Informatics in Medicine Unlocked 12 (2018) 138–142

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Informatics in Medicine Unlocked

journal homepage: www.elsevier.com/locate/imu

The ecological semantics of the IoMT: Modelling cyborgs networks for

health policy

Manuel G. Chavez-Angeles a, b, *

a
Universidad de la Sierra Sur (UNSIS), Oaxaca, Mexico
b
Universidad Intercultural del Estado de Puebla (UIEP), Puebla, Mexico

A B S T R A C T

The paper presents an application of the Internet of Medical Things (IoMT) to health policy, particularly to the management of electronic medical records (EMR) for
epidemiological surveillance. It develops a game theoretical semantics (GTS) approach for the study of a cyborg's behavior in the context of health policy. The article
also analyzes cyborg network dynamics, and presents a system dynamics simulation of the game theory model applied to this theoretical case. The model shows that
under certain conditions, cyborg networks can be useful in preventing pandemic results.

1. Introduction 2. Semantic games, semantic computing and doctor-nurse-

Cybernetics is the scientific study of control and communication in
the animal and the machine. A cyborg is a cybernetic organism, a being
with organic and mechatronic body parts [5]. proposed the idea of cy-
borgs as an extended organizational complex functioning of an integrated
homeostatic system. For understanding the adaptation of the human
body to any environment it is necessary to increased knowledge of ho-
meostatic functioning, and evolution brought about the altering of bodily
functions to suit different environments. Cyborgs achieve this to some
degree through suitable biochemical, physiological, and electronic
modifications. The Internet of Medical Things (IoMT) data is dynamic,
and time and space dependent, and is often correlated with resources in
the natural environment. Semantics in the form of modeling, annotation,
integration, and perception is becoming necessary to synthesize action-
able information from data. To make IoMT data useful and meaningful
for health applications and services will require application of methods
from semantic modelling, knowledge engineering, and abstraction over
the raw data. Semantic computing is used to identify patterns, to create
meaningful abstractions, and to extract machine interpretable, and
human-understandable knowledge [1].
The paper develops a game theory semantic model to mimic the
interaction between a health professional (e.g. nurse) and a patient. A
two actor, two strategies model is used for simplicity. The paper also
shows a system dynamics simulation that models cyborg adaptations in
the context of health care and disease prevention policy, applying the
basic game-theoretical semantics model to the case of electronic medical
records use for epidemiological surveillance.
patient interaction
Game-theoretical semantics (GTS) is a paradigm that gives a quanti-
fying treatment to language. The basic idea of GTS makes reference to
formal first-order (quantificational) language that we call L. We assume
that L is an interpreted language. This means that we are given some
domain of individuals D on which all the nonlogical constants of L are
interpreted. This also means that each sentence that can be formed from
the nonlogical constants of L, plus the names of the members of D, has a
definite truth-value, true or false. In this sense, GTS is a variant of truth-
conditional semantics. Games can be utilized as mediators of truth-
conditions. GTS can be explained by the truth-conditions it yields from
different kinds of sentences [8]; [9]. For instance, an atomic sentence of
the form “Pa” is defined to be true if and only if the interpretation v(a) of
“a” in D is a member of the class v(P), which is the interpretation of P in
D. A two-person zero-sum game G(S) is associated with each well-formed
sentence S of any language L0 , where L0 is L extended by adjoining to it a
finite number of names of members of D. W shall call the two players
Myself (or I) and Nature. The definition of G(S) is as follows:
(G. A) If A is atomic, then I have won G(A) and Nature has lost if A is true. If A is
false, Nature has won and I have lost.
(G. ξ) G (S1 ξ S2) begins by Nature's choice of S1 or S2. The rest of the game is
G(S1) or G(S2), respectively.
(G. v) G (S1 v S2) begins by Myself's choice of S1 or S2. The rest of the game is
G(S1) or G(S2) respectively.
(G. U) G((x)S[x]) begins by Nature's choice of a member of D. Let the name of the
member chosen be b. The rest of the game is then G(S[b]).
(continued on next page)

* Universidad de la Sierra Sur (UNSIS), Oaxaca, Mexico.

