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\section{Introduction}
\label{sec:intro}
Total knee arthroplasty (TKA) has evolved into a mature surgical intervention. According to the recent overview article of Sharkey et al. \cite{Sharkey.2014} and references therein, there is an ever more increasing number of patients undergoing TKA intervention; in 2003 more than 400\,000 primary TKA were performed and demand was estimated to increase by almost 700\% to over three million procedures by the year 2030. Despite long survivorship (survival rates greater than 90\% after 10 years follow-up), the increasing number of primary TKA has been associated with increased rates of revision TKA procedures According to Sharkey et al. \cite{Sharkey.2014} the most common failure mechanisms of TKA was loosening (39.9\%).

In view of these numbers, most notably the percentage of loosening among the failure mechanisms, there is a need and space for improvements. While implant loosening can have different causes as implant wear or infection \cite{Carr.2012}, stress shielding inducing bone loss an important case likewise, for a review of periprosthetic osteolysis we refer to \cite{Gallo.2013}.

The overall aim of this paper is to overcome stress shielding and bone resorption in post-TKA tibial bone by a novel implant fixation concept. To put things into perspective and to underpin the novelty of the present approach in comparison to other works, previous and on-going research activities shall be classified and their results briefly summarized.
\\[2mm]
Candidates to cause tibial stress shielding and bone resorption in TKA are (i) the implant material, (ii) the stem length, (iii) the fixation concept -- surface cementation versus full cementation, (iv) the baseplate positioning, and more characteristic features of TKA; for their investigation results from clinical research and through simulations have been obtained, partially with controversial results and conclusions.
\\[2mm]
One controversial topic is the role of implant material.
Martin et al. \cite{Martin.2017} considered medial tibial stress shielding by a radiographic comparative analysis with a focus on the role of material stiffness, cobalt chromium (CoCr), or an all polyethylene (AP) tibial implant. The finding that the CoCr cohort had the highest amount of medial tibial bone loss, the AP cohort the least amount of stress shielding, suggests that the more compliant the implant, the less the bone loss.

In their finite element analysis (FEA) Au et al. \cite{Au.2007} found that the Young's modulus mismatch of implant compared to bone is not sufficiently descriptive as the primary cause of stress shielding. Instead, they pointed out that loading conditions as a result of altered bone or implant condylar surface geometry, load placement on the condylar surface, and load pattern created by the TKA are at least as important in observed stress shielding.

The results of Zhang et al. \cite{Zhang.2016} suggest that the effect of stress shielding on the periprosthetic bone is more significantly influenced by the implant material than by the implant geometry. Pronounced stress shielding was found in metal-backed (MB) cases as opposed to AP cases, particularly in the bone regions right beneath the baseplate.
\\[2mm]
The influence of stem design and stem length must not be restricted to stress shielding but must cover the aspect of mechanical stability likewise. Completo et al. \cite{Completo.2009} assessed stress shielding and stress concentrations through FEA of different tibial stem designs. For bone regions underneath the tibial tray and around the stem, the geometry of stem had a more pronounced bone effect compared to the stem material. The results of this study support that short stems produce a minor effect in bone relatively to long stem in terms of stress shielding and stress concentration at tip region. No significant stress shielding differences was observed between Co–Cr and titanium stems. Overall, all stems provoked high stress concentrations in bone at the tip of the stem.

Scott and Biant \cite{Scott.2012} analyzed the role of stems in TKA. They found that stems improve the mechanical stability of tibial components (resistance to shear, reduced tibial lift-off, reduced micro motion), but come at a cost of stress shielding along their length. The authors conceded the disadvantages including stress shielding along the length of the stem with associated reduction in bone density and a theoretical risk of subsidence and loosening, periprosthetic fracture and end-of-stem pain. While these features make long stems unattractive in the primary TKA setting, they are often desirable in revision surgery with bone loss and instability.
\\[2mm]
Innocenti et al. \cite{Innocenti.2009} investigated the influence of baseplate positioning; they highlighted the medial cortical support of the tibial baseplate for normal stress transfer to the underlying bone which prevents local bone resorption at the proximal tibia as a result of  stress shielding.
\\[2mm]
Another important aspect of stress-shielding in TKA is cementation in its variants of full versus surface cementation, and other parameters like layer thickness and bone-cement interface. Cawley et al. \cite{Cawley.2013} found that
full cementation results in greater stress reduction under the tibial baseplate than surface cementation, and concluded that surface cementation will result in less proximal bone resorption, thus reducing the possibility of aseptic loosening.

Gallo et al. \cite{Gallo.2013} investigated the role of the bone-cement interface, Vanlommel et al. \cite{Vanlommel.2011}; Cawley et al. \cite{Cawley.2012,Cawley.2013} address the question of the best technique for cementation in TKA and thereby point to inter-surgeon differences which might introduce a bias thus avoiding a consensus in that question. Schlegel et al. \cite{Schlegel.2015} highlight the crucial role of surface preparation and pulsed lavage in TKA.
\\[2mm]
With the same aim as the above cited works, namely to overcome bone resorption in post-TKA tibial bone, the present work suggests a new pathway to achieve that goal by proposing a novel implant fixation concept.

\section{Materials and Methods}
\label{sec:Methods}

\subsection{Tibia reconstruction}
\label{subsec:FemurReconstruction}

The CAD-model of the tibia was generated using trial version of \textit{Simpleware Software} developed by \textit{Synopsys Inc., USA}. The CT data used for the present study were obtained from the Visible Human Project, \cite{VHP-ctdata}, \cite{VHP-general}, and belong to a 59 year old female cadaver. A data set of 340 CT images ($512\times512$ pixels, 12 bit gray scales, DICOM format) was used for the tibia reconstruction. The vertical and horizontal spacing between the pixels each of 0.33\,mm enabled cubic voxels in reconstruction.

The heterogeneous Young's modulus distribution is obtained from the computer tomography (CT) images in three steps. Firstly, the CT number measured in terms of the so-called Hounsfield unit (HU) is calculated for bony tissue by means of the attenuation coefficients $\mu$ of both bony tissue and water; it holds

\begin{equation}
 CT(\mu_\textrm{tissue}):=\frac{\mu_\textrm{tissue}-\mu_\textrm{water}}{\mu_\textrm{water}} \cdot 1000\,\textrm{HU}\,,
\label{CTnorm}
\end{equation}

Next, the tissue density $\rho_\textrm{tissue}$ is calculated as a function of the $CT$ number

\begin{equation}
\rho_\textrm{tissue}(CT)=\frac{\rho_\textrm{water}-\rho_\textrm{air}}{CT_\textrm{water}-CT_\textrm{air}}\cdot CT_\textrm{tissue}+\rho_\textrm{water}\,.
\label{dichte1}
\end{equation}

The linear conversion in \eqref{dichte1} reflects the fact that the $CT$ number is linear in the density of the material; $CT$ values for water and air are known.

Using the conversion of \cite{Rho.1995} for the proximal tibia, the density calculation in \eqref{dichte1} obeys the form \eqref{CTtoRho} and the Young's modulus is calculated according to \eqref{RhotoE}. The conversions are carried out using Bonemat tool developed by \cite{Taddei.2007}

\begin{eqnarray}
\rho_\textrm{tissue}(CT) &=& 114 + 0.916 \cdot CT \, \, \text{(kg/m$^{3}$)} \, .
\label{CTtoRho} \\
E &=& -326+5.54 \cdot \rho \, \, \text{(MPa)}
\label{RhotoE}
\end{eqnarray}

The data sets for the reconstructed bone model and finite element discretizations are published as a supplement. It shall facilitate research in the field of knee implants in the spirit of \cite{Viceconti.1996} and \cite{Eidel.2018}.

\subsection{Finite element analysis}
\label{subsec:FEA}
The finite element solver Abaqus 2017 (Dassault Syst\`{e}mes, Paris, France) was used in geometrically nonlinear simulations for deformation and stress analyses.
Tetrahedral finite elements with quadratic shape functions (10 nodes) along with displacement degrees of freedom were used for the discretization of bone and implant.

\subsubsection{Boundary and interface conditions}

\begin{Figure}[htbp]
	\begin{minipage}{16.5cm}
		\centering
		\subfigure[]{\includegraphics[height=8cm, angle=0]{PreOP_Force_Transfer_Arrow_V1.PNG}} \hspace*{6mm}
		\subfigure[]{\includegraphics[height=8cm, angle=0]{PostOP_Force_Transfer_Arrows_V1.png}} \hspace*{6mm}
		\subfigure[]{\includegraphics[height=7cm, angle=0]{Load_Surface_Views_01.png}}
	\end{minipage}
	\caption{(a) Pre-surgery tibial BCs, full force transmission in the cross-section. (b) Post surgery tibial BCs, force transmission decomposed into plate part and stem part.(c) Medial and lateral surfaces of PE insert element on which the respective loads are acting, contact areas in red color.	\label{fig:BVP_Tibia_and_concept}}
\end{Figure}

Figure~\ref{fig:BVP_Tibia_and_concept} displays the difference in the load-transfer of pre-surgery to post-surgery axial load transfer. Under pre-surgery conditions the joint forces applied by the two femoral condyles are completely transmitted by stresses in the cross-sectional plane which in surgery is chosen as the tibial resection plane. Under post-surgery conditions the axial force is decomposed according to \eqref{eq:Plate-stem-force-decomposition}, partially transmitted by the plate through normal stresses, partially by the stem through shear stresses
\begin{equation}
\bm F_{\mbox{\scriptsize axial}} = \bm F_{\mbox{\scriptsize axial,plate}} +
\bm F_{\mbox{\scriptsize axial,stem}} \, .
\label{eq:Plate-stem-force-decomposition}
\end{equation}

The force decomposition between plate and stem parts generally depends on stiffness of bone and implant, interface material (cemented or cement free fixation), and stem extension length. It is however clear that the force transmitted at the cross section of the base plate is in either case lowered compared to pre-surgery conditions, which implies a loss of bone loading in the proximal regions.

