Search Results (2,299)

Snow is an essential meteorological variable and an indicator of the changing climate. Its variations, particularly in snow depth and snow water equivalent, result mainly from changes in winter precipitation and air temperature. Recently, these conditions have been thoroughly investigated worldwide, revealing a general prevailing decline in precipitation and increasing tendencies in air temperatures. However, no systematic or up-to-date studies for Bulgaria exist. The main goal of the current project is to fill this national knowledge gap in the snow conditions in our mountains. For that purpose, we used 31 stations with altitudes ranging from 527 to 2925 m a.s.l. for the period between 1961 and 2020, covering two significant reference climatic periods. We extracted data about snow cover maximums, mean air temperatures, and precipitation amounts for the whole winter season in mountainous regions from October to April; however, we mainly present the results for the three winter months: December, January, and February. Most of the stations do not demonstrate any significant trends for snow depth maximums, except for the three lower stations in central west Bulgaria, which show significant increases. On the opposite end of the scale, two of the highest stations demonstrated notable decreases. The time series for the precipitation amounts are also predominantly indefinite. Significant decreasing trends can be found at the highest three alpine stations. The change in the mean seasonal air temperature is predominantly positive—17 of the stations show positive trends, and for 12, the increases are significant. The altitude of the strongest seasonal temperature rise lies between 1000 and 1700 m. Finally, due to the obvious nonlinearity of some of the time series, we decided to check for change points and a nonlinear approach to fit the data. This analysis demonstrates general changes in the investigated characteristics from the beginning of the 1970s to the middle of the 1980s. Full article

Background/Objectives: Cultural backgrounds can shape dietary beliefs, food preferences, and attitudes toward health interventions. However, limited research has explored adherence or behavioral responses following a dietary intervention in women from culturally and linguistically diverse (CALD) backgrounds. This secondary analysis of a randomized controlled feasibility trial in women with gestational diabetes (GDM) explored differences in adherence, satisfaction, and behavior change between CALD and White (non-CALD) women. Methods: Thirty-eight participants were randomized to the dietary intervention (individualized, culturally tailored dietary advice) or standard care. Data collected at baseline (26–32 weeks’ gestation) and end of study (close to delivery) included a behavior change questionnaire, a 10-point Likert scale for adherence and satisfaction with the intervention, and 24-h dietary recall. Results: Eighteen participants self-reported as CALD and 20 self-reported as non-CALD. All intervention group participants, irrespective of cultural background, were motivated to make dietary changes, with similar mean [95% CI] adherence scores (CALD: 8.10 [7.27, 8.94] vs. non-CALD: 7.58 [6.66, 8.51]), and satisfaction scores to the intervention (CALD: 7.85 [6.96, 8.74] vs. non-CALD 6.88 [5.89, 7.86]). Within the intervention or standard care groups there were no differences in dietary intake between CALD and non-CALD participants. Conclusions: A low-intensity individualized dietary intervention for GDM was similarly acceptable and feasible for our small group of CALD and non-CALD participants. Findings support the potential for broadly applicable dietary strategies in antenatal care but also highlight the need for more culturally nuanced research to ensure inclusive interventions. Full article

Background: Optimizing training load and recovery is crucial for achieving peak performance in competitive wrestling, a sport characterized by high physical, technical, and psychological demands. Methods: This study compared the effects of two different training programs—one emphasizing high-intensity interval training (HIIT) sessions and the other based on traditional volume-oriented training—on both competitive performance and autonomic regulation measured by heart rate variability (HRV). A total of 24 elite wrestlers were divided into two equal groups, each following a different weekly training regimen over a 3-month period. HRV was recorded using a wearable 3-channel ECG Holter before training, immediately after training, and during recovery phases (up to 2 h post-exercise). HRV parameters were analyzed to assess training-induced stress and recovery status. Competitive performance was evaluated using official national championship scores and ranking positions. Results: Both training programs improved competitive performance, the HIIT-based regimen induced greater short-term suppression of parasympathetic activity (RMSSD: −32% vs. −14%; HF power: −40% vs. −18%) and increased sympathetic dominance (LF/HF: +56% vs. +22%) after training. Wrestlers in the HIIT group achieved a mean competition score of 17.92 ± 4.50 points, compared to 15.08 ± 6.26 points in the volume-oriented group. These acute autonomic shifts may provide a higher readiness for intense and explosive actions, which is advantageous in short and dynamic matches. In contrast, the volume-oriented program induced smaller acute autonomic changes but showed a slower recovery to baseline. Conclusions: These findings suggest that HRV-derived measures can serve as sensitive indicators of training load tolerance, recovery capacity, and stress susceptibility in combat sports athletes. This study highlights the value of integrating HRV monitoring into the periodization of combat training to individualize the load, prevent overtraining, and optimize performance outcomes. Full article

