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The calibration of test materials generally involves the interaction between empirical analysis and expert judgement. This paper explores the extent to which scale familiarity might affect expert judgement as a component of test validation in the calibration process. It forms part of a larger study that investigates the alignment of the LanguageCert suite of tests, Common European Framework of Reference (CEFR), the China Standards of English (CSE) and China's College English Test (CET). In the larger study, Year 1 students at a prestigious university in China were administered two tests--one with items based on China's College English Test (CET), and the other a CEFR-aligned test developed by LanguageCert--the LanguageCert Test of English (LTE). Comparable sections of the CET and the LTE involved sets of discrete items targeting lexico-grammatical competence. In order to ascertain whether expert judges were equally comfortable placing test items on either scale (CET or CEFR), a group of professors from the university in China who set the CET-based test, were asked to expert judge the CET items against the nine CSE levels with which they were very familiar. They were then asked to judge the LTE items against the six CEFR levels, with which they were less familiar. Both sets of expert ratings and the test taker responses on both tests were then calibrated within a single frame of reference and located on the LanguageCert scale. In the analysis of the expert ratings, the CSE-familiar raters exhibited higher levels of agreement with the empirically-derived score levels for the CET items than they did with the equivalent LTE items. This supports the proposition that expert judgement may be used in the calibration process where the experts in question have a strong knowledge of both the test material and the standards against which the test material is to be judged.

In language performance tests, raters are important as their scoring decisions determine which aspects of performance the scores represent; however, raters are considered as one of the potential sources contributing to unwanted variability in scores (Davis, 2012). Although a great number of studies have been conducted to unpack how rater variability impacts on rating decisions, much still remains unclear about what raters actually do when they assess speaking performances. This paper aimed to extend our understanding of the rating process by analysing think-aloud protocols provided by 13 VSTEP speaking raters while they used an analytic rating scale to assess 15 recorded performances with varying proficiency levels. The data suggested that although all the raters seemed to experience similar stages in the rating process, differences in rating behaviour between novice raters and experienced raters exist. To finalise the scores, the raters used five different strategies of deciding the scores.

A result of the pandemic is an urgent need for data collaborations that empower the clinical and scientific communities in responding to rapidly evolving global challenges. The ICU4Covid project joined research institutions, medical centers, and hospitals all around Europe in a telemedicine network for sharing capabilities, knowledge, and expertise distributed within the network. However, healthcare data sharing has ethical, regulatory, and legal complexities that pose several restrictions on their access and use. To mitigate this issue, the ICU4Covid project integrates a federated learning architecture, allowing distributed machine learning within a cross-institutional healthcare system without the data being transported or exposed outside their original location. This paper presents the federated learning approach to support the decision-making process for ICU patients in a European telemedicine network. The proposed approach was applied to the early identification of high-risk hypertensive patients. Experimental results show how the knowledge of every single node is spread within the federation, improving the ability of each node to make an early prediction of high-risk hypertensive patients. Moreover, a performance evaluation shows an accuracy and precision of over 90%, confirming a good performance of the FL approach as a prediction test. The FL approach can significantly support the decision-making process for ICU patients in distributed networks of federated healthcare organizations. [ABSTRACT FROM AUTHOR]

Human skills are a critical factor in the success or failure of a digital project. Limited studies have been conducted to identify the industry demand for skills of scrum roles (product owner, scrum master, web developer) and levels (entry, associate, mid-senior). The evaluation of skills over time benefits both decision-makers and associated team members, which leads to successful project completions. The aim of this research is to improve decision making concerning the level-specific skills of selected scrum roles for digital projects. The study identifies major and minor skills, patterns, and relationships between levels, and formulates the mathematical equations as the most important inputs to the skill-driven model's implementation and evaluation. Both qualitative and quantitative research methods were used to analyse 900 surveyed job advertisements published on LinkedIn in Europe. Descriptive analysis was used to analyse quantitative data while the deductive approach was followed with thematic analysis. There are required skill sets for each level of roles, level-specific skills, industry-demanded skills, and formulas related to the initial and individual skill ratings that are investigated. A new mechanism for evaluation is introduced based on "the time spent with skills". As a result, the proposed model is implemented by feeding research findings into the Mendix programming platform. The skill-driven model is a decision-support solution in software project management to evaluate skills which assist in assigning the right person to the right digital project. Further investigation on different job portals can help to improve the accuracy of industry standards and reduce the lack of progression skills by overcoming limitations identified in this paper. [ABSTRACT FROM AUTHOR]