It is the main aim of the present work (i) to quantify the force decomposition according to \eqref{eq:Plate-stem-force-decomposition} for the standard fixation concept, (ii) to analyze its consecutive force flow through the tibia along with a comparison to pre-surgery bone loading, and (iii) to propose a novel fixation concept that minimizes post-TKA loading reduction.

Dirichlet boundary conditions are chosen at the distal end of the modeled tibia that is all $D=3$ degrees of freedoms are fixed. For the Neumann conditions, only the forces acting at the tibia plate in $z$-direction are modeled with $|\bm F|=F_z= 2 \times 543$ N. The set-up of knee joint prostheses that enable in vivo measurements of loading are described in Damm et al. \cite{Damm.2010}.

For the bone-implant interfaces we analyze various boundary conditions as detailed in Sec.~\ref{subsubsec:Standard-Short-Stem-Hip-Endoprothesis}. In either case, sticking friction conditions are set for the interface between the tibial tray and bone. For the case of a cemented fixation we assume sticking friction for the interfaces of implant-cement and cement-bone. For the cementless fixation we consider the cases of sticking friction and two different coefficients of friction.

\subsubsection{Material properties}

For the material behavior of tibial bone, an isotropic linear elasticity law is assumed to hold. The assumption of linear elasticity is corroborated by recent experimental findings by Juszczyk et al. \cite{Juszczyk.2011} and Grassi et al.  \cite{Grassi.2016} (for femoral bone), the validity of isotropic elasticity in simulations is underpinned by Schileo et al. \cite{Schileo.2014}. The figures of the strongly heterogeneous Young's modulus distribution follow from bone reconstruction as described in Sec.~\ref{subsec:FemurReconstruction}. The Poisson's ratio is assumed to be constant, $\nu=0.3$. For the implant material, linear elastic, isotropic material parameters are chosen for both the titanium-alloy (TiAl6V4) \cite{Long.1998} as well as for the cobalt-chrome alloy (CoCr) version.
The very standard of bone cement is PMMA (Polymethyl methacrylate). Polyethylene (PE) is used for the tibial tray; moreover, we consider for its low stiffness a fictitious implant fully made of PE (all-PE).

The material parameters of linear elasticity are listed in Table~\ref{tab:Material-parameters}.

\begin{Table}[htbp]
	\begin{minipage}{16.5cm}
		\centering
		\renewcommand{\arraystretch}{1.2}
		\begin{tabular}{lccccc}
			\hline
			&  Ti &  CoCr & PE & PMMA & Bone \\
			\hline
			Young's modulus $E$ [MPa] & {110\,000}  & {210\,000}  &    {1\,200} & 2\,200 & { $\in$ [30,\, 8\,193.59] }  \\
			Poisson's ratio $\nu$     & {0.33}    & {0.36}        &    {0.46} & 0.3  & {0.3} \\
			\hline
		\end{tabular}
		\newline
	\end{minipage}
	\caption{Elasticity constants for the tibial implant components (plate and stem), for the cement layer (PMMA), and for tibial bone. \label{tab:Material-parameters}}
\end{Table}

\subsubsection{Variants of tibia implant system}
\label{subsubsec:Standard-Short-Stem-Hip-Endoprothesis}
In the numerical analysis we consider distinct cases of the tibial implant systems showing variations in geometry, material and fixation:
\begin{enumerate}
	\item Stem extension length: $l=$\{5,40,75\} mm, see Fig.~\ref{fig:Variants-of-endoprotheses} (b,c,d). \\[-8mm]
	\item Material: titanium alloy (Ti), cobalt-chrome alloy (CoCr), all-polyethylen (PE). The first two are frequently referred to as metall-backed (MB).\\[-8mm]
	\item Implant-to-bone interface conditions: variants of sticking friction conditions and sliding friction conditions are considered. For sticking friction, the variant of (i) full cementation (FullC) and (ii) surface cementation (SurfC) along with stem fixation through press-fit and, after trabecular ingrowth, through osseointegration. For the variant of sliding friction different cases of coefficient of frictions (cof) are compared, (iii) cof=0.2 and the idealized case of (iv) cof=0.0 for perfectly smooth interfaces.
\end{enumerate}

Figure~\ref{fig:Variants-of-endoprotheses} (a) displays the orientation of the resection plane to the mechanical axis and the thickness of maximal bone removal, the image in (e) shows the case of full cementation.

\begin{Figure}[htbp]
	\begin{minipage}{16.5cm}
 	\centering
 	\subfigure[Resection plane]{\includegraphics[height=6.5cm, angle=0]{Tibia_Achse_Ebenen_cut.png}}  \hspace*{0mm}
 	\subfigure[5\,mm]{\includegraphics[height=5.3cm, angle=0]{Tibia_5mm_Implant.png}}  \hspace*{0mm}
 	\subfigure[40\,mm]{\includegraphics[height=5.3cm, angle=0]{Tibia_40mm_Implant.png}} \hspace*{0mm}
 	\subfigure[75\,mm]{\includegraphics[height=5.3cm, angle=0]{Tibia_75mm_Implant.png}} \hspace*{1mm}
 	\subfigure[FullC]{\includegraphics[height=5.8cm, angle=0]{Cemented_Tibia.png}}
	\end{minipage}
	\caption{{\bf Tibial device:} (a) Orientation of resection plane, (b-d) tibial device with base plate and PE insert on top of it, the two fins for rotational stiffness and conical stems with extensions of various lengths, (e) the fully cemented case.
		\label{fig:Variants-of-endoprotheses}}
\end{Figure}

\subsubsection{Measures in the numerical analysis}

The strain energy density (SED), which is defined by the scalar-product of work-conjugate pairs of stress and strain tensors, here the Second Piola-Kirchhoff stress tensor $\bm S$ and the Green-Lagrange strain tensor $\bm E$,
\begin{equation}
\mbox{SED} = \frac{1}{V}\int_V \bm S:\bm E\,\mbox{dV}
\label{eq:SED}
\end{equation}
is widely accepted as a mechanical stimulus for bone remodeling in biomechanics \cite{Huiskes.1992, Ehrlich.2002},
for a detailed discussion see \cite{Turner.1998}, \cite{Ambrosi.2011}.

The relative, percental SED deviation of the post-TKA bone from the pre-TKA bone is calculated according to
\begin{equation}
\textrm{SED}_{\mbox{\scriptsize diff}} =
\dfrac{ \textrm{SED}^{\mbox{\scriptsize post-TKA}} - \textrm{SED}^{\mbox{\scriptsize pre-TKA}} }
{\textrm{SED}^{\mbox{\scriptsize pre-TKA}}}\,.
\label{eq:SED-difference-definition}
\end{equation}

A similar metric based on von-Mises stress instead of SED is used by \cite{Fraldi.2010} --referred to as Stress Shielding Intensity SSI-- and by \cite{Boyle.2011}.

For a comparison among the implant variants and with the pre-surgery state, SED differences according to \eqref{eq:SED-difference-definition} and a decomposition of force transfer into plate and stem parts.

\section{Results}
\label{sec:results}

\subsection{Presurgery load transfer}
\label{subsec:Load-transfer-preTHA}

\begin{Table}[htbp]
	\begin{tabular}{| >{\centering\arraybackslash} m{8mm} | >{\centering\arraybackslash} m{6.5cm} >{\centering\arraybackslash} m{6.5cm}  |}
		\hline
	    & Spongiosa  & Corticalis \\
		\hline
		& & \\
		$E$ & {\includegraphics[height=9.0cm, angle=0]{E_Mod_2_Cut.png}}
	  	    & {\includegraphics[height=9.0cm, angle=0]{E_Mod_Cut.png}}
	    \\
		\hline
		& &  \\
		SED  & \hspace*{4mm} {\includegraphics[height=8.4cm, angle=0]{SED_Soft_Zone_cut.png}}
	      	 & \hspace*{0mm} {\includegraphics[height=8.4cm, angle=0]{SED_Stiff_Zone_cut.png}}
	    \\
		\hline
	\end{tabular}
	\caption{{\bf Pre-surgery tibia:} heterogeneous distributions of Young's modulus (MPa) and of SED (MPa) with range adjustments to spongious and cortical bone.
	\label{tab:YoungsMod-SEDpresurg-Tibia}}
\end{Table}

The images in Tab.~\ref{tab:YoungsMod-SEDpresurg-Tibia} display the heterogeneous Young's modulus distribution and the consecutive SED distribution in the tibia. Two different ranges are each chosen for visualization to account for the considerable differences between spongious and cortical bone in stiffness. As a consequence, SED distributions similarly exhibit a corresponding variation, which underpins that stiffness ''attracts'' bone loading in terms of SED.

Notice that in the most proximal cross section (which approximately coincides with the surgical resection plane) tibial bone is mostly spongious attaining stiffness above 1500 MPa only at some spots. The considerably stiffer corticalis continuously forms a closed ring of increasing thickness in more distal cross sections.

The distributions of Young's modulus and pre-surgery SED are the key reference for a proper interpretation of the post-surgery SED changes.

