{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:32:09Z","timestamp":1768570329484,"version":"3.49.0"},"posted":{"date-parts":[[2025,7,8]]},"group-title":"Neurology","reference-count":87,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>Premature infants often experience hypoxia and require prolonged ventilation, which can trigger systemic inflammation, damage the developing brain, and increase the risk of neurodevelopmental disorders such as Autism Spectrum Disorder (ASD). Early intervention is key for ensuring optimal outcomes for those with ASD; thus emphasizing the critical importance of accurately identifying infants at risk as early as possible. Here, infants underwent electroencephalography during social (held) and nonsocial (not held) resting state conditions to assess brain signal variability, saliva collection to determine inflammation, calculation of a novel Prognostic Respiratory Intensity Scoring Metric (PRISM) to assess the burden of respiratory support, and ASD testing in toddlerhood. Higher PRISM scores were associated with increased brain signal entropy during the nonsocial resting state. However, this association was not observed in the social resting state condition \u2013 particularly for male babies. Interestingly in female infants, we saw that the relationship between brain signal entropy and PRISM scores were potentially mediated by cytokines. Notably, the interaction between nonsocial resting state brain signal entropy, sex, and PRISM scores predicted risk of developing ASD with 88% accuracy. These non-invasive measures can identify infants at the highest risk for an ASD diagnosis before discharge.<\/jats:p>","DOI":"10.1101\/2025.07.07.25331007","type":"posted-content","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T07:50:10Z","timestamp":1752133810000},"source":"Crossref","is-referenced-by-count":0,"title":["From Breath to Brain: NICU Respiratory Interventions and Bedside Brain Signal Entropy Predict Later Autism Risk"],"prefix":"10.64898","author":[{"given":"Madelyn G.","family":"Nance","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winnie R.","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0539-9762","authenticated-orcid":false,"given":"Chad","family":"Aldridge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Burnsed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Pelphrey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santina","family":"Zanelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan H.","family":"Puglia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025071000500481000_2025.07.07.25331007v1.1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-1640"},{"key":"2025071000500481000_2025.07.07.25331007v1.2","doi-asserted-by":"publisher","DOI":"10.1002\/ca.22430"},{"key":"2025071000500481000_2025.07.07.25331007v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2019.02.016"},{"key":"2025071000500481000_2025.07.07.25331007v1.4","unstructured":"About Preterm Labor and Birth | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. https:\/\/www.nichd.nih.gov\/health\/topics\/preterm\/conditioninfo (2023)."},{"key":"2025071000500481000_2025.07.07.25331007v1.5","unstructured":"A profile of prematurity of United States. March of Dimes | PeriStats https:\/\/www.marchofdimes.org\/peristats\/reports\/united-states\/prematurity-profile."},{"key":"2025071000500481000_2025.07.07.25331007v1.6","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1001\/jamapediatrics.2023.3487","article-title":"National Trends in Preterm Infant Mortality in the United States by Race and Socioeconomic Status, 1995-2020","volume":"177","year":"2023","journal-title":"JAMA Pediatrics"},{"key":"2025071000500481000_2025.07.07.25331007v1.7","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1038\/s41372-023-01774-6","article-title":"Resuscitation, survival and morbidity of extremely preterm infants in California 2011\u20132019","volume":"44","year":"2024","journal-title":"J Perinatol"},{"key":"2025071000500481000_2025.07.07.25331007v1.8","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2014.40"},{"key":"2025071000500481000_2025.07.07.25331007v1.9","doi-asserted-by":"crossref","unstructured":"Chan, K. Y. Y. , Miller, S. L. , Schm\u00f6lzer, G. M. , Stojanovska, V. & Polglase, G. R . Respiratory Support of the Preterm Neonate: Lessons About Ventilation-Induced Brain Injury From Large Animal Models. Front Neurol 11, 862 (2020).","DOI":"10.3389\/fneur.2020.00862"},{"key":"2025071000500481000_2025.07.07.25331007v1.10","unstructured":"Bhutta, B. S. , Alghoula, F. & Berim, I. Hypoxia. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2022)."},{"key":"2025071000500481000_2025.07.07.25331007v1.11","doi-asserted-by":"publisher","DOI":"10.1159\/000329922"},{"key":"2025071000500481000_2025.07.07.25331007v1.12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0039535"},{"key":"2025071000500481000_2025.07.07.25331007v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2012.10.014"},{"key":"2025071000500481000_2025.07.07.25331007v1.14","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.mvr.2012.05.008","article-title":"Involvement of oxidative stress in hypoxia-induced blood\u2013brain barrier breakdown","volume":"84","year":"2012","journal-title":"Microvascular Research"},{"key":"2025071000500481000_2025.07.07.25331007v1.15","first-page":"469046","article-title":"Effects of Neonatal Systemic Inflammation on Blood-Brain Barrier Permeability and Behaviour in Juvenile and Adult Rats","volume":"2011","year":"2011","journal-title":"Cardiovascular Psychiatry and Neurology"},{"key":"2025071000500481000_2025.07.07.25331007v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.01.047"},{"key":"2025071000500481000_2025.07.07.25331007v1.17","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jpeds.2020.05.039","article-title":"Mechanical Ventilation Duration, Brainstem Development, and Neurodevelopment in Children Born Preterm: A Prospective Cohort Study","volume":"226","year":"2020","journal-title":"The Journal of Pediatrics"},{"key":"2025071000500481000_2025.07.07.25331007v1.18","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-032300"},{"key":"2025071000500481000_2025.07.07.25331007v1.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2017.03.013"},{"key":"2025071000500481000_2025.07.07.25331007v1.20","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/17.10.2762"},{"key":"2025071000500481000_2025.07.07.25331007v1.21","doi-asserted-by":"publisher","DOI":"10.1080\/08035250410024998"},{"key":"2025071000500481000_2025.07.07.25331007v1.22","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1038\/pr.2015.175","article-title":"Respiratory adaptation and surfactant composition of unanesthetized male and female lambs differ for up to 8 h after preterm birth","volume":"79","year":"2016","journal-title":"Pediatr Res"},{"key":"2025071000500481000_2025.07.07.25331007v1.23","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2011.50"},{"key":"2025071000500481000_2025.07.07.25331007v1.24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1700827"},{"key":"2025071000500481000_2025.07.07.25331007v1.25","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1268239"},{"key":"2025071000500481000_2025.07.07.25331007v1.26","doi-asserted-by":"crossref","unstructured":"Puglia, M. H. et al. Epigenetic tuning of brain signal entropy in emergent human social behavior. BMC Medicine 18, 244 (2020).","DOI":"10.1186\/s12916-020-01683-x"},{"key":"2025071000500481000_2025.07.07.25331007v1.27","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.5641-10.2011"},{"key":"2025071000500481000_2025.07.07.25331007v1.28","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.0907-17.2018"},{"key":"2025071000500481000_2025.07.07.25331007v1.29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1000106"},{"key":"2025071000500481000_2025.07.07.25331007v1.30","doi-asserted-by":"publisher","DOI":"10.4449\/AIB.V148I3.1225"},{"key":"2025071000500481000_2025.07.07.25331007v1.31","doi-asserted-by":"crossref","unstructured":"Waschke, L. , W\u00f6stmann, M. & Obleser, J . States and traits of neural irregularity in the age-varying human brain. Sci Rep 7, 17381 (2017).","DOI":"10.1038\/s41598-017-17766-4"},{"key":"2025071000500481000_2025.07.07.25331007v1.32","doi-asserted-by":"crossref","unstructured":"Costa, M. , Goldberger, A. L. & Peng, C.