=Paper=
{{Paper
|id=Vol-3609/paper3
|storemode=property
|title=Mobile Cyber-Physical System for Diabetic Patients' Health Status Monitoring
|pdfUrl=https://ceur-ws.org/Vol-3609/paper3.pdf
|volume=Vol-3609
|authors=Tetiana Hovorushchenko,Maksym Pytlyak,Olha Hovorushchenko,Illya Paionk,Vitaliy Osyadlyi,Artem Boyarchuk
|dblpUrl=https://dblp.org/rec/conf/iddm/HovorushchenkoP23
}}
==Mobile Cyber-Physical System for Diabetic Patients' Health Status Monitoring==
https://ceur-ws.org/Vol-3609/paper3.pdf
Mobile Cyber-Physical System for Diabetic Patients' Health
Status Monitoring
Tetiana Hovorushchenkoa, Maksym Pytlyaka, Olha Hovorushchenkob, Illya Paionka, Vitaliy
Osyadlyia, Artem Boyarchukc
a
Khmelnytskyi National University, Institutska str., 11, Khmelnytskyi, 29016, Ukraine
b
National Pirogov Memorial Medical University, Pirogova str., 56, Vinnytsya, 21018, Ukraine
c
Tallinna Tehhnikaülikool, Ehitajate tee 5, Tallinn, 12616, Estonia
Abstract
Continuous monitoring of the health status of diabetic patients using a mobile cyber-physical
system (continuous glucose monitor) is currently an urgent task. The aim of this study is to
develop a method and design the architecture of an invasive mobile cyber-physical system for
diabetic patients' health status monitoring. The developed method and mobile cyber-physical
system for diabetic patients' health status monitoring provide: measuring the patient's blood
sugar level, analyzing the sugar level, issuing a notification to the patient about the onset of a
hypo- or hyperglycemic state, as well as the threat of hypo- or hyperglycemic coma, as well as
sending messages about the existing threat of hypo- or hyperglycemic coma to the patient's
relatives. In addition, the developed method and system provide the formation of a set of ten-
minute indicators of the patient's blood sugar level per day, the formation of a set of average
daily indicators of the patient's blood sugar level per month and the formation of a set of
indicators of the patient's average monthly blood sugar level per year in order to demonstrate
the dynamics of changes in the patient's blood sugar level to the patient and his doctor. The
developed mobile cyber-physical system for diabetic patients' health status monitoring is
convenient and easy to use and wear, has a compact size, and is cheaper than known analogs.
Keywords 1
Mobile cyber-physical system, health monitoring, diabetes mellitus, blood sugar measurement,
subcutaneous sensor for measuring blood sugar.
1. Introduction
Diabetes mellitus is an endocrine disease characterized by a malfunction of the pancreas and, as a
result, a complete or partial cessation of the production of the hormone insulin or a decrease in the
sensitivity of insulin-dependent tissues to insulin. It is a chronic metabolic disease characterized by high
blood sugar (glucose) levels. It is a chronic hyperglycemia syndrome that leads to disorders of all types
of metabolism, primarily carbohydrate metabolism, vascular damage (angiopathy), nervous system
(neuropathy), and other organs and systems. It is a condition in which the body does not produce enough
insulin or does not use it effectively [1-3].
According to the World Health Organization, the number of people with diabetes was more than
537 million in 2021, which is 10% of the world's population. This number is expected to rise to 643
million by 2030 and 783 million by 2045 [4]. Diabetes mellitus leads to other diseases, such as complete
or partial vision loss, liver failure, heart attack, stroke, vascular disease, and lower limb amputation.
This disease ranks seventh among the diseases that most often lead to disability and mortality in the
world. The terrible fact is that the trend of the disease is growing and "getting younger". Until the early
IDDM’2023: 6th International Conference on Informatics & Data-Driven Medicine, November 17–19, 2023, Bratislava, Slovakia
EMAIL: tat_yana@ukr.net (T. Hovorushchenko); m.pytlyak@i.ya (M. Pytlyak), govorusenkoo@gmail.com (O. Hovorushchenko);
paionk@ukr.net (I. Paionk), vitalik9865@gmail.com (V. Osyadlyi); a.boyarchuk@taltech.ee (A. Boyarchuk)
ORCID: 0000-0002-7942-1857 (T. Hovorushchenko); 0009-0001-3149-8783 (M. Pytlyak); 0000-0001-6583-5699 (O. Hovorushchenko);
0009-0008-4023-0739 (I. Paionk); 0000-0001-7861-4684 (V. Osyadlyi); 0000-0001-7349-1371 (A. Boyarchuk)
© 2023 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
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2000s, diabetes was most often found in people over 25 years old, but now 15% of people with the
disease are children and adolescents under the age of 20 [4].
