European Sites Research Articles

Improved discrimination of biogenic and diagenetic elements in Palaeolithic mammoth ivory and bone from Hohle Fels Cave in the Swabian Jura of Southwestern Germany

Mammoth ivory was used by humans to manufacture personal ornaments, sculptures or music instruments during the Upper Palaeolithic. These objects are among the first and most precious witnesses of ancient artistic behaviour. Archaeological ivory, however, has been subjected to complex alteration processes due to exchange with its burial environment over time. Therefore, it is necessary to understand the diagenetic phenomena in order to develop adequate conservation measures for ivory artefacts. The element-analytical study of ivory artefacts can shed light on these processes and can help to track the origin of these objects.In this work we studied twelve mammoth ivory samples and ten bone samples coming from the Palaeolithic site Hohle Fels located in the Swabian Jura. Mammoth bone samples were included in the study in order to find eventual differences in the diagenetic changes between ivory and bone material. We performed ion beam analysis (PIXE/PIGE) at the microfocus beamline of the accelerator NewAGLAE at C2RMF and micro-X-ray fluorescence (XRF) mappings at the PUMA beamline at synchrotron SOLEIL. The obtained PIXE/PIGE results are consistent with previous studies of ivories from Hohle Fels and other contemporaneous European sites in terms of possible site-specific (Zn, Br, Sr contents) and diagenetic markers (F content). XRF mappings and their semi-quantitative analyses confirm former observations and provide additional criteria for the classification of endogenous and exogenous elements. Based on our results we could not find significant difference in the diagenetic alterations between archaeological ivory and bone samples for the studied archaeological site.

The emergence of the ‘rentocrat’

ABSTRACT Scholarship on rents and rentierism abounds. Commonly absent is analysis of the actors who perform rentierism: how they do it, when they do it, what outcomes result. To address this lacuna, I advance a three-tier typology of actors I term ‘rentocrats’. I then investigate the role of rentocrats in performing what has been labelled ‘infrastructure rentierism’ across infrastructure projects’ lifecycles: a scenario where surplus capital and labour are utilised by rentiers (rentocrats). This article contributes to an expanding literature on ‘assetisation’ by showing how rentocrats accrue rent across such lifecycles typically helped by local legal frameworks and a cross-coalition of politico-economic stakeholders, which together transform the good into an asset. As such, this article helps overcome a recognised blind spot in the assetisation scholarship: its empiricism. Through Case Study Analysis, I use the rentocrat conceptualisation and theorisation to highlight the variegated practice of infrastructure rentierism across the lifecycles of largescale (>USD100mn) Chinese-sourced capital-financed infrastructure projects in the United Kingdom, Germany, and Hungary. I intend the ‘rentocrat’ concept to be applied to and critiqued against other forms of rentierism not limited to Chinese-sourced capital, European sites, or its infrastructure variant.

CRISIS AFAR: an international collaborative study of the impact of the COVID-19 pandemic on mental health and service access in youth with autism and neurodevelopmental conditions

BackgroundHeterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services.MethodsUsing a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups.ResultsClustering revealed four subgroups. One subgroup—broad symptom worsening only (20%)—included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup.LimitationsNotable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic.ConclusionsConcomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis.

Long-term effects of clearcut and selective cut on seepage chemistry in a N-saturated spruce stand – Case study Höglwald

