• Obesity and health: Understanding the issues in Pakistani women living in the UK

      Ludwig, Alison F.; Ellahi, Basma; Cox, Peter; University of Chester (British Sociological Association, 2008)
    • On 'Kantian Experimentation' in the health sciences

      Lewis, Stephen J. (2002-05)
      This presentation dicusses various approaches to the definition of health and disease.
    • On the question of questions

      Lewis, Stephen J.; University College Chester (Philo Sophos.com, 2004)
      This article discusses Russell's dictum that "in philosophy, what is important is not so much the answers that are given, but rather the questions that are asked" - posing questions and posing them properly.
    • One strategy doesn’t fit all: determinants of urban adaptation in mammals

      Santini, Luca; González‐Suárez, Manuela; Russo, Danilo; Gonzalez‐Voyer, Alejandro; von Hardenberg, Achaz; Ancillotto, Leonardo; Radboud University; University of Reading; University of Napoli; Universidad Nacional Autónoma de México; University of Chester (Wiley, 2018-12-20)
      Urbanisation exposes wildlife to new challenging conditions and environmental pressures. Somemammalian species have adapted to these novel environments, but it remains unclear which char-acteristics allow them to persist. To address this question, we identified 190 mammals regularlyrecorded in urban settlements worldwide, and used phylogenetic path analysis to test hypothesesregarding which behavioural, ecological and life history traits favour adaptation to urban environ-ments for different mammalian groups. Our results show that all urban mammals produce largerlitters; whereas other traits such as body size, behavioural plasticity and diet diversity were impor-tant for some but not all taxonomic groups. This variation highlights the idiosyncrasies of theurban adaptation process and likely reflects the diversity of ecological niches and roles mammalscan play. Our study contributes towards a better understanding of mammal association tohumans, which will ultimately allow the design of wildlife-friendly urban environments and con-tribute to mitigate human-wildlife conflicts.
    • Open Carboniferous Limestone pavement grike microclimates in Great Britain and Ireland: understanding the present to inform the future

      Burek, Cynthia; Hosie, Lottie; Geary, Matt; York, Peter, J. (University of ChesterUniversity of Chester, 2020-04)
      Limestone pavements are a distinctive and irreplaceable geodiversity feature, in which are found crevices known as grikes. These grikes provide a distinct microclimate conferring a more stable temperature, higher relative humidity, lower light intensity and lower air speed than can be found in the regional climate. This stability of microclimate has resulted in an equally distinctive community of flora and fauna, adapted to a forest floor but found in an often otherwise barren landscape. This thesis documents the long-term study of the properties of the limestone pavement grike in order to identify the extent to which the microclimate may sustain its distinctive biodiversity, to provide recommendations for future research which may lead to more effective management. Over a five-year study, recordings of temperature, relative humidity, light intensity and samples of invertebrate biodiversity were collected from five limestone pavements situated in the Yorkshire Dales and Cumbria in Great Britain, and The Burren in the Republic of Ireland. An extensive description of the grike microclimate was undertaken using the data collected to understand the extent of the microclimate stability of the grike and the conditions for variation in the grike microclimate. Further insights into the grike microclimate were gained through simulation techniques more commonly used in engineering, to explore the effects of air flowing over a grike, the light from the sun entering the grike and regression analysis to simulate the temperature within the grike in the present and projected for the future. This study has indicated that although the whole of the grike confers a degree of microclimatic stability, it is made up of a less stable upper zone and a more stable lower zone. The instability of the upper zone is hypothesised to result from the extent to which the majority of light and external air can enter the grike, whereas the stability of the lower zone may be governed by the thermal stability of the limestone surrounding it. Based on this zonation and the projections for the grike temperature, it is hypothesised that climate change will have the most substantial effects in the upper grike zone where species obligated to this area could be most heavily impacted. This study recommends a range of areas in which research may be employed so that the limestone pavement habitat may be successfully managed in Great Britain and the Republic of Ireland.
    • Orally administered beta-glucan attenuates the Th2 response in a model of airway hypersensitivity

