French System Research Articles

Coronavirus Disease 2019 and Out-of-Hospital Cardiac Arrest: No Survivors.

OBJECTIVES:To describe and compare survival among patients with out-of-hospital cardiac arrest as a function of their status for coronavirus disease 2019.DESIGN:We performed an observational study of out-of-hospital cardiac arrest patients between March 2020 and December 2020. Coronavirus disease 2019 status (confirmed, suspected, or negative) was defined according to the World Health Organization’s criteria.SETTING:Information on the patients and their care was extracted from the French national out-of-hospital cardiac arrest registry. The French prehospital emergency medical system has two tiers: the fire department intervenes rapidly to provide basic life support, and mobile ICUs provide advanced life support. The study data (including each patient’s coronavirus disease 2019 status) were collected by 95 mobile ICUs throughout France.PATIENTS:We included 6,624 out-of-hospital cardiac arrest patients: 127 cases with confirmed coronavirus disease 2019, 473 with suspected coronavirus disease 2019, and 6,024 negative for coronavirus disease 2019.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:The “confirmed” and “suspected” groups of coronavirus disease 2019 patients had similar characteristics and were more likely to have suffered an out-of-hospital cardiac arrest with a respiratory cause (confirmed: 53.7%, suspected coronavirus disease 2019: 56.5%; p = 0.472) than noncoronavirus disease 2019 patients (14.0%; p < 0.001 vs confirmed coronavirus disease 2019 patients). Advanced life support was initiated for 57.5% of the confirmed coronavirus disease 2019 patients, compared with 64.5% of the suspected coronavirus disease 2019 patients (p = 0.149) and 70.6% of the noncoronavirus disease 2019 ones (p = 0.002). The survival rate at 30-day postout-of-hospital cardiac arrest was 0% in the confirmed coronavirus disease 2019 group, 0.9% in the suspected coronavirus disease 2019 group (p = 0.583 vs confirmed), and 3.5% (p = 0.023) in the noncoronavirus disease 2019 group.CONCLUSIONS:Our results highlighted a zero survival rate in out-of-hospital cardiac arrest patients with confirmed coronavirus disease 2019. This finding raises important questions with regard to the futility of resuscitation for coronavirus disease 2019 patients and the management of the associated risks.

A causality based feature selection approach for data-driven dynamic security assessment

The integration of renewable energy sources increases the operational uncertainty of electric power systems and can lead to more frequent dynamic phenomena. The use of classifiers from machine learning is promising to include dynamics in the security assessment of the power system. The training of these classifiers is typically performed offline on synthetically generated operating conditions (OCs) that are similar to real-time operation. However, the uncertainty in the generated OCs and the classifier’s inaccuracy is larger the longer the time between offline and real-time operation. Moving the classifier training closer to real-time operation is an important step forward to reduce inaccurate predictions and improve reliability. In this paper, a novel causality-based feature selection approach for an online dynamic security assessment (DSA) framework is proposed. The key novelty is to use the system’s physics to learn the causal structure between the features and then select the features based on this causal structure. The proposed approach results in faster computations, is more robust and more interpretable. Moreover, classifiers can be trained closer to real-time operation which enhances the predictive performance. Through a case study using transient stability on the IEEE 68-bus system, the proposed method reduces computational time by 75% in comparison to state of the art feature selection techniques. The proposed workflow showed superior performance in accuracy and robustness against uncertainty compared to conventional machine learning approaches for DSA. The computational benefit was also projected to a dataset of the French transmission system where the approach has the potential to achieve computational savings of up-to two orders of magnitudes.

The past participle and the periphrastic passive construction in French

Abstract Our hypothesis is that the past participle is a singular form in the TAM (tense-aspect-mood) linguistic system in French, in that it represents the internal time of the process on its terminal point ([R = Et]). Due to this representation of internal time, the p.p. can be related to the second argument – the patientive argument – of a direct transitive process: it is the essential element of the passive construction. Contrary to what is often written, the copula être ‘be’, is an optional element: it may serve to develop the construction in its periphrastic dimension, but it is not necessary to the passive construction itself, as the cases of the passive in the participial clause demonstrate. Moreover, the p.p. is not intrinsically resultative or processive, no more than it is active or passive: from its aspect [R = Et], it can, in interaction with different contexts, participate in the production of these different effects of meaning in discourse.

