The genetic epidemiology program is focused on two major themes: (1) evaluating the role of genetic and environmental contributions in the etiology of chronic mental health and medical conditions and (2) translating the current understanding of the role of genetic and environmental influences on these outcomes into innovative approaches for enhancing the adoption of best practices in the community, clinical practice, and public health. The program maintains active collaborations with several organizations to accomplish these goals, including: the Virginia Institute for Psychiatric and Behavioral Genetics, the Center for Society and Health, and the Seventh District Health and Wellness Initiative of Richmond.
1- The Developmental Genetic Epidemiology of Smoking Behaviors.
The goal of this project is to improve understanding of the genetic and environmental contributions to the development of adolescent and young adult smoking behaviors using extended twin and family samples with previously collected longitudinal data across multiple countries of individuals. This effort represents smoking behavior (ie: initiation, progression, dependence and cessation) data from 16 different samples consisting of over 80,000 adolescent twin pairs. Results from this work are expected to refine future genetic association studies and public health approaches related to smoking behaviors (Hermine Maes, PI- 5R01DA025109).
2- The Seventh District Health and Wellness Survey.
The goal of this project is to develop a framework to maintain sustainable community-based public health research within a collaborative partnership (Seventh District Health and Wellness Initiative, HWI) between residents, elected officials, health care providers, and community organizations working to implement health strategies targeting in the East End. The genetic epidemiology group assists the HWI through its involvement with the Seventh District Health and Wellness Survey. This community-based participatory research project combines the strengths and interests of residents, community organizations, students, researchers to collect and analyze health-related data from east end residents using an online health survey. Preliminary goals include: (1) assessing the current state of health and access to health care in the east end of Richmond, (2) developing the foundation for long-term health-related collaborations in the east end, and (3) testing the feasibility of using an internet-based survey to complete this project. Secondary goals include: (1) developing resident capacity to conduct, analyze and disseminate results from epidemiological data and (2) assessing community readiness to receive genetic information in the form of family health history in a public health setting. Regular updates on this project can be found on the Seventh District Health and Wellness Survey Blog
3- The Relationship between New/Emerging Tobacco Use and Tobacco Use Beliefs Across the Lifespan.
The goal of this pilot study (Elizabeth Prom-Wormley, PI), funded by the VCU Center for the Study of Tobacco Products, is to estimate the associations between functional beliefs/opinions with single- and poly-tobacco use (defined as the use of more than one tobacco product simultaneously) in adults as well as adolescents. Analyses supporting study goals will be conducted using Wave 1 data from the Population Assessment of Tobacco and Health (PATH) sample; a longitudinal population-based study of 32,320 adult as well as 13,651 adolescents (ages 12-17) in the United States. Successful completion of this project is expected to produce results that will inform FDA marketing policies to protect the health of US population across all ages. Results will also develop future research in tobacco regulation as well as nicotine dependence.
4- Evaluating the Relationship between Alcohol Use Reduction and Smoking Cessation.
This project is part of an administrative diversity supplement to the parent grant “Gene-Environment Environment Interaction in Adolescent Alcohol Use” (R01AA015416, PI- Danielle Dick). The specific aims of the project are to: (1) Use twin data to characterize gene-environment processes influencing substance use and externalizing behavior in young adulthood; (2) Conduct a series of exploratory analyses aimed at understanding how gene-environment interaction effects identified in twin data can inform our understanding of GxE effects associated with measured genes via a genome-wide association study; and (3) Test the generalizability of identified GxE effects (both twin and molecular) in a second, independent sample (the Virginia Twin Study of Adolescent Behavioral Development, VTSABD), with phenotypic data collection across a parallel age range and GWAS data. The parent project uses previously collected data from ~5,500 individual twins ages 12-27 participating in the longitudinal, population-based Finnish twin study (FinnTwin12) and a second sample, the VTSABD, with data on ~2800 individual twins followed longitudinally, with substance use assessments during childhood/adolescence (8-16 years) and in the early 20s. The grant involves studying both latent genetic influences (as indexed via twin models) and specific measured genetic influences, through the analysis of GWAS data available on both samples.
Maternal and Child Health
Derek Chapman, Ph.D.
The Maternal and Child Health epidemiology research program in the Division of Epidemiology is focused on improving the health and well-being of women, children and families.