Aim: The aim is to identify important factors for immigrants' health and well-being and for their use (or non-use) of primary health care (PHC) and other non-specialised services, and for possible ways that PHC can support healthy ageing of immigrants. Background: Older persons are an increasing share of the immigrant population in the global north, frequently in contact with various forms of health services, (PHC services most of all. Consequently, PHC services are in a particularly unique position to support healthy ageing of immigrants. Methods: The position paper builds on five international, multi-professional and cross-disciplinary small group discussions as well as an international workshop early summer. During the discussions and the workshop, topics were arrived at as to factors related to the health situation of older immigrants, their needs, and health-seeking behaviour, and to how PHC professionals could support healthy ageing in immigrants. Those main topics in turn guided search for relevant research literature and informed the selection of the main research questions of this paper. Findings: Several factors, in addition to culture and cultural differences, are important to for PHC professionals and decision-makers to take into consideration in encounters with older immigrants. The socio-economic position of the older immigrant and close relatives, inter-generational relationships within the immigrant communities, country-specific factors in the host country like health care expenditure, and communication skills in health professionals are all examples of factors playing an important role regarding the health and health-seeking behaviour of older immigrants. [ABSTRACT FROM AUTHOR]

This paper explores business models for community energy storage (CES) and examines their potential and feasibility at the local level. By leveraging Multi Criteria Decision Making (MCDM) approaches and real-world case studies in Europe and India, it presents insights into CES deployment opportunities, challenges, and best practices. Different business models, including community energy cooperatives, utility–community partnerships, demand response, energy services, and market mechanisms, are analyzed. The proposed method combines the MCDM method PROMETHEE II with the fuzzy set theory to obtain a complete CES business model ranking, addressing project uncertainties. The analysis emphasizes CES's role in balancing local renewable energy supply and demand, facilitating energy sharing, and achieving energy independence. Findings prioritize models like Community Cooperative, Energy Arbitrage, and Energy Arbitrage Peak Shaving for CES with renewables. Environmental benefits include reduced diesel use and greenhouse gas emissions. Efficient cooperatives are advocated to recover costs and enable competitive energy prices. The paper highlights the need for novel value propositions to boost the energy transition in local communities. This research contributes to the discourse on CES business models, fostering knowledge exchange and promoting effective strategies for sustainable energy systems. [ABSTRACT FROM AUTHOR]

This paper examines the ethical and legal challenges encountered during the GATEKEEPER Project and how these challenges informed the development of a comprehensive framework for future Large-Scale Pilot (LSP) projects. GATEKEEPER is a LSP Project with 48 partners conducting 30 implementation studies across Europe with 50,000 target participants grouped into 9 Reference Use Cases. The project underscored the complexity of obtaining ethical approval across various jurisdictions with divergent regulations and procedures. Through a detailed analysis of the issues faced and the strategies employed to navigate these challenges, this study proposes an ethical and legal framework. This framework, derived from a comparative analysis of ethical application forms and regulations, aims to streamline the ethical approval process for future LSP research projects. By addressing the hurdles encountered in GATEKEEPER, the proposed framework offers a roadmap for more efficient and effective project management, ensuring smoother implementation of similar projects in the future. [ABSTRACT FROM AUTHOR]