\subsection{Postsurgery load transfer at the implant-bone interfaces}
\label{sec:load_transfer_at_resection_plane}

\begin{Table}[htbp]
	\begin{minipage}{16.5cm}
		\centering
		\renewcommand{\arraystretch}{1.2}
		\begin{tabular}{lccccc}
			\hline
			& \multicolumn{4}{ c }{force transmission ratio [\%] \quad plate\,:\,stem  }                 \\
			\hline
			interface conditions     &       & implant &  \multicolumn{3}{ c }{extension length [mm]}     \\
			contact                  & cementation &  material &     75         &    40      &    5     \\
			\hline
			sticking friction        &  FullC   & CoCr  &  $17$:$83$   &  $27$:$73$  & $54$:$46$   \\
			                         &          & Ti    &  $23$:$77$   &  $30$:$70$  & $55$:$45$ \\
			                         &          & PE    &  $63$:$37$   &  $64$:$36$  & $74$:$26$ \\

			\cline{2-6}
			                         &  SurfC   & CoCr  &  $24$:$76$   &    $42$:$58$   & $61$:$39$   \\
			                         &          & Ti    &  $29$:$71$   &    $44$:$56$   & $62$:$38$   \\
			                         &          & PE    &  $81$:$19$   &    $81$:$19$   & $82$:$18$   \\
			\hline
			sliding friction cof=0.2 &  SurfC   & CoCr  &  $59$:$41$   &    $72$:$28$   & $56$:$44$   \\
			                         &          & Ti    &  $59$:$41$   &    $72$:$28$   & $56$:$44$   \\
			                         &          & PE    &  $71$:$29$   &    $81$:$19$   & $69$:$31$   \\
			\cline{2-6}
	      \phantom{sliding friction} cof=0.0 &  SurfC   & CoCr &  $72$:$28$   &    $77$:$23$   & $62$:$38$    \\
	                                         &          & Ti   &  $72$:$28$   &    $77$:$23$   & $62$:$38$    \\
			                         &          & PE   &  $79$:$21$   &    $84$:$16$   & $73$:$27$    \\
			\hline
		\end{tabular}
		\newline
	\end{minipage}
	\caption{Load partitioning for tibial plate-stem devices of various lengths, various  implant materials, and various interface conditions/fixations
		with FullC: full cementation, SurfC: cementation restricted to base plate. The applied force by the two femur condyles is symmetric, $|\bm F|=F_z= 2 \times 543$ N.. 	\label{tab:LoadPartitioning-PLate-vs-Stem2}}
\end{Table}

Table~\ref{tab:LoadPartitioning-PLate-vs-Stem2} decomposes the force in $z$-direction of the coordinate system of Fig.~\ref{fig:Variants-of-endoprotheses} into its plate and stem parts.
\begin{enumerate}
	\item The larger the stiffness of the implant material along with the stiffness of the stem-bone interface, the smaller the plate:stem force ratio; for the stiffest case (CoCr for FullC) the ratio of 17:83 indicates a stem-dominated force transmission, for the most compliant case (PE for SurfC/sliding friction at cof=0.0) the ratio of 84:16 indicates a plate-dominated force transfer.\\[-7mm]
	\item Point (1) with its upper and lower bounds for force ratios spans a wide interval where a further analysis reveals the impacts of interface conditions and stem lengths.\\[-7mm]
	\begin{enumerate}
		\item For sliding friction/SurfC the plate transmits a considerably larger force portion than for sticking friction conditions. This is true for the metall-backed (MB) variants along with 75mm and 40mm stem extension lengths. For the 5\,mm case however, the difference between sticking and sliding friction mostly vanishes.\\[-7mm]
		\item For sticking friction conditions, in both the FullC and SurfC cases, it holds that the longer the stem, the larger the force portion transmitted by the stem. For sliding friction conditions, in both the cof=0.2 and cof=0.0 cases, the same is true, but only for stem extension lengths of 40\,mm and 75\,mm. In the 5mm case however in sliding friction, the force transmitted by the stem is throughout larger than for the longer stems.\\[-7mm]
		\item The plate:stem force ratio is invariant with respect to interface conditions (sticking or gliding) only for the short stem.\\[-7mm]
	\end{enumerate}
	\item The PE case is an exception to the above rules in that it is almost invariant with respect to stem length and interface conditions; the force portion transmitted through the plate is constant at around 80\%.
\end{enumerate}

Elementary mechanical reasoning suggests that the larger the force part mediated by the plate, the larger the tibial bone loading into proximal bone and more distal regions. Notice in this context that in natural, pre-surgery conditions the applied force is completely transmitted through that tibial plane which is chosen in surgery to be resection plane. A more refined analysis which underpins the hypothesized relation of plate-bone loading transfer is carried out in Sec.~\ref{sec:postsurgery_SED_differences} by a detailed comparison of post-surgery with pre-surgery SED changes according to \eqref{eq:SED-difference-definition}.

\subsection{Postsurgery SED differences}
\label{sec:postsurgery_SED_differences}

\begin{Table}[htbp]
	\centering
 \begin{tabular}{| >{\centering\arraybackslash} m{10mm} | >{\centering\arraybackslash} m{3.2cm} >{\centering\arraybackslash} m{3.2cm} >{\centering\arraybackslash} m{3.2cm} >{\centering\arraybackslash} m{3.4cm} |}
		\hline
		& & & & \\[-2mm]
		stem   & Full cementation &  \multicolumn{3}{c|}{ ------------------ Surface cementation ------------------ }  \\[2mm]
		length & \multicolumn{2}{c}{ ------ sticking friction conditions ------}  &
		\multicolumn{2}{c|}{ ------ {\bf sliding friction conditions} ------}   \\[1mm]
		(mm)   & thickness 2mm & osseointegration  & cof=0.2 & cof=0.0 \\
		\hline
		& & & & \\[-3mm]
		75  & \includegraphics[height=6.0cm, angle=0]{SED_Diff_Redn_Zone_75mm_Ti_Imp_Ce_2mm_All_Tie_cut.png}
		& \includegraphics[height=6.0cm, angle=0]{SED_Diff_Redn_Zone_75mm_Ti_Imp_All_Tie}
		& \includegraphics[height=6.0cm, angle=0]{SED_Diff_Reduction_Zone_75mm_Ti_COF02}
		& \includegraphics[height=6.0cm, angle=0]{SED_Diff_Redn_Zone_75mm_Ti_Imp_NContact} \\[1mm]
		& 23:77 & 29:71 & 59:41 & 72:28 \\
		\hline
		& & & & \\[-3mm]
		40  & \includegraphics[height=4.8cm, angle=0]{SED_Diff_Redn_Zone_40mm_Ti_Imp_Ce_2mm_All_Tie_cut}
		& \includegraphics[height=4.8cm, angle=0]{SED_Diff_Reduction_Zone_40mm_Ti_Imp_All_Tie_cut}
		& \includegraphics[height=4.8cm, angle=0]{SED_Diff_Reduction_Zone_40mm_Ti_COF02_cut}
		& \includegraphics[height=4.8cm, angle=0]{SED_Diff_Reduction_Zone_40mm_Ti_Imp_NContact_cut} \\[1mm]
		& 30:70 & 44:56 & 72:28 & 77:23  \\
		\hline
		& & & & \\[-3mm]
		5   & \includegraphics[height=4.8cm, angle=0]{SED_Diff_Redn_Zone_5mm_Ti_Imp_Ce_2mm_All_Tie_cut.png}
		& \includegraphics[height=4.8cm, angle=0]{SED_Diff_Redn_Zone_5mm_Ti_Imp_All_Tie_cut}
		& \includegraphics[height=4.8cm, angle=0]{SED_Diff_Reduction_Zone_5mm_Ti_COF02_cut}
		& \includegraphics[height=4.8cm, angle=0]{SED_Diff_Redn_Zone_5mm_Ti_Imp_NContact_cut} \\[2mm]
		& 55:45 & 62:38 & 56:44 & 62:38 \\
		\hline
	\end{tabular}
	\caption{{{\bf Post- to pre-surgery SED differences [\%] and plate:stem force decomposition [\%]}} for Ti-alloy implant of various stem lengths and different interface conditions.}
	\label{fig:SEDdiff-Ti-variousBCs-variousStemLength-table}
\end{Table}

The impact of interface conditions and stem extension length on SED differences is visualized in Tab.~\ref{fig:SEDdiff-Ti-variousBCs-variousStemLength-table} for the Ti-alloy implant.
\begin{itemize}
	\item The lower the shear stiffness of the stem-bone interface, (decreasing from left to right in
	Tab.~\ref{fig:SEDdiff-Ti-variousBCs-variousStemLength-table}) the smaller the post-surgery SED loss both in intensity and spatial extension.\\[-7mm]
	\item The longer the stem extension in the case of sticking friction, the stronger and more distally extended is the SED loss, a consequence which is even more pronounced for the fully cemented fixation than for the case of press-fit/osseointegration at the stem.
	For sliding friction conditions however, the influence of stem length on post-surgery SED loss is confined to the proximal tibia, but distally very limited.\\[-7mm]
	\item The newly introduced force decomposition into plate and stem parts is a definite, reliable measure for the intensity and spatial extension of post-surgery SED reduction; if primarily the plate transmits the axial force, SED reduction is confined in magnitude and to small regions in most proximal cross sections, for the case of stem-mediated force transmission the opposite is true.\\[-7mm]
\end{itemize}

\begin{Table}[htbp]
\begin{tabular}{| >{\centering\arraybackslash} m{18mm} | >{\centering\arraybackslash} m{4.0cm} >{\centering\arraybackslash} m{4.0cm} >{\centering\arraybackslash} m{4.0cm}  |}
\hline
& & & \\[-2mm]
interface   & CoCr alloy       &  Ti-alloy    &  all-PE       \\[0mm]
conditions  & $E$=220\,000 MPa & $E$=110\,000 MPa &  $E$=1200 MPa \\[2mm]
\hline
& & & \\[-2mm]
sticking friction & \includegraphics[height=6.5cm, angle=0]{SED_Diff_Redn_Zone_40mm_CoCr_Imp_All_Tie}
          & \includegraphics[height=6.5cm, angle=0]{SED_Diff_Reduction_Zone_40mm_Ti_Imp_All_Tie}
          & \includegraphics[height=6.5cm, angle=0]{SED_Diff_Redn_Zone_40mm_PE_Imp_All_Tie} \\[1mm]
          &  42:58 & 44:56  & 81:19 \\
\hline
& & & \\[-2mm]
sliding friction cof=0.2  & \includegraphics[height=6.5cm, angle=0]{SED_Diff_Redn_Zone_40mm_CoCr_Imp_NContact}
          & \includegraphics[height=6.5cm, angle=0]{SED_Diff_Reduction_Zone_40mm_Ti_Imp_NContact}
          & \includegraphics[height=6.5cm, angle=0]{SED_Diff_Redn_Zone_40mm_PE_Imp_NContact} \\[1mm]
          & 77:23 & 77:23 & 84:16 \\
\hline