The following types of diabetes are distinguished:
1. type 1 diabetes is a complete or partial cessation of insulin secretion by the pancreas. This type
of diabetes develops when the body's immune system attacks and destroys the pancreatic cells
that produce insulin. It causes the body to be unable to produce enough insulin to control blood
glucose levels. This type of disease manifests itself immediately after birth, in childhood or
adolescence. It is usually caused by heredity. The prevalence of the first type of diabetes is 10-
15% of all cases of diabetes. In this type, the main method of regulating blood glucose is insulin
therapy, which is carried out in the form of injecting artificial insulin into human adipose tissue
by injection, which allows you to balance the body's metabolism. People with type 1 diabetes
need to inject insulin as needed to control blood sugar levels [1]
2. type 2 diabetes mellitus is a decrease in the sensitivity of the cell membrane to incoming insulin,
in some cases accompanied by impaired insulin secretion by the pancreas. This type of diabetes
occurs when the body does not produce enough insulin or does not use it effectively. Type 2
diabetes occurs when the body becomes less sensitive to insulin, or the pancreas does not
produce enough insulin. This type of diabetes usually develops slowly. It is the most common
type of diabetes and is often associated with poor lifestyle choices, including poor diet, lack of
physical activity, and being overweight. It is considered acquired and is usually detected in
people at an older age who have diseases associated with metabolic disorders, overweight. The
disease develops slowly, which is often the reason for late detection. The blood glucose level
is maintained through the use of hypoglycemic drugs, insulin injections, diet and regular
exercise. Treatment of type 2 diabetes may include dietary changes, physical activity, oral
medications, insulin injections, or a combination of these methods [2, 3, 5, 6]
3. gestational diabetes occurs in pregnant women who did not previously have diabetes. It usually
disappears after childbirth, but women who have had gestational diabetes are at increased risk
of developing type 2 diabetes in the future [7, 8].
It is vital for people with diabetes to maintain normal blood glucose levels. The blood glucose level
in a healthy person should reach from 4.0 to 6.0 mmol/l (in general, the reference values are 3.5-6.7
mmol/l). Determination of this indicator is a mandatory procedure when taking a complete blood count
of every patient admitted to a clinic or hospital. Glucose control is an important component of the life
of every person with diabetes, so it is most important that this process is as quick, painless and accurate
as possible. Collecting blood sugar readings plays an important role in the timely, proper treatment and
control of diabetes. Insulin therapy and medication administration (dose calculation, frequency, and
specifics of use) are prescribed by a doctor, but are performed by patients themselves on a daily basis
at home. Since blood glucose levels can change after physical activity, depending on the emotional state
of a person and other factors, it is advisable to measure glucose levels before each medication
administration. This manipulation has become possible thanks to glucose meters that can be used at
home without medical supervision and assistance [9-11].
At the moment, the most common method is to pierce a person's skin and extract a drop of blood
onto a test strip, which is a component of a glucometer, which is currently most often used to measure
blood sugar levels. The test strip contains chemicals that are sensitive to glucose in the blood sample.
This method is the most affordable, but not always convenient.
A blood glucose monitoring system is a very important tool for people with diabetes. Such systems
provide the ability to monitor blood glucose levels and take the necessary measures to maintain them
in the normal range. A glucose monitor is a medical device used to measure blood glucose levels. It
works by using test strips that interact with a drop of blood obtained with a lancet. After the drop of
blood hits, the test strip, the glucose monitor measures the glucose level and displays the result on the
screen. This can help people with diabetes manage their disease and reduce the risk of complications
[12-14].
