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Multisystem inflammatory syndrome (MIS) is a severe complication described in a minority of patients with COVID-19. Myocarditis has been reported in patients with COVID-19, including MIS. In this study, we compared the clinical characteristics and cardiac magnetic resonance (CMR) findings of COVID-19 myocarditis in patients with and without MIS. In the 330 patients with COVID-19 who were referred for CMR at our institution between July 24, 2020, to March 31, 2021, 40 patients were identified as having myocarditis, MIS myocarditis (n = 21) and non-MIS myocarditis (n = 19). MIS myocarditis was characterized by global myocardial inflammation/edema with significantly elevated native T1, whereas only regional inflammation, and edema were noted in the non-MIS group. Distinct late gadolinium enhancement (LGE) patterns—inferior myocardial involvement in non-MIS myocarditis and septal involvement in MIS myocarditis—were identified. The LGE burden was comparable between the 2 groups (5.9% vs 6.6%, MIS vs non-MIS group, p = 0.83). Myocarditis was diagnosed more frequently by CMR in the MIS group (70% vs 6.3%, MIS vs non-MIS, p

Objectives Hypertension is a modifiable risk factor for numerous comorbidities and treating hypertension can greatly improve health outcomes. We sought to increase the efficiency of a virtual hypertension management program through workflow automation processes. Methods We developed a customer relationship management (CRM) solution at our institution for the purpose of improving processes and workflow for a virtual hypertension management program and describe here the development, implementation, and initial experience of this CRM system. Results Notable system features include task automation, patient data capture, multi-channel communication, integration with our electronic health record (EHR), and device integration (for blood pressure cuffs). In the five stages of our program (intake and eligibility screening, enrollment, device configuration/setup, medication titration, and maintenance), we describe some of the key process improvements and workflow automations that are enabled using our CRM platform, like automatic reminders to capture blood pressure data and present these data to our clinical team when ready for clinical decision making. We also describe key limitations of CRM, like balancing out-of-the-box functionality with development flexibility. Among our first group of referred patients, 76% (39/51) preferred email as their communication method, 26/51 (51%) were able to enroll electronically, and 63% of those enrolled (32/51) were able to transmit blood pressure data without phone support. Conclusion A CRM platform could improve clinical processes through multiple pathways, including workflow automation, multi-channel communication, and device integration. Future work will examine the operational improvements of this health information technology solution as well as assess clinical outcomes.

The crude proteins were isolated using 0.125 M Tris-HCl with 50 mM NaCl at pH 7.4. The protein content of the crude extract was determined using the Lowry assay and was found to be 4.28 mg/mL. The major band which corresponds to the major protein has an approximate molecular weight of 20 KDa. The isolated crude proteins were subjected to enzymatic digestion using pepsin, trypsin, chymotrypsin, and thermolysin for 3, 4, 12, and 24 hours. The 24-hour digest was found to have the highest percent anti-Angiotensin Converting Enzyme (ACE) activity (36.02%) while the 12-hour digest was found to have the highest anti-oxidative activity (33.14%) using 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. The 24-hour digest was subjected to Ultra-Performance Liquid Chromatography (UPLC) to determine the peptide fraction responsible for the ACE inhibitory activity. Three peptide fractions (PF1, PF2 and PF3) were chosen and PF2 exhibited the highest percent inhibitory activity (32.21) against ACE. PF2 was subjected to thin layer chromatography (TLC) and the possible identity is EK based on the Rf value traveled by glutamic acid (E) (0.43) and Lysine (K) (0.13). In silico analysis was done to correlate the results with the presence of putative peptides with antioxidative and antihypertensive activities. Results showed that antihypertensive peptides EK, GS, TY, FNE, FP, LKA, PT, PP, FAL and antioxidative peptides IR and VPW were found based on the sequence of the protein in “Saba” banana. The presence of the antihypertensive peptide EK was verified using thin layer chromatography (TLC).

The computational study of x-pinch plasmas driven by pulsed power generators demands the development of advanced numerical models and simulation schemes, able to enlighten the experiments. The capabilities of PLUTO code are here extended to enable the investigation of low current produced x-pinch plasmas. The numerical modules of the code used and modified are presented and discussed. The simulations results are compared to experiments, carried out on a table-top pulsed power plasma generator implemented in a mode of producing a peak current of ∼45 kA with a rise time (10%–90%) of 50 ns, loaded with Tungsten wires. The structural evolution of plasma density is studied and its influence on the magnetic field is analyzed with the help of the new simulation data. The simulated areal mass density is compared with the experimentally measured dense opaque region to enlighten the dense plasma evolution. In addition, the measured areal electron density is compared to the simulation results. Moreover, the new simulation data offer valuable insights to the main jet formation mechanisms, which are further analyzed and discussed in relation to the influence of the J × B force and the momentum.

