From kilowatts to cents: Financial inclusion of citizens through Dutch community energy business model configurations

Community energy initiatives (CEIs) emphasize citizen empowerment, equitable distribution of energy transitioncosts and benefits, and the importance of local knowledge. While CEI goals align with energy justice principles,they have been criticized for not fully incorporating distributive justice, particularly the distribution of thebenefits of a sustainable energy transition. Therefore, they may potentially perpetuate income inequalities. Thereare insufficient studies to conclusively determine whether CEIs perpetuate or address income inequalities.Moreover, the integration of transition studies, energy justice and business model literature is lacking, hinderingeffective analysis of CEI configurations that address income inequalities. This paper aims to connect the sustainability, energy justice and business model literature by dissecting the business model configurations of CEIsand assessing the inclusiveness of these components. To do so, we develop and employ an adapted businessmodel canvas that incorporates societal and environmental considerations in the value proposition, value creation and delivery and value capture. The canvas is used to determine whether sustainability and energy justiceconsiderations, particularly distributive justice principles, are embedded in the CEI business models. Theresearch is focused on the Netherlands, a country with a high number of CEIs. However, the study may yieldinsights relevant to other countries and CEIs, informing the integration of principles for societal inclusion in theirown contexts. We utilize a mixed-method approach, including interviews, desk research and surveys, to ensurerobust analysis through data triangulation. The study finds that there are elements of CEI business model configurations that are aligned with energy justice principles. However, models specifically targeting and aligningwith minimum income social groups are rare

Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

BACKGROUND: A larger thrombus in patients with acute ischemic stroke might result in more complex endovascular treatment procedures, resulting in poorer patient outcomes. Current evidence on thrombus volume and length related to procedural and functional outcomes remains contradicting. This study aimed to assess the prognostic value of thrombus volume and thrombus length and whether this relationship differs between first-line stent retrievers and aspiration devices for endovascular treatment.METHODS: In this multicenter retrospective cohort study, 670 of 3279 patients from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) for endovascularly treated large vessel occlusions were included. Thrombus volume (0.1 mL) and length (0.1 mm) based on manual segmentations and measurements were related to reperfusion grade (expanded Treatment in Cerebral Infarction score) after endovascular treatment, the number of retrieval attempts, symptomatic intracranial hemorrhage, and a shift for functional outcome at 90 days measured with the reverted ordinal modified Rankin Scale (odds ratio &gt;1 implies a favorable outcome). Univariable and multivariable linear and logistic regression were used to report common odds ratios (cORs)/adjusted cOR and regression coefficients (B/aB) with 95% CIs. Furthermore, a multiplicative interaction term was used to analyze the relationship between first-line device choice, stent retrievers versus aspiration device, thrombus volume, and outcomes.RESULTS: Thrombus volume was associated with functional outcome (adjusted cOR, 0.83 [95% CI, 0.71-0.97]) and number of retrieval attempts (aB, 0.16 [95% CI, 0.16-0.28]) but not with the other outcome measures. Thrombus length was only associated with functional independence (adjusted cOR, 0.45 [95% CI, 0.24-0.85]). Patients with more voluminous thrombi had worse functional outcomes if endovascular treatment was based on first-line stent retrievers (interaction cOR, 0.67 [95% CI, 0.50-0.89]; P=0.005; adjusted cOR, 0.74 [95% CI, 0.55-1.0]; P=0.04). CONCLUSIONS: In this study, patients with a more voluminous thrombus required more endovascular thrombus retrieval attempts and had a worse functional outcome. Patients with a lengthier thrombus were less likely to achieve functional independence at 90 days. For more voluminous thrombi, first-line stent retrieval compared with first-line aspiration might be associated with worse functional outcome.</p