Abstract: Background: Endotracheal intubation is a painful and stressful procedure for neonates, often triggering adverse physiological responses. In 2010, the American Academy of Pediatrics (AAP) recommended premedication for elective intubation in neonates to reduce pain and stress and to increase the chances of success. In recent years, several drugs have emerged as a treatment option to improve comfort and safety of neonates undergoing endotracheal intubation. Worldwide, a range of agents are used. As remifentanil is a short-acting analgesic with sedative effects, it may be a suitable option. Therefore, we evaluated the available evidence regarding benefits and side effects for this drug. Methods: In this narrative review, we describe the benefits and risks of remifentanil as drug of choice for neonatal intubation. Results: Literature search demonstrates a relatively limited number of randomized trials, indicating that current practice is informed by a combination of small clinical trials, observational studies, and pharmacological research. Owing to its unique pharmacokinetic profile, remifentanil is an effective agent in the neonatal population allowing the provision of intense analgesia with a rapid recovery profile and has a good clinical applicability in situations where early extubation of patients is desired following the end of the opioid infusion. Reported side effects include respiratory depression, apnea, bradycardia, and chest wall rigidity, similar to other opioids. Chest wall rigidity appears to be strongly influenced by dosing strategies and the speed of intravenous administration. Conclusions: Remifentanil's unique properties make it a promising option for neonatal intubation. However vigilance and close monitoring is required. Further research is warranted to compare remifentanil with other opioids that have a near similar pharmacological profile (e.g., fentanyl analogues).

Abstract: An anti-contamination agent (Zn/Al–ATMP–LDH) has been synthesized by intercalation and used to correct the abnormal thickening and related operational risks caused by contact contamination between drilling fluids and cement slurries during high-temperature/high-pressure cementing. Experimental results have shown that the agent is chemically stable and exhibits good compatibility with conventional spacer-fluid additives. When compared with the direct addition of amino tris(methylenephosphonic acid) (ATMP), confining ATMP within a layered double hydroxide (LDH) markedly mitigates the retarding effect. At a dosage exceeding 0.3 wt%, the compressive strength of cement stone increases from 0 to 32.84 MPa following curing at 90 °C for 1 day, and continues to develop steadily after 7 days. Following conditioning at 187 °C, 145 MPa and 120 min, the spacer system formulated using the proposed agent as the core component serves to enhance the rheology of the mixed slurry via synergistic adsorption-regulation-dispersion stabilization-controlled release. The mixed slurry maintains stable rheological properties before and after aging with no uncontrolled thickening. When mixing the cement slurry and drilling fluid at a 7:3 volume ratio, the slurry consistency exceeds 60 Bc within 1 h, failing to meet operational requirements. In contrast, the mixed slurry containing the anti-contamination spacer (cement slurry:drilling fluid:spacer = 7:2:1) exhibits a thickening time greater than 300 min, and has been successfully applied in field cementing operations in a well in the Gaomo area.

Abstract: Protein Phosphatase 5 (PP5) is an evolutionarily conserved serine/threonine phosphatase with a unique tetratricopeptide domain. It has been implicated in a wide range of cellular processes in mammals, but its function in plants is unknown. Here we uncovered that Arabidopsis PP5 is required for immunity mediated by the nucleotide-binding leucine-rich repeat immune receptor protein SUMM2. Loss-of-function mutations in PP5 suppress the autoimmune phenotypes caused by the activation of SUMM2 due to the disruption of the MEKK1-MKK1/MKK2-MPK4 kinase cascade. Further biochemical analysis revealed that SUMM2 interacts with Heat Shock Protein 90 and PP5, and SUMM2 level is reduced in pp5 knockout mutant plants, suggesting that PP5 functions as a co-chaperone to regulate the accumulation of SUMM2.

Abstract: Although athlete monitoring can quantify training exposure and athlete status with increasing detail, conversion into daily training decisions remains inconsistent. This structured narrative review synthesizes evidence on training load, neuromuscular readiness, recovery, fatigue interpretation, measurement reliability, applied decision-making, and proposes the LOAD-R framework: a systems model linking Load, Organism response, Adaptive state, Decision, and Re-evaluation. A transparent non-PRISMA strategy was used because the aim was conceptual integration and framework development rather than effect-size pooling. Evidence was organized around field-applicable monitoring domains and their decision value. LOAD-R extends existing approaches by moving beyond single indicators, fixed thresholds, and dashboard alerts. It classifies athlete state into adaptive, functional-overload, underloaded, uncertain, or maladaptive zones, each linked to progress, maintain, modify, deload, or recover decisions. The framework also provides implementation levels and testable predictions. By shifting monitoring from passive data collection toward adaptive decision support, LOAD-R offers a scalable model that may improve decision consistency, reduce maladaptive training responses, and enhance the practical value of athlete monitoring in applied sport settings.

