Source Of Risk Information Research Articles

Research on a Three-Way Decision-Making Approach, Based on Non-Additive Measurement and Prospect Theory, and Its Application in Aviation Equipment Risk Analysis.

Due to the information non-independence of attributes, combined with a complex and changeable environment, the analysis of risks faces great difficulties. In view of this problem, this paper proposes a new three-way decision-making (3WD) method, combined with prospect theory and a non-additive measure, to cope with multi-source and incomplete risk information systems. Prospect theory improves the loss function of the original 3WD model, and the combination of non-additive measurement and probability measurement provides a new perspective to understand the meaning of decision-making, which could measure the relative degree by considering expert knowledge and objective data. The theoretical basis and framework of this model are illustrated, and this model is applied to a real in-service aviation equipment structures risk evaluation problem involving multiple incomplete risk information sources. When the simulation analysis is carried out, the results show that the availability of this method is verified. This method can also evaluate and rank key risk factors in equipment structures, which provides a reliable basis for decisions in aviation safety management.

The Roles of Social Media Use and Medical Mistrust in Black Americans’ COVID-19 Vaccine Hesitancy: The RISP Model Perspective

ABSTRACT The COVID-19 pandemic has brought unprecedented challenges to healthcare and public health messaging in the United States. One area of focus has been vaccination uptake among Black Americans, who have experienced COVID-19 deaths disproportionate to their share of the United States population, raising questions about the processes involved in vaccination perceptions and behaviors. Guided by the Risk Information Seeking and Processing model, this study explored the roles of medical mistrust and social media as a source of risk information in Black Americans’ vaccine hesitancy. Survey results from a YouGov panel sample of Black Americans (n = 1,136; 53.5% female) showed that social media use and medical mistrust were positively associated with belief in misinformation related to the COVID-19 vaccine, which, in turn, was positively related to vaccine hesitancy through perceived information insufficiency and information seeking intentions. Furthermore, we found that belief in misinformation and subjective norms toward anti-vaccination also serially mediated the association between social media use and medical mistrust with vaccine hesitancy. Theoretical and practical implications are discussed.

Bank risk aggregation based on the triple perspectives of bank managers, credit raters, and financial analysts

Previous studies have incorporated only textual risk information disclosed by bank managers into bank risk aggregation. Besides bank managers, credit raters and financial analysts are important sources of risk information. Thus, this study expands the sources of textual risk disclosures in bank risk aggregation to include the triple perspectives of bank managers, credit raters, and financial analysts to obtain more reasonable bank risk aggregation results. By aggregating credit, market, and operational risk in the U.S. banking system, we find that disregarding textual risk disclosures from credit rating reports and financial analyst reports leads to biased bank risk aggregation results.

Assessment of predation risk through conspecific cues by anuran larvae

Accurate assessment of predation risk is critical for prey survival during predator–prey interactions. Prey can assess predation risk by the presence of cues dropped by predators themselves, but they can also gather information about risk level through cues released by other prey, avoiding the hazard of being in close proximity to predators. In this study, we examine the ability of anuran larvae (Pelobates cultripes) to detect predation risk indirectly when they are in contact with conspecifics that have been recently exposed to chemical stimuli from natural predators (larvae of aquatic beetles). In a first experiment, we confirmed that larvae exposed to predator cues exhibited innate defensive behavior, indicating that they perceived the risk of predation and, thus, could potentially act as risk indicators for naïve conspecifics. In a second experiment, we observed that unexposed larvae paired with a startled conspecific adjusted their antipredator behavior, presumably by mirroring conspecifics’ behavior and/or using chemical cues from their partners as a risk information source. This cognitive ability of tadpoles to assess predation risk through conspecific cues might play an important role in their interaction with predators, facilitating the early detection of potential threats to elicit appropriate antipredator responses and increase the chances of survival.

