{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:19:54Z","timestamp":1792790394135,"version":"4.5.0"},"posted":{"date-parts":[[2026,9,17]]},"group-title":"Genetic and Genomic Medicine","reference-count":75,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"award":["5T32MH020030-25"],"award-info":[{"award-number":["5T32MH020030-25"]}],"id":[{"id":"https:\/\/ror.org\/04xeg9z08","id-type":"ROR","asserted-by":"publisher"}]},{"award":["R21MH137508"],"award-info":[{"award-number":["R21MH137508"]}],"id":[{"id":"https:\/\/ror.org\/04xeg9z08","id-type":"ROR","asserted-by":"publisher"}]},{"name":"National Institute on Alcohol Abuse and Alcoholism","award":["K25AA030072"],"award-info":[{"award-number":["K25AA030072"]}],"id":[{"id":"https:\/\/ror.org\/02jzrsm59","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  Post-traumatic stress disorder (PTSD) has a significant genetic component (\n                  <jats:italic>h<\/jats:italic>\n                  <jats:sup>2<\/jats:sup>\n                  = 24-72%). While the majority of prior studies have utilized common variants, recent research suggests rare variants also contribute to PTSD liability. Here, we examined the role of rare copy number variants (rCNVs; MAF &lt; 1%) from multi-ancestry whole-genome sequencing data in the All of Us Research Program, using an electronic health record-defined PTSD phenotype. Genome-wide burden analyses utilizing all rCNV lengths revealed significant associations for deletion count across European-like (EUR-like; \u03b2 = 0.005, SE = 0.001,\n                  <jats:italic>P<\/jats:italic>\n                  = 5.99 x 10\n                  <jats:sup>-6,<\/jats:sup>\n                  ,\n                  <jats:italic>FDR P<\/jats:italic>\n                  = 3.59 x 10\n                  <jats:sup>-5<\/jats:sup>\n                  ) and African-like (AFR-like;\n                  <jats:italic>\u03b2<\/jats:italic>\n                  = 0.003, SE = 0.001,\n                  <jats:italic>P<\/jats:italic>\n                  = 0.005,\n                  <jats:italic>FDR P<\/jats:italic>\n                  =0.02) ancestries. We conducted rCNV burden analyses within and across EUR-like (N case = 1,179, N control = 33,689), AFR-like (N case = 504, N control = 12,216), and Admixed American (AMR-like) (N case = 418, N control = 11,935) ancestries using three separate domains of gene-sets previously implicated in neuropsychiatric disorders: neurodevelopmental disorders (NDD; N = 53), abnormal behavior mouse mutant-derived (N = 146), and PTSD (N = 5). Within-ancestry analyses across all three domains yielded one significant brain-expressed gene-set within the EUR-like cohort. Meta-analyzing across ancestries identified 11 NDD gene-sets enriched for rCNV count (FDR\n                  <jats:italic>P<\/jats:italic>\n                  &lt; 0.05). rCNVs with lengths greater than 10kb were examined, but observed no significant signals. Future research using larger samples and detailed PTSD phenotypes, integrated with functional genomic data and brain-region-specific expression profiles, is needed to fully map the disorder\u2019s genetic landscape.\n                <\/jats:p>","DOI":"10.64898\/2026.09.11.26362867","type":"posted-content","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:25:29Z","timestamp":1789658729000},"source":"Crossref","is-referenced-by-count":0,"title":["Rare copy number variation in Post-traumatic stress disorder using whole genome sequencing and biobank data"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2278-3291","authenticated-orcid":false,"given":"Sydney","family":"Kramer","sequence":"first","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Farajzadeh Valilou","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Cellular, Molecular, and Genetic Medicine, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MadhurBain","family":"Singh","sequence":"additional","affiliation":[{"name":"Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Vieno","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roseann E.