Primary school expectations: the invisible curriculum as a tool for understanding learning inequalities

This paper reports the results of a study aimed at understanding the processes governing the construction of educational inequalities in French classrooms, the French school system being particularly unequal. Traditional explanations have focused on the factors governing the production of inequalities but have not always shown how these factors translate into learning inequalities in class. Consistent with relational approaches, the study draws on ethnographic research conducted over an 18-month period in 6 socially contrasting Parisian schools. Both students from wealthy families considered to be ‘high-achieving’ and students from poor families viewed as being ‘low-achieving’ were observed over the course of full school days to understand the factors that lead them to develop different activities. The evidence suggests that children interpret teacher expectations very differently, although the same expectations were observed in all the classes observed during the study. These expectations point to an invisible curriculum operating alongside the formal curriculum and generally perceived only by high-achieving students, who are able to grasp and understand it through their prior socialization. A further characteristic of the invisible curriculum is that it is rarely made explicit by teachers. This finding highlights the need to further examine explicitation strategies in schools.

Ginger (Zingiber officinale) based intercropping systems for enhancing productivity and income – a farmers’ participatory approach

Ginger (Zingiber officinale Rosc.), an important medicinal and aromatic rhizomatous spice crop has potential for improving the livelihood of hill farmers. A participatory field study was conducted in 35 farmers' field of Mawthei village (25°44’18.57” N, 91°58’27.89” E and elevation of 1000-1200 m amsl) of Meghalaya to identify a sustainable ginger based intercropping system to improve income of the resource poor hill farmers. Results indicated that fresh rhizome weight was the highest in ginger as sole crop (208 g/plant) which was at par with ginger + soybean, ginger + maize + French bean and ginger + groundnut intercropping systems. Ginger + maize + French bean + pumpkin system recorded the highest Ginger Equivalent Yield (GEY, 9.24 t/ha), i.e. 15.20% higher than sole ginger crop yield. Maximum Land Equivalent Ratio (LER) was obtained in ginger + maize + French bean (2.63) followed by ginger + maize + French bean + pumpkin (2.57) system. The highest net returns were recorded with ginger + maize + French bean + pumpkin (₹ 3.36 lakh/ha) followed by ginger + maize + French bean (₹ 3.17 lakh/ha) systems. The intercropping of ginger + groundnut recorded highest benefit cost ratio (3.42), followed by ginger + pumpkin and ginger + maize + French bean. Thus, adoption of ginger + maize + French bean + pumpkin and ginger + maize + French bean intercropping systems may help in improving the economic conditions of the hill farmers in eastern Himalayas.

APK: a network to improve the interest in steel construction

AbstractAPK was launched in 1991. It is now 30 years old and it continues to produce and to disseminate pedagogical resources and to bring academics and professionals together. Every 4 years, seminars are proposed to examine how to adapt the different curricula to be as close as possible to professional requirements. Alternately, a workshop is organized to focus on a specific problem related to the advantages of steel in construction. Three times a year, a consistent journal which contains useful tools to improve lectures is circulated.This paper describes how it has been possible for APK to maintain its activities and to remain as attractive as it was at the beginning. It emphasizes its main results, on the one hand for the academic world and, on the other hand, for the steel construction professionals. It clarifies the French system of education. It is a reminder of the European programs which have been disseminated. It describes some specific tools provided to the academics. It highlights proposals to attract students and make them interested in steel construction. It suggests different ways of promoting education to steel and provides some ideas to remain attractive in the future.

Catheter Closure of Clinically Silent Patent Ductus Arteriosus Using the Amplatzer Duct Occluder II-Additional Size: A Single-Center Experience.