Current projects in this research area include:
- Healthy Families for Youth: A comprehensive community-level intervention to reduce youth violence (Chapman Co-PI): The goal of the proposed research is to implement and evaluate the impact of a comprehensive community-level youth violence prevention strategy that integrates the Communities That Care prevention system and the Walker Talker community outreach and capacity building approach (CTC PLUS) in three high-risk urban communities. The project will assess the impact of the intervention on: a) primary youth violence outcomes (e.g., homicides and intentional injuries); b) proximal outcomes including decreased neighborhood disorganization, increased numbers of youth served by high quality, evidence-based violence prevention programs, and decreased risk and increased protective and promotive factors associated with youth violence; and c) aspects of neighborhood and community readiness and capacity associated with youth violence prevention. Findings from this study will inform youth violence prevention strategies in other communities.
Traumatic Brain Injury
Juan Lu, Ph.D., M.P.H., M.D.
The Traumatic Brain Injury (TBI) research program in the Division of Epidemiology is primarily focused on advancing clinical research methods in search of effective treatment for patients with TBI. The activities include (I) research collaborations with the IMPACT investigators on (i) improving experimental study design in TBI research and (ii) understanding the impact of outcome misclassification in TBI clinical trials in order to develop new methods minimizing Glasgow Outcome misclassification in TBI clinical trials; (II) research collaborations with the Oslo University Hospital and Oslo University, Norway on (i) evaluating health and economic outcomes in TBI research, (ii) developing effective rehabilitation intervention programs for patients with moderate and severe TBI, and (iii) studying long-term outcomes following moderate and severe TBI. Several selected projects are briefly described below:
Minimizing outcome misclassification in TBI clinical trials: This work aims at understanding the impact of Glasgow Outcome misclassification through sensitivity analysis in order to develop, validate and implement an online outcome data collection tool that minimizes outcome misclassification in TBI clinical trials. This is a collaborative research effort with IMPACT investigators (International Mission for Prognosis and Analysis of Clinical Trials in TBI), and the project was funded by NIH and sponsored by BHR Pharma in later phase.
Cost analysis in TBI research: This work is to promote a standardized methodology to estimate health and economic outcomes for TBI research in general and to perform a cost-effectiveness analysis for a TBI rehabilitation program in particular. This is collaborative research with Dr. Nada Andelic and investigators from the Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Norway.
Developing effective rehabilitation intervention programs at post-acute phase following TBI: Two rehabilitation intervention studies were funded recently by the Norwegian Health Council. One intervention was designed to target at the community level, and the other was designed with combined cognitive and vocational intervention components for patients with TBI. This is collaborative research with the Department of Physical Medicine and Rehabilitation, Oslo University Hospital and Research Center and Rehabilitation Models and Services (CHARM) at Oslo University, Norway. I am a guest professor for the program of CHARM and PI via a subcontract.
Studying long-term outcomes following moderate and severe TBI: A couple of activities are ongoing to (1) understand the trajectories of long-term functional outcomes and (2) multi-dimensional outcomes following moderate and severe TBI. Again, this is a collaborative research effort with CHARM.
The social epidemiology research program in the Division of Epidemiology is grounded in fundamental cause and life-course theories, and is focused on empirically documenting associations between "upstream" social determinants and adverse health outcomes. This program of research lies at the intersection of civil rights and social justice and is focused on: (1) understanding race/ethnic and gender disparities in health; (2) identifying biologic, behavioral and psychosocial mechanisms of associations between social determinants and health disparities; (3) conducting within-group analyses and examining effect modification to identify high risk groups, as well as protective factors for adverse health outcomes; (4) identifying policy-amenable social determinants of health; and (5) designing intervention studies focused on modifiable social, psychosocial, biologic and behavioral risk factors.
The VCU Center on Society and Health is an academic research center that studies the health implications of social factors—such as education, income, neighborhood and community environmental conditions—and public policy. Its mission is to is to raise awareness about the importance of factors outside of health care that shape health outcomes and to explore ways to improve population health and wellbeing. The values the Center brings to this work include a commitment to equity--opening the doors of opportunity for all members of society--and to partnerships that work across sectors to help stakeholders discover aligned incentives and together achieve meaningful impact. The Center approaches this work by blending four ingredients for success: (1) user-oriented research—scientific scholarship directed at delivering actionable and policy-relevant findings and evidence sought by decision-makers; (2) policy outreach—active efforts to meet with decision-makers in all sectors to gain deep familiarity with the decision-making environment, priorities, and language; (3) stakeholder and community engagement—engaging with affected populations and other stakeholders with an intimate understanding of priorities, context, key questions, and feasible solutions; and (4) strategic communication—an organized effort to identify target audiences and prepare materials and media in a tailored format that is engaging and accessible to the audience. The Center pursues these goals through collaboration with scholars in different disciplines at VCU and other institutions, and by nurturing partnerships with community, government, and private-sector stakeholders.