Norway spruce (Picea abies (L.) Karst.) is experiencing large-scale decline across Central Europe, with climate warming and bark beetle (Ips typographus L.) outbreaks as primary drivers. In lowland Białowieża Forest, Poland, spruce occupies a range of habitats that differ in their suitability for long-term persistence. We hypothesized that climate change accelerates spruce decline by reducing resilience in suboptimal habitats and increasing susceptibility to bark beetle outbreaks, with long-term persistence limited to optimal hydrological sites. To address this, we analysed spruce share from 1902–2018, its distribution across suitable versus unsuitable habitats, and long-term climate records in relation to outbreaks. Historical maps, forest site classifications, and meteorological data were used to calculate hydro-climatic indices (HTC, SPEI-12, Selyaninov), and outbreak relationships were tested using Welch’s t-test and point-biserial correlation, including lag effects. Spruce share increased from 12% in 1902 to 27% in 2015 and then declined to 9% by 2018. In 2015, 75% of spruce-dominated stands occurred in unsuitable habitats. Bark beetle outbreaks were significantly associated with drought, with outbreak years showing lower precipitation (–121 mm), reduced Selyaninov k (mean 1.40 vs. 1.61), and more negative SPEI-12 values (–0.48 vs. 0.07) compared to non-outbreak years (p < 0.05). One-year lag analysis indicated drought as both a predisposing and triggering factor. These findings highlight the interaction of habitat suitability and drought as a key driver of spruce decline, supporting adaptive management strategies that retain spruce in optimal habitats while converting suboptimal stands to more drought-tolerant species. Full article

Background and Objectives: To analyze changes in risk factors for refractive errors among Korean adolescents before and after the COVID-19 pandemic and examine the impact of lifestyle modifications on myopia development, Methods: this cross-sectional study utilized nationally representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) VII (2016) and VIII (2021). We analyzed 691 adolescents aged 10–18 years from 2016 (pre-COVID-19) and 490 from 2021 (post-COVID-19). Refractive errors were categorized as hyperopia (≥+0.50 D), emmetropia (−0.50 to +0.50 D), myopia (−6.00 to −0.50 D), and high myopia (≤−6.00 D). Complex sample linear regression analyses identified factors associated with spherical equivalent (SE) refractive errors. Results: At the population level, overall myopia prevalence declined from 84.2% in 2016 to 77.4% in 2021, whereas the prevalence of high myopia increased from 10.0% to 11.5% (p = 0.047). This indicates that although the absolute proportion of adolescents with myopia decreased, the relative contribution of high myopia to the overall myopia burden within this population increased. Mean SE was −2.77 ± 0.11 D in (−10.63~+3.00 D/median: −2.00 D) 2016 and −2.63 ± 0.13 D (−14.00~+1.63/median: −1.75 D) in 2021 (p = 0.443). Age-related myopia progression accelerated post-pandemic (−0.193 D to −0.324 D per year in univariate regression and −0.185 D to −0.312 D, in multivariate regression analysis, p < 0.001). In both the 3 h and ≥4 h near work groups, statistically significant associations were observed at both time points, but a greater myopic shift was evident after COVID-19 (B = –0.853 and –0.757 in 2016; B = –1.311 and –1.167 in 2021, p < 0.05). Conclusions: The COVID-19 pandemic altered myopia risk factors among Korean adolescents. High myopia prevalence increased despite overall myopia with underweight status and environmental factors such as digital device time and urban living identified as important considerations for post-pandemic myopia prevention. Full article