Proteomic Markers for Mechanobiological Properties of Metastatic Cancer Cells

The major cause (more than 90%) of all cancer-related deaths is metastasis, thus its prediction can critically affect the survival rate. Metastases are currently predicted by lymph-node status, tumor size, histopathology and genetic testing; however, all these are not infallible, and obtaining results may require weeks. The identification of new potential prognostic factors will be an important source of risk information for the practicing oncologist, potentially leading to enhanced patient care through the proactive optimization of treatment strategies. Recently, the new mechanobiology-related techniques, independent of genetics, based on the mechanical invasiveness of cancer cells (microfluidic, gel indentation assays, migration assays etc.), demonstrated a high success rate for the detection of tumor cell metastasis propensity. However, they are still far away from clinical implementation due to complexity. Hence, the exploration of novel markers related to the mechanobiological properties of tumor cells may have a direct impact on the prognosis of metastasis. Our concise review deepens our knowledge of the factors that regulate cancer cell mechanotype and invasion, and incites further studies to develop therapeutics that target multiple mechanisms of invasion for improved clinical benefit. It may open a new clinical dimension that will improve cancer prognosis and increase the effectiveness of tumor therapies.

From information to public preparedness in the Cascadia Subduction Zone: Examining risk communication outcomes in Metropolitan Portland, OR

A Cascadia Subduction Zone (CSZ) earthquake will cause widespread damage along the Pacific Northwest (PNW) coast of the United States. It is, therefore, crucial to understand how to reduce future impacts across this region and assess current levels of household preparedness. Here, we examine whether decades of risk and preparedness campaigns have established protective knowledge and promoted hazard adjustments for residents of the Portland, Oregon metropolitan (PDX) region, an area where risk and preparedness campaigns have been increasing over the last decade. We also explore how PDX preparedness levels compare to those in other PNW regions using analogous data from multiple surveys over a 20-year time interval and assess PDX respondent’s perceptions of risk information sources. We find that 63% of PDX residents do not intend to “Drop, Cover, and Hold On” (DCHO) when earthquake shaking starts and that, although residents are generally aware of earthquake hazards in the area, they are less aware of the specific risks for their homes. Furthermore, PDX residents’ preparedness levels seem to be comparable to those recently surveyed in Washington, but somewhat less than those surveyed two decades ago in California, though more comprehensive data are needed to verify these results. We also find that people rate risk information provided by emergency managers and their websites as more accurate, understandable, relevant, and new than other sources. Our results suggest that significant gaps remain in translating broad awareness of the CSZ earthquake into personal knowledge and preparedness. This work provides guidance to PDX emergency educators for more targeted messaging and provides methods to measure preparedness variables in other regions for future comparisons. By paying close attention to preparedness gaps, local officials can use their limited resources more effectively to develop strategies to inform their communities and improve preparedness before a major earthquake strikes.

Risk Information Sources for Snow Disaster Risk Preparedness in Scotland

Heavy snow disruptions are common and costly occurrences in the UK, including Scotland. Yet, heavy snow remains an underresearched aspect of disaster risks in Scotland. This study critically examined the 2018 heavy snow event in Scotland referred to as the “Beast from the East” (BfE) in order to explore the different sources of information used by the public in preparation for and response to heavy snow emergencies. Our study also examined the effectiveness of BfE risk communication between authorities and the public and sought to determine if there is a relationship between risk information received and the intention to mitigate risk. Data were collected through a semistructured survey from (n = 180) residents of the Annandale and Eskdale region of Dumfries and Galloway, Scotland. Our analysis shows that public authority information sources were the most sought-after information sources, followed by online and web sources. We found statistically significant differences between groups (such as age, gender, and mobility/disability) in terms of using risk information sources. Further analysis shows that the relationship between information received and the intention to mitigate risks is not linear but influenced by intervening variables such as work pressures, financial commitment, and stakeholders’ expectations. We argue that where full adherence to official risk advice is required, policymakers should carefully consider issues around these three factors.