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, State University of New York System [SUNY] Downstate University, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Chatzinakos","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, State University of New York System [SUNY] Downstate University, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley T.","family":"Webb","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Population Health Sciences, Geisinger, Danville, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R. I.","family":"Coleman","sequence":"additional","affiliation":[{"name":"Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananda B.","family":"Amstadter","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Elswick Gentry","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermine H.","family":"Maes","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Cellular, Molecular, and Genetic Medicine, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brien P.","family":"Riley","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Cellular, Molecular, and Genetic Medicine, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Kendler","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Cellular, Molecular, and Genetic Medicine, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Sheerin-Smith","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan-Hoang","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"},{"name":"Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026092102050835000_2026.09.11.26362867v1.1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291715001981"},{"key":"2026092102050835000_2026.09.11.26362867v1.2","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.1385"},{"key":"2026092102050835000_2026.09.11.26362867v1.3","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.10.1675"},{"key":"2026092102050835000_2026.09.11.26362867v1.4","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1993.01820160019002"},{"key":"2026092102050835000_2026.09.11.26362867v1.5","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1017\/S0033291713002286","article-title":"Combat exposure severity as a moderator of genetic and environmental liability to post-traumatic stress disorder","volume":"44","year":"2014","journal-title":"Psychol Med"},{"key":"2026092102050835000_2026.09.11.26362867v1.6","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2017.77"},{"key":"2026092102050835000_2026.09.11.26362867v1.7","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-024-01707-9"},{"key":"2026092102050835000_2026.09.11.26362867v1.8","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-019-12576-w"},{"key":"2026092102050835000_2026.09.11.26362867v1.9","doi-asserted-by":"publisher","DOI":"10.1038\/nature08516"},{"key":"2026092102050835000_2026.09.11.26362867v1.10","doi-asserted-by":"publisher","DOI":"10.1126\/science.1098918"},{"key":"2026092102050835000_2026.09.11.26362867v1.11","doi-asserted-by":"publisher","DOI":"10.1038\/nrg1767"},{"key":"2026092102050835000_2026.09.11.26362867v1.12","doi-asserted-by":"publisher","DOI":"10.1038\/ng.3834"},{"key":"2026092102050835000_2026.09.11.26362867v1.13","doi-asserted-by":"publisher","DOI":"10.1038\/nature15394"},{"key":"2026092102050835000_2026.09.11.26362867v1.14","doi-asserted-by":"crossref","first-page":"1688935","DOI":"10.1080\/20008198.2019.1688935","article-title":"A preliminary investigation of rare variants associated with genetic risk for PTSD in a natural disaster-exposed adolescent sample","volume":"10","year":"2019","journal-title":"Eur J Psychotraumatol"},{"key":"2026092102050835000_2026.09.11.26362867v1.15","doi-asserted-by":"crossref","first-page":"5062","DOI":"10.1038\/s41380-022-01776-4","article-title":"Rare copy number variation in posttraumatic stress disorder","volume":"27","year":"2022","journal-title":"Mol Psychiatry"},{"key":"2026092102050835000_2026.09.11.26362867v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2015.04.022"},{"key":"2026092102050835000_2026.09.11.26362867v1.17","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-018-0059-2"},{"key":"2026092102050835000_2026.09.11.26362867v1.18","doi-asserted-by":"publisher","DOI":"10.1186\/s13073-017-0497-y"},{"key":"2026092102050835000_2026.09.11.26362867v1.19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr1809937"},{"key":"2026092102050835000_2026.09.11.26362867v1.20","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-020-0594-5"},{"key":"2026092102050835000_2026.09.11.26362867v1.21","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.09r05072blu"},{"key":"2026092102050835000_2026.09.11.26362867v1.22","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06957-x"},{"key":"2026092102050835000_2026.09.11.26362867v1.23","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2287-8"},{"key":"2026092102050835000_2026.09.11.26362867v1.24","doi-asserted-by":"publisher","DOI":"10.1186\/s13742-015-0047-8"},{"key":"2026092102050835000_2026.09.11.26362867v1.25","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/80.1.27"},{"key":"2026092102050835000_2026.09.11.26362867v1.26","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1001\/jamapsychiatry.2019.0566","article-title":"Association