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The Chinese state uses cultural heritage as a source of power by linking it to political and economic goals, but heritage discourse has at the same time encouraged new actors to appropriate the discourse to protect their own traditions. This book focuses on that contested nature of heritage, especially through the lens of individuals, local communities, religious groups, and heritage experts. It examines the effect of the internet on heritage-isation, as well as how that process affects different groups of people.

BACKGROUND Cancer is prevalent in the rapidly growing Chinese American community, yet little is known about the symptom experience to guide comprehensive treatment planning. This study evaluated symptom prevalence and patient subgroups with symptom distress in a large sample of Chinese American cancer patients. METHODS Patients were consecutively recruited from 4 oncology practices, and they completed a translated cancer symptom scale. Latent class cluster analysis was used to identify subgroups of patients with distinct symptom distress profiles. RESULTS There were 1436 patients screened; 94.4% were non–English-speaking, and 45.1% were undergoing cancer therapy. The cancers included breast (32.6%), lung (14.8%), head and neck (12.5%), and hematologic cancer (10.1%). Overall, 1289 patients (89.8%) had 1 or more symptoms, and 1129 (78.6%) had 2 or more. The most prevalent symptoms were a lack of energy (57.0%), dry mouth (55.6%), feeling sad (49.3%), worrying (47.5%), and difficulty sleeping (46.8%). Symptoms causing “quite a bit” or “very much” distress included difficulty sleeping (37.9%), a lack of appetite (37.2%), feeling nervous (35.8%), pain (35.2%), and worrying (34.0%). Four patient subgroups were identified according to the probability of reporting moderate to high symptom distress: very low physical and psychological symptom distress (49.5%), low physical symptom distress and moderate psychological symptom distress (25.2%), moderate physical and psychological symptom distress (17.4%), and high physical and psychological symptom distress (7.8%). CONCLUSIONS Symptom prevalence is high in community-dwelling Chinese American cancer patients, and nearly half experience severe distress (rated as “quite a bit” or “very much” distressing) from physical symptoms, psychological symptoms, or both. These data have important implications for the development of effective symptom control interventions. Cancer 2015. © 2015 American Cancer Society. Cancer 2015;121:3352–3359. © 2015 American Cancer Society.

The enzyme chloroperoxidase (CPO) was immobilized in silica sol-gel beads prepared from tetramethoxysilane. The average pore diameter of the silica host structure (~3 nm) was smaller than the globular CPO diameter (~6 nm) and the enzyme remained entrapped after sol-gel maturation. The catalytic performance of the entrapped enzyme was assessed via the pyrogallol peroxidation reaction. Sol-gel beads loaded with 4 μg CPO per mL sol solution reached 9–12% relative activity compared to free CPO in solution. Enzyme kinetic analysis revealed a decrease inkcatbut no changes inKMorKI. Product release or enzyme damage might thus limit catalytic performance. Yet circular dichroism and visible absorption spectra of transparent CPO sol-gel sheets did not indicate enzyme damage. Activity decline due to methanol exposure was shown to be reversible in solution. To improve catalytic performance the sol-gel protocol was modified. The incorporation of 5, 20, or 40% methyltrimethoxysilane resulted in more brittle sol-gel beads but the catalytic performance increased to 14% relative to free CPO in solution. The use of more acidic casting buffers (pH 4.5 or 5.5 instead of 6.5) resulted in a more porous silica host reaching up to 18% relative activity.

