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Shear-induced alignment of hexagonal boron nitride (h-BN) platelets offers a scalable route to high-performance, electrically insulating thermal management materials, yet the role of filler geometry under practical shear processing remains unclear. Here, we examine how platelet aspect ratio governs alignment and heat transport in PDMS/h-BN composites processed by sequential roll-gap controlled two-roll milling. Using a geometric moment-arm perspective, we relate the platelet effective radius to the shear-driven rotational driving moment. High-aspect-ratio platelets (L-BN) exhibit more stable flow-parallel alignment than small platelets (S-BN), forming a better-connected conductive network. At 175 wt% loading, the aligned L-BN composite achieves 10.3 W m⁻¹ K⁻¹ (94% higher than its random counterpart) and outperforms the S-BN system while also improving stiffness and device-relevant heat dissipation. These results identify aspect ratio as an alignment-enabling design criterion for scalable thermal management. Full article

(This article belongs to the Special Issue Inorganic Filler-Based Polymeric Composites for Enhanced Mechanical and Thermal Properties)

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23 pages, 27622 KB

Open AccessArticle

Beyond Vertical Accuracy: Benchmarking Global DEMs for Hydrologic Connectivity and Flood Sensitivity in Flat Coastal Plains

by Jose Miguel Fragozo Arevalo, Jairo R. Escobar Villanueva and Jhonny I. Pérez-Montiel

Hydrology 2026, 13(2), 74; https://doi.org/10.3390/hydrology13020074 (registering DOI) - 22 Feb 2026

Abstract

We assessed the vertical accuracy of six global digital elevation models—FABDEM (SRTM-enhanced), SRTM, ASTER GDEM, ALOS AW3D30, DeltaDTM and GEDTM—against a local photogrammetry-derived DEM as a benchmark in a flat coastal plain of the Colombian Caribbean. Using GNSS-RTK ground points and a high-accuracy reference DEM, we computed BIAS, RMSE, and MAE. Errors were analyzed by land cover class and along transverse profiles relative to the reference DEM. We also evaluated hydrologic suitability by comparing flow accumulation and drainage patterns derived from each model, treating the photogrammetry-derived model as the control and the global DEMs as treatments to gauge their ability to represent hydraulic/hydrologic behavior. DeltaDTM, GEDTM and FABDEM showed the best overall performance, with the lowest vertical error (particularly in non-urban areas with sparse vegetation) and the highest drainage agreement, along with their flood extent sensitivity to a 0.5 m water level rise, all of which were comparable to the benchmark. These results provide practical guidance for selecting and preprocessing topographic models for risk management and territorial planning in flat regions. Full article

(This article belongs to the Special Issue Hydrological Modeling and Sustainable Water Resources Management, 2nd Edition)

41 pages, 10740 KB

Open AccessArticle

Dynamic Multi-Relation Learning with Multi-Scale Hypergraph Transformer for Multi-Modal Traffic Forecasting

by Juan Chen and Meiqing Shan

Future Transp. 2026, 6(1), 51; https://doi.org/10.3390/futuretransp6010051 (registering DOI) - 22 Feb 2026