Mass attendance and participation in the Morte Darthur helps to delineate a four-tier spiritual hierarchy—one which rewards faith with temporal benefits. The hierarchy outlined through mass attendance and participation suggests that the concrete, temporal differentiation between believers is an important Christian concern in the text. (DEC)

Objectives To understand the impact of GeneInsight Clinic (GIC), a web-based tool designed to manage genetic information and facilitate communication of test results and variant updates from the laboratory to the clinics, we measured the use of GIC and the time it took for new genetic knowledge to be available to clinicians. Methods Usage data were collected across four study sites for the GIC launch and post-GIC implementation time periods. The primary outcome measures were the time (average number of days) between variant change approval and notification of clinic staff, and the time between notification and viewing the patient record. Results Post-GIC, time between a variant change approval and provider notification was shorter than at launch (average days at launch 503.8, compared to 4.1 days post-GIC). After e-mail alerts were sent at launch, providers clicked into the patient record associated with 91% of these alerts. In the post period, clinic providers clicked into the patient record associated with 95% of the alerts, on average 12 days after the e-mail was sent. Discussion We found that GIC greatly increased the likelihood that a provider would receive updated variant information as well as reduced the time associated with distributing that variant information, thus providing a more efficient process for incorporating new genetic knowledge into clinical care. Conclusions Our study results demonstrate that health information technology systems have the potential effectively to assist providers in utilizing genetic information in patient care.

This article surveys future trends impacting corporate governance research and practice. These trends, which will impact all countries, but to varying degrees, include a movement towards unifying the diverse theories, models and language deployed in corporate governance research so that we can have a sounder epistemological base from which to advance our knowledge. Also discussed are the impact of technology on corporate governance research; the move to more inclusive and interdisciplinary models; a greater emphasis on Asian models of corporate governance; the impact of soft law; continued emphasis on the role of corporate governance in achieving sustainable growth and development; corporate governance within the context of new forms of capitalism and new institutional frameworks; a greater focus on comparative law and transnational models; and finally, an increased demand for evidence- based outcomes.

The emission characteristics of intense laser driven protons are controlled using ultra-strong (of the order of 10^9 V/m) electrostatic fields varying on a few ps timescale. The field structures are achieved by exploiting the high potential of the target (reaching multi-MV during the laser interaction). Suitably shaped targets result in a reduction in the proton beam divergence, and hence an increase in proton flux while preserving the high beam quality. The peak focusing power and its temporal variation are shown to depend on the target characteristics, allowing for the collimation of the inherently highly divergent beam and the design of achromatic electrostatic lenses., 9 Pages, 5 figures

Academic medical centers require many interconnected systems to fully support genetic testing processes. We provide an overview of the end-to-end support that has been established surrounding a genetic testing laboratory within our environment, including both laboratory and clinician facing infrastructure. We explain key functions that we have found useful in the supporting systems. We also consider ways that this infrastructure could be enhanced to enable deeper assessment of genetic test results in both the laboratory and clinic.

Genetic tests often identify variants whose significance cannot be determined at the time they are reported. In many situations, it is critical that clinicians be informed when new information emerges on these variants. It is already extremely challenging for laboratories to provide these updates. These challenges will grow rapidly as an increasing number of clinical genetic tests are ordered and as the amount of patient DNA assayed per test expands; the challenges will need to be addressed before whole-genome sequencing is used on a widespread basis.Information technology infrastructure can be useful in this context. We have deployed an infrastructure enabling clinicians to receive knowledge updates when a laboratory changes the classification of a variant. We have gathered statistics from this deployment regarding the frequency of both variant classification changes and the effects of these classification changes on patients. We report on the system's functionality as well as the statistics derived from its use.Genet Med advance online publication 5 April 2012.