Roles of Temporal Message Framing and Digital Channel Type in Perception and Dissemination of Food Risk Rumors

Now that online media channels have become important sources of risk information, online rumors about risks have become increasingly problematic. Guided by construal level theory and the social-mediated crisis communication model, this study tests direct, mediating, and moderating effects of temporal message frame and digital media channel type on people’s perceptions of food risk rumors and their intentions to share them. An online experiment with a 2 temporal frame (near vs. distant in time) x 2 channel type (web portal vs. social media site) between-subjects design was conducted among 413 Korean adults. Results show that risk perceptions are affected more by the channel on which rumor information is encountered than by the framing of the information. Specifically, rumor messages presumed to appear on social media generated (a) higher perceived susceptibility than those presumed to appear on web portals (main effects) and (b) higher levels of perceived susceptibility in a distant-future frame condition than in a near-future frame condition (conditional moderating effects). Perceived susceptibility also mediated the interaction effects of temporal frame and channel type on intention to share rumor. This study provides theoretical and practical implications for digital media channel effects on risk perceptions and dissemination intention for risk rumors.

What Severe Medication Errors Reported to Health Care Supervisory Authority Tell About Medication Safety?

ObjectivesThis study investigated severe medication errors (MEs) reported to the National Supervisory Authority for Welfare and Health (Valvira) in Finland and evaluated how the incident documentation applies to learning from errors.MethodsThis study was a retrospective document analysis consisting of medication-related complaints and authoritative statements investigated by Valvira in 2013 to 2017 (n = 58).ResultsMedication errors caused death or severe harm in 52% (n = 30) of the cases (n = 58). The majority (83%; n = 48) of the incidents concerned patients older than 60 years. Most likely, the errors occurred in prescribing (n = 38; 47%), followed by administration (n = 15; 19%) and monitoring (n = 14; 17%). The error process often included many failures (n = 24; 41%) or more than one health professional (n = 16; 28%). Antithrombotic agents (n = 17; 13%), opioids (n = 10; 8%), and antipsychotics (n = 10; 8%) were the therapeutic groups most commonly involved in the errors. Almost all error cases (91%; n = 53) were assessed as likely or potentially preventable. In 60% (n = 35) of the cases, the organization reported actions taken to improve medication safety after the occurrence of the investigated incident.ConclusionsMedication errors reported to the national health care supervisory authority provide a valuable source of risk information and should be used for learning from severe errors at the level of health care systems. High age remains a key risk factor to severe MEs, which may be associated with a wide range of medications including those not typically perceived as high-alert medications or high-risk administration routes. Despite being complex processes, the severe MEs have a great potential to lead to developing systems, processes, resources, and competencies of health care organizations.

Eroding Land and Erasing Place: A Qualitative Study of Place Attachment, Risk Perception, and Coastal Land Loss in Southern Louisiana

Southern Louisiana and its coastal bayous are sites of both frequent flooding and rapid coastal land loss, exacerbated by the increasing effects of climate change. Though much work has examined flood risk perceptions in coastal areas, few studies have considered the qualitative and contextual dimensions of perceptions of coastal land loss and its associated impacts, and how these perceptions relate to local culture, place, and intentions to mitigate personal exposure to risk. We conducted six focus groups in areas with distinct exposure to coastal land loss. Participants expressed strong attachment to community, culture, and place. Personal ties to land loss through family or social connections, experiences with fishing and water-based activities, and indirect impacts on Louisiana’s seafood industry and cuisine provided a lens for understanding the immediate impacts of coastal land loss. Participants felt that exposure to the risks of land loss was inevitable and that mitigation was beyond individual efforts, a feeling that manifested both as pessimism and as a resilient focus on collective action. Considering state history with political corruption, participants generally distrusted state-level mitigation initiatives. These findings shed light on the qualitative dimensions of coastal land loss perceptions in southern Louisiana and their relation to place attachment, mitigation intentions, and sources of risk information. While participants with personal ties to risk report feelings of exposure and inevitability, they are also embedded in communities with strong ties to place. This nuance only complicates the meanings that individuals associate with land loss and the actions that they are motivated to take; impacts of coastal land loss on the landscape and distinct place characteristics of southern Louisiana may lead to significant disruption to identity and well-being, but also provide a pathway for risk awareness and potential motivation of collective mitigation actions.