-K . Multiscale Entropy Analysis of Complex Physiologic Time Series. Phys. Rev. Lett. 89, 068102 (2002).","DOI":"10.1103\/PhysRevLett.89.068102"},{"key":"2025071000500481000_2025.07.07.25331007v1.33","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.3153-10.2011"},{"key":"2025071000500481000_2025.07.07.25331007v1.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneumeth.2016.09.004"},{"key":"2025071000500481000_2025.07.07.25331007v1.35","doi-asserted-by":"crossref","unstructured":"Puglia, M. H. , Slobin, J. S. & Williams, C. L . The automated preprocessing pipe-line for the estimation of scale-wise entropy from EEG data (APPLESEED): Development and validation for use in pediatric populations. Dev Cogn Neurosci 58, 101163 (2022).","DOI":"10.1016\/j.dcn.2022.101163"},{"key":"2025071000500481000_2025.07.07.25331007v1.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneumeth.2003.10.009"},{"key":"2025071000500481000_2025.07.07.25331007v1.37","doi-asserted-by":"publisher","DOI":"10.1111\/psyp.13566"},{"key":"2025071000500481000_2025.07.07.25331007v1.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneumeth.2010.07.015"},{"key":"2025071000500481000_2025.07.07.25331007v1.39","doi-asserted-by":"publisher","DOI":"10.1080\/87565641.2012.654867"},{"key":"2025071000500481000_2025.07.07.25331007v1.40","doi-asserted-by":"publisher","DOI":"10.1002\/cpim.40"},{"key":"2025071000500481000_2025.07.07.25331007v1.41","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e328335c2f6"},{"key":"2025071000500481000_2025.07.07.25331007v1.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2019.577071"},{"key":"2025071000500481000_2025.07.07.25331007v1.43","doi-asserted-by":"publisher","DOI":"10.1002\/eji.201141847"},{"key":"2025071000500481000_2025.07.07.25331007v1.44","doi-asserted-by":"publisher","DOI":"10.1177\/0734282913490916"},{"key":"2025071000500481000_2025.07.07.25331007v1.45","unstructured":"R: The R Project for Statistical Computing. https:\/\/www.r-project.org\/ (2023)."},{"key":"2025071000500481000_2025.07.07.25331007v1.46","doi-asserted-by":"publisher","DOI":"10.1101\/2025.06.28.25330368"},{"key":"2025071000500481000_2025.07.07.25331007v1.47","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-540-32827-8"},{"key":"2025071000500481000_2025.07.07.25331007v1.48","unstructured":"Ravand, H. & Baghaei, P . Partial Least Squares Structural Equation Modeling with R. Practical Assessment , Research, and Evaluation 21, (2016)."},{"key":"2025071000500481000_2025.07.07.25331007v1.49","doi-asserted-by":"crossref","unstructured":"Dingle, K. , Kassem, O. M. , Azizieh, F. , AbdulHussain, G. & Raghupathy, R . Quantitative analyses of cytokine profiles reveal hormone-mediated modulation of cytokine profiles in recurrent spontaneous miscarriage. Cytokine 164, 156160 (2023).","DOI":"10.1016\/j.cyto.2023.156160"},{"key":"2025071000500481000_2025.07.07.25331007v1.50","doi-asserted-by":"crossref","first-page":"e12818","DOI":"10.1111\/aji.12818","article-title":"Multivariate analysis of cytokine profiles in pregnancy complications","volume":"79","year":"2018","journal-title":"American Journal of Reproductive Immunology"},{"key":"2025071000500481000_2025.07.07.25331007v1.51","unstructured":"Sill, A. M . Statistics for Laboratory Scientists and Clinicians: A Practical Guide. (Cambridge University Press, 2021)."},{"key":"2025071000500481000_2025.07.07.25331007v1.52","doi-asserted-by":"crossref","unstructured":"Robin, X. et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 12, 77 (2011).","DOI":"10.1186\/1471-2105-12-77"},{"key":"2025071000500481000_2025.07.07.25331007v1.53","first-page":"220","article-title":"An introduction to the partial least squares approach to structural equation modelling: a method for exploratory psychiatric research","volume":"25","year":"2015","journal-title":"Int J Methods Psychiatr Res"},{"key":"2025071000500481000_2025.07.07.25331007v1.