The impression is that patients here cope better with terminal illness at home than do patients elsewhere. The extended family, with its strong ties, and the strong Islamic faith that encourages its members to provide for parents and children in case of need mean that any input by health professionals is magnified by the family in the care of the patient. At first, it was uncertain if foreign health professionals would be accepted into Saudi homes (which are intensely private and protected for the family) for the purpose of caring for patients. This has proved unfounded. Hospitality is a very important part of Saudi society; nurses and doctors are welcomed and respected. Much of this success is due to the use of Saudi men as drivers and translators. These people provide 24-hour service, act as social workers assessing the needs of the family, and are the link between the patient and family, the nurse, and the doctor. 2. "CURE" OR "PALLIATION": The emphasis for cancer patients in Saudi Arabia is still on "curative treatment," even after any realistic hope of a cure is gone. The problem this causes is compounded by many patients being excluded from the decision-making process. Decisions made by the family may not always reflect the patient's wishes. Greater communication is needed to guide treatment decisions. 3. TRUTH-TELLING: Denying information of the patient's illness is probably more a historical than a cultural phenomenon. Similar attitudes prevailed until very recently in practically all other countries. In this very conservative country, people are committed to preserving Islamic culture in the face of Western technology. As medicine continues to demonstrate its effectiveness as well as its limitations, people will come to realize that the right of patients to know and understand their illness allows them to cope much better, and is compatible with the responsibility of the family to care for them. 4. WORK FORCE: The government employs 14,500 doctors, but only 12% are Saudi nationals. Nearly all the 33,000 nursing work force are expatriates. There is a constant turnover of expatriate staff. The commitment to continuing care with proper communication that is required for the whole of medicine is likely to be fully realized only when the majority of the workforce are Saudi nationals. 5. PRIMARY, SECONDARY, AND TERTIARY CARE SERVICES: The Kingdom is well served by a system of 174 public hospitals and numerous private clinics. However, for a patient with a chronic or terminal illness, continuing care, even in the community, tends to be provided by the hospital service; whereas the polyclinics and health centers seem to provide mainly crisis management. The aim should be to develop community care for chronic illness as part of the primary health care system. The impact of Western medicine on Saudi society has been dramatic and sudden, as evidenced by the high growth rate of the population. There is now widespread interest in matching the culture to the technology. Much of the drive to change the attitudes of bot...

Thirty-three patients with bone tumours were treated by resection of the growth and reconstruction with a Kotz modular endoprosthesis. The average follow-up was for 50 months, ranging from 14 to 79 months. At the last review, 12 patients (36%) had died due to the tumour and 9 others (27%) had metastases. All 4 patients with proximal tibial reconstruction had poor functional results, due to an extension lag or to knee stiffness. Four of the six tumours of the proximal femur were complicated by local recurrence or dislocation of the hip, and had poor or fair functional results. Of the patients with distal femoral reconstruction, 17 out of 22 had excellent or good functional results. Reconstruction with a modular prosthesis after resection of a tumour gives excellent or good functional results in more than three-fourths of the cases of distal femur reconstruction, but it should be used with caution in the proximal tibia and proximal femur.

Most plant-pollinator networks are based on observations of contact between an insect and a flower in the field. Despite significant sampling efforts, some links are easier to report, while others remain unobserved. Therefore, visit-based networks represent a subsample of possible interactions in which the ignored part is variable. Pollen is a natural marker of insect visits to flowers. The identification of pollen found on insect bodies can be used as an alternative method to study plant-pollinator interactions, with a potentially lower risk of bias than the observation of visits, since it increases the number of interactions in the network. Here we compare plant-pollinator networks constructed (i) from direct observation of pollinator visits and (ii) from identification of pollen found on the same insects. We focused on three calcareous grasslands in France, with different plant and pollinator species diversities. Since pollen identification always yields richer, more connected networks, we focused our comparisons on sampling bias at equal network connectance. To do so, we first compared network structures with an analysis of latent blocks and motifs. We then compared species roles between both types of networks with an analysis of specialization and species positions within motifs. Our results suggest that the sampling from observations of insect visits does not lead to the construction of a network intrinsically different from the one obtained using pollen found on insect bodies, at least when field sampling strives to be exhaustive. Most of the significant differences are found at the species level, not at the network structure level, with singleton species accounting for a respectable fraction of these differences. Overall, this suggests that recording plant-pollinator interactions from pollinator visit observation does not provide a biased picture of the network structure, regardless of species richness; however, it provided less information on species roles than the pollen-based network.