various requirements depending on the region for which it was produced. This work investigates the differences in the composition and techno-functional properties of butters produced from high, medium and no pasture allowance diets during early, mid, and late lactation. Butters were produced using milks collected from 3 feeding systems: outdoor pasture grazing (high pasture allowance); indoor TMR (no pasture allowance); and a partial mixed ration (medium pasture allowance) system, which involved outdoor pasture grazing during the day and indoor TMR feeding at night. Butters were manufactured during early, mid, and late lactation. Creams derived from TMR feeding systems exhibited the highest milk fat globule size. The fatty acid profiles of butters also differed significantly as a function of diet and could be readily discriminated by partial least squares analysis. The most important fatty acids in such an analysis, as indicated by their highest variable importance projection scores, were CLA C18:2 cis-9,trans-11 (rumenic acid), C16:1n-7 trans (trans-palmitoleic acid), C18:1 trans (elaidic acid), C18:3n-3 (α-linolenic acid), and C18:2n-6 (linoleic acid). Increasing pasture allowances resulted in reduced crystallization temperatures and hardness of butters and concurrently increasing the "yellow" color. Yellow color was strongly correlated with Raman peaks commonly associated with carotenoids. The milk fat globule size of cream decreased with advancing stage of lactation and churning time of cream was lowest in early lactation. Differences in the fatty acid and triglyceride contents of butter as a result of lactation and dietary effects demonstrated significant correlations with the hardness, rheological, melting, and crystallization profiles of the butters. This work highlighted the improved nutritional profile and functional properties of butter with increasing dietary pasture allowance, primarily as a result of increasing proportions of unsaturated fatty acids. Biomarkers of pasture feeding (response in milk proportionate to the pasture allowance) associated with the pasture-fed status of butters were also identified as a result of the significant changes in the fatty acid profile with increasing pasture allowance. This was achieved through the use of 3 authentic feeding systems with varying pasture allowances, commonly operated by farmers around the world and conducted across 3 stages of lactation., (© 2024, The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

The objective of this study was to examine the impact of increasing proportions of grazed pasture in the diet on the composition, quality, and functionality of bovine milk across a full lactation. Fifty-four spring-calving cows were randomly assigned to 1 of 3 groups (n = 18), blocked on the basis of mean calving date (February 15, 2020 ± 0.8 d), pre-experimental daily milk yield (24.70 ± 3.70 kg), milk solids yield (2.30 ± 0.27 kg), lactation number (3.10 ± 0.13), and economic breeding index (182 ± 19). Raw milk samples were obtained weekly from each group between March and November 2020. Group 1 (GRS) consumed perennial ryegrass and was supplemented with 5% concentrates (dry matter basis); group 2 was maintained indoors and consumed a total mixed ration (TMR) diet consisting of maize silage, grass silage, and concentrates; and group 3 consumed a partial mixed ration diet (PMR), rotating between perennial ryegrass during the day and indoor TMR feeding at night. Raw milk samples consisted of a pooled morning and evening milking and were analyzed for gross composition, free amino acids, fatty acid composition, heat coagulation time, color, fat globule size, and pH. The TMR milks had a significantly higher total solids, lactose, protein, and whey protein as a proportion of protein content compared with both GRS and PMR milks. The GRS milks demonstrated a significantly lower somatic cell count (SCC), but a significantly higher pH and b*-value than both TMR and PMR milks. The PMR milks exhibited significantly lower total solids and fat content, but also demonstrated significantly higher SCC and total free amino acid content compared with GRS and TMR. Partial least squares discriminant analysis of fatty acid profiles displayed a distinct separation between GRS and TMR samples, while PMR displayed an overlap between both GRS and TMR groupings. Variable importance in projection analysis identified conjugated linoleic acid cis-9,trans-11, C18:2n-6 cis, C18:3n-3, C11:0, and C18:2n-6 trans as the largest contributors to the variation between the diets. Milk fats derived from GRS diets exhibited the highest proportion of unsaturated fats and higher unsaturation, health-promoting, and desaturase indices. The lowest proportions of saturated fats and the lowest atherogenic index were also exhibited by GRS-derived milk fats. This work highlights the positive influence of grass-fed milk for human consumption through its more nutritionally beneficial fatty acid profile, despite the highest milk solid percentages derived from TMR feeding systems. Furthermore, this study demonstrates the proportional response of previously highlighted biomarkers of pasture feeding to the proportion of pasture in the cow's diet., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

