Mapping Protocol Research Articles

Striatal morphology and neurocognitive dysfunction in Huntington disease: The IMAGE-HD study

We aimed to investigate the relationship between striatal morphology in Huntington disease (HD) and measures of motor and cognitive dysfunction. MRI scans, from the IMAGE-HD study, were obtained from 36 individuals with pre-symptomatic HD (pre-HD), 37 with early symptomatic HD (symp-HD), and 36 healthy matched controls. The neostriatum was manually segmented and a surface-based parametric mapping protocol derived two pointwise shape measures: thickness and surface dilation ratio. Significant shape differences were detected between all groups. Negative associations were detected between lower thickness and surface area shape measure and CAG repeats, disease burden score, and UHDRS total motor score. In symp-HD, UPSIT scores were correlated with higher thickness in left caudate tail and surface dilation ratio in left posterior putamen; Stroop scores were positively correlated with the thickness of left putamen head and body. Self-paced tapping (slow) was correlated with higher thickness and surface dilation ratio in the right caudate in symp-HD and with bilateral putamen in pre-HD. Self-paced tapping (fast) was correlated with higher surface dilation ratio in the right anterior putamen in symp-HD. Shape changes correlated with functional measures subserved by corticostriatal circuits, suggesting that the neostriatum is a potentially useful structural basis for characterisation of endophenotypes of HD.

Ontology negotiation: Knowledge interchange between distributed ontologies through agent negotiation

SummaryWith the proliferation of knowledge source on the internet as well as the widely professional agents, the knowledge interchange is drawing much attention. Ontology is recognized as the crucial technology due to their nature of sharing, formalization, and conceptualization to integrate and share the knowledge. In this paper, by interpreting and negotiating the communication content, a unified understanding of knowledge is formed; then, we can realize the interoperability between ontologies. We have developed the ontology automatic negotiation by agent elect protocol (AEP) to elect optimal participants and encourage agents to obey the protocol, concept mapping protocol (CMP) to find the corresponding concept mappings with the highest relevancy, and in addition, agent negotiation protocol (ANP). In ANP, we define the simultaneous negotiation protocol and agents' strategies to combine distributed ontologies interchange with agent negotiation. Finally, the implementation and preliminary results are given to verify the validity of the proposed ontology negotiation.

Reverse electrical and structural remodeling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation.

Adverse left atrial (LA) remodeling is known to be associated with persistent atrial fibrillation (PeAF). The time course and pattern of reversal of LA remodeling following catheter ablation is poorly understood. We aimed to evaluate LA chamber volumes and dimensions, LA conduction velocities, and LA bipolar voltages at baseline and at 2months after catheter ablation for PeAF. Twenty-three patients with PeAF underwent detailed LA mapping during fixed rate atrial pacing using the CARTO3 navigation system prior to undergoing pulmonary vein isolation. All patients returned for protocol-mandated repeat electrophysiology study at 2months, irrespective of symptoms or arrhythmia recurrence, during which all measurements were repeated using an identical mapping protocol. Patients then underwent daily ECG monitoring for 12months. Nineteen out of twenty-three (83.6%) patients had durable PVI of all veins at repeat electrophysiology study, while 4 (17.4%) patients had late reconnection of a single vein each. In the blinded offline analysis, LA volume at follow-up was significantly lower as compared with baseline (55 ± 14mL/m2 vs. 65 ± 15mL/m2, P < 0.001). LA conduction velocities were significantly greater at 2months (0.90 ± 0.13m/s vs. 0.78 ± 0.13m/s, P = 0.01). There was non-uniform regional LA voltage evolution, with a significant increase in bipolar voltages observed on the LA posterior wall (2.18 ± 0.85mV vs. 1.83 ± 0.49mV, P = 0.04), but not elsewhere. Individual variables of remodeling were not associated with AF recurrence. Significant structural and electrical reverse remodeling of the LA can be seen as early as 2months following successful catheter ablation for PeAF.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

P21-T The influence of the navigated TMS mapping protocol on the accuracy of motor representation characteristics