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.molmed.2018.06.008"},{"key":"2025071000500481000_2025.07.07.25331007v1.55","doi-asserted-by":"crossref","unstructured":"Bach, A. M. et al. Systemic inflammation during the first year of life is associated with brain functional connectivity and future cognitive outcomes. Developmental Cognitive Neuroscience 53, 101041 (2022).","DOI":"10.1016\/j.dcn.2021.101041"},{"key":"2025071000500481000_2025.07.07.25331007v1.56","doi-asserted-by":"publisher","DOI":"10.1002\/dev.21057"},{"key":"2025071000500481000_2025.07.07.25331007v1.57","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/ANC.0b013e31826093ee","article-title":"Comforting touch in the very preterm hospitalized infant: an integrative review","volume":"12","year":"2012","journal-title":"Adv Neonatal Care"},{"key":"2025071000500481000_2025.07.07.25331007v1.58","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s13312-010-0114-2","article-title":"Massage and touch therapy in neonates: the current evidence","volume":"47","year":"2010","journal-title":"Indian Pediatr"},{"key":"2025071000500481000_2025.07.07.25331007v1.59","doi-asserted-by":"crossref","unstructured":"P\u00fcschel, I. et al. Gentle as a mother\u2019s touch: C-tactile touch promotes autonomic regulation in preterm infants. Physiol Behav 257, 113991 (2022).","DOI":"10.1016\/j.physbeh.2022.113991"},{"key":"2025071000500481000_2025.07.07.25331007v1.60","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-7687.2009.00890.x"},{"key":"2025071000500481000_2025.07.07.25331007v1.61","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2008.108"},{"key":"2025071000500481000_2025.07.07.25331007v1.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2013.08.012"},{"key":"2025071000500481000_2025.07.07.25331007v1.63","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1002\/imhj.21949","article-title":"Why do we hunger for touch? The impact of daily gentle touch stimulation on maternal-infant physiological and behavioral regulation and resilience","volume":"42","year":"2021","journal-title":"Infant Ment Health J"},{"key":"2025071000500481000_2025.07.07.25331007v1.64","doi-asserted-by":"publisher","DOI":"10.1016\/j.dr.2011.01.001"},{"key":"2025071000500481000_2025.07.07.25331007v1.65","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2018.11.002"},{"key":"2025071000500481000_2025.07.07.25331007v1.66","doi-asserted-by":"crossref","first-page":"714169","DOI":"10.3389\/fcell.2021.714169","article-title":"Premyelinating Oligodendrocytes: Mechanisms Underlying Cell Survival and Integration","volume":"9","year":"2021","journal-title":"Front Cell Dev Biol"},{"key":"2025071000500481000_2025.07.07.25331007v1.67","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1038\/s41419-021-03446-9","article-title":"The immune-inflammatory response of oligodendrocytes in a murine model of preterm white matter injury: the role of TLR3 activation","volume":"12","year":"2021","journal-title":"Cell Death Dis"},{"key":"2025071000500481000_2025.07.07.25331007v1.68","doi-asserted-by":"publisher","DOI":"10.3389\/fncel.2020.00051"},{"key":"2025071000500481000_2025.07.07.25331007v1.69","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2021.722323"},{"key":"2025071000500481000_2025.07.07.25331007v1.70","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1038\/s41390-020-0781-1","article-title":"Preterm white matter injury: ultrasound diagnosis and classification","volume":"87","year":"2020","journal-title":"Pediatr Res"},{"key":"2025071000500481000_2025.07.07.25331007v1.71","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1038\/jp.2016.262","article-title":"Early EEG power predicts MRI injury in infants with hypoxic-ischemic encephalopathy","volume":"37","year":"2017","journal-title":"J Perinatol"},{"key":"2025071000500481000_2025.07.07.25331007v1.72","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2025.114702"},{"key":"2025071000500481000_2025.07.07.25331007v1.73","doi-asserted-by":"publisher","DOI":"10.3389\/fncel.2018.00428"},{"key":"2025071000500481000_2025.07.07.25331007v1.74","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.bbi.2023.05.002","article-title":"Neonatal immune signatures differ by sex regardless of neurodevelopmental disorder status: macrophage migration inhibitory factor (MIF) alone reveals a sex by diagnosis interaction effect","volume":"111","year":"2023","journal-title":"Brain Behav