title: Telehealth

text: Most telerehabilitation is highly visual. As of 2014, the most commonly used mediums are webcams, videoconferencing, phone lines, videophones and webpages containing rich web applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation; fitting of rehabilitation equipment such as wheelchairs, braces or artificial limbs; and in speech-language pathology. Rich web applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) were first introduced in 2001. This endeavor has expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology (hearing assessments) is a growing application. Currently, telerehabilitation in the practice of occupational therapy and physical therapy is limited, perhaps because these two disciplines are more "hands on".


title: Telehealth

text: Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future.


title: Telehealth

text: In the United States, the National Institute on Disability and Rehabilitation Research's (NIDRR) supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh, the Rehabilitation Institute of Chicago, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Health Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research is conducted in Australia and Europe.


title: Telehealth

text: Only a few health insurers in the United States, and about half of Medicaid programs, reimburse for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare will cover telerehabilitation services.


title: Telehealth

text: In India, the Indian Association of Chartered Physiotherapists (IACP) provides telerehabilitation facilities. With the support and collaboration of local clinics and private practitioners and the Members IACP, IACP runs the facility, named Telemedicine. IACP has maintained an internet-based list of their members on their website, through which patients can make online appointments.


title: Telehealth

text: Telemedicine can be utilized to improve the efficiency and effectiveness of the delivery of care in a trauma environment. Examples include:


title: Telehealth

text: Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on the scene of a mass casualty or disaster situation, via the internet using mobile devices, to determine the severity of injuries. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient.


title: Telehealth

text: Telemedicine for intensive care unit (ICU) rounds: Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people to include attending physicians, fellows, residents and other clinicians. This group usually moves from bed to bed in a unit discussing each patient. This aids in the transition of care for patients from the night shift to the morning shift, but also serves as an educational experience for new residents to the team. A new approach features the team conducting rounds from a conference room using a video-conferencing system. The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patient's bedside. They can see the vital signs on the monitor, view the settings on the respiratory ventilator, and/or view the patient's wounds. Video-conferencing allows the remote viewers two-way communication with clinicians at the bedside.


title: Telehealth

text: Telemedicine for trauma education: some trauma centers are delivering trauma education lectures to hospitals and health care providers worldwide using video conferencing technology. Each lecture provides fundamental principles, firsthand knowledge and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. The various sites collaborate and share their perspective based on location, available staff, and available resources.


title: Telehealth

text: Telemedicine in the trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. This capability allows the attending to view the residents in real time. The remote surgeon has the capability to control the camera (pan, tilt and zoom) to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to the patient.


title: Telehealth

text: ECGs, or electrocardiographs, can be transmitted using telephone and wireless. Willem Einthoven, the inventor of the ECG, actually did tests with transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab.


title: Telehealth

text: One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India in 1975 at GR Medical college by Ajai Shanker, S. Makhija, P.K. Mantri using an indigenous technique for the first time in India.


title: Telehealth

text: This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline.


title: Telehealth

text: This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrhythmia. This technique helped medical aid reach in remote areas.


title: Telehealth

text: In addition, electronic stethoscopes can be used as recording devices, which is helpful for purposes of telecardiology. There are many examples of successful telecardiology services worldwide.


title: Telehealth

text: In Pakistan three pilot projects in telemedicine were initiated by the Ministry of IT & Telecom, Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi and Holy Family Rawalpindi. These 12 remote sites were connected and on average of 1,500 patients were treated per month per hub. The project was still running smoothly after two years.


title: Telehealth

text: Wireless ambulatory ECG technology, moving beyond previous ambulatory ECG technology such as the Holter monitor, now includes smartphones and Apple Watches which can perform at-home cardiac monitoring and send the data to a physician via the internet.


title: Telehealth

text: Telepsychiatry, another aspect of telemedicine, also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. It offers wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical programs, diagnosis and assessment, medication therapy management, and routine follow-up meetings. Most telepsychiatry is undertaken in real time (synchronous) although in recent years research at UC Davis has developed and validated the process of asynchronous telepsychiatry. Recent reviews of the literature by Hilty et al. in 2013, and by Yellowlees et al. in 2015 confirmed that telepsychiatry is as effective as in-person psychiatric consultations for diagnostic assessment, is at least as good for the treatment of disorders such as depression and post traumatic stress disorder, and may be better than in-person treatment in some groups of patients, notably children, veterans and individuals with agoraphobia.


title: Telehealth

text: As of 2011, the following are some of the model programs and projects which are deploying telepsychiatry in rural areas in the United States:


title: Telehealth

text: There are a growing number of HIPAA- compliant technologies for performing telepsychiatry. There is an independent comparison site of current technologies.


title: Telehealth

text: Links for several sites related to telemedicine, telepsychiatry policy, guidelines, and networking are available at the website for the American Psychiatric Association.


title: Telehealth

text: There has also been a recent trend towards Video CBT sites with the recent endorsement and support of CBT by the National Health Service (NHS) in the United Kingdom.


title: Telehealth

text: In April 2012, a Manchester-based Video CBT pilot project was launched to provide live video therapy sessions for those with depression, anxiety, and stress related conditions called InstantCBT The site supported at launch a variety of video platforms (including Skype, GChat, Yahoo, MSN as well as bespoke) and was aimed at lowering the waiting times for mental health patients. This is a commercial, for-profit business.


title: Telehealth

text: In the United States, the American Telemedicine Association and the Center of Telehealth and eHealth are the most respectable places to go for information about telemedicine.


title: Telehealth

text: The Health Insurance Portability and Accountability Act (HIPAA) is a United States federal law that applies to all modes of electronic information exchange such as video-conferencing mental health services. In the United States, Skype, Gchat, Yahoo, and MSN are not permitted to conduct video-conferencing services unless these companies sign a business associate agreement stating that their employees are HIPAA-trained. For this reason, most companies provide their own specialized videotelephony services. Violating HIPAA in the United States can result in penalties of hundreds of thousands of dollars.


title: Telehealth

text: The momentum of telemental health and telepsychiatry is growing. In June 2012 the U.S. Veterans Administration announced expansion of the successful telemental health pilot. Their target was for 200,000 cases in 2012.


title: Telehealth

text: A growing number of HIPAA-compliant technologies are now available. There is an independent comparison site that provides a criteria-based comparison of telemental health technologies.


title: Telehealth

text: The SATHI Telemental Health Support project cited above is another example of successful telemental health support.


title: Telehealth

text: The COVID-19 pandemic has been associated with large increases in telemedicine visits in the United States for various behavioral and psychiatric conditions such as anxiety, bipolar disorder, depression, insomnia, opioid use disorder, and overactivity. During the first two quarters of 2020 (January to June), office-based visits decreased as telemedicine visits increased for these six conditions according to data from IQVIA.


title: Telehealth

text: Teleradiology is the ability to send radiographic images (x-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another. For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving-image review station. The most typical implementation are two computers connected via the Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience.


title: Telehealth

text: The teleradiology process begins at the image sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.


title: Telehealth

text: Today's high-speed broadband based Internet enables the use of new technologies for teleradiology: the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images; a standard personal computer (PC) and digital subscriber line (DSL) connection is enough to reach Keosys' central server. No particular software is necessary on the PC and the images can be reached from anywhere in the world.


title: Telehealth

text: Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.


title: Telehealth

text: Telepathology is the practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research. Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering diagnoses. The use of "television microscopy", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement is the selection of microscopic fields-of-view for analysis and diagnosis.


title: Telehealth

text: A pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He, and his collaborators, published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks. Weinstein is known to many as the "father of telepathology". In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.


title: Telehealth

text: Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses, at a distance, for education, and for research. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries.


title: Telehealth

text: Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency, access to specialty care, and patient satisfaction. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education. The dermatologists Perednia and Brown were the first to coin the term "teledermatology" in 1995, where they described the value of a teledermatologic service in a rural area underserved by dermatologists.


title: Telehealth

text: Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients. In Mizoram, India, a hilly area with poor roads, between 2011 and 2015, teleophthalmology provided care to over 10,000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after the patient images were viewed online by eye surgeons in the hospital 6–12 hours away. Instead of an average five trips for say, a cataract procedure, only one was required for surgery alone as even post-op care like removal of stitches and appointments for glasses was done locally. There were large cost savings in travel as well.


title: Telehealth

text: In the United States, some companies allow patients to complete an online visual exam and within 24 hours receive a prescription from an optometrist valid for eyeglasses, contact lenses, or both. Some US states such as Indiana have attempted to ban these companies from doing business.


title: Telehealth

text: Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting-edge telecommunications such as high-speed data connections, telehaptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.


title: Telehealth

text: Remote surgery is remote work for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.


title: Telehealth

text: Remote surgery or telesurgery is performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic teleoperator system controlled by the surgeon. The remote operator may give tactile feedback to the user. Remote surgery combines elements of robotics and high-speed data connections. A critical limiting factor is the speed, latency and reliability of the communication system between the surgeon and the patient, though trans-Atlantic surgeries have been demonstrated.