Learning Objectives After completing this course, the reader will be able to: Discuss the prevalence of frequent or persistent pain among non-English-speaking Chinese American cancer patients.Identify factors that were significantly associated with increased pain intensity and pain-related distress in the population studied. This article is available for continuing medical education credit at CME.TheOncologist.com Background. Little is known about cancer pain in Chinese Americans. The objective of this study was to describe the epidemiology of pain in this population. This information is needed to identify and address unmet clinical needs for culturally relevant interventions targeting pain and its consequences. Methods. A consecutive sample of underserved ethnic Chinese patients in a large community-based oncology practice was screened for persistent or frequent pain. Those patients with pain completed translated instruments assessing demographics, linguistic acculturation, disease-related characteristics, and pain-related characteristics. Results. Of 312 patients screened, 178 (57.1%) reported frequent or persistent pain, 175 were eligible, and 170 participated. Most participants (85.9%) were born in China and 84.7% overall spoke Cantonese only. The most common cancers were gastrointestinal (28.2%), lung (21.8%), breast (20.6%), head and neck (12.9%), and genitourinary (4.7%); 43.5% had metastatic disease. The mean worst pain severity on a 0–10 numeric scale was 4.7 (standard deviation, 2.4), with 28.2% of patients rating their worst pain at ≥7 of 10. Although 37.6% used opioids and 47.1% used nonopioids, 45.8% reported “little” or “no” pain relief from medications. Complementary or alternative medicine therapies for cancer pain were used by 35.8%. In multiple regression analyses, worst pain was positively associated with acculturation to the English language and opioid therapy, and pain-related distress was positively associated with opioid therapy. Conclusion. Pain is prevalent among community-dwelling, ethnic Chinese American cancer patients. Additional studies are needed to confirm these results and investigate the finding that higher linguistic acculturation is associated with reports of more intense pain.

Objective The objective of this study was to identify the most commonly retreated tooth at a postgraduate endodontics program and to compare this result with teeth requiring primary root canal treatment as well as those that required further surgical endodontic treatment. Study design The study population consisted of 6,894 patients treated between 2000 and 2005 by endodontic postgraduate students at the University of Pennsylvania School of Dental Medicine. Data regarding tooth type and endodontic treatment rendered were obtained from the Penn Endo database. Results Initial root canal treatment was most commonly done on mandibular molars. Anterior teeth were 1.411 times more likely to undergo NSRT than molars. Maxillary molars were 1.048 times more likely to undergo conventional retreatment than mandibular molars. Maxillary anterior teeth were 3.032 times more likely than mandibular molars to undergo surgical treatment. Conclusions Mandibular molars may most commonly receive initial root canal treatment but it is the anterior teeth that are more likely to undergo surgical and nonsurgical retreatment. Maxillary molars are more likely to receive surgical intervention than mandibular molars. These data call for further investigation into the reasons for such discrepancy.

Purpose Little is known about the potential adverse effects of interventions to reduce dietary fat. We examined the physical and emotional health effects, and social consequences experienced by women at high risk for breast cancer who had participated in a low-fat diet intervention, randomized, controlled trial for at least 5 years. Methods Participants in the Canadian Diet and Breast Cancer Prevention Trial from British Columbia were mailed a survey questionnaire that included the validated Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and Women's Health Questionnaire (WHQ), and a series of questions on health-related and social constructs. Responses were compared between the diet intervention and control groups by menopausal status. Results Completed questionnaires were returned by 359 women in the diet intervention group and 382 in the control group. No significant differences were found between these groups for SF-36 and WHQ health outcomes, hair/nail changes, physical activity levels, family/friend support levels, and doctor visits. Significantly more women in the intervention group reported taking products for arthritis (other than pain medication), greater difficulty in maintaining eating habits in social situations and at work, greater stress, and guilt related to personal eating habits. These findings persisted for both premenopausal and postmenopausal women. Conclusion Changes resulting from a low-fat diet intervention can be incorporated into women's daily lives with limited long-term negative effects.