The essays collected here put considerable emphasis on Arthurian narratives in material culture and historical context, as well as on purely literary analysis, a reminder of the enormous range of interests in Arthurian narratives in the Middle Ages, in a number of different contexts. The volume opens with a study of torture in texts from Chrétien to Malory, and on English law and attitudes inparticular. Several contributors discuss the undeservedly neglected Stanzaic Morte Arthur, a key source for Malory. His Morte Darthur is the focus of several essays, respectively on thesources of the "Tale of Sir Gareth"; battle scenes and the importance of chivalric kingship; Cicero's De amicitia and the mixed blessings and dangers of fellowship; and comparison of concluding formulae in the Winchester Manuscript and Caxton's edition. Seven tantalizing fragments of needlework, all depicting Tristan, are discussed in terms of the heraldic devices they include. The volume ends with an update on newly discovered manuscripts of Geoffrey of Monmouth's seminal Historia regum Britanniae, the twelfth-century best-seller which launched Arthur's literary career. Elizabeth Archibald is Professor of English Studies at Durham University, and Principal of St Cuthbert's Society; David F. Johnson is Professor of English at Florida State University, Tallahassee. Contibutors: David Eugene Clark, Marco Nievergelt, Ralph Norris, Sarah Randles, Lisa Robeson, Richard Sévère, Jaakko Tahkokallio, Larissa Tracy

The future of personalized medicine will hinge on effective management of patient genetic profiles. Molecular diagnostic testing laboratories need to track knowledge surrounding an increasingly large number of genetic variants, incorporate this knowledge into interpretative reports, and keep ordering clinicians up to date as this knowledge evolves. Treating clinicians need to track which variants have been identified in each of their patients along with the significance of these variants. The GeneInsight(SM) Suite assists in these areas. The suite also provides a basis for interconnecting laboratories and clinicians in a manner that increases the scalability of personalized medicine processes.

Australia, with a competitive, modern economy, an educated workforce, modern communications, and its positioning on the doorstep of Asia, has attracted many international businesses that have enjoyed success there. Some companies that immediately come to mind are Nokia and Optus (Singtel) in the case of telecommunications, IKEA in home design, the global accounting firms, and well-known brands such as Google, Yahoo, and FedEx. Australia has attracted to its shores well-known food franchises, such as McDonald's, KFC, Starbucks, and Baskin-Robbins. It has airlines, including Virgin Blue; the big agriculture and mining equipment companies such as Rio Tinto; Rivers and other big clothing companies; computing companies such as Hewlett-Packard; and manufacturers such as Toyota. Looking to the future, Australia offers significant investment and business opportunities for international managers seeking a presence there for their firms. This article provides an overview of the Australian business, government, and legal scene and offers some practical guidance for managers who decide to venture there. © 2008 Wiley Periodicals, Inc.

Information communication technology (ICT) governance is a subset of the larger notion of “corporate governance”. As ICT issues become increasingly important and information becomes one of the most valuable assets of organisations, the sound governance of ICT becomes a major factor in organisational success. Standards such as the Australian New Zealand Standard on ICT Governance provide useful guidance to organisations about how best to meet their corporate and ICT governance ‘obligations. At the same time, notions of what is meant by corporate and ICT governance are rapidly evolving in Australia, the EU and US. New concepts, models, theories and applications of governance are emerging as various disciplines such as management, politics, law, sociology, psychology, economics, ethics and computer science contribute to the governance dialogue and debate. In response to such concepts, etc the discussion here urges clarity and common definitions concerning ICT governance. It also cautions against the uncritic...

This paper introduces the articles in this issue of MIA on the theme of ‘Copyright, Media, and Innovation’. The paper also provides a context for these articles via a discussion of historical and contemporary issues in copyright law, particularly in relation to new technologies.

Brink Lindsey. 2002. Against the Dead Hand: The Uncertain Struggle for Global Capitalism. New York: John Wiley & Sons. 336 pages; ISBN 0-471-44277-1. Peter Hall & David Soskice (Eds.). 2001. Varieties of Capitalism: The Institutional Foundations of Comparative Advantage. Oxford: Oxford University Press. 540 pages; ISBN 0-199-24775-7.

Australia is recognized as a leading country in the move to an information economy, and the Australian government has played a pivotal role in this transformation. This commentary outlines some of the key issues confronting Australia as it moves towards its policy goal of achieving e-government. Although governments differ in the pace and nature of reforms required to bring about the transformation to e-government, many of the underlying issues are the same for most governments. © 2003 Wiley Periodicals, Inc.