Given the current trend toward the introduction of information technology [15-17] and cyber-
physical systems [18, 19] in all areas of medicine, and given the importance of continuous monitoring
of the health of patients with diabetes, it is necessary to make such monitoring permanent and automate
it as much as possible using a cyber-physical system that combines the complex physiological dynamics
of patients in the modern medical field with built-in programmable control devices. Glucose control
using modern continuous monitoring technology is more accurate and efficient today. In this case, a
mobile cyber-physical system for diabetic patients' health status monitoring in the form of a
subcutaneous sensor and mobile app will be useful for continuous automatic blood glucose
measurements, which will continuously monitor the blood glucose level of a patient with diabetes
(continuous measurement and transmission of readings to a mobile application) and will promptly
notify the patient and his or her family of excessively high or excessively low glucose levels, allowing
them to take timely measures to normalize sugar levels. So, continuous monitoring of the health status
of diabetic patients using a mobile cyber-physical system (continuous glucose monitor) is currently an
urgent task.
2. Case Study
There are two types of blood glucose monitoring systems – invasive and non-invasive (Figure 1).
Figure 1: Blood glucose monitoring systems [10]
Invasive blood glucose monitoring is used to accurately and continuously monitor glucose levels in
people with diabetes. This method requires the insertion of a sensor directly into the body to measure
glucose levels. The data from the sensor can be transmitted directly to an external device or read only
by a reader that is placed on the skin over the sensor. Continuous glucose monitors measure blood sugar
every few minutes using a sensor inserted under the skin [20-22].
The advantages of invasive blood glucose monitoring include [20-22]:
1. constant availability of information about glucose levels, which allows you to see the dynamics
of changes and respond appropriately
2. assistance in decision-making – with the help of information provided by invasive monitoring
tools, it is possible to better understand the impact of nutrition, physical activity and treatment
on blood glucose levels, which helps to make more effective decisions about diabetes treatment
and behavior of diabetic patient.
However, invasive monitoring also has its limitations and disadvantages [20-22]:
1. high cost of commercial invasive monitoring systems
2. measurement error that needs to be taken into account (but invasive monitoring provides more
accurate data than traditional glucose measurement methods)
3. the need for proper care and maintenance (regular replacement of sensors, proper calibration of
the system, etc.)
4. the risk of infections and complications when the sensor is inserted under the skin (it is
important to follow proper hygiene and care procedures)
5. the impact of external factors on the monitoring system (high humidity, temperature, magnetic
fields, etc.).
Non-invasive blood glucose monitoring is used to continuously monitor glucose levels without the
need to insert a sensor under the skin. These methods are based on measuring glucose using external
devices that do not require penetration into the body. However, it is worth noting that to date, non-
invasive blood glucose monitoring has not yet reached the same accuracy and reliability as invasive
methods [23-26].
Here are some modern types of non-invasive blood glucose monitoring [23-26]:
1. near-infrared spectroscopy – measures the reflection or absorption of infrared light from tissues
to determine glucose levels and is based on the fact that glucose levels affect the light
characteristics of tissues
2. electrochemical sensors – use electrodes that react with glucose in the blood and create an
electrical signal that can be measured, but for accurate measurement, the problem of the
influence of other substances on the results must be solved
3. optical sensors – use optical methods, such as photoplethysmography (measuring pulse with
light), to determine changes in blood glucose; based on the observation of the dependence of
the optical properties of blood on glucose levels
4. non-contact technologies – include the use of technologies, such as radio wave or microwave
devices to measure glucose levels in the body, which do not require physical contact with the
body
5. breathing equipment – assesses the relationship between blood glucose and exhaled glucose;
this method may require special breathing equipment and exhaled air analysis.
Non-invasive glucose monitoring systems have the following advantages that make them attractive
to users: painlessness (no need for a skin puncture to measure glucose levels) and reduced risk of
infection (due to no skin puncture and no contact with blood).
Although non-invasive blood glucose monitoring has potential in the future, some of these
technologies are still under research and development. The accuracy and reliability of their
measurements still need to be further improved.
The aim of our study is to develop a method and design the architecture of an invasive mobile cyber-
physical system for diabetic patients' health status monitoring, which will consist of a subcutaneous
sensor and a mobile application, will be cheaper than known analogues, convenient and easy to use and
wear, have a compact size; will perform continuous monitoring of blood glucose levels in a patient with
diabetes; Analyzing the results of such monitoring, it will promptly notify the patient and his or her
family of excessively high or excessively low glucose levels; as well as accumulate and display (in the
form of numbers and charts) the dynamics of changes in the patient's blood sugar level during the day,
month, year, etc.