\end{tabular}
\caption{\color{black}{{\bf Post- to presurgery SED differences [\%] and plate:stem force decomposition [\%]}} for various implant materials and interface conditions at stem length of 40mm and cementless stem fixation.}
\label{fig:SEDdiff-40-VariousMaterials-VariousInterfaceCond-tab}
\end{Table}

The impact of the implant material on SED-changes is shown in Tab.~\ref{fig:SEDdiff-40-VariousMaterials-VariousInterfaceCond-tab}.
The comparison of the CoCr-case with the Ti-alloy case indicates that stiffness change of the implant material, here roughly 2:1, has very little influence on SED changes compared to pre-surgery conditions, which is true for both sticking and sliding friction conditions at low friction coefficients. It is only the sticking friction case, where the drastic Young's modulus reduction from CoCr/Ti (210/110 GPa) to PE (1.2 GPa) material (Young's modulus ratio Ti-alloy to PE: 91) does considerably avoid SED loss. For sliding friction however, the improvement of the fully PE implant compared to the much stiffer materials CoCr and Ti is minor. In conclusion, interface conditions are more relevant for SED changes than the stiffness of the implant material.

If the stiffnesses of bone and implant are decoupled by sliding friction conditions, the stiffness of the implant does not matter; the all-PE variant exhibits almost the same SED-differences as the much stiffer Ti-alloy does.

\section{Discussion}

\subsection{What is and what drives stress shielding? How can it be overcome?}

Stress shielding refers to the reduction in bone density caused by a reduction of physiological  stress from the bone by a stiff, metallic implant. This is because of bone's adaptivity to remodel in response to the loads referred to as Wolff's law. As a consequence, a decrease of loading on bone decreases bone density and stiffness because of the lowered stimulus for maintaining the existing bone density.

While none of these statements is wrong, the present work suggests a distinguished analysis of stress shielding with respect to its roots.

The point of departure is the finding that the force transmitted by the tibial plate is relatively small, if the stem is rigidly connected to bone, either by press-fit/osseointegration in cementless fixation (referred to as surface cementation) or by cemented fixation (referred to as full cementation). In that case, it is the stem which transmits by shear stresses the majority of the applied load in axial direction into bone. As a consequence, the proximal regions in the tibia suffer from considerable SED reduction; in view of the necessity for vital bone cells to get fed by loading it can be seen as a SED-starvation. This effect expands to more distal tibia parts the longer the tibial stem extension.

The present work shows that the key aspect to overcome stress shielding in tibial bone is the mechanical activation of the tibia plate for the implant-to-bone force transfer. The activation is realized by resolving the sticking connection between implant stem and bone\footnote{The plate remains fixed to bone by cement (PMMA).}, which implies that the cemented interface shall be avoided. For the case of sliding friction in the regime of low coefficients of friction (cof=0.2) SED reduction is bounded to modest magnitude almost everywhere, if present at all.

The above described effects follow the regime of decreasing stiffnesses: FullC $>$ SurfC/osseointegration $>$ SurfC/sliding friction, cof=0.2 $>$ sliding friction, cof=0.0. The comparison of FullC with SurfC for sticking friction (hence the two stiffest cases in the above hierarchy) was analyzed in \cite{Cawley.2013}, where the authors find a stress reduction under the tibial baseplate for both cases, but stronger for the full cementation.
\\[2mm]
{\bf Impact of implant-to-bone stiffness mismatch.} Even if the considerable stiffness mismatch between implant material and bone persists (140:1 for the CrMo case, 73:1 for the Ti-alloy) stress shielding is overcome for compliant stem-to-bone interface conditions.
Remarkably, in terms of SED-preservation the fully polyethylene implant ($E$=1200 MPa) rigidly connected to bone does not excel the Ti-based implant, if the latter exhibits a smooth stem surface avoiding force transmission by shear.

The notion of stress-shielding as an inevitable consequence of the implant-bone stiffness mismatch is misleading, since stress shielding becomes effective only for a rigid  stem-to-bone connection, by cementation or osseointegration. Among great many descriptions of the mechanical sources of stress-shielding, Gefen's definition is one of the very few precise ones \cite{Gefen.2002}.

The smaller the stiffness of the stem-to-bone connection, the lower the SED-reduction. This is a simple consequence of a reduced force transfer through the plate for stiffer shear support along the stem. The simulation results underpin this hierarchy. The use of short-keeled cemented tibial components however is no generally best solution, since an increased risk for aseptic loosening was reported \cite{Ries.2013}.

\subsection{Post-TKA excess SED, source and consequences}

In all cases considered in Tables \ref{fig:SEDdiff-Ti-variousBCs-variousStemLength-table} and \ref{fig:SEDdiff-40-VariousMaterials-VariousInterfaceCond-tab} some regions indicate a drastic post-surgery SED increase, which calls for a mechanical explanation addressing whether it is of harm.  To put things into perspective, the images in Figure~\ref{fig:Postsurgery-Excess-SED} (a) and (b) underpin that despite the huge maximal values of SED increase, excess SED is bounded both in magnitude and spatial extension. Moreover, it becomes transparent that along the stem the SED increase is in the soft spongious core of the tibia, where pre-surgery tibia exhibits  low SED values (c) due to low stiffness (d) such that a drastic post-surgery increase does not necessarily exceed the bone strength.
\begin{Figure}[htbp]
	\begin{minipage}{16.5cm}
		\centering
		\subfigure[]{\includegraphics[height=6.4cm, angle=0]{SED_Diff_Incre_Zone_40mm_Ti_COF02_V8.png}}  \hspace*{-2mm}
		\subfigure[]{\includegraphics[height=6.4cm, angle=0]{SED_Diff_Incre_Zone_Shaft_40mm_Ti_COF02_V1.png}} \hspace*{-2mm}
		\subfigure[]{\includegraphics[height=6.4cm, angle=0]{SED_Soft_Zone_Verticle.png}} \hspace*{-2mm}
		\subfigure[]{\includegraphics[height=6.4cm, angle=0]{E_mod_verticle_V2.png}} \hspace*{-2mm}
	\end{minipage}
	\caption{{\bf Post-surgery excess SED:} SED increase in (a) planes perpendicular to the $z$-axis and (b) in a cross section along the stem axis, (c) pre-surgery SED distribution adapted to spongious tibia and (d) Young's modulus distribution.
		\label{fig:Postsurgery-Excess-SED}}
\end{Figure}

\subsection{Transferability, realization and limitations}
{\bf Transferability.} Since the plate-based force transfer mimics on purpose the pre-surgery  physiological conditions, it is justified to assume that the favorable characteristics are preserved no matter how patient-specific bone data or loading conditions may differ from the particular setting of the present work.

Remodeling depends on mechanical stimulus, biochemical processes, on age, sex and individual disposition showing considerable scatter between individuals. As a consequence, models for remodeling necessarily contain uncertainties and simulations cannot be predictive in a deterministic way. \\[2mm]
{\bf Realization.} The novel fixation concept can be realized without considerable changes in implant geometry and surgery techniques. The surface of the stem must be sufficiently smooth. For realizing a low-friction regime at the implant-bone interface, a protective thin film of a biocompatible Diamond-Like Carbon (DLC) is favorable and well-established for its excellent bio- and hemocompatibility \cite{Robertson.2002}. Friction coefficients generally in the range of 0.05-0.2 have been reported for DLC \cite{Grill.1997}
which are considerably lower than oxidized Ti-alloy surfaces \cite{RamosSaenz.2010}.

Relative motion of the implant with respect to bone can be avoided by an interface layer between stem and bone similar to the cemented fixation, where a soft material is filled in which exhibits a low shear modulus and by virtue of incompressibility (Poisson contraction close to 0.5) a relatively high compression modulus.

In either case, the stem serves and preserves the purpose of implant stability by interaction with surrounding bone through normal contact stresses.

{\bf Limitations.} The proposed fixation concept crucially relies on sufficient stiffness and strength of tibial bone and therefore not applicable in any case. In conclusion, the key premise to apply the proposed concept of avoiding stress-shielding along with bone resorption, is that other medical indications do not overrule this aspect.

There are several simplifications in the model in terms of one single loading instead of a full gait analysis \cite{Galloway.2013}, \cite{Bergmann.2014}, \cite{Knarr.2016}, thereby restricting to pure axial forces and e.g. no shear forces, no consideration of muscles and ligaments. Moreover, the cement mantle is assumed to exhibit constant thickness, clearly an idealization \cite{Taylor.2015}.

\subsection{Implant fixation at knee compared to hip -- a broader perspective}
The present work adopts the idea of \cite{Eidel.2018} for a novel fixation concept of short-stem hip implants. Therein, the concept is referred to as ''collar-cortex compression concept (CO$^4$)'' for describing the key mechanisms of force transmission for avoiding SED-reduction. The crucial aspect of modified interface conditions is transferable beyond the existing considerable differences between fixation of the plate-stem system into femur and tibia in view of different geometries, loading conditions, stiffness distributions to name but a few differences. For the hip implant however, the current generation of models typically do not exhibit a plate device while it is standard in TKA. Remarkably, the idea of the mechanical activation of cortical bone in the resection plane by a pre-stressed thrust-plate for a hip implant was introduced already by \cite{Huggler.1995}.

