A requirement of realism-based ontology design is that classes denote exclusively entities that exist objectively in reality and that their definitions adhere to strict criteria to ensure that the classes are re-usable in other ontologies while preserving their ontological commitment. Building realism-based ontologies is therefore quite challenging and time-consuming, demanding considerable training. Although the top-level in the form of the Basic Formal Ontology (BFO) is worked out very well, and also the upper levels of certain domains, there is still a disconnect with the bottom- up or middle-out approach which is typical, and more practical, for application ontologies. Using the development of an application ontology for diabetes management in diabetes camps as an example, we present an overview of problems trainees in realism-based ontology design can be confronted with and offer some guidelines on how to deal with them in case no ideal solution is available.
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