Current Role at Stanford

Data scientist

Education & Certifications

  • BS, Virginia Tech, Exercise Physiology & Biology (1990)
  • BS, University of Texas Health Science Center at San Antonio, PA Studies (1997)
  • MPAS, University of Nebraska Medical Center, PA Studies (1998)
  • PhD, The University of Chicago, Pritzker School of Medicine, Health Studies (2012)

Personal Interests

Humanitarian relief
Sports data analytics
Restoring and racing vintage sports cars


Professional Interests

Precision & personalized medicine
Clinical decision support
Preventive medicine
Large dataset analytics
Predictive analytics
Sports medicine
Health problems of the military


All Publications

  • Military Occupational Disability Risk Surveillance: A Retrospective Cohort Study of Modifiable Risk Factors. Military medicine Nelson, D. A., Pflipsen, M. C., Kurina, L. M. 2020


    INTRODUCTION: Occupational disability among military service members is an important target for preventive screening. The specific aim of this study was to quantify disability risk levels among soldiers with selected risk factors (body mass index extremes, poor or absent physical fitness scores, and tobacco and opioid use) and combinations thereof, suggesting priorities for preventive actions.MATERIALS AND METHODS: This was a retrospective cohort study of 607,006 active-duty soldiers who served in the U.S. Army during 2011-2014. Official medical and administrative data were combined to produce a person-month-based panel dataset with identifiers removed. The subjects were observed longitudinally for incident disability (termed medical nonreadiness) during 1,305,618 person-years at risk. We employed Weibull parametric survival regression models to determine the adjusted medical nonreadiness hazard for selected variables. We then computed individual adjusted risk scores and the population proportions affected by risk factors and combinations thereof in postregression analyses. The project was approved by the Stanford University's Institutional Review Board and underwent secondary review by the Human Research Protections Office of the Defense Health Agency.RESULTS: During the observed time, 81,571 (13.4%) of subjects were found medically not ready. High or low body mass index, low or missing physical fitness test scores, tobacco use, and the highest levels of opioid use were each associated with increased adjusted hazards of medical nonreadiness. The hazards increased substantially when multiple risk factors were present, albeit while affecting reduced population proportions.CONCLUSIONS: We identified marked disability hazard increases, especially in association with opioid use and high body mass index. These factors, in addition to tobacco use and low physical fitness, are potential early prevention targets for clinicians who screen military service members.

    View details for DOI 10.1093/milmed/usaa175

    View details for PubMedID 32779704

  • Stressful Life Changes and Their Relationship to Nutrition-Related Health Outcomes Among US Army Soldiers. The journal of primary prevention Jayne, J. M., Blake, C. E., Frongillo, E. A., Liese, A. D., Cai, B., Nelson, D. A., Kurina, L. M., Funderburk, L. 2020


    Stressful life changes may tax people's adaptive capacity. We sought to determine if and when experiences of stressful life changes were associated with increased odds of adverse nutrition-related health outcomes among US Army soldiers relative to those who did not experience the same stressful life change. An additional aim was to determine which stressful life changes had the greatest association with these outcomes and if there were gender differences in the magnitude of the associations. Stressful life changes studied included: changes in marital status, combat deployment or return from deployment, relocation, adding a child, change in rank, change in occupation, and development of a physical limitation to duty. Using longitudinal data from the Stanford Military Data Repository, which represents all active-duty soldiers aged 17-62 between 2011 and 2014 (n=827,126), we employed an event history analysis to examine associations between stressful life changes and a subsequent diagnosis of hyperlipidemia, substantial weight gain, and weight-related separation from the Army. Marriage was associated with an increase in the odds of substantial weight gain 3months later for both men and women. Developing a physical duty limitation was associated with an increase in the odds of a hyperlipidemia diagnosis 2months later for both men and women, as was substantial weight gain 2months later. Stressful life changes were also associated with increased odds of nutrition-related health outcomes, although we found gender differences in the magnitude of the associations. Findings could be used to mitigate the effects of stress on health by health professionals.