title: Telehealth

text: Telemedicine has been used globally to increase access to abortion care, specifically medical abortion, in environments where few abortion care providers exist or abortion is legally restricted. Clinicians are able to virtually provide counseling, review screening tests, observe the administration of an abortion medication, and directly mail abortion pills to people. In 2004, Women on Web (WoW), Amsterdam, started offering online consultations, mostly to people living in areas where abortion was legally restricted, informing them how to safely use medical abortion drugs to end a pregnancy. People contact the Women on Web service online; physicians review any necessary lab results or ultrasounds, mail mifepristone and misoprostol pills to people, then follow up through online communication. In the United States, medical abortion was introduced as a telehealth service in Iowa by Planned Parenthood of the Heartland in 2008 to allow a patient at one health facility to communicate via secure video with a health provider at another facility. In this model a person seeking abortion care must come to a health facility. An abortion care provider communicates with the person located at another site using clinic-to-clinic videoconferencing to provide medical abortion after screening tests and consultation with clinic staff. In 2018, the website Aid Access was launched by the founder of Women on Web, Dr. Rebecca Gomperts. It offers a similar service as Women on Web in the United States, but the medications are prescribed to an Indian pharmacy, then mailed to the United States.


title: Telehealth

text: The TelAbortion study conducted by Gynuity Health Projects, with special approval from the U.S. Food and Drug Administration (FDA), aims to increase access to medical abortion care without requiring an in-person visit to a clinic. This models was expanded during the COVID-19 pandemic and as of March 2020 exists in 13 U.S. states and has enrolled over 730 people in the study. The person receives counseling and instruction from an abortion care provider via videoconference from a location of their choice. The medications necessary for the abortion, mifepristone and misoprostol, are mailed directly to the person and they have a follow-up video consultation in 7–14 days. A systematic review of telemedicine abortion has found the practice to be safe, effective, efficient, and satisfactory.


title: Telehealth

text: In the United States, eighteen states require the clinician to be physically present during the administration of medications for abortion which effectively bans telehealth of medication abortion: five states explicitly ban telemedicine for medication abortion, while thirteen states require the prescriber (usually required to be a physician) to be physically present with the patient. In the UK, the Royal College of Obstetricians and Gynecologists approved a no-test protocol for medication abortion, with mifepristone available through a minimal-contact pick-up or by mail.


title: Telehealth

text: Telemedicine can facilitate specialty care delivered by primary care physicians according to a controlled study of the treatment of hepatitis C. Various specialties are contributing to telemedicine, in varying degrees.


title: Telehealth

text: In light of the ongoing COVID-19 pandemic, primary care physicians have relied on telehealth to continue to provide care in outpatient settings. The transition to virtual health has been beneficial in providing patients access to care (especially care that does not require a physical exam e.g. medication changes, minor health updates) and avoid putting patients at risk of COVID-19.


title: Telehealth

text: Telemedicine has also been beneficial in facilitating medical education to students while still allowing for adequate social distancing during the COVID-19 pandemic. Many medical schools have shifted to alternate forms of virtual curriculum and are still able to engage in meaningful telehealth encounters with patients.


title: Telehealth

text: Telehealth is a modern form of health care delivery. Telehealth breaks away from traditional health care delivery by using modern telecommunication systems including wireless communication methods. Traditional health is legislated through policy to ensure the safety of medical practitioners and patients. Consequently, since telehealth is a new form of health care delivery that is now gathering momentum in the health sector, many organizations have started to legislate the use of telehealth into policy. In New Zealand, the Medical Council has a statement about telehealth on their website. This illustrates that the medical council has foreseen the importance that telehealth will have on the health system and have started to introduce telehealth legislation to practitioners along with government.


title: Telehealth

text: Traditional use of telehealth services has been for specialist treatment. However, there has been a paradigm shift and telehealth is no longer considered a specialist service. This development has ensured that many access barriers are eliminated, as medical professionals are able to use wireless communication technologies to deliver health care. This is evident in rural communities. For individuals living in rural communities, specialist care can be some distance away, particularly in the next major city. Telehealth eliminates this barrier as health professionals are able to conduct medical consultations through the use of wireless communication technologies. However, this process is dependent on both parties having Internet access.


title: Telehealth

text: Telehealth allows the patient to be monitored between physician office visits which can improve patient health. Telehealth also allows patients to access expertise which is not available in their local area. This remote patient monitoring ability enables patients to stay at home longer and helps avoid unnecessary hospital time. In the long-term, this could potentially result in less burdening of the healthcare system and consumption of resources.


title: Telehealth

text: During the COVID-19 pandemic, there were large increases in the use of telemedicine for primary care visits within the United States, increasing from an average of 1.4 million visits in Q2 of 2018 and 2019 to 35 million visits in Q2 2020, according to data from IQVIA. The telehealth market is expected to grow at 40% a year in 2021. Use of telemedicine by General Practitioners in the UK rose from 20%-30% pre-COVID to almost 80% by the beginning of 2021. More than 70% of practitioners and patients were satisfied with this. Boris Johnson was said to have ‘piled pressure on GPs to offer more in-person consultations’ supporting a campaign largely orchestrated by the Daily Mail. The Royal College of General Practitioners said that a patient ‘right’ to have face-to-face appointments if they wished was ‘undeliverable’.


title: Telehealth

text: The technological advancement of wireless communication devices is a major development in telehealth. This allows patients to self-monitor their health conditions and to not rely as much on health care professionals. Furthermore, patients are more willing to stay on their treatment plans as they are more invested and included in the process as the decision-making is shared. Technological advancement also means that health care professionals are able to use better technologies to treat patients for example in maternal care and surgery. Technological developments in telehealth are essential to improve health care, especially the delivery of healthcare services, as resources are finite along with an ageing population that is living longer.


title: Telehealth

text: Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of states require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.


title: Telehealth

text: If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. Even if the practitioner never practices medicine face-to-face with a patient in another state, he/she still must meet a variety of other individual state requirements, including paying substantial licensure fees, passing additional oral and written examinations, and traveling for interviews.


title: Telehealth

text: In 2008, the U.S. passed the Ryan Haight Act which required face-to-face or valid telemedicine consultations prior to receiving a prescription.


title: Telehealth

text: In 2015, Teladoc filed suit against the Texas Medical Board over a rule that required in-person consultations initially; the judge refused to dismiss the case, noting that antitrust laws apply to state medical boards.


title: Telehealth

text: Telehealth allows multiple, varying disciplines to merge and deliver a potentially more uniform level of care, using technology. As telehealth proliferates mainstream healthcare, it challenges notions of traditional healthcare delivery. Some populations experience better quality, access and more personalized health care.


title: Telehealth

text: Telehealth can also increase health promotion efforts. These efforts can now be more personalised to the target population and professionals can extend their help into homes or private and safe environments in which patients of individuals can practice, ask and gain health information. Health promotion using telehealth has become increasingly popular in underdeveloped countries where there are very poor physical resources available. There has been a particular push toward mHealth applications as many areas, even underdeveloped ones have mobile phone and smartphone coverage.


title: Telehealth

text: In a 2015 article reviewing research on the use of a mobile health application in the United Kingdom, authors describe how a home-based application helped patients manage and monitor their health and symptoms independently. The mobile health application allows people to rapidly self-report their symptoms - 95% of patients were able to report their daily symptoms in less than 100 seconds, which is less than the 5 minutes (plus commuting) taken to measure vital signs by nurses in hospitals. Online applications allow patients to remain at home to keep track of the progression of their chronic illnesses. The downside of using mHealth applications is that not everyone, especially in developing countries, has daily access to internet or electronic devices.


title: Telehealth

text: In developed countries, health promotion efforts using telehealth have been met with some success. The Australian hands-free breastfeeding Google Glass application reported promising results in 2014. This application made in collaboration with the Australian Breastfeeding Association and a tech startup called Small World Social, helped new mothers learn how to breastfeed. Breastfeeding is beneficial to infant health and maternal health and is recommended by the World Health Organisation and health organisations all over the world. Widespread breastfeeding can prevent 820,000 infant deaths globally but the practice is often stopped prematurely or intents to do are disrupted due to lack of social support, know-how or other factors. This application gave mother's hands-free information on breastfeeding, instructions on how to breastfeed and also had an option to call a lactation consultant over Google Hangout. When the trial ended, all participants were reported to be confident in breastfeeding.


title: Telehealth

text: A scientific review indicates that, in general, outcomes of telemedicine are or can be as good as in-person care with health care use staying similar.


title: Telehealth

text: Advantages of the nonexclusive adoption of already existing telemedicine technologies such as smartphone videotelephony may include reduced infection risks, increased control of disease during epidemic conditions, improved access to care, reduced stress and exposure to other pathogens<ref name="10.1016/j.jaip.2020.03.008"></ref> during illness for better recovery, reduced time and labor costs, efficient more accessible matching of patients with particular symptoms and clinicians who are experts for such, and reduced travel while disadvantages may include privacy breaches (e.g. due to software backdoors and vulnerabilities or sale of data), dependability on Internet access and, depending on various factors, increased health care use.