The objective of this research was to evaluate how different feeding strategies based on various pasture availability (PA) treatments within intensive seasonal production systems affected pasture production and utilization, sward quality, and the milk production, body weight (BW), and body condition score (BCS) of dairy cows. The performance data were obtained from a 3-yr experiment conducted previously (2018-2020, inclusive). In total, records from 208 spring-calving dairy cows were available for analysis. The animals were randomly allocated to 1 of 3 PA grazing treatments in spring that varied in average pasture cover (measured as herbage mass available above 3.5 cm) that was established via different pasture management strategies in the previous autumn. Thus, the opening average pasture cover across all paddocks on February 1 was 1,100 kg of dry matter (DM)/ha for high pasture availability (HPA), 880 for medium pasture availability (MPA), and 650 for low pasture availability (LPA), respectively. The measurements were taken over an 8-wk period during the first grazing rotation in spring, commencing on February 16 (±2 d) and finishing when all paddocks were grazed once on April 12 (±5 d). Paddocks that were part of the HPA treatment showed the highest pregrazing herbage masses and pregrazing sward heights (1,645 kg of DM/ha and 8.2 cm, respectively) compared with MPA (1,412 kg of DM/ha and 7.5 cm, respectively) and LPA (1,170 kg of DM/ha and 6.9 cm, respectively). Owing to the differences in PA, daily herbage allowance was greatest for HPA (11.7 kg of DM/cow), intermediate for MPA (10.2 kg of DM/cow), and lowest for LPA (8.8 kg of DM/cow), with the remaining feed deficit composed of additional daily grass silage supplementation (0.8, 1.5, and 2.8 kg of DM/cow for HPA, MPA, and LPA, respectively), while the daily concentrate and daily total feed allowance were equal between treatments during spring (2.7 and 15.0 kg of DM/cow). Despite salient differences in fresh pasture used, complementing pasture intake with grass silage did not affect daily or cumulative milk, solids-corrected milk, fat, or protein yield or milk constituents. Similarly, BW and BCS were also unaffected by PA treatment. The results highlight the importance of high spring pasture utilization and grazing efficiency achievable with higher pregrazing herbage masses, which also allow larger animal intakes from grazed pasture as the cheapest feed source during spring. Moreover, targeting an adequate pasture supply at the commencement of calving increases the grazing days per hectare and lowers the requirement for supplementary feed on farm, particularly when facing increasing variability in climatic conditions., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

The objectives of this study were to evaluate the effects of (1) protein supplementation strategy, (2) cow genotype and (3) an interaction between protein supplementation strategy and cow genotype on milk production and nitrogen (N) utilisation efficiency (milk N output/ total dietary N intake × 100; NUE) in late-lactation, spring-calving grazing dairy cows. A 2 × 2 factorial arrangement experiment, with two feeding strategies [13% (lower crude protein; LCP) and 18% CP (higher CP; HCP) supplements with equal metabolisable protein supply] offered at 3.6 kg dry matter/cow perday, and two cow genotype groups [lower milk genotype (LM) and higher milk genotype (HM)], was conducted over 53 days. Cows were offered 15 kg dry matter of grazed herbage/cow/day. Herbage intake was controlled using electric strip wires which allowed cows to graze their daily allocation-only. There was an interaction for herbage dry matter intake within cows offered HCP, where higher milk genotype (HM) cows had increased herbage dry matter intake (+0.58 kg) compared to lower milk genotype (LM) cows. Offering cows LCP decreased fat + protein yield (-110 g) compared to offering cows HCP. Offering cows LCP decreased the total feed N proportion that was recovered in the urine (-0.007 proportion units) and increased the total feed N proportion that was recovered in the faeces (+0.008 proportion units) compared to offering cows HCP. In conclusion, our study shows that reducing the supplementary CP concentration from 18% to 13% resulted in decreased milk production (-9.8%), reduced partitioning of total feed N to urine (-0.9%) and increased partitioning of total feed N to faeces (+14%) in late lactation, grazing dairy cows.

