A proposed semantic framework for diabetes education content management, customisation and delivery within the M2DM project.

M2DM (multi access services for telematic management of diabetes mellitus, ) is an EU-funded telemedicine project that aims at increasing the quality of diabetes care by improving communication between patients and caregivers. As part of this project, we have undertaken the initial work of describing the necessary requirements (framework) of an advanced educational component for M2DM in accordance with the latest Semantic Web concepts. This paper describes our proposed semantic framework for educational content management, customisation and delivery. A big internet challenge today is to find and push situation and user-specific quality knowledge to users based on their actual individual needs, circumstances and profiles at any given time. We believe that the semantic framework presented in this paper could be a good step towards meeting this challenge. Benefits for users, both developers and end users, of adopting such framework are also discussed. The ideas discussed in this paper could be easily adapted to other similar services besides M2DM and to different health topics besides diabetes mellitus.

Comparison of instream methods for measuring hydraulic conductivity in sandy streambeds.

Streambed hydraulic conductivity (K) values were determined at seven stream transects in the Platte River Basin in Nebraska using different instream measurement techniques. Values were compared to determine the most appropriate technique(s) for use in sandy streambeds. Values of K determined from field falling- and constant-head permeameter tests analyzed using the Darcy equation decreased as permeameter diameter increased. Seepage meters coupled with hydraulic gradient measurements failed to yield K values in 40% of the trials. Consequently, Darcy permeameter and seepage meter tests were not preferred approaches. In the upper 0.25 m of the streambed, field falling- and constant-head permeameter tests analyzed with the Hvorslev solution generally had similar K values that were significantly greater than those determined using the Hazen grain-size, Bouwer and Rice slug test for anisotropic and isotropic conditions, and Alyamani and Sen grain-size methods; median differences between these tests and the Hvorslev falling-head 60 cm diameter permeameter were about 8, 9, 17, and 35 m/day, respectively. The Hvorslev falling-head permeameter test is considered the most robust method for measuring K of the upper 0.25 m of the streambed because of the inherent limitations of the empirical grain-size methods and less sediment disturbance for permeameter than slug tests. However, lateral variability in K along transects on the Platte, North Platte, and Wood Rivers was greater than variability in K between valid permeameter, grain-size, or slug tests, indicating that the method used may matter less than making enough measurements to characterize spatial variability adequately. At the Platte River tributary sites, the upper 0.3 m of the streambed typically had greater K than sediment located 0.3 to 2.5 m below the streambed surface, indicating that deposits below the streambed may limit ground water/surface water fluxes. The Hvorslev permeameter tests are not a practical measurement approach for these greater depths. Thus, selection of a method for measuring streambed K needs to consider the vertical location of the sediments that are most likely to limit the rate of ground water/surface water interaction.

Use of NADP archive samples to determine the isotope composition of precipitation: characterizing the meteoric input function for use in ground water studies.

Stable oxygen and hydrogen isotopes have been used in ground water studies to investigate recharge, mixing, ground water/surface water interaction, advective-diffusive transport, paleohydrogeologic interactions and to estimate ground water ages. Such studies require that the isotopic composition of precipitation be known, as precipitation is a major input to ground water and surface water systems. As oxygen-18 and deuterium data for precipitation are lacking across much of the United States, there is need to establish additional local meteoric water lines as isotope input functions across the region, as well as to develop better understanding of the isotopic climate linkages that control oxygen and hydrogen isotope ratios in precipitation. In the absence of long-term monitoring stations, one possible solution to this problem is to determine the delta 18O and delta 2H values of precipitation using archive samples collected at monitoring stations managed by the National Atmospheric Deposition Program (NADP). This study describes and interprets the seasonal delta 18O and delta 2H composition of archived precipitation samples collected in eastern Nebraska near the town of Mead during the years 1992-1994. Values for delta 18O range from -23.6 to -0.7@1000. Values for delta 2H range from -172 to 0@1000. Yearly arithmetic mean delta 18O and delta 2H values for the Mead station are -8.1@1000 and -53@1000, respectively. Weighted yearly means for delta 18O and delta 2H were -7.4@1000 and -48@1000, respectively. Mead values show a strong isotopic enrichment between winter and summer precipitation, and a strong delta 18O-T correlation (r2 = 0.91) for mean monthly values of about 0.5@1000 per degree Celsius. The local meteoric water line for the Mead site is delta 2H = 7.40 delta 18O + 7.32. Deuterium excess values suggest that most of the moisture across the region is derived primarily from a Gulf of Mexico source. The results of this study demonstrate that in the absence of long-term monitoring stations such as those operated globally by the International Atomic Energy Association, NADP archive samples can be used to determine the isotopic composition of precipitation, to characterize the local meteoric water line and establish the various climatic relationships, and define the meteoric input function for use in ground water studies.

Delineating ground water recharge from leaking irrigation canals using water chemistry and isotopes.