title: Telehealth

text: Theoretically, the whole health system could benefit from telehealth. There are indications telehealth consumes fewer resources and requires fewer people to operate it with shorter training periods to implement initiatives. Commenters suggested that lawmakers may fear that making telehealth widely accessible, without any other measures, would lead to patients using unnecessary health care services. Telemedicine could also be used for connected networks between health care professionals.


title: Telehealth

text: Telemedicine also can eliminate the possible transmission of infectious diseases or parasites between patients and medical staff. This is particularly an issue where MRSA is a concern. Additionally, some patients who feel uncomfortable in a doctors office may do better remotely. For example, white coat syndrome may be avoided. Patients who are home-bound and would otherwise require an ambulance to move them to a clinic are also a consideration.


title: Telehealth

text: However, whether or not the standard of health care quality is increasing is debatable, with some literature refuting such claims. Research has reported that clinicians find the process difficult and complex to deal with. Furthermore, there are concerns around informed consent, legality issues as well as legislative issues. A recent study also highlighted that the swift and large-scale implementation of telehealth across the United Kingdom NHS Allied Health Professional (AHP) services might increase disparities in health care access for vulnerable populations with limited digital literacy. Although health care may become affordable with the help of technology, whether or not this care will be "good" is the issue. Many patient experience studies indicate high satisfaction with telemedicine.


title: Telehealth

text: Major problems with increasing adoption include technically challenged staff, resistance to change or habits and age of patient. Focused policy could eliminate several barriers.


title: Telehealth

text: A review lists a number of potentially good practices and pitfalls, recommending the use of "virtual handshakes" for confirming identity, taking consent for conducting remote consultation over a conventional meeting, and professional standardized norms for protecting patient privacy and confidentiality.<ref name="10.1016/j.dsx.2020.06.007"></ref> It also found that the COVID-19 pandemic substantially increased, voluntarily, the adoption of telephone or video consultation and suggests that telemedicine technology "is a key factor in delivery of health care in the future".


title: Telehealth

text: Due to its digital nature it is often assumed that telehealth saves the health system money. However, the evidence to support this is varied. When conducting economic evaluations of telehealth services, the individuals evaluating them need to be aware of potential outcomes and extraclinical benefits of the telehealth service. Economic viability relies on the funding model within the country being examined (public vs private), the consumers willingness-to-pay, and the expected remuneration by the clinicians or commercial entities providing the services (examples of research on these topics from teledermoscopy in Australia)


title: Telehealth

text: In a UK telehealth trial done in 2011, it was reported that the cost of health could be dramatically reduced with the use of telehealth monitoring. The usual cost of in vitro fertilisation (IVF) per cycle would be around $15,000; with telehealth it was reduced to $800 per patient. In Alaska the Federal Health Care Access Network, which connects 3,000 healthcare providers to communities, engaged in 160,000 telehealth consultations from 2001 and saved the state $8.5 million in travel costs for just Medicaid patients.


title: Telehealth

text: Digital interventions for mental health conditions seem to be cost-effective compared to no intervention or non-therapeutic responses such as monitoring. However when compared to in-person therapy or medication their added value is currently uncertain.


title: Telehealth

text: Telemedicine can be beneficial to patients in isolated communities and remote regions, who can receive care from doctors or specialists far away without the patient having to travel to visit them. Recent developments in mobile collaboration technology can allow healthcare professionals in multiple locations to share information and discuss patient issues as if they were in the same place. Remote patient monitoring through mobile technology can reduce the need for outpatient visits and enable remote prescription verification and drug administration oversight, potentially significantly reducing the overall cost of medical care. It may also be preferable for patients with limited mobility, for example, patients with Parkinson's disease. Telemedicine can also facilitate medical education by allowing workers to observe experts in their fields and share best practices more easily.


title: Telehealth

text: Remote surgery and types of videoconferencing for sharing expertise (e.g. ad hoc assistance) have been and could be used to support doctors in Ukraine during the 2022 Russian invasion of Ukraine.


title: Telehealth

text: While many branches of medicine have wanted to fully embrace telehealth for a long time, there are certain risks and barriers which bar the full amalgamation of telehealth into best practice. For a start, it is dubious as to whether a practitioner can fully leave the "hands-on" experience behind. Although it is predicted that telehealth will replace many consultations and other health interactions, it cannot yet fully replace a physical examination, this is particularly so in diagnostics, rehabilitation or mental health.


title: Telehealth

text: The benefits posed by telehealth challenge the normative means of healthcare delivery set in both legislation and practice. Therefore, the growing prominence of telehealth is starting to underscore the need for updated regulations, guidelines and legislation which reflect the current and future trends of healthcare practices. Telehealth enables timely and flexible care to patients wherever they may be; although this is a benefit, it also poses threats to privacy, safety, medical licensing and reimbursement. When a clinician and patient are in different locations, it is difficult to determine which laws apply to the context. Once healthcare crosses borders different state bodies are involved in order to regulate and maintain the level of care that is warranted to the patient or telehealth consumer. As it stands, telehealth is complex with many grey areas when put into practice especially as it crosses borders. This effectively limits the potential benefits of telehealth.


title: Telehealth

text: An example of these limitations include the current American reimbursement infrastructure, where Medicare will reimburse for telehealth services only when a patient is living in an area where specialists are in shortage, or in particular rural counties. The area is defined by whether it is a medical facility as opposed to a patient's' home. The site that the practitioner is in, however, is unrestricted. Medicare will only reimburse live video (synchronous) type services, not store-and-forward, mhealth or remote patient monitoring (if it does not involve live-video). Some insurers currently will reimburse telehealth, but not all yet. So providers and patients must go to the extra effort of finding the correct insurers before continuing. Again in America, states generally tend to require that clinicians are licensed to practice in the surgery' state, therefore they can only provide their service if licensed in an area that they do not live in themselves.


title: Telehealth

text: More specific and widely reaching laws, legislations and regulations will have to evolve with the technology. They will have to be fully agreed upon, for example, will all clinicians need full licensing in every community they provide telehealth services too, or could there be a limited use telehealth licence? Would the limited use licence cover all potential telehealth interventions, or only some? Who would be responsible if an emergency was occurring and the practitioner could not provide immediate help – would someone else have to be in the room with the patient at all consult times? Which state, city or country would the law apply in when a breach or malpractice occurred?


title: Telehealth

text: A major legal action prompt in telehealth thus far has been issues surrounding online prescribing and whether an appropriate clinician-patient relationship can be established online to make prescribing safe, making this an area that requires particular scrutiny. It may be required that the practitioner and patient involved must meet in person at least once before online prescribing can occur, or that at least a live-video conference must occur, not just impersonal questionnaires or surveys to determine need.


title: Telehealth

text: Telehealth has some potential for facilitating self-management techniques in health care, but for patients to benefit from it, the appropriate contact with, and relationship, between doctor and patient must be established first. This would start with an online consultation, providing patients with techniques and tools that help them participate in healthy behaviors, and initiating a collaborative partnership between health care professionals and patient. Self-management strategies fall into a broader category called patient activation, which is defined as a “patients' willingness and ability to take independent actions to manage their health.” It can be achieved by increasing patients’ knowledge and confidence in coping with and managing their own disease through a “regular assessment of progress […] and problem-solving support.” Teaching patients about their conditions and ways to cope with chronic illnesses will allow them to be knowledgeable about their disease and willing to manage it, improving their everyday life. Without a focus on the doctor-patient relationship and on the patient's understanding, telehealth cannot improve the quality of life of patients, despite the benefit of allowing them to do their medical check-ups from the comfort of their home.


title: Telehealth

text: The downsides of telemedicine include the cost of telecommunication and data management equipment and of technical training for medical personnel who will employ it. Virtual medical treatment also entails potentially decreased human interaction between medical professionals and patients, an increased risk of error when medical services are delivered in the absence of a registered professional, and an increased risk that protected health information may be compromised through electronic storage and transmission. There is also a concern that telemedicine may actually decrease time efficiency due to the difficulties of assessing and treating patients through virtual interactions; for example, it has been estimated that a teledermatology consultation can take up to thirty minutes, whereas fifteen minutes is typical for a traditional consultation. Additionally, potentially poor quality of transmitted records, such as images or patient progress reports, and decreased access to relevant clinical information are quality assurance risks that can compromise the quality and continuity of patient care for the reporting doctor. Other obstacles to the implementation of telemedicine include unclear legal regulation for some telemedical practices and difficulty claiming reimbursement from insurers or government programs in some fields.


title: Telehealth

text: Another disadvantage of telemedicine is the inability to start treatment immediately. For example, a patient with a bacterial infection might be given an antibiotic hypodermic injection in the clinic, and observed for any reaction, before that antibiotic is prescribed in pill form.


title: Telehealth

text: We must also be wary of equitability. Many families and individuals in the United States, and other countries, do not have internet access in their homes. Not to mention they may lack the necessary equipment to access telehealth services, such as a laptop, tablet, or smart phone.