Abstract

Accurate multi-modal traffic demand forecasting is key to optimizing intelligent transportation systems (ITSs). To overcome the shortcomings of existing methods in capturing dynamic high-order correlations between heterogeneous spatial units and decoupling intra- and inter-mode dependencies at multiple time scales, this paper proposes a Dynamic Multi-Relation Learning with Multi-Scale Hypergraph Transformer method (MST-Hype Trans). The model integrates three novel modules. Firstly, the Multi-Scale Temporal Hypergraph Convolutional Network (MSTHCN) achieves collaborative decoupling and captures periodic and cross-modal temporal interactions of transportation demand at multiple granularities, such as time, day, and week, by constructing a multi-scale temporal hypergraph. Secondly, the Dynamic Multi-Relationship Spatial Hypergraph Network (DMRSHN) innovatively integrates geographic proximity, passenger flow similarity, and transportation connectivity to construct structural hyperedges and combines KNN and K-means algorithms to generate dynamic hyperedges, thereby accurately modeling the high-order spatial correlations of dynamic evolution between heterogeneous nodes. Finally, the Conditional Meta Attention Gated Fusion Network (CMAGFN), as a lightweight meta network, introduces a gate control mechanism based on multi-head cross-attention. It can dynamically generate node features based on real-time traffic context and adaptively calibrate the fusion weights of multi-source information, achieving optimal prediction decisions for scene perception. Experiments on three real-world datasets (NYC-Taxi, -Bike, and -Subway) demonstrate that MST-Hyper Trans achieves an average reduction of 7.6% in RMSE and 9.2% in MAE across all modes compared to the strongest baseline, while maintaining interpretability of spatiotemporal interactions. This study not only provides good model interpretability but also offers a reliable solution for multi-modal traffic collaborative management. Full article

(This article belongs to the Special Issue Recent Advances in Artificial Intelligence and Big Data for Intelligent Transportation Systems)

23 pages, 11516 KB

Open AccessArticle

Symmetry-Constrained Multi-Camera Tracking for Aircraft Preflight Inspection via Spatio-Temporal Graph Optimization

by Wanli Dang, Jian Cheng, Jiang Wang, Huaiyu Zheng, Qian Luo, Chao Wang and Ping Zhang

Symmetry 2026, 18(2), 387; https://doi.org/10.3390/sym18020387 (registering DOI) - 22 Feb 2026

Abstract

Automated verification of preflight aircraft inspection—a critical safety procedure—is addressed by integrating multi-camera tracking with procedural knowledge through a symmetry-aware spatio-temporal graph model. Departing from conventional tracking paradigms, the framework encodes operational protocols and structural symmetries of the aircraft as explicit constraints for trajectory association. Semantically consistent inspection zones are derived from geometric symmetry, and reliable tracklets extracted within them are connected using rules that enforce temporal order and identity consistency. Verification is formulated as a constrained shortest-path search over this graph, ensuring sequential and complete coverage of all mandatory zones by a single inspector. Evaluated on real-world airport surveillance data across diverse conditions, the proposed approach achieves a Complete Inspection Success Rate of 86.5%, significantly outperforming state-of-the-art tracking and re-identification baselines. The results demonstrate that explicit procedural integration substantially enhances the reliability and interpretability of automated compliance verification in safety-critical industrial monitoring. Full article

(This article belongs to the Special Issue Computer Vision, Robotics, and Automation Engineering)

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11 pages, 1206 KB

Open AccessArticle

Morphological and Biochemical Abnormalities of Gracilis Muscle from Children with Cerebral Palsy

by Vadim Evreinov, Maksim Stogov, Elena Kireeva, Galina Filimonova, Tatyana Zhirova, Margarita Alisa Popkova and Dmitry Popkov

J. Funct. Morphol. Kinesiol. 2026, 11(1), 90; https://doi.org/10.3390/jfmk11010090 (registering DOI) - 22 Feb 2026

Abstract

Background: Developing an evidence base for physiotherapy programs for patients with Cerebral Palsy (CP) requires an understanding of the microscopic and metabolic processes in striated muscle. The gracilis muscle represents a logical object of study due to the significant morphological changes in individuals with cerebral palsy. This research aims to study morphological and biochemical alterations in the gracilis muscle depending on the severity of motor impairments in CP patients. Methods: The cross-sectional study included 24 patients stratified by the severity of motor impairment. Intraoperative gracilis muscle samples were obtained during tenomyotomies. Nutritional status of patients, morphometric, and biochemical parameters were evaluated. Results: Initial body mass and Quetelet index (p = 0.02) were lower in GMFCS V patients (p = 0.01) compared to GMFCS IV and GMFCS II-III. Muscle tissue predominated in histological samples of GMFCS II-III and GMFCS V patients (p = 0.79), while connective tissue content was higher in the GMFCS IV group (p = 0.03). Strong, fast-twitch, anaerobic fibers (p = 0.761) with reduced creatine phosphokinase activity (p = 0.012) were more frequently observed in the intraoperative samples of GMFCS V patients. Low creatine phosphokinase activity was revealed in children in the GMFCS V group (p = 0.012). Conclusions: The structural and metabolic abnormalities observed in gracilis muscle of patients with spastic cerebral palsy indicates profound functional muscular dysfunction, representing one of the factors limiting children’s motor ability. The morphological and biochemical alterations in the striated muscle of CP children correlate with severity of motor dysfunction conditioned by the primary upper motor neuron disorders. Less significant changes in muscles in ambulatory children reflect favorable basis for physical therapy. Full article