Abstract: Background: Influenza vaccination uptake among healthcare professionals remains subop-timal despite their key role in influencing public vaccination behavior. This study investi-gated motivational and behavioral determinants of influenza vaccination uptake and ad-vocacy among primary healthcare professionals in Greece. Methods: A cross-sectional study was conducted among 304 physicians and pharmacists using an anonymous online questionnaire. Vaccination uptake (2023–2024 season and annual) and motivational and advocacy constructs were assessed using the validated MoVac-flu and MovAd scales. Factor structure was evaluated using confirmatory and ex-ploratory factor analyses. Multivariable logistic regression models were applied to identify predictors of vaccination uptake. Results: The study sample consisted of 304 healthcare professionals of whom 61.2% were physicians and 38.8% were pharmacists. Most of the participants were female (52.6%) and aged 41-60 years (57.6%). Influenza vaccination uptake was 77.6% for the 2023–2024 sea-son and 75.3% for annual vaccination. A two- and a four-factor structure was found for the MoVac-flu (F1: Vax Self-Care, F2: Vax Awareness) and MoVAd (F1: Vax Communica-tion, F2: Vax Influence, F3: Vax Confidence, F4: Vax Choice) scales, respectively. Both scales demonstrated high internal consistency (Cronbach’s alpha coefficient > 0.87). Mo-tivation toward influenza vaccination and vaccination advocacy were high among the participants. Vaccinated participants had higher motivation and advocacy scores than non-vaccinated ones. In multivariable analyses, higher scores on Vax Self-Care (aOR = 3.22, 95% CI: 2.08-4.96, p < 0.001) and Vax Communication (aOR = 1.64, 95% CI: 1.14-2.34, p = 0.007) subscales, demonstrating enhanced motivation and advocacy, respectively, as well as male sex (aOR = 2.35, 95% CI: 1.14-4.83, p = 0.020) were associated with higher odds of annual vaccination. Higher scores on the Vax Self-Care subscale (aOR = 3.66, 95% CI: 2.33-5.77, p < 0.001) were also found to be associated with higher odds of 2023–2024 vaccination uptake, as well as living with vulnerable individuals (aOR = 2.95, 95% CI: 1.18-7.38, p = 0.020) Conclusions: Influenza vaccination uptake among primary healthcare professionals in Greece was relatively high; however, it was strongly driven by intrinsic motivational fac-tors, particularly the perceived personal and public health benefits of vaccination. Com-munication-related competencies also independently contributed to vaccination behavior, highlighting the link between professional practice and personal uptake. In contrast, con-textual factors, such as cohabitation with vulnerable individuals, appeared to exert a more situational and less consistent influence. These findings suggest that interventions focus-ing on strengthening intrinsic motivation and communication skills may lead to more sustained improvements in both vaccination uptake and advocacy among healthcare professionals.

Abstract: The transition toward a circular economy (CE) in the plastic recycling sector requires integrated management frameworks that align technical performance with organizational governance. This study proposes an exploratory diagnostic framework for formalized recycling SMEs, integrating Latent Dirichlet Allocation (LDA) and Random Forest (RF) algorithms. Given the specialized nature of the sector, a purposive sample of 16 ‘pioneer’ SMEs in Bogotá was analyzed. Data were standardized through a 5-point ordinal scale, and the Spearman rank correlation analysis (ρ≥0.85) revealed high internal consistency and structural synchronization. This high correlation reflects the operational homogeneity of the analyzed vanguard rather than a universal statistical generalization. The findings suggest that for these leading firms, circularity is driven by social impact, collaborative networks, and systemic process reengineering. The proposed framework serves as a methodological blueprint for analytical generalization, providing an adaptable diagnostic tool that can be iteratively refined as the sector matures and data availability increases.