The themes of Dr. Zhao's multidisciplinary research program are two-folded. First, there is a focus on identifying genetic and phenotypic factors that are associated with cancer risk and outcomes following cancer diagnosis. The goal is to develop these predictors into strategies for risk-stratified screening, treatment, and follow-up recommendations to avoid adverse events, improve quality of life, and ultimately reduce mortality. Dr. Zhao has conducted research identifying genetic and phenotypic predictors of cancer risk and clinical outcomes through genome-wide, global, and targeted approaches – including genetic variants, gene, microRNA and lncRNA expression proôling, DNA methylation patterns, and metabolomics. He has ongoing molecular epidemiologic studies in breast cancer, glioma, melanoma, and pancreatic neuroendocrine tumor. Second, he has a research interest in studying cancer racial disparity. He attempts to discover etiological and modifiable factors with the risk of developing cancer, obesity, and other chronic diseases in minority population. Dr. Zhao has conducted research identifying social-demographic and genetic predictors of obesity and weight gain through cutting-edge omic approach, including genome wide association, metabolomics, and gene-wide DNA methylation analysis.
Breast Cancer: Dr. Zhao has studied molecular epidemiology of breast cancer for over 10 years. His research interest in breast cancer has been racial/ethnic disparities in incidence and survival, with African American women more likely to develop an aggressive form of cancer (i.e., triple-negative breast cancer) at an early age. A substantial proportion of the observed racial/ethnic disparity remains unexplained. Working closing with colleagues, his team has initiated studies to identify alternative approaches that are critically needed to provide new insight to biological function and carcinogenesis. With the grant funding from NIH (5U01CA179655), they have been able to examine whether serum metabolite profiles and genetic susceptibility play a role in the racial/ethnic disparities in breast cancer risk. The metabolomics data have been collected. Currently, the data analysis is still ongoing. At VCU, Dr. Zhao plans to continue his research in molecular epidemiology of breast cancer and expand the research from blood based assays to tumor tissue based molecular analyses. Due to the large proportion of African Americans in the catchment area of Massey Cancer Center, VCU offers a unique opportunity to study racial disparity of breast cancer. He will assess how genetic and epigenetic difference between Blacks and Whites may interact with social and environmental factors and thereby contribute to racial disparity in breast cancer.
Melanoma: Dr. Zhao is the PI of a large melanoma case control study with over 2,200 melanoma cases and 1,300 healthy controls. He has participated in international melanoma consortiums with leaders in the melanoma epidemiology field over the past 3-4 years. Through these efforts and working with Drs. Chad Huff (MD Anderson Cancer Center at the University of Texas) and Lisa Cannon-Albright (University of Utah), the team obtained a $6.5M RO1 grant studying the role of rare variants in the etiology of melanoma. This grant includes validation of top genes in samples from over 4,000 cases and 4,000 controls. This large grant will generate a wealth of data for analysis and collaborations present real opportunities to quickly have an impact in risk assessment for melanoma. In addition to sequencing projects, Dr. Zhao has investigated several intermediate biomarkers linking known melanoma risk factors (e.g. sun exposure, pigmentation) and melanoma risk. For example, they found that melanoma cases had significantly lower levels of global DNA methylation than healthy controls. Among healthy controls, however, those who had fair skin color or light or no tanning after prolonged sun exposure or used a sunlamp had lower levels of global DNA methylation than their counterparts. In addition, those with an intermediate or high phenotypic index, an indicator of cutaneous cancer susceptibility, had increased likelihood of having a low level of global DNA methylation than those with a low phenotypic index. At VCU, Dr. Zhao will continue to collaborate with colleagues at MD Anderson and University of Utah. VCU will participate the melanoma case control study by providing biospecimens from melanoma patients.