ObjectivesTranscatheter closure is the treatment of choice for most patent ductus arteriosus (PDA) in infants, children, and adults. However, there is a controversy regarding transcatheter closure of clinically silent PDAs. Some authors favor device closure to eliminate the lifelong risk of infective endarteritis while others recommend avoiding PDA closure in such patients. The study describes our experience of closing the silent PDAs using the Amplatzer duct occluder II-additional size (ADO II-AS) (St. Jude Medical Corp, St. Paul, MN).Materials and methodsFrom April 2018 through March 2021, 52 consecutive pediatric patients aged 18 years and less with clinically silent PDA who had transcatheter closure at our center were enrolled. Patients were excluded if they had clinically detected PDAs; had surgical ligation of PDA with no residual shunt; had left heart dilatation on echocardiography; or moderate-sized PDAs closed with ADO II-AS. In addition, patients with an innocent murmur or murmur due to an associated lesion were included. This study was retrospective, and all of the 52 patients underwent PDA device closure using ADO II-AS.ResultsFifty-two consecutive patients were enrolled with a median age of 17 months, range (97-2.5) 94.5 months. Mean weight was 11.29 kilogram, range (24.8-3.5) 21.3 kilogram, and mean follow-up was 13.5 months, range (29-0) 29 months. Thirty-one (59.6%) were females, and 21 (40.4%) were males. The mean procedure time was 30.6 min, range (60-10) 50 min, and mean fluoroscopic time was 5.5 min, range (28-1.7) 26.3 min. The mean volume of contrast given was 9.1 milliliter, range (30-4) 26 milliliter. Forty-five (45; 88.2%) patients had immediate closure of PDA. No patients had anesthetic or vascular complications; however, two patients had procedural complications. Device placement was unsuccessful in one patient with Downs syndrome. The mean follow-up for our patients was 13.5 months, range (29-0) 29 months; the patients were asymptomatic at the follow-up, and none of the patients had any residual leak. None of the patients showed coarctation or left pulmonary artery stenosis at the latest follow-up.ConclusionThe usefulness of catheter-based therapy for silent PDA is less well-established by current evidence. Further studies are needed to justify the intervention solely based on the premise that the silent duct is a substrate for infective endarteritis; however, our reason to close silent PDA was to do so primarily because of social reasons. This study found that device closure of silent PDA is safe and effective using an ADO II-AS device with minimal risk of embolization and a low residual shunt rate. Coils have been used to close small PDAs, however, with higher rates of embolization and device malpositioning. We believe ADO-II AS offers an advantage of safety and efficacy over coils. In addition, the study highlights the advantage of using an ADO II-AS device, which can be delivered via a four French delivery system with no arterial complications.

Causal Effect Relationship in Medical Cases. An Old Problem in a New Scenario. Commentary to CJEU Judgment (Second Chamber) of 21 June 2017, N.W. &amp; Others V. Sanofi Pasteur MSD &amp; Others, Case C-621/15, EU:C:2017:484. Approbative Gloss

This commentary evaluates the problem in assessing the role of a causal connection between damage and the use of a defective medical product, specifically a vaccine. The judgment of the Court of Justice of the European Union (CJEU) in the Sanofi Pasteur Case, which allowed the possibility of recognizing damage claims, even in cases where the prevailing scientific theory claims that there is no scientific evidence of a causal link between a vaccination and the disease, became a base for consideration. Consequently, procedural solutions (such as the standard of proof required, the admissibility of prima facie evidence reasoning and other solutions in cases of an uncertain causation) remain to be decided by national law. The authors assessed two legal systems: the French and Polish legal systems in the context of how to resolve these dilemmas and to describe the impact of the above-mentioned judgment on the case-law of French and Polish courts as regards the application of Directive 85/374/EEC. As a result, they concluded that the most important interpretative motive has become the individual interest of the vaccination’s victim as a consumer of medical services. It seems to be in accordance with Directive 85/374/EEC, which is motivated by the necessity of approximation of the laws of the Member States concerning the liability of the producer for damage caused by the defectiveness of his products. However, since the existing divergences may distort competition and affect the movement of goods within the common market and entail a differing degree of protection of the consumer against damage caused by a defective product to his health or property, in countries belonging to the European Union, the authors wonder how the commented judgment will affect the further development of consumers protection against defective vaccines.

Selecting decision trees for power system security assessment

Power systems transport an increasing amount of electricity, and in the future, involve more distributed renewables and dynamic interactions of the equipment. The system response to disturbances must be secure and predictable to avoid power blackouts. The system response can be simulated in the time domain. However, this dynamic security assessment (DSA) is not computationally tractable in real-time. Particularly promising is to train decision trees (DTs) from machine learning as interpretable classifiers to predict whether the system-wide responses to disturbances are secure. In most research, selecting the best DT model focuses on predictive accuracy. However, it is insufficient to focus solely on predictive accuracy. Missed alarms and false alarms have drastically different costs, and as security assessment is a critical task, interpretability is crucial for operators. In this work, the multiple objectives of interpretability, varying costs, and accuracies are considered for DT model selection. We propose a rigorous workflow to select the best classifier. In addition, we present two graphical approaches for visual inspection to illustrate the selection sensitivity to probability and impacts of disturbances. We propose cost curves to inspect selection combining all three objectives for the first time. Case studies on the IEEE 68 bus system and the French system show that the proposed approach allows for better DT-selections, with an 80% increase in interpretability, 5% reduction in expected operating cost, while making almost zero accuracy compromises. The proposed approach scales well with larger systems and can be used for models beyond DTs. Hence, this work provides insights into criteria for model selection in a promising application for methods from artificial intelligence (AI).