      Burg, Ashley R.; Quigley, Laura; Jones, Adam V.; O'Connor, Geraldine M.; Boelte, Kimberly; McVicar, Daniel W.; Orr, Selinda J.; National Cancer Institute-Frederick; University of Alabama at Birmingham; University Dental Hospital, Cardiff and Vale University Health Board; University of Chester; Cardiff University School of Medicine (SpringerOpen, 2016-06-21)
      beta-Glucan is a polysaccharide that can be extracted from fungal cell walls. Wellmune WGP((R)), a preparation of beta-1,3/1,6-glucans, is a dietary supplement that has immunomodulating properties. Here we investigated the effect WGP had on a mouse model of asthma. OVA-induced asthma in mice is characterized by infiltration of eosinophils into the lung, production of Th2 cytokines and IgE. Daily oral administration of WGP (400 microg) significantly reduced the influx of eosinophils into the lungs of OVA-challenged mice compared to control mice. In addition, WGP inhibited pulmonary production of Th2 cytokines (IL-4, IL-5, IL-13), however serum IgE levels were unaffected by WGP treatment. These data indicate that WGP could potentially be useful as an oral supplement for some asthma patients, however, it would need to be combined with therapies that target other aspects of the disease such as IgE levels. As such, further studies that examine the potential of WGP in combination with other therapies should be explored.
    • The osteological use of diagnostic radiographs: Further material for osteoarchaeologists

      Lewis, Stephen J.; Chester College of Higher Education (1996)
      This article discusses the use of radiography in osteoarchaeology.
    • Osteoprotegerin is produced when prostaglandin synthesis is inhibited causing osteoclasts to detach from the surface of mouse parietal bone and attach to the endocranial membrane

      O’Brien, E. A.; Williams, John H. H.; Marshall, Michael J.; Charles Salt Centre, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry ; Chester College ; Charles Salt Centre, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry (Elsevier, 2001-02-13)
      This article tests the hypothesis that osteoprotegerin (OPG) mediates the inhibition of osteoclast activity that occurs with indomethacin in the mouse calvaria.
    • An overview of extra-curricular education for sustainable development (ESD) interventions in UK universities

      Lipscombe, Bryan P.; Burek, Cynthia V.; Potter, Jacqueline; Ribchester, Chris; Degg, Martin; University of Chester (Emerald, 2008-07-11)
      This article explores the extent and type of extra-curricular education for sustainable development-related practice in UK universities and to record opinions about the utility of such work, through a postal questionnaire survey of all UK universities was undertaken in 2006.
    • Patterns in island endemic forest-dependent bird research: the Caribbean as a case-study

      Devenish-Nelson, Eleanor S.; orcid: 0000-0002-9029-4772; email: ellie.devenish@ed.ac.uk; Weidemann, Douglas; Townsend, Jason; Nelson, Howard P. (Springer Netherlands, 2019-05-04)
      Abstract: Unequal patterns in research effort can result in inaccurate assessments of species extinction risk or ineffective management. A group of notable conservation concern are tropical island endemic birds, many of which are also forest-dependent, which increases their vulnerability to extinction. Yet, island bird species have received limited research attention compared to their continental congeners, despite this taxon being globally regarded as well-studied. We used the insular Caribbean, a globally important endemism hotspot with high rates of deforestation, to explore research bias of island and regional endemic forest-dependent birds. A review of the published literature (n = 992) found no significant increase in the number of studies over the search period. Research effort was significantly higher among species with threatened status, long generation time, wide habitat breadth and low to intermediate elevational distributions. Among family groups, the Psittacidae received the highest research effort, while the Cuculidae were the most underrepresented family (30-fold higher and six-fold less than expected, respectively). We found geographic biases in effort, with Jamaica having six-fold less and Puerto Rico eight times more research than expected for their level of endemism. These patterns likely reflect individual interests and limited capacity and funding, typical of Small Island Developing States. With over 50% of species in this review having declining population trends, we recommend prioritizing research that emphasises conservation- and management-relevant data across underrepresented families and islands, by fostering greater collaboration between researchers, practitioners and the existing local amateur ornithological community.
    • Patterns of behaviour, group structure and reproductive status predict levels of glucocorticoid metabolites in zoo-housed ring-tailed lemurs, Lemur catta.