Abstract: Background and Objectives: Emerging clinical data indicate that glucose levels in women with type 1 diabetes (T1D) fluctuate throughout the menstrual cycle. However, data concerning the adolescent population remain sparse. This study aimed to compare continuous glucose monitoring (CGM)-derived glycemic metrics between the early follicular and late luteal phases in adolescent girls with T1D in order to establish a clinical basis for phase-specific treatment adjustments. Materials and Methods: Ninety-nine menstrual cycles from 34 female adolescents with T1D were retrospectively analyzed. Time in range (TIR), time above range (TAR), time below range (TBR), mean glucose, and glucose variability were compared between the early follicular and late luteal phases. Additional analyses were performed to evaluate the impact of different insulin delivery methods and to assess glycemic metrics across subgroups by glycemic control. Results: During the late luteal phase, TIR was significantly lower, while TAR and mean glucose were significantly higher compared to the early follicular phase (p < 0.05). Although the continuous subcutaneous insulin infusion (CSII) group achieved better overall glycemic metrics then the multiple daily injections (MDI) group, phase-related fluctuations in TIR and TAR reached significance precisely within the CSII group. Furthermore, glycemic shifts in TAR, TBR and mean glucose were especially pronounced in adolescents with tight glycemic control (HbA1c < 7.0%). Conclusions: The late luteal phase is associated with significant glycemic deterioration in adolescent girls with T1D, particularly in those with optimal glycemic control. These findings underscore the need for targeted education and menstrual-cycle-tailored insulin dose adjustments.

Abstract: Livestock production systems in East Africa depend heavily on forage resources, yet productivity and quality of available forages vary widely across agroecological zones. This study evaluated the influence of soil type and altitude on biomass production, biomass allocation, and forage quality of three improved tropical forage grasses—Massai (Megathyrsus maximus), Mestizo (a Urochloa hybrid blend), and Talisman (Urochloa hybrid)—across five experimental sites in Tanzania and Kenya. Field trials were established using a randomized complete block design with three replicates per site. Measurements included cumulative dry matter yield, root: shoot ratio, and nutritive yield expressed as metabolizable energy and crude protein per hectare. Root: shoot ratios varied significantly among species, soil types, and altitudes, with higher ratios observed in Mestizo and Talisman, clay-loam soils, and high-altitude sites. Biomass production was highest in sandy-loam soil and mid-altitude environments. Massai consistently produced the highest cumulative dry matter yield across locations. Significant genotype × environment interactions influenced both productivity and nutritive yield. Metabolizable energy and crude protein yields varied considerably among sites, emphasizing the importance of site-specific forage selection to maximize biomass production and nutritional value in East African livestock systems.

Abstract: Sugar sorghum has emerged as a highly promising crop for bioethanol production owing to its high biomass yield potential and its remarkable capacity to accumulate fermentable sugars in the stalks. The aim of this study was to evaluate the productivity, sugar accumulation capacity, and bioethanol potential of 12 sugar sorghum accessions under the conditions of Northern Kazakhstan. Field experiments were carried out over the 2024-2025 growing seasons, during which key agronomic and technological traits were assessed, including green biomass yield, juice yield, total soluble solids (Brix), sugar concentration, and theoretical ethanol yield. The analysis of variance revealed that biomass yield was predominantly driven by weather conditions (p < 0.001), whereas sugar concentration was significantly influenced by genotype (p < 0.05). Several genotypes, namely Volonter, Kapital, Sevilya, Flagman, Chayka, and Sauri, consistently exhibited high sugar productivity and bioethanol potential across years, confirming considerable genetic variability in these traits. Storage of stem juice resulted in sugar losses of up to 30.7%, indicating the necessity for rapid processing of raw biomass after harvest. Under laboratory fermentation conditions, juice from the Sevilya genotype (17.9 Brix) achieved a sugar-to-ethanol conversion efficiency of 74.3% relative to the theoretical yield. Overall, the findings confirm the suitability of sugar sorghum for bioethanol production and highlight its strong potential as an energy crop under the arid agroclimatic conditions of Northern Kazakhstan.