(This article belongs to the Section Functional Anatomy and Musculoskeletal System)

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30 pages, 11141 KB

Open AccessArticle

Mapping Spatial Synergies and Trade-Offs: A Geographically Weighted Analysis of Ecosystem Services and Carbon Sequestration in Southern Italy

by Federica Isola, Bilge Kobak, Sabrina Lai, Francesca Leccis, Federica Leone and Corrado Zoppi

Sustainability 2026, 18(4), 2146; https://doi.org/10.3390/su18042146 (registering DOI) - 22 Feb 2026

Abstract

The transition towards climate neutrality requires the development of spatially explicit planning approaches that account for territorial differences and land-use dynamics. Within this conceptual framework, this study has the objective of identifying and discussing spatially explicit planning approaches that can support the transition to climate neutrality in different regional spatial contexts. With reference to this research question, a methodological framework is introduced and applied that is designed to support climate neutrality through spatial planning strategies. Carbon sequestration (CS) serves as a key metric to evaluate both the current state and the temporal evolution of this process, examined in connection with the provision of specific ecosystem services (ESs) within the relevant spatial setting. The work is structured as follows. An approach is developed to define the provision of ESs. Drawing on previous research and detailed assessments of environmental, landscape, and socio-cultural features, the study considers the following ESs: maintaining or improving habitat quality to sustain the life cycles of wild species valuable to humans; regulating climate by mitigating land surface temperature; agricultural and forestry production; and nature-based recreational opportunities. Moreover, spatial relationships between CS capacity and ES provision are examined through geographically weighted regressions, allowing comparisons across Basilicata, Campania, and Sardinia, three Regions in southern Italy forming the Italian Mezzogiorno. The multifunctional characteristics of ES supply contributes to optimizing CS capacity and advancing climate neutrality goals. In particular, in all three regional contexts, high values of CS capacity elasticity are recognized in relation to habitat quality and ground temperature mitigation, and very low elasticity conditions as regards the supply of recreational ESs and agricultural and forestry production. Full article

(This article belongs to the Special Issue Ecosystem Services in the Planning and Sustainable Development of Urban Green Spaces)

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20 pages, 6380 KB

Open AccessArticle

Quantitative Evaluation of Displacement Fields in a Tailings Dam Physical Model Under Elevated Pore Water Pressure Using Digital Image Processing

by Abraham Armah, Mehrdad Razavi, Richard Otoo, Benjamin Abankwa and Sandra Donkor

Mining 2026, 6(1), 17; https://doi.org/10.3390/mining6010017 (registering DOI) - 22 Feb 2026