Importance: Reducing the duration of untreated psychosis (DUP) is essential to improving outcomes for people with first-episode psychosis (FEP). Current US approaches are insufficient to reduce DUP to international standards of less than 90 days., Objective: To determine whether population-based electronic screening in addition to standard targeted clinician education increases early detection of psychosis and decreases DUP, compared with clinician education alone., Design, Setting, and Participants: This cluster randomized clinical trial included individuals aged 12 to 30 years presenting for services between March 2015 and September 2017 at participating sites that included community mental health clinics and school support and special education services. Eligible participants were referred to the Early Diagnosis and Preventative Treatment (EDAPT) Clinic. Data analyses were performed in September and October 2019 for the primary and secondary analyses, with the exploratory subgroup analyses completed in May 2021., Interventions: All sites in both groups received targeted education about early psychosis for health care professionals. In the active screening group, clients also completed the Prodromal Questionnaire-Brief using tablets at intake; referrals were based on those scores and clinical judgment. In the group receiving treatment as usual (TAU), referrals were based on clinical judgment alone., Main Outcomes and Measures: Primary outcomes included DUP, defined as the period from full psychosis onset to the date of the EDAPT diagnostic telephone interview, and the number of individuals identified with FEP or a psychosis spectrum disorder. Exploratory analyses examined differences by site type, completion rates between conditions, and days from service entry to telephone interview., Results: Twenty-four sites agreed to participate, and 12 sites were randomized to either the active screening or TAU group. However, only 10 community clinics and 4 school sites were able to fully implement population screening and were included in the final analysis. The total potentially eligible population size within each study group was similar, with 2432 individuals entering at active screening group sites and 2455 at TAU group sites. A total of 303 diagnostic telephone interviews were completed (178 [58.7%] female individuals; mean [SD] age, 17.09 years [4.57]). Active screening sites reported a significantly higher detection rate of psychosis spectrum disorders (136 cases [5.6%], relative to 65 [2.6%]; P < .001) and referred a higher proportion of individuals with FEP and DUP less than 90 days (13 cases, relative to 4; odds ratio, 0.30; 95% CI, 0.10-0.93; P = .03). There was no difference in mean (SD) DUP between groups (active screening group, 239.0 days [207.4]; TAU group 262.3 days [170.2])., Conclusions and Relevance: In this cluster trial, population-based technology-enhanced screening across community settings detected more than twice as many individuals with psychosis spectrum disorders compared with clinical judgment alone but did not reduce DUP. Screening could identify people undetected in US mental health services. Significant DUP reduction may require interventions to reduce time to the first mental health contact., Trial Registration: ClinicalTrials.gov Identifier: NCT02841956.

Selection for feed efficiency, the ratio of output (e.g., milk yield) to feed intake, has traditionally been limited on commercial dairy farms by the necessity for detailed individual animal intake and performance data within large animal populations. The objective of the experiment was to evaluate the effects of individual animal characteristics (animal breed, genetic potential, milk production, body weight (BW), daily total dry matter intake (TDMI), and energy balance) on a cost-effective production efficiency parameter calculated as the annual fat and protein (milk solids) production per unit of mid-lactation BW (MSperBW lact ). A total of 1,788 individual animal intake records measured at various stages of lactation (early, mid, and late lactation) from 207 Holstein-Friesian and 200 Jersey × Holstein-Friesian cows were used. The derived efficiency traits included daily kilograms of milk solids produced per 100 kg of BW (dMSperBW int ) and daily kilograms of milk solids produced per kilogram of TDMI (dMSperTDMI). The TDMI per 100 kg of BW was also calculated (TDMI/BW int ) at each stage of lactation. Animals were subsequently either ranked as the top 25% (Heff) or bottom 25% (Leff) based on their lactation production efficiency (MSperBW lact ). Dairy cow breed significantly affected animal characteristics over the entire lactation and during specific periods of intake measurements. Jersey crossbred animals produced more milk, based on a lower TDMI, and achieved an increased intake per kilogram of BW. Similarly, Heff produced more milk over longer lactations, weighed less, were older, and achieved a higher