\r\n\tThis publication will aim to collect those projects and research that seek to make buildings, including urban environments, self-sufficient in terms of energy, focusing here on the solutions for HVAC and the energy systems they require and doing so from a double point of view: \r\n\t- Complexity. As is the case with the automobile and aeronautics industries, buildings have become human-inhabited spaces with an ever-increasing technological load, which will presumably also be used in other ways, as the pandemic associated with COVID-19 has shown. In these scenarios, will HVAC systems be considered as before, or will new solutions have to be considered for new challenges? \r\n\t- Disruptive technologies. In the coming years, the implementation of technologies such as hydrogen fuel cells, polygeneration of energy, the use of second-use electric batteries in buildings to accumulate energy from renewable energies, or the resolution of constructive solutions with 3D printing will become widespread in buildings. In this scenario, what will be the answers given by those responsible for HVAC systems? \r\n\tIn addition, concepts such as artificial intelligence, technology transfer, biomimicry, or stigmergy will undoubtedly provide high-value solutions to new and refurbished buildings that society demands.
",isbn:"978-1-83768-174-7",printIsbn:"978-1-83768-173-0",pdfIsbn:"978-1-83768-175-4",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"c911b61042fae2c465f4ee69077e0a4b",bookSignature:"Dr. César Martín-Gómez",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/12033.jpg",keywords:"Heating, Cooling, Ventilation, Air-Conditioning, Renewable, Biomass, Hydrogen, Geothermal, Heat-Pump, Engineering, nZEB, Integration",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 25th 2022",dateEndSecondStepPublish:"June 22nd 2022",dateEndThirdStepPublish:"August 21st 2022",dateEndFourthStepPublish:"November 9th 2022",dateEndFifthStepPublish:"January 8th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"11 days",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. Gómez (Ph.D. Architect) has been responsible for building services and energy systems in complex buildings such as the Auditorium of Navarra and the Spanish Pavilion at the Saragossa Expo since 2000. 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\n
1. Introduction
\n
Firmness is a major quality parameter in grading fresh produce, governed by the mechanical and structural properties of fruit. For producers, it can indicate ripeness and/or storage potential, and for consumers, it directly influences consumer acceptance and satisfaction. The industry standard instrument for firmness assessment is a penetrometer, which drives a metal plunger into the fruit flesh and records the maximum resistance force. This technique has three main drawbacks [1]: it is destructive, leaving the fruit unsaleable, measurements are highly variable (up to 30%) and it cannot be used in online situations. A fast and nondestructive technique would be desirable for the fresh fruit industry as it offers the benefit of grading and sorting each individual fruit.
\n
Firmness has been a difficult parameter to measure by fruit graders. To date, no commercially successful nondestructive system has been created on a high-speed grader. Most prior research has focused on mechanical methods such as acoustic resonance, impact response, and force-deformation [2–6]. Most of the mechanical methods require contact with the fruit, which limits the grading speed due to the difficulty of achieving reliable physical contact and consistent fruit compliance at high speeds. It also potentially causes physical damage to the fruit. Moreover, mechanical methods are sensitive to each method’s specific mechanical property such as deformation force, so they often do not correlate well or consistently with the penetrometer. For this reason, the industry is reluctant to adopt these methods [7]. This has led to more research into the use of optical methods, which have the unique feature of being noncontact. Modern high-speed fruit-grading systems run at speeds in excess of 10 fruit per second and noncontact methods will be advantageous in such circumstances.
\n
This chapter reviews the current optical techniques for firmness measurement. Among these techniques, near-infrared spectroscopy (NIRS) [8–10] and spatially resolved reflectance spectroscopy (SRRS) [11, 12] have been investigated more commonly in recent years, and are more suitable for high-speed operation.
\n
\n
\n
2. Principle of optical methods for measuring firmness
\n
Optical techniques are based on light interactions with fruit tissue. In the visible to near-infrared (Vis/NIR) range of the electromagnetic spectrum, fruit can be considered as semi-transparent or turbid. There are two optical phenomena that describe how light interacts with turbid biological material: absorption and scattering (Figure 1). Absorption is primarily due to the chemical composition of the tissue (pigments, chlorophylls, water, etc.). Scattering depends on microscopic changes in refractive index caused by the tissue density, cell composition, and extra- and intra-cellular structure of the fruit, and thus may be useful for assessing textural properties such as firmness. The light transportation in fruit can be characterized by fundamental optical properties of absorption, scattering and refraction, which are defined by the absorption coefficient (μa), scattering coefficient (μs), refractive index (n), and anisotropy factor (g).
\n
Figure 1.
Distribution of incident light in fruits: (1) surface/specular reflectance, (2a) diffuse reflectance, (2b) transmittance, and (3) absorption [13] (Copyright 2016 American Society of Agricultural and Biological Engineers. Used with permission).
\n
Cen et al. [14] used a hyperspectral backscattering system to measure optical properties of “Golden Delicious” and “Granny Smith” apples over 30 days’ storage time. The optical properties from 300 to 1000 nm were compared with acoustic and impact firmness. They found the scattering coefficient generally decreased as the fruit softened (r > 0.9 for both mechanical properties). Absorption coefficients also had high correlations with firmness (r ~ 0.9 for “Golden Delicious”) in the wavelength range that associated with chlorophyll and anthocyanin absorption.
\n
The inverse adding-doubling (IAD) technique was used to measure optical properties between 400 and 1050 nm in another study on apples [15]. The reduced scattering coefficient between 550 and 900 nm had an average correlation r = −0.68 with penetrometer firmness. Changes in optical properties at carotenoid (400–500 nm) and chlorophyll-a (680 nm) wavelengths correlated with penetrometer firmness with r = −0.69 and 0.52, respectively. However, Tomer et al. [16] found that the IAD technique could be quite inaccurate for absorption coefficient measurements on fresh produce at 785 nm, reporting a coefficient for fresh onions that was five times larger than that required for light transport modeling on onions.
\n
There have been some studies based on other optical principles. For example, Costa et al. [17] used a biospeckle laser system to measure the biospeckle images on the Acrocomia aculeata fruit pulp. The calculated biological activity (BA) had a negative correlation with penetrometer firmness. The correlation varied depending which tree was evaluated, the highest was r = −0.903. Skic et al. [18] used a similar approach for “Ligol” and “Szampion” apples. They achieved a correlation of about r = −0.5 for both cultivars. Peña-Gomar et al. [19] used a technique called laser reflectometry near the critical angle (LRCA) to measure the refractive index of mango pulp, which was expected to correlate with acoustic firmness. Their results showed some correlation but the authors did not report the correlation coefficient, and only six fruits were measured.
\n
\n
\n
3. Optical techniques for firmness measurements
\n
Optical methods are noncontact; a feature that distinguishes them from most mechanical methods. In the past two decades, the most common optical sensing method for produce grading is NIRS. Grading lines equipped with NIR sensors are now commercially available from many manufacturers. Firmness is not an attribute commonly assessed using industrial NIR sensors [1], but it has been studied in a number of research applications (Table 1).
\n
In theory, the optical scattering properties are more directly related to firmness than absorption properties and have been reported to correlate with firmness, as discussed in Section 2 [14, 15]. Optical techniques that can measure optical properties of biological materials have been studied more recently, aiming to provide a more accurate and robust technique compared to NIRS. These techniques may be divided into three main categories: time resolved, frequency domain, and spatially resolved. Time-resolved and frequency domain techniques have been extensively researched in the biomedical area, but they may not be suitable for applications on a grader line because of expensive instrumentation, slow speed, and the requirement of good contact between the sample and detector [20]. Spatially resolved techniques, and more specifically SRRS, have been researched more commonly for such applications as it can overcome many of those deficiencies.
\n
\n
3.1. Near-infrared spectroscopy
\n
NIRS is widely used to determine fruit quality parameters, particularly compositional parameters such as soluble solids or dry matter content [4, 21]. Standard NIRS measures the spectral pattern of light transmitted through a representative portion of the flesh, and chemometric analysis methods are generally used to interpret the resulting absorbance spectra in terms of the parameters of interest. The disadvantage is that this technique relies on a prior extensive training exercise to develop a predictive model, based on the careful selection and measurement of a representative calibration data set from a suitable population. The model also needs to be checked and updated constantly.
\n
For measuring fruit firmness, the NIRS method is limited in theory because it involves measurement of the apparent light absorbing power of a sample, which does not segregate scattering and absorption properties. However previous studies have suggested firmness may affect the apparent light-absorbing power through chemical changes associated with cell wall degradation, physical changes in intercellular structure and/or indirectly through correlated pigment absorption changes such as a chlorophyll decrease on ripening [14, 15].
\n
\n
3.1.1. Basic concepts
\n
Near-infrared radiation covers the range of the electromagnetic spectrum between 780 and 2500 nm. Often wavelengths below 780 nm are also included in the analysis as these regions contain valuable information on absorbing pigments within the fruit flesh and skin [15]. Therefore, this technique is often referred to as Vis/NIR spectroscopy.
\n
The typical NIRS set-up uses a broadband light source to illuminate the sample and the transmitted or reflected light is measured using a spectrometer. In the design process, it is useful to know that the NIR light intensity decreases exponentially with depth. One study [22] showed that the light intensity dropped to 1% of the initial intensity at a depth of 25 mm inside an apple in the 700–900 nm range. The depth was less than 1 mm in the 1400–1600 nm range. Therefore, the optical arrangement and the effective optical path length for the light are crucial elements to consider in order to collect spectra containing relevant information from the sample. This also explains why NIRS is suited for use with thin-skinned fruit, the thicker skins limiting light penetration [23].