3. Mobile cyber-physical system for diabetic patients' health status
monitoring
Method for diabetic patients’ health status monitoring consists of the followings stages:
1. measurement of the patient's blood sugar level (variable bsl) every 10 minutes
2. analysis of the patient's blood sugar level (of variable bsl):
- if bsl ≥ 3.5 mmol/l and bsl ≤ 6.7 mmol/l, then patient's blood sugar level is normal and no
action is required
- if bsl < 3.5 mmol/l and bsl ≥ 2 mmol/l, then patient is notified: "Hypoglycemia"
- if bsl > 6.7 mmol/l and bsl ≤ 16.5 mmol/l, then patient is given a message: "Hyperglycemia"
- if bsl < 2 mmol/l, then message "Threat of hypoglycemic coma" is issued not only to the
patient, but also sent to his relatives (the patient's geolocation and name and surname are
also added to the message)
- if bsl > 16.5 mmol/l, then message "Threat of hyperglycemic coma" is issued not only to the
patient, but also sent to his/her relatives (the patient's geolocation and name and surname
are also added to the message)
3. generating a set of ten-minute blood sugar levels per day (set DBSL): DBSL = {bsl1, bsl2, bsl3,
…, bsl144} – this set is available in the patient's mobile application (in the form of numbers
and/or diagrams) so that the patient and his/her doctor can see the dynamics of changes in blood
sugar levels during the day (there are 24 hours in a day, 1440 minutes, i.e. 144 10-minute
intervals)
4. calculation of the average daily (144 10-minute intervals) blood sugar level of the patient by
the formula (1):
𝑎𝑑𝑏𝑠𝑙 = (∑"##!$" 𝑏𝑠𝑙! )/144 (1)
5. generating a set of average daily blood glucose levels for a patient for a month (set MBSL):
MBSL = {adbsl1, asbsl2, adbslm} – this set is also available in the patient's mobile application
(in the form of numbers and/or diagrams) so that the patient and his/her doctor can see the
dynamics of changes in the average daily blood sugar level during the month; we assume there
are m days in a month
6. calculation of the patient's average monthly (m days in a month) blood sugar level by the
formula (2):
𝑎𝑚𝑏𝑠𝑙 = (∑& %$" 𝑎𝑑𝑏𝑠𝑙% )/𝑚 (2)
7. generating a set of average monthly blood sugar levels for the patient for the year (set YBSL):
YBSL = {ambsl1, ambsl2, ambsl12} – this set is also available in the patient's mobile application
(in the form of numbers and/or diagrams) so that the patient and his/her doctor can see the
dynamics of changes in the average monthly blood sugar level during the year.
The developed method for diabetes patients' health status monitoring provides: measuring the
patient's blood sugar level, analyzing the sugar level, issuing a notification to the patient about the onset
of a hypo- or hyperglycemic state, as well as the threat of hypo- or hyperglycemic coma, as well as
sending messages about the existing threat of hypo- or hyperglycemic coma to the patient's relatives. It
is possible case, that information about the level of sugar that characterizes a hyperglycemic state or
warns of the threat of hyperglycemic coma is transmitted to the insulin pump to ensure the calculation
of the insulin dose and the performance of an insulin injection, if necessary. In addition, the developed
method provides the formation of a set of ten-minute indicators of the patient's blood sugar level per
day, the formation of a set of average daily indicators of the patient's blood sugar level per month and
the formation of a set of indicators of the patient's average monthly blood sugar level per year in order
to demonstrate the dynamics of changes in the patient's blood sugar level to the patient and his doctor.
Mobile cyber-physical system for diabetic patients’ health status monitoring is based on the
developed method for diabetic patients’ health status monitoring.
The mobile cyber-physical system for diabetic patients' health status monitoring includes a
subcutaneous sensor for measuring blood sugar levels (such sensors are usually worn for several weeks
to several months, and then need to be replaced; such sensor is the physical component of the system),
as well as a web server (receiver) and a specially developed mobile application that is installed on the
patient's and his relatives' phone.