TDMI compared with the Leff animals. Both Jersey × Holstein-Friesian and Heff cows achieved superior production efficiency due to lower maintenance energy requirements, and consequentially increased milk solids production per kilogram of BW and per kilogram of TDMI at all stages of lactation. Indeed, within breed, Heff animals weighed 20 kg less and produced 15% more milk solids over the total lactation than Leff. In addition, Heff achieved increased daily milk solids yield (+0.16 kg) and milk solids yield per kilogram of TDMI (+ 0.23 kg/kg DM) during intake measurement periods. Moreover, the strong and consistently positive correlations between MSperBW lact and detailed production efficiency traits (dMSperBW int , dMSperTDMI) reported here demonstrate that MSperBW lact is a robust measure that can be applied within commercial grazing dairy systems to increase the selection intensity for highly efficient animals., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

The objective of this study was to investigate the effect of increasing stocking rate (SR) and extending grazing season (GS) length on pasture and animal productivity on a marginal, poorly draining soil type. The study was a multiyear (2017 to 2020, inclusive) whole farm systems evaluation with a 2 × 2 factorial experimental arrangement of treatments. The systems evaluated comprised 2 GS lengths, average (AGS; 205 d) and extended (EGS; 270 d), and the 2 whole farm stocking rates were medium (2.5 cows/ha) and high (2.9 cows/ha). We used this study design to create 4 grazing system intensities (500, 600, 700, and 800 cow grazing days per hectare per year). In 2017, cows were randomly allocated to 1 of the 4 whole farm systems precalving and remained on the same treatments for the duration of the study. We found no significant differences in total average annual pasture production [14,133 ± 538 kg of dry matter (DM) per hectare] or sward chemical composition between GS and SR treatments over the 4-yr period, with the exception of average crude protein content, which was lower for EGS (211 g/kg DM) compared with AGS (218 g/kg DM). Grazed pasture production was significantly increased in EGS treatments (+758 kg of DM/ha) compared with AGS (9,917 kg of DM/ha), whereas conserved silage DM production was greater for AGS (+716 kg of DM/ha) compared with EGS (3,583 kg of DM/ha). Neither GS nor SR had a significant effect on daily or cumulative lactation milk and fat plus protein production per cow (5,039 and ±440 kg, respectively). Increasing SR resulted in increased milk fat plus protein yield per hectare based on increased grazed pasture utilization. These results add further credence to the important additive contributions of both extended grazing and SR intensification to achieve high levels of grazed pasture utilization and milk production per hectare while reducing supplementary feed requirements within spring-calving grazing systems., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Background: Brief questionnaires, such as the Prodromal Questionnaire (PQ) positive scale, have been used to pre-screen individuals who may be at clinical high-risk (CHR) for psychosis. Despite the apparent utility of the PQ, few studies have examined response styles in non-clinical settings, which this study aimed to assess., Methods: Response frequencies were examined for PQ positive subscale items in 3584 students (ages 18-35) from a nationally representative, semi-public undergraduate institution. Highly endorsed items were evaluated further in conjunction with established cutoffs and associated symptom ratings from the Structured Interview for Psychosis-risk Syndromes (SIPS) in a smaller subset of participants (n = 162). Positive subscale and distressing item responses were also evaluated by gender, race, and ethnicity using measurement invariance analyses and by comparing the relative proportion of individuals above established cutoffs., Results: Fifteen symptoms were endorsed by over 20 % of the sample with as high as 71 % of respondents endorsing them. Responses to 12 of these items were not associated with ratings on the SIPS. The PQ functioned similarly across demographic characteristics with strong evidence found for gender and race invariance across items and strong ethnicity invariance and partial invariance for positive subscale items and distressing items, respectively., Conclusions: These findings suggest that a commonly used psychosis-risk questionnaire may not be appropriate for non-clinical samples, with the possibility of high false positive rates of those at CHR for psychosis. Future large-scale epidemiological studies should evaluate if psychosis-risk screeners can be improved to identify CHR individuals in community settings., Competing Interests: Declaration of competing interest All authors declare they have no conflicts of interest in relation to the work described., (Copyright © 2022 Elsevier B.V. All rights reserved.)