Abstract: Traditional discriminative recommenders score and rank items indexed by single item IDs, whereas Semantic ID-based generative recommendation formulates recommendation as conditional generation of Semantic ID token sequences. This shift offers a unified view of retrieval and ranking and shows promising scaling properties, but the literature is fragmented across tokenization and quantization choices, model backbones, and training and decoding protocols, making systematic comparison difficult. To address this, we present the first survey that organizes the field, with four pivotal contributions. First, we introduce a unified five-stage reference pipeline: Representation Layer, Tokenization, Generative Backbone, Training, and Inference. This pipeline standardizes terminology and exposes shared structure. Second, grounded in this pipeline, we map existing methods into a fine-grained typology along semantic granularity, architectural coupling, and learning objectives. Third, based on this structured view, we provide a scaling-oriented perspective that connects component-level decisions to expressiveness, efficiency, and empirical performance, clarifying trade-offs. Finally, we synthesize open challenges and concrete directions that follow from the identified bottlenecks. To support reproducibility and controlled ablations across stages, we release UniGenRec (https://github.com/hupeiyu21/UniGenRec-A-universal-generative-recommendation-toolbox), an open-source modular toolbox implementing the proposed pipeline.

Abstract: This paper examines how the body of research and innovation on electric cooking for low and middle income countries has evolved to the extent that electric cooking is now influencing energy system performance. Methods: The paper synthesises recent evidence from pilots, market developments, and system-level analysis across Africa and Asia, focusing on demand patterns, utility economics, carbon finance mechanisms, and emerging digital and financing models. Results: Electric cooking is increasingly acting as a system-strengthening demand, rather than a system stressor. Two reinforcing mechanisms are identified: (i) an electricity revenue loop, in which increased consumption improves utility and mini-grid viability and supports further investment; and (ii) a carbon finance loop, enabled by metered methodologies and measurable emissions reductions, which can improve household affordability and accelerate adoption. The analysis also highlights the importance of diversified demand (household, commercial, and institutional), which improves load factors and aligns demand with generation. However, a persistent planning blind spot remains, with cooking demand largely excluded from energy models. Conclusions: Electric cooking is moving from proof of concept toward system integration, but scale is constrained by affordability, reliability, tariff design, fuel stacking, institutional fragmentation, and carbon market uncertainty. The findings suggest that electric cooking should be treated as a core component of energy system design, requiring coordinated policy, planning, and financing to realise its full potential.

Abstract: This study investigated the feasibility of using blood feather transcriptomics to detect sex-differences and gene response to physiological changes in chickens. The identification of molecular markers associated with metabolism in poultry typically requires invasive sampling of tissues, such as liver. Feathers represent a promising non-invasive biological source of RNA: the quill pulp of growing feathers contains living cells capable of active transcription. Growing feathers were collected from 150-day-old male and female chickens (Bionda Piemontese, slow-growing breed) raised under a free-range system and fed two finishing diets differing in lipid content: low-lipid (LL, ether extract 3.6%) and high-lipid (HL, ether extract 9.3%). RNA was extracted from quill pulp and subjected to whole RNA-Seq analy-sis. Differential gene expression and functional enrichment analyses were performed us-ing the RaNA-Seq platform. A total of 17,360 transcripts were detected and used for downstream analyses. Across all individuals, three genes associated with ether lipid metabolism (PLA2G10, PLA2G4F, and ENPP6) were consistently upregulated in chickens fed the HL diet. Sex-specific responses were also observed. In roosters, HL feeding significantly affected genes involved in lipid transport and metabolic regulation within the PPAR signaling pathway, including APOA1 and SLC27A4. In contrast, hens showed differential expression primarily in pathways related to apelin signaling, extracellular matrix remodeling, and cardiovascular function rather than classical lipid metabolism pathways. These findings demonstrate differential responses to dietary treatments between males and females and reveal metabolic differences, confirming the need for sex-specific anal-yses in this local breed. In conclusion, feather RNA-Seq successfully captured diet-induced molecular responses and revealed sex-specific metabolic adaptations to dietary lipid levels. This study demon-strates that quill pulp represents a practical and ethically favorable alternative to tradi-tional tissue sampling and may support future nutrigenomic and genetic improvement studies. The findings support the development of non-invasive biomarkers applicable to genetic selection and precision nutrition, ultimately supporting more sustainable poultry production.