Background: Sustainable energy transition of a country is complex and long-term process, which requires decision-making in all stages and at all levels, including a large number of different factors, with different causality. The main objective of this paper is the development of a probabilistic model for decision-making in sustainable energy transition in developing countries of SE Europe. The model will be developed according to the specificities of the countries for which it is intended—SE Europe. These are countries where energy transition is slower and more difficult due to many factors: high degree of uncertainty, low transparency, corruption, investment problems, insufficiently reliable data, lower level of economic development, high level of corruption and untrained human resources. All these factors are making decision-making more challenging and demanding. Methods: Research was done by using content analysis, artificial intelligence methods, software development method and testing. The model was developed by using MSBNx—Microsoft Research's Bayesian Network Authoring and Evaluation Tool. Results: Due to the large number of insufficiently clear, but interdependent factors, the model is developed on the principle of probabilistic (Bayesian) networks of factors of interest. The paper presents the first model for supporting decision-making in the field of energy sustainability for the region of Southeastern Europe, which is based on the application of Bayesian Networks. Conclusion: Testing of the developed model showed certain characteristics, discussed in paper. The application of developed model will make it possible to predict the short-term and long-term consequences that may occur during energy transition by varying these factors. Recommendations are given for further development of the model, based on Bayesian networks. [ABSTRACT FROM AUTHOR]

In Europe, the two main nuclear accident response decision support systems in use are ARGOS and JRODOS, both of which make use of the FDMT (Food Chain and Dose Module for Terrestrial pathways) model to simulate the transfer of radioactivity along terrestrial food chains and to predict radionuclide activity concentrations in human foodstuffs. FDMT was originally developed in the early 1990s for Southern German agricultural conditions. Its application to other geographical settings has raised concerns regarding its fitness for purpose. Furthermore, the FDMT model in its original format lacks transparency, flexibility, and the possibility to be run probabilistically. In order to improve FDMT's fitness for purpose and overcome its main shortcomings, it has been implemented in a new modelling platform which incorporates powerful numerical solvers and renders uncertainty and sensitivity analysis possible. The modelling structure of FDMT has been re-configured, and a library configuration has been introduced which offers flexibility in working such that model components can be tested, modified, or replaced easily. The new FDMT allows for the consideration of case/region-specific issues and to make predictions which are of more relevance and of better use with regard to decision making and management of risk. Furthermore, the default databases of FDMT have been updated and wherever possible PDFs have been assigned. In this paper, the transition of FDMT from an old to a new modelling structure is presented along with a demonstration of developments achieved. [ABSTRACT FROM AUTHOR]

Using a five-year data set including the crowd-less games in the 2020 English, Spanish, Italian, and German first division football leagues and multivariate regression analysis, this paper estimated how fans influence home field advantage. Consistent with previous studies, the estimates showed that in games with crowds, referees gave fewer fouls, yellow cards, and red cards but more penalty kicks to the home team than to the away team. Removing the fans from the stadium eliminated these home advantages coming through referee decisions. Removing fans reduced yellow and red cards given to away teams but did not change cards given to home teams. There was not a similar asymmetry for fouls and penalty kicks. These results suggest that crowds influenced referee judgments about how severe an infraction was more than they influenced decisions about whether a foul occurred. The addition of VAR had little impact on referee decisions and no effect on the home advantage in goal differential. Despite the home bias in referee decisions when crowds were in the stadium, fouls, cards, and penalty kicks played a relatively small role in determining home advantage in game outcomes and most of the home advantage remained after fans were removed. [ABSTRACT FROM AUTHOR]

Background: Shared decision-making is one key element of interprofessional collaboration. Communication is often considered to be the main reason for inefficient or ineffective collaboration. Little is known about group dynamics in the process of shared decision-making in a team with professionals, including the patient or their parent. This study aimed to evaluate just that. Methods: Simulation-based training was provided for groups of medical and allied health profession students from universities across the globe. In an overt ethnographic research design, passive observations were made to ensure careful observations and accurate reporting. The training offered the context to directly experience the behaviors and interactions of a group of people. Results: Overall, 39 different goals were defined in different orders of prioritizing and with different time frames or intervention ideas. Shared decision-making was lacking, and groups chose to convince the parents when a conflict arose. Group dynamics made parents verbally agree with professionals, although their non-verbal communication was not in congruence with that. Conclusions: The outcome and goalsetting of an interprofessional meeting are highly influenced by group dynamics. The vision, structure, process, and results of the meeting are affected by multiple inter- or intrapersonal factors. [ABSTRACT FROM AUTHOR]