Immun"},{"key":"2025071000500481000_2025.07.07.25331007v1.75","doi-asserted-by":"crossref","first-page":"2334850","DOI":"10.1080\/14767058.2024.2334850","article-title":"Gender and sex hormone effects on neonatal innate immune function","volume":"37","year":"2024","journal-title":"The Journal of Maternal-Fetal & Neonatal Medicine"},{"key":"2025071000500481000_2025.07.07.25331007v1.76","doi-asserted-by":"crossref","unstructured":"Fenoglio, A. , Georgieff, M. K. & Elison, J. T . Social brain circuitry and social cognition in infants born preterm. Journal of Neurodevelopmental Disorders 9, 27 (2017).","DOI":"10.1186\/s11689-017-9206-9"},{"key":"2025071000500481000_2025.07.07.25331007v1.77","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24031819"},{"key":"2025071000500481000_2025.07.07.25331007v1.78","unstructured":"Garc\u00e9s, P. et al. Resting state EEG power spectrum and functional connectivity in autism: a cross-sectional analysis. Molecular Autism 13, 22 (2022)."},{"key":"2025071000500481000_2025.07.07.25331007v1.79","doi-asserted-by":"publisher","DOI":"10.4103\/tjem.tjem_182_23"},{"key":"2025071000500481000_2025.07.07.25331007v1.80","unstructured":"Early Intervention for Autism | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. https:\/\/www.nichd.nih.gov\/health\/topics\/autism\/conditioninfo\/treatments\/early-intervention."},{"key":"2025071000500481000_2025.07.07.25331007v1.81","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jpeds.2022.05.026","article-title":"Disparities and Early Engagement Associated with the 18- to 36-Month High-Risk Infant Follow-Up Visit among Very Low Birthweight Infants in California","volume":"248","year":"2022","journal-title":"The Journal of Pediatrics"},{"key":"2025071000500481000_2025.07.07.25331007v1.82","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.neubiorev.2020.06.027","article-title":"Early behavioral markers for neurodevelopmental disorders in the first 3 years of life: An overview of systematic reviews","volume":"116","year":"2020","journal-title":"Neuroscience & Biobehavioral Reviews"},{"key":"2025071000500481000_2025.07.07.25331007v1.83","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.jpeds.2014.10.038","article-title":"Referral of Very Low Birth Weight Infants to High-Risk Follow-Up at Neonatal Intensive Care Unit Discharge Varies Widely across California","volume":"166","year":"2015","journal-title":"The Journal of Pediatrics"},{"key":"2025071000500481000_2025.07.07.25331007v1.84","first-page":"546","article-title":"Rural Residence and Factors Associated with Attendance at the Second High-Risk Infant Follow-up Clinic Visit for Very Low Birth Weight Infants in California","volume":"40","year":"2021","journal-title":"American Journal of Perinatology"},{"key":"2025071000500481000_2025.07.07.25331007v1.85","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1038\/s41372-018-0180-1","article-title":"Preterm infants are less likely to have a family-centered medical home than term-born peers","volume":"38","year":"2018","journal-title":"J Perinatol"},{"key":"2025071000500481000_2025.07.07.25331007v1.86","doi-asserted-by":"crossref","first-page":"e2023062511","DOI":"10.1542\/peds.2023-062511","article-title":"Primary Care Framework to Monitor Preterm Infants for Neurodevelopmental Outcomes in Early Childhood","volume":"152","year":"2023","journal-title":"Pediatrics"},{"key":"2025071000500481000_2025.07.07.25331007v1.87","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1044\/2023_JSLHR-23-00273","article-title":"Toward Generalizable Machine Learning Models in Speech, Language, and Hearing Sciences: Estimating Sample Size and Reducing Overfitting","volume":"67","year":"2024","journal-title":"J Speech Lang Hear Res"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2025.07.07.25331007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:40:08Z","timestamp":1768509608000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2025.07.07.25331007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,8]]},"references-count":87,"URL":"https:\/\/doi.org\/10.1101\/2025.07.07.25331007","relation":{},"subject":[],"published":{"date-parts":[[2025,7,8]]},"subtype":"preprint"}}