E-mail addresses: manuelchavezangeles@hotmail.com, mchavez@unsis.edu.mx, manuel.chavez@uiep.edu.mx.

https://doi.org/10.1016/j.imu.2018.04.005
Received 23 February 2018; Received in revised form 17 April 2018; Accepted 23 April 2018
Available online 1 May 2018
2352-9148/© 2018 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
M.G. Ch 
avez-Angeles Informatics in Medicine Unlocked 12 (2018) 138–142

(continued ) choose, they build up a sequence a0, a1, a2, …of elements of D. Infinite
(G. E) G((x)S[x]) is defines likewise except that b is chosen by Myself. sequences of elements of D are called 'plays'. Finite sequences of elements
(G. ~ ) G (~S) is played like G(S) except that the roles of the two players (as defined of D are called 'positions'; they record where a play might have reached
by these rules) are interchanged. by a certain time.
A function τ (the turn function or player function) takes each position
a to either 9 or 8; if τ(a) ¼ 9, this means that when the game has reached
These rules are said to define semantical games. This type of game is
a, player 9 makes the next choice (and likewise with 8). The game rules
bearing on semantics by showing how they can be used to define the
define two subsets W8, W9 ∊ D, consisting of positions and plays, with the
crucial concept of truth. The truth of a sentence S of L can be defined as
following properties: if a position a is in W8 then so is any play or longer
the existence of a winning strategy in G(S) for Myself. The falsity of S
position that starts with a (and likewise with W9); and no play is in both
means that Nature has a winning strategy in G(S) [8]; [9].
W8 and W9. We say that player 8 wins a play b, and that b is a win for 8, if
These games can also be understood as the activities by means of
b is in W8; if some position a that is an initial segment of b is in W8, then
which one can try to verify quantificational sentences. By describing
we say that player 8 wins already at a. (And likewise with 9 and W9.) So
these games in some detail, it is necessary to see from what activities we
to summarize, a logical game is defined by (D, τ, W8, W9) with the
are making a prediction when we assert a quantificational sentence. For
properties just described [7].
instance, there is a close logical connection between quantifiers and the
In our game elements from the set D are medical diagnostics. When a
games of looking and finding. If quantifiers go together with the verb ‘to
player wins a game it means they connect and exchange information in a
seek’, ‘to look for’, and ‘to find’, the conditions for the significant use of
relevant way in accordance with the rules of the game. In this case, the
quantifiers must be approximately the same as the conditions for the use
relevant topic for information exchange is healthcare data that can be
of these verbs. The requirements for these activities to make sense are: (i)
archived in an electronic medical record (EMR). The set D can contain
the field of search must somehow be defined, however partially; (ii) there
multiple kinds of information not related with EMR. Medical semantics
must be ways of ascertaining when one has found the individual or the
allows to distinguish between winning and non-winning elements of D.
kind of individual one has been looking for [7].
We can imagine this interaction to take place in a hospital environment
The basic GTS model proposed in this article mimics decisions and
between ‘Health Professional’ (8) and ‘Patient’ (9).
rules in the exchange of information between two cyborgs. Each time two
Considering a GTS of seeking and finding in the situation of infectious
cyborgs encounter, they have two channels for sharing information. If
disease epidemiological surveillance, we can consider the statement ‘a
both cyborgs decide use the same information channel they become a
patient is an infected person’. In this statement the class of ‘infected
network. Fig. 1 shows the basic normal form of the model.
person’ constitutes the relevant field of search, which is taken to be given
We assume human cyborgs act in a rational way considering the [3]
clearly enough for the operation of seeking and finding so as to make
statement: to be rational is to reason intelligently. Rationality is often
sense. Attention should be concentrated on the clinical questions
construed narrowly as deductive skills. Nevertheless, the essence of a
whether within this well-defined universe (in case is well-defined) of
rational agent is the ability to use information from many sources, of
medical diagnosis one can find ‘patients’ with a particular infection.
which reasoning is only one. Equally crucial information for our daily
In relation to the requirement that the field of search is to be delin-
tasks comes from observation and communication. In this model
eated, the verb ‘to diagnose’ behaves differently than the verb ‘to look
communication depends on the channel chosen by each cyborg.
for’. The methods to diagnose an object (which could be a person) of a
In this sense decisions for entering or not entering a network depend
certain kind, both with respect to their scope and with respect to the
on costs and rewards for doing so. We also use the [3] definition in
nature of the procedures involved, are restricted somewhat less narrowly
defining a cyborg's decision-making process. Payments on each channel
than the method of finding one. In this sense, the field of search con-
would then be a function of questions, inference and observation. Cy-
nected with the diagnosis is wider and more flexible than those con-
borgs would process information for taking decisions over their actions.
nected with searching and finding. We may consider this difference to be
In this sense, cyborg decisions are determined by a system of evaluation.
connected with the fact that the object of diagnosis does not necessarily
Therefore, cyborgs would deal intelligently with both information and
exist objectively apart from the method of diagnosis.
evaluation.
In this article we consider communication to be mediated by a digital
Semantics games have better convincing philosophical accounts than
interface. Although artificial intelligence (AI) is an important element of
logical games. They can better answer the so called ’Dawkins question’:
semantic computing, decisions and interpretation of data is mostly done
what it means to play them, for the proponent to win. This characteristic
by the cyborg's human side. Electronic devices conforming cyborgs
can give semantic games almost the status of a paradigm in computer
receive and process data. Some AI can be used for the processing of in-
science [11].
formation but human knowledge and intuition should be at the center of
We use the semantic game for modeling interaction among cyborgs in
decision-making Fig. 2 shows a modification of the basic game, allowing
healthcare situations. For this purpose we call cyborg 1 and cyborg 2,
for Channel 2 to be used for giving attention to patients.
‘Health Professional’ (8) and ‘Patient’ (9) respectively. The players play
by choosing elements from the domain of the game or set D. As they