D. LeBaron, with D. Carpenter. 2002. Mao, Marx, and the Market: Capitalist Adventures in Russia and China. New York: John Wiley & Sons, Inc. 303 pages; ISBN: 0-471-15315-X. B. Granville & P. Oppenheimer (Eds.). 2001. Russia's Post-Communist Economy. Oxford, England: University Press. 538 pages; ISBN 0-19-829525-1. H. Fung & K.H. Zhang (Eds.). 2002. Financial Markets and Foreign Direct Investment in Greater China. New York: M.E. Sharpe, Inc. 302 pages; ISBN: 0-7656-0804-9.

This article provides an overview of recent developments in the use of technology in dispute resolution processes, especially when dispute resolution is provided online. It discusses the nature of new technologies, the advantages and disadvantages involved with the use of such technology and the policy and regulatory issues arising from such processes. The article also describes current uses of information communication technologies to provide dispute resolution services from negotiation to online courts. A concluding section suggests that, while online dispute resolution is both a tool and a process, its development is still in its infancy. Various government and industry bodies have been struggling to develop a policy and practice framework governing ODR . However, it is clear that more research is required, especially from an interdisciplinary perspective, before we can be confident that such practices and guidelines take advantage of the new technologies while avoiding their disadvantages.

Summarization: This article addresses key features for the implementation of low current pulsed power plasma devices for the study of matter dynamics from the solid to the plasma phase. The renewed interest in such low current plasma devices lies in the need to investigate methods for the mitigation of prompt seeding mechanisms for the generation of plasma instabilities. The low current when driven into thick wires (skin effect mode) allows for the simultaneous existence of all phases of matter from solid to plasma. Such studies are important for the concept of inertial confinement fusion where the mitigation of the instability seeding mechanisms arising from the very early moments within the target's heating is of crucial importance. Similarly, in the magnetized liner inertial fusion concept it is an open question as to how much surface non-uniformity correlates with the magneto-Rayleigh-Taylor instability, which develops during the implosion. This study presents experimental and simulation results, which demonstrate that the use of low current pulsed power devices in conjunction with appropriate diagnostics can be important for studying seeding mechanisms for the imminent generation of plasma instabilities in future research. Παρουσιάστηκε στο: Plasma Physics and Controlled Fusion

Hypertrophic cardiomyopathy (HCM) is caused primarily by pathogenic variants in genes encoding sarcomere proteins. We report genetic testing results for HCM in 2,912 unrelated individuals with nonsyndromic presentations from a broad referral population over 10 years.Genetic testing was performed by Sanger sequencing for 10 genes from 2004 to 2007, by HCM CardioChip for 11 genes from 2007 to 2011 and by next-generation sequencing for 18, 46, or 51 genes from 2011 onward.The detection rate is ~32% among unselected probands, with inconclusive results in an additional 15%. Detection rates were not significantly different between adult and pediatric probands but were higher in females compared with males. An expanded gene panel encompassing more than 50 genes identified only a very small number of additional pathogenic variants beyond those identifiable in our original panels, which examined 11 genes. Familial genetic testing in at-risk family members eliminated the need for longitudinal cardiac evaluations in 691 individuals. Based on the projected costs derived from Medicare fee schedules for the recommended clinical evaluations of HCM family members by the American College of Cardiology Foundation/American Heart Association, our data indicate that genetic testing resulted in a minimum cost savings of about $0.7 million.Clinical HCM genetic testing provides a definitive molecular diagnosis for many patients and provides cost savings to families. Expanded gene panels have not substantively increased the clinical sensitivity of HCM testing, suggesting major additional causes of HCM still remain to be identified.

A photon detector suitable for the measurement of bremsstrahlung spectra generated in relativistically intense laser-solid interactions is described. The Monte Carlo techniques used to extract the fast electron spectrum and laser energy absorbed into forward-going fast electrons are detailed. A relativistically intense laser-solid experiment using frequency doubled laser light is used to demonstrate the effective operation of the detector. The experimental data were interpreted using the 3-spatial-dimension Monte Carlo code MCNPX [D. Pelowitz, MCNPX User's Manual Version 2.6.0, Los Alamos National Laboratory, 2008], and the fast electron temperature found to be 125 keV.

