For this research communication our objective was to investigate to what extent milk coagulation properties and milk fatty acid (FA) composition were affected by different feeding systems, season and their interaction. Eighteen cows in total were subjected to one of three different feeding system treatments: full-time grazing or part-time grazing combined with indoor feeding of fresh grass with low or high concentrate supplementation. Milk was sampled in spring, summer and autumn. Milk coagulation time was 15.0, 19.0 and 17.7 min, coagulation dynamics 1.67, 3.41 and 1.79 min, and curd firmness 52.7, 32.4 and 47.0 mm in spring, summer and autumn, respectively. Thus, milk coagulation properties of the milk were lower during summer. There were strong seasonal effects on milk FA proportions, but there were not always changes with progressing season, or changes were different with respect to the impact of the feeding systems (system × season interaction). The milk fat was favourably rich in oleic acid, conjugated linoleic acid and α-linolenic acid and had a low n-6/n-3 fatty acid ratio in all systems. Factors like seasonal variations in grass composition and the energy balance of the cows were considered relevant for the milk FA composition. Overall, seasonal variations in milk quality were less pronounced with part-time grazing with fresh grass indoors as compared to full-time grazing without concentrate.

This research paper addresses the hypotheses (1) that milk produced from hay-fed cows differs from that of silage-fed cows and (2) that silage type has an important impact, too. Four diets differing in forage type but with equal estimated milk production potential and a forage:concentrate ratio of 0.85 : 0.15 were compared regarding their effect on feed intake, milk yield and milk properties. The forages tested were hay, grass silage, conventional short-chopped and long-chopped maize silage subjected to a novel processing technology (Shredlage®). Twenty-four dairy cows were fed two of the four diets in two consecutive runs in an incomplete (4 × 2) Latin-square design (n = 12 per diet). Each experimental period lasted 22 d, with 12 d of adaptation and 10 d of sampling. During sampling, feed intake and milk yield were recorded daily, milk composition and coagulation properties were determined four times. The composition of the diet ingredients was analysed weekly. Data were analysed with a mixed model considering feed, period and their interaction as fixed effects. Stage of lactation, milk yield and milk composition from the pre-experimental period were used as covariates in the model. Dry matter intake was lower with the long-chopped processed maize silage compared to the other three groups. There were some diet differences in intakes of net energy for lactation and absorbable protein in the duodenum, but this did not result in changes in milk yield. The milk fat content was higher with the grassland-based diets compared to the maize silage diets. No treatment effect on milk acidity and rennet coagulation properties was observed. In conclusion, there were no indications for specific physico-chemical properties of milk from a hay-based diet, and maize processing technology was not of large effect either. Future investigations should focus on sensory differentiation of the milk produced with different forages.

The influence of phenol-rich dietary grapeseed extract on performance, energy and N balance and methane production was determined in sixteen lambs and thirteen goat kids (body weight 20·5 and 19·0 kg, 2 months of age, day 1 of study). Half of the animals received a concentrate containing grapeseed extract, and the others received concentrate without grapeseed extract (total extractable phenols analysed 27 v. 9 g/kg dietary DM; concentrate and hay 1:1). Diets were fed for 7 weeks with 1 week for determining intake, excretion and gaseous exchange in metabolism crates and respiration chambers. Overall, there was an adverse effect of the phenolic diet on apparent N digestibility and body N retention. Faecal N loss as proportion of N intake increased while urinary N loss declined. Relative to N intake, total N excretion was higher and body N retention lower in goat kids than lambs. Diets and animal species had no effect on methane emissions. The saliva of the goat kids had a higher binding capacity for condensed tannins (CT). Goat kids on the phenolic diet had higher CT concentrations in faeces and excreted more CT compared with the lambs (interaction species × diet P < 0·001). The lambs had overall higher (P < 0·001) urinary phenol concentrations than the goat kids (2·19 v. 1·48 g/l). The negative effect on body N retention and lack of effect on methane emissions make the use of the extract in the dosage applied not appealing. Species differences need to be considered in future studies.

