Design Study Research Articles

The design study for the development of sea wall construction on mangrove ecosystems : A case study of Tambak Lorok and Genuk district

The Design Study of the Semarang Sea Wall Development Plan will result in a change in environmental conditions in the eastern coastal area. Changes in environmental conditions that will occur in the area include changes in sea currents which originally flowed eastward moving to the Tambak Lorok area on the west coast and the Java Sea. The method uses Descriptive Qualitative with the help of SEM analysis. Based on the results of the analysis of the SEM model, it is known that the indicator that will be affected based on the Design Study of the Sea Wall Development Plan is the Mangrove Ecosystem of 0.477. To maintain the sustainability of the mangrove ecosystem, a coastal area management system needs to pay attention to the principle of the continuity of the function of existing mangrove forests. Mangrove ecosystems in coastal areas that are maintained, and supported by awareness and common perceptions of various parties about the importance of the existence of mangrove ecosystems will have an impact on the sustainability of coastal areas.

Exploring bracket torque expression: A comparative in vitro study of new self-ligating bracket designs and archwire geometries

This in vitro study aimed to evaluate the torque expression efficiency when it is integrated into the bracket slot versus the bracket base. Additionally, the impact of archwire geometry (rectangular vs. rhomboid) on torque expression has been examined. The torque expression was evaluated in a full arch printed maxillary model, focusing on tooth #11, which was positioned within an alveolus filled with Typodont wax. Three different types of brackets were utilized: conventional metallic bracket (Minidiamond™), self-ligating bracket with torque in base (Damon Q2™), and a new self-ligating bracket design with torque in slot (Damon Ultima™). Two variations of archwires were used: rectangular and rhomboid stainless steel, measuring 0.019×0.025 inches and 0.019×0.0275 inches, respectively, from ORMCO™. The study included seven groups: six experimental groups and a control group, with 15 measurements in each group, totaling 105 torque measurements. Optical impressions were taken of the tooth's original position and its final position after torque expression. STL files were superimposed using GEOMAGIC software to calculate the percentage of torque expression. The self-ligating bracket with torque in slot (Damon Ultima™) shows significantly higher torque expression than the self-ligating bracket with torque in base (Damon Q2™) with a rectangular stainless steel archwire (P=0.00015). The Ultima™ bracket also demonstrates higher torque expression than both the Q2™ and conventional 22° brackets with a rhomboid stainless steel archwire (P<0.003). No significant difference in torque expression was found between the rectangular and rhomboid stainless steel archwires for any bracket group (P>0.05). The self-ligating bracket with torque in slot shows comparable torque expression effectiveness to the conventional bracket, outperforming the self-ligating bracket with torque in base. Archwire geometry does not significantly impact torque expression.

Centering Racial Health Equity in Systematic Reviews Paper 2: Themes from Semi-structured Interviews

ObjectiveIn the context of profound and persistent racial health inequities, we sought to understand how to define racial health equity in the context of systematic reviews and how to staff, conduct, disseminate, sustain, and evaluate systematic reviews that address racial health equity. Study Design and SettingThe study consisted of virtual, semi-structured interviews followed by structured coding and qualitative analyses using NVivo. ResultsTwenty-nine individuals, primarily US-based, including patients, community representatives, systematic reviewers, clinicians, guideline developers, primary researchers, and funders, participated in this study. These interest holders brought up systems of power, injustice, social determinants of health, and intersectionality when conceptualizing racial health equity. They also emphasized including community members with lived experience in review teams. They suggested making changes to systematic review scope, methods, and eligible evidence (such as adapting review methods to include racial health equity considerations in prioritizing topics for reviews, formulating key questions and searches, and specifying outcomes) and broadening evidence to include designs that address implementation and access. Interest holders noted that sustained efforts to center racial health equity in systematic reviews require resources, time, training, and demonstrating value to funders. ConclusionInterest holders identified changes to the funding, staffing, conduct, dissemination, and implementation of systematic reviews to center racial health equity. Action on these steps requires clear standards for success, an evidence base to support transformative changes, and consensus among interest holders on the way forward.