title: Telehealth

text: "Informed consent" is another issue – should the patient give informed consent to receive online care before it starts? Or will it be implied if it is care that can only practically be given over distance? When telehealth includes the possibility for technical problems such as transmission errors, security breaches, or storage issues, it can impact the system's ability to communicate. It may be wise to obtain informed consent in person first, as well as having backup options for when technical issues occur. In person, a patient can see who is involved in their care (namely themselves and their clinician in a consult), but online there will be other involved such as the technology providers, therefore consent may need to involve disclosure of anyone involved in the transmission of the information and the security that will keep their information private, and any legal malpractice cases may need to involve all of those involved as opposed to what would usually just be the practitioner.


title: Telehealth

text: The rate of adoption of telehealth services in any jurisdiction is frequently influenced by factors such as the adequacy and cost of existing conventional health services in meeting patient needs; the policies of governments and/or insurers with respect to coverage and payment for telehealth services; and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians.


title: Telehealth

text: Projections for the growth of the telehealth market are optimistic, and much of this optimism is predicated upon the increasing demand for remote medical care. According to a recent survey, nearly three-quarters of U.S. consumers say they would use telehealth. At present, several major companies along with a bevvy of startups are working to develop a leading presence in the field.


title: Telehealth

text: In the UK, the Government's Care Services minister, Paul Burstow, has stated that telehealth and telecare would be extended over the next five years (2012–2017) to reach three million people.


title: Telehealth

text: In the United States, telemedicine companies are collaborating with health insurers and other telemedicine providers to expand marketshare and patient access to telemedicine consultations.


title: Telehealth

text: , 95% of employers believe their organizations will continue to provide health care benefits over the next five years.


title: Telehealth

text: The COVID-19 pandemic drove increased usage of Telehealth services in the U.S. The U.S. Centers for Disease Control and Prevention reported a 154% increase in telehealth visits during the last week of March 2020, compared to the same dates in 2019.


title: Telehealth

text: From 1999 to 2018, the University Hospital of Zurich (USZ) offered clinical telemedicine and online medical advice on the Internet. A team of doctors answered around 2500 anonymous inquiries annually, usually within 24 to 48 hours. The team consisted of up to six physicians who are specialists in clinical telemedicine at the USZ and have many years of experience, particularly in internal and general medicine. In the entire period, 59360 inquiries were sent and answered. The majority of the users were female and on average 38 years old. However, in the course of time, considerably more men and older people began to use the service. The diversity of medical queries covered all categories of the International Statistical Classification of Diseases and Related Health Problems (ICD) and correlated with the statistical frequency of diseases in hospitals in Switzerland. Most of the inquiries concerned unclassified symptoms and signs, services related to reproduction, respiratory diseases, skin diseases, health services, diseases of the eye and nervous systems, injuries and disorders of the female genital tract. As with the Swedish online medical advice service, one-sixth of the requests related to often shameful and stigmatised diseases of the genitals, gastrointestinal tract, sexually transmitted diseases, obesity and mental disorders. By providing an anonymous space where users can talk about (shameful) diseases, online telemedical services empower patients and their health literacy is enhanced by providing individualized health information. The Clinical Telemedicine and Online Counselling service of the University Hospital of Zurich is currently being revised and will be offered in a new form in the future.


title: Telehealth

text: For developing countries, telemedicine and eHealth can be the only means of healthcare provision in remote areas. For example, the difficult financial situation in many African states and lack of trained health professionals has meant that the majority of the people in sub-Saharan Africa are badly disadvantaged in medical care, and in remote areas with low population density, direct healthcare provision is often very poor However, provision of telemedicine and eHealth from urban centers or from other countries is hampered by the lack of communications infrastructure, with no landline phone or broadband internet connection, little or no mobile connectivity, and often not even a reliable electricity supply.


title: Telehealth

text: India has broad rural-urban population and rural India is bereaved from medical facilities, giving telemedicine a space for growth in India. Deprived education and medical professionals in rural areas is the reason behind government's ideology to use technology to bridge this gap. Remote areas not only present a number of challenges for the service providers but also for the families who are accessing these services. Since 2018, telemedicine has expanded in India. It has undertaken a new way for doctor consultations. On 25 March 2020, in the wake of COVID-19 pandemic, the Ministry of Health and Family Welfare issued India's Telemedicine Practice Guidelines. The Board of Governors entasked by the Health Ministry published an amendment to the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 that gave much-needed statutory support for the practice of telemedicine in India. This sector is at an ever-growing stage with high scope of development. In April 2020, the union health ministry launched the eSanjeevani telemedicine service that operates at two levels: the doctor-to-doctor telemedicine platform, and the doctor-to-patient platform. This service crossed five million tele-consultations within a year of its launch indicating conducive environment for acceptability and growth of telemedicine in India.


title: Telehealth

text: Sub-Saharan Africa is marked by the massive introduction of new technologies and internet access. Urban areas are facing a rapid change and development, and access to internet and health is rapidly improving. Population in remote areas however, still lack access to healthcare and modern technologies. Some people in rural regions must travel more between 2 and 6 hours to reach the closest healthcare facilities of their country. leaving room for telehealth to grow and reach isolated people in the near future.


title: Telehealth

text: The Satellite African eHEalth vaLidation (SAHEL) demonstration project has shown how satellite broadband technology can be used to establish telemedicine in such areas. SAHEL was started in 2010 in Kenya and Senegal, providing self-contained, solar-powered internet terminals to rural villages for use by community nurses for collaboration with distant health centers for training, diagnosis and advice on local health issues. Those methods can have major impact on both health professionals to get and provide training from remote areas, and on the local population who can receive care without traveling long distances. Some non-profits such as the Christian organization Mission Aviation Fellowship (MAF) provide internet to rural places around the world using a mobile VSAT terminal. This VSAT terminal equips remote regions allowing them to alert the world when there is a medical emergency, resulting in a rapid deployment or response from developed countries. Technologies such as the ones used by MAF allows health professionals in remote clinics to have internet access, making consultations much easier, both for patients and doctors.


title: Telehealth

text: In 2014, the government of Luxembourg, along with satellite operator, SES and NGOs, Archemed, Fondation Follereau, Friendship Luxembourg, German Doctors and Médecins Sans Frontières, established SATMED, a multilayer eHealth platform to improve public health in remote areas of emerging and developing countries, using the Emergency.lu disaster relief satellite platform and the Astra 2G TV satellite. SATMED was first deployed in response to a report in 2014 by German Doctors of poor communications in Sierra Leone hampering the fight against Ebola, and SATMED equipment arrived in the Serabu clinic in Sierra Leone in December 2014. In June 2015 SATMED was deployed at Maternité Hospital in Ahozonnoude, Benin to provide remote consultation and monitoring, and is the only effective communication link between Ahozonnoude, the capital and a third hospital in Allada, since land routes are often inaccessible due to flooding during the rainy season.


title: Telehealth

text: The development and history of telehealth or telemedicine (terms used interchangeably in literature) is deeply rooted in the history and development in not only technology but also society itself. Humans have long sought to relay important messages through torches, optical telegraphy, electroscopes, and wireless transmission. Early forms of telemedicine achieved with telephone and radio have been supplemented with videotelephony, advanced diagnostic methods supported by distributed client/server applications, and additionally with telemedical devices to support in-home care.


title: Telehealth

text: In the 21st century, with the advent of the internet, portable devices and other such digital devices are taking a transformative role in healthcare and its delivery.


title: Telehealth

text: Although, traditional medicine relies on in-person care, the need and want for remote care has existed from the Roman and pre-Hippocratic periods in antiquity. The elderly and infirm who could not visit temples for medical care sent representatives to convey information on symptoms and bring home a diagnosis as well as treatment. In Africa, villagers would use smoke signals to warn neighboring villages of disease outbreak. The beginnings of telehealth have existed through primitive forms of communication and technology. The exact date of origin for Telehealth is unknown, but it was known to have been used during the Bubonic Plague. That version of Telehealth was far different from how we know it today. During that time, they were communicating by heliograph and bonfire. Those were used to notify other groups of people about famine and war. Those are not using any form of technology yet but are starting to spread the idea of connectivity among groups of people who geographically couldn't be together.


title: Telehealth

text: As technology developed and wired communication became increasingly commonplace, the ideas surrounding telehealth began emerging. The earliest telehealth encounter can be traced to Alexander Graham Bell in 1876, when he used his early telephone as a means of getting help from his assistant Mr. Watson after he spilt acid on his trousers. Another instance of early telehealth, specifically telemedicine was reported in "The Lancet" in 1879. An anonymous writer described a case where a doctor successfully diagnosed a child over the telephone in the middle of the night. This Lancet issue, also further discussed the potential of Remote Patient Care in order to avoid unnecessary house visits, which were part of routine health care during the 1800s. Other instances of telehealth during this period came from the American Civil War, during which telegraphs were used to deliver mortality lists and medical care to soldiers. As the 1900s started, physicians quickly found a use for the telephone making it a prime communication channel to contact patients and other physicians. Over the next fifty-plus years, the telephone was a staple for medical communication. As the 1930s came around, radio communication played a key role, especially during World War I. It was specifically used to communicate with remote areas such as Alaska and Australia. They used the radio to communicate medical information. During the Vietnam War, radio communication had become more advanced and was now used to send medical teams in helicopters to help. This then brought together the Aerial Medical Service (AMS) who used telegraphs, radios, and planes to help care for people who lived in remote areas.