The contribution of milk and dairy products to daily iodine intake is high but variable in many industrialised countries. Factors that affect iodine concentrations in milk and dairy products are only poorly understood. Our aim was to: (1) assess the effect of feed iodine concentration on milk iodine by supplementing five groups of five cows each with one of five dosages from 0–2 mg iodine/kg DM; (2) quantify iodine losses during manufacturing of cheese and yogurt from milk with varying iodine concentrations and assess the effect of cellar-ripening; and (3) systematically measure iodine partitioning during heat treatment and skimming of milk. Milk iodine reached a near-steady state after 3 weeks of feeding. Median milk iodine (17–302 μg/l for 0–2 mg iodine/kg DM) increased linearly with feed iodine (R2 0·96; P < 0·001). At curd separation, 75–84 % of iodine was lost in whey. Dairy iodine increased linearly with milk iodine (semi-hard cheese: R2 0·95; P < 0·001; fresh cheese and yogurt: R2 1·00; P < 0·001), and cellar-ripening had no effect. Heat treatment had no significant effect, whereas skimming increased (P < 0·001) milk iodine concentration by only 1–2 μg/l. Mean daily intake of dairy products by Swiss adults is estimated at 213 g, which would contribute 13–52 % of the adults’ RDA for iodine if cow feed is supplemented with 0·5–2 mg iodine/kg DM. Thus, modulation of feed iodine levels can help achieve desirable iodine concentrations in milk and dairy products, and thereby optimise their contribution to human iodine nutrition to avoid both deficiency and excess.

Milk and dairy products are important iodine sources and contribute about 30–40 % of total iodine in the Swiss diet. Information about variation in milk iodine concentration (MIC) in Switzerland is limited. We examined MIC and its potential determinants in milk from organic and conventional farms. We collected bulk milk samples at 3-month intervals over 1 year from thirty-two farms throughout Switzerland and Aosta valley, North-West Italy. We sampled all feed components including tap water, collected information on farm characteristics, feeding and teat disinfection practices by questionnaire and estimated the cows’ winter and summer iodine intake. Iodine in milk and feed components was measured using inductively coupled plasma MS. The overall median MIC was 87 (range 5–371) µg/l. In multivariate analysis, predictors of MIC were as follows: (1) farm type: median MIC from organic and conventional farms was 55 and 93 µg/l (P=0·022); (2) season: 53, 97 and 101 µg/l in September, December and March (P<0·002); and (3) teat dipping: 97 µg/l with v. 56 µg/l without (P=0·028). In conclusion, MIC varied widely between farms because of diverse farming practices that result in large differences in dairy cow exposure to iodine via ingestion or skin application. Standardisation of MIC is potentially achievable by controlling these iodine exposures. In order for milk to be a stable iodine source all year round, dietary iodine could be added at a set level to one feed component whose intake is regular and controllable, such as the mineral supplement, and by limiting the use of iodine-containing teat disinfectants.

Enteric methane (CH4) production is a side-effect of herbivore digestion, but it is unknown whether CH4 itself influences digestive physiology. We investigated the effect of adding CH4 to, or reducing it in, the reticulorumen (RR) in a 4×4 Latin square experiment with rumen-fistulated, non-lactating cows, with four treatments: (i) control, (ii) insufflation of CH4 (iCH4), (iii) N via rumen fistula, (iv) reduction of CH4 via administration of bromochloromethane (BCM). DM intake (DMI), apparent total tract digestibility, digesta mean retention times (MRT), rumen motility and chewing activity, spot breath CH4 emission (CH4exhal, litre/kg DMI) as well as CH4 dissolved in rumen fluid (CH4RRf, µg/ml) were measured. Data were analysed using mixed models, including treatment (or, alternatively, CH4exhal or CH4RRf) and DMI relative to body mass0·85 (rDMI) as covariates. rDMI was the lowest on the BCM treatment. CH4exhal was highest for iCH4 and lowest for BCM treatments, whereas only BCM affected (reduced) CH4RRf. After adjusting for rDMI, CH4RRf had a negative association with MRT in the gastrointestinal tract but not in the RR, and negative associations with fibre digestibility and measures of rumination activity. Adjusting for rDMI, CH4exhal had additionally a negative association with particle MRT in the RR and a positive association with rumen motility. Thus, higher rumen levels of CH4 (CH4exhal or CH4RRf) were associated with shorter MRT and increased motility. These findings are tentatively interpreted as a feedback mechanism in the ruminant digestive tract that aims at mitigating CH4 losses by shortening MRT at higher CH4.