Grouting seepage characteristics in microfracture under triaxial stress conditions: Device design and experimental study

Water plugging by grouting in rock microfracture is a technical challenge in deep underground engineering. In this paper, a novel grouting test system was developed, which can simulate microfracture grouting tests under triaxial stress conditions. A specimen preparation method that can monitor the seepage and diffusion of microfine cement slurry in microfracture was also proposed. Microfracture grouting model tests were conducted on sandstone-like specimens to investigate the effects of confining pressure, roughness, and microfracture aperture on the seepage and diffusion characteristics of sandstone-like specimens. The test results show that microfine cement slurry can effectively seal the microfracture. However, when the microfracture aperture is small or the roughness is large, the slurry is easy to gather and deposit at the inlet, resulting in the phenomenon of "seepage filtration", which makes it difficult for the slurry to be injected into the microfracture. The pressure at the measuring point gradually decreases along the seepage and diffusion direction of the slurry, and the decreasing trend increases with the increase of microfracture roughness. The nonlinear relationship between the slurry volume flow rate and the hydraulic gradient can be described by Forchheimer's law. Moreover, both coefficients a and b in Forchheimer's equation show a gradual increase with increasing microfracture roughness. This study can provide a meaningful reference for the development of rock microfracture grouting technology in deep engineering.

Design, off-design and operation study of concentrating solar power system with calcium-looping thermochemical energy storage and photovoltaic-driven compressed CO2 energy storage

The combination of thermochemical energy storage (TCES) based on calcium-looping (CaL) and concentrating solar power (CSP) is favorable as the potential choice for large-scale, low-cost green power production in the future. However, the self-consumption power of TCES based on CaL accounts for a relatively large proportion compared to the existing molten salt energy storage. To this end, this paper innovatively proposes a 50 MW CSP system integrated with CaL-TCES and photovoltaic (PV)-driven compressed CO2 energy storage (CCES). The percentage of system self-consumption has been significantly reduced after system being optimized based on the results of energy and energy analysis. Consequently, the overall system performance is significantly improved with the energy and exergy efficiencies increased from 14.6 % and 15.7 % to 29.4 % and 31.6 %, respectively, at design-point. Furthermore, a parametric study of the optimized system is investigated. Moreover, the annual operational performance of the optimized CSP-CaL system located in Delingha, China is predicted on an hourly basis. Finally, from a techno-economic perspective, the solar multiple (SM) and TCES capacity are optimized aiming the minimal levelized cost of electricity (LCOE). The results indicate that LCOE ranges from 0.010 to 0.159 $∙kWh-1 for different plant sizes and TCES capacities.

Cancer mortality and geographic inequalities: a detailed descriptive and spatial analysis of social determinants across US counties, 2018–2021

ObjectiveIn the United States, cancer mortality rates continue to decline, yet geographic and racial disparities persist and are particularly evident in the Delta region, characterized by high economic distress and disease burden. We examined cancer mortality patterns by demographic groups across geographic region (Delta vs non-Delta) and investigated the influence of macro-level social determinants of health (SDoH) in cancer death. Study design and methodsThis observational study included cancer death records of individuals aged ≥20 years from 2018 to 2021 in the United States. County-level characteristics were ascertained through the linkage of multiple national administrative and community surveys. We estimated age-standardized mortality rates (ASR) and rate ratios. We calculated the adjusted relative risks by county-level SDoH (geographic region, rurality, household income, income inequality, health insurance, and education) and other factors using age-adjusted multivariate quasi-Poisson regression. ResultsIn 2018–2021, approximately 2.4 million cancer deaths occurred in the United States. We observed important declines in the Black-White disparities, from 16.6% in 2018 (ASR = 289.9 vs 248.6 per 100,000) to 12.1% in 2021 (281.1 vs 250.8) in the Delta region and from 15.9% (254.9 vs 219.9) to 10.7% (240.6 vs 217.3) in the non-Delta region, though Black men in the Delta region remained the highest rate (ASR2021 = 346.9 per 100,000). County-level analyses provided strong evidence of geographic inequality and the role of SDoH, particularly education and income inequality. ConclusionsUnfavorable SDoH are associated with increased cancer death risk. Region-specific health policies and interventions in the Delta region are essential to advance cancer health equity.

The Potential Roles of Ficus carica Extract in the Management of COVID-19 Viral Infections: A Computer-aided Drug Design Study.