title: Telehealth

text: From the late 1800s to the early 1900s the early foundations of wireless communication were laid down. Radios provided an easier and near instantaneous form of communication. The use of radio to deliver healthcare became accepted for remote areas. The Royal Flying Doctor Service of Australia is an example of the early adoption of radios in telehealth.


title: Telehealth

text: In 1925 the inventor Hugo Gernsback wrote an article for the magazine "Science and Invention" which included a prediction of a future where patients could be treated remotely by doctors through a device he called a "teledactyl". His descriptions of the device are similar to what would later become possible with new technology.


title: Telehealth

text: When the American National Aeronautics and Space Administration (NASA), began plans to send astronauts into space, the need for telemedicine became clear. In order to monitor their astronauts in space, telemedicine capabilities were built into the spacecraft as well as the first spacesuits. Additionally, during this period, telehealth and telemedicine were promoted in different countries especially the United States and Canada. After the telegraph and telephone started to successfully help physicians treat patients from remote areas, telehealth became more recognized. Technological advancements occurred when the National Aeronautics and Space Administration (NASA) sent men to space. Engineers for NASA created biomedical telemetry and telecommunications systems. NASA technology monitored vitals such as blood pressure, heart rate, respiration rate, and temperature. After the technology was created, it then became the base of telehealth medicine for the public.


title: Telehealth

text: Massachusetts General Hospital and Boston's Logan International Airport had a role in the early use of telemedicine, which more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts. On October 26, 1960, a plane struck a flock of birds upon takeoff, killing many passengers and leaving a number wounded. Due to the extreme complexity of trying to get all the medical personnel out from the hospital, the practical solution became telehealth. This was expanded upon in 1967, when Kenneth Bird at Massachusetts General founded one of the first telemedicine clinics. The clinic addressed the fundamental problem of delivering occupational and emergency health services to employees and travellers at the airport, located three congested miles from the hospital. Clinicians at the hospital would provide consultation services to patients who were at the airport. Consultations were achieved through microwave audio as well as video links. The airport began seeing over a hundred patients a day at its nurse-run clinic that cared for victims of plane crashes and other accidents, taking vital signs, electrocardiograms, and video images that were sent to Massachusetts General. Over 1,000 patients are documented as having received remote treatment from doctors at MGH using the clinic's two-way audiovisual microwave circuit. One notable story featured a woman who got off a flight in Boston and was experiencing chest pain. They performed a workup at the airport, took her to the telehealth suite where Dr. Raymond Murphy appeared on the television, and had a conversation with her. While this was happening, another doctor took notes and the nurses took vitals and any test that Dr. Murphy ordered. At this point, telehealth was becoming more mainstream and was starting to become more technologically advanced, which created a viable option for patients.


title: Telehealth

text: In 1964, the Nebraska Psychiatric Institute began using television links to form two-way communication with the Norfolk State Hospital which was 112 miles away for the education and consultation purposes between clinicians in the two locations.


title: Telehealth

text: In 1972 the Department of Health, Education and Welfare in the United States approved funding for seven telemedicine projects across different states. This funding was renewed and two further projects were funded the following year.


title: Telehealth

text: In March 1972, the San Bernardino County Medical Society officially implemented its Tel-Med program, a system of prerecorded health-related messages, with a log of 50 tapes. The nonprofit initiative began in 1971 as a local medical project to ease the doctor shortage in the expanding San Bernardino Valley and improve the public's access to sound medical information. It covered subjects ranging from cannabis to vaginitis. In January 1973, in response to the developing "London flu" epidemic hitting California and the country, a tape providing information on the disease was on air within a week after news broke of the flu spreading in the state. That spring, programs were implemented in San Diego and Indianapolis, Indiana, signaling a national acceptance of the concept. By 1979, its system offered messages on over 300 different subjects, 200 of which were available in Spanish as well as English, and serviced over 65 million people in 180 cities around the country.


title: Telehealth

text: Telehealth projects underway before and during the 1980s would take off but fail to enter mainstream healthcare. As a result, this period of telehealth history is called the "maturation" stage and made way for sustainable growth. Although state funding in North America was beginning to run low, different hospitals began to launch their own telehealth initiatives. NASA provided an ATS-3 satellite to enable medical care communications of American Red Cross and Pan American Health Organization response teams, following the 1985 Mexico City earthquake. The agency then launched its SateLife/HealthNet programme to increase health service connectivity in developing countries. In 1997, NASA sponsored Yale's Medical Informatics and Technology Applications Consortium project.


title: Telehealth

text: Florida first experimented with "primitive" telehealth in its prisons during the latter 1980s. Working with Doctors Oscar W. Boultinghouse and Michael J. Davis, from the early 1990s to 2007; Glenn G. Hammack led the University of Texas Medical Branch (UTMB) development of a pioneering telehealth program in Texas state prisons. The three UTMB alumni would, in 2007, co-found telehealth provider NuPhysician.


title: Telehealth

text: The first interactive telemedicine system, operating over standard telephone lines, designed to remotely diagnose and treat patients requiring cardiac resuscitation (defibrillation) was developed and launched by an American company, MedPhone Corporation, in 1989. A year later under the leadership of its President/CEO S Eric Wachtel, MedPhone introduced a mobile cellular version, the MDPhone. Twelve hospitals in the U.S. served as receiving and treatment centers.


title: Telehealth

text: As the expansion of telehealth continued in 1990 Maritime Health Services (MHS) was a big part of the initiation for occupational health services. They sent a medical officer aboard the Pacific trawler that allowed for round-the-clock communication with a physician. The system that allows for this is called the Medical Consultation Network (MedNet). MedNet is a video chatting system that has live audio and visual so the physician on the other end of the call can see and hear what is happening. MetNet can be used from anywhere, not just aboard ships. Being able to provide onsite visual information allows remote patients expert emergency help and medical attention that saves money as well as lives. This has created a demand for at-home monitoring. At-home care has also become a large part of telehealth. Doctors or nurses will now give pre-op and post-op phone calls to check-in. There are also companies such as Lifeline, which give the elderly a button to press in case of an emergency. That button will automatically call for emergency help. If someone has surgery and then is sent home, telehealth allows physicians to see how the patient is progressing without them having to stay in the hospital. TeleDiagnostic Systems of San Francisco is a company that has created a device that monitors sleep patterns, so people with sleep disorders do not have to stay the night at the hospital. Another at-home device that was created was the Wanderer, which was attached to Alzheimer's patients or people who had dementia. It was attached to them so when they wandered off it notified the staff to allow them to go after them. All these devices allowed healthcare beyond hospitals to improve, which means that more people are being helped efficiently.


title: Telehealth

text: The advent of high-speed Internet, and the increasing adoption of ICT in traditional methods of care, spurred advances in telehealth delivery. Increased access to portable devices, like laptops and mobile phones, made telehealth more plausible; the industry then expanded into health promotion, prevention and education.


title: Telehealth

text: In 2002, Dr. G. Byron Brooks, a former NASA surgeon and engineer who had also helped manage the UTMB Telemedicine program, co-founded Teladoc in Dallas, Texas, which was then launched in 2005 as the first national telehealth provider.


title: Telehealth

text: In the 2010s, integration of smart home telehealth technologies, such as health and wellness devices, software, and integrated IoT, has accelerated the industry. Healthcare organizations are increasingly adopting the use of self-tracking and cloud-based technologies, and innovative data analytic approaches to accelerate telehealth delivery.


title: Telehealth

text: In 2015, Mercy Health system opened Mercy Virtual, in Chesterfield, Missouri, the world's first medical facility dedicated solely to telemedicine.


title: Telehealth

text: Telehealth is playing a significant role amidst the COVID-19 pandemic. With the pandemic, telehealth has become a vital means of medical communication. It allows doctors to return to humanizing the patient. It forces them to listen to what people have to say and from there make a diagnosis. Some researchers claim this creates an environment that encourages greater vulnerability among patients in self disclosure in the practice of narrative medicine. Telehealth allows for Zoom calls and video chats from across the world checking in on patients and speaking to physicians. Universities are now ensuring that medical students are coming out of school with proficient telehealth communication skills. Experts suggest telehealth will be a vital part of medicine; with more virtual options becoming available, the public is now able to pick whether they want to stay home or go into the office.


title: Nattamai

text: Nattamai () is a 1994 Indian Tamil-language drama film directed by K. S. Ravikumar. It starred Sarathkumar, Meena and Khushbu. The film was released on 2 November 1994, during Diwali, and completed a 175-day run at the box office. It is considered to be one of the most popular Tamil films of the 1990s and in general. It became a trendsetter for many films in later years. The Goundamani-Senthil comic duo was one of the most popular aspects of the film.