Background Navigated transcranial magnetic stimulation enables noninvasive mapping of muscle cortical representations for research and clinical purposes. Several mapping protocols are in use, with no consensus regarding the optimal one and insufficient data about their influence on the mapping accuracy. We aimed to determine this influence for protocols that employ a stimulation point grid. Methods We mapped the abductor pollicis brevis muscle representations in 8 healthy volunteers (3 women, age median 28, quartiles 24, 29) three times on consecutive days. We used a 7 × 7 stimulation grid, with 10 stimuli per cell applied in a pseudorandom order at an intensity of 110% of the resting motor threshold. The grid size was chosen to cover on average 98% of the area of 121 representations previously mapped without grid. The studied parameters were the area of cells with mean motor evoked potential (MEP) amplitude above 50 μV, the area of cells with at least one (or 6) suprathreshold MEP, the area weighted by the mean amplitude (or the probability of suprathreshold MEP), and the location of the center of gravity. Results Parameter accuracy significantly increased with the number of stimuli. The area weighted by the probability of suprathreshold MEP had the highest accuracy and differed significantly between sessions in three subjects. Conclusions The obtained accuracy dependencies can guide the choice of a sufficient number of stimuli for a given problem, e.g. the detection of significant area changes between sessions in our dataset was possible with at least 7 stimuli per cell. Funding RSF17-75-10062.

Robotic sentinel node mapping in clinical stage 1 endometrial cancer using methylene blue dyes using the robotic platform

Endometrial cancer is a surgically staged cancer. We examined our preliminary experience with sentinel lymph node (SLN) mapping in early stage endometrial cancer using methylene blue dyes. Retrospective review of all clinically stage 1 endometrial cancer staged surgically using the robotic platform. Logistic regression models were built to predict nodal metastasis taking into account age, grade, histology, depth of myometrial invasion, cervical involvement, and use of SLN mapping. Four hundred sixty-nine patients were reviewed. Sixty patients had SLN mapping (13%). Four hundred nine patients underwent standard lymphadenectomy with five documented nodal metastasis (1.2%). Five nodal metastasis (8.3%) were seen in the SLN patients. In the logistic model, the application of SLN mapping was significantly associated with diagnosed nodal metastasis (OR 7.74; 95% CI, 2.04-29.3; P=.003) together with nonendometroid histology (OR 5.05; 95% CI, 1.27-20.12; P=.022). SLN mapping protocol using methylene blue significantly identifies more nodal metastasis than standard lymphadenectomy.

Accuracy of Estimating the Area of Cortical Muscle Representations from TMS Mapping Data Using Voronoi Diagrams.

Motor evoked potentials (MEPs) caused by transcranial magnetic stimulation (TMS) provide a possibility of noninvasively mapping cortical muscle representations for clinical and research purposes. The interpretation of such results is complicated by the high variability in MEPs and the lack of a standard optimal mapping protocol. Comparing protocols requires the determination of the accuracy of estimated representation parameters (such as the area), which is problematic without ground truth data. We addressed this problem and obtained two main results: (1) the development of a bootstrapping-based approach for estimating the within-session variability and bias of representation parameters and (2) estimations of the area and amplitude-weighted area accuracies for motor representations using this approach. The method consists in the simulation of TMS mapping results by subsampling MEPs from a single map with a large number of stimuli. We studied the extensor digitorum communis (EDC) and flexor digitorum superficialis (FDS) muscle maps of 15 healthy subjects processed using Voronoi diagrams. We calculated the (decreasing) dependency of the errors in the area and weighted area on the number of stimuli. This result can be used to choose a number of stimuli sufficient for studying the effects of a given size (e.g., the protocol with 150 stimuli leads to relative errors of 7% for the area and 11% for the weighted area in 90% of the maps). The approach is applicable to other parameters (e.g., the center of gravity) and other map processing methods, such as spline interpolation.

Mapping of transgenic alleles in soybean using a nanopore-based sequencing strategy.

Transgenic technology was developed to introduce transgenes into various organisms to validate gene function and add genetic variations >40 years ago. However, the identification of the transgene insertion position is still challenging in organisms with complex genomes. Here, we report a nanopore-based method to map the insertion position of a Ds transposable element originating in maize in the soybean genome. In this method, an oligo probe is used to capture the DNA fragments containing the Ds element from pooled DNA samples of transgenic soybean plants. The Ds element-enriched DNAs are then sequenced using the MinION-based platform of Nanopore. This method allowed us to rapidly map the Ds insertion positions in 51 transgenic soybean lines through a single sequencing run. This strategy is high throughput, convenient, reliable, and cost-efficient. The transgenic allele mapping protocol can be easily translated to other eukaryotes with complex genomes.