\n
In practice, three measurement set-ups are used (Figure 2). In reflection mode, light source and spectrometer are on one side but at a specific angle to avoid specular reflection, while in transmission mode the light source and detector are on opposite sides. Interactance requires a special optical arrangement so that specular and surface reflection cannot directly enter the detector.
\n
Figure 2.
Three different set-ups: (a) reflectance, (b) transmittance, and (c) interactance. (i) Is the light source, (ii) is the sample, (iii) is the detector, (iv) is a light barrier, and (v) is the mechanical support [21] (Used with permission from Elsevier).
\n
Transmission measurement has the advantages of exploring the largest volume of the internal flesh and all the light measured has interacted with the flesh. Thus it is suitable to find internal defects, but the transmitted light might also contain information of the two layers of skin (front entrance and back exit), and the core of the fruit. For firmness measurement, although light penetration is limited and one skin layer is still present, reflection and interactance set-ups will be more desirable as the light interacts with some portion of flesh without interference from the core. Schaare and Fraser [24] compared reflectance, interactance and transmission measurements for measuring soluble solid content (SSC), density and internal flesh color of kiwifruit and concluded that interactance measurements provided the most accurate results.
\n
\n
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3.1.2. Firmness applications
\n
Sensors based on NIRS techniques have been mainly developed for chemical compositions such as SSC, and most of the studies have been carried out under static conditions. The industry is taking the lead in the development of online systems, but there is little scientific evidence of their accuracies [21]. Attempts to use NIRS for fruit firmness prediction have met with varying degrees of success with some studies reporting correlations as high as R ~ 0.8 − 0.9. Table 1 gives an overview of NIRS applications that measure firmness of fruits and vegetables.
\n
Most reported scientific studies consider only a single NIR instrument format for fruit assessment. For example, McGlone et al. [25] used an interactance mode (Figure 3). The system contained a broadband light source (50 W quartz halogen, RJL 5012 FL, Radium, Germany) and a nonscanning polychromatic diode array spectrometer (Zeiss MMS1-NIR, Germany). Fruits were placed on a holder with stem-calyx horizontal. Measurements were generally taken on two opposite sides around the circumference, taking care to avoid any obvious surface defects. The absorbance spectrum measured was the average of 5 contiguous acquisitions at 175 ms integration time.
\n
Figure 3.
The benchtop NIRS system [25].
\n
The wavelength range used varies among the reported literature studies (Table 1). Walsh [23] suggested that restricted wavelength ranges could improve the robustness of a model and allow for the development of lower cost “multispectral” measurement systems. Prediction performance was generally determined by dividing the fruits randomly into a calibration and a validation set for model development. Walsh [23] also reported that such a model will predict the attribute of interest within the population, but it is likely to fail spectacularly on a new, independent set.
Figure 1 illustrates two types of light reflectance: surface reflectance and diffuse reflectance. Surface reflectance contains information about the object surface such as color. Only 4–5% of incident light is reflected by surface reflection and external diffuse reflectance, so most reflected light contains the diffuse reflected/backscattered photons that carry information of the internal tissue properties [11].
\n
Figure 4 shows a small continuous-wave light beam perpendicularly illuminates the sample’s surface, and the reflected light is measured at different distances from the light source, forming the spatial profile (Figure 3). Optical properties/parameters can be obtained by using a phenomenological diffusion model and/or a heuristic modified Lorentzian model from the measured one-dimensional scattering profile. Mollazade et al. [28] used texture-based features methods to build models to predict mechanical properties of various produce. Instead of looking at a single 1D scattering profile, this technique analyzed the entire 2D images, which was expected to improve the correlation to firmness.
\n
Figure 4.
Measuring principle for spatially resolved reflectance spectroscopy (SRRS) [20] (Used with permission from the author).
\n
The extracted parameters can then be used to predict firmness using statistical models such as multiple linear regression (MLR) and artificial neural network (ANN). Typically, images are first processed to reduce noise and then converted into one-dimensional profile [29]. Figure 5 illustrates the process used by Sun et al. [30] for measuring apple firmness. The scattering image was first processed to find the center of the illuminated area (Figure 5(a)). Then a process called ring/radial averaging was performed. The distance to each pixel was calculated and rounded to the nearest whole number (Figure 5(b)). All pixels at each of these integer radii were grouped and averaged providing a vector of intensity values that correspond to single pixel rings expanding out from the center point (Figure 5(d)). The intensity profile (Figure 5(c)) was finally produced.
\n
Figure 5.
Imaging processing used by Sun et al. [30] for apple firmness measurements: (a) finding center in the raw image, (b) ring average, and (c) & (d) producing the spatial profile.
\n
\n
3.2.1. Parameters extraction
\n
In turbid material, a diffusion equation is often used as an approximation of the transport of the light. For SRRS under the assumption of inexistence of photon source in the medium, the diffusion equation can be simplified to an equation consisting of three variables: r (source-detector distance), μa and μs′ [11, 31]. Unknown optical properties μa and μs′ can be obtained by applying a curve fitting procedure with respect to r.
\n
Researchers have also used statistical distribution functions to fit scattering profiles as a function of scattering distance. Peng and Lu [32] investigated a number of variations of modified Lorentzian functions aiming to find one suitable for firmness and SSC measurements. They concluded Eq.(1) was the best performing equation, which was also used in other studies for firmness applications [7, 29, 30]:
where I is the intensity along a radial intensity profile, a is the asymptotic value of light intensity when x (distance to center of the light spot) approaches infinity, b is the peak value corresponding to the intensity at the center of the image, c is the full width half maximum (FWHM) of the intensity profile, and d is related to the slope of the profile in the FWHM region.
\n
\n
\n
3.2.2. Hardware
\n
A SRRS system consists of two essential components: light source and imaging system. All the systems can be divided into three types according to the light source and operating wavelength range: laser light backscatter imaging (LLBI), multispectral light backscatter imaging (MLBI), and hyperspectral light backscatter imaging (HLBI).
\n
The LLBI technique requires a small illumination spot on the target fruit, and measurement scattering areas of 25–30 mm diameter have been used for beam diameters of 0.8–1.5 mm by Lu [33] and Peng and Lu [32], respectively. Lasers are particularly suitable for this purpose since lasers can produce focused high-irradiance illumination spots on the fruit, which allows for deeper light penetration and fast image acquisition (shorter integration time). Moreover, LLBI systems are more robust and cost-effective than MLBI and HLBI. Overall, LLBI systems are potentially suitable for online high-speed operations. One of the drawbacks of LLBI systems is the limited operating wavelength. One to four lasers are typically used [28, 30, 34].
\n
In the MLBI and HLBI systems, the light source is a tungsten-halogen lamp. The light usually passes through an optical fiber and then focuses on the fruit by a collimating lens, as shown in Figure 6. One exception is the system developed by Van Beers et al. [35] where a super-continuum laser and a monochromator were used for the hyperspectral measurements.
\n
Figure 6.
Hyperspectral system (HLBI) for measuring the firmness of peach [36] (Used with permission from Elsevier).
\n
The scattering profiles can be measured using multiple spectrometers at different source-detector distances. The advantage of using a spectrometer is that multiple wavelengths or a specific spectral region can be obtained simultaneously. However, it requires a good contact/focus between the probes and the sample, which will not be suitable for online operations. A CCD camera is more commonly used as it is noncontact, which has been a dominant format in all three types of systems (Table 2), except that Sun et al. [30] used a CMOS camera. CCD and CMOS cameras allow only single wavelength operation, but an imaging spectrograph has been used in HLBI systems to provide spectral and spatial information on a single image (Figure 6). Filters were also used in MLBI system to enable the image acquisition at specific wavelength [33].
Overview of applications of SRRS in firmness measurements.
\n
\n
\n
3.2.3. Applications
\n
An overview of SRRS to measure the firmness of fruits and vegetables is given in Table 2. The studies show that SRRS achieves similar performance compared with NIRS. The correlations with penetrometer firmness are often in the range of r = 0.8 − 0.9. It is not clear which type or instrument format of SRRS is more advantageous. Most studies evaluated the potential of SRRS systems for firmness measurements on static fruit and have not considered the practical challenges of applying SRRS to online situations. Unlike NIRS, there have been no commercially available sensors based on SRRS. All the studies listed in Table 2 are laboratory systems specifically constructed for measuring stationary fruits. Lu and Peng [7] developed a real-time LLBI system for measuring the firmness of apples on a belt conveyor and achieved a correlation of r = 0.86. They claimed that the LLBI system could be integrated into existing grader lines without significant modification. However, their measurements were taken when the conveyor speed was only two fruit per second which is well below the maximum speed of a modern grader. Also, the fruit was manually positioned so that the scattering images could be captured from the equatorial areas of the fruit. The authors suggested the lasers and CCD camera should allow faster acquisition of the scattering images, but the algorithm for processing the images was the bottleneck. Overall, fruit orientation and data processing speed are the main challenges for applying SRRS in online systems.
\n
\n
\n
\n
\n
4. Conclusion
\n
For the main two optical techniques discussed here, NIRS and SRRS, there have been prior studies showing correlations with penetrometer firmness as high as r = 0.8 − 0.9. Both techniques can come in many instrument formats, so it is hard to judge from the literature which instrument is more advantageous. A direct comparison of the NIRS and SRRS methods has not been performed on the exact same fruit samples commonly. Sun et al. [30] compared an interactance mode NIRS system with an LLBI system using “Royal Gala” apples. The two systems had similar correlations with penetrometer firmness of about r = 0.9. By contrast, a comparison of a reflectance mode NIRS system and an MLBI system using “Red Delicious” and “Golden Delicious” was conducted by Lu and Peng [40]. Their MLBI system outperformed NIRS system with r = 0.82 and 0.81 for two apple cultivars, versus r = 0.5 and 0.48 from the NIRS system.