Across the Great Plains irrigation canals are used to transport water to cropland. Many of these canals are unlined, and leakage from them has been the focus of an ongoing legal, economic, and philosophical debate as to whether this lost water should be considered waste or be viewed as a beneficial and reasonable use since it contributes to regional ground water recharge. While historically there has been much speculation about the impact of canal leakage on local ground water, actual data are scarce. This study was launched to investigate the impact of leakage from the Interstate Canal, in the western panhandle of Nebraska, on the hydrology and water quality of the local aquifer using water chemistry and environmental isotopes. Numerous monitoring wells were installed in and around a small wetland area adjacent to the canal, and ground water levels were monitored from June 1992 until January 1995. Using the water level data, the seepage loss from the canal was estimated. In addition, the canal, the monitoring wells, and several nearby stock and irrigation wells were sampled for inorganic and environmental isotope analysis to assess water quality changes, and to determine the extent of recharge resulting from canal leakage. The results of water level monitoring within study wells indicates a rise in local ground water levels occurs seasonally as a result of leakage during periods when the canal is filled. This rise redirects local ground water flow and provides water to nearby wetland ecosystems during the summer months. Chemical and isotopic results were used to delineate canal, surface, and ground water and indicate that leaking canal water recharges both the surface alluvial aquifer and upper portions of the underlying Brule Aquifer. The results of this study indicate that lining the Interstate Canal could lower ground water levels adjacent to the canal, and could adversely impact the local aquifer.

Information technology and computer-based decision support in diabetic management.

This paper describes the application of computer-based techniques within an intelligent, knowledge-based framework to the management of diabetes. The objectives are to structure data collection and storage so that the relevant patient-specific data are collected and made accessible as needed, and to provide clinical decision support on either a day-by-day or longer timescale as appropriate; these objectives relating to both hospital clinic and general practice. For longer-term management, a prototype rule set (greater than 500 rules) has been developed (coded in Sigma PROLOG), validated and tested on patient data. The data collection programs (written in SCULPTOR) to feed the ruleset have been tested in the hospital clinic and compared with the resident data collection system for usability, and impact on the running of the clinic. Links between the data collection programs and the ruleset program have been written and tested. The computer system will also incorporate a module, combining knowledge-based advisory system and glucose/insulin model as patient simulator, that can be tested as a potential decision aid for adjusting insulin dosage on a daily basis.

Computer-assisted diabetic management: a complex approach.

This paper describes the architecture of, and the main reasoning methods involved in, a computer system developed to assist in diabetic management. The system integrates (i) a database module used for blood glucose monitoring, (ii) an interpreter module used to analyse the adequacy of diet and insulin treatment for diabetics, and (iii) an advisory module suggesting alterations in diet and/or insulin regimen in order to improve glycaemic control. The analysis of blood glucose profiles and hypoglycaemic episodes, as well as the suggestions for altered diet and insulin therapy, are based on qualitative and quantitative models of insulin effect and carbohydrate absorption using meal-time related glucose balance and distance from the preselected target (DFT) glucose values as focal concepts in the reasoning process. During the sequence of consultations with the system, a dynamic model of carbohydrate metabolism is gradually adjusted in order to constitute an appropriate simulation for the specific patient. This model is used to confirm the suggestions made by the ADVISOR program and to assist the health care professional in selecting the best control action by predicting the blood glucose profiles resulting from alternative control policies.

Data management and expert systems for outpatient diabetes care--16 years experience with diabeta.

The continuing development and implementation of a computer-based diabetes register and management system are described. For 15 years the system has been used as a readily accessible source of clinical data, for letter generation, for prompting screening procedures and for clinical audit and research. Later developments include the incorporation of specialist "intelligence" for advising management of individual patients. This is intended for use by non-specialists to enable their greater participation in diabetes care. It is currently undergoing preliminary evaluation with a view to conducting clinical trials both in Hospital and in General Practice.

The principles and prototyping of a knowledge-based diabetes management system.

This paper describes the principles and prototyping of a computer-based system being developed to assist in the management of diabetes mellitus. Unlike other approaches based upon mathematical modelling or the use of computer algorithms, this system adopts one derived from artificial intelligence, seeking to incorporate the dynamics of glucose and insulin in a manner which reflects their clinical importance. The resultant logical model (qualitative algebra) defines the relationships between changes in insulin dose and site and time of injection and glycaemic response. In this manner the computer-based system, implemented in Prolog, can be used to provide advice concerning insulin therapy by means of making qualitative predictions of patient outcome of blood glucose profile resulting from alternative insulin regimens.

Effects of external chemical environment on the developing olfactory bulbs of the mouse (Mus musculus).

Female mice were reared in observation incubators from day 1 of life for three weeks. During that time they were continuously exposed to the odors of either cyclooctanone, adult male mouse urine or distilled water. The growth rate was temporarily accelerated for the cyclooctanone-exposed mice. There was no difference in age at sexual maturation of the three groups. Olfactory preference, when adult, was not affected by early odor exposure, but sniffing behaviour was markedly increased in the urine-exposed mice as compared with the other two groups. The olfactory bulbs of the cyclooctanone-reared mice were larger than those of the other two groups. Mitral cells in the olfactory bulbs were examined histologically for abnormalities. All mice had some shrunken, darkly staining mitral cells, but the cyclooctanone-reared mice had twice as many as the other two groups, mainly in the dorsal half of the bulb. The urine-exposed mice also had more darkly staining cells than the control mice particularly in the dorsolateral region of the bulb, but also in the dorsomedial region.