High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA.

Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training.

SchulzCM, SkrzypczakM, RaithS, HinzmannD, KrautheimV, HeuserF, MayerV, KreuzerC, HimslM, HollM, LippC, KochsEF, WagnerKJ. High-fidelity Human Patient Simulators Compared with Human Actors in an Unannounced Mass-Casualty Exercise. Prehosp Disaster Med. 2014;29(2):1-7.

An experiment was conducted to study the seasonal changes in the fatty acid profile of milk from yaks (Bos grunniens) when kept at altitudes of 3000 m above sea level (a.s.l.) and higher. Data and samples were collected in summer (July), autumn (September), winter (November) and spring (March) from ten lactating yaks (four in spring). The yaks grazed pastures adjacent to the farm building throughout the year. In spring only they received 0·6 kg crop by-products per day (dry matter basis). Fresh alpine grasses, available in summer and autumn, showed high concentrations of α-linolenic acid (46–51 g/100 g lipids) compared with the dry, yellow vegetation of winter and spring (16 g/100 g lipids). In autumn and summer, the milk fat had higher concentrations of polyunsaturated fatty acids than in winter. These polyunsaturated fatty acids were comprised of vaccenic acid, rumenic acid and α-linolenic acid, which are all considered beneficial to human health. The rare fatty acid, γ-linolenic acid, was also detected in yak milk, especially in the milk obtained in spring. The results suggest that yak milk, which is the most important basic food of the Tibetan herders, has the most favourable fatty acid profile when yaks grazed green pasture, which also corresponds to the period of highest milk production.

Fresh buckwheat (Fagopyrum esculentum) and chicory (Cichorium intybus) had been shown to have the potential to improve certain milk quality traits when fed as forages to dairy cows. However, the process of ensiling might alter these properties. In the present study, two silages, prepared from mixtures of buckwheat or chicory and ryegrass, were compared with pure ryegrass silage (Lolium multiflorum) by feeding to 3 × 6 late-lactating cows. The dietary dry matter proportions realised for buckwheat and chicory were 0·46 and 0·34 accounting also for 2 kg/d of concentrate. Data and samples were collected from days 10 to 15 of treatment feeding. Buckwheat silage was richest in condensed tannins. Proportions of polyunsaturated fatty acids (PUFA) and α-linoleic acid in total fatty acids (FA) were highest in the ryegrass silage. Feed intake, milk yield and milk gross composition did not differ among the groups. Feeding buckwheat resulted in the highest milk fat concentrations (g/kg) of linoleic acid (15·7) and total PUFA (40·5; both P < 0·05 compared with ryegrass). The concentration of α-linolenic acid in milk fat was similar across treatments, but its apparent recovery in milk relative to the amounts ingested was highest with buckwheat. The same was true for the occurrence of FA biohydrogenation products in milk relative to α-linolenic acid intake. Recovery of dietary linoleic acid in milk remained unaffected. Feeding buckwheat silage shortened rennet coagulation time by 26% and tended (P < 0·1) to increase curd firmness by 29%. In conclusion, particularly buckwheat silage seems to have a certain potential to modify the transfer of FA from feed to milk and to contribute to improved cheese-making properties.

Feeding plants containing elevated levels of polyphenols may reduce ruminal CH4 emissions, but at the expense of nutrient utilisation. There might, however, be non-additive effects when combining high-phenolic plants with well-digestible, high-nutrient feeds. To test whether non-additive effects exist, the leaves of Carica papaya (high in dietary quality, low in polyphenols), Clidemia hirta (high in hydrolysable tannins), Swietenia mahagoni (high in condensed tannins) and Eugenia aquea (high in non-tannin phenolics) were tested alone and in all possible mixtures (n 15 treatments). An amount of 200 mg DM of samples was incubated in vitro (24 h; 39oC) with buffered rumen fluid using the Hohenheim gas test apparatus. After the incubation, total gas production, CH4 concentration and fermentation profiles were determined. The levels of absolute CH4, and CH4:SCFA and CH4:total gas ratios were lower (P< 0·05) when incubating a combination of C. papaya and any high-phenolic plants (C. hirta, S. mahagoni and E. aquea) than when incubating C. papaya alone. Additionally, mixtures resulted in non-additive effects for all CH4-related parameters of the order of 2–15 % deviation from the expected value (P< 0·01). This means that, by combining these plants, CH4 in relation to the fermentative capacity was lower than that predicted when assuming the linearity of the effects. Similar non-additive effects of combining C. papaya with the other plants were found for NH3 concentrations but not for SCFA concentrations. In conclusion, using mixtures of high-quality plants and high-phenolic plants could be one approach to CH4 mitigation; however, this awaits in vivo confirmation.