Self-management interventions (SMIs) offer a promising approach to actively engage patients in the management of their chronic diseases. Within the scope of the COMPAR-EU project, our goal is to provide evidence-based recommendations for the utilisation and implementation of SMIs in the care of adult individuals with type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, utilising a core outcome set (COS), identified critical outcomes and established effect thresholds for each outcome. The panel formulated recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, a transparent and rigorous framework for developing and presenting the best available evidence for the formulation of recommendations. All recommendations are based on systematic reviews (SR) of the effects and of values and preferences, a contextual analysis, and a cost-effectiveness analysis. The COMPAR-EU panel is in favour of using SMIs rather than usual care (UC) alone (conditional, very low certainty of the evidence). Furthermore, the panel specifically is in favour of using ten selected SMIs, rather than UC alone (conditional, low certainty of the evidence), mostly encompassing education, self-monitoring, and behavioural techniques. The panel acknowledges that, for most SMIs, moderate resource requirements exist, and cost-effectiveness analyses do not distinctly favour either the SMI or UC. Additionally, it recognises that SMIs are likely to enhance equity, deeming them acceptable and feasible for implementation. [ABSTRACT FROM AUTHOR]

Structural condition diagnostics provides the basis for decision making regarding the possibility of continued safe operation, necessary reinforcement, repair work, and in extreme cases, dismantling of the structure. The most reliable results concerning the condition and strength of materials are provided by destructive testing. However, these tests are very time-consuming, costly, and difficult to perform on in-service facilities. In addition, they involve the need to obtain the consent of the occupants of the premises and subsequent renovations. This article focuses on presenting an opportunity to reduce the number of destructive tests necessary to reliably assess the condition of large-panel structures, which constitute a significant housing stock in Europe. Based on tests carried out on a real building, the risk factors associated with obtaining reliable results by non-destructive methods were determined. Areas where destructive testing is necessary were identified. In addition, reference was made to standard recommendations and guidelines from a reputable research institution. Practical guidelines were formulated regarding the diagnostics of large-panel structures, resulting in a reduction in the number of destructive tests required. [ABSTRACT FROM AUTHOR]

The present study aimed to compare the scored and conceded goals of the top six European football leagues (Portugal, Spain, France, Italy, England, and Germany) between 2001 and 2020. The champions have a mean combo (indicator that combines attack and defence ranking) result between 1 and 1.40. The French and Italian leagues were the only ones where variation coefficients of this combo result overpassed 50% (71 and 59%, respectively) compared to the remaining football leagues. Further subsequent analysis showed that the Portuguese and French leagues differ significantly from Italy in terms of the best attack position of the champions (Z=3.196; p=0.01; η2=0.123). Regarding position in the defensive ranking, Portugal and Italy showed significantly different results compared to France (Z=3.763; p=0.003; η2=1.42). Besides, the only two countries with significant differences in scored and conceded goals positioning were France (attack better than defence; t=-3; p<0.01; d=2.236) and Italy (defence better than attack; t=2.881 p<0.01; d=1.164). Hence, in the French football league, a higher attack performance than a defence seems to indicate the champion. Oppositely, in the Italian football league, champions traditionally occupy top positioning on defence, even if they do not present the same performance on scored goals. [ABSTRACT FROM AUTHOR]

The concept of the homo oeconomicus is often used to model human behaviour in economic contexts. However, other factors like tradition or the preference to comply with social norms can play a role in decision‐making processes.To emphasize the need for incorporating non‐pecuniary values in economic models, we use data for participation in several agri‐environment schemes (AES) in Europe and show that dynamical patterns can not be simulated by models using the homo oeconomicus concept.The presented data show gradually increasing participation levels in AES even if payment levels are constant. Furthermore, low participation levels are sometimes observed despite appropriate incentive schemes.We propose and investigate a dynamic mathematical model to implement social norms in farmers' land‐use decision‐making in the face of AES. This socio‐economic model can help to explain the variety of observed behavioural patterns. It can generate multistable dynamics regarding the level of AES participation in the long‐term. We further assume that informative campaigns can modify farmers' perception of norms. Campaigns can have a stabilizing effect if strong enough.The attempt of this work is to gain a better understanding of how the integration of social human behaviour in economic models affects simulation patterns. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