Sustainable aviation fuel (SAF) is a drop-in alternative to conventional jet fuels, designed to reduce greenhouse gas (GHG) emissions while requiring minimal infrastructure changes and certification under the American Society for Testing and Materials (ASTM) D7566 standard. This study assesses recently identified high-energy-density (HED) strained polycycloalkanes as SAF candidates. Strain energy (E_se) was calculated using density functional theory (DFT), while operational properties such as boiling point (BP) and flash point (FP) were predicted using support vector regression (SVR) models. The models demonstrated strong predictive performance (R² > 0.96) with mean absolute errors of 6.92 K for BP and 9.58 K for FP, with robustness sensitivity analysis. It is found that approximately 65% of these studied polycycloalkanes fall within the Jet A fuel property boundaries. The polycycloalkanes (C₉–C₁₅) with strain energies below approximately 60 kcal/mol achieve an balance between energy density and ignition safety, aligning with the specifications of Jet A. The majority of structures were dominated by five-membered rings, with a few three- or four-membered rings enhancing favorable trade-offs among BP, FP, and HED. This early pre-screening indicates that moderately strained polycycloalkanes are safe, energy-dense candidates for next-generation sustainable jet fuels and provide a framework for designing high-performance SAFs. Full article

This research explores a phase-shift-based discontinuous PWM method used for 24 V battery-powered onboard micro inverters, which are critical for thermally limited applications like micromachines, where efficient heat dissipation and compact size are paramount. Discontinuous pulse width modulation (DPWM) reduces switching losses by clamping the phase voltage to the DC bus in order to improve inverter efficiency. Due to the change in power factor at different operating points from motors or the inductor load, the use of only one DPWM method cannot achieve the optimal efficiency of a three-phase voltage source inverter (3ph-VSI). This paper proposes a generalized DPWM method with a continuously adjustable phase shift angle, which extends the six traditional DPWM methods to any type. According to different power factors, the proposed DPWM method is divided into five power factor angle intervals, namely [−90°, −60°], [−60°, −30°], [−30°, 30°], [30°, 60°], and [60°, 90°], and automatically adjusts the phase shift angle to the optimal-efficiency DPWM mode. The power factor is calculated by means of the Synchronous Reference Frame Phase-Locked Loop (SRF-PLL) method. The switching losses and harmonic characteristics of the proposed DPWM are analyzed, and finally, a 24 V onboard 3ph-VSI experimental platform is built. The experimental results show that the efficiency of DPWM methods can be improved by 3–6% and the switching loss can be reduced by 40–50% under different power factors. At the same time, the dynamic performance of the proposed algorithm with a transition state is verified. This method is particularly suitable for miniaturized inverters where efficiency and thermal management are critical. Full article

Wind turbines face significant operational challenges due to their complex electromechanical systems, exposure to harsh environmental conditions, and high maintenance costs. Reliable structural health monitoring and condition monitoring are therefore essential for early fault detection, minimizing downtime, and optimizing maintenance strategies. Traditional approaches typically rely on either Trend Monitoring (TM) or Change Point Detection (CPD). TM methods track the long-term behaviour of process parameters, using statistical analysis or machine learning (ML) to identify abnormal patterns that may indicate emerging faults. In contrast, CPD techniques focus on detecting abrupt changes in time-series data, identifying shifts in mean, variance, or distribution, and providing accurate fault onset detection. While each approach has strengths, they also face limitations: TM effectively identifies fault type but lacks precision in timing, while CPD excels at locating fault occurrence but lacks detailed fault classification. This review critically examines the integration of TM and CPD methods for wind turbine diagnostics, highlighting their complementary strengths and weaknesses through an analysis of widely used TM techniques (e.g., Fast Fourier Transform, Wavelet Transform, Hilbert–Huang Transform, Empirical Mode Decomposition) and CPD methods (e.g., Bayesian Online Change Point Detection, Kullback–Leibler Divergence, Cumulative Sum). By combining both approaches, diagnostic accuracy can be enhanced, leveraging TM’s detailed fault characterization with CPD’s precise fault timing. The effectiveness of this synthesis is demonstrated in a case study on wind turbine blade fault diagnosis. Results shows that TM–CPD integration enhances early detection through coupling vibration and frequency trend analysis with robust statistical validation of fault onset. Full article