Glioma: Since middle of 2014, Dr. Zhao has initiated a molecular epidemiologic study in glioma with the collaboration with Dr. Amy Heimberger from the Department of Neurosurgery (MD Anderson). So far, over 800 glioma cases have been recruited. Blood sample from each case has been collected and they have obtained epidemiologic and clinical data from chart review. One goal is to identify genetic and molecular biomarkers predicting glioma progression and survival. So far, they have investigated the roles of circulating metabolites, microRNAs, and lncRNAs in glioma progression and survival. In addition, they have recently completed genome wide association study using OncoArray chip in 600 glioma cases. At VCU, Dr. Zhao will continue the glioma study by recruiting glioma patients from Massey Cancer Center.
Prostate cancer: Working with Dr. Bernard Fuemmeler from the VCU Department of Health Behavior and Policy, they have begun to establish collaboration with Dr. John Semmes from Eastern Virginia Medical School (EVMS) on prostate cancer research. EVMS has collected epidemiological and clinical data as well as various types of biospecimens from over 13,000 newly diagnosed prostate patients (including over 4,700 Blacks) from Virginia.
Renal Cell carcinoma: Utilizing banked tumor tissues in renal cell carcinoma, Dr. Zhao plans to study how alcohol drinking may influence tumor molecular characterization and consequently modify clinical outcomes. In addition, he is interested in exploring the roles of microbiome and virome in the development of renal cell carcinoma.
Jim Burch, M.S., Ph.D.
Jim Burch, M.S., Ph.D.
Division of Epidemiology
Phone: (804) 828-9785
One Capitol Square, 8th floor, room 822
830 E. Main Street
Richmond, VA 23219
Sleep and Circadian Rhythm Disturbance and Cancer
Current and Future Research Interests
Dr. Burch's research focuses primarily on linkages between sleep disturbances, circadian rhythm disruption, and cancer incidence or survival. This area of scholarship offers promise not only for ameliorating health and safety impacts among shiftworkers, but also for the development of innovative cancer prevention and survivorship strategies. His recently awarded R01 grant (1R01CA231321-01A1) targets one of the National Cancer Institute’s research priorities (Provocative Question 6: ‘How do circadian processes affect tumor development, progression, and response to therapy?’, RFA-CA-17-017). This case-control study will determine whether the disruption of circadian rhythms and sleep, including their genetic and epigenetic correlates, is associated with gastrointestinal inflammation or colorectal adenoma formation among African- and European-American patients receiving a screening colonoscopy for colorectal cancer. This project was derived in part from research Dr. Burch performed to help document some of the significant and incompletely explained racial cancer disparities in South Carolina,1-4 as well as the role of ‘circadian disruption’ in cancer susceptibility.5-9 His case-control study in India was the first among non-shiftworking women to suggest that extremes in chronotype (morning or evening preference) may confer an increase in breast cancer susceptibility.6 This research is innovative and significant because ‘circadian hygiene’ may serve as a novel strategy for the cancer prevention.
Another aspect of Dr. Burch's research focuses on military personnel and police, who are impacted by myriad occupational hazards associated with increased disease risk (e.g., irregular sleep/wake schedules, extreme stress, physical and psychological injury, and exposure to chemical and biological agents). His National Veteran Sleep Disorder Study found a ~6-fold increase in sleep disorder prevalence among Veterans in the USA from 2000 to 2010.10 The largest increases were observed among those with post-traumatic stress disorder (PTSD), or combat experience. Dr. Burch is a Multi-Principal Investigator (M-PI) for a recently awarded National Institute of Justice grant (2019-R2-CX-0021) that includes collaborators at National Institute for Occupational Safety and Health (NIOSH) and the State University of New York at Buffalo. They will utilize data from one of the most comprehensive shiftwork cohorts in existence, the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study, from which they have previously published multiple papers.11-16 The team's manuscript on shiftwork and cortisol secretion received honorable mention from NIOSH for the national Alice Hamilton Award for Excellence in Occupational Safety and Health (in the epidemiology and surveillance category).14 This new study will examine the role of shiftwork, overtime hours, and secondary jobs on adverse trends in health risk indicators over time (chronic inflammation, metabolic dysregulation, DNA hypomethylation, reduced heart rate variability [HRV]). The goal is to identify evidence-based shiftwork adaptation strategies that foster beneficial trajectories of immune, neurological, and metabolic health. This investigation was informed by Dr. Burch's research on shiftwork adaptation,17-19 his recent publications using longitudinal latent class analysis to examine sleep disturbances and PTSD,20-22 and his recently completed BCOPS study that identified biomarkers of inflammation and metabolic disturbance associated with shiftwork maladaptation (submitted, in review). There are surprisingly few studies of health risks among adapted versus maladapted shiftworkers. In future research, Dr. Burch intends to examine the potential role of shiftwork maladaptation in carcinogenesis.
