A Tribute to William S. Geimer

A Tribute to William S. Geimer Meredith Susan Palmer* * Associate Dean for Student Affairs and Admissions, Washington and Lee University School of Law, J.D., 1985, Washington and Lee University. Truly, I say to you, as you did it to one of the least of these my brethren, you did it to me.1 Bill Geimer is not a man of material things. But somehow, in the material things that he chose to have around him - the mementos, the odd souvenirs, the offerings from students, clients, friends - I find the story of the man, the teacher, and the lawyer Bill Geimer is to me. In my mind's eye, I see Bill's office here at Washington and Lee as I first saw it, as a hesitant first-year law student approaching the sanctum sanctorum of a faculty member. There is a desktop name plate, regular Army issue, decorated with grenades or something equally militaristic and intimidating. But next to that is a picture of Dr. Martin Luther King, with his stirring words evoking hope for justice and freedom on earth. And next to that, a membership certificate for the Lawyer's Alliance for Nuclear Arms Control, and a drawing of Quijote, lance raised to a windmill. How could this be? While reconciling the seemingly irreconcilable is the everyday task of the law student, no trick of logic could make these disparate pieces fit; one simply had to get to know the man. That one could do so as a law student is itself part of what defines Bill Geimer. The student who came to know Bill heard a story of a kid from the rural south, off to a small state university to play basketball but who, like countless kids before him, spent a bit more time playing than studying. Come Graduation Day, with no game plan, he joined Uncle Sam's family. A grounding in tanks, guns, and tactics preceded duty with the military police, but something else happened during those years. Assigned to assist with an investigation, he finds an aptitude for the law, an appreciation of justice, and a burning sense of the unfairness of justice denied. The young man who returned from service to go on to a distinguished career as a law student at the University of North Carolina was a man with a game plan, and a mission. It was no surprise that Bill's mission as a lawyer was not in the office towers of Atlanta or the corporate boardrooms of Wall Street, but among the plain folks of Fayetteville, North Carolina, and later in the community of migrant farm labor working and living hard under the hot Carolina sun. I see another memento, this time in Bill's home. It's an odd piece of, well, let's call it folk art. Crudely carved, frankly ugly. Taste is a delicate thing, so one observes diplomatically that it is an "interesting" object. There's a story, of course, a story of a client for whom Bill had worked, putting together the paperwork to get a fledgling arts-and-crafts shop off the ground. This client, like many Bill served, claimed not to have the cash to pay. But, the client said, he could give Bill this valuable piece of work. Barter being a fundamentally more honest exchange and thus appealing to Bill, the transaction was concluded. Not until Bill brought his sculpture home did he discover the price tag stuck to the underside, for something substantially less than the agreed-upon fee. He kept the awkward thing, price tag intact, I think as a reminder of his own fallibility, of the ingenuity of the ordinary man, and of the need to forget neither. Another memento, in some ways the most important to this former student, is a large, faded, well-handled poster on the professor's office door. A young man in Carolina Blue goes up for a shot, stretching for the basket, with seconds left on the clock. Anyone who knows Bill Geimer knows that he is devoted to Carolina basketball. In fact, Bill may have spent so much time watching the Tar Heels play that he began to confuse teaching with coaching. As a former student of Bill's, I'm not sure that was a bad thing.

On the nature and variability of the east Greenland Spill Jet : a case study in Summer 2003

Author Posting. © American Meteorological Society, 2011. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 41 (2011): 2307–2327, doi:10.1175/JPO-D-10-05004.1.Results from a high-resolution (~2 km) numerical simulation of the Irminger Basin during summer 2003 are presented. The focus is on the East Greenland Spill Jet, a recently discovered component of the circulation in the basin. The simulation compares well with observations of surface fields, the Denmark Strait overflow (DSO), and the hydrographic structure of typical sections in the basin. The model reveals new aspects of the circulation on scales of O(0.1–10) days and O(1–100) km. The model Spill Jet results from the cascade of dense waters over the East Greenland shelf. Spilling can occur in various locations southwest of the strait, and it is present throughout the simulation but exhibits large variations on periods of O(0.1–10) days. The Spill Jet sometimes cannot be distinguished in the velocity field from surface eddies or from the DSO. The vorticity structure of the jet confirms its unstable nature with peak relative and tilting vorticity terms reaching twice the planetary vorticity term. The average model Spill Jet transport is 4.9 ±1.7 Sv (1 Sv ≡ 106 m3 s−1) equatorward, about 2½ times larger than has been previously reported from a single ship transect in August 2001. Kinematic analysis of the model results suggests two different types of spilling events. In the first case (type I), a local perturbation results in dense waters descending over the shelf break into the Irminger Basin. In the second case (type II), surface cyclones associated with DSO deep domes initiate the spilling process. During summer 2003, more than half of the largest Spill Jet transport values are of type II.The research is supported by the National Science Foundation Grants OCE-0726393 and OCI-0904640 (MGM and TWNH) and OCE-0726640 (RSP).2012-06-0

Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia

Chronic limb-threatening ischemia (CLTI)is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG)are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD)in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI)is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR)hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP)and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen)has not been established. Regenerative medicine approaches (eg, cell, gene therapies)for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative. © 2019 Society for Vascular Surgery and European Society for Vascular Surger