\section{Conclusions}

The main results and conclusions of the present work can be summarized as follows:

\begin{itemize}

	\item The stiffer the stem-bone interface, (i) the larger (smaller) the force fraction transmitted through the stem (plate), and (ii) the more pronounced the post-surgery SED reduction, hence stress-shielding.\\[-6mm]

	\item Vice versa, force transmission primarily mediated through the tibial plate mechanically activates proximal tibia and confines SED reduction to an unprecedented extent both in intensity and spatially distal extension.\\[-6mm]

	\item Stress shielding can be avoided even for a metallic implant despite its large implant-to-bone stiffness mismatch, if the stem-bone interface is sufficiently compliant in terms of sliding friction conditions.\\[-6mm]

	\item The newly introduced force decomposition ratio of plate-stem is a reliable indicator of post-surgery SED changes. \\[-6mm]

	\item The base-plate force transmission concept follows a bionics perspective in that
	it mimics pre-surgery conditions of axial force transmission.\\[-6mm]

	\item For surgery practice in TKA the established standard set-up can be preserved; the implant geometry and materials, the cemented base-plate to bone interface and therefore all techniques and procedures.\\[-6mm]

	\item In spite the considerable differences in geometry, stiffness and loading conditions, the main characteristics of a recently proposed collar cortex compression concept CO$^4$ for the fixation of short stem hip endoprostheses in \cite{Eidel.2018} are transferable to the tibial implant fixation.

\end{itemize}

\bigskip

{\bf Declarations of interest:} None.

\bigskip

{\bf Funding:} This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

\bigskip

{\bf Acknowledgments:} BE acknowledges support by the Deutsche Forschungsgemeinschaft (DFG) within the Heisenberg program (grant no. EI 453/2-1).

redpajama_set_name: RedPajamaArXiv


text:
Thanksgiving III – Return of the Turkey
Today marks the third Thanksgiving we have attended in a row since we moved here, and it was probably the best so far. Our nieces and nephews have progressed from babies into the realm of children: Mikey walked in wearing a nice shirt, an Argyle tank-top and sensible shoes, all that was missing was a pipe; Siena is taking pleasure in just about everything around her; and Gianna wanted to play hide-and-seek an infinite number of times.
Also the food was first class and so plentiful that I was in a turkey coma for most of the evening. The turkey was grilled, which was a new concept for me, but it was spectacular! It was possibly the best turkey I've ever tasted. There was also a selection of hors d'oeuvres that would have sufficed as a full meal: deviled-eggs, yummy-sausagey-cheesey-bready-things, dips, wasabi-peas and allsorts were all available and plentiful.
And then home for parrots, wine, and Guest House Paradiso. And no work until next Tuesday!
This entry was posted in Uncategorized on November 27, 2009 by veg.
Mad Mandy
What do Peter Mandelson and Herpes have in common ? They're both a massive pain in the cock that you can't ever get rid of. And they both manifest themselves as purulent scabs.
How did this happen? Twice now he has been forced to resign in disgrace (what normal people call "being sacked") for being a big slimy crook, and yet again he's back in power, without being elected. As if that wasn't bad enough, he's now trying to push a bill through Parliament that will make him all powerful and immortal and stuff.
He is currently attempting to pass the Digital Economy Bill which, despite its friendly and harmless-sounding title, is actually a terrifying piece of Orwell-inspired oppression. The most alarming component of the bill is where Peter Mandelson is trying to give himself so-called "Henry VIII powers" which would enable him to create and modify legislation without parliamentary interference. It's worth repeating: Mandelson it attempting to pass a law that would let him make and modify laws, without parliamentary involvement. If you're not shaking with fear and anger, please re-read that last sentence.
Meanwhile, it turns out he has also been secretly plotting to take control of Europe!
Somebody stop him! Gordon, can't you have him killed? Please! Does anyone have a human-sized can of anti-fungal cream? Has anyone tried pouring a bucket of water over him? Garlic?
Failing that, can I urge every Brit to sign this petition to kill the bill, and call your MP.
In the past I have been accused of bullying. I've also felt like I'd been bullied, although at the time I really felt it was my fault for being weak. I was weak. Also, I was a coward.
Looking back at those times, I realise I was party to bullying, and I was personally bullied. But now I'm not weak. Well, physically I'm the biggest weakling you've ever met, but I'm not scared any more, and I'll take on any fucker even if it results in being hospitalised.
At school there was a kid in my class, let's call him "Dick". He was a weird-looking moron who spent his entire life talking about all of the things he believed he got up to outside of school. All of them not only bullshit, but offensive: tales of killing cats, and setting fire to old ladies houses. Me and my geeky friends didn't like him, and didn't want him hanging around with us. But he was glued to one particular friend that I really liked. We used to regularly try to run away from him, mock him, and generally let him know we didn't like him. That was bullying, even though it didn't feel like it at the time.
Years later we discover that he was from a fucked-up family, and he had secretly been introduced to our friend as someone who needed support. We were kids, we didn't know or understand what could turn a frightened kid into a nasty, bullshit-spouting git. Maybe that's what happened to Nick Griffin.
Nowadays I'm only too acutely aware of bullying, and frequently see it in everyday life. None of the bullies would consider themselves so, and the victims likewise. Social pressure is a strong motivator, and it's too easy to forget how strong the urge can be to pretend you're ok, even to yourself.
Tonight we watched the next episode of "I'm a celebrity, get me out of here" which should now be more aptly titled as "the international bullying awards".
Jordan/Katie-Price may be an odious, ego-driven, publicity-whore. But does that justify our entertainment of watching her genuinely suffer? We all wish we had her money and we all know she got it through being a publicity-whore; a job at which she is obviously skilled. But does that really justify watching her undergo treatment that is, clearly and genuinely, traumatic ?
Since Jordan entered the Jungle last time she has transformed from a genuinely beautiful woman (albeit with ridiculously over-sized, concrete-looking, fake, breasts) to being a freakish demonstration of the dangers of plastic surgery. She now looks beaten-up, especially her pathetically fucked lips. She's also older, which is a curse that weakens people. Every day so far "the general public" have voted her into performing like a wounded sea-lion for everyone to laugh at. It feels like watching They shoot horses don't they?
As I write this, I have a small green bird on my shoulder, a beautiful budgie (who looks like a little fluffy cloud) in a cage next to me, and a Meyers Parrot sitting on top of his cage grinding his beak. Our two "big guys" are in the kitchen, covered, and sleeping. That's five birds. There are five birds in my house. How did this happen ? How did I end up with a house full of birds ? How did I end up with a house ? I'm only 15.
Earlier this evening I wish we could have taken a photo of us eating a curry, watching Harry Hill's TV Burp, with five beautiful birds around; and then sent it back in time to myself at age 21. The first thing I would have noticed was the gorgeous blonde girl sitting next to me. Then I would have noticed the parrots, and spent the next few years trying to find girls that like birds. Asking M if she was into birds at the time would have resulted in "no, just bats" so the future probably wouldn't be altered too much.
The reason for our increased flock size is that we are bird sitting The Grinch, and we're looking after a beautiful little budgie until we can re-home him/her. If you live near NW Philly and believe you could give enough TLC to a beautiful little parrot, please let me know. He was terrified at first but now, despite being too scared to step-up, he's far more confident. He also makes some of the most incredible noises we've ever heard.
"Now I'm going now down to the showers, stretch me legs, and to wash em n'all. Then after that I shall come back and sit in the chapel, and contemplate the error of my ways and try, to make peace, with my bookmaker."
Norman Stanley Fletcher – Slade Prison – in the 70s
Big numbers, v6, and baby squirrels
For a while now I've been convinced that one of the biggest hurdles to the human race is our inability to deal with large numbers. As soon as you get to around 10,000 it all seems a bit samey. Hence the inability of creationists to understand about geological time, the inability of most people to understand cryptography, people's willingness to do the lottery, and the bizarre acceptance of the bank bailout by everyone outside the banking cult.
For example, the odds of winning the UK national lottery are around 14,000,000 (14 million) to 1. So, if you play twice a week, you'll probably win once every 130,000 years which, providing you believe in reincarnation, is around 1800 lifetimes. The human race hasn't existed that long yet. These are diabolical odds but people still indulge.
I'm far from immune to this cloudy judgment. When I first learned about how the Internet worked, I was shocked to discover that Internet Addresses were 4 bytes (thats 32 bits) long. "That's tiny!" I thought, "that means there's an absolute maximum of 4 billion." Technically I was right, but the fact that 18 years later
the Internet is as ubiquitous as it is, whilst still remaining limited to those paltry 32-bits of address space, shows I didn't really know what 4 billion meant.
In fairness, we would have run out by now if the wizards behind the scenes hadn't cast a bunch of magic spells (called things like NAT, and CIDR) to wring every bit of space out of the addresses. But we are now at the very, very low watermark level and it's only a matter of months before we run out of addresses completely.
The Wizards were on the case though and in 1998 they created an entirely new Internet Protocol called "IP Next Generation (IPng)", or more formally "IP version 6 (IPv6)" to replace the existing Internet Protocol (known as version 4). I was really excited at the time! It was actually a cut down version of version 4, with much of the useless stodge removed and new cool stuff like auto-configuration and encryption built-in. It also allowed for many more addresses as it used 128 bits to represent each address. At the time I remember thinking that 128 bits sounded pretty meagre. Why not 1024 bits or 2048 if we really want to future proof ourselves, I thought ?
At the time I worked at an ISP and badgered them into allowing me to hook up our network to the experimental IPv6 Internet (known as the 6bone) so that we could lead the way into the brave new world. After the initial excitement of playing with the new addresses, protocols and tools, I got bored because there was nothing to see yet. There was only one website that I could find that was on the IPv6 Internet…and it consisted of a page of rants about the problems with the new protocol. It was slow too. Really slow.
11 years later, the Internet is still running on IPv4 and, despite most people's computers being able to use the shiny new IPv6 network, very few ISPs support it. I still don't really understand why.
A couple of weeks ago some fear-mongering articles in the press about the paucity of IPv4 addresses rekindled my interest and I decided to get hooked up to IPv6 at home. Surely, I thought, my ISP must have IPv6 support by now. They don't. So I had to resort to a method called "tunneling" which is how I had to do it back in 1998. But this time, things were very, very different. The IPv6 Internet exists, and works as we were promised it would! Setting up a tunnel involved registering with a free tunnel service on-line and running a single command on my Linux box. Bang – the box was pingable on both IPv4 and IPv6. I ordered a block of addresses for the other machines in my house (we have about 5) and as if by magic, they all configured themselves with their new IPv6 addresses automatically. Networking has never been this simple!
But there was something that worried me, and this is where we get back to big numbers; the number of addresses I'd been allocated. It turns out that these days IPv6 subnets are all 64-bits – what that means in simple terms is that my tunnel, which needs precisely two addresses (one for me, one for my ISP) is using up 18446744073709551616 addresses. We are wasting a number of addresses which is equal to the size of the regular IPv4 Internet, squared.
The next thing that alarmed me was that the size of the block of addresses I was given for my other 4 home machines also seemed a little large. It was a 48 bit prefix which equates to a million, billion, billion addresses. I only needed 4!
At this rate, I thought to myself, we'll exhaust the 128 bit address space in no time! Why would these ISP's have such a disgracefully cavalier attitude to address allocation ? Had they learned nothing from the IPv4 experience. I mean 128 bits is a lot, but it's not that much…
After doing some reading and some very basic maths, I found the reason for their "reckless" behaviour: 128 bit numbers are enormously, vastly, adjective-defyingly huge. I could write out how big it is, but like the expression "128 bit", it doesn't really give much insight. The fact is that we will not run out of addresses. Ever. NAT for IPv6 doesn't exist, because it's just not needed. Someday everyone will have as many fully routeable IP addresses as they can eat.
As I said, big numbers are difficult to comprehend…for me and many others if not for you.
So the next time you hear a journalist, politician or banker talk about billions of anything, don't let it lie. They don't really understand how vast those numbers are either.
Thanks for reading this far. I would have got bored about 3 lines in. Your reward is the baby-squirrel bit. Last night Michele took me along with her to the wildlife rehab and let me hold a couple of baby squirrels while she fed them. I got to stroke them and feel their little feet. They were even cuter and more beautiful than I imagined they could be! They were really playful and snuggly too. It's bad form to try and relate to them I know, but not too long from now they'll be released back into the wild.
This entry was posted in Uncategorized on November 7, 2009 by veg.
Name That Scumbag
Good evening everyone, and welcome to this week's edition of "Name That Scumbag"! What a lovely audience you are. So much better than last week's! But seriously, can you name this week's scumbag ? Here are the clues:
He got the bus with me this evening
Half way home he said he was getting tired and needed a sleep
He laid back and closed his eyes ready for slumber
Then, whilst appearing to sleep, let out the most obnoxious, deathly, abomination of a fart that I have ever been unfortunate enough to smell
It made my eyes water! It was awful, awful, awful, and I knew that the crowd of people sitting around us were having problems with it too. There was coughing! I tried closing my eyes to stop the watering, but it started to sting and all I could do was wince. If this could have been bottled, Saddam would have won the second Gulf war. Everyone nearby was clearly having problems and understandably thought it must have been my fault, as I was apparently the epi-centre. Surely that soporific cherub next to me would never have been able to produce something so vile.
Obviously, I considered waking him up with a loud reprimand, but I knew he would be loudly, and devastatingly frank about it, and as an Englishman that would have been enough to force me to join the foreign legion.
So David, what sort of scumbag could let out a guff like this?