\n
It has been suggested r = 0.94 (r2 = 0.89) be considered as a minimum for any useful sorting/grading purposes [41]. Although sometimes very close to that mark, the correlations reported here and in most previous studies are lower. Moreover, NIRS sensors are likely to perform worse across grader lines and seasons because of the low robustness of the calibration models. These may explain why there are no optical sensors for firmness measurements yet commercially available. For SRRS, another concern is the feasibility of online applications; most studies discussed here are bespoke laboratory systems for measuring static fruits. Fruit speed and orientation are normally not a problem for NIRS but might be an issue for the online application of SRRS.
\n
NIRS is a relatively mature technique for quality grading of fruits and vegetables, though not commonly used for firmness. SRRS might well be a better method for firmness, being more robust in practice as it is more directly linked to the optical scattering properties that are presumed to be directly affected by changes in texture properties. However, the SRRS systems will have to be improved and demonstrate better performance than has been achieved to date before they can be considered for commercial implementation. We recommend further research across a wider variety of fruits in the future, and feasibility studies to assess the potential of SRRS for online applications.
\n
\n\n',keywords:"produce, firmness, spatially resolved reflectance spectroscopy, near-infrared spectroscopy, optical methods",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/56041.pdf",chapterXML:"https://mts.intechopen.com/source/xml/56041.xml",downloadPdfUrl:"/chapter/pdf-download/56041",previewPdfUrl:"/chapter/pdf-preview/56041",totalDownloads:1485,totalViews:288,totalCrossrefCites:1,totalDimensionsCites:3,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:64,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"November 21st 2016",dateReviewed:"April 18th 2017",datePrePublished:null,datePublished:"September 13th 2017",dateFinished:"June 15th 2017",readingETA:"0",abstract:"This chapter is devoted to a review of optical techniques to measure the firmness of fresh produce. Emphasis is placed on the techniques that have a potential for online high-speed grading. Near-infrared spectroscopy (NIRS) and spatially resolved reflectance spectroscopy (SRRS) are discussed in detail because of their advantages for online applications. For both techniques, this chapter reviews the fundamental principles as well as the measured performances for measuring the firmness of fresh produce, particularly fruit. For both techniques, there have been studies that show correlations with penetrometer firmness as high as r = 0.8 − 0.9. However, most studies appear to involve bespoke laboratory instruments measuring single produce types under static conditions. Therefore, accurate performance comparison of the two techniques is very difficult. We suggest more studies are now required on a wider variety of produce and particularly comparative studies between the NIRS and SRRS systems on the same samples. Further instrument developments are also likely to be required for the SRRS systems, especially with an online measurement where fruit speed and orientation are likely to be issues, before the technique can be considered advantageous compared to the commonly used NIRS systems.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/56041",risUrl:"/chapter/ris/56041",book:{id:"5972",slug:"postharvest-handling"},signatures:"Jason Sun, Rainer Künnemeyer and Andrew McGlone",authors:[{id:"202132",title:"Ph.D. Student",name:"Jason",middleName:null,surname:"Sun",fullName:"Jason Sun",slug:"jason-sun",email:"zhesun89@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"University of Waikato",institutionURL:null,country:{name:"New Zealand"}}},{id:"206093",title:"Prof.",name:"Rainer",middleName:null,surname:"Kunnemeyer",fullName:"Rainer Kunnemeyer",slug:"rainer-kunnemeyer",email:"r.kunnemeyer@ieee.org",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"206096",title:"Dr.",name:"Andrew",middleName:null,surname:"McGlone",fullName:"Andrew McGlone",slug:"andrew-mcglone",email:"andrew.mcglone@plantandfood.co.nz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Principle of optical methods for measuring firmness",level:"1"},{id:"sec_3",title:"3. Optical techniques for firmness measurements",level:"1"},{id:"sec_3_2",title:"3.1. Near-infrared spectroscopy",level:"2"},{id:"sec_3_3",title:"3.1.1. Basic concepts",level:"3"},{id:"sec_4_3",title:"3.1.2. Firmness applications",level:"3"},{id:"sec_6_2",title:"3.2. Spatially resolved reflectance spectroscopy (SRRS)",level:"2"},{id:"sec_6_3",title:"3.2.1. Parameters extraction",level:"3"},{id:"sec_7_3",title:"Table 1.",level:"3"},{id:"sec_8_3",title:"3.2.3. Applications",level:"3"},{id:"sec_11",title:"4. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'García-Ramos FJ, Valero C, Homer I, Ortiz-Cañavate J, Ruiz-Altisent M. Non-destructive fruit firmness sensors: A review. Spanish Journal of Agricultural Research. 2005;3(1):61-73\n'},{id:"B2",body:'Abbott JA. Quality measurement of fruits and vegetables. 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Integrated spectral and image analysis of hyperspectral scattering data for prediction of apple fruit firmness and soluble solids content. Postharvest Biology and Technology. 2011;62(2):149-160\n'},{id:"B38",body:'Nguyen Do Trong N, Erkinbaev C, Tsuta M, De Baerdemaeker J, Nicolaï B, Saeys W. Spatially resolved diffuse reflectance in the visible and near-infrared wavelength range for non-destructive quality assessment of braeburn apples. Postharvest Biology and Technology. 2014;91:39-48\n'},{id:"B39",body:'Noh HK, Lu R. Hyperspectral laser-induced fluorescence imaging for assessing apple fruit quality. Postharvest Biology and Technology. 2007;43(2):193-201\n'},{id:"B40",body:'Lu R, Peng Y. Comparison of multispectral scattering and Visible/NIR spectroscopy for predicting apple fruit firmness. Information and Technology for Sustainable Fruit and Vegetable Production, (FRUTIC). 2005;5:493-502\n'},{id:"B41",body:'McGlone VA, Kawano S. Firmness, dry-matter and soluble-solids assessment of postharvest kiwifruit by NIR spectroscopy. Postharvest Biology and Technology. 1998;13(2):131-141\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Jason Sun",address:"zhesun89@gmail.com",affiliation:'
School of Engineering, University of Waikato, Hamilton, New Zealand
Dodd Walls Centre for Photonic and Quantum Technologies, New Zealand
The New Zealand Institute for Plant & Food Research, Hamilton, New Zealand
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1. Introduction
The technological advances which occur at a rapid pace in the sectors of biomedicine, information technology and telecommunications, have already transformed fundamentally the entire spectrum of production and distribution of health services. The open e-government promotion leads in its turn, to the reshaping of the health sector, which is being called upon to respond to the contemporary challenges including the restriction of the expenses incurred, the effectiveness and simultaneous increase of the health services users’ satisfaction [1, 2].
The Greek National Health System, especially after the prolonged period of economic crisis which it has experienced since 2009, faces up against accumulated problems in the citizen’s relations with the services (responsiveness, quality and accessibility in the provided health services), having to solve a difficult equation. It’s being required to balance and find the golden mean between the healthcare cost, which is constantly rising, since the destitute and uninsured citizens are multiplying, the population of Greece is aging, chronic and degenerative conditions are striking more and more people, while at the same time the refugees who arrive in the country amount to tens of thousands. On the other hand, the available system resources, both material and human, are constantly decreasing [3, 4]. Thus, inevitably, the need arises for healthcare in Greece to readjust to the new circumstances and utilize the digital technology so that hospital institutions will be decongested and healthcare expenditure limited [5, 6].
This paper will define the content of e-Health in accordance with the decisions of the World Health Organization and other international legal entities. It will then focus on how Greece implemented the specific decisions of international organizations. It will describe in detail the forms of e-Health adopted by the Greek National Health System, it will assess the benefits and the problems that have emerged from their implementation. Finally, it will discuss some of the challenges that Greece faces in the coming years in the context of the implementation of e-Health and highlight the role that the COVID-19 pandemic may play in accelerating them.
2. The concept of e-health
The term “e-Health” describes the utilization of modern technologies of Information Technology and telecommunications across the board of provided services by health professionals [7, 8]. In the framework of e-Health there are included programmes, systems and services which exceed the simple applications based on the Internet and are addressed both to health professionals and patients-users of health services, such as organized networks of health information, an electronic health record, an electronic health card, e-prescription, telemedicine, tele-counseling, tele-monitoring, personal portable communication systems, mobile phones and health portals. According to the World Health Organization [9] and the European Commission [10], e-Health refers to a wide range of products, systems and tools, which build their operation around the advanced information and communication technologies (ICT), aiming not only at the better management of health, but also the applied lifestyle on the whole. These online applications are addressed both to health professionals and patients-users and adopt a philosophy of a holistic approach, as they handle the prevention, diagnosis, treatment and later monitoring [11].
e-Health essentially comprises an emerging field in the intercept point of the scientific fields of medical informatics, public health and operational research. Its utilization focuses on the immediate, valid, qualitative and safe provision of health or healthcare services via the Internet and other available communication technologies. The desired effect is the transference of expertise and ensuring the smooth and unencumbered information flow, concerning not only healthcare, but also public health or preventive medicine [12].
At a global level, e-Health implementation is governed by the e-Health Resolution adopted by the 58th World Health Assembly in 2005 and aimed at better understanding [13] as well as its e-Health standardization and interoperability of World Health Organization [14], which stresses the need for standardization and interoperability of electronic applications, convergence of standards and their evaluation using common indicators, for comparable results. Furthermore, in 2012, the World Health Organization, in collaboration with the International Telecommunication Union (ITU), provided in the form of a manual the necessary guidelines to facilitate states in developing their national e-Health planning. This WHO-ITU National e-Health Strategy Toolkit [15] is a comprehensive operation plan and monitoring of e-Health applications and can be implemented by all countries wishing to develop or upgrade their national policy for e-Health, regardless of the level they are in today.