Abstract: Cancer initiation is commonly interpreted through mutation-centered models in which tumor development results from the progressive accumulation of genetic alterations. Although this framework remains essential, it does not fully account for the long latency of many cancers, the persistence of cellular phenotypes after removal of environmental stressors, or the stable epigenetic changes associated with chronic metabolic and inflammatory disease. This article proposes a testable theoretical framework termed Temporal Genomic Memory. The model suggests that prolonged biological exposures, including chronic inflammation, metabolic stress, oxidative injury, immune dysregulation, and environmental pressure, may be progressively encoded within epigenetic and RNA-mediated regulatory systems. These signals may be compressed into relatively stable molecular information signatures that shape future transcriptional responses. Under triggering conditions such as aging, immune decline, renewed inflammation, or metabolic imbalance, these stored regulatory states may be reactivated through molecular recall mechanisms, thereby altering cellular behavior and increasing susceptibility to oncogenic transformation. A simplified mathematical representation is introduced to describe biological signal accumulation, regulatory compression, and recall activation over time. The hypothesis does not replace somatic mutation theory; rather, it adds a complementary temporal-regulatory layer linking metabolic history, epigenetic memory, mitochondrial signaling, and cancer initiation. A practical experimental strategy is proposed to examine whether prolonged metabolic stress can generate persistent epigenetic and transcriptional signatures after stress withdrawal.

Abstract: The ability of cells to translate optical radiation into biochemical signals, i.e., optotransduction, plays an important role in emerging therapeutic strategies, with a relevant influence on inflammation. However, a systemic understanding of the molecular pathways underlying the transduction of these physical stimuli is still lacking. In this work, we present a molecular map of optotransduction reconstructed from the literature and provide its representation as pathway, using the standard Systems Biology Markup Language. This representation enables network-based analyses and allows us to investigate the differential effect of stimuli wavelengths and overlap with other forms of physical transduction, namely mechanotransduction.

Abstract: Student safety during daily school transportation remains a major concern, particularly in systems that rely mainly on GPS tracking and manual supervision. Existing approaches often lack proactive safety mechanisms for monitoring both student attendance and driver condition in real time. This paper presents MUTMA’INN derived from the Arabic word “مطمئن”, meaning being reassured, at peace, or tranquil, reflecting the system’s role in ensuring the safety and security of students during transportation. The proposed system is an AI-powered school bus safety framework designed to improve the security and reliability of daily student transportation in alignment with Saudi Vision 2030’s Quality of Life Program. The proposed system consists of two integrated components: a cross-platform Flutter mobile application for parents, drivers, and school administrators, and a Python-based edge system connected to Firebase for real-time synchronization. The framework automates student attendance through facial recognition at the bus gate, reducing manual effort and the risk of human error. In addition, it monitors the driver using contactless remote photoplethysmography and facial analysis techniques to estimate heart rate and detect signs of fatigue or emotional distress. When abnormal conditions are detected, immediate alerts are sent to administrators to support timely intervention. By combining mobile computing, edge intelligence, computer vision, and cloud services into a unified platform, MUTMA’INN provides a proactive approach to school transportation safety. The proposed framework demonstrates how AI can support safer and more intelligent student transit systems.

Abstract: Accurate estimation of meal composition from food images can support safer and more reliable insulin bolus decision-making for individuals with Type 1 diabetes. Existing food recognition and nutrition estimation systems are often designed for general dietary logging and do not directly integrate food analysis with personalized insulin therapy parameters. This study presents an image-based nutrition estimation and insulin decision-support module developed within the AI-assisted Diabetes Care (AIDCARE) platform. The proposed system uses a convolutional neural network (CNN) to classify food items from a single meal image and retrieves reference nutritional values from a food composition database. A separate multimodal large language model (MLLM)-based estimation component is then used to estimate portion size, allowing carbohydrate and nutrient values to be scaled according to the observed serving. A curated food image dataset containing 40 food categories was used to evaluate three CNN architectures: ResNet50, Inception V3, and EfficientNet-B0. EfficientNet-B0 achieved the best classification performance, with 94.91% validation accuracy, 95.55% precision, 94.87% recall, and 94.90% F1-score. The portion-estimation component achieved an MAE of 12.27 g and an RMSE of 15.11 g. The estimated carbohydrate value is combined with user-specific clinical parameters, including the insulin-to-carbohydrate ratio and insulin sensitivity factor, to generate advisory bolus guidance. To support safety, the system requires user confirmation or correction of the recognized food category and estimated portion before insulin guidance is displayed. The proposed system is intended for advisory decision support only and is not designed to replace clinical judgment or autonomous insulin delivery systems.