While comprehensive literature is available concerning the effects of clearcutting on N leaching via seepage water little information is available comparing different harvesting intensities. In order to close this gap of knowledge in 1999 an experiment comparing selective cut and clearcut at the Höglwald site was started. The Höglwald is a major Central European ecosystem study site and represents a typical spruce forest ecosystem in Southern Germany, subject to high nitrogen deposition. Bulk deposition, throughfall and seepage water concentrations at 0 and 40 cm depth were measured from 1999 until 2017 at three plots (control, clearcut, selective cut). Elemental fluxes were calculated using measured water fluxes (precipitation, throughfall) or calculated soil water fluxes using a hydrological model. Here we present the final results for the 17-year measurement period comparing different harvesting intensities from initial harvesting until the complete removal of all mature trees.Initial nitrate peaks after clearcutting the nitrogen saturated spruce ecosystems were very high (up to 34 mg nitrate-N l−1) but short-lived (2 years). Afterwards nitrate leaching strongly decreased to values close to zero due to reduced input and the demand of the upcoming vegetation. For the investigated 17-year period cumulative nitrogen losses at the clearcut plot were lower as compared to the uncut control. The selective cut was not able to prevent nitrate leaching in our N-saturated spruce stand. Here cumulative nitrogen losses in the first 17 years are similar compared to the uncut control due to a combination of ongoing high deposition and partially enhanced mineralisation after harvesting events.At our nitrogen saturated study site the selective cut showed no advantages concerning nitrate leaching via seepage water. From a silvicultural and forest ecological point of view, however, big cleared areas with their sudden change to a non-forest climate should be avoided due to several disadvantages like high initial mineralisation with its excessive nutrient release, the risk of grass invasion as well as higher stress and often lower quality of the planted trees.

Can remote green hydrogen production play a key role in decarbonizing Europe in the future? A cradle-to-gate LCA of hydrogen production in Austria, Belgium, and Iceland

Hydrogen can play a key role in decarbonizing industrial and transportation processes. As the European demand for hydrogen rises, several EU member states have been looking into ways to import remotely-produced hydrogen (H2) to fulfill their local needs. This cradle-to-gate LCA study assesses the H2 production in Iceland using local renewable energy sources, including the transport to potential gates in Austria and Belgium and compares it with locally produced H2 at the European sites. Our results indicate that the Global Warming Potential (GWP) of H2 production depends primarily on the energy mix, while transportation of H2 generates a minor impact. Furthermore, in its current state, H2 production in Iceland through Polymer electrolyte membrane electrolysis (PEM-EC) yields over 13- and 21 times lower GHG emissions compared respectively to Austria and Belgium. Based on these results, we conclude that remotely produced hydrogen can play an important part in decarbonizing European carbon-intensive industries.

New species of Tanaidacea from Cretaceous Kachin amber, with a brief review of the fossil record of tanaidacean crustaceans

Tanaidaceans are benthic, mostly marine, crustaceans that live burrowed in the substrate or in self-built tubes. The fossil record of Tanaidacea reaches back to the Carboniferous, 350 million years ago, but it is especially species-rich in Cretaceous amber sites from Spain and France. We report and formally describe a new species of Tanaidacea from 100-million-year-old Kachin amber, from the Hukawng Valley, Northern Myanmar, the first record of Cretaceous tanaidaceans outside Europe. The combination of character states of Tanaidaurum kachinensisgen. nov. et sp. nov. suggests that the new species is a representative of the early diversification of an unnamed group (Paratanaoidea+Tanaidoidea), an ingroup of the monophyletic group Tanaidomorpha. We briefly review the biased fossil record of Tanaidacea and present its abundance in European amber sites.

Numerical modelling of laterally loaded piles driven in low-to-medium density fractured chalk

Chalk’s sensitive, variable nature poses difficulties for foundation designers. It can present as weak rock and yet be de-structured to very weak putty by dynamic or high-pressure loading. The development of multiple offshore wind farms at north European chalk sites led to the recent ALPACA Joint Industry Programme, which undertook intensive material characterisation and large-scale field testing at St Nicholas at Wade (SNW), Kent, UK to capture and better understand the behaviour of piles driven in fractured low-to-medium density chalk. Noting that lateral loading response is a vital design concern for monopile and jacket supported structures, this paper focuses on 3D Finite Element (FE) modelling of ALPACA’s monotonic lateral loading field tests on open-ended driven tubular steel piles. The brittle chalk is modelled with a strain-softening Mohr-Coulomb model combined with nonlocal regularisation, calibrated meticulously against the ALPACA characterisation dataset. A second, simpler modelling approach, adopting a perfectly-plastic Mohr-Coulomb model, is also explored as a simplified practical alternative. Both approaches can match field lateral capacity and bending moment distributions, after taking due account of pile installation and chalk fracturing effects. The analyses indicate how robust, accurate and cost-effective lateral loading design may be approached for low-to-medium density fractured chalks.