In Greece, its implementation was placed in the Greek framework of open government e-GIF (Electronic Government Interoperability Framework) and information online management, that was integrated in the Digital Agenda 2006–2013 (for the adjustment of services to the demands of the modern era), which was later readjusted in the framework of National Digital Strategy from 2016 to 2021 [16]. The Greek framework of open government specifies in essence the commands of the European action eEurope 2005-eGovernment and the programme eEurope-i2010, which divide the online provision of services in four axes: e-Government, e-Health, e-Learning and e-Business [17]. Towards the further propulsion of e-Health, the National Council of e-Health Management (NCHM) was established in 2015, which is headquartered in the Greek Ministry of Health.
3. Forms of e-health in Greece
e-Health does not only provide technological and procedural solutions to the needs of healthcare, but also reliable supportive applications, which are called upon to serve man, as the object and recipient of the health services provided. The tools that are employed in the context of e-Health promoting, are more effective, more user-friendly and more widely accepted both by the health professionals and the patients themselves. In e-Health applications there are included the electronic patient record, the electronic health card, e-prescription, development of telemonitoring and teleconsultation systems, as well as e-referral and electronic refund of medical expenses [18].
3.1 Electronic patient record
More specifically, the Electronic Patient Record or alternatively the Electronic Health Record comprises an individual electronic catalog, in which the medical data concerning the patient is registered and kept, so that its transference to any hospital institution or authorized doctor can be possible, aiming at a better diagnosis and limitation of medical mistakes [19, 20]. The same philosophy is served by using the electronic health card, so that an overview of its owner’s health condition arises.
The electronic record includes data regarding the patient’s medical history, such as their admission or readmission dates, their treatment duration, the results of laboratory and paraclinical tests conducted, the administered medicines and other treatment actions, information for the cost of the provided services, prior services offered as well as reports of acute cases, so as to constitute the patient’s diagnosis basis and treatment approach, and at the same time the basis of epidemiological studies. In addition, it provides information of administrative, financial and statistical nature which is related to the respective hospital unit and the patient’s demographic data (full name, VAT number, competent insurance institution, blood type), as well as quality control data [21].
The Electronic Health Record comprises an updated version of the Electronic Patient Record, as it aims at the continuous observation of its owner’s health and not exclusively during their treatment period. In contrast with handwritten records, it ensures the preservation of the registered data (health data, laboratory results, medical instructions, imaging records, bio-signal records), and their endurance through time, it allows their holistic management while providing interconnection capacity via applications of data transmission. This way, it facilitates the provision of medical consultation remotely, simultaneously enabling the electronic prescription. It also contributes to the timely and correct illness diagnosis, the right observation of patients, the elimination of multiple registrations, the operational cost reduction (e.g. avoidance of pointless examinations, facilitation of payment, distribution of resources connected to the diagnosis and treatment), and at the same time it creates a constantly developing “electronic library” which is also compatible with research purposes [22, 23, 24].
Since the data which is included in the patient’s medical record, fall within the most sensitive personal information (main illness, history of present illness, allergies and medicines, medical history, family history, social history, occupational history, sexual history, addiction to use of drug, smoke and other substances), every aspect of their safety, confidentiality and protection must be ensured substantially [25, 26]. In the last few years, the Citizen Health Record has been promoted in Europe, which corresponds more thoroughly to the contemporary vision of the globalized citizen, as far his expectations from the health services are concerned. It is an improved version which fully covers the digital recording and preservation of the contents of the electronic medical record and simultaneously deals successfully with the problems that arise from its electronic nature [27].
In Greece, the creation of a National Medical Record is being promoted, in order that all the necessary information regarding a citizen’s health condition (hospital treatments, medical opinions, imaging and laboratory examinations, prescriptions, etc.) will accompany them from now on [28]. The efficiency of this modern digital tool will be bidirectional. On the one hand, it will guide and facilitate the citizen in their contact with the National Health System (e.g. through the application myHealth, the appointment making will be conducted digitally, as well as the system navigation). Nonetheless, at the same time it will comprise a “portal” of access to their data for the treating doctors, so that they have the full medical history available, thus abolishing the printed records. The first step has been taken with the activation of the Individual Electronic Health Record. In the next stage, there is the provision of its further reinforcement and its gradual disengagement from the Family Doctor through legislative interventions [29]. As the General Secretary of the Ministry of Health stated, in the electronic record there will be included the patient’s biochemistry and blood tests, as well as the main clinical documents of the hospitals that concern them [30].
The formation process of the Electronic Patient Record is advancing at a satisfactory pace. It is noteworthy that the non-profit Public Company under the name “Electronic Government of Social Insurance” (IDIKA P.C.), which undertook the implementation of the project, was awarded an international distinction at the awards ceremony of the World Information Technology and Services Association “WITSA Global ICT Excellence Awards 2019” that took place in the context of the World Congress on Information Technology, on October 8th, 2019 in Erevan, Armenia. The project of the Electronic Health Record (EHR) was distinguished as Merit Winner in the category “Innovative eHealth Solutions” [31].
It should also be pointed out that the pandemic of COVID-19 gave a new impetus to the formation process of the electronic record in Greece. In particular, in April 2020, there was enforced by the Greek Ministry of Health and the Ministry of Digital Government the Electronic COVID-19 Patients Register. In this way, the contact of patients suffering from COVID-19 with their treating doctors was simplified, especially in the sectors of tele-consultation and both intangible and remote prescription. What is more, it should be highlighted that based on the Greek and European Law, the patients’ personal data are protected, as health services have at their disposal merely the information which is helpful for the handling of the pandemic [32].
3.2 Electronic prescription
Furthermore, the adoption and application of electronic programmes in the field of pharmaceutical policy, such as the medicine list and the electronic prescription, contributes crucially to the rational management of the provided pharmaceutical services, ensuring the appropriate and more economical care with a simultaneous minimization of expenses [33]. The uniform electronic medicine list includes the approved available pharmaceutical preparations, their cost and the amount of their provided for compensation.
Despite the fact that this specific list mainly comprises a clinical tool, facilitating the doctors’ e-prescription substantially, it also assists by its central management, the significant restriction of pharmaceutical expenditure, in combination with the promoted policy of generic medicine selection (i.e. the copies of pharmaceutical preparations), instead of the original ones which are more expensive due to the patent they possess [34, 35]. Additionally, both the electronic entries of the prescriptions on the part of the doctors with the help of personalized passwords and the obligatory prescription based on the active substance and not the commercial name of the preparation, allows the wider administration of the more economical generic medicines and the electronic monitoring of medical prescription behavior in real time [36, 37].
During the COVID-19 pandemic, it became clear that the utilization of digital technologies is the only safe way in order for the patients to gain access to the health system. Thus, in the summer of 2020, the intangible electronic medicine prescription was established by law in Greece (L. 4704/2020). Both the intangible prescription and the intangible referral are transferred now exclusively using electronic means to the Primary Healthcare System. The patients log in there and state that they wish to receive their medicine prescription electronically, either through a message (SMS) on their mobile phone or via an email to their email address. In the fulfillment of the intangible electronic prescription, the printed form of the doctor’s medicine prescription is not submitted to the chemist. The chemist retrieves the intangible electronic prescription by entering in the Electronic Prescription System the prescription barcode or the patient’s Social Security Registration Number (SSRN) [38].
3.3 National Network of telemedicine (NNTM)
The potential that new technologies offer is expanded in the field of telemedicine, tele-monitoring and teleconsultation, as well. The utilization of telemedicine and telecare, which means the remote support or provision of health services by specialized and suitably trained health professionals to that purpose, goes a long way towards dealing in a timely manner with situations that could turn out to be a health hazard. Therefore, it is about technical knowledge transfer instead of patient transfer. Its major significance lies in the fact that it provides the possibility of remote support for patient management at the regional health facilities by general medicine practitioners.
In Greece, a mainly insular country which is divided in seven health regions, there has been materialized a National Network of Telemedicine since 2016, headquartered in the country’s 2nd Regional Health Authority to which the large port of Piraeus and the Aegean islands belong. The same year, NNTM won the award of Business I.T. Excellence Gold (BITE) for its output, which is awarded in cases where technological innovation coincides with business excellence. The Network of Telemedicine is based on the Public Data Network of OTE “INTERCONNECTION” and it includes 43 telemedicine units. Those are based on 12 regional and central hospitals, as well as 30 centers of the Aegean islands, including the border islands of Astypalaia, Icaria, Kalymnos, Ios, Kasos, Kastellorizo. Lastly, there is a telemedicine unit in the center of operations of the Greek Ministry of Health [39].
The National Telemedicine Center is bound to be expanded to 22 additional islands of the Northern and South Aegean, covering the healthcare needs of 52 islands on the whole, with 71 telemedicine units and 90 patient monitoring systems at home [40]. This way, there is provided an equal access of the island regions patients to the services of the National Health System. At the same time, the pointless transfers and evacuations by air are limited, simultaneously relieving the hospitals Out-patient Clinics.