Abstract

The mining industry still faces major environmental and socioeconomic problems as a result of tailings dam failures, which highlights the urgent need for improved monitoring and early-warning systems. This research offers practical recommendations for improved monitoring and safer design practices, in addition to investigating the use of digital image processing (DIP) as a non-invasive technique for tracking slope deformation in tailings dam models subjected to incremental pore water pressure increases. To replicate real-world conditions as closely as possible, a scaled laboratory embankment was built using coarse and fine tailings. During controlled pore-pressure loading, more than 500 high-resolution photos were taken, recording the entire deformation sequence from initial displacement to slope failure. The images were processed using Mathematica to generate pixel-by-pixel displacement fields and vector plots, providing a detailed visualization of deformation mechanisms. The findings demonstrated that DIP accurately detects and measures surface displacement, revealing the mechanisms, direction, and intensity of deformation. This study illustrates the extensive potential of DIP for real-time monitoring by directly connecting slope instability triggered by incremental pore water pressure with visual indications of slope deformation. While the results confirm the strong potential of DIP for deformation monitoring with a minimum detectable displacement of approximately 1.0 mm under controlled laboratory conditions, its field application may be affected by scale effects, variable lighting, and environmental occlusion. The mining industry benefits greatly from the insights gained through in-depth image analysis, which promotes safer tailings dam design and management. Overall, DIP can provide a reliable, scalable foundation for real-time deformation monitoring in operational tailings dams, where continuous image-based measurements can help identify early signs of instability and support proactive risk management. Full article

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29 pages, 1532 KB

Open AccessArticle

ANFIS-Based Controller and Associated Cybersecurity Issues with Hybrid Energy Storage Used in EV-Connected Microgrid System

by Md Nahin Islam and Mohd. Hasan Ali

Energies 2026, 19(4), 1103; https://doi.org/10.3390/en19041103 (registering DOI) - 22 Feb 2026

Abstract

The increasing integration of electric vehicles (EVs) and renewable energy sources has accelerated the adoption of DC microgrids, where maintaining voltage stability and effective power sharing remains a critical challenge. Hybrid energy storage systems (HESS), combining batteries and supercapacitors, are commonly employed to address dynamic power variations. However, conventional proportional–integral (PI)-based control strategies for HESS can exhibit performance limitations under nonlinear and varying operating conditions. To overcome this drawback, this paper presents an adaptive neuro-fuzzy inference system (ANFIS)-based control strategy for HESS located in a DC microgrid, with comparative evaluation against both conventional PI and traditional Fuzzy Logic controller (FLC) schemes. The proposed approach is evaluated using a detailed MATLAB/Simulink R2024a model of a DC microgrid including EVs. Simulation results show that, under normal operating conditions, the ANFIS-based control demonstrates improved transient response, reduced voltage fluctuations, and effective coordination between the battery and supercapacitor during renewable power variations, compared to PI and FLC-controlled systems. In addition to nominal performance assessment, this work investigates the vulnerability of the ANFIS controller to cyber-attacks. Two representative attack scenarios, false data injection (FDI) and denial-of-service (DoS), are applied to critical measurement and control signals of HESS. Simulation results reveal that, although the DC-bus voltage regulation is largely maintained during attack intervals, cyber manipulation significantly disrupts the intended HESS power-sharing behavior. Full article

(This article belongs to the Special Issue Algorithmic Approaches and Control Techniques for Energy Optimization in Power Converters and Grid Transmission)

72 pages, 3368 KB

Open AccessReview

A Review of Control Solutions for Vehicle Platooning via Network Synchronisation Methods

by Omar Hanif, Patrick Gruber, Aldo Sorniotti and Umberto Montanaro

Automation 2026, 7(1), 35; https://doi.org/10.3390/automation7010035 (registering DOI) - 22 Feb 2026

Abstract

Vehicle platooning is a cooperative driving scenario in which a set of consecutive, connected and autonomous vehicles travel at the same speed while controlling their inter-vehicular distance. Organising traffic in platoons of vehicles can mitigate issues in road transport by improving safety, energy efficiency, and road usage. Vehicle platooning scenarios are enabled by communication across the fleet, allowing the design of distributed controllers to impose cooperative vehicle motion. In contrast to initial control strategies tailored for specific network topologies, the last decade has witnessed a substantial increase in vehicle platooning control solutions that treat the cooperative platoon motion as the synchronisation of a network of dynamic systems, thereby enabling their use across a wider range of topologies. Despite numerous publications in recent years, the literature lacks a comprehensive survey of network synchronisation methods for vehicle platooning. To fill this gap, this paper aims to review network synchronisation strategies proposed for controlling the longitudinal motion of vehicle platoons over the period 2013–2025, with particular focus on contributions from 2018 onwards. The literature on network-synchronisation-based vehicle platooning methods is reviewed within a four-component framework. Then, the most widely used families of distributed consensus controllers are analysed, and the ways in which heterogeneity, nonlinearities, delays, packet drops, external disturbances, and cyber attacks are accounted for and mitigated are examined, along with different types of closed-loop stability. The review also surveys approaches from the literature for validating and assessing synchronisation algorithms in vehicle platoons, covering both experimental and simulation studies, as well as the related simulation platforms. The review paper concludes by presenting research trends and gaps, as well as potential future directions. Full article