Cancer is prevalent in the rapidly growing Chinese American community, yet little is known about the symptom experience to guide comprehensive treatment planning. This study evaluated symptom prevalence and patient subgroups with symptom distress in a large sample of Chinese American cancer patients.Patients were consecutively recruited from 4 oncology practices, and they completed a translated cancer symptom scale. Latent class cluster analysis was used to identify subgroups of patients with distinct symptom distress profiles.There were 1436 patients screened; 94.4% were non-English-speaking, and 45.1% were undergoing cancer therapy. The cancers included breast (32.6%), lung (14.8%), head and neck (12.5%), and hematologic cancer (10.1%). Overall, 1289 patients (89.8%) had 1 or more symptoms, and 1129 (78.6%) had 2 or more. The most prevalent symptoms were a lack of energy (57.0%), dry mouth (55.6%), feeling sad (49.3%), worrying (47.5%), and difficulty sleeping (46.8%). Symptoms causing "quite a bit" or "very much" distress included difficulty sleeping (37.9%), a lack of appetite (37.2%), feeling nervous (35.8%), pain (35.2%), and worrying (34.0%). Four patient subgroups were identified according to the probability of reporting moderate to high symptom distress: very low physical and psychological symptom distress (49.5%), low physical symptom distress and moderate psychological symptom distress (25.2%), moderate physical and psychological symptom distress (17.4%), and high physical and psychological symptom distress (7.8%).Symptom prevalence is high in community-dwelling Chinese American cancer patients, and nearly half experience severe distress (rated as "quite a bit" or "very much" distressing) from physical symptoms, psychological symptoms, or both. These data have important implications for the development of effective symptom control interventions.

Chinese family caregivers in the United States experience high rates of burden. Studies in this population require culturally appropriate and valid instruments.To adapt a Chinese version of the Brief Assessment Scale for Caregivers (BASC), a tool measuring positive and negative effects of caregiving.New items for the Chinese adaptation were generated from the literature, an interdisciplinary professional group, and caregiver focus groups. The new items were translated into Chinese, added to the original 14-item BASC, then administered to caregivers in two surveys (n=205); participants also completed Chinese versions of the Caregiver Burden Inventory-Chinese (CBI-C), the Hospital Anxiety and Depression Scale (HADS), and the Katz Index for Activities of Daily Living. Item reduction and exploration of internal consistency, reliability and validity using correlational, exploratory, and confirmatory factor analysis were performed.Factor analysis and item-total correlations supported reduction in the number of new items. The final BASC-Chinese (BASC-C) included 10 new items plus the 14 items from the original tool with an overall α coefficient of 0.79 for the 24-item scale. Three Chinese-specific factors-cultural strain, decision-making strain, and emotional strain-showed α coefficients of 0.69 to 0.79. Significant first order correlations were found between the BASC-C and previously validated measures (total BASC-C with HADS Anxiety [r=0.64, p0.001], HADS Depression [r=0.60, p0.001], and CBI-C [r=0.60, p0.001]). Partial correlations indicated that the new Chinese items provided information supplemental to the original BASC.This study suggests that the BASC-C is a valid measure of caregiver burden among Chinese family caregivers.

Chan Ching Selina. Les indigènes indignés. La question du droit d'héritage des femmes dans les Nouveaux Territoires. In: Perspectives chinoises, n°22, 1994. pp. 47-50.

27 Background: Cancer is prevalent in the rapidly-growing Chinese-American community, yet little is known about symptom burden to guide comprehensive treatment planning. We evaluated symptom distress and symptom clusters in a large sample of Chinese-American patients with cancer. Methods: Patients were consecutively recruited from four oncology practices and completed a translated cancer symptom scale. Latent class cluster analysis explored symptom distress clusters in patients. Results: Of 1,436 patients screened, 94.4% were non-English speaking and 45.1% were undergoing active cancer therapy. The most common cancer sites were breast (32.6%), lung (14.8%), head and neck (12.5%), and hematologic (10.1%). Overall, 1,289 (89.8%) patients had > 1 symptom and 1,129 (78.6%) patients had > 2. The most prevalent symptoms were lack of energy (57.0%), dry mouth (55.6%), feeling sad (49.3%), worrying (47.5%), and difficulty sleeping (46.8%). Symptoms causing “quite a bit” or “very much” distress included: difficulty sleeping (37.9%), lack of appetite (37.2%), feeling nervous (35.8%), pain (35.2%), and worrying (34.0%). Four symptom distress clusters were identified: very low physical and psychological symptom distress (49.5%); very low physical and moderate psychological symptom distress (25.2%); moderate physical and psychological symptom distress (17.4%), and high physical and psychological symptom distress (7.8%). Patients in the last group reported lack of energy, difficulty sleeping, pain, feeling sad, and worrying. Conclusions: Symptom prevalence is high in community-dwelling, Chinese-American cancer patients and half experience moderate to high distress from clusters of physical symptoms, psychological symptoms, or both. These data have important implications for the development of effective interventions for symptom control.