Fig. 1. Interaction among cyborgs. Fig. 2. Interaction between health professional and patient.

139
M.G. Ch 
avez-Angeles
3. System dynamics simulation of healthcare semantic networks
A simulation using system dynamics can provide some results as to
how a cyborg network in a hospital setting would perform. Fig. 3 shows
the basic model. For simplicity, we use a two channel model emulating
the basic game theoretical form use that is described above. There is a
flow of connections from one network to the other that depends upon the
rate of connection and the size of the network. The size of the network
has a negative relation with the connection rate. Although network 1 is
bigger than network 2, the adoption rate of network 2 is higher, and
therefore this network grows in members while network 1 decreases in
size. The growth of each network depends on the differential in networks
sizes. In this simulation, the size of network 1 is larger than the size of
network 2.
The spread of rumors, ideas and technologies, in this case the spread
of healthcare networks, can all be viewed as epidemics spreading by
positive feedback, as those who have adopted the network and those who
have not. The concept of positive feedback as a driver to adoption and
diffusion is very general and can be applied to many domains of social
contagion [17]. The model shown in Fig. 3 is a first-order diffusion model
that presumes that the adopters of Channel 2 would grow in the presence
of certain conditions. One way to model repeat adoption behavior is to
assume that adopters move back into potential adopters when it is no
longer necessary to remain in Channel 2. Technological diffusions can
also involve many other different positive feedbacks driving growth,
including word of mouth (WoM). The model in Fig. 4 involves these types
of loops (see Fig. 5).
A relevant question the model tries to answer is how a cyber-network
of healthcare professionals would behave in the case of an epidemic.
Fig. 4 shows the cyborg model connected to a SIR (susceptible-infectious-
Fig. 3. System Dynamics Simulation (basic model).
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Informatics in Medicine Unlocked 12 (2018) 138–142
recovered) model. On this model we allow healthcare professionals to
use Channel 2 for communicating during the epidemics. Although the
behavior of infectious and recovered population are a natural response to
epidemics, we observe how adopters of channel 2 grow during the
epidemic while adopters of channel 1 decrease.
SIR models are second-order models that are useful to analyze the
dynamics of epidemics qualitatively. In this model it is possible for a
disease to die out without causing an epidemic. If the infection rate is less
than the recovery rate, the infectious population will fall. As it falls, the
infection rate will also do so. The infectious population can therefore fall
to zero before everyone contracts the disease. Intuitively, for an epidemic
to occur, the infection rate must exceed the recovery rate; if so, the in-
fectious population will grow, causing an epidemic [17]. In our model,
we use the SIR as a subsystem to explain the behavior of health networks
formed by healthcare professionals and patients. We model a generic
infection, but it is important to recall that different diseases present
different parameters. In practice, it would be different to model a Hep-
atitis C infection than as compared to HIV or a dengue fever epidemic.
4. Conclusion
Healthcare networks can be considered to be a common-pool
resource. With the advent of the Information Society, problems of over-
exploitation, parcelization, lack of cooperation, and contamination of
common-pool resources began to appear in areas like the Internet, and
with the handling of information and knowledge. This has been known as
the “new commons”. Whether labeled in the digital, electronic, infor-
mation, virtual, communication, intellectual, internet and technological