19 pages, 799 KB

Open AccessArticle

The Energetic Aspect of the Formation of Molecular Hydrogen During Gamma Irradiation of Liquid Cyclohexane

by Igor Y. Shchapin and Andrey I. Nekhaev

Hydrogen 2026, 7(1), 29; https://doi.org/10.3390/hydrogen7010029 (registering DOI) - 22 Feb 2026

Abstract

Molecular hydrogen, the basis of hydrogen energy, is formed in many physical and chemical processes, including the absorption of gamma-ray energy by liquid cyclohexane. From the point of view of energy consumption, the stages of gamma radiolytic formation of molecular hydrogen have not been quantified. By means of a new energy method, we analyzed the amounts of released molecular hydrogen during gamma irradiation of liquid cyclohexane in the absence and presence of small additives of bicyclic mono- and dienes RH (initial concentrations of C₀(RH) ≈ 5 × 10⁻³ M/L), depending on the first ionization potentials of the components of solutions determined in the gas phase. Using the new energy method, four primary intermediates—radical anion, electronically excited molecule, radical cation, and superexcited molecule—of liquid cyclohexane gamma radiolysis were identified. Energy, mechanistic, and spin relationships and connections between these four cyclohexane intermediates were established. The experimental value of the adiabatic electron affinity of the cyclohexane molecule is −2.01 eV. The energy of formation of the superexcited cyclohexane molecule is 18 eV (gas phase). Using the energy method, it is shown that an increase in C₀(RH) concentrations from 5 × 10⁻³ to 0.1 M/L leads to a change in the mechanism of RH consumption. Instead of RH activation, as a result of the single electron transfer reaction, RH polymerization begins, which is initiated by cyclohexyl radicals. Full article

(This article belongs to the Special Issue Advances in Hydrogen Production, Storage, and Utilization (2nd Edition))

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17 pages, 2032 KB

Open AccessArticle

Coordinated Inertia Synthesis and Stability Design for PV Systems Utilizing DC-Link Capacitors

by Qi Hua, Lunbo Deng, Qiao Peng and Yongheng Yang

Energies 2026, 19(4), 1100; https://doi.org/10.3390/en19041100 (registering DOI) - 22 Feb 2026

Abstract

The increasing penetration of inverter-based resources (IBRs) has been reducing system inertia and intensifying frequency stability challenges. Hence, various grid demands have been imposed on grid-connected systems, e.g., requiring the provision of an auxiliary service to the grid. In this context, this paper investigates the provision of synthesized inertia from the DC-link capacitors in grid-connected photovoltaic (PV) systems. For this configuration, the PV converter adopts a frequency–voltage droop control (FVDC) strategy, while a virtual synchronous generator (VSG) is employed on the grid side to emulate a synchronous generator, to enable the DC-link energy to contribute to primary frequency support. To quantify the virtual inertia and evaluate the closed-loop stability, a small-signal model of the inverter system is established. An eigenvalue analysis reveals that while increasing the DC-link voltage or capacitance enhances the achievable virtual inertia, it simultaneously narrows the stability margin. As such, comparative stability assessments under different parameter settings are performed, highlighting the distinct impacts of the DC-link voltages and capacitances on the emulated inertia and stability margins. The study provides insights into the maximum virtual inertia achievable via DC-link capacitors and offers practical guidelines for coordinating the controller and DC-link design to enhance frequency robustness in low-inertia power systems. Real-time hardware-in-the-loop (RT-HIL) tests validate the analytical findings. Full article