Review on the progress regarding the intervention mapping protocol

Along with the significant development on both theory and practice of health promotion programs, the application of behavioral and social science theories has also been advanced in the fields of design and evaluation regarding the intervention-related studies. Intervention mapping is a new planning protocol, efficiently used to develop, implement, and evaluate health promotion related intervention programs. In this article, we are briefly introducing the basic concepts, implementation steps, specific requirements, as well as reviewing the current progress in methodologies, application that are related to intervention mapping, so as to provide reference for health intervention research studies, domestically.

Development of an exercise adherence program for breast cancer survivors with cancer-related fatigue-an intervention mapping approach.

Cancer-related fatigue (CRF) is the most common and distressing symptom in breast cancer survivors (BCS), with severe impact on quality of life. CRF can be reduced through exercise, but conversely, is also a barrier to exercising. The aim of this article was to apply the intervention mapping protocol (IMP) to develop an exercise adherence intervention for BCS with CRF. The program was developed using the IMP, which consists of six steps. Based on the data from focus group interviews and literature review, we produced a logic model of change. Two performance objectives (survivors adopt and maintain exercise and survivors cope with fatigue) and 17 change objectives were generated. Also, we designed theory-based methods of change, and strategies for practical application. A structured program plan that includes intervention content and methods, ranges, and program data was proposed. Finally, an implementation and evaluation plan was developed. The IMP provided a useful framework to systematically plan an exercise adherence program. This study resulted in a theory and practice-based exercise adherence program, based on behavioral change theories, and practice-based knowledge that fits the needs of BCS with CRF.

Blockchain Design for an Embedded System

This paper proposes a blockchain-based mapping protocol for distributed robotic systems running on embedded hardware. This protocol was developed for a robotic system designed to locomote on lattice structures for space applications. A consensus mechanism, Proof of Validity, is introduced to allow the effort of mining blocks to correlate with the desired tasks the robotic system was designed for. These robots communicate using peer-to-peer LoRa radio. Options, trade-offs and considerations for implementing blockchain technology on an embedded system with wireless radio communication are explored and discussed.

A Nurse-Led Self-Management Support Intervention (ZENN) for Kidney Transplant Recipients Using Intervention Mapping: Protocol for a Mixed-Methods Feasibility Study.

BackgroundOptimal self-management in kidney transplant recipients is essential for patient and graft survival, reducing comorbidity and health care costs while improving the quality of life. However, there are few effective interventions aimed at providing self-management support after kidney transplantation.ObjectiveThis study aims to systematically develop a nurse-led, self-management (support) intervention for kidney transplant recipients.MethodsThe Intervention Mapping protocol was used to develop an intervention that incorporates kidney transplant recipients’ and nurses’ needs, and theories as well as evidence-based methods. The needs of recipients and nurses were assessed by reviewing the literature, conducting focus groups, individual interviews, and observations (step 1). Based on the needs assessment, Self-Regulation Theory, and the “5A’s” model, change objectives were formulated (step 2). Evidence-based methods to achieve these objectives were selected and subsequently translated into practical implementation strategies (step 3). Then, program materials and protocols were developed accordingly (step 4). The implementation to test the feasibility and acceptability was scheduled for 2015-2017 (step 5). The last step of Intervention Mapping, evaluation of the intervention, falls outside the scope of this paper (step 6).ResultsThe intervention was developed to optimize self-management (support) after kidney transplantation and targeted both kidney transplant recipients and nurse practitioners who delivered the intervention. The intervention was clustered into four 15-minute sessions that were combined with regular appointments at the outpatient clinic. Nurses received a training syllabus and were trained in communication techniques based on the principles of Solution-Focused Brief Therapy and Motivational Interviewing; this entailed guiding the patients to generate their own goals and solutions and focus on strengths and successes. Kidney transplant recipients were encouraged to assess self-management challenges using the Self-Management Web and subsequently develop specific goals, action plans, and pursuit skills to solve these challenges.ConclusionsThe Intervention Mapping protocol provided a rigorous framework to systematically develop a self-management intervention in which nurses and kidney transplant recipients’ needs, evidence-based methods, and theories were integrated.International Registered Report Identifier (IRRID)DERR1-10.2196/11856