of rare copy number variants with risk of depression","volume":"76","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"2026092102050835000_2026.09.11.26362867v1.27","doi-asserted-by":"publisher","DOI":"10.3389\/fgene.2014.00187"},{"key":"2026092102050835000_2026.09.11.26362867v1.28","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1995.tb02031.x"},{"key":"2026092102050835000_2026.09.11.26362867v1.29","doi-asserted-by":"publisher","DOI":"10.1152\/physiolgenomics.00040.2001"},{"key":"2026092102050835000_2026.09.11.26362867v1.30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgen.1001097"},{"key":"2026092102050835000_2026.09.11.26362867v1.31","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2579-z"},{"key":"2026092102050835000_2026.09.11.26362867v1.32","doi-asserted-by":"publisher","DOI":"10.1111\/j.1420-9101.2005.00917.x"},{"key":"2026092102050835000_2026.09.11.26362867v1.33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2007.00380.x"},{"key":"2026092102050835000_2026.09.11.26362867v1.34","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0012462"},{"key":"2026092102050835000_2026.09.11.26362867v1.35","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1159\/000358538","article-title":"A novel (paternally inherited) duplication 13q31.3q32.3 in a 12-year-old patient with facial dysmorphism and developmental delay","volume":"5","year":"2014","journal-title":"Mol Syndr"},{"key":"2026092102050835000_2026.09.11.26362867v1.36","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13039-023-00666-w","article-title":"Prenatal identification of an inverted duplicated 13q marker chromosome with a neocentromere","volume":"16","year":"2023","journal-title":"Mol Cytogenet"},{"key":"2026092102050835000_2026.09.11.26362867v1.37","doi-asserted-by":"crossref","unstructured":"Mcdonald-Mcginn, D. , Sullivan, K. & Marino, B. 22q11.2 deletion syndrome. Nat Rev Primer 1,.","DOI":"10.1038\/nrdp.2015.71"},{"key":"2026092102050835000_2026.09.11.26362867v1.38","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1471-2350-5-21","article-title":"A 4q35.2 subtelomeric deletion identified in a screen of patients with co-morbid psychiatric illness and mental retardation","volume":"5","year":"2004","journal-title":"BMC Med Genet"},{"key":"2026092102050835000_2026.09.11.26362867v1.39","doi-asserted-by":"crossref","first-page":"e2130","DOI":"10.1002\/mgg3.2130","article-title":"3q29 microduplication syndrome: New evidence for the refinement of the critical region","volume":"11","year":"2023","journal-title":"Mol Genet Genomic Med"},{"key":"2026092102050835000_2026.09.11.26362867v1.40","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.ejmg.2010.07.009","article-title":"De novo 325 kb microdeletion in chromosome band 10q25.3 including ATRNL1 in a boy with cognitive impairment, autism and dysmorphic features","volume":"53","year":"2010","journal-title":"Eur J Med Genet"},{"key":"2026092102050835000_2026.09.11.26362867v1.41","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/s41398-023-02316-6","article-title":"Epigenetics of traumatic stress: The association of NR3C1 methylation and posttraumatic stress disorder symptom changes in response to narrative exposure therapy","volume":"13","year":"2023","journal-title":"Transl Psychiatry"},{"key":"2026092102050835000_2026.09.11.26362867v1.42","doi-asserted-by":"crossref","first-page":"112797","DOI":"10.1016\/j.psychres.2020.112797","article-title":"The NR3C1 gene expression is a potential surrogate biomarker for risk and diagnosis of posttraumatic stress disorder","volume":"284","year":"2020","journal-title":"Psychiatry Res"},{"key":"2026092102050835000_2026.09.11.26362867v1.43","doi-asserted-by":"publisher","DOI":"10.1093\/hmg\/ddh239"},{"key":"2026092102050835000_2026.09.11.26362867v1.44","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1038\/tp.2011.9","article-title":"Convergent functional genomics of anxiety disorders: translational identification of genes, biomarkers, pathways and mechanisms","volume":"1","year":"2011","journal-title":"Transl