    View details for DOI 10.1007/s10935-020-00583-3

    View details for PubMedID 32124157

  • INCIDENCE OF PELVIC FLOOR DISORDERS IN US ARMY FEMALE SOLDIERS. Urology Rogo-Gupta, L. J., Nelson, D. A., Young-Lin, N., Shaw, J. G., Kurina, L. M. 2020


    To determine the incidence of pelvic floor disorders (PFD) among active-duty US Army female soldiers.We studied 102,015 women for incident PFD using the Stanford Military Data Repository, which comprises medical, demographic and service-related information on all soldiers on active duty in the US Army during 2011-14. Cox proportional hazards estimated adjusted associations with PFD diagnoses. In the adjusted models, military-specific characteristics and fitness were evaluated alongside known PFD predictors.Among 102,015 subjects at risk there was a cumulative incidence of 6.4% over a mean of 27 months (median 29, range 1-42). In adjusted models, obese soldiers were more likely to have a PFD compared to those of normal weight (HR 1.23, CI 1.14-1.34, p<0.001) and those with recent weight gain were more likely to have a PFD compared to those without (HR 1.32, CI 1.24-1.40, p<0.05). Women with the lowest physical fitness scores were more likely to have a PFD (HR 1.14, CI 1.04-1.25) compared to those with the highest scores.Over a median follow-up time of 29 months, 1 in 15 women in this active-duty cohort was diagnosed with a PFD. Optimizing risk factors including BMI and physical fitness may benefit the pelvic health of female soldiers, independent of age, children, and years of service.

    View details for DOI 10.1016/j.urology.2020.05.085

    View details for PubMedID 32650018

  • The value of shorter opioid prescriptions: a simulation evaluation Pharmacoeconomics Bjarnadottir, M., Anderson, D., Agarwal, R., Prasad, K., Nelson, D. 2020; 38 (1): 109-119
  • Gender differences in the associations of body mass index, physical fitness and tobacco use with lower extremity musculoskeletal injuries among new US Army soldiers INJURY PREVENTION Bedno, S. A., Nelson, D., Kurina, L. M., Choi, Y. 2019; 25 (4): 295?300
  • Sickle cell trait and renal disease among African American US Army soldiers BRITISH JOURNAL OF HAEMATOLOGY Hu, J., Nelson, D., Deuster, P. A., Marks, E. S., O'Connor, F. G., Kurina, L. M. 2019; 185 (3): 532?40

    View details for DOI 10.1111/bjh.15820

    View details for Web of Science ID 000465109900015

  • Association of Nonsteroidal Anti-inflammatory Drug Prescriptions With Kidney Disease Among Active Young and Middle-aged Adults JAMA NETWORK OPEN Nelson, D., Marks, E. S., Deuster, P. A., O'Connor, F. G., Kurina, L. M. 2019; 2 (2)
  • Trajectories of body mass index among active-duty US Army soldiers, 2011-2014 Preventive Medicine Reports Jayne, J. M., Blake, C. E., Frongilo, E. A., Liese, A. D., Cai, B., Nelson, D. A., Kurina, L. M., Funderburk, L. 2019; 14
  • Timing and Predictors of Mild and Severe Heat Illness among New Military Enlistees. Medicine and science in sports and exercise Nelson, D. A., Deuster, P. A., O?Connor, F. G., Kurina, L. M. 2018


    PURPOSE: Heat illnesses are important and potentially fatal conditions among physically active individuals. We determined predictors of heat illness among enlistees in a large military population experiencing common physical activity patterns.METHODS: We estimated the adjusted odds of mild and severe heat illness associated with demographic, health-related, and geographic factors among active-duty, United States Army soldiers enlisting between January 2011 - December 2014 (N=238,168) using discrete-time multivariable logistic regression analyses.RESULTS: We observed 2,612 incident cases of mild heat illness (MHI) and 732 incident cases of severe heat illness (SHI) during 427,922 person-years of follow-up, with a mean and median of 21.6 and 21 months per subject. During the first six duty months, 71.3% of the MHIs and 60.2% of the SHIs occurred, peaking at month two. The odds of MHI quadrupled among those with prior SHI (OR=4.02, 95% confidence interval [CI]: 2.67 - 6.03). Body mass index (BMI) extremes increased risk substantially (ORs at BMI ?30: for MHI, 1.41, CI 1.19 - 1.67; for SHI, 1.94, CI 1.47 - 2.56; ORs at BMI <18.5: for MHI, 1.50, CI 1.01 - 2.21; for SHI, 2.26, CI 1.16 - 4.39). Tobacco use was associated with a 55% increase (CI: 1.37 - 1.77) in MHI odds. The odds of MHI increased if taking NSAIDs, opioids or methylphenidate stimulants. Lower age and lower entry aptitude scores were associated with progressively increased MHI odds.CONCLUSION: The majority of heat illnesses occurred at the outset of service, indicating the need for focused prevention methods at the initiation of military duty. Prior heat illness, BMI extremes, medications and tobacco use represent potentially actionable risk factors to address by education, policy, and/or clinician intervention.