Abstract PO-042: Nanoparticles imaging for cancer metastasis diagnosis

Abstract The main cause of cancer-related mortality is metastasis; thus, its prediction can critically affect the survival rate. Metastases are currently predicted by lymph-node status, tumor size, histopathology and genetic testing, however, all these are not infallible and getting the results may require weeks. The identification new potential prognostic factors will be an important source of risk information for the practicing oncologist, potentially leading to enhanced patient care through the proactive optimization of treatment strategies. We propose to use fluorescent nanoparticles for metastasis detection. Nowadays nanoparticles are widely used for targeted drug delivery, while particles with specific coatings are encapsulated by cancer cells via endocytosis. We have used low-cost carboxylate-modified fluorescent 200 nm particles to achieve the adhesion and encapsulation efficiency of breast cancer cells with high (MDA-MB-231) and low (MCF7) metastatic potential. Using high-content fluorescence imaging microscope (ImageXpress Micro XL), we have discovered that during short time (up to 1h) highly metastatic cells are able to adhere and encapsulate sufficiently more (p<0.05) nanoparticles than lowly metastatic cells. We have created automatic image analysis algorithms to find quantitative colocalization (Pearson’s and Overlap coefficients) of fluorescent nanoparticles with imaged cells. Migration and invasion of cancer cells is a critical step in metastases formation. The cytoskeleton machinery mechanisms (i.e. actin network), utilized by metastatic cells for invasion process have been found similar to the involvement of actin cytoskeleton in endocytosis process. From the other side, for migration process cells use adhesive structures (developed also by nano-particles adhesion) to probe their surroundings and adapt their mechanical properties. We have previously characterized the invasive and migrative abilities of breast cancer cells, as well as patient-derived tumor cells, by indentation and migration assays. We have achieved quantitative and significantly different results for various cancer cells; however, the data-acquisition of such kind assays requires 4-72hs. The obtained results of encapsulation and adhesion efficiency may lead to developing novel clinical tool for metastasis prediction. The proposed here method is very simple, it does not require neither expensive materials and equipment nor cell manipulations (e.g. serum starvation, staining, expansion), it is potentially suitable for a variety of cells. Rapid (up to 1h), quantitative, patient-specific determination of the metastatic likelihood from biopsy/surgery sample, will directly affect the choice of treatment protocols for cancer patients and eventually increase their life-expectancy. Citation Format: Yulia Merkher, Elizaveta Kontareva, Anna Melekhova, Sergey Leonov. Nanoparticles imaging for cancer metastasis diagnosis [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PO-042.

Public support for healthcare-mediated disclosure of hereditary cancer risk information: Results from a population-based survey in Sweden