commons, all of these concepts address the new territory of globally
distributed information [6]. Particularly in healthcare sciences and
M.G. Ch 
avez-Angeles
Fig. 4. Cyborg network model in response to an epidemic.
policy, such as genomics, and industries that have been severely
impacted by digital technology like the pharmaceutical industry, infor-
mation management has encountered significant dilemmas with respect
to intellectual property, free exchange and commercialization. In this
regard, healthcare commons can be understood as a coalition of parties
that agree to share data, knowledge, and services under standardized
terms and conditions by committing to a set of common technologies,
digital information standards, research materials, contracts, workflows,
and software. These commitments ensure that knowledge, data, mate-
rials and tools can move seamlessly from partner to partner to enable
healthcare policy [18].
In this article a GTS model was proposed that mimics decisions and
rules in the exchange of information between two cyborgs. These cyborgs
can be a ‘health professional’ or a ‘patient’. When the cyborgs encounter,
they have two channels for sharing information useful to healthcare and
epidemiological surveillance. Information exchange in the model should
be useful for discovery, access, search, integration, and interpretation
that may integrate information and knowledge from the Semantic Sensor
Network (SSN) ontology. The data exchange could involve representa-
tion of observations from various sensors such as temperature, humidity,
video cameras, etc. The annotation techniques rely on the model of
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Informatics in Medicine Unlocked 12 (2018) 138–142
observations for annotating raw sensor observations. The annotated ob-
servations will enable integration of heterogeneous observations and
interpretation of these observations in a contextually meaningful way.
Web semantics are therefore necessary for achieving the goals of IoMT
based applications such as scalability, interoperability, efficiency, ana-
lytics, timeliness, mobility, and discovery [1].
In our model healthcare data is produced by the interaction of a pa-
tient with a healthcare professional through a digital interface. In real
practice, data associated with health, fitness and well-being is increas-
ingly been produced outside the traditional healthcare system. Patients
in control of new technologies complement and corroborate traditional
healthcare data creation and collection. This is possible by: (a) use of
Web-based tools, including search and social media, for health inquiry
and information exchange; (b) mobile applications; and (c) Internet of
Things (IoMTs), growing health-centric cyber-physical systems that
communicate over the Internet [15].
At the population level, an important complement of individual or
personal healthcare signals are the public health signals that include
analysis and outcomes of data gathered by public health systems such as
EMR, reports from the Center for Disease Control, or regional, national,
or international advisory from the World Health Organization (WHO).
M.G. Ch 
avez-Angeles
Fig. 5. Results.
Population health signals include data from the natural environment that
affect large sections of population such as from allergy/pollen and air
quality reports, or data from natural disasters. General conversations in
social media regarding health topics and a growing use of mobile Health
(mHealth) applications should also been considered [15]. An EMR pro-
duces health data, but should also discern which of this information
created by social media, mobile applications and the IoMT should be
considered for diagnosis.
Appendix A. Supplementary data
Supplementary data related to this article can be found at https://doi.
org/10.1016/j.imu.2018.04.005.
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