The Human Influence Experiment (Part 2): Guidelines for Improved Mapping of Local Climate Zones Using a Supervised Classification

Since 2012, Local Climate Zones (LCZ) have been used for numerous studies related to urban environment. In 2015, this use amplified because a method to map urban areas in LCZs was introduced by the World Urban Database and Access Portal Tools (WUDAPT). However in 2017, the first HUMan INfluence EXperiment showed that these maps often have poor or low quality. Since the maps are used in different applications such as urban modelling and land use/land cover change studies, it is of the utmost importance to improve mapping accuracies and a second experiment was launched. In HUMINEX 2.0, the focus lies on providing guidelines on the use of the mapping protocol based on the results of both HUMINEX 1.0 and 2.0. The results showed that: (1) it is important to follow the mapping protocol as strictly as possible, (2) a reasonable amount of time should be spent on the mapping procedure, (3) all users should perform a driving test, and (4) training area sets should be stored in the WUDAPT database for other users.

Development of a Smoke-Free Homes Intervention for Parents: An Intervention Mapping Approach.

Exposure to second-hand smoke (SHS) is associated with various ill-health outcomes for children and adults. Barriers to creating a smoke-free home (SFH) are well-documented. Feasible and effective interventions to create smoke-free homes for disadvantaged households are lacking. Interventions that include providing parents with objective information about the impact of smoking on air quality in their home may be particularly effective. This study describes the development of a novel, theory- and evidence-based smoke-free homes intervention using objectively-assessed air quality feedback. The intervention was developed using the six-step Intervention Mapping (IM) protocol. Findings from literature reviews, focus groups with parents, interviews with health/care professionals, and expert panel discussions shaped intervention content and materials. Findings highlighted the importance of parents receiving personalised information on second-hand smoke levels in their home. Professionals considered the use of non-judgemental language essential in developed materials. Previous literature highlighted the need to address home smoking behaviour at a household rather than individual level. The AFRESH intervention is modular and designed to be delivered face-to-face by healthcare professionals. It includes up to five meetings with parents, two sets of five days’ air quality monitoring and personalised feedback, and the option to involve other household members in creating a smoke-free home using educational, motivational, and goal setting techniques. Further research is needed to evaluate the acceptability and effectiveness of the AFRESH intervention and which specific groups of parents this intervention will most likely benefit. IM was a useful framework for developing this complex intervention. This paper does not present evaluation findings.

Multiparameter MRI quantification of microstructural tissue alterations in multiple sclerosis.

ObjectivesConventional MRI is not sensitive to many pathological processes underpinning multiple sclerosis (MS) ongoing in normal appearing brain tissue (NABT). Quantitative MRI (qMRI) and a multiparameter mapping (MPM) protocol are used to simultaneously quantify magnetization transfer (MT) saturation, transverse relaxation rate R2* (1/T2*) and longitudinal relaxation rate R1 (1/T1), and assess differences in NABT microstructure between MS patients and healthy controls (HC).MethodsThis prospective cross-sectional study involves 36 MS patients (21 females, 15 males; age range 22–63 years; 15 relapsing-remitting MS - RRMS; 21 primary or secondary progressive MS - PMS) and 36 age-matched HC (20 females, 16 males); age range 21–61 years). The qMRI maps are computed and segmented in lesions and 3 normal appearing cerebral tissue classes: normal appearing cortical grey matter (NACGM), normal appearing deep grey matter (NADGM), normal appearing white matter (NAWM). Individual median values are extracted for each tissue class and MR parameter. MANOVAs and stepwise regressions assess differences between patients and HC.ResultsMS patients are characterized by a decrease in MT, R2* and R1 within NACGM (p < .0001) and NAWM (p < .0001). In NADGM, MT decreases (p < .0001) but R2* and R1 remain normal. These observations tend to be more pronounced in PMS. Quantitative MRI parameters are independent predictors of clinical status: EDSS is significantly related to R1 in NACGM and R2* in NADGM; the latter also predicts motor score. Cognitive score is best predicted by MT parameter within lesions.ConclusionsMultiparametric data of brain microstructure concord with the literature, predict clinical performance and suggest a diffuse reduction in myelin and/or iron content within NABT of MS patients.