    View details for PubMedID 29613996

  • Stated Pain Levels, Opioid Prescription Volume, and Chronic Opioid Use Among United States Army Soldiers. Military medicine Nelson, D. A., Bjarnadottir, M. V., Wolcott, V. L., Agarwal, R. 2018


    Introduction: The use of opioids has increased drastically over the past few years and decades. As a result, concerns have mounted over serious outcomes associated with chronic opioid use (COU), including dependency and death. A greater understanding of the factors that are associated with COU will be critical if prescribers are to navigate potentially competing objectives to provide compassionate care, while reducing the overall opioid use problem. In this study, we study pain levels and opioid prescription volumes and their effects on the risk of COU. This study leveraged passive data sources that support automated decision support systems (DSSs) currently employed in a large military population. The models presented compute monthly, person-specific, adjusted probability of subsequent COT and could potentially provide critical decision support for clinicians engaged in pain management.Materials and Methods: The study population included all outpatient presentations at military medical facilities worldwide among active duty United States Army soldiers during July 2011 to September 2014 (17,664,006 encounters; population N = 552,193). We conducted a retrospective cohort study of this population and employed longitudinal data and a discrete time multivariable logistic regression model to compute COT probability scores. The contribution of pain scores and opioid prescription quantities to the probability of COT represented analytic foci.Results: There were 13,891 subjects (2.5%) who experienced incident COT during the observed time period. Statistically significant interactions between pain scores and prescription quantity were present, in addition to effects of multiple other control variables. Counts of monthly opioid prescriptions and maximum stated pain scores per month were each positively associated with COT. A wide range in individual COT risk scores was evident. The effect of prescription volume on the COT risk was larger than the effect of the pain score, and the combined effect of larger pain scores and increased prescription quantity was moderated by the interaction term.Conclusions: The results verified that passive data on the US Army can support a robust COT risk computation in this population. The individual, adjusted risk level requires statistical analyses to be fully understood. Because the same data sources drive current military DSSs, this work provides the potential basis for new, evidence-based decision support resources for military clinicians. The strong, independent impact of increasing opioid prescription counts on the COT risk reinforces the importance of exploring alternatives to opioids in pain management planning. It suggests that changing provider behavior through enhanced decision support could help reduce COT rates.

    View details for PubMedID 29590410

  • Sickle Cell Trait and Heat Injury Among US Army Soldiers AMERICAN JOURNAL OF EPIDEMIOLOGY Nelson, D., Deuster, P. A., O'Connor, F. G., Kurina, L. M. 2018; 187 (3): 523?28


    There is concern that sickle cell trait (SCT) increases risk of exertional collapse, a primary cause of which is heat injury. However, to our knowledge, no population-based studies among active individuals have addressed this, representing a critical evidence gap. We conducted a retrospective cohort study of SCT-tested African-American soldiers who were on active duty in the US Army anytime between January 2011 and December 2014. Using Cox proportional hazards models and adjusting for demographic and medical factors, we observed no significant associations between SCT and either mild heat injury (hazard ratio (HR) = 1.15, 95% confidence interval (CI): 0.84, 1.56; n = 45,999) or heat stroke (HR = 1.11, 95% CI: 0.44, 2.79; n = 46,183). Risk of mild heat injury was substantially higher among soldiers with recent prescriptions for antipsychotic agents (HR = 3.25, 95% CI: 1.33, 7.90). Risk of heat stroke was elevated among those with a prior mild heat injury (HR = 17.7, 95% CI: 8.50, 36.7) and among overweight and obese individuals (HR = 2.91 (95% CI: 1.38, 6.17) and HR = 4.04 (95% CI: 1.72, 9.45), respectively). In a setting where universal precautions are utilized to mitigate risk of exertion-related illnesses, SCT is not associated with either mild heat injury or heat stroke.