redpajama_set_name: RedPajamaCommonCrawl


Several members of the mainstream media have gone to bat for former Vice President Joe Biden as he faces allegations of inappropriate touching and hair sniffing, but at least one late-night host has a different take on the touchy-feely pol.
Two women have come forward with claims that the current Democratic frontrunner made them feel uncomfortable during their interactions. Former Democratic candidate for Nevada lieutenant governor Lucy Flores says Biden put his hands on her shoulders, smelled her hair, and kissed her on the back of her head in 2014 at a campaign event. And former congressional staffer Amy Lappos alleges that Biden grabbed her head and neck and touched noses, expressing that she thought he was going to kiss her on the mouth at a fundraiser in 2009.
Biden issued multiple statements in response to Flores' claims.
But the potential 2020 hopeful has found many defenders in the media who are downplaying the controversy.
Washington Post columnist Jonathan Capehart appeared on MSNBC and claimed he has had the same "intimate" interactions with Biden.
"The View" co-hosts Whoopi Goldberg and Meghan McCain both offered strong defenses of the former vice president. Goldberg referred to Biden as "overly familiar" and a "hands-on kind of guy." She repeatedly suggested to Flores that she should have said something to Biden immediately instead of waiting five years to come forward.
McCain praised Biden as a "retail politician" and called him a "good, decent man" who has never made her feel uncomfortable.
MSNBC's Chris Matthews led a panel fully supportive of Biden. Former Sen. Barbara Boxer, D-Calif, called the former vice president "endearing" insisted that he treated all women as equals when they both held Senate seats.
"Boy, I can't beat that. I thought that was a great perception of all the bases here," Matthews responded.
MSNBC political analyst Susan Del Percio agreed with Boxer, telling Matthews it's "just the way he is" and expressing that she didn't think he did anything wrong. She dismissed the allegations as a "political hit job" to prevent Biden from running.
Over on CNN, former Obama White House official Jen Psaki, who served with Biden, vouched for her colleague's character.
"There were times when he would grab my hand in meetings to make a point. There were probably times where he kissed the back of my head. I never thought anything of that. I didn't find it creepy, but then again, I was in the administration," Psaki told CNN anchor Anderson Cooper.
Both Matthews and Lemon also tied President Donald Trump to the Biden conversation, invoking the infamous Access Hollywood Tape and the multiple allegations made against him during the 2016 election.
"If rubbing noses was just Biden 'being cute' and being a 'harmless grandpa,' how come you've never seen him do it with men?" Noah asked.


text:
Vital: Van der Graaf Live is the first live album by English progressive rock band Van der Graaf Generator. It was recorded 16 January 1978 at the Marquee Club in London and was released in July, one month after the band's 1978 break-up. The album (on vinyl and, later, on CD) was credited under the abbreviated name Van der Graaf, like the previous year's The Quiet Zone/The Pleasure Dome (1977), and featured the same line-up plus newcomer cellist/keyboardist Charles Dickie, who had officially joined the band in August 1977, and original saxophonist and flautist David Jackson, who re-joined the band for this recording.

The album is noted for its sometimes radical reworking of the older material. Although Van der Graaf Generator were seldom less than intense on stage, the 1977 and 1978 tours were remarkable for their ferocity. The absence of Hugh Banton, whose organ work was a hallmark of the group's sound before his departure in 1976, as well as frontman Peter Hammill's increased duties as a rhythm guitarist, account for much of this.

Background
Van der Graaf Generator, in their 'Van der Graaf' incarnation, debuted on 20 February 1977 at the Roundhouse in London. After a European tour with Charisma Records labelmates Hawkwind and a concert at Brunel University on 25 March, the band spent a month recording their next album, The Quiet Zone/The Pleasure Dome, at the Foel, Rockfield, and Morgan recording studios. Following two concerts in Ibiza, cellist Charles Dickie was added to the line-up in August. Dickie debuted with Van der Graaf in September at the First Rider Open Air Festival Scheeßel. For the rest of 1977, the band toured in Portugal, Belgium, the United Kingdom, France, Switzerland and Germany.

After this, a two-night stint at the Marquee Club in London was scheduled for 15–16 January 1978, and David Jackson, who had left almost exactly one year before for financial, personal, and musical reasons, was invited to join Van der Graaf for these shows. As a guest, Jackson played only in the second part of the shows, but as the two opening songs ("Cat's Eye/Yellow Fever" and "The Sphinx in the Face") were omitted for the album, there were only four songs left on Vital on which he wasn't featured.

Recording
A 24-track mobile recording unit was used to record Van der Graaf's second performance of their Marquee stint, and Guy Evans used these tapes to mix what would become Vital at Foel Studio. At this time, Peter Hammill was touring in America and completing his next solo album, The Future Now (1978). Evans discovered a technical problem with the tapes. Jackson said about this:

Because of the technical restrictions placed upon the recording I was only allocated one track of the 24 available on the tape. When Guy came to mix the tapes he discovered that my track was completely silent. There had been a fault on the line to the tape machines. Guy had to search through all the other tracks to find those where my saxophone had bled onto them, such as the vocal track. He then had to take out my sax, clean it up, and boost the level. That's what you hear on the finished album.