Feeding agro-industrial by-products and unconventional forages, rich in potentially anti-nutritional factors, may influence the quality of the raw milk and the dairy products prepared therefrom. The aim of the present study was to determine side-effects on physicochemical properties of milk, yoghurt and cheese of feeding diets where one third were feeds either rich in lipids (tomato pomace and olive cake) or phenols (olive leaves and lentil straw) or electrolytes (Atriplex leaves). The diets, including a control diet, were designed to be isoenergetic and isonitrogenous. They were fed in amounts of 2 5 kg dry matter/day per head during 50 days to 6×10 multiparous fat-tailed Awassi ewes. Milk samples were analysed for various physicochemical traits and fatty acid composition on days 0, 24, 36 and 48. Three times, milk pooled by group was processed to yoghurt and non-aged farmer-type cheese, which were analysed for their gross and fatty acid composition and texture, and were subjected to sensory evaluation. Feeding olive cake and tomato pomace reduced milk casein, but increased proportions of monounsaturated fatty acids. There were some variations in minerals among test diets but, contrary to expectations, Atriplex did not increase milk sodium. The nutritional composition of yoghurt and cheese was not varied much by the test feeds, except for some changes in fatty acid profile similar to the milk. Yoghurt firmness declined with all test diets, but texture score tended to be lower only for olive cake and leaf diets relative to control. Cheese firmness was increased by feeding the Atriplex leaf and olive cake diets which was also reflected in the texture scores. No off-flavours were reported. Possible reasons for effects on the dairy products are discussed. In conclusion, the feeds investigated had certain effects on the physicochemical properties of dairy products, but these were neither very systematic nor large thus not prohibiting their use in Mediterranean sheep milk production systems.

Ruminants represent an important source of methane (CH4) emissions; therefore, CH4 mitigation by diet supplementation is a major goal in the current ruminant research. The objective of the present study was to use a rumen simulation technique to evaluate the CH4-mitigating potential of pure compounds in comparison with that achieved with garlic oil, a known anti-methanogenic supplement. A basal diet (15 g DM/d) consisting of ryegrass hay, barley and soyabean meal (1:0·7:0·3) was incubated with the following additives: none (negative control); garlic oil (300 mg/l incubation liquid; positive control); allyl isothiocyanate (75 mg/l); lovastatin (150 mg/l); chenodeoxycholic acid (150 mg/l); 3-azido-propionic acid ethyl ester (APEE, 150 mg/l); levulinic acid (300 mg/l); 4-[(pyridin-2-ylmethyl)-amino]-benzoic acid (PABA, 300 mg/l). Fermentation profiles (SCFA, microbial counts and N turnover) and H2 and CH4 formation were determined. Garlic oil, allyl isothiocyanate, lovastatin and the synthetic compound APEE decreased the absolute daily CH4 formation by 91, 59, 42 and 98 %, respectively. The corresponding declines in CH4 emitted per mmol of SCFA were 87, 32, 40 and 99 %, respectively, compared with the negative control; the total SCFA concentration was unaffected. Garlic oil decreased protozoal numbers and increased bacterial counts, while chenodeoxycholic acid completely defaunated the incubation liquid. In vitro, neutral-detergent fibre disappearance was lower following chenodeoxycholic acid and PABA treatments ( − 26 and − 18 %, respectively). In conclusion, garlic oil and APEE were extremely efficient at mitigating CH4 without noticeably impairing microbial nutrient fermentation. Other promising substances were allyl isothiocyanate and lovastatin.