The conventional processes of drug discovery are too expensive, timeconsuming and the success rate is limited. Searching for alternatives that have evident safety and potential efficacy could save money, time and improve the current therapeutic regimen outcomes. Clinical phytotherapy implies the use of extracts of natural origin for prophylaxis, treatment, or management of human disorders. In this work, the potential role of common Fig (Ficus carica) in the management of COVID-19 infections has been explored. The antiviral effects of Cyanidin 3-rhamnoglucoside which is abundant in common Figs have been illustrated on COVID-19 targets. The immunomodulatory effect and the ability to ameliorate the cytokine storm associated with coronavirus infections have also been highlighted. This work involves various computational studies to investigate the potential roles of common figs in the management of COVID-19 viral infections. Two molecular docking studies of all active ingredients in common Figs were conducted starting with MOE to provide initial insights, followed by Autodock Vina for further confirmation of the results of the top five compounds with the best docking score. Finally, Molecular dynamic simulation alongside MMPBSA calculations were conducted using GROMACS to endorse and validate the entire work.

Trends in Hepatocellular Carcinoma Mortality Rates in the US and Projections Through 2040

ImportanceThe burden of liver cancer varies worldwide. An upward trend in both hepatocellular carcinoma (HCC) incidence and mortality in the past 2 decades has been observed.ObjectiveTo assess observed HCC-related age-standardized mortality rates (ASMRs) in the US for 2006 to 2022 and provide ASMR projections through 2040.Design, Setting, and ParticipantsThis cross-sectional study used data from the National Vital Statistics System, which is accessible through the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research website. Data on deaths attributed to HCC (from January 1, 2006, to December 31, 2022) were obtained for adults 25 years or older and were stratified by liver disease etiology, age, sex, and race and ethnicity. Etiologies included alcohol-associated liver disease (ALD), hepatitis B virus (HBV), hepatitis C virus (HCV), and metabolic dysfunction–associated steatotic liver disease (MASLD).Main Outcomes and MeasuresThe main outcomes were (1) observed ASMRs of HCC per 100 000 persons using Joinpoint regression (National Cancer Institute) to assess trends during 2006 to 2022 and (2) ASMRs projected for 2023 to 2040 using Prophet and AutoARIMA modeling.ResultsThis study included 188 280 HCC-related deaths from 2006 to 2022. Most deaths occurred among males (77.4%). The annual percentage change was 4.1% (95% CI, 2.2% to 7.7%) for 2006 to 2009 and decreased to 1.8% (95% CI, 0.7% to 2.0%) for 2009 to 2022, with an overall observed ASMR of 5.03 per 100 000 persons in 2022 and a projected ASMR of 6.39 per 100 000 persons by 2040, with consistent trends for both sexes. By etiology, ASMRs decreased for HCV- and HBV-related mortality but increased for ALD- and MASLD-related mortality. In 2022, MASLD surpassed HBV as the third-leading cause of HCC-related death and was projected to overtake HCV in 2032 as the second-leading cause; ALD was projected to be the leading cause of HCC-related death in 2026. In 2022, the ASMR was higher among individuals aged 65 years or older compared with those aged 25 to 64 years (18.37 vs 1.79 per 100 000 persons). The American Indian or Alaska Native population had the largest increase in projected ASMR by 2040 (14.71 per 100 000 persons) compared with the Asian population (3.03 per 100 000 persons).Conclusions and RelevanceIn this cross-sectional study, ASMRs for ALD- and MASLD-related HCC death increased rapidly from 2006 to 2022; ALD-related HCC was projected to be the leading cause by 2026, with MASLD as the second-leading cause by 2032. These findings may serve as a reference for public health decision-making and timely identification of groups at high risk of HCC death.

Three Strikingly Different Crystal Habits of Tadalafil: Design, Characterization, Pharmaceutical Performance, and Computational Studies

Three Strikingly Different Crystal Habits of Tadalafil: Design, Characterization, Pharmaceutical Performance, and Computational Studies

Effectiveness of Game-Based Training of Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Randomized Multiple Baseline Design Study