Songs
"Ship of Fools" was the B-side to the 1977 "Cat's Eye" single, only released in France. A first release on CD appeared on the compilation album "I Prophesy Disaster", and the same reissue series, that released Vital in its entirety, made the studio version again available as a bonus track on the release of The Quiet Zone/The Pleasure Dome (1977). "Door" was another song from around this time, and a long unknown studio recording was featured both on The Box and the aforementioned reissue of The Quiet Zone/The Pleasure Dome. A studio version of "Mirror Images" would later appear on Peter Hammill's 1979 solo album pH7, and "Nadir's Big Chance" was the title track to his 1975 studio album of the same name. Hammill would also re-record "Sci-Finance" as "Sci-Finance (Revisited)" with some altered lyrics on his 1988 solo album In a Foreign Town. In his review for AllMusic, Greg Prato called "Sci-Finance (Revisited)" "Talking Heads-like." "Urban" was a composition that was sometimes played in 1975 (without the instrumental section taken from "Killer"), but was the only then new song of which no studio version was recorded. The newly reformed Van der Graaf returned to Urban for the spring tour 1977, now with the added section from "Killer", then dropped the track again for the rest of the year, before it came back to the set in 1978. It is now the only song from Vital of which no studio version is known. "The Medley" is a somehow new track, created from a combination of the "A Plague of Lighthouse Keepers" sections "Eyewitness" and "The Clot Thickens" with the 2nd part of "The Sleepwalkers". A studio version of this unique track was recorded for a Peel session in Oct 1977, and has been released on the VdGG BBC compilation After the Flood: At the BBC 1968-1977.

The studio version of "Still Life" was on the eponymous 1976 album, a studio version of "Last Frame" was on The Quiet Zone/The Pleasure Dome, and studio versions of "Killer" and "Pioneers Over c" are the bookends of H to He, Who Am the Only One (1970). The studio version of "The Sleepwalkers" is on Godbluff (1975), and the studio version of "A Plague of Lighthouse Keepers" is on Pawn Hearts (1971).

Track listing
All tracks are written by Peter Hammill except where indicated.

Side One

Side Two

Side Three

Side Four

(*) Peter Hammill solo album.

Release
The European release was a double LP on Charisma Records, ref'ed CVL0D101; the US release on double vinyl LP was on PVC Records, PVC 9901. The album was originally issued twice on CD in the UK (CVLCD101, 1989), first with the entire 2LP track listing on the cover and label, but only actually containing sides one and two, and then reissued restoring some of the songs from sides three and four (excluding "Sci-Finance" and "Nadir's Big Chance") and correcting the cover and label. The entire album was only originally issued on CD in Japan (VJD-25023~24, 1989), and this had a booklet with incorrect lyrics (for instance "Sit down with the greats" on "Still Life" instead of the correct "Citadel reverberates"). In 2005, a remastered double CD version (CVLCDR101) restored the omitted tracks, as part of a Van der Graaf Generator reissue series from Virgin Records, who revived the Charisma Records imprint to commemorate the 2005 reunion album Present.

Response
Vital has been reviewed twice on AllMusic. Bruce Eder's review refers to the CVLCD101 CD pressing (which omits "Sci-Finance" and "Nadir's Big Chance"), while Dave Thompson's review covers the 2005 re-release, which is called Vital [Bonus Tracks] despite the fact that the tracks in question are merely those deleted from the earlier CD pressing and were on the initial double LP. Eder writes that "the group presents the raw, up-close, in-your-face approach that made Van Der Graaf Generator favorites of the punk bands despite the group's prog rock origins – between Hammill's loud, raspy vocals and his crunchy overamplified guitar, 'Still Life', 'Door', and 'Pioneers Over c' all sound almost like punk band performances." Both reviews give Vital a three-star rating out of five.

At the time, critical response was generally positive. A positive review appeared in Melody Maker that called VdGG "a band with enough enigma to keep Sherlock Holmes on the case for three volumes," and stated that "[Vital] indicates more fully than ever the inspired maelstrom of bitter vision and controlled desolate grandeur that Van der Graaf can create". John Gill, reviewing for Sounds said "Unashamedly betraying my partisan affections, 'Vital' really is," and that "[the album] captures the dark soul of VdG, laying past and present musical nightmares on to vinyl".

A negative review published in NME by John Gray said "...even endless ecstasy can be boring." While Gray praised Vital's revamp of "Pioneers over c" as sounding "well-rehearsed and complete," favourably compared Nic Potter's bass sound to Jannick Top of Magma, and approved of some of the violin and cello work, he was critical of "torturous renditions of two of Hammill's best songs" ("Still Life", "Last Frame"), claimed the deliberately omitted lyrics in the medley of "A Plague of Lighthouse Keepers" and "Sleepwalkers" "rendered [them] ineffective", and responded to the "Nadir's Big Chance" lyric "jerks in leather bondage suits" by writing "what Hammill doesn't realize is that there's more bondage in his songs than there will ever be down the Kings Road."

Personnel
Van der Graaf
 Peter Hammill – vocals, piano, guitar
 Nic Potter – bass
 Graham Smith – violin
 Charles Dickie – cello, electric piano, synthesizer
 David Jackson – saxophones and flute (plays on tracks 4-7)
 Guy Evans – drums
Technical
 Mike Dunne – recording engineer
 Mixed at Foel Studio, Llanfaircaereinion, Powys
 Dave Anderson – engineer
 Guy Evans – producer
 Peter Hammill – existential producer
 Cover photo by Gordian Troeller
 Stage equipment by: Faraday & John Goodman
 Sound by: H.H.B., Martin Westwood, Noel Mawer & Graham Hayes
 16 track by: Brian
 Gordianisation [sic] by: Troeller

References

External links
 Van der Graaf - Vital: Van der Graaf Live (1978) album review by Bruce Eder, credits & releases at AllMusic.com
 Van der Graaf - Vital: Van der Graaf Live (1978) album releases & credits at Discogs.com
 Van der Graaf - Vital: Van der Graaf Live (1978) album credits & user reviews at ProgArchives.com
 Van der Graaf - Vital: Van der Graaf Live (1978) album to be listened as stream at Spotify.com

Van der Graaf Generator albums
1978 live albums
Charisma Records live albums
Live albums recorded at The Marquee Club

redpajama_set_name: RedPajamaWikipedia


Hassio not suitable for offline environments (no local control, privacy second)?
I migrated my home assistant from a Debian based to hassio. My environment has no (physically no) access to the world wide web.
As home assistant puts local control and privacy first I had no issues with this setup (Debian based & offline environment) in the past.
Specially the thing with the time is kind a showstopper on my raspberry pi which is missing a in build RTC and can't recover the time when power cycled for example. Even though I actually added a RTC DS3231 to my setup hassio can't utilize it.
And if times not right in home assistant many things will just not work like history or time based automatizations. In all the system just behaves really bad as most things in ha just depend on a proper time.
In all it looks like hassio does not put local control (and privacy?) first like home assistant does. Is this true?
If though it should be considered to at at least a warning to the download page of hassio that it doesn't support (only) local control and relies on a permanent internet connection and google services (for NTP).
You can follow the Linux-based install and put Hass.io on Raspbian Lite. NTP should be able to be set there.
The Hass.io image used their own stripped down HassOs.
I ran Hass.io with no incoming Internet access to control some z-wave devices. It may have got NTP externally. I did not check.
Could these setup actually solve all of the mentioned problems (local time with ntp+rtc, local TTS, local camera)?
Would I be able to migrate (export/import) my actual setup from my existing hassio - or need I - once again to start from scratch?
Yes. You have full control over the host os.
or need I - once again to start from scratch?
No matter how you install home assistant the config directory is the same and can be used between all the different install methods.
This would actually mean I have a perfect synergy with the advances of hassio (easy addons for example) without the down sides of the walled garden (mandatory google home calling for example) but rather full control of the things I need?
I'm not too familiar with NTP servers but would it be possible to have a local NTP server for HassOS to connect to?
or Would it be possible to give it internet access to NTP only?
would it be possible to have a local NTP server for HassOS to connect to?
NTP is "Network Time Protocol" You could set up an NTP server that syncs with servers online. Some enterprises have NTP servers that sync their time off GPS.
And the router likely gets its NTP settings from DHCP or manual configuration.
Netgear learned their lesson about hardcoding NTP servers.
If even netgear learend the lession hassio should be able to do so! I actually have no idea how hard it is to change hassio that the ntp time source would be changeable (with a config file for example) but I think it should be worth it.
Without internet access you get no weather, sun information (for automations utilizing position of sun), no updates, no add-ons, and without internet you can't even install hassio.
Seems odd to me, since I don't wear a tin foil hat, to NOT allow it to access the internet just for grabbing data it expects.
Hardcoding does seem a little probablematic; I think google servers are even blocked in some regions of the world.
add a feature request for hassOS to add NTP server settings, you could have it in the same section as the network settings. You may be able to do a feature request on github of the forum.
192.168.0.222 being your local NTP server. This may seem like a hack it may well give you offline acces to HASSIO.
If this works then I'd be intested to know.
My internet access does occasionally have issues, and not being able to reboot my HassIO box while the internet is down would be a nice issue to fix.
One of HA's features is offline functionality, I think HassIO should also offer offline functionality, especially considering that complete OS updates can be done offline with a USB stick, it seems like it's almost there.
Did you ever thought of that there could be locations without internet?
Did you ever thought of that their are high security facilities without internet access?
Do you ever thought of using home assistant for access control and/or alarm system? Would be a smart move to don't connect it to the Internet then!
And Installations and updates could easily taken in without exposing your whole network.
But anyway. Their are still people (or lemmings?) using still cisco products, nest, google <service/product>… and their still alive - so what?
My hassio actually boots always without internet connection (because their is none!). But doesn't have a proper time which makes quite everything unable to use proper.
This would be awesome… The infrastructure for this seems ready to roll… Just need to implement it?
Evil or not. I also avoid google services as most as possible because of privacy concerns. For sure dns and ntp from google is a no go. Google search only bubble free with third party (proxified) search engines like startpage.com. For the smartphone there is just the possibility of a vanilla android (aosp) without google services but with root and firewall.
Would be nice if hassio would offer a easy solution to not rely on google services too!
PS.: The other option google choose for a slogan was "do good" if I'm right? Sounds a little bit like a church slogan - I would say: not trust able at all!
Sure. I wouldn't use home assistant there, but ok.
WTF? So you would be using home assistant in a high security facility? LMAO. Ok.
I use it for my home alarm system…and, gasp! It's connected to the internet!
It just seems stupid to be using a product like HASSIO in a completely offline environment.
They do. It's called installing Hassio on Linux.
:tractor: Hass.io build tools. Contribute to home-assistant/hassio-build development by creating an account on GitHub.
Beside the usage of the images it's also possible to run Hass.io on a generic system without flashing an image.