Comparison of vertical and horizontal atmospheric deposition of nitrate at Central European mountain-top sites during three consecutive winters

Nitrogen (N) deposition, a key process of atmospheric self-cleaning, represents an important pathway for nutrients and pollutants to ecosystems. Enhanced N deposition flux contributes to acidification, eutrophication and loss of biodiversity. N-NO3− concentrations in rime and snow were measured at 10 Czech plots situated in borderline mountains in 2009–2011 winters. The results were put in context with data-driven geostatistical modelling results of annual wet vertical and horizontal deposition. Our hypotheses were that: (i) rime and snow would be more polluted in the highly industrialized north than in the south, (ii) the N-NO3− concentrations would differ in the three winters studied, and (iii), that N-NO3− rime deposition is not negligible in Central European mountain ranges. Our results indicated that winter N-NO3− concentrations were significantly higher in rime than in snow and that there were much larger between-site differences in N-NO3− concentrations for rime than for snow. Relatively large differences were found between individual years. Atmospheric input of N-NO3− in winter was dominated by vertical deposition, i.e., snow. Modelled results showed that mean winter rime deposition corresponded to about 6–25 %, and mean winter snow deposition made up 25–72.5 % of mean annual N-NO3− wet-only deposition. Model N-NO3−occult deposition estimated from throughfall and total (wet and dry) deposition is highly uncertain, however: N throughfall is not a relevant proxy for estimation of realistic total N deposition due to N exchange between the tree canopy and atmosphere.

Interpolation of airborne LiDAR data for archaeology

The use of topographic airborne LiDAR data has become an essential part of archaeological prospection, and the need for an archaeology-specific data processing workflow is well established. However, interpolation, an important step in which the digital elevation model is derived from the classified point cloud, has received little attention from archaeologists. This processing step has a direct impact on the accuracy and visual performance of the digital elevation model, but remains a challenge despite numerous studies. Most studies have compared the accuracy of different interpolators (with conflicting results), but very few compare the visual performance. Also, there are no archaeology-specific studies. This article addresses this problem by providing an archaeology-specific visual performance assessment of six of the most commonly used interpolators. The data was tested at four European test sites with innovative use of the triangular assessment method. Kriging was the best interpolator in undersampled areas, and inverse distance weighting was a distant second. In other areas, triangulation with linear interpolation was marginally better than kriging. However, when availability and computational costs are also taken into account, inverse distance weighting is currently the most suitable archaeology-specific interpolator. In addition, we propose a hybrid interpolator that combines the strengths of triangulation with linear interpolation and inverse distance weighting (QGIS plug-in). All results are to be considered European-data specific.

Modelling phosphorus dynamics in four European long-term experiments

CONTEXTPhosphorus (P) is a non-renewable geological macronutrient that plays an essential role in food security. The excessive use of P as a fertilizer and its subsequent diffuse loss leads to the deterioration of water quality, eutrophication, and loss of biodiversity. Ecosystem process-based models are a powerful tool to depict the P cycle, investigate the effects of management practices and climate change, and ultimately assess policy interventions that affect biogeochemical cycles. Of the limited number of P models in agricultural production systems, none have been tested in temperate conditions for periods of decades using long-term field experiments. OBJECTIVEThe objective of this study is to evaluate the ability of the detailed P submodel from DayCent to: simulate the magnitude and temporal dynamics of P outputs; assess changes in P soil pools from European agricultural long-term experiments; and interpret the main causal factors inducing the differences between the observed vs. the simulated pools and fluxes. METHODSWe used data from four long-term experiments to calibrate and test the P submodel of DayCent. The experiments involve five different soils, mineral and organic fertilizer treatments, management intensity levels, various crop rotations, crop residue management, and irrigation. RESULTS AND CONCLUSIONSThe DayCent model captured the gross P budget (input minus output) in the four long-term experiments, and it performed well in simulating their soil total P (PTotal) over time. The model application simulated the soil available P (PAvailable) in the same range as the measured data, but the temporal dynamic did not always match the observed trends. P modelling is subject to a wide range of uncertainties with respect to both input data (particularly the unknown initial distribution of the different pool sizes of P and the uncertainty of the measurements) and the representation of processes influencing the P cycle that are not yet accounted for in the model. Despite these uncertainties and calls for further model assessment and developments, the results show that DayCent was capable of satisfactorily predicting the main P fluxes over time under a wide variety of management practices and European site conditions. SIGNIFICANCEThe model may be used to assess different scenarios with a changing climate, a change in management or land-use, and to analyse potential feedback between the terrestrial and the climate system. This makes this model a promising tool for assessing policy and practical interventions.