Background Selective voluntary motor control (SVMC) is the ability to control joint movements independently. Impairments in SVMC can affect functional activities, but only a few interventions directly target SVMC. Therefore, we developed a game-based intervention for children with upper motor neuron lesions to improve SVMC. The intervention trained selective activation of a muscle or joint movement while providing immediate feedback about involuntarily occurring muscle activations or movements in another joint. The intervention was provided in a playful manner with a custom-made game environment and a technology-based interface to capture muscle activation or joint movements. Objective This study aimed to investigate the effectiveness of this game-based intervention and explore treatment response–related factors in children with impaired SVMC undergoing inpatient neurorehabilitation. Methods We conducted a single-case research study with a randomized, nonconcurrent, multiple baseline design. The study consisted of a random-length baseline phase where no SVMC-specific intervention was provided and an intervention phase with additional SVMC training. Concurrently in both phases, children attended their individual multimodal rehabilitation program at our clinic, Swiss Children’s Rehab. During the intervention phase, participants completed ten 45-minute sessions with our game-based SVMC training. SVMC was measured repeatedly throughout both phases and at the 3-month follow-up with a short custom-made assessment. Results Eighteen children with reduced SVMC from upper motor neuron lesions participated in the study. The mean age of the children was 12.7 (SD 2.9) years, and they mostly had spastic cerebral palsy. A linear mixed-effects model revealed a significant trend (P&lt;.001) for improved SVMC already in the baseline phase. This trend did not change significantly (P=.15) when the game-based SVMC training was introduced in the intervention phase, suggesting no additional improvements due to the SVMC training. Although we could not find an overall treatment effect, we could explain 89.4% of the total random variation of the treatment effect by patient and therapy characteristics. Children with spasticity in the trained movement (20.1%), and those who trained the more affected side (23.5%) benefited most from the intervention. At the 3-month follow-up, SVMC had deteriorated compared to the end of the intervention but was still better than at the beginning of the study. Conclusions The regular concomitant rehabilitation program already yielded improvements in SVMC, while the game-based SVMC training showed no additional effects. Although the intervention did not show a group effect, we could identify patient and therapy characteristics that determine who is likely to profit from the intervention. Trial Registration German Clinical Trials Register DRKS00025184; https://tinyurl.com/msnkek9b

Influence of Pnictogen and Ligand Framework on the Lewis Acidity and Steric Environment in Pnictogen Pincer Complexes.

Pnictogen pincer complexes are a fascinating class of compounds due to their dynamic molecular and electronic structures, and valuable stoichiometric or catalytic reactivity. As recognition of their unique chemistry has grown, so too has the library of pincer ligands employed and pnictogen centres engaged to prepare them. Here we computationally study how the choice of pincer ligand framework and pnictogen influence the electronic and steric outcomes within the complexes obtained. The most relevant electronic parameter is the pnictogen-centred electrophilicity, which has been quantified by fluoride ion affinities and LUMO energies, while the most relevant steric parameter is the crowding around the central pnictogen, which has been quantified by the %Vbur values and visualized using steric maps. The resulting trends are analyzed with reference to binding pocket size, acceptor orbital type, electronic delocalization, π-donor strengths, and heteroatom incorporation. Thus, considering 16 ligand frameworks and 4 heavy pnictogen centres, this study provides a broad-spectrum view of stereo-electronic variation in pnictogen pincer complexes, which, together with a recent study on geometric variation in the same family, provides a substantial dataset to guide future molecular design and reactivity studies.

Design and performance study of narrowband polarized colloidal quantum dots photodetector

Abstract Colloidal quantum dot-based (CQD) photodetectors have shown exceptional potential for low-cost, room-temperature broadband imaging. However, the isotropic optical properties of the CQD absorber hinder the capability for multi-dimensional photodetection, such as polarization. Here, we design and theoretically study a CQD photodetector with an encapsulation layer and metal grating layer, which can achieve narrowband polarization sensitivity with a full width at half maximum of 230 nm at a wavelength of 2 μm. We first investigate the effect of the geometric parameters of the architecture. Moreover, we examine the broadband polarized optical properties and analyze the corresponding mechanisms. A large linear polarization ratio of 66 is obtained at an illuminated light wavelength of 2 μm. These results contribute to offering a promising design for constructing narrowband polarized CQD photodetectors, particularly for quantum information processing in the realms of quantum communication and quantum cryptography.

Explicit description of viral capsid subunit shapes by unfolding dihedrons.

Viral capsid assembly and the design of capsid-based nanocontainers critically depend on understanding the shapes and interfaces of constituent protein subunits. However, a comprehensive framework for characterizing these features is still lacking. Here, we introduce a novel approach based on spherical tiling theory that explicitly describes the 2D shapes and interfaces of subunits in icosahedral capsids. Our method unfolds spherical dihedrons defined by icosahedral symmetry axes, enabling systematic characterization of all possible subunit geometries. Applying this framework to real T = 1 capsid structures reveals distinct interface groups within this single classification, with variations in interaction patterns around 3-fold and 5-fold symmetry axes. We validate our classification through molecular docking simulations, demonstrating its consistency with physical subunit interactions. This analysis suggests different assembly pathways for capsid nucleation. Our general framework is applicable to other triangular numbers, paving the way for broader studies in structural virology and nanomaterial design.