Dr. Burch also served as M-PI of a Merit Award from the Veterans Affairs’ Office of Research and Development (I01CX001182) that is examining HRV biofeedback as an intervention to alleviate symptoms of chronic pain, stress, fatigue, depression, cognitive disturbances, and insomnia among Veterans. He also served as M-PI for a recently completed pilot intervention examining HRV biofeedback for the treatment of symptom clusters among cancer survivors.23 Improved sleep is among the most potent effects of this treatment. This research builds upon Dr. Burch's previous studies that used wrist actigraphy to characterize sleep.18,21,22,24,25 Through the submission of several recent grants, Dr. Burch intends to expand this research to evaluate whether HRV biofeedback can improve sleep, cognitive performance and other symptoms among Veterans with concussion (mild traumatic brain injury or mTBI), and among firefighters. His recent Dorn Research Institute Seed Grant facilitated development of a telemedicine-based protocol for delivering HRV biofeedback, which will increase its potential for broader dissemination, for exampleamong health care providers working irregular shifts, or for rural or homebound chronically ill patients.
1.Hebert JR, Daguise VG, Hurley DM, Wilkerson RC, Mosley CM, Adams SA, Puett R,Burch JB, Steck SE, Bolick-Aldrich SW. Mapping cancer mortality-to-incidence ratios toillustrate racial and sex disparities in a high-risk population. Cancer. Jun 12009;115(11):2539-2552.
2.Daguise VG, Burch JB, Horner MJ, Mosley C, Hofseth LJ, Wargovich MJ, Lloyd SC,Hebert JR. Colorectal cancer disparities in South Carolina: descriptive epidemiology,screening, special programs, and future direction. J S C Med Assoc. Aug2006;102(7):212-220.
3.Hebert JR, Braun KL, Kaholokula JK, Armstead CA, Burch JB, Thompson B.Considering the Role of Stress in Populations of High-Risk, Underserved CommunityNetworks Program Centers. Prog Community Health Partnersh. 2015;9 Suppl:71-82.
4.Adams SA, Hebert JR, Bolick-Aldrich S, Daguise VG, Mosley CM, Modayil MV, BergerSH, Teas J, Mitas M, Cunningham JE, Steck SE, Burch J, Butler WM, Horner MJD,Brandt HM. Breast cancer disparities in South Carolina: Early detection, specialprograms, and descriptive epidemiology. J SC Med Assoc. Jul 2006;102:231-239.
5.Alexander M, Burch JB, Steck SE, Chen C-F, Hurley TG, Cavicchia P, Ray M, ShivappaN, Guess J, Zhang H, Youngstedt SD, Creek KE, Lloyd S, Yang X, Hébert JR. Case-control study of the PERIOD3 clock gene length polymorphism and colorectal adenomaformation. Oncology Reports. 2015;33:935-941.
6.Wirth MD, Burch JB, Hebert JR, Kowtal P, Mehrotra-Kapoor A, Steck SE, Hurley TG,Gupta PC, Pednekar MS, Youngstedt SD, Zhang H, Sarin R. Case-control study of breast cancer in India: Role of PERIOD3 clock gene length polymorphism and chronotype. Cancer Invest. Aug 2014;32(7):321-329.
7. Burch JB, Wirth M, Yang X. Disruption of circadian rhythms and sleep: role in carcinogenesis. In: Kushida CA, ed. The Encyclopedia of Sleep. Vol 3. Waltham, MA: Academic Press; 2013:150-155.
8. Burch JB, Hrushesky WJM. The protective role of melatonin in breast cancer. Breast Disease: A Year Book Quarterly. 2009;20:240-245.
9. Alexander M, Burch JB, Steck SE, Chen CF, Hurley TG, Cavicchia P, Shivappa N, Guess J, Zhang H, Youngstedt SD, Creek KE, Lloyd S, Jones K, Hebert JR. Case-control study of candidate gene methylation and adenomatous polyp formation. Int J Colorectal Dis. Feb 2017;32(2):183-192.
10. Alexander M, Ray MA, Hebert JR, Youngstedt SD, Zhang H, Steck SE, Bogan RK, Burch JB. The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010. Sleep. 2016;39(7):1399-1410.
11. Wirth MD, Andrew ME, Burchfiel CM, Burch JB, Fekedulegn D, Hartley TA, Charles LE, Violanti JM. Association of shiftwork and immune cells among police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. Chronobiol Int. May 10 2017:1-11.