Encapsulated in sediments: eDNA deciphers the ecosystem history of one of the most polluted European marine sites

The Anthropocene is characterized by dramatic ecosystem changes driven by human activities. The impact of these activities can be assessed by different geochemical and paleontological proxies. However, each of these proxies provides only a fragmentary insight into the effects of anthropogenic impacts. It is highly challenging to reconstruct, with a holistic view, the state of the ecosystems from the preindustrial period to the present day, covering all biological components, from prokaryotes to multicellular eukaryotes. Here, we used sedimentary ancient DNA (sedaDNA) archives encompassing all trophic levels of biodiversity to reconstruct the two century-natural history in Bagnoli-Coroglio (Gulf of Pozzuoli, Tyrrhenian Sea), one of the most polluted marine-coastal sites in Europe. The site was characterized by seagrass meadows and high eukaryotic diversity until the beginning of the 20th century. Then, the ecosystem completely changed, with seagrasses and associated fauna as well as diverse groups of planktonic and benthic protists being replaced by low diversity biota dominated by dinophyceans and infaunal metazoan species. The sedaDNA analysis revealed a five-phase evolution of the area, where changes appear as the result of a multi-level cascade effect of impacts associated with industrial activities, urbanization, water circulation and land-use changes. The sedaDNA allowed to infer reference conditions that must be considered when restoration actions are to be implemented.

The glass finds from the Vetricella site (9th-12th c.)Introduction

We examine here the glass finds from the Vetricella site. This site, investigated during the ERC-Avanced nEU-Med project (www.neu-med.unisi.it ) is interpreted as the centre of the royal curtis of Valli attested in documentary sources from 937. During the excavation, a large number of glass objects dated from the 4th to the 12th centuries were unearthed. The compositions of the early mediaeval Vetricella glass vessels (beakers, goblets, bottles, ampoules/vials), are studied and compared with those of similar finds from various other European sites. With the exception of one glass bottle, made with Syro-palestinian plant ash soda glass, all the other studied glasses belong to Antique or Late-Antique natron glass groups (Mn- and Sb-decolorized, Foy 2 and HIMT). All these objects illustrate the recycling practices of Antique and Late Antique glass in Europe as they are described by Theophilus for the 11th and 12th centuries.

The Making and Unmaking of San Luis, an Apalachee-Spanish Town in Florida

The Spanish archival record is, perhaps unsurprisingly, relatively silent about the lives, experiences, and interactions of women in colonial San Luis and Apalachee. The gendered silence in the colonial archive is in part due to the lack of baptismal, marriage, and death records from Apalachee—in other words, the documents in which women are most likely to appear in Spanish colonial archives are missing for Apalachee. The archaeological and material records tell a different story. The ongoing archaeological excavations in Mission San Luis have uncovered a wealth of artifacts to help us reconstruct everyday life in the southern town. Although the European sites have been far more explored than the Apalachee ones, the archaeological findings help fill out, as well as complicate, a historical narrative focused on Spanish men. Correcting a male-centered focus requires not only writing stories of and about women, but also questioning the narratives and limitations produced by androcentric and un-gendered constructions of the past. This essay combines both historical documents and archaeological findings to offer a gendered reading of San Luis, its structures, and its everyday operations. It centers the life and experiences of women to explore the everyday contours of power in this early southern town.