      Smith, Tessa E.; McCusker, Cara; Stevens, Jeroen M. G.; Elwood, Robert W.; University of Chester; Queens University of Belfast; Centre for Research and Conservation, Royal Zoological Society of Antwerp, Belguim (Karger Publishing, 2016-01-30)
      In ring-tailed lemurs, Lemur catta, the factors modulating hypothalamic-pituitary-adrenal (HPA) activity differ between wild and semi-free-ranging populations. Here we assess factors modulating HPA activity in ring-tailed lemurs housed in a third environment: the zoo. First we validate an enzyme immunoassay to quantify levels of glucocorticoid (GC) metabolites in the faeces of L. catta. We determine the nature of the female-female dominance hierarchies within each group by computing David’s scores and examining these in relation to faecal GC (fGC). Relationships between female age and fGC are assessed to evaluate potential age-related confounds. The associations between fGC, numbers of males in a group and reproductive status are explored. Finally, we investigate the value of 7 behaviours in predicting levels of fGC. The study revealed stable linear dominance hierarchies in females within each group. The number of males in a social group together with reproductive status, but not age, influenced fGC. The 7 behavioural variables accounted for 68% of the variance in fGC. The amounts of time an animal spent locomoting and in the inside enclosure were both negative predictors of fGC. The study highlights the flexibility and adaptability of the HPA system in ring-tailed lemurs.
    • Pavement pleasures

      Burek, Cynthia V.; Deacon, Joanna; University College Chester (English Nature, 1998-06)
      This journal article discusses limestone pavements in north Wales.
    • A pelagic thresher shark (Alopias pelagicus) gives birth at a cleaning station in the Philippines

      Oliver, Simon P.; Bicskos Kaszo, Attila E.; University of Chester; The Thresher Shark Research and Conservation Project (Springer, 2014-12-23)
      This article discusses photographic evidence captured on April 4, 2013, as the first record of a thresher shark giving birth.
    • Pemphigus is associated with KIR3DL2 expression levels and provides evidence that KIR3DL2 may bind HLA-A3 and A11 in vivo.

      Augusto, Danillo G.; O'Connor, Geraldine M.; Lobo-Alves, Sara C.; Bass, Sara; Martin, Maureen P.; Carrington, Mary; McVicar, Daniel W.; Petzl-Erler, Maria L.; Departamento de Genética, Universidade Federal do Paraná, Curitiba, PR, Brazil; Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA; Leidos Biomedical Research, Cancer and Inflammation Program, Laboratory for Experimental Immunology, Frederick National Laboratory for Cancer Research, Frederick, MD, USA; Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA. (Wiley, 2015-05-06)
      Although HLA-A3 and A11 have been reported to be ligands for KIR3DL2, evidence for any in vivo relevance of this interaction is still missing. To explore the functional importance of KIR3DL2 allelic variation, we analyzed the autoimmune disease pemphigus foliaceus, previously associated (lower risk) with activating KIR genes. KIR3DL2*001 was increased in patients (odds ratio (OR) = 2.04; p = 0.007). The risk was higher for the presence of both KIR3DL2*001 and HLA-A3 or A11 (OR = 3.76, p = 0.013), providing the first evidence that HLA-A3 and A11 may interact with KIR3DL2 in vivo. The nonsynonymous single nucleotide polymorphism 1190T (rs3745902) was associated with protection (OR = 0.52, p = 0.018). This SNP results in a threonine-to-methionine substitution. Individuals who have methionine in this position exhibit a lower percentage of KIR3DL2-positive natural killer (NK) cells and also lower intensity of KIR3DL2 on expressing natural killer cells; additionally, we show that the expression of KIR3DL2 is independent of other killer cell immunoglobulin-like receptors. Pemphigus foliaceus is a very unique complex disease strongly associated with immune-related genes. It is the only autoimmune disease known to be endemic, showing a strong correlation with environmental factors. Our data demonstrate that this relatively unknown autoimmune disease may facilitate understanding of the molecular mechanisms of KIR3DL2 ligand recognition.
    • Peptide-Dependent Recognition of HLA-B*57:01 by KIR3DS1