    View details for PubMedID 29020197

  • Deployment and Preterm Birth Among United States Army Soldiers American Journal of Epidemiology Shaw, J. G., Nelson, D. A., Shaw, K. A., Woolaway-Bickel, K., Phibbs, C. S., Kurina, L. M. 2018: 687?95


    With increasing integration of women into combat roles in the US military, it is critical to determine whether deployment, which entails unique stressors and exposures, is associated with adverse reproductive outcomes. Few studies have examined whether deployment increases the risk of preterm birth; no studies (to our knowledge) have examined a recent cohort of servicewomen. We therefore used linked medical and administrative data from the Stanford Military Data Repository for all US Army soldiers with deliveries between 2011 and 2014 to estimate the associations of prior deployment, recency of deployment, and posttraumatic stress disorder with spontaneous preterm birth (SPB), adjusting for sociodemographic, military-service, and health-related factors. Of 12,877 deliveries, 6.1% were SPBs. The prevalence was doubled (11.7%) among soldiers who delivered within 6 months of their return from deployment. Multivariable discrete-time logistic regression models indicated that delivering within 6 months of return from deployment was strongly associated with SPB (adjusted odds ratio = 2.1, 95% confidence interval: 1.5, 2.9). Neither multiple past deployments nor posttraumatic stress disorder was significantly associated with SPB. Within this cohort, timing of pregnancy in relation to deployment was identified as a novel risk factor for SPB. Increased focus on servicewomen's pregnancy timing and predeployment access to reproductive counseling and effective contraception is warranted.

    View details for DOI 10.1093/aje/kwy003

    View details for PubMedCentralID PMC5889029

  • Gender differences in limited duty time for lower limb injury OCCUPATIONAL MEDICINE-OXFORD Holsteen, K. K., Choi, Y. S., Bedno, S. A., Nelson, D. A., Kurina, L. M. 2018; 68 (1): 18?25


    Among active-duty military personnel, lower limb musculoskeletal injuries and related conditions (injuries) frequently arise as unintended consequences of physical training. These injuries are particularly common among women. The practical impact of such injuries on temporary military occupational disability has not been estimated with precision on a large scale.To determine the proportion of service time compromised by limited duty days attributable to lower limb injuries, characterize the time affected by these limitations in terms of specific lower limb region and compare the limited duty time between male and female soldiers.Administrative data and individual limited duty assignments (profiles) were obtained for active-duty US Army personnel who served in 2014. Lower limb injury-related profiles were used to calculate the percent of person-time requiring duty limitations by gender and body region.The study group was 568 753 soldiers of whom 14% were women. Nearly 13% of service days for active-duty US Army soldiers required limited duty for lower limb injuries during 2014. Knee injuries were responsible for 45% of those days. Within integrated military occupations, female soldiers experienced 27-57% more time on limited duty for lower limb injuries compared with men.The substantial amount of limited duty for lower limb musculoskeletal injuries among soldiers highlights the need for improvement in training-related injury screening, prevention and timely treatment with particular attention to knee injuries. The excessive impact of lower limb injuries on female soldiers' occupational functions should be a surveillance priority in the current environment of expanding gender-integrated training.

    View details for PubMedID 29267959

  • Exertional Heat Illness in the Military: Risk Mitigation HUMAN HEALTH AND PHYSICAL ACTIVITY DURING HEAT EXPOSURE Kazman, J. B., O'Connor, F. G., Nelson, D., Deuster, P. A., Hosokawa, Y. 2018: 59?71
  • Prior depression and incident back pain among military registered nurses: A retrospective cohort study INTERNATIONAL JOURNAL OF NURSING STUDIES Nelson, D., Menzel, N., Horoho, P. 2017; 74: 149?54