Abstract: Dengue remains a major public health problem in tropical and subtropical regions, particularly in Latin America. Acute kidney injury (AKI) is one of the severe complications associated with dengue and has been linked to worse clinical outcomes, including prolonged hospitalization, need for renal replacement therapy, and increased mortality. This review aimed to summarize the available evidence on the epidemiology, pathophysiology, clinical manifestations, diagnosis, management, and prognosis of dengue-associated AKI, while also providing an overview of the literature from Latin America. This manuscript was developed as a narrative review. For the Latin America-specific overview, a focused structured search was conducted in PubMed, ScienceDirect, Cochrane Library, LILACS, and Web of Science, including studies published up to December 2025. The available data suggest that AKI in dengue is multifactorial, involving plasma leakage, renal hypoperfusion, endothelial dysfunction, tubular injury, rhabdomyolysis, thrombotic microangiopathy, and inflammatory renal damage. Clinically, AKI has been associated with oliguria, proteinuria, elevated serum creatinine, renal replacement therapy, and higher mortality. Only four eligible indexed studies from Latin America were identified in our search, all from Brazil, with small sample sizes and incomplete reporting of renal outcomes; however, additional unpublished or non-indexed local data may exist. In summary, dengue-associated AKI is a relevant complication of severe dengue, but the evidence available from Latin America remains limited. These findings highlight the need for improved renal surveillance and standardized reporting in dengue-endemic settings across Latin America.

Abstract: Photovoltaic (PV) systems are fundamentally limited by spectral mismatch between the solar spectrum and semiconductor band gaps, resulting in thermalization and transmission losses that reduce overall efficiency. This paper presents a critical review of spectral management approaches, focusing on solar spectrum splitting as a means to improve energy conversion. Existing strategies, including multijunction solar cells, optical spectrum splitting, dispersive and diffractive systems, luminescent solar concentrators, hybrid photovoltaic–thermal systems, and photonic filtering, are analyzed and compared. While these approaches improve spectral utilization, they are often constrained by fabrication complexity, alignment sensitivity, angular dependence, or inherent energy losses. A qualitative, integrative literature review methodology is used to evaluate performance, limitations, and implementation feasibility across these technologies. The analysis shows that no current approach simultaneously achieves high efficiency, low complexity, and robust performance under diffuse illumination. Photonic spectrum splitting combined with independently operated photovoltaic channels is identified as a promising direction. However, the absence of experimental validation remains a limitation, and future work should focus on developing compact, alignment-tolerant systems for practical applications.

Abstract: West Nile Virus (WNV) belongs to the orthoflavivirus genus and is part of the Flaviviridae family, which includes the Japanese encephalitis virus, Dengue virus, Zika virus, and yellow fever virus. WNV circulates among birds and mosquitoes, posing infection risks to humans and mammals. The significant rise in WNV's geographic spread and infection rates over the past five decades has prompted urgent public health concerns, driving the need for accelerated vaccine research. The development of a vaccine for WNV infection presents several challenges, primarily due to the virus's complex biology, the risk of cross-reactivity with other flaviviruses, safety concerns such as Antibody-dependent enhancement (ADE), and the economic and logistical hurdles in vaccine production. Despite significant research efforts, no human vaccine has been approved, although several candidates are in various stages of development. The current review offers a comprehensive summary of the latest progress and the concomitant challenges in the development of vaccines. It also discusses the role of host-pathogen interaction, host immunity, viral immune evasion, and disease pathogenesis in facilitating the advancement of vaccines.

Abstract: Amid COVID-19-related in-person school closures in 2021, an agent-based simulation grounded in social impact theory was implemented and documented to investigate the effects of in-person school closure on nonmedical prescription opioid use among adolescents in Ontario, Canada. The results of model simulations forecasted an alarming rebound effect in the opioid use prevalence after the lifting of in-person school closures and identified secure medication storage in households as an effective strategy for mitigating associated risks. This study evaluates this result by comparing the baseline projection from the previously published study with newly released 2023 data from the Ontario Student Drug Use and Health Survey. Furthermore, it employs the developed agent-based model to simulate the projection through 2030 and assesses the efficacy of secure medication storage in households for the coming years. The study confirms that the previously published simulation projection for 2023 closely aligns with observed data, showing nonmedical prescription opioid use prevalence among Ontario adolescents nearly doubling from 2021 to 2023. Additionally, the results show that nonmedical prescription opioid use prevalence among youth is projected to remain at these elevated levels. Critically, the findings suggest that the temporal window for effective secure medication storage interventions has elapsed, and these interventions are now expected to have minimal impact on reducing this increase, even when applied extensively. The agreement between reported predictions and observed data demonstrates that a simulation model with relevant conceptual foundation can accurately predict future trends and provide sufficient lead time for policymakers to implement interventions within critical time-sensitive windows to alter undesirable trajectories before public health crises escalate.