The purpose of this report is to investigate how Dutch thermal energy communities can successfully transition from grassroots initiatives to formal thermal energy organisations. The study explores the knowledge and values required by community boards to achieve this transformation, focussing on how they address internal knowledge gaps and collaborate with external stakeholders. Key areas of inquiry include the types of knowledge needed, how the board ensures community members understand the social, environmental, and economic impacts of thermal energy, and the role of partnerships in advancing these initiatives. The findings aim to provide insights that can support scalable implementations in the Netherlands and Europe.

The theoretical framework of this report is based on the 3C model, which builds on Amartya Sen’s capability approach. This model emphasises three key capabilities: conscientiality, conciliation, and collaboration, which are necessary for the successful transition of thermal energy community initiatives into formal organisations. Conscientiousness involves raising critical awareness within communities about their energy needs and environmental impacts. Conciliation focusses on the building of consensus among stakeholders, while collaboration emphasises partnerships with ex- ternal actors, such as municipalities and energy companies, to access resources and expertise.
The research methodology combines a qualitative approach with thematic analysis. Semi-structured interviews were conducted with key members of five energy cooperatives to gather insights into community dynamics, knowledge sharing and values. These interviews were supported by an anal- ysis of existing literature and two additional interviews. The data collected was analysed using a systematic coding process, grouped into themes aligned with the research questions and the the- oretical framework to identify patterns and insights related to the development of thermal energy communities. This methodology ensures both reliability and validity in capturing the challenges and successes of grassroots energy initiatives.

The key findings of the report highlight several important aspects of thermal energy initiatives in the Netherlands. First, these initiatives require diverse knowledge, including financial, technical, and organisational expertise, which can be sourced both locally and externally. Partnerships with pro- fessional entities are crucial to fill knowledge gaps, especially in the legal, technical, and financial areas. Community involvement is essential for the success of these initiatives. Trust and familiarity within the community are critical to convincing residents to adopt sustainable heating solutions, es- pecially when costs are comparable to traditional heating options. Personal interactions, such as one-on-one conversations, were found to be the most effective way of sharing information and gain- ing community trust. Collaboration with external stakeholders, especially local governments, is also vital. The success of these initiatives often hinges on their relationship with the local government, which is involved in the funding, approvals, and overall support of the project. However, challenges such as differing work paces and ownership questions can slowly progress. These insights provide a clear understanding of the dynamics and hurdles faced by thermal energy communities in the Netherlands.

The study found that knowledge and trust are critical factors in the success of thermal energy com- munities transitioning to formal organisations. Boards rely on a mix of local expertise and external consulting for specialised knowledge, with local involvement fostering trust among residents. Per- sonal involvement, such as door-to-door communication, is essential to gain support. In addition, collaboration with external partners, particularly local governments, plays a key role in the practical implementation of projects. Challenges such as ownership and the varied cooperation of municipali- ties have emerged as significant hurdles. The study suggests that the ability of the board to manage knowledge, build trust, and collaborate effectively determines the success of these initiatives.

The majority of patients with osteogenesis imperfecta (OI) have mutations in the COL1A1 or COL1A2 gene, which has consequences for the composition of the bone matrix and bone architecture. The mutations result in overmodified collagen molecules, thinner collagen fibres and hypermineralization of bone tissue at a bone matrix level. Trabecular bone in OI is characterized by a lower trabecular number and connectivity as well as a lower trabecular thickness and volumetric bone mass. Cortical bone shows a decreased cortical thickness with less mechanical anisotropy and an increased pore percentage as a result of increased osteocyte lacunae and vascular porosity. Most OI patients have mutations at different locations in the COL1 gene. Disease severity in OI is probably partly determined by the nature of the primary collagen defect and its location with respect to the C-terminus of the collagen protein. The overall bone biomechanics result in a relatively weak and brittle structure. Since this is a result of all of the above-mentioned factors as well as their interactions, there is considerable variation between patients, and accurate prediction on bone strength in the individual patient with OI is difficult. Current treatment of OI focuses on adequate vitamin-D levels and interventions in the bone turnover cycle with bisphosphonates. Bisphosphonates increase bone mineral density, but the evidence on improvement of clinical status remains limited. Effects of newer drugs such as antibodies against RANKL and sclerostin are currently under investigation. This paper was written under the guidance of the Study Group Genetics and Metabolic Diseases of the European Paediatric Orthopaedic Society. Cite this article: Nijhuis WH, Eastwood DM, Allgrove J, Hvid I, Weinans HH, Bank RA, Sakkers RJ. Current concepts in osteogenesis imperfecta: bone structure, biomechanics and medical management.

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