Every telemedicine unit consists of a specially configured chamber, a camera, a screen and appropriate medical instruments that broadcast the indications of examinations live at hospitals of Athens and Piraeus. In this effort towards not only the provision of specialized health services, but also the guidance and education of the regional health professional in the Aegean islands which are isolated from the major urban centers, 270 health professionals participate, among whom 67 doctors-consultants from 27 different specialties (Psychiatry, Child-Psychiatry, Pediatrics, Surgery, Pediatric Surgery, Breast Surgery, Orthopedics, Pathology, Bio-pathology, Pathologic Oncology, Cardiology, Dermatology, Medical Imaging, Dentistry, Pulmonology, Obstetrics-Gynecology, Chest Surgery, Plastic Surgery, Nuclear Medicine, Ophthalmology, Rheumatology, Gastroenterology, Endocrinology, Nephrology, Urology, Critical Care Specialist, Emergency Unit Specialist) [39]. The examinations categories which are mainly requested are child-psychiatric, endocrinologic, diabeteologic, psychiatric and oncologic [40]. In a country such as Greece, which has over 90 islands, the telemedicine network is estimated to serve the needs of more than 320,000 permanent residents and a fairly large number of visitors each year [41].
According to the information available, there were held more than 4,500 appointments of specialized health services provision in regular and emergency incidents in Aegean islands of the Greek-Turkish border through the NNTM. At the same time, actions of prevention and promotion of oral hygiene were conducted to children aged 6–12 in Chios (Pyrgi, Kalamoti), in Oinousses and Icaria’s Fournoi, as well as an action of prevention aimed at children and adolescents of the border island of Ios about mental health issues. Furthermore, continuous education of the health professionals who staff the insular health units is carried out, the main bodies being the University General Hospital “Atticon” and the General Nikaia Hospital “Agios Panteleemon”. It is interesting that over 300 educational seminars have been materialized to date. Alongside, in the education context of the general population, junior high and high school students of Lesbos island (Antissa) were educated on Basic Life Support (BLS) and the use of an automatic external defibrillator.
Moreover, the telemedicine network is used for administrative support, with frequent video-conferences (approximately 70,000 teleconferences were carried out up to November 2020) for the further familiarization with the use of the system and primarily for the change of philosophy of the employees in the sector of health and the adoption of the operation of NNTM οn everyday practice. What is especially important is the free-of-charge provision of tele-interpreting for the facilitation of hospital institutions and Health Centers in the handling of incidents where there is no common communication language between the patient and the health professionals. As far as the future goals of NNTM are concerned, they include the integration of emergency incidents in the hospital shifts, in order to achieve a 24-hour coverage of the Aegean islands, at least concerning cardiologic and pediatric incidents.
3.4 Patient tele-monitoring
An advancement of telemedicine is the provision of health services at home, which supports tele-monitoring and tele-management of patients in their own premises. The health professionals, who provide care remotely, can diagnose X-rays, receive a medical history from patients, assess laboratory findings and suggest courses of treatment. Electronic recording devices are used, which send the data to the treating doctor, and then he/she on his/her part, having all the necessary documentation, consults the patient-user comprehensively. The system under discussion addresses mostly patients with heart disease, pulmonary disease, hypertension and diabetes, who require long-term monitoring. Nevertheless, there is also the possibility to utilize it in the monitoring of patients having different treatment needs, such as post-operative or psychiatric patients [42].
Greece has also demonstrated significant progress in the sector of patient tele-monitoring in the last few years. More specifically, the following programmes are being carried out:
3.4.1 Telecare programme renewing health
The programme was applied for the first time at 2014 in the area of Thessaly, in Central Greece, granting monitoring remote services to patients with chronic conditions, in particular to patients with type 2 diabetes, cardiovascular disease and obstructive pulmonary disease. It is noteworthy that in the cases of the patients suffering from diabetes and cardiovascular failure, there were noted positive clinical results as far as intervention via tele-monitoring is concerned. However, at the same time various problems arose, such as the slow pace of adoption of technological innovations in healthcare, the complexity of the institutional framework, the lack of compensation models, as well as the lack of interoperability in telemedicine infrastructure. The Greek Ministry of Health is making an effort to resolve all those problems [43].
3.4.2 SmartCare programme
It’s a European programme in which the Greek Municipalities of Palaio Faliro, Alimos and Agios Dimitrios participated. The project was related with the development and incorporation of technologies in the existing care structures for the independent living of patients and the elderly at home (home platforms). The programme provided various services, such as observation of the patients’ physiological, environmental and behavioral parameters, self-care functions, management of the patients’ medication, prevention of falls and accidents and practice of the patients’ cognitive functions [43].
3.4.3 United4Health programme
In the programme United for Health, there were overall 33 participants from all Europe as well as international organizations from the sector of electronic health. Greece took part through the 5th Regional Health Authority of Thessaly and Continental Greece, as well as via the “Cities NET S.A.” (Larissa, Ioannina, Volos, Lamia, Kozani, Katerini, Veria, Karditsa, Trikala and Grevena) after being granted permission from the competent Ministries. The programme had a duration of 3 years and a total budget of 10,151,56 Euros for all Europe, while it was cofounded by the European Committee. In the context of the programme, there were selected patients suffering from chronic diseases (such as diabetes mellitus for the case of the pilot in Greece) by the treating doctors with the criteria of the need for intensive home monitoring and adjustment of medication [44]. There were utilized some conclusions from the Renewing Health Telecare Programme in Central Greece and there were organized telecare services of an out-patient clinic in actual conditions. The study conclusions demonstrated that the clinical efficacy of telecare for diabetes mellitus patients is feasible, depending on the service per National Health System, though [43].
3.5 Video-communication stations for the deaf and hearing-impaired
The National Institution for Deaf People of Greece, since March of 2019, began to develop a new form of service for people with hearing/impaired hearing problems with the aid of technology (Relay Service). The referred to service is of a 24-hour cycle. People with hearing/impaired hearing problems can make use of the electronic appliance on their mobile phone or on an electronic computer of any kind and contact a special interpreter via video call. By using the programme, the improvement of communication and service of the deaf and hearing-impaired is achieved, as the transmission of information to health professionals is facilitated. By extension, the users are able to receive equally quality health services at the levels of prevention, diagnosis, treatment, hospital treatment, rehabilitation and support in administrative services.
In the framework of social support for the disabled, the specific initiative was adopted by the Ministry of Health in Greece, anticipating inequality decrease and equal access to social communication commodities for all citizens. With a document from the Administration of Primary Healthcare of the Greek Ministry of Health (Γ1γ/ΓΦ.20.ΣΤ/ΓΠ. 66393/26.10.2020), it was requested by all structures and services of healthcare provision, both of the public (Hospitals, Health Centers, Centers of Mental Health and other supervised bodies of the Ministry of Health) and the private sector (private clinics, private practices, dental practices, group practices, laboratories, units of daily treatment) to accept and utilize the recommended authorized way of communication through the programme of Relay Service in order to accommodate the deaf and hearing-impaired, as well as for the provision of services in which their physical presence is not required [45].
The first video-communication station for the deaf and hearing-impaired in Greece operated in July 2020 at the “Laikon” General Hospital of Attica. According to the national plan, 30 stations of video-communication for the deaf and hearing-impaired are expected to operate for a trial period of one (1) year both in hospitals and other public services and bodies of common interest in Greece, for instance Local Authorities, Regions, Airports and the Underground [46].
The example of the “Laikon” General Hospital of Attica was followed, in October 2020, by the 4th Macedonia and Thrace Regional Health Authority, which announced the operation initiation of three (3) video-communication stations for the deaf and hearing-impaired at the AHEPA University General Hospital, the Alexandroupoli University General Hospital and at the 25th Martiou Health Center in Thessaloniki [47].
3.6 Mobile health (m-health)
One of the subdivisions of e-Health is the exploitation of mobile phones, mobile Health (m-Health). The cellular phone is proved to be the handiest tool nowadays, as it has evolved into a personal object that the majority of the population uses and does not part with. It can be recruited in the context of e-Health in a variety of ways: notification of the patient about the taking of their medication through automatized messages, their scheduled appointments or reminders to pregnant women either about different stages of pregnancy or advice when they cope with an unusual condition [48, 49, 50].
In Greece, mobile Health was used extensively during the COVID-19 pandemic. In this context, a special hotline of psychosocial support operated in Greece (10306) by the National Public Health Organization. The hotline service was offered under the supervision of the Medical School of the National and Kapodistrian Athens University [51].
4. The contribution of e-health to smart and pervasive healthcare. Challenges for Greece in formulating a national strategy for the future of e-health
e-Health certainly does not constitute the “magic solution” for the existing health system’s various problems in infrastructure, staffing, organization and resources. However, it can significantly enable the successful dealing with its chief function issues, optimizing the provided services of Primary Healthcare. In particular, e-Health ensures fast, valid, reliable and directly accessible medical information for everyone, which covers not only topics of general interest, but also specific issues that cope with specific needs. By the exploitation of the possibilities it grants, the prompt and correct diagnosis of diseases becomes feasible, as well as the regular monitoring of patients and the remote provision of medical consultation, with an emphasis on preventive medicine. It also facilitates both the medical care of people who reside in isolated areas and individualized medical healthcare in combination with patients’ safety [52].
The applications of e-Health contribute to the correct diagnosis, with the assistance of non-invasive systems that base their function on imaging. Thus, the sector of Primary Healthcare provision is re-determined and expanded, regionally and temporally, as well as with regard to the speediness, utilization easiness, availability, operability, possibilities of control and cost reduction, the degree of participation and awareness, combined with the improvement of service of the patients-users [53].