BackgroundTargeted surveillance of at-risk individuals in families with increased risk of hereditary cancer is an effective prevention strategy if relatives are identified, informed and enrolled in screening programs. Despite the potential benefits, many eligible at-risk relatives remain uninformed of their cancer risk. This study describes the general public’s opinion on disclosure of hereditary colorectal cancer (CRC) risk information, as well as preferences on the source and the mode of information.MethodsA random sample of the general public was assessed through a Swedish citizen web-panel. Respondents were presented with scenarios of being an at-risk relative in a family that had an estimated increased hereditary risk of CRC; either 10% (moderate) or 70% (high) lifetime risk. A colonoscopy was presented as a preventive measure. Results were analysed to identify significant differences between groups using the Pearson’s chi-square (χ2) test.ResultsOf 1800 invited participants, 977 completed the survey (54%). In the moderate and high-risk scenarios, 89.2 and 90.6% respectively, would like to receive information about a potential hereditary risk of CRC (χ2, p = .755). The desire to be informed was higher among women (91.5%) than men (87.0%, χ2, p = .044). No significant differences were found when comparing different age groups, educational levels, place of residence and having children or not. The preferred source of risk information was a healthcare professional in both moderate and high-risk scenarios (80.1 and 75.5%). However, 18.1 and 20.1% respectively would prefer to be informed by a family member. Assuming that healthcare professionals disclosed the information, the favoured mode of information was letter and phone (38.4 and 33.2%).ConclusionsIn this study a majority of respondents wanted to be informed about a potential hereditary risk of CRC and preferred healthcare professionals to communicate this information. The two presented levels of CRC lifetime risk did not significantly affect the interest in being informed. Our data offer insights into the needs and preferences of the Swedish population, providing a rationale for developing complementary healthcare-assisted communication pathways to realise the full potential of targeted prevention of hereditary CRC.

Understanding relationship between risks and claims for assessing risks with project data

PurposeIn construction management, risks and claims are treated separately, but several studies tacitly acknowledge a strong link between the two. In this context, this research intends to investigate whether risks and claims have a causal relationship? Based on this causal relationship, a claim-based risk assessment model (C-RAM) is developed to quantify occurrences and cost implications of risks using project data.Design/methodology/approachFirst, the causal relationship between risks and claims is established through a conceptual framework for content analysis of the literature on risk management (RM) and claim management (CM). Then, a C-RAM is developed based on the content analysis of 234 claims from 24 settled arbitration awards.FindingsRisks and claims are found to be two stages in the same chain of uncertain events that affect projects, subsequently revealing a causal relationship between risks and claims. Due to this causal relationship, claim documents become a potential source of risk information from past projects. Proposed C-RAM quantifies occurrences of risks with three parameters: number of projects in which a risk occurs, number of ways in which a risk occurs, and number of claims a risk causes if it occurs. Also, cost implications of risks are quantified as percentage of contract sums for interpretation as tangible values.Research limitations/implicationsThough C-RAM is applicable to all types of claims, the results in this paper are based on impacts of risks in past projects that caused claims and reached to arbitration stage.Practical implicationsThe causal relationship between risks and claims will encourage integration of knowledge on RM and CM which is currently treated separately. Practitioners can now visualize claims as cost implications of risks that occurred in projects. Further, C-RAM makes risk assessment (RA) more objective by quantifying the cost implications of risks as percentage of contract sums which can be readily used for contingency estimation.Originality/valueThe relationship between risks and claims, and the potential of claim documents as a source of project risk information, can initiate a new paradigm in RM research based on project data.

That sinking feeling: The changing price of urban disaster risk following an earthquake

Urban resilience to disasters is enhanced through good information and prudent prior decision-making. The 2010/11 Christchurch (Canterbury region) earthquakes provided a new source of risk information to New Zealand home-buyers. We compare pre- and post-earthquake property prices in two other urban areas (one high, one low seismicity) to estimate how pricing of earthquake-related risks changed. We test for risk premia changes associated with soil liquefaction potential (previously largely ignored) and house construction type (with well-known safety implications), exploiting the two risk types across two areas with differing seismicity, pre- and post-earthquake. Consistent with rational responses, we find no evidence that the price of known construction risk changed in either area or that pricing of liquefaction risk changed in the low seismic area, while we find strong evidence that a liquefaction risk discount emerged in the high seismic area following the earthquakes. However the liquefaction risk discount in the high seismic area appears to have largely dissipated within four years. These dynamic results are consistent with the existence of a range of behavioural biases, indicating that public policy actions may be required to enhance urban resilience.

Considerations and Future Research Directions for E-Cigarette Warnings-Findings from Expert Interviews.