Neopterin is a well-characterized marker of cell-mediated immunity. Here, we used neopterin as a biomarker to identify the cellular immunity status of breeding giant pandas throughout gestation. Urine samples were collected from captive adult female giant pandas that had entered estrus and were either naturally bred and/or artificially inseminated (AI) during the breeding seasons at the Chengdu Research Base of Giant Panda Breeding. This study was divided into two parts. In the first part, we examined the urinary neopterin and progesterone (Pg) profiles during pregnancy in parturient and nonparturient individuals. From the day of mating to the Pg peak, there was no correlation between neopterin and Pg in both parturient individuals (n = 3) and nonparturient individuals (n = 3). During the period when the Pg dropped from its peak to approximately 100 ng/mg Cr, the changes in neopterin and Pg showed a negative correlation in parturient individuals, while there was no correlation between the changes in neopterin and Pg in nonparturient individuals. Subsequently, urine samples were categorized into four phases based on the reproductive status of giant pandas: (1) Estrus phase (Es); (2) Primary Pg increase phase (S1), during which Pg levels rise from the day of mating to 100 ng/mg Cr; (3) Secondary Pg increase phase (S2), during which Pg levels rise from 100 ng/mg Cr (inclusive) to their peak value; and (4) Post-peak Pg decline phase (S3), during which Pg levels decrease from their peak (inclusive) until they drop to approximately 200 ng/mg Cr. Analysis revealed that differences between parturient and nonparturient females emerged in the S3 phase. Compared to nonparturient individuals, neopterin concentrations showed sustained elevation in parturient pandas during the S3 phase. The second part of the study, building on the findings of the first part, specifically focused on analyzing the urine samples of giant pandas during the S2 and S3 phases. Statistical analysis of an expanded sample of individuals (including those from the first part) revealed a significant difference in the neopterin mean S3/S2 ratio between the parturient group (mean S3/S2 = 1.71 ± 0.12; n = 14) and the nonparturient group (mean S3/S2 = 0.85 ± 0.04; n = 17). Correspondingly, parturient individuals gave birth 5 to 16 days after the end of the S3 phase (this time corresponds to the point when Pg levels decrease to approximately 200 ng/mg Cr). The results revealed the validity and applicability of using the neopterin mean S3/S2 ratio (1.71 ± 0.12) for diagnosing successful pregnancy in mated female giant pandas. Full article

Introduction: Alpha-1 antitrypsin deficiency (AATD) is a genetic condition caused by SERPINA1 variants with variable severity. Current international guidelines do not recommend augmentation therapy for intermediate AATD; nevertheless, some patients show clinically severe phenotypes in real-world practice. We aimed to evaluate, in an exploratory manner, the potential effects of augmentation therapy on exacerbations, quality of life, and lung function in this subgroup. Methods: In this multicenter retrospective study, we included 27 heterozygous patients with intermediate AATD (serum AAT 50–110 mg/dL), Chronic Obstructive Pulmonary Disease (COPD), and/or emphysema. Clinical phenotypes included emphysema-predominant disease, COPD with frequent exacerbations, and overlap with bronchiectasis/asthma; HRCT patterns were recorded. We assessed the annual number of exacerbations (moderate: steroids/antibiotics; severe: hospitalization/including pneumothorax), St. George’s Respiratory Questionnaire (SGRQ), and lung function before and after 12 months of therapy. Results: Augmentation therapy was associated with a reduction in annual exacerbations from a median (IQR) of 2 (1.5–3) to 1 (0–1) (p < 0.0001) and an improvement in SGRQ total score (58.89 ± 16.83 to 48.34 ± 21.20; p = 0.0039). The mean SGRQ change exceeded the 4-point MCID for COPD. No significant changes were observed in spirometry or Diffusing Capacity of the Lung for Carbon Monoxide (DLCO). Conclusions: These exploratory findings suggest that augmentation therapy may reduce exacerbations and improve quality of life in selected patients with intermediate AATD and COPD/emphysema. Given the retrospective design, small sample, and lack of a control group, the results should be interpreted as hypothesis-generating and warrant confirmation in prospective studies. Full article