(This article belongs to the Special Issue Renewable and Sustainable Energy in Light of Energy Transition Processes—3rd Edition)

24 pages, 1286 KB

Open AccessReview

Periodontitis-Induced Immune Reprogramming: Implications for Cancer Immunotherapy Response

by Claudia Florina Bogdan-Andreescu, Ștefan-Dimitrie Albu, Dan Alexandru Slăvescu, Lucia Bubulac, Viorica Tudor, Oana Botoacă, Andreea-Mariana Bănățeanu, Emin Cadar and Cristina-Crenguţa Albu

Biomedicines 2026, 14(2), 480; https://doi.org/10.3390/biomedicines14020480 (registering DOI) - 22 Feb 2026

Abstract

Background: Chronic periodontitis is a prevalent inflammatory disease. It goes beyond the oral cavity, exerting systemic immunomodulatory effects through continuous low-grade inflammation, microbial dysbiosis, and cytokine spillover. Accumulating evidence suggests that the immunological consequences of periodontitis may influence systemic immune homeostasis and alter responses to cancer immunotherapies, specifically checkpoint blockade. Objectives: This narrative review describes how periodontal inflammation induces systemic immune reprogramming. It also investigates possible effects on the efficacy of immunotherapy. Methods: The paper synthesizes current findings on molecular and cellular mechanisms linking periodontitis to immune dysfunction. It underscores the mutual signaling pathways NF-κB, STAT3, and PD-1/PD-L1 that connect oral and systemic immunity. Results: Chronic periodontal inflammation reprograms innate and adaptive immune responses. It elevates proinflammatory mediators, such as IL-1β, IL-6, and TNF-α. It alters T-cell polarization and promotes myeloid cell “training”. This process may lead to immune exhaustion, impaired antigen presentation, and treatment resistance. Preclinical and new clinical data suggest that controlling periodontal inflammation may partially reduce systemic inflammatory burden, although clinical evidence in immunotherapy-treated cancer cohorts remains limited. Conclusions: Periodontal health should be considered in the management of immunotherapy. This can facilitate new studies that integrate oral and systemic immunology. Understanding the two-way link between periodontal inflammation and systemic immune reprogramming may offer fresh opportunities for personalized immunomodulation and combined interventions. Full article

(This article belongs to the Collection Feature Papers in Immunology and Immunotherapy)

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22 pages, 3040 KB

Open AccessArticle

Prefabricated Co-Working Spaces’ Window Design: Emotional Salience Scale-Based Optimisation

by Antonio Ciervo, Massimiliano Masullo, Luigi Maffei, Roxana Adina Toma, Maria Dolores Morelli and Michelangelo Scorpio

Buildings 2026, 16(4), 875; https://doi.org/10.3390/buildings16040875 (registering DOI) - 22 Feb 2026

Abstract

Windows are key elements of the building’s system; they connect workers with the outdoor environment, influence daylight penetration, sound insulation, and thermal exchanges of façades, but they also moderate the workers’ well-being and productivity. This research investigates how the window-to-wall ratio, as well as the position and orientation of mullions, in movable offices affect the combination of workers’ perceptual and emotional responses. A smart co-working prefabricated movable office was modelled in virtual reality to include dynamic visual elements and acoustic stimuli. Experiments were performed in a laboratory under controlled thermal conditions involving 32 volunteers. The Igroup Presence and Emotional Salience Questionnaires were used to collect subjective responses. ANOVA analysis and post hoc test with the Bonferroni correction were used for data elaboration. Results revealed that window design affects emotional salience. High window-to-wall ratio and no mullions achieved the highest scores. Increasing the number of mullions, particularly when they obstruct key visual elements, reduced the positive emotional salience rating. Horizontal mullions diminish the outdoors’ spatial perception, interrupting visual continuity and restricting users’ capacity to recognise variations in the views. Finally, the results suggest some valuable insights and suggestions that can help designers improve window design and people’s well-being and satisfaction. Full article