      O'Connor, Geraldine M.; Vivian, Julian P.; Gostick, Emma; Pymm, Phillip; Lafont, Bernard A.; Price, David A.; Rossjohn, Jamie; Brooks, Andrew G.; McVicar, Daniel W.; Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, USA. Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia Australian Research Council Centre of Excellence for Advanced Molecular Imaging, Monash University, Clayton, Victoria, Australia. Institute of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, Wales, United Kingdom. Non-Human Primate Immunogenetics and Cellular Immunology Unit, Laboratory of Molecular Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA. Institute of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, Wales, United Kingdom Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA. Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia Australian Research Council Centre of Excellence for Advanced Molecular Imaging, Monash University, Clayton, Victoria, Australia Institute of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, Wales, United Kingdom. Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia. (American Society for Microbiology, 2015-04-21)
      Killer cell immunoglobulin-like receptors (KIRs) play an important role in the activation of natural killer (NK) cells, which in turn contribute to the effective immune control of many viral infections. In the context of HIV infection, the closely related KIR3DL1 and KIR3DS1 molecules, in particular, have been associated with disease outcome. Inhibitory signals via KIR3DL1 are disrupted by downregulation of HLA class I ligands on the infected cell surface and can also be impacted by changes in the presented peptide repertoire. In contrast, the activatory ligands for KIR3DS1 remain obscure. We used a structure-driven approach to define the characteristics of HLA class I-restricted peptides that interact with KIR3DL1 and KIR3DS1. In the case of HLAB*57:01, we used this knowledge to identify bona fide HIV-derived peptide epitopes with similar properties. Two such peptides facilitated productive interactions between HLA-B*57:01 and KIR3DS1. These data reveal the presence of KIR3DS1 ligands within the HIV-specific peptide repertoire presented by a protective HLA class I allotype, thereby enhancing our mechanistic understanding of the processes that enable NK cells to impact disease outcome.
    • Personality dimensions and their behavioral correlates in wild virunga mountain gorillas (Gorilla beringei beringei)

      Eckardt, Winnie; Steklis, Dieter H.; Steklis, Netzin G.; Fletcher, Alison W.; Stoinski, Tara S.; Weiss, Alexander; University of Chester & The Dian Fossey Gorilla Fund International ; University of Arizona ; University of Arizona ; University of Chester ; Zoo Atlanta & The Dian Fossey Gorilla Fund International ; University of Edinburgh & Scottish Primate Research Group. (Americal Psychological Association, 2014-12-22)
      Studies of animal personality improve our understanding of individual variation in measures of life-history and fitness, such as health and reproductive success. Using a 54 trait personality questionnaire developed for studying great apes and other nonhuman primates, we obtained ratings on 116 wild mountain gorillas (Gorilla beringei beringei) monitored by the Dian Fossey Gorilla Fund’s Karisoke Research Center in Rwanda. There were eight raters who each had more than 1.5 years of working experience with the subjects. Principal component analyses identified four personality dimensions with high inter-rater reliabilities --- Dominance, Openness, Sociability, and Proto-Agreeableness --- that reflected personality features unique to gorillas and personality features shared with other hominoids. We next examined the associations of these dimensions with independently collected behavioral measures derived from long-term records. Predicted correlations were found between the personality dimensions and corresponding behaviors. For example, Dominance, Openness, Sociability, and Proto-Agreeableness were related to gorilla dominance strength, time spent playing, rates of approaches and rates of interventions in intra-group conflicts, respectively. These findings enrich the comparative-evolutionary study of personality and provide insights into how species differences in personality are related to ecology, social systems, and life history.
    • Personality in the cockroach Diploptera punctata: Evidence for stability across developmental stages despite age effects on boldness