The structure of the State and its influence on Administrative Law: Analysis in the German, Spanish and French legal systems

There has been a long and interesting discussion between those who maintain that the state determines the law and those who defend that it is the right that does it, reaching the point of identifying them. On this occasion, this article makes an analysis of the way in which the State and its structural conformations affect administrative law based on the forms adopted in the German, French and Spanish legal systems. It is clear, at least for the Colombian legal system, that administrative law has a strong antecedent in France; for this reason, the State structure adopted in said country has had a clear influence on the normative regulations to which the administration’s activity is subject; to this extent, the decentralized unitary state form exerts a clear influence on this branch of public law. But the other forms of State, such as the federal and the autonomous, also exert notorious influence on the normative regulations of administrative law; even more so in the institutions that make it up as the cornerstone of these legal systems, because the substantial aspects in one way or another end up being identical. In effect, the notions of Administration, sovereignty, public power, public prerogatives, functions of the state, among others, are very similar, perhaps not identical, in the three forms of state and therefore, in the three legal systems, as well as the structures that make it up have marked differences, because one is a decentralized unitary state, the other is a federal state and the third is an autonomous state; but all of them in what corresponds to administrative action, they do so through a mechanism that in our concept is identical to all of them, such as the administrative act.

Overview of hospitalizations in women undergoing oocyte retrieval for ART in the French national health data system.

What is the incidence rate of complications in women undergoing ART procedures compared to the period prior to their first oocyte retrieval? The study shows a significant increase in the post-ART incidence rate of some complications but a low overall rate of occurrence relative to the total number of oocyte retrievals. ART, widely used in Europe, accounts for 3.3% of births in France. The various studies of ART complications are fairly reassuring, showing relatively low overall complication rates but only few studies have used exhaustive national registers. The cohort for this study was identified from the comprehensive French national hospital-discharge database and includes women under 50 years with a first oocyte retrieval (T0) in 2012-2017, classified in three population subgroups according to the indication for oocyte retrieval: infertility (IF), oocyte donation (OD), and fertility preservation (FP). This study includes 156 916 women whose first oocyte retrieval occurred in 2012-2017 and 542 775 hospitalizations in 2010-2019 (excluding first retrieval). Hospitalizations for complications or others events (oocyte retrieval, delivery, pregnancy loss, and death in the hospital) during the 2 years before (control period) and after their first oocyte retrieval (post-oocyte retrieval period) were compared and expressed per 10 000 person-months (pm). In the IF subgroup, incidence rates were significantly higher after (vs before) retrieval for hospitalized ovarian hyperstimulation syndrome (OHSS) (162 vs 6/10 000 pm), adnexal torsion (14 vs 3), venous thrombosis (8 vs 1), arterial thrombosis (3 vs 1), trauma (2 vs 1), and significantly lower for infections (61 vs 87). The higher incidences of OHSS, adnexal torsion and venous thrombosis could only partially be explained by the occurrence of pregnancy.In the FP subgroup, incidence increased significantly after (vs before) retrieval for hospitalized OHSS (55 vs 0), venous thrombosis (59 vs 4), and infections (176 vs 56). For the OD subgroup, hospitalized OHSS (116 vs 0) and bleeding (24 vs 0) were significantly higher after (vs before) retrieval. The French national health data system, despite all its advantages, present some limitations such as the risk of coding errors. The unavailability of some personal information and the absence of consideration of risk factors prevented us from adjusting the risk. Finally, only complications resulting in hospitalization were analyzed which probably leads to their underestimation. The use of medico-administrative bases will be a valuable tool in public health and will furnish a better overview of the complications. Further studies are needed to complete this analysis. Adding information on drugs would help to better define T0 and less severe complications. N/A. N/A.

First symptoms and health care pathways in hospitalized patients with acute heart failure: ICPS2 survey. A report from the Heart Failure Working Group (GICC) of the French Society of Cardiology.