Tobacco warning labels are important sources of risk information but research historically has been cigarette-centric. This qualitative study aimed to inform future direction and research on warnings for e-cigarettes. Between June and August 2016, we conducted interviews with 10 researchers with expertise in tobacco warning label research. Interviewees were registrants of a 2016 National Cancer Institute grantee meeting on tobacco warnings. Several participants agreed that the Food and Drug Administration’s new nicotine addiction warning for e-cigarettes could be informative but that it might not resonate with young people. Many agreed that more than one warning would be important as e-cigarette science evolves and that research on additional warning themes (e.g., nicotine exposure, harmful constituents) and execution styles (including use of pictorials) was important. Participants were somewhat mixed about the use of reduced-risk messages within e-cigarette warnings, but agreed that research on how to communicate about cigarette/e-cigarette relative risks was needed. Overall, more research is needed on tobacco warnings for non-cigarette products, including on the message content, placement, execution and potential impact on audiences’ product knowledge, risk perceptions and use intentions. This is particularly needed for products such as e-cigarettes which may have harm-reduction potential relative to cigarettes and require unique considerations.

Market Value Volatility and the Volume of Traded Stock for U.S. Industrial Corporations

A novel two-phase econometric approach was used to first obtain the variance (volatility) of the firm’s market value adjusted for its common stock repurchases and other determinants (the traditional approach). Then, the variance of some 1,077 firms was used to predict the volume of the firm’s common stock traded over a given period of time (the novel approach). The hypothesis was that fast traders in the stock market can use the variance of the firm’s market value as a source of risk information, when deciding on what stock to purchase. An unbalanced panel of firms covering the quarterly time periods from 1999 (4) to 2017 (1) was analyzed by the longitudinal method to obtain the variances. Then, linear regression was used to relate the volume of stock traded to the variances. The novel method goes beyond the traditional volatility approach. The statistical results were acceptable for both phases, but with some concern over the use of the variance as an independent determinant in the second phase analysis.

Socio-demographic differences in risk information seeking sources for non-steroidal anti-inflammatory drugs (NSAIDS)

ObjectivesNon-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for musculoskeletal pain and inflammatory conditions. A better understanding of patient information seeking behavior can help bridge the gap between patient knowledge and health care resources. This study examines the primary sources of NSAID risk information and the associations with patient socio-demographic factors. MethodsA cross-sectional survey analysis of patients on prescription NSAIDs (n=220) seen by primary care physicians in Alabama. Bivariate and multivariable, multinomial logistic regression analyses were conducted to evaluate the associations among primary NSAID risk information sources used with patient socio-demographic factors. ResultsThe primary patient source of information on NSAID risks was physician (57.3%), followed by internet (16.8%), pharmacist (16.4%), and other sources, such as nurses and family/friends (9.6%). Compared to people who use the internet as a primary source of NSAID risk information, patients who were Black/African-American (p=0.002) and 65 years of age or older (p=0.009) were more likely to use a physician. Older patients were also more likely to use a pharmacist (p=0.008) than the internet. In contrast, females (p=0.032) were less likely to use the pharmacist compared to the internet (p=0.032). ConclusionsPatients obtain information from a variety of sources, but primarily from health care providers. While the internet is a fast growing source of health information, socio-demographic disparities in internet use for seeking information exist. Health care providers should be aware of their patient preferences for information sources on medication risks to meet the age, race, and gender need differences of all patients.

Smokers' and E-Cigarette Users' Perceptions about E-Cigarette Warning Statements.