      Stanley, Christina R.; Mettke-Hofmann, Claudia; Preziosi, Richard F.; University of Chester; University of Manchester; Liverpool John Moores University; Manchester Metropolitan University (PLOS, 2017-05-10)
      Despite a recent surge in the popularity of animal personality studies and their wide-ranging associations with various aspects of behavioural ecology, our understanding of the development of personality over ontogeny remains poorly understood. Stability over time is a central tenet of personality; ecological pressures experienced by an individual at different life stages may, however, vary considerably, which may have a significant effect on behavioural traits. Invertebrates often go through numerous discrete developmental stages and therefore provide a useful model for such research. Here we test for both differential consistency and age effects upon behavioural traits in the gregarious cockroach Diploptera punctata by testing the same behavioural traits in both juveniles and adults. In our sample, we find consistency in boldness, exploration and sociality within adults whilst only boldness was consistent in juveniles. Both boldness and exploration measures, representative of risk-taking behaviour, show significant consistency across discrete juvenile and adult stages. Age effects are, however, apparent in our data; juveniles are significantly bolder than adults, most likely due to differences in the ecological requirements of these life stages. Size also affects risk-taking behaviour since smaller adults are both bolder and more highly explorative. Whilst a behavioural syndrome linking boldness and exploration is evident in nymphs, this disappears by the adult stage, where links between other behavioural traits become apparent. Our results therefore indicate that differential consistency in personality can be maintained across life stages despite age effects on its magnitude, with links between some personality traits changing over ontogeny, demonstrating plasticity in behavioural syndromes.
    • Physiological and behavioural measures of stress in domestic horses

      Young, Tamsin (University of Liverpool (Chester College of Higher Education), 2011-09)
      The welfare of domestic horses has been scrutinised by the scientific community in recent years. Traditional riding and stable management practices have been recognised to be at odds with the physical and behavioural adaptations of the horse. There is, therefore, a growing need to understand how modern horse management can impact on horse welfare. The first study in this thesis assessed the impact of common management practices on physiological stress in the horse. Faecal cortisol was higher in horses that were stabled and exercised, than turned out to grass with no exercise. The effect of exercise alone was also seen to increase levels of salivary cortisol. No change was seen in cortisol following short-term routine husbandry procedures such as exposure to the sound of electric coat clippers, but it was suggested that this required further investigation. The study confirmed exercise increased stress as reflected by cortisol concentration, and indicated that individual stabling may also contribute to elevated stress. The study recommended that horses may benefit from periods of rest and turn out to grass, to reduce stress levels and improve welfare. The measurement of stress for the purpose of welfare assessment is, however, best carried out using an integration of both physiological and behavioural measures. Behaviour scores offer non-invasive, quick and easy methods of assessing stress in domestic animals, but have typically been developed using only behavioural assessment of the stress response. In the second study a scale of behavioural indicators of stress was developed using behavioural and physiological measures for the purpose of assessing stress in stabled domestic horses. Principal component analysis of behavioural reactions and changes in salivary cortisol concentration in response to routine husbandry procedures, revealed three meaningful components that were used as the basis to the stress scale. Behavioural reactions to the husbandry procedures were further analysed by a panel of equestrian professionals using free choice profiling, and results were added to the appropriate components. The final scale comprised of four levels of stress (no stress, low, iii medium and high stress), and each category was further sub-divided into behaviour scores (BS). The scores represented accumulating levels of behavioural indicators of stress within each stress level, and provided indices of physiological stress. The scale offers an easy to use method of welfare assessment in horses, and reduces the need for additional physiological measures to be taken. The scale represented a novel approach to measuring stress, and was used in the final study to measure stress in horses stabled individually, group housed, and in horses moved from stabling to group housing. The effectiveness of the scale at measuring stress, was compared to the effectiveness of measures of heart rate variability (HRV) and faecal cortisol at measuring stress in the same horses. Lower levels of stress were recorded in group housed horses as measured by the BS, but measures of HRV and faecal cortisol showed no difference between those stabled or group housed. Stress levels were unaffected by the move to group housing, but BS declined significantly over the three weeks that the horses remained group housed. The physiological measures did not, however, reflect such a decrease in stress. Stress levels were also compared between horses housed in both environments whilst waiting to be fed. Group housed horses had lower stress levels as measured by the BS. Results provided by the BS were supported by relevant literature, and the scale appeared to be more sensitive than the physiological measures which did not yield significant results with the small sample sizes used in the study. The research confirmed short-term management practices horses are typically exposed to daily, can elevate their stress levels. Further research into which practices put horse welfare at a particular risk, and thus require modification or need to be avoided where possible, is necessary. The findings also suggest horse-owners may need to pay more attention to their horse’s stress levels, to avoid repeated or on-going stress that can jeopardise health and welfare. The scale of behavioural indicators of stress would provide a suitable method by which stress could be monitored and thus become a part of horse management.
    • Physiological stress in the Eurasian badger (Meles meles): Effects of host,