    Occupational back pain rates are substantial among registered nurses, and nurses also report high rates of depression. The role of depression as a potential predictor of back pain among nurses appears understudied.The objective of the study was to determine whether a history of depression predicted incident back pain in a population of military registered nurses when controlling for relevant risk factors.We employed a retrospective cohort approach using longitudinal data in which gender-specific subject groups were followed from the beginning of duty as a registered nurse to the occurrence of an outcome, or to censoring due to completion of service or the end of available data.This study included all United States Army registered nurses who began work during 2011-2014 without evidence of prior back pain in clinical records.Data from automatically-collected medical and administrative sources were combined and used to provide 2134 person-years of observation on 1248 individuals. These data were organized at the person-month level in a panel data structure to support discrete-time multivariable logistic regression models. The models examined the relationships between prior depression, Body Mass Index, the presence of prior combat duty and selected control variables and the outcome, the incident occurrence of back pain.The incidence rate of back pain was 18.6 per 100 person-years and the period prevalence was 31.7%. Prior depression was a statistically-significant predictor of incident back pain among female subjects (odds ratio [OR]: 1.75, 95% confidence interval [CI]: 1.08-2.83, P-value<0.05). Body Mass Index of 30kg/m2 or greater, prior combat deployments, and age 36 years or older was each associated with back pain for male and female nurses.The study's findings provide the first evidence of a temporal link between antecedent depression and later back pain among female military nurses. High Body Mass Index was found to be a further, modifiable risk factor for back pain in this population.

    View details for PubMedID 28697419

  • Objective Effects of Breast Reduction Surgery on Physical Fitness. Annals of plastic surgery Knox, J. A., Nelson, D. A., Latham, K. P., Kurina, L. M. 2017


    BACKGROUND: Reduction mammaplasty is known for excellent outcomes and patient satisfaction. Although patients report improvements in pain, weight loss, and exercise levels, objective data on physical fitness benefits are limited.METHODS: Using the Stanford Military Data Repository, we identified 89 US Army active duty women with at least 1 pre- and postoperative Army Physical Fitness Test (APFT) who underwent reduction mammaplasty during 2011 to 2014. We used paired t tests to compare pre- and postoperative APFT score means and raw values for push-ups, sit-ups, and the 2-mile run.RESULTS: There were 56 subjects (62.9%) who improved in total APFT scores. Total score means increased from 235.9 preoperatively to 243.4 postoperatively (P = 0.0065). Of 28 subjects with at least 2 APFT scores before and after surgery, 20 (71.4%) improved in total scores. The subgroup's mean total score increased from 237.8 to 251.3 (P = 0.0009). Comparing individual pre- and postprocedure APFTs, all subjects demonstrated a mean 3.9% (SD, 0.1) improvement in total scores, and the subpopulation of 28 improved by 6.3% (SD, 0.1). In all events, mean performance values trended toward better postoperative scores. Differences were statistically significant for the total population for the number of sit-ups (P = 0.035), and, for the subgroup of 28, differences were statistically significant for the total score (P = 0.0009), sit-ups (P = 0.0002), and push-ups (P = 0.0134).CONCLUSIONS: Reduction mammaplasty was associated with postoperative physical fitness improvements among US Army active duty women. Soldier data are useful for objectively assessing physical fitness effects of breast reduction surgery.

    View details for DOI 10.1097/SAP.0000000000001167

    View details for PubMedID 28650408

  • Long-Acting Reversible Contraceptive Placement Among Active-Duty U.S. Army Servicewomen. Obstetrics and gynecology Erickson, A. K., Nelson, D. A., Shaw, J. G., Loftus, P. D., Kurina, L. M., Shaw, K. A. 2017; 129 (5): 800-809