(This article belongs to the Section Building Energy, Physics, Environment, and Systems)

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25 pages, 4437 KB

Open AccessArticle

Coordinated Control of Unmanned Ground Vehicle and Unmanned Aerial Vehicle Under Line-of-Sight Maintenance Constraint

by Xiyue Wen, Bo Hou, Yao Chen, Danyang Wang and Zhiliang Fan

Drones 2026, 10(2), 151; https://doi.org/10.3390/drones10020151 (registering DOI) - 22 Feb 2026

Abstract

Cooperative operations in which a UAV advances ahead of a UGV to conduct forward reconnaissance are critical in disaster relief and urban inspection missions. Prevalent air–ground coordination methods operate under the assumption of ideal communication or treat connectivity as a secondary objective. However, obstacle occlusion, such as high-rise buildings in urban areas and mountainous terrain, results in Non-Line-of-Sight (NLOS) conditions, disrupting communication between the two platforms. To address these challenges, this paper introduces a cooperative control framework based on dynamically varying modulation matrices for both the UAV and the UGV. By evaluating and mapping occlusion risks in real time, the cooperative motions of the UAV and UGV are adaptively adjusted to maintain Line-of-Sight (LOS). An LOS assessment function is designed and mapped to the eigenvalues of the modulation matrices, enabling smooth and adaptive coordination under changing environmental conditions while avoiding the limitations of traditional discrete mode-switching strategies. Theoretical analysis and simulation results confirm that the proposed approach not only ensures stable LOS connectivity but also enhances trajectory smoothness, adaptability, and computational efficiency. Full article

(This article belongs to the Topic Advanced Technologies and Applications for Unmanned Systems)

25 pages, 637 KB

Open AccessArticle

Constructing Wholeness in LGBTQ+ Healthcare Access: A Grounded Theory Model

by Braveheart Gillani, Jessamyn Moxie, Meagan Ray-Novak, Roni Diamant-Wilson, Dana M. Prince, Laura J. Mintz and Scott Emory Moore

Healthcare 2026, 14(4), 536; https://doi.org/10.3390/healthcare14040536 (registering DOI) - 22 Feb 2026

Abstract

LGBTQ+ individuals continue to experience substantial barriers to accessing affirming healthcare, including discrimination, structural inequities, and provider-level limitations. This study aimed to develop an emergent grounded theory model of constructing wholeness in healthcare. Methods: This study employed a secondary constructivist grounded theory analysis of qualitative data from The Rainbow Connections Study, a community-based system dynamics project. Data were collected through eight group model-building sessions conducted via Zoom with 28 LGBTQ+ participants, including older adults, youth, transgender and gender-diverse individuals, and staff from the LGBTQ+ community center who also held service and practitioner roles; analytic claims are framed to reflect this mixed-role sample. Sessions were audio- and video-recorded, transcribed verbatim, and analyzed using open, axial, and selective coding procedures. Constant comparative methods, reflexive memoing, and member checking were used to support analytic rigor and trustworthiness. Results: Analysis revealed a dynamic process in which LGBTQ+ individuals encounter external forces within healthcare systems that alternately support or fragment their sense of self. In response, participants engaged in four interconnected internal processes—interconnecting selves, intra-community support, self-determined care, and meaning-finding—that facilitated movement toward wholeness. These processes were non-linear, iterative, and present across diverse identities and life stages. Conclusions: The emergent theory of Constructing Wholeness in Connecting to Healthcare highlights that LGBTQ+ healthcare experiences extend beyond access and utilization to include identity integration, community reliance, and meaning making. Supporting LGBTQ+ health requires healthcare approaches that affirm wholeness, reduce structural harm, and recognize the central role of community in navigating care. Full article

(This article belongs to the Special Issue Gender, Sexuality and Mental Health)

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