By utilizing e-Health extensively, the exchange of data is facilitated, while at the same time, standardized forms of communication are now created between health professionals. Primarily, however, a new status is given to the interaction and mutual cooperation of the doctor with the patient, which must, nonetheless, be governed by honesty, trustworthiness and confidentiality [54].
e-Health is a key component that the European Union also emphasizes in the setting of Europe 2020 targets [10]. As of 2011, the European Commission’s Implementing Decision of 22 December laying down the rules for the establishment, management and operation of the network of national authorities responsible for e-Health (Decision 2011/890/EU) entered into force. The following year, the European Commission, through the Directorate-General for Health of the European Union, adopted common rules of procedure for the implementation of the e-Health network in European countries, aiming at interoperability and uniform evaluation [12]. Concerning the Member States of the European Union, according to a press release issued by the European Commission on the extent of e-Health in Europe, the use of e-Health systems has been generalized in most European countries. The pioneers are: Denmark, the Netherlands, Great Britain, Estonia, Sweden, Finland and Germany. More specifically, the countries that perform best in the implementation of e-Health in hospitals are Denmark (66%), Estonia (63%) and closely followed by Sweden and Finland (62%). In the digitization of medical files the best performance has been made by the Netherlands (83.2%), followed by Denmark (80.6%) and Great Britain (80.5%), while Estonia stands out (100%) in e-prescription followed by Croatia (99%) and Sweden (97%) [55].
In 2015, the top ten European States in e-Health applications between doctors and patients were as follows: Denmark, Finland, Spain, the Netherlands, Sweden, Estonia, Croatia, Portugal, Germany and France. The e-Health applications evaluated included physicians’ ability to diagnose and prescribe electronically, the ability of health professionals to exchange data, make appointments with patients, and communicate with care providers, medical surveillance, patients’ electronic information about their health and the ability to obtain valid information via the Internet [56].
In Greece, e-Health has experienced a rapid development in the last two decades. As contradictory as it may sound, the economic crisis following 2019 became an opportunity for the country to proceed to extensive changes in the National Health System. That was necessary since health expenditure had to be significantly reduced. In this context, e-Health applications were deemed very effective so that the country could secure resources for the repayment of foreign loans. According to the European Union data, per capita expenditure in the health sector in Greece in 2009 amounted to 2,287 Euros. That amount decreased to 1,650 Euros in 2015 [57], a sum which is 45% lower than the European Union average [58].
An additional pressure to the National Health System was given by the thousands of refugees who arrived in the country in the last few years. According to the data, only in the year of 2015, Greece in collaboration with NPO, provided medical care to approximately 870,000 refugees. The available data shows that, from the e-Health sectors, e-prescription has proved to be an essential factor towards expenditure restriction. It is estimated that in the time period 2009–2014, 3 billion Euros were saved thanks to intangible prescription [59].
The last pandemic of COVID-19 is expected to contribute even more towards the reinforcement of e-Health. In various countries, there have already been made and are currently functioning applications of tracking of contacts for cell phones. The said applications are installed voluntarily and, by using the Bluetooth technology, warn the users who were very close to a person affected by the virus for a period of time. In this way, it is possible to control the expansion of the infection more easily. Nonetheless, it is vital that the privacy and personal information of the users be protected, with the commitment from the national authorities that they will not make use of them and that they will deactivate the respective applications as soon as the pandemic has been overcome [60].
However, the way towards the direction of a smart and pervasive healthcare is still long both for Greece and the rest of the world. The only thing certain is that it is a one-way street. In our era, the era of the Fourth Industrial Revolution, e-Health is expected to experience an exponential growth in the years to come.
Unfortunately, in the case of Greece there are still no reliable financial data on the cost of implementing e-Health programmes and the benefits of their implementation. This is a significant lag in relation to the European reality, which is undoubtedly an obstacle on the further promotion of e-Health in Greece. The only reliable data that has been able to be found are based on research by the Association of Greek Industries which include as good practice the application of the National Network of Telemedicine in the remote Greek islands as well as the case of a public hospital, which is included in smart hospitals, i.e. those hospitals that have largely implemented the digitization of their services [61].
5. Conclusions
e-Health can yield significant benefits to the society as a whole, contributing conspicuously to the accessibility and quality of the provided health services to the citizens who are in need of them. Furthermore, it helps towards the development of a National Health System with an anthropocentric orientation, founded on the viability of the health field, with the spreading of correct practices and the optimal exploitation of the available resources, both material and human. Moreover, e-Health is bound to increase the effectiveness and efficiency of the services provided by health professionals, thus contributing to the rationalization and reduction of expenditure.
The promotion of e-Health renders possible the provision of better care to more patients, releasing the institutional resources (of Hospitals, Clinics, Health Centers, Regional Surgeries) and limiting healthcare expenses. The new technologies provide various possibilities, readjusting the provided healthcare forms, depending on the individualized needs and expectations of every patient. Geographical distances are nullified and the provision range of health services is expanded, granting equal access even to residents of removed from the urban centers areas. This way, the citizens’ feeling of their equal participation to the public commodities is consolidated, particularly to those who live in remote and isolated areas.
There are certainly several issues which must be resolved so as for e-Health to be reinforced. It is essential that all bodies concerned, and especially Leadership, realize the value and the advantages which derive from its utilization. It is also necessary that e-Health applications be more user-friendly. Above all, though, there must be ensured the confidentiality of the transmitted information and the patients’ personal data. Only in this way will everybody understand that e-Health can really contribute towards the direction of a smart and pervasive healthcare.
In the case of Greece, it is necessary to have measurable results that prove in practice the benefits of implementing smart and pervasive healthcare. In addition, the Greek National Health System needs to adopt good practices, which are already successfully applied in other European countries, such as Denmark, Estonia and Finland.
Conflict of interest
The author declares no conflict of interest.
\n',keywords:"e-Health, information and communication technologies, health services, telemedicine, accessibility",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/74980.pdf",chapterXML:"https://mts.intechopen.com/source/xml/74980.xml",downloadPdfUrl:"/chapter/pdf-download/74980",previewPdfUrl:"/chapter/pdf-preview/74980",totalDownloads:349,totalViews:0,totalCrossrefCites:1,dateSubmitted:"November 29th 2020",dateReviewed:"January 6th 2021",datePrePublished:"February 1st 2021",datePublished:"January 12th 2022",dateFinished:"January 30th 2021",readingETA:"0",abstract:"e-Health leads to the reshaping of the traditional ways of providing services by health professionals, aiming both at the rationalization of the expenses and the satisfaction of the patients-users of health services. Nevertheless, the key elements which prejudge its success are the measurable results, the guarantee of a broad consensus, as well as the leadership’s commitment to implement it. Ιn Greece, it is implemented within the European action eEurope 2005-eGovernment and the eEurope-i2010 programme. The application of e-Health in Greece is a national priority, for a number of reasons, such as the thousands of islands in the Greek archipelago which make the traditional form of medical care practically impossible. However, the economic crisis that broke out in Greece in 2009, as well as the arrival of waves of refugees in the country raised new issues in the development of the e-Health sector. This chapter analyses the institutional framework of e-Health in Greece. It also outlines the various technological, legal and organizational challenges that arise in the process of implementing e-Health in the pivots of effectiveness, efficiency, quality and equal accessibility. Finally, it develops a strategy for the future of e-Health in the Greek National Health System.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/74980",risUrl:"/chapter/ris/74980",signatures:"Sofia Voutsidou",book:{id:"10298",type:"book",title:"Smart and Pervasive Healthcare",subtitle:null,fullTitle:"Smart and Pervasive Healthcare",slug:"smart-and-pervasive-healthcare",publishedDate:"January 12th 2022",bookSignature:"Urvashi Sharma",coverURL:"https://cdn.intechopen.com/books/images_new/10298.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83968-681-8",printIsbn:"978-1-83968-680-1",pdfIsbn:"978-1-83968-682-5",isAvailableForWebshopOrdering:!0,editors:[{id:"105398",title:"Dr.",name:"Urvashi",middleName:null,surname:"Sharma",slug:"urvashi-sharma",fullName:"Urvashi Sharma"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"330657",title:"Dr.",name:"Sofia",middleName:null,surname:"Voutsidou",fullName:"Sofia Voutsidou",slug:"sofia-voutsidou",email:"svoutsidou@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. The concept of e-health",level:"1"},{id:"sec_3",title:"3. Forms of e-health in Greece",level:"1"},{id:"sec_3_2",title:"3.1 Electronic patient record",level:"2"},{id:"sec_4_2",title:"3.2 Electronic prescription",level:"2"},{id:"sec_5_2",title:"3.3 National Network of telemedicine (NNTM)",level:"2"},{id:"sec_6_2",title:"3.4 Patient tele-monitoring",level:"2"},{id:"sec_6_3",title:"3.4.1 Telecare programme renewing health",level:"3"},{id:"sec_7_3",title:"3.4.2 SmartCare programme",level:"3"},{id:"sec_8_3",title:"3.4.3 United4Health programme",level:"3"},{id:"sec_10_2",title:"3.5 Video-communication stations for the deaf and hearing-impaired",level:"2"},{id:"sec_11_2",title:"3.6 Mobile health (m-health)",level:"2"},{id:"sec_13",title:"4. The contribution of e-health to smart and pervasive healthcare. Challenges for Greece in formulating a national strategy for the future of e-health",level:"1"},{id:"sec_14",title:"5. 