title: Nattamai

text: Sarathkumar earned both the Tamil Nadu State Film Award for Best Actor and Filmfare Award for Best Actor – Tamil for his performance in the film. The film was later remade in Telugu as "Pedarayudu", in Hindi as "Bulandi" and in Kannada as "Simhadriya Simha" (2000).


title: Nattamai

text: Shanmugam (Sarathkumar) is the village head, fondly called "Nattamai" in his village in Coimbatore. He sits on the ancestral throne in his village to do justice. He hears all the cases and gives solutions to the people and punishments to the wrongdoers. His wife Lakshmi (Khushbu) admires and respects him. His brothers Pasupathi (Sarathkumar) and Selvaraj (Raja Ravindra) fear him but also have a lot of respect for him as he has brought them up as his children. Pasupathi marries Meena (Meena), the daughter of an industrialist (Vinu Chakravarthy). She dislikes Shanmugam "Nattamai" because of his verdicts and attitude and her husband for being so timid with his brother but later transforms after learning of the former's greatness from her father. Selvaraj loves his paternal cousin, who is his paternal aunt (Manorama) granddaughter Kanmani (Sanghavi).


title: Nattamai

text: In the flashback, Periya Nattamai (Vijayakumar), Shanmugam Nattamai's, Pasupathi, and Selvaraj's father, orders Manorama's son (and Kanmani's father) (Ponnambalam) to marry his servant's daughter whom he raped. Manorama (who is Periya Nattamai's brother) begs him to forgive her son, however, he asks her to not interfere with his judgments. His brother-in-law, (Ponnambalam's father and Manorama husband (Erode Soundar), shoots him as he is disappointed by his verdict. Enraged, Periya Nattamai gives his final judgment before dying. He expellees Ponnambalam's family from the village and makes Shanmugam the new Nattamai, before dying.


title: Nattamai

text: Years later, Ponnambalam's father dies. Ponnambalam builds envy on his uncle's family and waits for an opportunity to take revenge on them. He hires a woman as the village school teacher and asks her to make Pasupathi fall for her. She does so to save her father, who is in the hands of Ponnambalam. He kills her and makes the villagers believe that Pasupathi has committed the murder. "Shanmugam Nattamai" sentences ten years of exile for Pasupathi, and his wife Meena. Ponnambalam learns of his daughter's love for Selvaraj and tries to kill him, with the help of his goons. Pasupathi goes to his rescue of him, and a pregnant Meena goes to Shanmugam to convey this message. While Pasupathi starts to take revenge on Ponnambalam, Manorama rushes to Shanmugam, kills her son Ponnambalam, and reveals the truth and tells that he punished his brother without committing any mistake and also told that the crimes blamed on Pasupathi were really perpetrated by Ponnambalam. Shanmugam dies upon learning that he gave a wrong judgment, and Pasupathi is shown taking his place as the new "Nattamai".


title: Nattamai

text: Director K. S. Ravikumar initially approached Mammootty to play the supporting role played by vijayakumar. For reasons unknown, he declined the offer. Sarathkumar was then signed for as the lead. The film became the fourth collaboration between Ravikumar and Sarathkumar. When Ravikumar approached Khushbu for Nattamai's wife role, she hesitated as in most part of the film she had to look old, except in a brief flashback. She asked him whom he will cast if she denies, Ravikumar said he will approach veteran actress Lakshmi; this made Kusbhoo to take up this role. Mahendran was introduced as child artist through this film. Vijayakumar was initially cast as the elder brother, but a few days before shooting began, Ravikumar decided to have Sarathkumar play both brothers and Bharathiraja was Ravikumar's initial choice for the character of Vijayakumar.


title: Nattamai

text: In his early days as an actor, Sarathkumar was considered to be close to AIADMK supremo Jayalalithaa. However, Sarath's proximity to Jayalalithaa landed him in deep trouble when "Nattamai", which was still running in Tamil Nadu theatres, was aired by Jayalalithaa's television channel JJ TV, using a U-matic tape, which Sarathkumar gave her for personal viewing at her residence. What the understanding between Jayalalithaa and Sarathkumar was not clear. However, this caused a furore in the film industry as the producer R. B. Choudary threatened action against Sarathkumar for misusing a tape given to him for personal viewing. An embarrassed Sarathkumar explained that he was taken by surprise and that he never expected Jayalalithaa to give it to the channel for telecast. He sought an explanation from both Jayalalitha and JJ TV, but without success. The ruling party reacted predictably, using every forum to attack Sarathkumar.


title: Nattamai

text: "Nattamai" was released on 2 November 1994, during Diwali. "The Indian Express" wrote that there was "never a dull moment" in the film. It became a blockbuster and completed a 175-day run at the box office.


title: Nattamai

text: The success of the film prompted Super Good Films, K. S. Ravikumar, Erode Soundar and Sarathkumar to announce a film titled "Paamaran" soon after. However, the project was later stalled owing to a fallout between the actor and the director. Despite discussions for director Vikraman to take over the film, the project was stalled.


title: Nattamai

text: Owing to its success, "Nattamai" was remade in Telugu as "Pedarayudu" (1995), It was remade in Kannada as "Simhadriya Simha" (2001). It was also remade in Hindi as "Bulandi" (2000).


title: Nattamai

text: The tagline "Nattamai, theerpa maathi sollu" (Chieftain, change your judgement) became popular after release. It became a trendsetter for many films in later years. The success of the film inspired similar themes about village chieftain. Vijayakumar's portrayal of village chieftain received critical acclaim and he went on to be typecasted with similar characters in later films. The film gave breakthrough in the career of Sarathkumar and the actor did similar films – "Suryavamsam" (1997), "Natpukkaga" (1998), "Maayi" (2000), "Diwan" (2003) and "Ayyaa" (2005) which featured him in double roles in the backdrop of village.


title: Nattamai

text: "Nattamai" has been parodied and referenced many times. In a comedy scene from "Aahaa Enna Porutham" (1998), Goundamani mocks at the superstitions of village panchayat saying that chieftain should have assistant tagging along with him and should have a pot of water. Comedian Vivek has parodied this aspect in many films. He did a similar spoof in "Sandai" (2008) and "Thoondil" (2008) and made fun of village rituals in "Kadhal Sadugudu" (2003). Scenes from the film was parodied in Shiva starrer "Thamizh Padam" (2010), Ponnambalam who did the negative role in the original film had appeared as village chieftain in this film.


title: Egusi

text: Egusi (Yoruba: "ẹ̀gúsí," Igbo: ègwusi), also known as, agusi, ohue, Ikpan, Ikon, or agushi) is the name for the protein-rich seeds of certain cucurbitaceous plants (squash, melon, gourd), which, after being dried and ground, are used as a major ingredient in West African cuisine.


title: Egusi

text: Authorities disagree whether the word is used more properly for the seeds of the colocynth, those of a particular large-seeded variety of the watermelon, or generically for those of "any" cucurbitaceous plant. The characteristics and uses of all these seeds are broadly similar. Major egusi-growing nations include Nigeria, Burkina Faso, Togo, Ghana, Côte d'Ivoire, Benin, Mali, and Cameroon.


title: Egusi

text: Egusi soup is a soup thickened with the seeds. Egusi soup is popular in West Africa, with considerable local variations. Besides the seeds, water, and oil, egusi soup typically contains leaf vegetables, palm oil, other vegetables, seasonings, and meat. Leaf vegetables typically used for egusi soup include bitterleaf, pumpkin leaf, celosia and spinach. Typical other vegetables include tomatoes and okra. Typical seasonings include chili peppers, onions, and locust beans. Also commonly used are beef, goat, fish, shrimp, or crayfish.


title: Egusi

text: In Nigeria, egusi is common among the people of the southeastern Igbo people, Efik, Ibibio and Annang people of southern Nigeria, and the southwestern part of Nigeria by the Yoruba people.


title: Egusi

text: In Ghana, egusi is also called akatoa or agushi, and is used for soup and stew, most popularly in palaver sauce.


title: Egusi

text: In the late 1980s, the Government of Canada funded a project intended to develop a machine to help Cameroonians shell egusi seeds. A machine has also been developed in Nigeria to shell egusi.


title: Elegua

text: Elegua (Yoruba: Èṣù-Ẹlẹ́gbára, also spelled Eleggua; known as Eleguá in Latin America and Spanish-speaking Caribbean islands) is an Orisha, a deity of roads in the religions of Santería, Winti, Umbanda, Quimbanda, Holy Infant of Atocha, and Candomblé.


title: Elegua

text: Elegua is known as Èṣù-Ẹlẹ́gbára in the Yoruba religion and is closely associated with Eshu. "Ẹlẹ́gbára" means the "master of force" in the Yoruba language.


title: Elegua

text: Eleguá (Legba) is known in the Dominican Republic, Haiti, Colombia, Cuba and Puerto Rico as the orisha and "owner" of "caminos", or roads and paths. All ceremonies and rituals in Santería must first have the approval of Eleguá before progressing. He is the messenger of Olofi. Within the ""Regla de Ocha"" [Cuba], he slightly differs from Echu, who in this case is seen as his brother, by having less dangerous and less aggressive characteristics. Eleguá moves silently; in contrast, Echu "breaks through". Manifestations of Eleguá includes Akefun, Aleshujade, Arabobo, Awanjonu, Lalafán, Obasín, Oparicocha, and Osokere.