BackgroundAcute heart failure (AHF) is a common serious condition that contributes to about 5% of all emergency hospital admissions in Europe.HypothesisTo assess the type and chronology of the first AHF symptoms before hospitalization and to examine the French healthcare system pathways before, during and after hospitalization.Material and MethodsA retrospective observational study including patients hospitalized for AHFResults793 patients were included, 59.0% were men, 45.6% identified heart failure (HF) as the main cause of hospitalization; 36.0% were unaware of their HF. Mean age was 72.9 ± 14.5 years. The symptoms occurring the most before hospitalization were dyspnea (64.7%) and lower limb edema (27.7%). Prior to hospitalization, 47% had already experienced symptoms for 15 days; 32% of them for 2 months. Referral to hospital was made by the emergency medical assistance service (SAMU, 41.6%), a general practitioner (GP, 22.3%), a cardiologist (19.5%), or the patient (16.6%). The modality of referral depended more on symptom acuteness than on type of symptoms. A sudden onset of AHF symptoms led to making an emergency call or to spontaneously attending an emergency room (ER), whereas cardiologists were consulted when symptoms had already been present for over 15 days. Cardiologists referred more patients to cardiology departments and fewer patients to the ER than general practitioners or the SAMU.ConclusionThis study described the French healthcare system pathways before, during and after hospitalization AHF. AHF clinic network should be developed to provide adequate care for all HF patients and create awareness regarding AHF symptoms.

“What do they say in Quebec?”

This paper examines how non-binary French-speakers in Quebec express their gender identities in speech. I argue that reformist efforts regarding neutral French should include increased attention to how neutral French is done in informal spoken Quebec French, as I examine how current recommendations based on spelling can fail to be taken up in speech, and how regional varieties can sometimes require different prescriptions. Based on a preliminary field study with eight participants who are part of this community of practice, I find that participants did not use any audible neologisms, such as the ones recommended for writing and for other varieties. Not only did they all use gendered language to refer to non-binary referents, although at a much lower frequency than for binary referents, but they also used gender-avoidance strategies in most cases. I also show that third person clitics seem to be the word category most resistant to neutralization or avoidance for speakers of this variety. I argue that these results point to the development of two distinct systems of neutral French, one for speech and one for writing.

RETRACTED ARTICLE: A neural network–based rainfall trend in plain areas and a personalized French learning system

RETRACTED ARTICLE: A neural network–based rainfall trend in plain areas and a personalized French learning system

Pourquoi l’évaluation structurée du risque de récidive violente et sexuelle est une pratique marginale en France ? Revue systématique de la littérature

IntroductionIn France, the recidivism of offenders (both sexual and non-sexual violence) is a national concern as evidenced by the media and the succession of laws relating to the prevention of recidivism. Risk assessment can be performed using unstructured professional judgment which is unreliable or by structured risk assessment which are more reliable. Abroad, this structured assessment is considerably developed. In France, it gives rise to two opposing positions: (i) encouragement by public authorities; and (ii) fear by a majority of professionals in the field. ObjectiveThis article offers a systematic literature review, meeting PRISMA criteria, on the perception and practice of standardized evaluation in France by the professionals concerned. MethodThe keywords “Risk assessment” AND “recurrence” AND “France” were searched in French and in English in the search engines Pubmed, PsycInfo, Cairn, and ScienceDirect. ResultsThe 23 articles obtained in the results highlighted: (a) fears and few advantages regarding the use of structured evaluation; (b) a possibility of a hybrid evaluation system in France; and (c) a report of some works already using scales of risk on French populations. This article focused mainly on the fears and perceived benefits of structured risk assessment. The reluctance has concerned both: (i) the French judicial system (fear of a new penology based only on the actuarial approach and its consequences); (ii) the professional valuers (fear of a confusion of professional's roles in health and justice fields); (iii) the persons assessed (fear of a risk of stigmatization of high-risk patients concerning violence); and (iv) the tools themselves (fear of a poor reliability of the risk assessment). Very few articles highlighted their advantages: reliability, simplicity of use, good inter-judge fidelity, guideline for care, and specially an ability to overcom the insufficient basis for the evaluation resulting from unstructured clinical judgment. Results also suggested the possibility of a hybrid evaluation system in France, which could rely on risk scales, without neglecting the interview and the qualitative collected information that have to respect precise steps and allow the management of offenders. Finally, this paper presented the few French studies using risk scales mainly focused both in sexual offenders’ risks and associated factors, and showing a better productivity of these scales than an unstructured professional judgment. Discussion and conclusionFears related to the structured risk assessments are important. However, these scales may also supply a better vision of offenders. They require skills of professionals from various fields and allow both a fairer assessment of the offender and a penal system more adjusted. This perceived reluctance seems to be due to a poor knowledge of structured assessment the risk scales and a lack of research studies using them in France, where it is necessary to have a broad reflection on their development in the future.

Comment et pourquoi l’éducation à l’esprit d’entreprendre questionne l’évolution du système éducatif français ?