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The principles underlying RF‐magnetron sputtering used to prepare calcium phosphate‐based, mainly hydroxyapatite coatings, are discussed in this chapter. The fundamental characteristic of the RF‐magnetron sputtering is an energy input into the growing film. In order to tailor the film properties, one has to adjust the energy input into the substrate depending on the desired film properties. The effect of different deposition control parameters, such as deposition time, substrate temperature, and substrate biasing on the hydroxyapatite (HA) film properties is discussed.",book:{id:"5541",slug:"modern-technologies-for-creating-the-thin-film-systems-and-coatings",title:"Modern Technologies for Creating the Thin-film Systems and Coatings",fullTitle:"Modern Technologies for Creating the Thin-film Systems and Coatings"},signatures:"Roman Surmenev, Alina Vladescu, Maria Surmeneva, Anna Ivanova,\nMariana Braic, Irina Grubova and Cosmin Mihai Cotrut",authors:[{id:"193921",title:"Dr.",name:"Alina",middleName:null,surname:"Vladescu",slug:"alina-vladescu",fullName:"Alina Vladescu"},{id:"193922",title:"Prof.",name:"Roman",middleName:null,surname:"Surmenev",slug:"roman-surmenev",fullName:"Roman Surmenev"},{id:"193923",title:"Dr.",name:"Maria",middleName:null,surname:"Surmeneva",slug:"maria-surmeneva",fullName:"Maria Surmeneva"},{id:"193948",title:"Dr.",name:"Mariana",middleName:null,surname:"Braic",slug:"mariana-braic",fullName:"Mariana Braic"},{id:"194047",title:"Ms.",name:"Anna",middleName:null,surname:"Ivanova",slug:"anna-ivanova",fullName:"Anna Ivanova"},{id:"194048",title:"BSc.",name:"Irina",middleName:null,surname:"Grubova",slug:"irina-grubova",fullName:"Irina Grubova"},{id:"196398",title:"Prof.",name:"Cosmin Mihai",middleName:null,surname:"Cotrut",slug:"cosmin-mihai-cotrut",fullName:"Cosmin Mihai Cotrut"}]},{id:"21157",doi:"10.5772/24330",title:"Compilation on Synthesis, Characterization and Properties of Silicon and Boron Carbonitride Films",slug:"compilation-on-synthesis-characterization-and-properties-of-silicon-and-boron-carbonitride-films",totalDownloads:5194,totalCrossrefCites:6,totalDimensionsCites:19,abstract:null,book:{id:"326",slug:"silicon-carbide-materials-processing-and-applications-in-electronic-devices",title:"Silicon Carbide",fullTitle:"Silicon Carbide - Materials, Processing and Applications in Electronic Devices"},signatures:"P. Hoffmann, N. Fainer, M. Kosinova, O. Baake and W. Ensinger",authors:[{id:"56722",title:"Dr.",name:"Peter",middleName:null,surname:"Hoffmann",slug:"peter-hoffmann",fullName:"Peter Hoffmann"},{id:"56726",title:"Dr.",name:"Marina",middleName:null,surname:"Kosinova",slug:"marina-kosinova",fullName:"Marina Kosinova"},{id:"56727",title:"Prof.",name:"Wolfgang",middleName:null,surname:"Ensinger",slug:"wolfgang-ensinger",fullName:"Wolfgang Ensinger"}]}],mostDownloadedChaptersLast30Days:[{id:"52684",title:"Advance Deposition Techniques for Thin Film and Coating",slug:"advance-deposition-techniques-for-thin-film-and-coating",totalDownloads:7639,totalCrossrefCites:32,totalDimensionsCites:59,abstract:"Thin films have a great impact on the modern era of technology. Thin films are considered as backbone for advanced applications in the various fields such as optical devices, environmental applications, telecommunications devices, energy storage devices, and so on . The crucial issue for all applications of thin films depends on their morphology and the stability. The morphology of the thin films strongly hinges on deposition techniques. Thin films can be deposited by the physical and chemical routes. In this chapter, we discuss some advance techniques and principles of thin-film depositions. The vacuum thermal evaporation technique, electron beam evaporation, pulsed-layer deposition, direct current/radio frequency magnetron sputtering, and chemical route deposition systems will be discussed in detail.",book:{id:"5541",slug:"modern-technologies-for-creating-the-thin-film-systems-and-coatings",title:"Modern Technologies for Creating the Thin-film Systems and Coatings",fullTitle:"Modern Technologies for Creating the Thin-film Systems and Coatings"},signatures:"Asim Jilani, Mohamed Shaaban Abdel-wahab and Ahmed Hosny\nHammad",authors:[{id:"192377",title:"Dr.",name:"Asim",middleName:null,surname:"Jilani",slug:"asim-jilani",fullName:"Asim Jilani"},{id:"192972",title:"Dr.",name:"M.Sh",middleName:null,surname:"Abdel-Wahab",slug:"m.sh-abdel-wahab",fullName:"M.Sh Abdel-Wahab"},{id:"192973",title:"Dr.",name:"Ahmed",middleName:"H",surname:"Hammad",slug:"ahmed-hammad",fullName:"Ahmed Hammad"}]},{id:"68467",title:"Semiconductor Nanocomposites for Visible Light Photocatalysis of Water Pollutants",slug:"semiconductor-nanocomposites-for-visible-light-photocatalysis-of-water-pollutants",totalDownloads:1803,totalCrossrefCites:7,totalDimensionsCites:11,abstract:"Semiconductor photocatalysis gained reputation in the early 1970s when Fujishima and Honda revealed the potential of TiO2 to split water in to hydrogen and oxygen in a photoelectrochemical cell. Their work provided the base for the development of semiconductor photocatalysis for the environmental remediation and energy applications. Photoactivity of some semiconductors was found to be low due to larger band gap energy and higher electron-hole pair recombination rate. To avoid these problems, the development of visible light responsive photocatalytic materials by different approaches, such as metal and/or non-metal doping, co-doping, coupling of semiconductors, composites and heterojunctions materials synthesis has been widely investigated and explored in systematic manner. This chapter emphasizes on the different type of tailored photocatalyst materials having the enhanced visible light absorption properties, lower band gap energy and recombination rate of electron-hole pairs and production of reactive radical species. Visible light active semiconductors for the environmental remediation purposes, particularly for water treatment and disinfection are also discussed in detail. Studies on the photocatalytic degradation of emerging organic compounds like cyanotoxins, VOCs, phenols, pharmaceuticals, etc., by employing variety of modified semiconductors, are summarized, and a mechanistic aspects of the photocatalysis has been discussed.",book:{id:"7671",slug:"concepts-of-semiconductor-photocatalysis",title:"Concepts of Semiconductor Photocatalysis",fullTitle:"Concepts of Semiconductor Photocatalysis"},signatures:"Fatima Imtiaz, Jamshaid Rashid and Ming Xu",authors:[{id:"292882",title:"Dr.",name:"Jamshaid",middleName:null,surname:"Rashid",slug:"jamshaid-rashid",fullName:"Jamshaid Rashid"},{id:"302498",title:"Ms.",name:"Fatima",middleName:null,surname:"Imtiaz",slug:"fatima-imtiaz",fullName:"Fatima Imtiaz"},{id:"308434",title:"Prof.",name:"Ming",middleName:null,surname:"Xu",slug:"ming-xu",fullName:"Ming Xu"}]},{id:"17728",title:"Defect Related Luminescence in Silicon Dioxide Network: A Review",slug:"defect-related-luminescence-in-silicon-dioxide-network-a-review",totalDownloads:9472,totalCrossrefCites:46,totalDimensionsCites:98,abstract:null,book:{id:"332",slug:"crystalline-silicon-properties-and-uses",title:"Crystalline Silicon",fullTitle:"Crystalline Silicon - Properties and Uses"},signatures:"Roushdey Salh",authors:[{id:"48391",title:"Dr.",name:"Roushdey",middleName:null,surname:"Salh",slug:"roushdey-salh",fullName:"Roushdey Salh"}]},{id:"58469",title:"The Electrochemical Performance of Deposited Manganese Oxide-Based Film as Electrode Material for Electrochemical Capacitor Application",slug:"the-electrochemical-performance-of-deposited-manganese-oxide-based-film-as-electrode-material-for-el",totalDownloads:1736,totalCrossrefCites:4,totalDimensionsCites:8,abstract:"The transition metal oxide has been recognized as one of the promising electrode materials for electrochemical capacitor application. Due to the participation of charge transfer reactions, the capacitance offered by transition metal oxide can be higher compared to double layer capacitance. The investigation on hydrous ruthenium oxide has revealed the surface redox reactions that contributed to the wide potential window shown on cyclic voltammetry curve. Although the performance of ruthenium oxide is impressive, its toxicity has limited itself from commercial application. Manganese oxide is a pseudocapacitive material behaves similar to ruthenium oxide. It consists of various oxidation states which allow the occurrence of redox reactions. It is also environmental friendly, low cost, and natural abundant. The charge storage of manganese oxide film takes into account of the redox reactions between Mn3+ and Mn4+ and can be accounted to two mechanisms. The first one involves the intercalation/deintercalation of electrolyte ions and/or protons upon reduction/oxidation processes. The second contributor for the charge storage is due to the surface adsorption of electrolyte ions on the electrode surface.",book:{id:"6083",slug:"semiconductors-growth-and-characterization",title:"Semiconductors",fullTitle:"Semiconductors - Growth and Characterization"},signatures:"Chan Pei Yi and Siti Rohana Majid",authors:[{id:"197956",title:"Associate Prof.",name:"S.R.",middleName:null,surname:"Majid",slug:"s.r.-majid",fullName:"S.R. Majid"},{id:"216449",title:"Ms.",name:"Pei Yi",middleName:null,surname:"Chan",slug:"pei-yi-chan",fullName:"Pei Yi Chan"}]},{id:"60792",title:"TCAD Device Modelling and Simulation of Wide Bandgap Power Semiconductors",slug:"tcad-device-modelling-and-simulation-of-wide-bandgap-power-semiconductors",totalDownloads:2113,totalCrossrefCites:15,totalDimensionsCites:15,abstract:"Technology computer-aided Design (TCAD) is essential for devices technology development, including wide bandgap power semiconductors. However, most TCAD tools were originally developed for silicon and their performance and accuracy for wide bandgap semiconductors is contentious. This chapter will deal with TCAD device modelling of wide bandgap power semiconductors. In particular, modelling and simulating 3C- and 4H-Silicon Carbide (SiC), Gallium Nitride (GaN) and Diamond devices are examined. The challenges associated with modelling the material and device physics are analyzed in detail. It also includes convergence issues and accuracy of predicted performance. Modelling and simulating defects, traps and the effect of these traps on the characteristics are also discussed.",book:{id:"6625",slug:"disruptive-wide-bandgap-semiconductors-related-technologies-and-their-applications",title:"Disruptive Wide Bandgap Semiconductors, Related Technologies, and Their Applications",fullTitle:"Disruptive Wide Bandgap Semiconductors, Related Technologies, and Their Applications"},signatures:"Neophytos Lophitis, Anastasios Arvanitopoulos, Samuel Perkins and\nMarina Antoniou",authors:[{id:"236488",title:"Dr.",name:"Neophytos",middleName:null,surname:"Lophitis",slug:"neophytos-lophitis",fullName:"Neophytos Lophitis"},{id:"247344",title:"Dr.",name:"Marina",middleName:null,surname:"Antoniou",slug:"marina-antoniou",fullName:"Marina Antoniou"},{id:"247347",title:"Mr.",name:"Anastasios",middleName:null,surname:"Arvanitopoulos",slug:"anastasios-arvanitopoulos",fullName:"Anastasios Arvanitopoulos"},{id:"247349",title:"Mr.",name:"Samuel",middleName:null,surname:"Perkins",slug:"samuel-perkins",fullName:"Samuel Perkins"}]}],onlineFirstChaptersFilter:{topicId:"159",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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\r\n\tEducation and Human Development is an interdisciplinary research area that aims to shed light on topics related to both learning and development. This Series is intended for researchers, practitioners, and students who are interested in understanding more about these fields and their applications.