The Atomic Weapons Establishment has proposed building a new laser facility in the United Kingdom. This will use 10 ns-class beams in conjunction with two, subpicosecond, petawatt-class beams to access plasma conditions inaccessible to even the largest megajoule-class facilities. Diagnostic techniques for the long pulse regime are fairly mature, whereas techniques in the short pulse regime are still evolving. This article describes the development of a suite of target diagnostics to exploit the high temperature, high density plasma conditions that will be achievable on the Orion laser, and discusses some of the opportunities and problems that will be encountered in attempting to combine the two sets of techniques.

Nitric oxide mediates neuromuscular events in the opossum esophagus. The NADPH diaphorase stain is used to localize nitric oxide synthase-containing enteric neurons. Cells stain by the NADPH diaphorase technique because they reduce nitroblue tetrazolium to the visible formazan. The effects of nitroblue tetrazolium on neuromuscular function and nitric oxide synthase of esophageal muscle were studied. The NADPH diaphorase stain was performed. Nitroblue tetrazolium inhibited lower esophageal sphincter relaxation, abolished the latency gradient of the off response, and inhibited nitric oxide synthase. The NADPH diaphorase technique stained myenteric plexus nerve cell bodies and nerve processes. Nitroblue tetrazolium is not a nonspecific muscle or nerve toxin, as nerve-mediated cholinergic responses, responses to exogenous nitric oxide, and responses to myogenic stimulation were maintained after nitroblue tetrazolium abolished the off response and lower esophageal sphincter relaxation. Nitroblue tetrazolium inhibits nitric oxide-mediated events and nitric oxide synthase. It stains neurons in the esophageal myenteric plexus.

THIS article surveys some of the most significant issues facing Australian legal education today. Although referencing the research of others, the views expressed in this article are necessarily personal to the authors; they represent a “reflective practitioners'” insight into Australian legal education. The perspectives drawn in this article are painted with a broad brush on a large canvas and in an impressionistic style. As with all ‘overviews’, most of the areas discussed warrant further discussion and research. While some of the concerns raised will be of immediate interest to Australians, the broader issues encompass areas relevant to legal educators in countries facing similar problems and undergoing, as is the UK, a major review of legal education.1

Background/Aims: Nitric oxide mediates the nonadrenergic, noncholinergic neural control of esophageal motor function. The purpose of this study was to characterize the NO synthase found in the muscularis propria of the opossum esophagus and determine its distribution along the esophagus. Methods: Esophageal muscle was homogenized in HEPES buffer and ultracentrifuged. The supernatant was exposed to [ 3 H]l-arginine. The [ 3 H]l-citrulline produced by NO synthase was separated from [ 3 H]l-arginine with a Dowex AG 50 W-X8 column (Biorad, Hercules, CA). Assays were performed in the presence and absence of Ca 2+ or reduced nicotinamide adenine dinucleotide phosphate (NADPH). The distribution of NO synthase activity along the esophagus was determined. Results: The apparent Michaelis constant and maximum velocity of NO synthase were 7.5 ± 1.4 μmol/L l-arginine and 76.0 ± 17.3 pmol·mg protein −1 ·min −1 , respectively. The enzyme required both Ca 2+ and NADPH for activity. Smooth muscle tissue from the lower esophageal sphincter and the esophageal body 1–2 cm or 5–6 cm above the lower esophageal sphincter differed little in enzymatic activity, ranging from 0.97 to 1.27 pmol·mg wet wt −1 ·min −1 . Striated muscle had less activity with 0.40 pmol·mg wet wt −1 ·min −1 . Conclusions: These data indicate the presence of a constitutive NO synthase in the esophagus of the opossum.

This article has two broad objectives. First, it reports on progress towards achieving the Australian National Electronic Conveyancing System (NECS). Secondly, the article analyses the significance of the NECS in the general context of e-Government. The NECS project was established by Australian state and territory governments in 2005 and significant progress has been made over the past five years. When the NECS is completed, conveyancers, legal practitioners, financial institutions, mortgage processors and other players involved in conveyancing will be able to access the NECS online with an electronic workspace provided for each property transaction. The system will allow users to provide, secure, certify and sign documentation. Digital Signature Certificates (DSCs) will ensure authentication and prevent repudiation and various risk mitigation and fraud prevention measures will be taken. Financial settlement will occur through the Reserve Bank's Information and Transfer System (RITS) and the State and Territory Revenue Offices will receive duty and tax payments electronically. Consumers will be able to track the progress of their transaction via limited Internet access to the NECS. Financial institutions will be able to integrate their services and mortgage documentation systems with the NEC system. Collectively, the NECS is an excellent example of the substantive and procedural challenges involved in making e-government a reality.