Background: Assessments of functional capacity require considerable time and space and are thus generally not suitable for home-based assessments. Reproducibility measures from tests evaluating functional capacity suitable for home-based assessment are warranted. The aim of this study was to investigate the intra- and inter-rater reproducibility of home-based assessments of the one-minute sit-to-stand test (1MSTS), handgrip strength (HGS), and short physical performance battery (SPPB) in patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Methods: Fifty patients were recruited from an ongoing RCT study prior to the start of the intervention. All patients performed two 1MSTS attempts with 30 min intervals, three HGS attempts, and one SPPB attempt. The procedure was repeated after 7–10 days by a blinded assessor. Results: Fifty patients (29 females; mean (SD): age 71.3 (±7.7) years, FEV1% predicted 37.4 (±14.1), and COPD assessment test score 19.4 (±6.5) were assessed. The 1MSTS intra-rater reliability (intraclass correlation coefficient; ICC_1.1) was 0.95 (lower limit 95% CI: 0.91) and classified as excellent; agreement (standard error of measurement, SEM) was 1.7 repetitions. The inter-rater reliability ICC_1.1 for 1MSTS was 0.91 (lower limit 95% CI: 0.84) and SEM 2.5 repetitions; for HGS it was ICC_1.1 of 0.84 (lower limit 95% CI: 0.74) and SEM 4.2 kg; for SPPB it was ICC_1.1 of 0.86 (lower limit 95% CI: 0.77) and SEM 0.9 points, respectively. Conclusions: The reproducibility of home-based assessment with 1MSTS, HGS, and SPPB in patients with moderate to very severe COPD showed good to excellent intra- and inter-rater reliability and acceptable agreement below the established minimal important change. These findings support the utility and feasibility of these tests as reliable outcome measures in clinical practice and their applicability in home-based settings enabling functional assessments of patients with transportation challenges and mobility limitations. Full article

Background: As we age, our autonomic function declines, resulting in altered autonomic balance during postural transitions. These changes can affect the dynamic interplay between sympathetic and parasympathetic modulation, compromising short-term compensatory responses to active standing. Objectives: This study aimed to compare heart rate variability (HRV) at baseline, cardiac parasympathetic modulation (CPM), and cardiac baroreflex gain (CRG) between younger adults (YA) and older adults (OA) following active standing orthostatic stress. A secondary objective was to analyze the incidence of orthostatic intolerance (OI) symptoms. Methods: Participants (n = 76) completed sit-to-stand and lie-to-stand maneuvers with continuous beat-to-beat blood pressure and heart rate (HR, electrocardiogram). HRV at baseline was analyzed in both time and frequency domains. CPM was measured by the HR 30:15 ratio on standing. CBG was determined as the ratio of HR and SBP changes (ΔHR/ΔSBP) at specific phase time points (30 s, 60 s, 180 s, and 420 s). Results: At baseline, OA showed reduced Standard Deviation of RR intervals (SDRR), Root Mean Square of Successive Differences (RMSSD), low-frequency (LF), and high-frequency (HF) power, and elevated LF/HF ratio (all p < 0.05), indicating a shift toward sympathetic dominance. During active standing orthostatic stress, OA demonstrated a lower HR30:15 ratio and CBG in later phases (phases 2–4) (all p < 0.05). Also, OA reported more symptoms (14%) of OI than YA (0%) (p = 0.041). Conclusions: These findings indicate that older adults have impaired autonomic function characterized by reduced HRV, CPM and CBG responses. These impairments lead to diminished autonomic regulation under active-standing orthostatic stress and a higher incidence of OI symptoms. Full article

Background: Despite the widespread use of antibiotics, acute mastoiditis (AM) and related complications resulting from acute purulent otitis media continue to occur, predominantly in children. Although numerous studies have focused on the pathogenesis, aetiological agents, and treatment of AM, comprehensive investigations of the long-term outcomes of AM and the physiological consequences of surgical intervention in the temporal bone are lacking. Methods: Thirty patients who had undergone mastoidectomy for acute mastoiditis at a median age of 2.12 years were invited for evaluation at least five years postoperatively. The assessment included the Chronic Otitis Media Questionnaire 12, clinical examination with otomicroscopy, extended high-frequency pure-tone audiometry, distortion product otoacoustic emissions, middle ear impedance testing, and a newly developed protocol for noninvasive mastoid function measurement. Results were compared with a control group of 30 ears and with a group of 30 ears treated solely with tympanostomy for acute otitis media at risk of mastoiditis. Results: Although mean Chronic Otitis Media Questionnaire 12 scores were below 1 point, patients who had undergone mastoidectomy reported slightly greater difficulties with hearing in both quiet and noisy environments, along with an increased perception of tinnitus and unpleasant sensations around the ear. Otomicroscopy revealed minor structural changes in the test groups, which were absent from the control group. Pure-tone audiometry demonstrated approximately 10 dB higher thresholds at high and extended high frequencies, with similar findings observed in the distortion product otoacoustic emissions. Middle ear impedance testing indicated elevated stapedius reflex thresholds in the mastoidectomy group, while other parameters showed no statistically significant differences. Mastoid function testing demonstrated preserved pressure-buffering capacity but reduced thermal insulation of the vestibular organ under extreme thermal stimulation—an occurrence rarely encountered in daily life. Conclusions: In the long term, most patients recovering from acute mastoiditis exhibit only minor functional and structural sequelae, and the impact of mastoidectomy appears negligible compared with less invasive surgical interventions. Full article