Cigarette warning labels are important sources of risk information, but warning research for other tobacco products is limited. This study aimed to gauge perceptions about warnings that may be used for e-cigarettes. We conducted six small focus groups in late 2014/early 2015 with adult current e-cigarette users and cigarette-only smokers. Participants rated and discussed their perceptions of six e-cigarette warning statements, and warnings in two existing Vuse and MarkTen e-cigarette ads. Participants were open to e-cigarette warnings and provided the strongest reactions to statements warning that e-liquid/e-vapor or e-cigarettes can be poisonous, contain toxins, or are “not a safe alternative to smoking”. However, many also noted that these statements were exaggerated, potentially misleading, and could scare smokers away from reducing their harm by switching to e-cigarettes. Opinions on the Food and Drug Administration’s proposed nicotine addiction warning and warnings that e-cigarettes had not been approved for smoking cessation or had unknown health effects were mixed. Participants perceived MarkTen’s advertisement warning to be stronger and more noticeable than Vuse’s. Care should be taken in developing e-cigarette warnings given their relative recentness and potential for harm reduction compared to other tobacco products. Additional research, including with varied audiences, would be instructive.

Weighing the Risks of Nuclear Energy and Climate Change: Trust in Different Information Sources, Perceived Risks, and Willingness to Pay for Alternatives to Nuclear Power.

We examined how individuals perceive nuclear energy in the context of climate change mitigation and how their perceptions are associated with trust in different risk information sources. We analyzed the interrelationships between trust, perceived risk of nuclear power, climate change concern, perception of nuclear energy as an acceptable way to mitigate climate change, and willingness to pay (WTP) for alternatives to nuclear power. A nationwide survey (N = 967) collected in Finland was analyzed with structural equation modeling. The associations between trust and perceived risk of nuclear power, climate change concern, and perception of nuclear power as a way to mitigate climate change varied by the type of information source. Political party support and other background variables were associated with trust in different information sources. The effect of trust in information sources on WTP was mediated by perceived risks and benefits. The results will increase our understanding of how individuals perceive nuclear energy as a way to cut CO2 emissions and the role of trust in different information sources in shaping nuclear risk perceptions and energy choices.

Abstract P6-09-07: The development of a prediction tool for moderate to severe diarrhea in HER-2/hormone positive metastatic breast cancer (MBC) patients receiving lapatinib in combination with letrozole (L-L)

Abstract Background: For patients with HER-2/hormone positive MBC, the addition of lapatinib to letrozole is associated improvements in tumour response rates and a prolongation of progression free survival. However, moderate to severe diarrhea (≥ grade 2) is a potentially serious toxicity which can lead to dose reductions, delays, hospitalizations and even the premature discontinuation of treatment. Patient care could substantially be improved if these diarrhea events could be accurately predicted through the use of validated and easy-to-use mathematical models. In this study, the development of a repeated measures model to predict the risk of ≥ grade 2 diarrhea prior to each month of L-L therapy is described. Methods Data from 111 patients who received the L-L combination as part of a clinical trial were reviewed [Johnston, 2009]. Generalized estimating equations (GEE) were used to develop the final risk model using a backwards elimination process. Internal validation of the final regression coefficients was done using nonparametric bootstrapping. A risk scoring algorithm (range 0-250) was then derived from the final model coefficients. A receiver operating characteristic curve (ROC) analysis was then undertaken to measure the predictive accuracy of the final scoring algorithm. Results: Presence of skin and lung metastases at baseline, cumulative lapatinib dose and Hg level (nadir) were identified as being important predictors for ≥ grade 2 diarrhea. There was also a negative association between time on therapy and risk of diarrhea where a higher frequency was observed in the first few months. The ROC analysis indicated good predictive accuracy with an area under the curve of 0.80 (95%CI: 0.72 – 0.88). Prior to each new month of therapy, patients with risk scores > 125 units would be considered at high risk for developing ≥ grade 2 diarrhea. Conclusions: Risk of ≥ grade 2 diarrhea is associated with cumulative lapatinib exposure, disease related factors as well as Hg level. The planned external validation and eventual clinical application of this prediction tool will be an important source of risk information for the practicing oncologist and can enhance patient care by optimizing preventative therapies earlier in a proactive manner. Citation Format: George Dranitsaris, Mario E Locouture. The development of a prediction tool for moderate to severe diarrhea in HER-2/hormone positive metastatic breast cancer (MBC) patients receiving lapatinib in combination with letrozole (L-L) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-09-07.