title: Elegua

text: There is a "patakí" (story) in Santería in which Olodumare gives Eleguá the keys to the past, present, and future; for this reason, Eleguá is often depicted holding a set of keys. A figure of Eleguá may be placed in the house behind the entrance door.


title: Jakob Böhme

text: Jakob Böhme (; ; 24 April 1575 – 17 November 1624) was a German philosopher, Christian mystic, and Lutheran Protestant theologian. He was considered an original thinker by many of his contemporaries within the Lutheran tradition, and his first book, commonly known as "Aurora", caused a great scandal. In contemporary English, his name may be spelled Jacob Boehme (retaining the older German spelling); in seventeenth-century England it was also spelled Behmen, approximating the contemporary English pronunciation of the German "Böhme".


title: Jakob Böhme

text: Böhme had a profound influence on later philosophical movements such as German idealism and German Romanticism. Hegel described Böhme as "the first German philosopher".


title: Jakob Böhme

text: Böhme was born on 24 April 1575 at Alt Seidenberg (now Stary Zawidów, Poland), a village near Görlitz in Upper Lusatia, a territory of the Kingdom of Bohemia. His father, George Wissen, was Lutheran, reasonably wealthy, but a peasant nonetheless. Böhme was the fourth of five children. Böhme's first job was that of a herd boy. He was deemed to be not strong enough for husbandry. When he was 14 years old, he was sent to Seidenberg, as an apprentice to become a shoemaker. His apprenticeship for shoemaking was hard; he lived with a family who were not Christians, which exposed him to the controversies of the time. He regularly prayed and read the Bible as well as works by visionaries such as Paracelsus, Weigel and Schwenckfeld, although he received no formal education. After three years as an apprentice, Böhme left to travel. Although it is unknown just how far he went, he at least made it to Görlitz. In 1592 Böhme returned from his journeyman years. By 1599, Böhme was master of his craft with his own premises in Görlitz. That same year he married Katharina, daughter of Hans Kuntzschmann, a butcher in Görlitz, and together he and Katharina had four sons and two daughters.


title: Jakob Böhme

text: Böhme's mentor was Abraham Behem who corresponded with Valentin Weigel. Böhme joined the "Conventicle of God's Real Servants" - a parochial study group organized by Martin Moller. Böhme had a number of mystical experiences throughout his youth, culminating in a vision in 1600 as one day he focused his attention onto the exquisite beauty of a beam of sunlight reflected in a pewter dish. He believed this vision revealed to him the spiritual structure of the world, as well as the relationship between God and man, and good and evil. At the time he chose not to speak of this experience openly, preferring instead to continue his work and raise a family.


title: Jakob Böhme

text: In 1610 Böhme experienced another inner vision in which he further understood the unity of the cosmos and that he had received a special vocation from God.


title: Jakob Böhme

text: The shop in Görlitz, which was sold in 1613, had allowed Böhme to buy a house in 1610 and to finish paying for it in 1618. Having given up shoemaking in 1613, Böhme sold woollen gloves for a while, which caused him to regularly visit Prague to sell his wares.


title: Jakob Böhme

text: Twelve years after the vision in 1600, Böhme began to write his first book, "Morgenröte im Aufgang" ("Dawn of the Day in the East"). The book was given the name "Aurora" (sometimes translated into English as "The Day-spring") by a friend. Böhme originally wrote the book for himself and it was never completed. A manuscript copy of the unfinished work was lent to Karl von Ender, a nobleman, who had copies made and began to circulate them. A copy fell into the hands of , the chief pastor of Görlitz, who attacked it as being heretical, speaking against it from the pulpit, and threatened Böhme with exile if he continued working on it. Richter also wrote a pamphlet denouncing Böhme and his work.


title: Jakob Böhme

text: As a result, Böhme did not write anything for several years; however, at the insistence of friends who had read "Aurora", he started writing again in 1618. In 1619 Böhme wrote "De Tribus Principiis" or "The Three Principles of the Divine Essence". It took him two years to finish his second book, which was followed by many other treatises, all of which were copied by hand and circulated only among friends.} In 1620 Böhme wrote "The Threefold Life of Man, Answers to Forty Questions on the Soul, The Incarnation of Jesus Christ, The Six Theosophical Points, The Six Mystical Points", the "Mysterium Pansophicum" and "Informatorium novissimorum" ("Of the Last Times"). In 1621 Böhme wrote "De Signatura Rerum" (relying in part on the doctrine of signatures). In 1623 Böhme wrote "On Election to Grace, On Christ's Testaments, Mysterium Magnum, Clavis" ("Key"). The year 1622 saw Böhme write some short works all of which were subsequently included in his first published book on New Year's Day 1624, under the title "Weg zu Christo" ("The Way to Christ").


title: Jakob Böhme

text: The publication caused another scandal and following complaints by the clergy, Böhme was summoned to the Town Council on 26 March 1624. The report of the meeting was that:


title: Jakob Böhme

text: Böhme left for Dresden on 8 or 9 May 1624, where he stayed with the court physician for two months. In Dresden he was accepted by the nobility and high clergy. His intellect was also recognized by the professors of Dresden, who in a hearing in May 1624, encouraged Böhme to go home to his family in Görlitz. During Böhme's absence his family had suffered due to the Thirty Years' War.


title: Jakob Böhme

text: Once home, Böhme accepted an invitation to stay with Herr von Schweinitz, who had a country-seat. While there Böhme began to write his last book, the "177 Theosophic Questions". Böhme fell terminally ill with a bowel complaint forcing him to travel home on 7 November. Gregorius Richter, Böhme's adversary from Görlitz, had died in August 1624, while Böhme was away. The new clergy, still wary of Böhme, forced him to answer a long list of questions when he wanted to receive the sacrament. He died on 17 November 1624.


title: Jakob Böhme

text: In this short period, Böhme produced an enormous amount of writing, including his major works "De Signatura Rerum" ("The Signature of All Things") and "Mysterium Magnum". He also developed a following throughout Europe, where his followers were known as Behmenists.


title: Jakob Böhme

text: The son of Böhme's chief antagonist, the pastor primarius of Görlitz Gregorius Richter, edited a collection of extracts from his writings, which were afterwards published complete at Amsterdam with the help of Coenraad van Beuningen in the year 1682. Böhme's full works were first printed in 1730.


title: Jakob Böhme

text: The chief concern of Böhme's writing was the nature of sin, evil and redemption. Consistent with Lutheran theology, Böhme preached that humanity had fallen from a state of divine grace to a state of sin and suffering, that the forces of evil included fallen angels who had rebelled against God, and that God's goal was to restore the world to a state of grace.


title: Jakob Böhme

text: There are some serious departures from accepted Lutheran theology, such as his rejection of justification by faith alone, as in this passage from "The Way to Christ":


title: Jakob Böhme

text: For he that will say, "I have a Will, and would willingly do Good, but the earthly Flesh which I carry about me, keepeth me back, so that I cannot; yet I shall be saved by Grace, for the Merits of Christ. I comfort myself with his Merit and Sufferings; who will receive me of mere Grace, without any Merits of my own, and forgive me my Sins". Such a one, I say, is like a Man that knoweth what Food is good for his Health, yet will not eat of it, but eateth Poison instead thereof, from whence Sickness and Death, will certainly follow.


title: Jakob Böhme

text: Another place where Böhme may depart from accepted theology (though this was open to question due to his somewhat obscure, oracular style) was in his description of the Fall as a necessary stage in the evolution of the Universe. A difficulty with his theology is the fact that he had a mystical vision, which he reinterpreted and reformulated. According to F. von Ingen, to Böhme, in order to reach God, man has to go through hell first. God exists without time or space, he regenerates himself through eternity. Böhme restates the trinity as truly existing but with a novel interpretation. God, the Father is fire, who gives birth to his son, whom Böhme calls light. The Holy Spirit is the living principle, or the divine life.


title: Jakob Böhme

text: It is clear that Böhme never claimed that God sees evil as desirable, necessary or as part of divine will to bring forth good. In his "Threefold Life", Böhme states: "[I]n the order of nature, an evil thing cannot produce a good thing out of itself, but one evil thing generates another." Böhme did not believe that there is any "divine mandate or metaphysically inherent necessity for evil and its effects in the scheme of things." Dr. John Pordage, a commentator on Böhme, wrote that Böhme "whensoever he attributes evil to eternal nature considers it in its fallen state, as it became infected by the fall of Lucifer... ." Evil is seen as "the disorder, rebellion, perversion of making spirit nature's servant", which is to say a perversion of initial Divine order.