We've talked several times on the blog about rethinking how we manage and transport the huge data loads flowing within a city and from one city to another. These data flows run on our most high-capacity fiber optic lines using laser light. But we need to make these systems more efficient and interoperable as data demand continues to grow.
Over the last several months, we've been perfecting that new technology. The next step will be to launch it across our network.
ROADM stands for Reconfigurable Optical Add/Drop Multiplexers. They're a kind of network switch that manages data traveling over high-capacity fiber optic lines. These are the workhorses of the network. Software-controlled ROADMs can automatically detect and adjust bandwidth. They can move traffic to different lanes as needed.
Starting in our metro network, we've been using technology based on the new Open ROADM Multi Source Agreement (MSA). This is the group we helped create to write industry-wide specifications for how software-controlled ROADMs should operate and how hardware from different manufacturers should work together. For the first time, we now have optical interoperability between equipment made by different vendors. We also have common management APIs and a common network model.
We're now moving toward scaling Open ROADM deployments using multiple vendors and an optical SDN controller that's integrated into ECOMP. ECOMP is the operating system for our software-defined network. We're starting with our Open ROADM deployment in Dallas. Soon, we'll be deploying Open ROADM technology as the standard design for all metro ROADMs – and eventually all ROADMs.
We're using the new ROADMs and SDN controller in our own management systems at AT&T. We're starting to use these ROADMs for production customer traffic.
The interoperability specifications and models were developed by 15 MSA members consisting of network operators and equipment developers. The team is currently working on 3rd generation features including higher rate wavelengths.
Today's networks require integrated, multi-layer planning and service assurance to provide the best customer experience. We've deployed a multi-layer SDN controller in our inter-city network that provides centralized traffic engineering.
This is an improvement on the distributed protocol. Now, there's a global view of traffic demands and we can see which network resources are available. We're now enhancing the SDN controller so we can fully reconfigure the optical layer to boost network capacity where and when it's needed. We'll do it using intelligent algorithms.
The biggest takeaway? We're moving beyond the test and demonstration phase. We're moving into the deployment and scale phase of our SDN-controlled optical network. This new technology, along with our AI algorithms, will help ensure our customers can continue to do whatever they need to do, from streaming movies to running their businesses.
Starting next Monday at OFC 2018 (Optical Fiber Conference) in San Diego, AT&T network experts will be speaking in a variety of forums about our optical network evolution and experiences with deploying Open ROADM and multi-layer SDN control.


This being my first time trying Dolphin, I started with the x64 version of 3.0-757. I wanted to pick up Skyward Sword where I had left off on my actual Wii, so I adjusted the graphics settings per the compatibility suggestions, imported the save from my SD card and gave it a shot. No matter what I tried, all I could get is the black screen with "Clearing code cache." on it, among a few other notes about my CPU and Backend choice (Direct3D11). See this screenshot.
I was able to hit esc and return to the main Dolphin screen as long as I didn't let it sit there for very long. I tried Direct3D9 and OpenGL, both of which produced the same result. I also tried some random earlier builds, as well as the stable 3.0 build. I began to notice that in the Graphics options, the adapter would always default to my integrated Intel graphics. Changing the setting in the Nvidia control panel to force Dolphin to run under the GeForce didn't change it. Then, once, while trying to select the GeForce from the dropdown menu, Dolphin crashed. Every time after that, it would crash just by clicking the graphics button. This would happen with any x64 version I'd download, regardless of whether I deleted the previous versions or not. And now, instead of the black screen with "Clearing code cache.", it also crashes when I try to run the game without adjusting the graphics.
I also tried the x32 version (3.0-758). That does not crash, but it does return to my previous code cache problem. It also lists my GeForce as an option for Direct3D11...but only before trying to run Skyward Sword. Afterward, the Intel adapter is the only one available. I read another thread that seems to say that even though the integrated Intel adapter is what's listed, that's not actually what's going to be USED, so I'm not too worried about that. What I'm more worried about is getting the x64 versions to work (and why did they work at first but not now?) and ultimately getting a game running.
I know that's a lot of info, but please let me know if you have any ideas or suggestions, or if you need any further info. Logs or anything? I gather that since my laptop specs are in my profile, you should be good with that, right? I'm giving up for tonight, so I'll check in tomorrow. Thanks!
Have you tried redumping the game?
(08-26-2012, 05:14 AM)ExtremeDude2 Wrote: Have you tried redumping the game?
I'll try redumping the game, but I definitely have everything set to high performance, and I have Dolphin set to run on the better GPU. My main problem at this point is getting the 64-bit versions to stop crashing, though.
Running the Dolphin exe's as Administrator got rid of the crashes. AND, redumping the game solved the "Clearing Code Cache" problem. Running fine now! Thanks!


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Pre-heat your oven to 220 degrees Celsius.
Place your whole peppers on a baking tray and cover with a little oil. Place in the oven to roast for 20-25 minutes.
Whilst your peppers are baking, place a large frying pan onto the hob with a little oil. Slice your sausages into chunks approx. 1 inch thick and place into the frying pan.
Once your sausages have browned add in your red pesto mixture and a splash of single cream - leave to heat through. Make sure you add enough pesto to coat your pasta.
Drain pasta and add to the sausage and pesto mix. Take peppers out of the oven carefully (they will be hot!), stab with a knife to extract the steam and carefully slice into 1-inch thick slices. Place in with your sausage and pesto mix, stir and place into an oven-proof dish.
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text:
Robert M. Tammero
The Federal Reserve Pushes Back on Narrow Banking
U.S. Depository Institutions Alert
Alerts/Updates
The FDIC Considers Modernizing its Brokered Deposit Rules
Dealing with Confidential Supervisory Information in a Bank Merger or Acquisition
This article was first published in Banking New England
Structuring Bank and Fintech Collaborations
Merger Considerations Include Strategy, Fit, Roadblocks
BBA Presentation Summary: Libor – What it is, What it Does, and Why it Matters
BBA Financial Services Section Newsletter
K&L Gates Advises Bar Harbor Bankshares on Acquisition of Regional Bank Branches
LL.M., Boston University School of Law, 2011
J.D., Suffolk University Law School, 2010, (cum laude)
B.A., Providence College, 2007, cum laude)
Bar of Massachusetts
Rob Tammero is a senior associate in the firm's Boston office. Mr. Tammero represents companies in a range of corporate and transactional matters, including mergers and acquisitions, debt and equity financings, and corporate governance. He advises buyers and sellers of businesses and assets, investors, and companies raising capital. Mr. Tammero's practice includes representation of financial institutions and their holding companies, FinTech companies, investment funds, and other financial service providers in corporate, transactional, and regulatory matters.
Prior to joining the firm, Mr. Tammero was an associate in the corporate and securities section of a national, Boston-based law firm. Before entering private practice, Mr. Tammero served as a law clerk with the Federal Deposit Insurance Corporation.
Professional/Civic Activities
Boston Bar Association, Banking Committee Co-Chair, 2012- 2014
American Bar Association Presidential Task Force on Financial Markets Regulatory Reform, Assistant Reporter, 2011- 2012
Big Brothers Big Sisters of Massachusetts Bay, 2008-2018
Bank and Fintech Partnerships, Massachusetts Bankers Association New England Conference (2018)
The Function of the Corporate Secretary, Massachusetts Bankers Association (2018)
Understanding Insider Lending and Regulation O, Lorman Education Services (2019)
Represented Salem Five Bancorp in its acquisitions of Georgetown Bancorp (NASDAQ: GTWN) and Sage Bank
Represented Cognition Financial Corporation in the sale of its payments subsidiary, Tuition Management Systems LLC, to Nelnet Business Solutions, Inc., a division of Nelnet, Inc. (NYSE: NNI)
Represented Middlesex Federal Savings, F.A. in its fintech partnership with Novo Platform Inc.
Represented Springstone Financial, LLC, an arranger of patient financing for medical and dental procedures, in its sale to LendingClub Corporation (NYSE: LC)
Represented Brooks Automation, Inc. (NASDAQ: BRKS) in its acquisition of cooling and freezing technology from BioCision, LLC
Represented inviCRO, LLC, a medical imaging company, in its acquisition of Molecular NeuroImaging, LLC
Represented Next Generation Children's Centers, a provider of early education and childcare, in its sale to Cadence Education, Inc.
Represented Tarpon Biosystems, Inc., a developer of continuous processing technology, in its sale to Pall Corporation (NYSE: PLL)
Represented Giant Glass Company Inc. in its sale to Safelite AutoGlass
Represented TraceLink, Inc. in its Series D and secondary financings
Represented Spero Therapeutics (NASDAQ: SPRO) in venture capital financings and its acquisition of pharmaceutical candidates from Pro Bono Bio
Represented Quabbin Capital Inc. in its acquisition of bankruptcy assets of the Upper Crust Pizzeria restaurant chain
Represented Hemoglobin Oxygen Therapeutics, LLC in its financing and acquisition of bankruptcy assets of OPK Biotech, LLC
Represented RA Capital Management, LLC in several venture capital financings of life sciences companies, including Aclaris, Inc. (NASDAQ: ACRS) and Arvinas, Inc.