The economic and strategic value of high-latitude maritime regions is increasingly significant, yet traditional Global Navigation Satellite Systems remain constrained by unfavorable geometric configurations and slow convergence speeds at high latitudes, failing to meet the growing demand for real-time centimeter-level high-precision positioning in these areas. Benefiting from their rapid motion and superior coverage over high-latitude zones, Low Earth Orbit (LEO) satellites offer an effective means to enhance positioning performance in such regions. This paper uses the real BDS data collected by an unmanned surface vessel in the high-latitude waters of the Southern Hemisphere, jointly simulates polar and medium-inclination LEO constellations, and systematically assess the enhancement effects of LEO augmentation on Precise Point Positioning (PPP) and Real-Time Kinematic (RTK) techniques. The results demonstrate that the polar-orbiting constellation markedly improves the observation environment, increasing the number of visible satellites by 70.2% and reducing the Position Dilution of Precision from 2.4 to 1.7, whereas the medium-inclination orbit constellation offered negligible improvement due to insufficient visibility. The rapid geometric change brought by LEO constellations is the core key to achieving fast convergence. Incorporating LEO observations drastically shortened the BDS PPP convergence time from 45.3 min to under 1 min, achieving a reduction of over 97%. Simultaneously, it improved the three-dimensional Root Mean Square accuracy by 54.7%, from 0.086 m to 0.039 m. Convergence within one minute was consistently achieved when at least 5.4 LEO satellites were included in the solution. Moreover, the addition of LEO signals increased the fixed solution rate of short-baseline RTK from 96.5% to 100%, while improving horizontal and vertical accuracy by 31.5% and 12.3%, respectively. This study confirms that LEO constellations, especially those in polar orbits, can substantially enhance BDS precise positioning performance in high-latitude maritime environments, thereby providing critical technical support for related navigation applications. Full article

Background/Objectives: Bulking agents such as Bulkamid^® are well-established surgical options for the treatment of stress urinary incontinence (SUI). Pelvic floor sonographic imaging is readily accessible and may assist in identifying patients who are more likely to benefit from bulking therapies. Urethral mobility appears to significantly influence treatment outcomes and can be classified into hypo-, normo-, and hypermobility. The primary aim of this study was to evaluate the impact of sonographic urethral mobility on the success rate of Bulkamid^® injections. The secondary objective was to assess differences between pre- and postoperative urinary incontinence scores. Methods: In women with SUI, linear dorsocaudal movement (LDM) of the urethra was measured sonographically. The International Consultation on Incontinence Modular Questionnaire—Urinary Incontinence Short Form (ICIQ-UI SF) was completed prior to Bulkamid^® injection. Patients were categorized into hypo-, normo-, and hypermobility groups based on their LDM measurements. Results: A total of 130 patients participated, with 101 undergoing both pre- and postoperative sonographic assessment. The difference in LDM before and after treatment was calculated. Patients with normomobile urethras (n = 79) exhibited the greatest mean improvement in continence scores, with LDM changes ranging from 6 to 24 mm and an average ICIQ-UI SF score reduction of 3.8 points. Patients with hypomobile (n = 16) or hypermobile urethras (n = 6) also demonstrated improvements, but to a lesser extent than the normomobile group. Conclusions: This study indicates that patients with a normomobile urethra experience the most significant improvement in continence outcomes following Bulkamid^® injection. Urethral mobility assessment via sonography may serve as a valuable preoperative tool and appears to play a crucial role in predicting treatment success with bulking agents. Full article