title: Jakob Böhme

text: Böhme's correspondences in "Aurora" of the seven qualities, planets and humoral-elemental associations:


title: Jakob Böhme

text: In "De Tribus Principiis" or "On the Three Principles of Divine Being" Böhme subsumed the seven principles into the Trinity:


title: Jakob Böhme

text: In one interpretation of Böhme's cosmology, it was necessary for humanity to return to God, and for all original unities to undergo differentiation, desire and conflict—as in the rebellion of Satan, the separation of Eve from Adam and their acquisition of the knowledge of good and evil—in order for creation to evolve to a new state of redeemed harmony that would be more perfect than the original state of innocence, allowing God to achieve a new self-awareness by interacting with a creation that was both part of, and distinct from, Himself. Free will becomes the most important gift God gives to humanity, allowing us to seek divine grace as a deliberate choice while still allowing us to remain individuals.


title: Jakob Böhme

text: Böhme believed that the Son of God became human through the Virgin Mary. Before the birth of Christ, God recognized himself as a virgin. This virgin is therefore a mirror of God's wisdom and knowledge. Böhme follows Luther in that he views Mary within the context of Christ. Unlike Luther, he does not address himself to dogmatic issues very much, but to the human side of Mary. Like all other women, she was human and therefore subject to sin. Only after God elected her with his grace to become the mother of his son, did she inherit the status of sinlessness. "Mary did not move the Word, the Word moved Mary", so Böhme, explaining that all her grace came from Christ. Mary is "blessed among women" but not because of her qualifications, but because of her humility. Mary is an instrument of God; an example of what God can do: It shall not be forgotten in all eternity, that God became human in her.


title: Jakob Böhme

text: Böhme, unlike Luther, did not believe that Mary was the "Ever Virgin". Her virginity after the birth of Jesus is unrealistic to Böhme. The true salvation is Christ, not Mary. The importance of Mary, a human like every one of us, is that she gave birth to Jesus Christ as a human being. If Mary had not been human, according to Böhme, Christ would be a stranger and not our brother. Christ must grow in us as he did in Mary. She became blessed by accepting Christ. In a reborn Christian, as in Mary, all that is temporal disappears and only the heavenly part remains for all eternity. Böhme's peculiar theological language, involving fire, light and spirit, which permeates his theology and Marian views, does not distract much from the fact that his basic positions are Lutheran.


title: Jakob Böhme

text: Böhme's writing shows the influence of Neoplatonist and alchemical writers such as Paracelsus, while remaining firmly within a Christian tradition. He has in turn greatly influenced many anti-authoritarian and mystical movements, such as Radical Pietism (including the Ephrata Cloister and Society of the Woman in the Wilderness), the Religious Society of Friends, the Philadelphians, the Gichtelians, the Harmony Society, the Zoarite Separatists, Rosicrucianism, Martinism and Christian theosophy. Böhme's disciple and mentor, the Liegnitz physician Balthasar Walther, who had travelled to the Holy Land in search of magical, kabbalistic and alchemical wisdom, also introduced kabbalistic ideas into Böhme's thought. Böhme was also an important source of German Romantic philosophy, influencing Schelling in particular. In Richard Bucke's 1901 treatise "Cosmic Consciousness", special attention was given to the profundity of Böhme's spiritual enlightenment, which seemed to reveal to Böhme an ultimate nondifference, or nonduality, between human beings and God. Jakob Böhme's writings also had some influence on the modern theosophical movement of the Theosophical Society. Blavatsky and W.Q. Judge wrote about Jakob Böhme's philosophy. Böhme was also an important influence on the ideas of Franz Hartmann, the founder in 1886 of the German branch of the Theosophical Society. Hartmann described the writings of Böhme as “the most valuable and useful treasure in spiritual literature.”


title: Jakob Böhme

text: Behmenism, also Behemenism or Boehmenism, is the English-language designation for a 17th-century European Christian movement based on the teachings of German mystic and theosopher Jakob Böhme (1575-1624). The term was not usually applied by followers of Böhme's theosophy to themselves, but rather was used by some opponents of Böhme's thought as a polemical term. The origins of the term date back to the German literature of the 1620s, when opponents of Böhme's thought, such as the Thuringian antinomian Esajas Stiefel, the Lutheran theologian Peter Widmann and others denounced the writings of Böhme and the "Böhmisten". When his writings began to appear in England in the 1640s, Böhme's surname was irretrievably corrupted to the form "Behmen" or "Behemen", whence the term "Behmenism" developed. A follower of Böhme's theosophy is a "Behmenist".


title: Jakob Böhme

text: Behmenism does not describe the beliefs of any single formal religious sect, but instead designates a more general description of Böhme's interpretation of Christianity, when used as a source of devotional inspiration by a variety of groups. Böhme's views greatly influenced many anti-authoritarian and Christian mystical movements, such as the Religious Society of Friends (Quakers), the Philadelphians, the Gichtelians, the Society of the Woman in the Wilderness (led by Johannes Kelpius), the Ephrata Cloister, the Harmony Society, Martinism, and Christian theosophy. Böhme was also an important source of German Romantic philosophy, influencing Schelling and Franz von Baader in particular. In Richard Bucke's 1901 treatise "Cosmic Consciousness", special attention was given to the profundity of Böhme's spiritual enlightenment, which seemed to reveal to Böhme an ultimate nondifference, or nonduality, between human beings and God. Böhme is also an important influence on the ideas of the English Romantic poet, artist and mystic William Blake. After having seen the William Law edition of the works of Jakob Böhme, published between 1764 and 1781, in which some illustrations had been included by the German early Böhme exegetist Dionysius Andreas Freher (1649–1728), William Blake said during a dinner party in 1825 "Michel Angelo could not have surpassed them".


title: Jakob Böhme

text: Despite being based on a corrupted form of Böhme's surname, the term Behmenism has retained a certain utility in modern English-language historiography, where it is still occasionally employed, although often to designate specifically English followers of Böhme's theosophy. Given the transnational nature of Böhme's influence, the term at least implies manifold international connections between Behmenists. In any case, the term is preferred to clumsier variants such as "Böhmeianism" or "Böhmism", although these may also be encountered.


title: Jakob Böhme

text: In addition to the scientific revolution, the 17th century was a time of mystical revolution in Catholicism, Protestantism and Judaism. The Protestant revolution developed from Böhme and some medieval mystics. Böhme became important in intellectual circles in Protestant Europe, following from the publication of his books in England, Holland and Germany in the 1640s and 1650s. Böhme was especially important for the Millenarians and was taken seriously by the Cambridge Platonists and Dutch Collegiants. Henry More was critical of Böhme and claimed he was not a real prophet, and had no exceptional insight into metaphysical questions. Overall, although his writings did not influence political or religious debates in England, his influence can be seen in more esoteric forms such as on alchemical experimentation, metaphysical speculation and spiritual contemplation, as well as utopian literature and the development of neologisms. More, for example, dismissed "Opera Posthuma" by Spinoza as a return to Behmenism.


title: Jakob Böhme

text: While Böhme was famous in Holland, England, France, Denmark and America during the 17th century, he became less influential during the 18th century. A revival occurred late in that century with interest from German Romantics, who considered Böhme a forerunner to the movement. Poets such as John Milton, Ludwig Tieck, Novalis, William Blake and W. B. Yeats found inspiration in Böhme's writings. Coleridge, in his "Biographia Literaria", speaks of Böhme with admiration. Böhme was highly thought of by the German philosophers Baader, Schelling and Schopenhauer. Hegel went as far as to say that Böhme was "the first German philosopher". Danish Bishop Hans Lassen Martensen published a book about Böhme.


title: Jakob Böhme

text: Several authors have found Boehme's description of the three original Principles and the seven Spirits to be similar to the Law of Three and the Law of Seven described in the works of Boris Mouravieff and George Gurdjieff.


title: Jakob Böhme

text: In 2022, Jacob Boehme was officially added to the Episcopal Church liturgical calendar along with Johann Arndt with a feast day on 11 May.


title: Jakob Böhme

text: Cormac McCarthy's 1985 novel "Blood Meridian" includes three epigraphs, the second of which comes from Jacob Boehme: "It is not to be thought that the life of darkness is sunk in misery and lost as if in sorrowing. There is no sorrowing. For sorrow is a thing that is swallowed up in death, and death and dying are the very life of the darkness."


title: Jakob Böhme

text: "The Life and Legacy of Jacob Boehme". A documentary directed by Łukasz Chwałko. Premiered: June 2016, Zgorzelec (Poland).


title: Port of New York and New Jersey

text: The Port of New York and New Jersey is the port district of the New York-Newark metropolitan area, encompassing the region within approximately a radius of the Statue of Liberty National Monument.


title: Port of New York and New Jersey

text: It includes the system of navigable waterways in the New York–New Jersey Harbor Estuary, which runs along over of shoreline in the vicinity of New York City and northeastern New Jersey, and is considered one of the largest natural harbors in the world.


title: Port of New York and New Jersey

text: Having long been the busiest port on the East Coast it became it the busiest port by maritime cargo volume in the United States in August 2022 and is a major economic engine for the region.


title: Port of New York and New Jersey

text: The region's airports make the port the nation's top gateway for international flights and its busiest center for overall passenger and air freight flights. There are two foreign-trade zones (FTZ) within the port.