The frequency of selection of functional groups and plant species by free-ranging cattle foraging in a diverse environment and its changes during the dry and the following prehumid seasons were investigated using direct observations and bite counting. The study was conducted at two sites in the Bolivian–Tucuman montane forests in southern Bolivia, by including datasets of a total of 16 animals. Across both study sites and the entire observation period (May to October/November), the cattle were found to select a broad spectrum of plant species from different functional groups. However, just a limited number of species made up a considerable contribution to overall plant selection. The functional group of the graminoids was selected most frequently, but their contribution to plant selection decreased significantly from 63.5% of total bites in May to 15.9% in September/October, in accordance with a decrease in availability. Selection of woody plants (shrubs and tree parts, the latter mainly in the form of leaf litter and fruits) increased with time, reaching its peak at the beginning of the prehumid season, while the herbs showed a curvilinear pattern of selection which was highest in August. Plant species belonging to the functional groups of ferns, climbers and epiphytes were also selected by the cattle, but generally at low relative proportions. Plant selection might be influenced by temporal differences in nutritional quality and availability of the preferred plant species and functional groups. Sampling behaviour seems to be the most likely reason for the inclusion of a broad range of plant species with overall low contribution to plant selection.

The transfer of ingested α-linolenic acid (ALA) and linoleic acid (LA) determines the nutritional quality of milk, but the factors determining this transfer are unclear. The present experiment investigated the influence of roughage to concentrate proportions and the effect of concentrate types on milk fat composition. Respectively, six lactating dairy cows were fed one of three isoenergetic (5·4±0·05 MJ net energy for lactation/kg dry matter; DM) and isonitrogenous (215±3·5 g crude protein/kg DM) diets, consisting of ryegrass hay only (33 g fatty acids/kg DM; ALA-rich, no concentrate), maize (straw, whole maize pellets and gluten; 36 g fatty acids/kg DM; LA-rich; 560 g concentrate/kg DM), or barley (straw and grain plus soybean meal; 19 g fatty acids/kg DM; LA-rich; 540 g concentrate/kg DM). The fatty acid composition of feeds and resulting milk fat were determined by gas chromatography. The ALA concentration in milk fat was highest (P<0·001) with the hay-diet, but the proportionate transfer of ALA from diet to milk was lower (P<0·001) than with the maize- or barley-diets. The LA concentration in milk fat was highest with the maize-diet (P<0·05, compared with hay) but relative transfer rate was lower (P=0·01). The transfer rates of ALA and LA were reciprocal to the intake of individual fatty acids which thus contributed more to milk fat composition than did roughage to concentrate proportions. The amount of trans-11 18:1 in milk fat was lowest with the barley-diet (P<0·001) and depended on the sum of ALA and LA consumed. The milk fat concentration of cis-9, trans-11 18:2 (rumenic acid) was more effectively promoted by increasing dietary LA (maize) than ALA (hay). Amounts of 18:0 secreted in milk were four (maize) to seven (hay) times higher than the amounts ingested. This was suggestive of a partial inhibition of biohydrogenation in the maize-diet, possibly caused by the high dietary LA level.

The influence of high altitude, alpine origin of the forage and roughage-only diets on milk protein content and composition, plasmin activity and cheesemaking properties was investigated. There were four treatment groups, each consisting of six dairy cows in early to mid-lactation. Two groups were fed only with hay ad libitum either at 2000 m or at 400 m a.s.l. One group, kept in the lowlands, was pair-fed to the alpine-site group and another group received a mixed diet of silages, hay and concentrates. Two hay types, harvested either at the alpine site or in the lowlands, were offered to all cows fed with hay alone, following a change-over design in three periods each of 3 weeks. In the respective third week, milk was sampled at every milking. Hay of alpine origin significantly reduced milk protein, in particular whey proteins, which is why the casein number increased. κ-Casein proportion in total casein was reduced and its glycosylation was increased by the alpine hay. The apparent plasminogen-derived activity was reduced when alpine hay was given, but apparent plasmin activity and rennet coagulation properties of the milk were not affected by hay type. Independent of hay type, the high altitude group showed a significantly reduced milk protein content, lower glycosylation of κ-casein and impaired rennet coagulation properties. For several of the traits, the trend was the same in the pair-fed group. There was no effect of altitude on apparent plasmin activity. Hay-alone v. the mixed diet resulted initially in marked declines in milk protein content but did not impair cheesemaking properties. Thus the extensive diet without concentrates, typical of high-alpine conditions, contributed less to the overall effect of extensive alpine v. intensive lowland feeding systems than hay quality and altitude did. In conclusion, certain positive influences of the alpine sojourn of cows on cheese processing quality are overruled by the major adverse impact of lower milk protein content.