The BrEasT cancer afTER-CARE (BETTER-CARE) programme to improve breast cancer follow-up: design and feasibility study results of a cluster-randomised complex intervention trial.

The risk of breast cancer patients for long-term side effects of therapy such as neurotoxicity and cardiotoxicity as well as late effects regarding comorbidities varies from individual to individual. Personalised follow-up care concepts that are tailored to individual needs and the risk of recurrences, side effects and late effects are lacking in routine care in Germany. We describe the methodology of BETTER-CARE, a parallel-arm cluster-randomised controlled trial conducted at 15 intervention and 15 control centres, aiming to recruit 1140 patients, and the results of the pilot phase. The needs- and risk-adapted complex intervention, based on existing development frameworks, includes a multidisciplinary network and digital platforms for symptom and need documentation and just-in-time adaptive interventions. The control group comprises usual care according to clinical guidelines. The primary outcome is health-related quality of life (EORTC QLQ-C30 global health), and secondary outcomes include treatment adherence. The 2-month pilot phase comprising 16 patients in one intervention and one control pilot centre demonstrated the feasibility of the BETTER-CARE approach. BETTER-CARE is a feasible intervention and study concept, investigating individualised needs- and risk-adapted breast cancer follow-up care in Germany. If successful, the approach could be implemented in German routine care. German Clinical Trial Register DRKS00028840. Registered on April 2022.

Design, synthesis and biological studies of new isoxazole compounds as potent Hsp90 inhibitors.

Heat shock protein 90 (Hsp90), a molecular chaperone, contributes to the preservation of folding, structure, stability, and function proteins. In this study, novel compounds comprising isoxazole structure were designed, synthesized and their potential ability as Hsp90 inhibitors was validated through docking studies. The active site-based compounds were prepared through a multi-step synthesis process and their chemical structures were characterized employing FT-IR, NMR, and mass spectrometry analysis. Cytotoxic and Hsp90 inhibition activities of synthesized compounds were assessed by MTT assay and ELISA kit, respectively. Based on the obtained results, compound 5 exhibited the highest cytotoxicity (IC50; 14 µM) against cancer cells and reduced Hsp90 expression from 5.54 ng/mL in untreated (normal cells) to 1.56 ng/mL in cancer cells. Moreover, molecular dynamics (MD) simulation results indicated its high affinity to target protein and approved its excellent stability which is essential for exerting an inhibitory effect on cancer cell proliferation.

‘Crushing The Stress’: An Experimental Study on the Positive Impact of Casual Video Games in Indian Context

Research on Casual Video Gaming in the Indian context are focused on exploring the negative ramifications of gameplay such as addiction and sedentary lifestyle effects. With the rise of video game interventions and increased use of casual games for cognitive training and stress relief in applied settings, there is a need to analyze the positive ramifications of casual video games in India. In this research study, two positive benefits of casual games are looked at: stress relief and cognitive benefits. The research is a repeated measures experimental design study that aims to examine these positive effects in contrast to an assigned control task. 30 participants, between the ages of 18-28 years act as their own controls. The study analyzes the impact of popular American casual game, Bejeweled Classic on stress; measured through blood pressure, heart-rate and state anxiety; and reaction time through the Stroop Task. The data was analyzed using a paired sample t-test. Results did not support the first hypothesis that casual video games reduce stress. The second benefit, however, that of cognitive benefits of casual games, was found to be statistically significant by a p value of 0.01. The study is useful in contributing to the literature of Indian studies that examine positive ramifications of casual games.

Transition from Virtual Reality to Metaverse: Students’ Experiences Regarding the Future of Nursing Education

The study was aimed at determining the effect of educational intervention on nursing students’ awareness of virtual reality (VR), augmented reality (AR), and metaverse in nursing education, both on their level of virtual presence, and their knowledge of, attitudes towards, and awareness of metaverse. A quasi-experimental study with a single-group pretest–posttest design study was conducted at a university. Ninety-three nursing students participated in the present study. Descriptive statistics, independent t-tests, and Pearson’s correlation analysis were used for data analysis. Of all the participants, 60.2% had heard of metaverse, 50.5% had VR experience, and 62.4% said that metaverse could be used in nursing education in the future. The participating nursing students’ experiences regarding their transition from VR to metaverse revealed that their level of readiness for e-learning and knowledge and awareness of metaverse was high. It was concluded that metaverse could be used in nursing education within the possibilities provided by today’s technology.