245. A protocol set-up for fast brain T1 mapping of subcortical tissues

PurposeThis work is part of a larger cohort study aimed at investigating the long term effects of exposure to manganese [1]. In this study we set up a protocol for brain fast T1 mapping and segmentation of subcortical tissues, in particular globus pallidus (GP), that is reported to be a target tissue for manganese deposition in brain. MethodsThe variable flip angle model was used for T1 mapping. Acquisition protocol, set up on a 3T Siemens Skyra MR system, includes 10 RF spoiled 3D gradient echoes (VIBE) with flip angles from 2° to 30° and a reduced scanned volume to cover GP in the shortest possible time, an extra 30° VIBE covering the whole brain (WB- VIBE), two fast acquisitions with different TEs for B1 map calculation, used to correct nominal flip angles, and a 3D-MPRAGE acquisition of the whole brain with the same WB-WIBE geometry. T1 and error maps were calculated offline with a bespoke Matlab script, checking accuracy with calibrated gels. The most efficient pipeline for post-processing, shown in Fig. 1, is as follows: T1 map calculation of the reduced volume, and zero padding of the missing slices to get the same WB-VIBE volume (WB-T1MAP); 3D-MPRAGE and WB-T1MAP coregistration using the WB-VIBE to 3D transformation matrix (WB-T1MAP-COR); GP automatic segmentation of the 3D-MPRAGE and, with the output mask, GP statistics calculation of the WB-T1MAP-COR. In order to cancel possible partial volume effects, segmented regions were eroded by 1 pixels and T1 results were compared. The protocol was checked on a group of 10 adolescents that were exposed to Mn during childhood. ResultsT1 accuracy was 4.3% (median) and within 13.8% (interquartile distance). GP-T1 average values were 1314,65 ms and 1302,92 ms after erosion, close to the values reported in other papers, with a coefficient of variation respectively decreased from 6.8%, to 5.6%. ConclusionsWe set up a fast and automated T1 mapping protocol with good accuracy and optimised data variability in vivo.

Development of a conversation approach for practice nurses aimed at making shared decisions on goals and action plans with primary care patients

BackgroundPrimary care nurses play a crucial role in setting personal goals and action plans together with chronically ill patients. This may be a challenge for practice nurses, who are often trained to adopt protocol-based work routines. The aim of this study was to systematically develop a conversation approach, and a corresponding training course, for practice nurses aimed at making shared decisions about goals and actions with their chronically ill patients.MethodsThe 6-step iterative Intervention Mapping protocol was used as a framework. This paper describes the first four steps of the protocol. After the first step, in which literature studies as well as qualitative studies were conducted, the overall aim and objectives for the approach were formulated (step 2). In step 3, methods and strategies for the approach were chosen, which were translated into practical components in step 4. In addition, a pilot study was conducted.ResultsThe main objectives of the approach focus on the ability of practice nurses to explore the patients’ perspectives from a holistic point of view, to explicitly formulate goals and action plans, to tailor shared decision making about goals and action plans to individual patients, and to continuously reflect on work-related attitudes. The approach consists of a practical framework for shared decision making about goals and actions. The framework involves a tool for exploring patients’ perspectives and a tool for identifying patient profiles, to facilitate tailoring shared decision making. A comprehensive training course for practice nurses was developed.ConclusionWe systematically developed a conversation approach, involving a practical framework with several tools, which aims to support practice nurses in making shared decisions about goals and actions with their patients. As practice nurses need support in their learning process to be able to share decisions with patients, we also developed a comprehensive training course for them. The approach and the training course were developed in close collaboration with important stakeholders. Some critical factors for the implementation of the approach were revealed. These factors will be addressed in the next step, a process evaluation (not part of this paper).