Physiological strategies of moult-migrating Black-necked Grebes (Podiceps nigricollis) in a polluted staging site according to blood chemistry

After breeding, Black-necked Grebes (Podiceps nigricollis) perform a moult-migration to autumn hypersaline staging sites, where they moult the flight feathers and forage on superabundant brine shrimp (Artemia spp.) before leaving for wintering areas. During the stay in moulting sites, the grebes experience changes in organs and muscle size (atrophy, hypertrophy), and almost double their body mass, which has been suggested to act as an insurance against a collapse in prey availability in late autumn. During two years we collected blood samples from hundreds of individuals at one of the most important European moulting sites (the Odiel marshes, SW Spain), which is a highly polluted area due to mining drainage and chemical industry. We assessed the potential effect of moulting stage, day of the year and body condition on 16 blood biochemical parameters. Because of the changes in prey availability and body composition of grebes, we expected some physiological adjustments during moult. Elevated levels of cholesterol suggested that birds in active moult increased foraging effort to face the costs of moulting. There was increased amount of lactate dehydrogenase, corresponding to periods of breast muscle atrophy. Birds in active moult augmented protein ingestion, likely to account for the requirements of feather growth. We also show that the probability of fasting due to low prey availability increased late in the moulting season, as demonstrated by an increase in plasma β-hydroxy-butyrate.

Towards Emission-Free Construction Sites

EPTO is a smart solution for emission reduction on European construction sites

Interaction between temperature and salinity stress on the physiology of Dinophysis spp. and Alexandrium minutum: implications for niche range and blooming patterns

Abrupt changes in environmental conditions in estuaries and coastal waters have direct (physiological) and indirect (through changes in water column stability) effects on planktonic microalgae. Understanding and quantifying these effects is important to improve harmful algal bloom predictive models. Dinophysis spp. (D. acuminata, D. acuta and D. caudata) and Alexandrium minutum produce toxins that are transferred through the food web (particulate) by filter feeders and also released in the seawater. These dinoflagellates cause lengthy harvesting bans in European aquaculture sites and affect marine life. The 4 species were exposed to different combinations of temperature (T) and salinity (S) to investigate their short-term response (days) to and their recovery (weeks) from T/S stress. Dinophysis species showed varying capacities to deal with sudden changes in S, from the most resilient D. acuminata, equally affected by T and S stress, to the less tolerant D. acuta, and in particular D. caudata, more affected by S than T stress. The euryhaline A. minutum thrived under all the T/S combinations assayed. Further experiments showed a similar rate of okadaic acid toxin production (pg cell-1 d-1) for the 3 Dinophysis species under different T/S conditions. In contrast, a significant increment of gonyautoxin 4 content per cell was observed in A. minutum with decreasing S without significant effects associated with T. Our results highlight the response to environmental (T/S) stress of 3 species of Dinophysis and A. minutum with specific adaptations to thrive in different sub-habitats of the Galician Rías, an estuarine/coastal upwelling system in NW Spain.

"It depends on the people!" - A qualitative analysis of contextual factors, prior to the implementation of digital health innovations for chronic condition management, in a German integrated care network.

Integrated care and digital health technology interventions are promising approaches to coordinate services for people living with chronic conditions, across different care settings and providers. The EU-funded ADLIFE project intends to provide digitally integrated personalized care to improve and maintain patients' health with advanced chronic conditions. This study conducted a qualitative assessment of contextual factors prior to the implementation of the ADLIFE digital health platforms at the German pilot site. The results of the assessment are then used to derive recommendations for action for the subsequent implementation, and for evaluation of the other pilot sites. Qualitative interviews with healthcare professionals and IT experts were conducted at the German pilot site. The interviews followed a semi-structured interview guideline, based on the HOT-fit framework, focusing on organizational, technological, and human factors. All interviews were audio recorded, transcribed, and subsequently analysed following qualitative content analysis. The results of the 18 interviews show the interviewees' high openness and motivation to use new innovative digital solutions, as well as an apparent willingness of cooperation between different healthcare professionals. Challenges include limited technical infrastructure and large variability of software to record health data, lacking standards and interfaces. Considering contextual factors on different levels is critical for the success of implementing innovations in healthcare and the transfer into other settings. In our study, the HOT-fit framework proved suitable for assessing contextual factors, when implementing IT innovations in healthcare. In a next step, the methodological approach will be transferred to the six other European pilot sites, participating in the project, for a cross-national assessment of contextual factors.