    To quantify uptake of long-acting reversible contraceptives (LARC)-intrauterine devices (IUDs) and hormonal implants-among U.S. Army active-duty female soldiers and identify characteristics associated with uptake.This retrospective cohort study used the Stanford Military Data Repository, which includes all digitally recorded health encounters for active-duty U.S. Army soldiers from 2011 to 2014. We analyzed data from women aged 18-44 years to assess rates of LARC initiation using medical billing codes. We then evaluated predictors of LARC initiation using multivariable regression.Among 114,661 servicewomen, 14.5% received a LARC method; among those, 60% received an IUD. Intrauterine device insertions decreased over the study period (38.7-35.9 insertions per 1,000 women per year, ?=0.14, 95% confidence interval [CI] -0.23 to -0.05, P<.05), whereas LARC uptake increased, driven by an increase in implant insertions (20.3-35.4/1,000 women per year, ?=0.41, CI 0.33-0.48, P<.001). Younger age was a positive predictor of LARC uptake: 32.4% of IUD users and 62.6% of implant users were in the youngest age category (18-22 years) compared with 9.6% and 2.0% in the oldest (36-44 years). The likelihood of uptake among the youngest women (compared with oldest) was most marked for implants (adjusted relative risk 7.12, CI 5.92-8.55; P<.001). A total of 26.2% of IUD users had one child compared with 13.2% among non-LARC users (adjusted relative risk 1.94, CI 1.85-2.04, P<.001). The majority (52.2%) of those initiating IUDs were married, which was predictive of uptake over never-married women (adjusted relative risk 1.52, CI 1.44-1.59, P<.001).Among servicewomen, we observed low but rising rates of LARC insertion, driven by increasing implant use. Unmarried and childless soldiers were less likely to initiate LARC. These findings are consistent with potential underutilization and a need for education about LARC safety and reversibility in a population facing unique consequences for unintended pregnancies.

    View details for DOI 10.1097/AOG.0000000000001971

    View details for PubMedID 28383371

  • Is Provider Secure Messaging Associated With Patient Messaging Behavior? Evidence From the US Army JOURNAL OF MEDICAL INTERNET RESEARCH Wolcott, V., Agarwal, R., Nelson, A. 2017; 19 (4): e103


    Secure messaging with health care providers offers the promise of improved patient-provider relationships, potentially facilitating outcome improvements. But, will patients use messaging technology in the manner envisioned by policy-makers if their providers do not actively use it?We hypothesized that the level and type of secure messaging usage by providers might be associated with messaging initiation by their patients.The study employed a dataset of health care and secure messaging records of more than 81,000 US Army soldiers and nearly 3000 clinicians with access to a patient portal system. We used a negative binomial regression model on over 25 million observations to determine the adjusted association between provider-initiated and provider-response messaging and subsequent messaging by their patients in this population over a 4-year period.Prior provider-initiated and response messaging levels were associated with new patient messaging when controlling for the patient's health care utilization and diagnoses, with the strongest association for high provider-response messaging level. Patients whose providers were highly responsive to the messages of other patients initiated 334% more secure messages (P<.001) than patients with providers who did not personally respond to other patients' messages.Our results indicate that provider messaging usage levels and types thereof predict their patients' subsequent communication behavior. The findings suggest the need for more study into the factors associated with provider messaging to fully understand the mechanisms of this relationship.

    View details for PubMedID 28385681

  • Sickle Cell Trait, Rhabdomyolysis, and Mortality among U.S. Army Soldiers. New England journal of medicine Nelson, D. A., Deuster, P. A., Carter, R., Hill, O. T., Wolcott, V. L., Kurina, L. M. 2016; 375 (5): 435-442


    Studies have suggested that sickle cell trait elevates the risks of exertional rhabdomyolysis and death. We conducted a study of sickle cell trait in relation to these outcomes, controlling for known risk factors for exertional rhabdomyolysis, in a large population of active persons who had undergone laboratory tests for hemoglobin AS (HbAS) and who were subject to exertional-injury precautions.We used Cox proportional-hazards models to test whether the risks of exertional rhabdomyolysis and death varied according to sickle cell trait status among 47,944 black soldiers who had undergone testing for HbAS and who were on active duty in the U.S. Army between January 2011 and December 2014. We used the Stanford Military Data Repository, which contains comprehensive medical and administrative data on all active-duty soldiers.There was no significant difference in the risk of death among soldiers with sickle cell trait, as compared with those without the trait (hazard ratio, 0.99; 95% confidence interval [CI], 0.46 to 2.13; P=0.97), but the trait was associated with a significantly higher adjusted risk of exertional rhabdomyolysis (hazard ratio, 1.54; 95% CI, 1.12 to 2.12; P=0.008). This effect was similar in magnitude to that associated with tobacco use, as compared with no use (hazard ratio, 1.54; 95% CI, 1.23 to 1.94; P<0.001), and to that associated with having a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30.0 or more, as compared with a BMI of less than 25.0 (hazard ratio, 1.39; 95% CI, 1.04 to 1.86; P=0.03). The effect was less than that associated with recent use of a statin, as compared with no use (hazard ratio, 2.89; 95% CI, 1.51 to 5.55; P=0.001), or an antipsychotic agent (hazard ratio, 3.02; 95% CI, 1.34 to 6.82; P=0.008).Sickle cell trait was not associated with a higher risk of death than absence of the trait, but it was associated with a significantly higher risk of exertional rhabdomyolysis. (Funded by the National Heart, Lung, and Blood Institute and the Uniformed Services University of the Health Sciences.).