9 - Chlorination and oxidation of human plasma fibronectin by myeloperoxidase-derived oxidants, and its consequences for smooth muscle cell function

Background Fibronectin (FN) occurs as both a soluble form, in plasma and at sites of tissue injury, and a cellular form in tissue extracellular matrices (ECM). FN is critical to wound repair, ECM structure and assembly, cell adhesion and proliferation. FN is reported to play a critical role in the development, progression and stability of cardiovascular atherosclerotic lesions, with high FN levels associated with a thick fibrotic cap, stable disease and a low risk of rupture. Evidence has been presented for FN modification by inflammatory oxidants, and particularly myeloperoxidase (MPO)-derived species including hypochlorous acid (HOCl). The targets and consequences of FN modification are poorly understood. Hypothesis That HOCl and MPO-derived oxidants generate specific modifications (oxidation and chlorination) on FN, and that this alters the adhesion, proliferation and gene expression in human coronary artery smooth muscle cells. Results Mass spectrometry using a novel peptide mass mapping protocol show that HOCl and an enzymatic MPO system, generate site-specific, dose-dependent, chlorination and dichlorination of Tyr residues (up to 16 of 100 residues modified), and oxidation of Trp (7 of 39 residues), Met (3 of 26) and His (1 of 55) residues. This damage occurs within selected FN domains, and particularly the heparin- and cell-binding regions. These alterations increase FN binding to heparin-containing columns. Studies using primary human coronary artery smooth muscle cells (HCASMC) show that exposure to HOCl-modified FN, results in decreased adherence, increased proliferation and altered expression of genes involved in ECM synthesis and remodelling. Conclusions These findings indicate that the presence of modified fibronectin may play a major role in the formation, development and stabilization of fibrous caps in atherosclerotic lesions and may play a key role in the switching of quiescent contractile smooth muscle cells to a migratory, synthetic and proliferative phenotype.

Integrity of Carbon-Fibre Epoxy Composites through a Nanomechanical Mapping Protocol towards Quality Assurance

The purpose of this study is to assess the integrity of carbon-fibre reinforced plastics (CFRP) comprising of commercial and surface modified CFs through nanomechanical mapping protocol, towards the feasibility of nanoindentation tool as a quality assurance means in a composite manufacturing process. Carbon fibre surface modification was selected for enhancement of the wetting properties of carbon fibres in order to improve the adhesion force between the fibre and the polymer matrix. In all cases, epoxy resin was used as a matrix for the manufacturing of composite samples. Plastic deformation/elastic recovery were recorded (together with viscoelasticity and adhesion-discontinuities and fluctuations during measurement), while elastic modulus values are also mapped. Moreover, the resistance to applied load is assessed and compared for all cases.

Systematically Developing a Web-Based Tailored Intervention Promoting HPV-Vaccination Acceptability Among Mothers of Invited Girls Using Intervention Mapping.

Background: Currently, the eHealth field calls for detailed descriptions of theory-based interventions in order to support improved design of such interventions. This article aims to provide a systematic description of the design rationale behind an interactive web-based tailored intervention promoting HPV-vaccination acceptability.Methods: The 6-step Intervention Mapping (IM) protocol was used to describe the design rationale. After the needs assessment in Step 1, intervention objectives were formulated in Step 2. In Step 3, we translated theoretical methods into practical applications, which were integrated into a coherent intervention in Step 4. In Step 5, we anticipated future implementation and adoption, and finally, an evaluation plan was generated in Step 6.Results: Walking through the various steps of IM resulted in a detailed description of the intervention. The needs assessment indicated HPV-vaccination uptake remaining lower than expected. Mothers play the most important role in decision-making about their daughter's immunization. However, they generally feel ambivalent after they made their decisions, and their decisions are based on rather unstable grounds. Therefore, intervention objectives were to improve HPV-vaccination uptake and informed decision-making, and to decrease decisional conflict among mothers of invited girls. Computer-tailoring was chosen as the main method; virtual assistants were chosen as a practical application to deliver interactive tailored feedback. To maximize compatibility with the needs of the target group, a user-centered design strategy by means of focus groups and online experiments was applied. In these, prototypes were tested and sequentially refined. Finally, efficacy, effectiveness, and acceptability of the intervention were tested in a randomized controlled trial. Results showed a significant positive effect of the intervention on informed decision-making, decisional conflict, and nearly all determinants of HPV-vaccination uptake (P < 0.001). Mothers evaluated the intervention as highly positive.Discussion: Using IM led to an innovative effective intervention for promoting HPV-vaccination acceptability. The intervention maps will aid in interpreting the results of our evaluation studies. Moreover, it will ease the comparison of design rationales across interventions, and may provide leads for the development of other eHealth interventions. This paper adds to the plea for systematic reporting of design rationales constituting the process of developing interventions.