132 Background: Chinese Americans, the largest Asian subgroup, have high cancer rates. Many are recent immigrants who are economically disadvantaged. Patients often present with advanced illness and poorly controlled pain. Although quality improvement (QI) methodologies, such as rapid-cycle QI, may improve clinical practice and patient outcomes, few QI programs for pain management exist for this population. We aim to 1) test the effectiveness of a rapid-cycle QI intervention to enhance the processes and outcomes of pain management for poor and underserved ethnic Chinese patients; 2) determine whether a rapid-cycle QI intervention for pain can be generalized to other symptoms (fatigue and dyspnea), and 3) identify demographic, cultural, and other barriers and facilitators that are related to intervention uptake. Methods: In this ongoing community study, we are developing and testing a rapid-cycle QI model to improve pain among underserved Chinese American cancer patients, and evaluating factors that influence its uptake and sustainability. Ethnic Chinese patients and clinicians from four oncology practices are the intervention targets. The systems-based intervention incorporates repeated “plan-do-study-assess” QI cycles, including: pain screening, follow-up and early treatment for pain, referral, and provider education. Results: Initial data demonstrates that documentation of pain scores improved from 24-71% of patients overall. In one practice, 37% of 89 patients screened over 45 days had moderate or severe pain; 90% with moderate pain had follow-up appointments within 1 week; 92% with severe pain had immediate clinician attention. Intervention effectiveness will be determined by 2-week longitudinal surveys. The primary outcome is the change in the proportion of patients who achieve adequate and timely pain control after initial presentation. Conclusions: Multiple cultural, system-related, and provider challenges to QI implementation are being addressed. Findings will show the importance of QI interventions to reduce pain disparities, the importance of programs that address underserved Chinese Americans, and the relevance of community-based QI programs for long-term changes in clinical pain management.

106 Background: Chinese Americans are the largest Asian subgroup in the U.S., and many are recent immigrants with high rates of cancer, a leading cause of death for this population. Although Chinese American patients frequently present with advanced illness and poorly controlled pain, information on symptom burden in this population is very limited. As part of an ongoing community study to test the effectiveness of a rapid-cycle quality improvement (QI) intervention to enhance symptom management, we evaluated the prevalence and burden of cancer symptoms in a large sample of first-generation, non-English speaking, ethnic Chinese patients. Methods: A consecutive sample of Chinese American patients in two large community-based oncology practices and one hospital-based practice in New York were screened for cancer symptoms. Eligible adults who self-identified as ethnic Chinese, spoke Cantonese or Mandarin as their primary language, and had a history of cancer completed translated instruments assessing symptom prevalence, severity, and distress administered by bilingual research assistants. The study was approved by the IRB at Beth Israel Medical Center in New York. Results: Of 1,018 cancer patients screened to date (62.2% women; M age = 64.0 years (SD = 13.7, range = 23 to 101); 20.6% reported persistent cancer pain for the past month. The most common cancers were breast (34.3%) lung (12.6%), and head and neck (11.8%) and 41.9% were undergoing active treatment. The mean worst pain intensity on a 0-10 numeric scale was 5.5 (SD = 2.2), with 34.4% rating their worst pain as > 6 of 10. Many (84.5%) reported other symptoms, including fatigue (54.4%), dry mouth (52.4%), difficulty sleeping (44.8%), and drowsiness (37.5%). Overall, 32.7% rated their symptoms as “quite a bit” or “very much” distressing, with sleep disturbance (33.1%), lack of appetite (31.3%), and constipation (29.2%) causing the most severe distress. Conclusions: Symptom burden is high among community-dwelling, economically-disadvantaged ethnic Chinese cancer patients. Our ongoing QI intervention may alleviate the high symptom rate in this population and clarify potential patient, provider, and system-related factors that are associated with symptom control outcomes.