The interactions of lauric (C12) and myristic acid (C14) in suppressing ruminal methanogenesis and methanogens were investigated with the rumen simulation technique (Rusitec) using bovine ruminal fluid. The fatty acids were added to basal substrates (grass hay:concentrate, 1:1.5) at a level of 48 g/kg DM, provided in C12:C14 ratios of 5:0, 4:1, 3:2, 2·5:2.5, 2:3, 1:4 and 0:5. Additionally, an unsupplemented control consisting of the basal substrates only was employed. Incubation periods lasted for 15 (n 4) and 25 (n 2) d. CH4 formation was depressed by any fatty acid mixture containing at least 40 % C12, and effects persisted over the complete incubation periods. The greatest depression (70 % relative to control) occurred with a C12:C14 ratio of 4:1, whereas the second most effective treatment in suppressing CH4 production (60 % relative to control) was found with a ratio of 3:2. Total methanogenic counts were decreased by those mixtures of C12 and C14 also successful in suppressing methanogenesis, the 4:1 treatment being most efficient (60 % decline). With this treatment in particular, the composition of the methanogenic population was altered in such a way that the proportion of Methanococcales increased and Methanobacteriales decreased. Initially, CH4 suppression was associated with a decreased fibre degradation, which, however, was reversed after 10 d of incubation. The present study demonstrated a clear synergistic effect of mixtures of C12 and C14 in suppressing methanogenesis, mediated probably by direct inhibitory effects of the fatty acids on the methanogens.

The efficiency of myristic acid (14:0) as a feed additive to suppress CH4 emissions of ruminants was evaluated under different dietary conditions. Six sheep were subjected to a 6 × 6 Latin square arrangement. A supplement of non-esterified 14: 0 (50 g/kg DM) was added to two basal diets differing in their forage:concentrate values (1:1/5 and 1: 0/5), which were adjusted to dietary Ca contents of 4/2 and 9/0 g/ kg DM, respectively. Comparisons were made with the unsupplemented basal diets (4/2 g Ca/kg DM). The 14:0 supplementation decreased (P < 0/001) total tract CH4 release depending on basal diet type (interaction, P < 0/001) and dietary Ca level (P < 0/05, post hoc test). In the concentrate-based diet, 14:0 suppressed CH4 emission by 58 and 47% with 4/2 and 9/0 g Ca/kg DM, respectively. The 14:0 effect was lower (22%) in the forage-based diet and became insignificant with additional Ca. Myristic acid inhibited (P < 0/05) rumen archaea without significantly altering proportions of individual methanogen orders. Ciliate protozoa concentration was decreased (P < 0/05, post hoc test) by 14:0 only in combination with 9/0 g Ca/kg DM. Rumen fluid NH3 concentration and acetate:pro-pionate were decreased (P < 0/05) and water consumption was lower (P < 0/01) with 14:0. The use of 14:0 had no clear effects on total tract organic matter and fibre digestion; this further illustrates that the suppressed methanogenesis resulted from direct effects against methanogens. The present study demonstrated that 14:0 is a potent CH4 inhibitor but, to be effective in CH4 mitigation feeding strategies, interactions with other diet ingredients have to be considered.

Objective: To inform about the specifics of medical devices and the resulting consequences for health technology assessment (HTA) and to present the European industry position on this topic.

Methods: The paper is based on an intensive debate within Eucomed, the European trade association in the field of medical devices, informed by an HTA Experts Group, comprising experts from within and outside the medical device industry.

Results: Based on the specifics of medical devices, there are a number of methodologic considerations that require a tailored HTA, differing from the approach taken for, for example, pharmaceutical products. These differences have an impact on the selection of the technology, the timing of the assessment, the study design, and the patient population.

Conclusion: The European medical device industry can commit to an HTA that takes into consideration the specifics of medical technologies, which is appropriate and fair, and which is done under full participation of industry. Under these circumstances HTA can be a useful tool to support rational decision making in health care.