Valorization of the newly discovered European snake-eyed skink population (Ablepharus kitaibelii) on Stinice, Papuk Mountain in Croatia

The European snake-eyed skink (Ablepharus kitaibelii) is an endangered lizard species in Croatia, limited to a very small area in Papuk Nature Park, and several localities in the town of Ilok and the surrounding area. On Mt Papuk, the species is limited to an area of the warm southern slopes of the Turjak-Mališćak-Pliš peaks, above Velika. In the year 2019, the species was documented in a new location, on Stinice. The aim of this study is to analyse morphometric measures, relative density, predatory pressure, and to determine the sustainability of this population. Data obtained were compared with the previous research into the European snake-eyed skink on Turjak, the most researched European snake-eyed skink site on Papuk so far. The population on Stinice has lower density, and is under higher predatory pressure than the population on Turjak. Also, there are differences in some morphometric measures between these two populations that should be further explored.

Battle or ballet? Metaphors archaeological Facebook administrators live by

ABSTRACT The emergence of online social networks such as Facebook provide new opportunities for communication between archaeologists, and between archaeologists and communities. While many studies, analyse the potential, advocate best practices, present relevant initiatives, and address the ethical challenges posed by social network sites for public archaeology, the motivations and ideas of those involved in setting up and managing such sites have been relatively underexplored to date. In this study, we present a qualitative text analysis and conceptual metaphor analysis of a focus group conversation and scoping interviews with eleven European archaeological Facebook site administrators, aimed to investigate their profiles, motivations and ideas.

The ExTINGUISH Trial: A Phase-2B Randomized Placebo-Controlled Trial of Inebilizumab in Anti-NMDA Receptor Encephalitis

Objective To assess the safety and efficacy of inebilizumab in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Background The lack of approved therapies for NMDAR encephalitis has led to substantial variability in treatment. High-quality data is needed to guide treatment and optimize long-term outcomes in recovering patients. Inebilizumab is a humanized anti-CD19 monoclonal antibody that can be administered intravenously with good CSF penetration and high target engagement. Inebilizumab may be an efficacious treatment for NMDAR encephalitis, with the potential to achieve early robust and sustained suppression of NMDAR autoantibodies and CD19+ plasmablasts and plasma cells leading to better long-term outcomes. Design/Methods The ExTINGUISH trial is a Phase 2B randomized double-blind placebo-controlled trial designed to evaluate the safety and efficacy of inebilizumab 300 mg for the acute treatment of moderate-to-severe NMDAR encephalitis. 120 participants will be enrolled at 20 US and two European sites (Barcelona, Spain; Rotterdam, The Netherlands). All patients will receive standard “first-line” immunotherapies prior to randomization. Cyclophosphamide IV rescue therapy will be provided after 6 weeks to patients who fail to respond to initial treatment. Motor, cognitive, and functional outcomes will be assessed over 96 weeks. Study operations will be supported via the NINDS-supported NeuroNEXT infrastructure. Results Primary outcomes will be ascertained at 16 weeks using the change in modified Rankin scale (adjusted for rescue therapy) and accepted safety measures. Comprehensive neuropsychological tests, bedside cognitive screening tools, and quality of life/ functional indices will be measured across study participation (secondary outcomes). Clinical data will be combined with biofluid biomarkers of immune activation to inform the biologic contributors to outcomes and identify surrogate endpoints that may be used in future clinical trials (tertiary outcomes). Conclusions ExTINGUISH Trial findings will immediately influence patient care, while informing the design and implementation of future clinical trials in autoimmune encephalitis.