The mobile application has two possible roles: "patient" or "patient's relative". When registering in
the mobile application, the patient indicates his or her name and surname, mandatory provides access
to geolocation data, and specifies the mobile phone numbers of relatives to whom notifications about
the existing threat of hypo- or hyperglycemic coma should be sent. When registering in the mobile
application, the patient's relatives select from the database by name, surname and/or phone number of
patient, whose critical health condition they authorize to send them notifications.
The subcutaneous sensor measures the patient's blood sugar level every 10 minutes, the sensor
transmits the received value to the receiver (web server), which organizes online data recording to the
database and online transmitting the measurement results to the patient's mobile application, where the
sugar level is analyzed. The blood sugar level is measured and analyzed automatically, and the
information is recorded in the database every 10 minutes. If the blood glucose level does not fall within
the range of reference values, the patient receives a notification in the mobile application about the
hypo- or hyperglycemic state. If the blood sugar level is critically low or critically high, the mobile
application sends a notification about the existing threat of hypoglycemic or hyperglycemic coma to
both the patient and his or her relatives (the patient's geolocation and name and surname are also
included in the notification to the relatives).
In addition, the mobile application provides accumulation (in the database) and display (in the form
of numbers and charts) of the dynamics of changes in the patient's blood sugar level during the day,
month, year, etc., which can be useful both for the patient in the selection of physical activities,
nutrition, etc., and for his or her doctor in the selection of medications and their dosage to avoid
hypoglycemia or hyperglycemia in the future.
Architecture of mobile cyber-physical system for diabetic patients’ health status monitoring is
represented on Figure 2.
Figure 2: Architecture of mobile cyber-physical system for diabetes patients’ health status monitoring
4. Results & Discussion
Let's consider the case of using the developed method and cyber-physical system for diabetic
patients' health status monitoring.
The patient decided to use the developed cyber-physical system. To do so, he purchased an
Eversense sensor to measure his blood sugar level, and his doctor implanted the sensor under the skin
on his forearm. The patient installed the developed mobile application on his phone and on the phone
of his relatives. When registering in the mobile application, the patient chose the role of "patient",
indicated his first and last name, provided access to geolocation data, and indicated the mobile phone
numbers of relatives to whom notifications about the existing threat of hypoglycemic or hyperglycemic
coma should be sent. When registering in the mobile application, the patient's relatives chose the role
of "patient's relative" and selected from the database by name, surname and/or phone number the patient
whose critical health condition was allowed to be notified. After that, the mobile cyber-physical system
began to function.
The results of the mobile cyber-physical system functioning on 20 measurements, starting from time
i and then every 10 minutes, during which the patient developed a threat of hyperglycemic coma, are
presented in Table 1.
Table 1
Results of the mobile cyber-physical system functioning on 20 measurements
Variable Blood Actions of the cyber-physical system
sugar
level
bsli 5.8 The patient's blood sugar level is normal and no action is required
bsli+10 5.75 The patient's blood sugar level is normal and no action is required
bsli+20 5.9 The patient's blood sugar level is normal and no action is required
bsli+30 6.3 The patient's blood sugar level is normal and no action is required
bsli+40 6.7 The patient's blood sugar level is normal and no action is required
bsli+50 7 The patient was given a message: "Hyperglycemia"
bsli+60 7.2 The patient was given a message: "Hyperglycemia"
bsli+70 8 The patient was given a message: "Hyperglycemia"
bsli+80 8.9 The patient was given a message: "Hyperglycemia"
bsli+90 9.7 The patient was given a message: "Hyperglycemia"
bsli+100 11.1 The patient was given a message: "Hyperglycemia"
bsli+110 14 The patient was given a message: "Hyperglycemia"
bsli+120 15.8 The patient was given a message: "Hyperglycemia"
bsli+130 17.9 Message "Threat of hyperglycemic coma" was sent to the patient and his
relatives (the patient's geolocation and name and surname were also
added to the message to the relatives)
bsli+140 16.5 The patient was given a message: "Hyperglycemia"
bsli+150 13.4 The patient was given a message: "Hyperglycemia"
bsli+160 10.8 The patient was given a message: "Hyperglycemia"
bsli+170 8.7 The patient was given a message: "Hyperglycemia"
bsli+180 7.75 The patient was given a message: "Hyperglycemia"
bsli+190 6.5 The patient's blood sugar level is normal and no action is required
This example demonstrates how rapidly a patient's blood sugar can change. Obviously, most
probably the patient missed the notifications of the hyperglycemic state and did not take an insulin
injection on time, so the blood sugar level began to rise rapidly and reached a level that threatens to
cause a hyperglycemic coma. After the system sent a message about the threat of hyperglycemic coma
to the patient and his relatives, the patient apparently took an insulin injection, because his blood sugar
level began to drop rapidly, until it returned to normal.