12. Wirth M, Vena JE, Smith EK, Bauer SE, Violanti J, Burch J. The epidemiology of cancer among police officers. Am J Ind Med. Apr 2013;56(4):439-453.
13. Wirth M, Burch J, Violanti J, Burchfiel C, Fekedulegn D, Andrew M, Zhang H, Miller DB, Youngstedt SD, Hebert JR, Vena JE. Association of the Period3 clock gene length polymorphism with salivary cortisol secretion among police officers. Neuro Endocrinol Lett. 2013;34(1):27-37.
14. Wirth M, Burch J, Violanti J, Burchfiel C, Fekedulegn D, Andrew M, Zhang H, Miller DB, Hebert JR, Vena JE. Shiftwork duration and the awakening cortisol response among police officers. Chronobiol Int. May 2011;28(5):446-457.
15. Holst MM, Wirth MD, Mnatsakanova A, Burch JB, Charles LE, Tinney-Zara C, Fekedulegn D, Andrew ME, Hartley TA, Violanti JM. Shiftwork and biomarkers of subclinical cardiovascular disease: the BCOPS study. J Occup Environ Med. May 2019;61(5):391-396.
16. Wirth MD, Burch J, Shivappa N, Violanti JM, Burchfiel CM, Fekedulegn D, Andrew ME, Hartley TA, Miller DB, Mnatsakanova A, Charles LE, Steck SE, Hurley TG, Vena JE, Hebert JR. Association of a dietary inflammatory index with inflammatory indices and metabolic syndrome among police officers. J Occup Environ Med. Sep 2014;56(9):986-989.
17. Burch JB, Tom J, Zhai Y, Criswell L, Leo E, Ogoussan K. Shiftwork impacts and adaptation among health care workers. Occupational Medicine. Vol 592009:159-166.
18. Burch JB, Yost MG, Johnson W, Allen E. Melatonin, sleep, and shift work adaptation. Journal of occupational and environmental medicine. 2005;47(9):893-901.
19. Burch JB, Alexander M, Balte P, Sofge J, Winstead J, Kothandaraman V, Ginsberg JP. Shift work and heart rate variability coherence: pilot study among nurses. Appl Psychophysiol Biofeedback. Mar 2019;44(1):21-30.
20. McBride D, Porter N, Lovelock K, Shepherd D, Zubizarreta M, Burch JB. Risk and protective factors for the course of post-traumatic stress disorder in frontline workers after the Christchurch, New Zealand earthquake. Disaster Prevention and Management. 2018;27(2):193-206.
21. McMahon DM, Burch JB, Wirth MD, Youngstedt SD, Hardin JW, Hurley TG, Blair SN, Hand GA, Shook RP, Drenowatz C, Burgess S, Hebert JR. Persistence of social jetlag and sleep disruption in healthy young adults. Chronobiol Int. Mar 2018;35(3):312-328.
22. McMahon DM, Burch JB, Youngstedt SD, Wirth MD, Hardin JW, Hurley TG, Blair SN, Hand GA, Shook RP, Drenowatz C, Burgess S, Hebert JR. Relationships between chronotype, social jetlag, sleep, obesity and blood pressure in healthy young adults. Chronobiol Int. Apr 2019;36(4):493-509.
23. Burch JB, Ginsberg JP, McLain AC, Franco R, Stokes S, Susko K, Hendry W, Crowley E, Christ A, Hanna J, Anderson A, Hebert JR, O'Rourke MA. Symptom management among cancer survivors: randomized pilot intervention trial of heart rate variability biofeedback. Appl Psychophysiol Biofeedback. May 1 2020;45:99-108.
24. Du-Quiton J, Wood PA, Burch JB, Grutsch JF, Gupta D, Tyer K, Lis CG, Levin RD, Quiton DF, Reynolds JL, Hrushesky WJ. Actigraphic assessment of daily sleep-activity pattern abnormalities reflects self-assessed depression and anxiety in outpatients with advanced non-small cell lung cancer. Psychooncology. Feb 2010;19(2):180-189.
25. Ray M, Youngstedt SD, Zhang H, Wagner SE, Harmon BE, Jean-Louis G, Cai B, Hurley TG, Hébert JR, Bogan RK, Burch JB. Examination of wrist and hip actigraphy using a novel sleep estimation procedure. Sleep Science. 2014;7:74-81.