      George, Shelia C.; Smith, Tessa E.; Mac Cana, Pól S. S.; Coleman, Robert C.; Montgomery, William I.; Queens University of Belfast, UK; University of Chester, UK (Elsevier, 2014-03-04)
      A method for monitoring hypothalamic–pituitary–adrenal (HPA) responses of the Eurasian badger (Meles meles) to stressors was validated by measuring cortisol excretion in serum and faeces. Serum and faecal samples were collected under anaesthesia from live-captured, wild badgers and fresh faeces was collected from latrines at 15 social groups in County Down, Northern Ireland. Variation in levels of cortisol in wild badgers was investigated relative to disease status, season, age, sex, body mass, body condition and reproductive status and environmental factors that might influence stress. Faecal cortisol levels were significantly higher in animals testing culture-positive for Mycobacterium bovis. Prolonged elevation of cortisol can suppress immune function, which may have implications for disease transmission. There was a strong seasonal pattern in both serum cortisol, peaking in spring and faecal cortisol, peaking in summer. Cortisol levels were also higher in adults with poor body condition and low body mass. Faecal samples collected from latrines in grassland groups had significantly higher cortisol than those collected from woodland groups, possibly as a result of greater exposure to sources of environmental stress. This study is the first to investigate factors influencing physiological stress in badgers and indicates that serological and faecal excretion are valid indices of the HPA response to a range of stressors.
    • A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones

      Hughes, Stephen F.; Thomas-Wright, Samantha J.; Banwell, Joseph; Williams, Rachel; Moyes, Alyson J.; Mushtaq, Sohail; Abdulmajed, Mohamed; Shergill, Iqbal; University of Chester; BCUHB Wrexham Maelor Hospital (Public Library of Science, 2015-05-04)
      Purpose: The number of patients undergoing shock wave lithotripsy (SWL) in the UK for solitary unilateral kidney stones is increasing annually. The development of postoperative complications such as haematuria and sepsis following SWL is likely to increase. Comparing a range of biological markers with the aim of monitoring or predicting postoperative complications following SWL has not been extensively researched. The main purpose of this pilot-study was to test the hypothesis that SWL results in changes to haemostatic function. Subsequently, this pilot-study would form a sound basis to undertake future investigations involving larger cohorts. Methods: Twelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 male and 4 females) aged between 31–72 years (median—43 years), venous blood samples were collected pre-operatively (baseline), at 30, 120 and 240 minutes postoperatively. Specific haemostatic biomarkers [platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, von Willebrand Factor (vWF), sE-selectin and plasma viscosity (PV)] were measured. Results: Platelet counts and fibrinogen concentration were significantly decreased following SWL (p = 0.027 and p = 0.014 respectively), while D-dimer and vWF levels significantly increased following SWL (p = 0.019 and p = 0.001 respectively). PT, APTT, sE-selectin and PV parameters were not significantly changed following SWL (p>0.05). Conclusions: Changes to specific biomarkers such as plasma fibrinogen and vWF suggest that these represent a more clinically relevant assessment of the extent of haemostatic involvement following SWL. Analysis of such markers, in the future, may potentially provide valuable data on “normal” response after lithotripsy, and could be expanded to identify or predict those patients at risk of coagulopathy following SWL. The validation and reliability will be assessed through the assessment of larger cohorts.