Psychiatry"},{"key":"2026092102050835000_2026.09.11.26362867v1.45","doi-asserted-by":"publisher","DOI":"10.1038\/ng.534"},{"key":"2026092102050835000_2026.09.11.26362867v1.46","doi-asserted-by":"publisher","DOI":"10.1101\/2023.05.18.23290169"},{"key":"2026092102050835000_2026.09.11.26362867v1.47","doi-asserted-by":"crossref","first-page":"7065","DOI":"10.1016\/j.cell.2025.09.012","article-title":"Genetic modifiers and ascertainment drive variable expressivity of complex disorders","volume":"188","year":"2025","journal-title":"Cell"},{"key":"2026092102050835000_2026.09.11.26362867v1.48","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2308-7"},{"key":"2026092102050835000_2026.09.11.26362867v1.49","doi-asserted-by":"publisher","DOI":"10.1038\/nn.2719"},{"key":"2026092102050835000_2026.09.11.26362867v1.50","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/bts535"},{"key":"2026092102050835000_2026.09.11.26362867v1.51","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06957-x"},{"key":"2026092102050835000_2026.09.11.26362867v1.52","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-024-01894-5"},{"key":"2026092102050835000_2026.09.11.26362867v1.53","doi-asserted-by":"publisher","DOI":"10.1101\/2025.02.22.25322721"},{"key":"2026092102050835000_2026.09.11.26362867v1.54","doi-asserted-by":"publisher","DOI":"10.1101\/gr.278378.123"},{"key":"2026092102050835000_2026.09.11.26362867v1.55","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.12586"},{"key":"2026092102050835000_2026.09.11.26362867v1.56","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btq559"},{"key":"2026092102050835000_2026.09.11.26362867v1.57","doi-asserted-by":"publisher","DOI":"10.1111\/j.0006-341X.1999.00997.x"},{"key":"2026092102050835000_2026.09.11.26362867v1.58","doi-asserted-by":"publisher","DOI":"10.1038\/ng1333"},{"key":"2026092102050835000_2026.09.11.26362867v1.59","doi-asserted-by":"publisher","DOI":"10.1093\/gigascience\/giab008"},{"key":"2026092102050835000_2026.09.11.26362867v1.60","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btq033"},{"key":"2026092102050835000_2026.09.11.26362867v1.61","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2021.678548"},{"key":"2026092102050835000_2026.09.11.26362867v1.62","doi-asserted-by":"publisher","DOI":"10.1038\/S41588-025-02291-2"},{"key":"2026092102050835000_2026.09.11.26362867v1.63","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1038\/s41398-021-01513-5","article-title":"Longitudinal genome-wide methylation study of PTSD treatment using prolonged exposure and hydrocortisone","volume":"11","year":"2021","journal-title":"Transl Psychiatry"},{"key":"2026092102050835000_2026.09.11.26362867v1.64","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2022.02.010"},{"key":"2026092102050835000_2026.09.11.26362867v1.65","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-023-01978-4"},{"key":"2026092102050835000_2026.09.11.26362867v1.66","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2308-7"},{"key":"2026092102050835000_2026.09.11.26362867v1.67","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2019.06.011"},{"key":"2026092102050835000_2026.09.11.26362867v1.68","doi-asserted-by":"publisher","DOI":"10.1038\/nn.4086"},{"key":"2026092102050835000_2026.09.11.26362867v1.69","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.yjmcc.2025.01.011","article-title":"Mouse model of post-traumatic stress disorder negatively impacts cardiac homeostasis","volume":"201","year":"2025","journal-title":"J Mol Cell Cardiol"},{"key":"2026092102050835000_2026.09.11.26362867v1.70","doi-asserted-by":"publisher","DOI":"10.1126\/science.adh3707"},{"key":"2026092102050835000_2026.09.11.26362867v1.71","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-024-07708-2"},{"key":"2026092102050835000_2026.09.11.26362867v1.72","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1995.03950240066012"},{"key":"2026092102050835000_2026.09.11.26362867v1.73","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2026092102050835000_2026.09.11.26362867v1.74","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gks003"},{"key":"2026092102050835000_2026.09.11.26362867v1.75","doi-asserted-by":"publisher","DOI":"10.1016\/j.cancergen.2013.11.002"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.09.11.26362867","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:05:17Z","timestamp":1789981517000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.09.11.26362867"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":75,"URL":"https:\/\/doi.org\/10.64898\/2026.09.11.26362867","relation":{},"subject":[],"published":{"date-parts":[[2026,9,17]]},"subtype":"preprint"}}