The Casco concept as an enabler for interdisciplinary design: Designing with flood risk in Venice, Italy

ABSTRACT The environmental crisis demands for an interdisciplinary design of urban infrastructure to increase resilience to climate change. Interdisciplinary design is about integration of data, concepts, ambitions and goals by bridging instrumental differences between engineering and spatial design. This paper presents the results of an interdisciplinary design study that deals with persistent flood issues in the Venice lagoon (Italy). The study illustrates how the differences in languages, methods and tools of the disciplines can be overcome by interdisciplinary collaboration directed towards the designing of spatial and technical solutions. Two design proposals are instrumentally described through the lens of the Casco and the Open Building concepts; both advocate the creation of an overarching frame as the basic condition for adaptive design. The paper gives insights on how to cooperate in interdisciplinary design settings in educational environments and builds knowledge on the collaboration between fields that might be relevant also for professional figures.

Development of a Mobile App for Occupational Stress Screening Among Female Workers: Protocol for an Exploratory Sequential Design Study.

Occupational safety hazards include physical, chemical, ergonomic, biological, and psychological hazards. Technological innovation in screening for occupational stress, especially among female workers, is needed to improve their health and productivity. This research is being conducted to obtain a prediction model of work stress through a questionnaire instrument that includes stressors and symptoms based on the transactional model, as well as measurement of work stress through a mobile app that can be used anywhere. The research is conducted in 3 stages: qualitative research, quantitative research (cross-sectional), and mobile app development. Data were collected from companies located in Jakarta, Indonesia. The sample was chosen based on purposive sampling. For the quantitative research (n=430), logistic regression analysis was used. We are developing a work stress screening instrument for female workers, which includes stressors and symptoms based on the transactional model, in the form of a digital platform so that female workers can undertake the examination anywhere without interfering with working hours or home duties. This research was funded in January 2024 and qualitative data collection began in February 2024. Quantitative data were obtained in March 2024; the number of respondents in the qualitative stage was 6, and in the quantitative stage it was 430. The work stress screening app is in the development stage and will be launched at the same time as the data collection is performed so we can examine the respondents' perspectives on the use of the app. This study analyzes the prediction of work stress to help female workers screen for work stress. Workers who are detected as experiencing work stress will be educated using an algorithm programmed in the app. PRR1-10.2196/55874.

Pathology driven automation to improve updating documented follow up recommendations in the EHR after colonoscopy

Background: Failure to document colonoscopy follow-up needs post-polypectomy can lead to delayed detection of colorectal cancer (CRC). Automating the update of a unified follow-up date in the electronic health record (EHR) may increase the number of patients with guideline concordant CRC follow-up screening. Methods: Prospective pre-post design study of an automated rules-engine-based tool using colonoscopy pathology results to automate updates to documented CRC screening due dates was performed as an operational initiative, deployed enterprise-wide May 2023. Participants were aged 45-75 who received a colonoscopy November 2022 to November 2023. Primary outcome measure is rate of updates to screening due dates and proportion with recommended follow-up &lt;10-years. Multivariable log-binomial regression was performed [relative risk (RR), 95% confidence intervals (95% CIs)]. Results: Study population included 9,824 standard care and 19,340 intervention participants. Participants had a mean age of 58.6±8.6 years and included 53.4% females, 69.6% non-Hispanic White, 13.5% non-Hispanic Black, 6.5% Asian, and 4.6% Hispanic. Post-intervention, 46.7% of follow-up recommendations were updated by the rules engine. The proportion of patients with a 10-year default follow-up frequency significantly decreased (88.7% to 42.8%, p&lt;0.001). The mean follow-up frequency decreased by 1.9 years (9.3 to 7.4 years, p&lt;0.001). Overall likelihood of an updated follow-up date significantly increased (RR 5.62, 95%CI: 5.30 – 5.95, p&lt;0.001). Conclusion: An automated rules-engine-based tool has the potential to increase accuracy of colonoscopy follow-up dates recorded in patient EHR. The results emphasize the opportunity for more automated and integrated solutions for updating and maintaining EHR health maintenance activities.