We assess the development of the relationship between the institution of the head of state and judicial power as it has developed from the patrimonial state through individual other epochs of the history of monarchical power to the present. The original concentration of all power in the hands of the monarch is gradually changing so that, in the process of revolutions, monarchs leave legislative, executive and judicial powers to the decision-making framework of parliaments and governments. This process takes on a special form in the era of so-called constitutional monarchies at the turn of the 18th and 19th centuries. Special history then concerns the development of the judiciary, when the modern ministries of justice (from the 19th century) and after the Second World War even special bodies such as the Supreme Council of the Judiciary perform important functions precisely in relation to the judiciary in the selection of judges, their appointment and promotion to positions, in matters of a disciplinary nature, etc. Modern systems of a republican nature basically place the function of the president in a position like that of the head of state as in modern constitutional monarchies. Presidents and monarchs therefore, even in relation to the judiciary, mostly remain in the position of the highest body of the state, which confirms the personnel proposals of other bodies of the division of power by means of an appointment decree. Special attention is paid to the character of the relationship examined here in the Czech Republic and its constitutional system. [ABSTRACT FROM AUTHOR]

Background: Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs). The aims of this study protocol are: 1) to elicit the experiences of bereaved relatives and health care professionals of patients treated with palliative sedation and 2) to explore the understanding of the decision-making process to start palliative sedation across care settings in 5 European countries. Methods: This study protocol is part of the larger HORIZON 2020 Palliative Sedation project. Organisational case study methodology will be used to guide the study design. In total, 50 cases will be conducted in five European countries (10 per country). A case involves a semi-structured interview with a relative and an HCP closely involved in the care of a deceased patient who received some type of palliative sedation at the end-of-life. Relatives and health care professionals of deceased patients participating in a linked observational cohort study of sedated patients cared for in hospital wards, palliative care units and hospices will be recruited. The data will be analyzed using a framework analysis approach. The first full case will be analyzed by all researchers after being translated into English using a pre-prepared code book. Afterwards, bimonthly meetings will be organized to coordinate the data analysis. Discussion: The study aims to have a better understanding of the experiences of relatives and professional caregivers regarding palliative sedation and this within different settings and countries. Some limitations are: 1) the sensitivity of the topic may deter some relatives from participation, 2) since the data collection and analysis will be performed by at least 5 different researchers in 5 countries, some differences may occur which possibly makes it difficult to compare cases, but using a rigorous methodology will minimize this risk. [ABSTRACT FROM AUTHOR]

Bovine besnoitiosis (BB) is a chronic and debilitating parasitic disease in cattle caused by the protozoan parasite Besnoitia besnoiti. South European countries are affected and have reported clinical cases of BB. However, BB is considered as emerging in other countries/regions of central, eastern and northern Europe. Yet, data on drivers of emergence of BB in Europe are scarce. In this study, fifty possible drivers of emergence of BB in cattle were identified. A scoring system was developed per driver. Then, the scoring was elicited from eleven recognized European experts to: (i) allocate a score to each driver, (ii) weight the score of drivers within each domain and (iii) weight the different domains among themselves. An overall weighted score was calculated per driver, and drivers were ranked in decreasing order of importance. Regression tree analysis was used to group drivers with comparable likelihoods to play a role in the emergence of BB in cattle in Europe. Finally, robustness testing of expert elicitation was performed for the seven drivers having the highest probability to play a key role in the emergence of BB: i.e., (i) legal/illegal movements of live animals from neighbouring/European Union member states or (ii) from third countries, (iii) risk of showing no clinical sign and silent spread during infection and post infection, (iv) as a consequence, difficulty to detect the emergence, (v) existence of vectors and their potential spread, (vi) European geographical proximity of the pathogen/disease to the country, and (vii) animal density of farms. Provided the limited scientific knowledge on the topic, expert elicitation of knowledge, multi-criteria decision analysis, cluster and sensitivity analyses are very important to prioritize future studies, e.g., the need for quantitative import risk assessment and estimation of the burden of BB to evidence and influence policymaking towards changing (or not) its status as a reportable disease, with prevention and control activities targeting, firstly, the top seven drivers. The present methodology could be applied to other emerging animal diseases. [ABSTRACT FROM AUTHOR]