Figure 3 shows a chart of the patient's ten-minute blood sugar levels for the day (from time 0, which
is the start of the day, to time 1440 minutes, which is 24 hours), from which the 20 measurements for
Table 1 were taken. Figure 4 shows a chart of the patient's average daily blood sugar levels for August
2023, during which he used the proposed mobile cyber-physical system.
In the above case, the developed mobile cyber-physical system for diabetic patients' health status
monitoring helped save the patient and prevent the onset of hyperglycemic coma. The developed system
also helps the patient to monitor his health status, in particular, blood sugar levels, and to take the
necessary medications in time in case of hypo- or hyperglycemic conditions. In addition, the proposed
system provides accumulation and display of the dynamics of changes in the patient's blood sugar level
during the day, month, and year, which can be useful for self-diagnosis by the patient and for research
by the doctor to avoid hypoglycemia or hyperglycemia in the future.
Figure 3: Chart of ten-minute blood sugar levels for a patient per day
Figure 4: Chart of average daily blood sugar levels for a patient for August 2023
The developed mobile cyber-physical system for diabetic patients' health status monitoring is
convenient and easy to use and wear, has a compact size (subcutaneous sensor and smartphone app), and
is cheaper than known analogues, as the patient currently only has to purchase the sensor, the mobile
application is currently developed as a pilot sample and is free of charge. In the future, it is planned to set
a small fee for the patient's use of the mobile application to cover the costs of hosting and cloud storage.
In summary, the proposed mobile cyber-physical system for diabetic patients' health status
monitoring helps patients with diabetes monitor their blood sugar levels and receive emergency
assistance in case of a threat of hypoglycemic or hyperglycemic coma.
5. Conclusions
The aim of this study is to develop a method and design of the architecture of an invasive mobile
cyber-physical system for diabetic patients' health status monitoring, which will consist of a
subcutaneous sensor and a mobile application, will be cheaper than known analogues, convenient and
easy to use and carry, and will have a compact size; it will continuously monitor the blood glucose level
of a patient with diabetes; will promptly notify the patient and his/her relatives of excessively high or
excessively low glucose levels, as well as accumulate and display (in the form of numbers and charts)
the dynamics of changes in the patient's blood sugar level during the day, month, year, etc.
The developed method for diabetic patients' health status monitoring provides: measuring the
patient's blood sugar level, analyzing the sugar level, issuing a notification to the patient about the onset
of a hypo- or hyperglycemic state, as well as the threat of hypo- or hyperglycemic coma, as well as
sending messages about the existing threat of hypo- or hyperglycemic coma to the patient's relatives.
In addition, the developed method provides the formation of a set of ten-minute indicators of the
patient's blood sugar level per day, the formation of a set of average daily indicators of the patient's
blood sugar level per month and the formation of a set of indicators of the patient's average monthly
blood sugar level per year in order to demonstrate the dynamics of changes in the patient's blood sugar
level to the patient and his doctor.
The proposed mobile cyber-physical system for diabetic patients' health status monitoring helps the
patient to monitor their health status, in particular, blood sugar levels, and to take the necessary
medications in time in case of hypo- or hyperglycemic conditions. In addition, the proposed system
provides accumulation and display of the dynamics of changes in the patient's blood sugar level during
the day, month, and year, which can be useful for self-diagnosis by the patient and for research by the
doctor to avoid hypoglycemia or hyperglycemia in the future.
The developed mobile cyber-physical system for diabetic patients' health status monitoring is
convenient and easy to use and wear, has a compact size, and is cheaper than known analogues, as the
patient currently only needs to purchase a sensor, the mobile application is currently developed as a
pilot sample and is free of charge. In the future, it is planned to charge a small fee for the patient's use
of the mobile application to cover hosting and cloud storage costs. Directions for further research:
standardization of the developed mobile cyber-physical system, certification of the developed mobile
application, ensuring cybersecurity of the developed mobile cyber-physical system.
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