    View details for DOI 10.1056/NEJMoa1516257

    View details for PubMedID 27518662

    View details for PubMedCentralID PMC5026312

  • Prediction of all-cause occupational disability among US Army soldiers OCCUPATIONAL AND ENVIRONMENTAL MEDICINE Nelson, D. A., Wolcott, V. L., Kurina, L. M. 2016; 73 (7): 442-451


    Long-term occupational disability rates associated with eventual discharges from military service have risen sharply among active-duty US Army soldiers during the last three decades, with important implications for soldier health and national security alike. To address this problem, we built predictive models for long-term, all-cause occupational disability and identified disability risk factors using a very large, multisource database on the total active-duty US Army.We conducted a cross-temporal retrospective cohort study and used mixed-effects logistic regression models to derive and validate disability risk assignments. The derivation cohort included 510?616 US Army soldiers on duty in December 2012, and the validation cohort included 483?197 soldiers on duty in December 2013.The predictive model yielded an overall c-statistic of 85.97% (95% CI 85.61% to 86.32%). Risk thresholds at the population's 75th and 95th centiles identified 80.53% and 42.08%, respectively, of the disability designations that occurred population wide during the subsequent 9?months. Frequent work excusals, high outpatient care utilisation and psychotropic medication use were the strongest independent predictors of later disability.These findings indicate that predictive models using diverse data types can successfully anticipate long-term occupational disability among US Army soldiers and could be used for disability risk screening.

    View details for DOI 10.1136/oemed-2015-103436

    View details for Web of Science ID 000378094300005

    View details for PubMedID 27129391

  • Clinical prediction of musculoskeletal-related "medically not ready" for combat duty statuses among active duty U.S. army soldiers. Military medicine Nelson, D. A., Kurina, L. M. 2013; 178 (12): 1365-1372


    No evidence-based mechanism currently exists to inform U.S. Army clinicians of soldiers at risk of being found "Medically Not Ready" for combat duty. Historically, musculoskeletal conditions represent high-frequency medical problems among Army soldiers. We explored the feasibility of using centrally archived medical and administrative data on Army soldiers in the automated prediction of musculoskeletal-related Medically Not Ready soldiers who did not deploy. We examined 56,443 active duty U.S. Army soldiers who underwent precombat medical screening during March through December 2009 and in March 2010. Musculoskeletal problems were associated with 23.0% of nonreadiness cases in the study population. We used multivariable logistic regression in derivation cohorts to compute risk coefficients and cut points. We then applied these coefficients to covariates in validation cohorts, simulating predictions 2 to 3 months before their medical screenings. The analysis yielded c statistics ranging from 83 to 90%. The predictions identified 45 to 73% and 50 to 82% of the individual male and female outcome-positive soldiers, respectively, while obtaining 83 to 95% specificity. Our findings demonstrate the potential of Army data to create evidence-based estimates of nonreadiness risk. These methods could enable earlier patient referrals and improved management, and potentially reduce medically related nondeployment.

    View details for DOI 10.7205/MILMED-D-13-00182

    View details for PubMedID 24306021

  • The evaluation and treatment of patients with low back pain. Journal of the American Academy of Physician Assistants Nelson, D. 2007; 20 (4): 22-26
  • The downward spiral of diabetic ketoacidosis. Advance for Physician Assistants Nelson, D. 2006; 14 (11): 34-36

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