Algorithmic decision-making based on profiling may significantly affect people's destinies. As a rule, however, explanations for such decisions are lacking. What are the chances for a "right to explanation" to be realized soon? After an exploration of the regulatory efforts that are currently pushing for such a right it is concluded that, at the moment, the GDPR stands out as the main force to be reckoned with. In cases of profiling, data subjects are granted the right to receive meaningful information about the functionality of the system in use; for fully automated profiling decisions even an explanation has to be given. However, the trade secrets and intellectual property rights (IPRs) involved must be respected as well. These conflicting rights must be balanced against each other; what will be the outcome? Looking back to 1995, when a similar kind of balancing had been decreed in Europe concerning the right of access (DPD), Wachter et al. (2017) find that according to judicial opinion only generalities of the algorithm had to be disclosed, not specific details. This hardly augurs well for a future right of access let alone to explanation. Thereupon the landscape of IPRs for machine learning (ML) is analysed. Spurred by new USPTO guidelines that clarify when inventions are eligible to be patented, the number of patent applications in the US related to ML in general, and to "predictive analytics" in particular, has soared since 2010—and Europe has followed. I conjecture that in such a climate of intensified protection of intellectual property, companies may legitimately claim that the more their application combines several ML assets that, in addition, are useful in multiple sectors, the more value is at stake when confronted with a call for explanation by data subjects. Consequently, the right to explanation may be severely crippled. [ABSTRACT FROM AUTHOR]

(1) Background: Cloud storage is often required for successful operation of novel smart applications, relying on data produced by the Internet of Things (IoT) devices. Big Data processing tasks and management operations for such applications require high Quality of Service (QoS) guarantees, requiring an Edge/Fog computing approach. Additionally, users often require specific guarantees in the form of Service Level Agreements (SLAs) for storage services. To address these problems, we propose QoS-enabled Fog Storage Services, implemented as containerised storage services, orchestrated across the Things-to-Cloud computing continuum. (2) Method: The placement of containerised data storage services in the Things-to-Cloud continuum is dynamically decided using a novel Pareto-based decision-making process based on high availability, high throughput, and other QoS demands of the user. The proposed concept is first confirmed via simulation and then tested in a real-world environment. (3) Results: The decision-making mechanism and a novel SLA specification have been successfully implemented and integrated in the DECENTER Fog and Brokerage Platform to complement the orchestration services for storage containers, thus presenting their applicable value. Simulation results as well as practical experimentation in a Europe-wide testbed have shown that the proposed decision-making method can deliver a set of optimal storage nodes, thus meeting the SLA requirements. (4) Conclusion: It is possible to provide new smart applications with the expected SLA guarantees and high QoS for our proposed Fog Storage Services. [ABSTRACT FROM AUTHOR]

Aim: To inform the primary care community about priorities for research in primary care as came up from the European project TO-REACH and to discuss transferability of service and policy innovations between countries. Background: TO-REACH stands for Transfer of Organizational innovations for Resilient, Effective, equitable, Accessible, sustainable and Comprehensive Health services and systems. This EU-funded project has put health systems and services research higher on the European agenda and has led to the current development of a European 'Partnership Transforming Health and Care Systems'. Methods: To identify research priorities, both qualitative and quantitative approaches were used. Policy documents and strategic roadmaps were searched, and priorities were mapped. Stakeholders were involved through national roundtable consultations and online consultations. Regarding transferability, we carried out a review of the literature, guided by a conceptual framework, and using a snowballing approach. Findings: Primary care emerged as an important priority from the inventory, as are areas that are conducive to strengthening primary care, such as workforce policies. The large variation in service organisation and policy around primary care in Europe is a huge potential for cross-country learning. However, the simple transfer of primary care service and policy arrangements from one health system to another has a big chance to fail, unless known conditions for successful transfer are taken into account and gaps in our knowledge about transfer are resolved. [ABSTRACT FROM AUTHOR]

Background. While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. Methods. We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style – Staff questionnaire and a set of questions regarding clinicians’ expertise, training, and practice. Results. SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. Conclusions. The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe. [ABSTRACT FROM AUTHOR]