This paper reports on progress towards achieving the National Electronic Conveyancing system (NECS) and analyses its significance in the general context of e-Government. NECS was created by Australian State and Territory Governments in 2005 and significant progress has been made over the past five years. Conveyancers, legal practitioners, financial institutions, mortgage processors and other players involved in conveyancing will be able to access the NECS online with an electronic workspace provided for each property transaction. The system will allow users to provide, secure, certify and sign documentation. Digital Signature Certificates will ensure authentication and prevent repudiation and various risk mitigation and fraud prevention measures will be taken. Financial settlement will occur through the Reserve Bank’s Information and Transfer System (RITS) and the State and Territory Revenue Offices will receive duty and tax payments electronically. Consumers will be able to track the progress of their transaction via limited Internet access to the NECS. Financial institutions will be able to integrate their services and mortgage documentation systems with the NEC system. Collectively, the NECS is an excellent example of what is required if the promises of e-government are to be realised.

The expansion of electromagnetic postsolitons emerging from the interaction of a 30? ps, 3×1018Wcm⊃-2 laser pulse with an underdense deuterium plasma has been observed up to 100? ps after the pulse propagation, when large numbers of postsolitons were seen to remain in the plasma. The temporal evolution of the postsolitons has been accurately characterized with a high spatial and temporal resolution. The observed expansion is compared to analytical models and three-dimensional particle-in-cell results, revealing a polarization dependence of the postsoliton dynamics. © 2010 The American Physical Society.

Purpose: Genetic tests for the most commonly mutated genes in dilated cardiomyopathy (DCM) can confirm a clinical diagnosis in the proband and inform family management. Presymptomatic family members can be identified, allowing for targeted clinical monitoring to minimize adverse outcomes. However, the marked locus and allelic heterogeneity associated with DCM have made clinical genetic testing challenging. Novel sequencing platforms have now opened up avenues for more comprehensive diagnostic testing while simultaneously decreasing test cost and turn around time. Methods: By using a custom design based on triplicate resequencing and separate genotyping of known disease-causing variants, we developed the DCM CardioChip for efficient analysis of 19 genes previously implicated in causing DCM. Results: The chip's analytical sensitivity for known and novel substitution variants is 100% and 98%, respectively. In screening 73 previously tested DCM patients who did not carry clinically significant variants in 10 genes, 7 variants of likely clinical significance were identified in the remaining 9 genes included on the chip. Compared with traditional Sanger-based sequencing, test cost and turn around time were reduced by ∼50%. Conclusions: The DCM CardioChip is a highly efficient screening test with a projected clinical sensitivity of 26–29%.

Accessing the high repetition regime of ultra intense laser‐target interactions at small or moderate laser energies is now possible at a large number of facilities worldwide. New projects such as HiPER and ELI promise to extend this regime to the high energy realm at the multi‐kJ level. This opportunity raises several issues on how best to approach this new regime of operation in a safe and efficient way. At the same time, a new class of experiments or a new generation of secondary sources of particles and radiation may become accessible, provided that target fabrication and diagnostics are capable of handling this rep‐rated regime. In this paper, we explore this scenario and analyse existing and perspective techniques that promise to address some of the above issues.

Although the alternate cover test is a widely accepted test of ocular alignment, clinical ambiguity exists with regard to the specific location of the examiner. This study was an attempt to replicate the findings of a previous study that compared two examiner positions and their effect on heterophoria measurement at 40 cm.Fifty-seven adult subjects (mean age, 24.0 +/- 2.88 years) with normal binocular vision were measured for heterophoria posture using the alternate cover test while the examiner position was varied between midline and offset 30 degrees to the right of patient midline.A significant difference between midline and offset position of 1.3delta was found (p0.0001). The results show that a greater exophoric measurement was seen when the examiner performed the test in the 30 degrees offset position.A 1.3delta difference in measured phoria associated with examiner position is consistent with, though smaller than previously reported. Why the examiner position should influence the phoria is possibly related to proximal awareness or prismatic measurement error. Given the small magnitude of the effect found in this study, its relevance for patients with normal binocular vision is slight, though examiner position may contribute to variability in cover test measures between examiners or on test-retest.