Comment et pourquoi l’éducation à l’esprit d’entreprendre questionne l’évolution du système éducatif français ?

National images and their reception through football literature

AbstractAs demonstrated extensively by translation studies, national images and their reception undergo significant changes in the transfer process to another culture. From this perspective,La pena máximaby Roncagliolo is an interesting case: not only is the plot tied in with the theme of football, which is widely believed to embody national identity, but it has also been commented on in different target cultures. The reception study displays how the images of Argentina and Peru, which the novel deconstructs by using the 1978 World Cup as a pretext to expose the atrocities perpetrated by their respective totalitarian regimes, are perceived in the Hispanic context and in the French and Dutch literary systems into which they have been translated. While the Argentinian and the French reviews skate over the gruesome reality, the Peruvian, the Spanish and the Dutch ones assume the negative images by emphasizing their socio-political relevance.

Construction of the transitivity system of Myanmar

Abstract A number of studies on transitivity systems of languages have been conducted in the field of Systemic Functional Linguistics. Different linguists have described the transitivity systems of English, French, German, Japanese, Tagalog, Chinese, Vietnamese, Telugu, and Pitjantjatjara, adopting an upward approach which is not effective enough for discourse analysis. So far, there has been no description of the transitivity system of Myanmar in literature. The purpose of this paper is to put forward a clear description of the transitivity system of Myanmar that functions as one of the clause analysis methods from the experiential perspective. To construct a workable transitivity system of Myanmar, the present study follows He’s (forthcoming) (He, Wei. forthcoming. Categorization of experience of the world and construction of transitivity system of Chinese) new description of the Chinese transitivity system containing 32 types of processes that represent our experience of the world. Unlike previous studies, He (forthcoming) proposes autonomous and influential processes of action, mental, and relational clauses with no description of ergativity hypothesized by Halliday (1985) (Halliday, Michael Alexander Kirkwood. 1985. An introduction to functional grammar. London: Arnold) and Matthiessen (1995) (Matthiessen, C. M. I. M. 1995. Lexicogrammatical cartography: English systems. Tokyo: International Language Sciences Publishers). This new model is more comprehensive and effective than previous ones because it adopts a downward approach which can smoothly be applied to discourse analysis. In this paper, the transitivity analysis of Myanmar clauses is performed in accordance with the theories put forward by He (forthcoming) and the semantic configurations of 32 processes in Myanmar transitivity system are illustrated with authentic examples. Findings show that the proposed transitivity system of Myanmar can analyze clauses effectively and it is compatible with the discourse analysis of Myanmar. These findings will make an important contribution to further study of the systemic functional grammar of Myanmar.

Assessing the SAIN,LIM nutrient profile of foods sold by fast food restaurants in Tunisia: Exploring ways for improvement

ObjectivesNon-communicable diseases have increased in Tunisia after the epidemiological transition. That is why the national strategy to prevent and control obesity was elaborated and implemented. Improving the quality of foods is one axis of this strategy. The purpose of this paper was to estimate and evaluate the nutritional profiles of Tunisian foods sold by fast food restaurants, and explore ways for improvement. Material and methodsNutritional quality of 35 average recipes or items was assessed by 70 recipes of dishes sold by fast food restaurants. The SAIN,LIM French scoring system was used. Foods were classified into the four SAIN,LIM classes, i.e. from the healthiest (class 1) to the least healthy (class 4). The recipes were then reformulated and improved by deleting or reducing some unfavorable ingredients like salt. ResultsBefore reformulation, the items were spread over the 4 SAIN,LIM classes (class 1: 42.9%; class 2: 8.6%; class 3: 20.0% and class 4: 28.6%). After reformulation, the items were spread over class 1 (85.7%) and class 3 (14.3%), showing clear improvement of their nutritional quality. ConclusionIn Tunisia, an important percentage of foods sold by fast food restaurant have a good nutrient profile (43%). After reformulation, most items were in the healthiest class. This study is the first to show that it is possible to improve the nutritional quality of foods sold by fast food restaurants, and that the SAIN,LIM system can help to that end.

The limits of accrual accounting applied to public accounts: A French view

The French system of public accounts continues to function at its current state with little doubt. The gap between information provided on the one hand, and users’ vague expectations on the other however, is insistent and continues to widen. At its current state, the public accounts system is not only costly but is also starting to prove inadequate in addressing the challenges of the future. This article aims to determine the extent to which this system could be enhanced – and at what cost – or whether the development of a new system built on different principles should be considered.