",coverUrl:"https://cdn.intechopen.com/series/covers/23.jpg",latestPublicationDate:"June 25th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"280770",title:"Dr.",name:"Katherine K.M.",middleName:null,surname:"Stavropoulos",slug:"katherine-k.m.-stavropoulos",fullName:"Katherine K.M. Stavropoulos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRdFuQAK/Profile_Picture_2022-05-24T09:03:48.jpg",biography:"Katherine Stavropoulos received her BA in Psychology from Trinity College, in Connecticut, USA. Dr. Stavropoulos received her Ph.D. in Experimental Psychology from the University of California, San Diego. She completed her postdoctoral work at the Yale Child Study Center with Dr. James McPartland. Dr. Stavropoulos’ doctoral dissertation explored neural correlates of reward anticipation to social versus nonsocial stimuli in children with and without autism spectrum disorders (ASD). She has been a faculty member at the University of California, Riverside in the School of Education since 2016. Her research focuses on translational studies to explore the reward system in ASD, as well as how anxiety contributes to social challenges in ASD. She also investigates how behavioral interventions affect neural activity, behavior, and school performance in children with ASD. She is also involved in the diagnosis of children with ASD and is a licensed clinical psychologist in California. She is the Assistant Director of the SEARCH Center at UCR and is a Faculty member in the Graduate Program in Neuroscience.",institutionString:null,institution:{name:"University of California, Riverside",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:2,paginationItems:[{id:"89",title:"Education",coverUrl:"https://cdn.intechopen.com/series_topics/covers/89.jpg",isOpenForSubmission:!1,annualVolume:null,editor:{id:"260066",title:"Associate Prof.",name:"Michail",middleName:null,surname:"Kalogiannakis",slug:"michail-kalogiannakis",fullName:"Michail Kalogiannakis",profilePictureURL:"https://mts.intechopen.com/storage/users/260066/images/system/260066.jpg",biography:"Michail Kalogiannakis is an Associate Professor of the Department of Preschool Education, University of Crete, and an Associate Tutor at School of Humanities at the Hellenic Open University. He graduated from the Physics Department of the University of Crete and continued his post-graduate studies at the University Paris 7-Denis Diderot (D.E.A. in Didactic of Physics), University Paris 5-René Descartes-Sorbonne (D.E.A. in Science Education) and received his Ph.D. degree at the University Paris 5-René Descartes-Sorbonne (PhD in Science Education). His research interests include science education in early childhood, science teaching and learning, e-learning, the use of ICT in science education, games simulations, and mobile learning. He has published over 120 articles in international conferences and journals and has served on the program committees of numerous international conferences.",institutionString:"University of Crete",institution:{name:"University of Crete",institutionURL:null,country:{name:"Greece"}}},editorTwo:{id:"422488",title:"Dr.",name:"Maria",middleName:null,surname:"Ampartzaki",slug:"maria-ampartzaki",fullName:"Maria Ampartzaki",profilePictureURL:"https://mts.intechopen.com/storage/users/422488/images/system/422488.jpg",biography:"Dr Maria Ampartzaki is an Assistant Professor in Early Childhood Education in the Department of Preschool Education at the University of Crete. Her research interests include ICT in education, science education in the early years, inquiry-based and art-based learning, teachers’ professional development, action research, and the Pedagogy of Multiliteracies, among others. She has run and participated in several funded and non-funded projects on the teaching of Science, Social Sciences, and ICT in education. She also has the experience of participating in five Erasmus+ projects.",institutionString:"University of Crete",institution:{name:"University of Crete",institutionURL:null,country:{name:"Greece"}}},editorThree:null},{id:"90",title:"Human Development",coverUrl:"https://cdn.intechopen.com/series_topics/covers/90.jpg",isOpenForSubmission:!0,annualVolume:11974,editor:{id:"191040",title:"Dr.",name:"Tal",middleName:null,surname:"Dotan Ben-Soussan",slug:"tal-dotan-ben-soussan",fullName:"Tal Dotan Ben-Soussan",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBf1QAG/Profile_Picture_2022-03-18T07:56:11.jpg",biography:"Tal Dotan Ben-Soussan, Ph.D., is the director of the Research Institute for Neuroscience, Education and Didactics (RINED) – Paoletti Foundation. Ben-Soussan leads international studies on training and neuroplasticity from neurophysiological and psychobiological perspectives. As a neuroscientist and bio-psychologist, she has published numerous articles on neuroplasticity, movement and meditation. She acts as an editor and reviewer in several renowned journals and coordinates international conferences integrating theoretical, methodological and practical approaches on various topics, such as silence, logics and neuro-education. She lives in Assisi, Italy.",institutionString:"Research Institute for Neuroscience, Education and Didactics, Patrizio Paoletti Foundation",institution:null},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:5,paginationItems:[{id:"82394",title:"Learning by Doing Active Social Learning",doi:"10.5772/intechopen.105523",signatures:"Anat Raviv",slug:"learning-by-doing-active-social-learning",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Active Learning - Research and Practice",coverURL:"https://cdn.intechopen.com/books/images_new/11481.jpg",subseries:{id:"89",title:"Education"}}},{id:"82310",title:"Knowledge of Intergenerational Contact to Combat Ageism towards Older People",doi:"10.5772/intechopen.105592",signatures:"Alice Nga Lai Kwong",slug:"knowledge-of-intergenerational-contact-to-combat-ageism-towards-older-people",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Social Aspects of Ageing - Selected Challenges, Analyses, and Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11479.jpg",subseries:{id:"90",title:"Human Development"}}},{id:"81993",title:"Emergent Chemistry: Using Visualizations to Develop Abstract Thinking and a Sense of Scale Within the Preschool Setting",doi:"10.5772/intechopen.105216",signatures:"Karina Adbo",slug:"emergent-chemistry-using-visualizations-to-develop-abstract-thinking-and-a-sense-of-scale-within-the",totalDownloads:5,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Active Learning - Research and Practice",coverURL:"https://cdn.intechopen.com/books/images_new/11481.jpg",subseries:{id:"89",title:"Education"}}},{id:"82252",title:"Early Childhood: Enriched Environments and Roles of Caring Adults",doi:"10.5772/intechopen.105157",signatures:"Analía Mignaton",slug:"early-childhood-enriched-environments-and-roles-of-caring-adults",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Active Learning - Research and Practice",coverURL:"https://cdn.intechopen.com/books/images_new/11481.jpg",subseries:{id:"89",title:"Education"}}}]},overviewPagePublishedBooks:{paginationCount:0,paginationItems:[]},openForSubmissionBooks:{paginationCount:1,paginationItems:[{id:"11478",title:"Recent Advances in the Study of Dyslexia",coverURL:"https://cdn.intechopen.com/books/images_new/11478.jpg",hash:"26764a18c6b776698823e0e1c3022d2f",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"June 30th 2022",isOpenForSubmission:!0,editors:[{id:"294281",title:"Prof.",name:"Jonathan",surname:"Glazzard",slug:"jonathan-glazzard",fullName:"Jonathan Glazzard"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{paginationCount:45,paginationItems:[{id:"82135",title:"Carotenoids in Cassava (Manihot esculenta Crantz)",doi:"10.5772/intechopen.105210",signatures:"Lovina I. 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\r\n\tThe demographic shifts are creating interesting challenges. People are living longer, resulting to an aging demographic. We have a large population of older workers and retirees who are living longer lives, combined with a declining birthrate in most parts of the world. Businesses of all types are looking at how technology is affecting their operations. Several questions arise, such as: How is technology changing what we do? How is it transforming us internally, how is it influencing our clients and our business strategy? It is about leveraging technology to improve efficiency, connect with customers more effectively, and drive innovation. The majority of innovative companies are technology-driven businesses. Realizing digital transformation is today’s top issue and will remain so for the next five years. Improving organizational agility, expanding portfolios of products and services, creating, and maintaining a culture of innovation, and developing next -generation leaders were also identified as top challenges in terms of both current and future issues.
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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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