Data on hemodynamic variables and doses of vasoactive agents are shown in Figure 3 and Figure 4 in the Supplementary Appendix. The mean arterial pressure was similar in the two treatment groups at baseline, and it changed similarly over time, although it was slightly higher from 12 to 24 hours in the norepinephrine group. The doses of the study drug were similar in the two groups at all times. More patients in the dopamine group than in the norepinephrine group required open-label norepinephrine therapy at some point (26% vs. 20%, P<0.001), but the doses of open-label norepinephrine that were administered were similar in the two groups. The use of open-label epinephrine at any time was similar in the two groups (administered in 3.5% of patients in the dopamine group and in 2.3% of those in the norepinephrine group, P=0.10), as was the use of vasopressin (0.2% in both groups, P=0.67). Dobutamine was used more frequently in patients treated with norepinephrine, but 12 hours after randomization, the doses of dobutamine were significantly higher in patients treated with dopamine. The mean (±SD) time to the achievement of a mean arterial pressure of 65 mm Hg was similar in the two groups (6.3±5.6 hours in the dopamine group and 6.0±4.9 hours in the norepinephrine group, P=0.35). There were no major between-group differences in the total amounts of fluid given, although patients in the dopamine group received more fluids on day 1 than did patients in the norepinephrine group. Urine output was significantly higher during the first 24 hours after randomization among patients in the dopamine group than among those in the norepinephrine group, but this difference eventually disappeared, so that the fluid balance was quite similar between the two groups.
Since the magnitude of the effect derived from observational studies can be misleading, we opted for a sequential trial design with two-sided alternatives20; the trial design called for analyses to be performed after inclusion of the first 50 and 100 patients, and then after inclusion of each additional 100 patients, and allowed for the discontinuation of the trial according to the following predefined boundaries: superiority of norepinephrine over dopamine, superiority of dopamine over norepinephrine, or no difference between the two. An independent statistician who is also a physician monitored the efficacy analyses and the adverse events; on October 6, 2007, after analysis of the outcome in the first 1600 patients showed that one of the three predefined boundaries had been crossed, the statistician advised that the trial be stopped.
Similar to building explosive power by jumping over a stationary object, hurdles allow you to practice your leap. Space eight flights of hurdles two feet from each other and aim to jump over each like a pogo stick—basically, as high as you can. Repeat this for 10 repetitions: one flight of eight hurdles equals one repetition. Do this twice per week.
The phrase "slam dunk" has entered popular usage in American English outside of its basketball meaning, to refer to a "sure thing": an action with a guaranteed outcome, or a similarly impressive achievement. This is related to the high probability of success for a slam dunk versus other types of shots. Additionally, to "be dunked on" is sometimes popularly used to indicate that a person has been easily embarrassed by another, in reference to the embarrassment associated with unsuccessfully trying to prevent an opponent from making a dunk. This ascension to popular usage is reminiscent of, for example, the way that the baseball-inspired phrases "step up to the plate" and "he hit it out of the park," or American football-inspired phrases such as "victory formation" or "hail Mary" have entered popular North American vernacular.
We conducted this multicenter trial between December 19, 2003, and October 6, 2007, in eight centers in Belgium, Austria, and Spain. All patients 18 years of age or older in whom a vasopressor agent was required for the treatment of shock were included in the study. The patient was considered to be in shock if the mean arterial pressure was less than 70 mm Hg or the systolic blood pressure was less than 100 mm Hg despite the fact that an adequate amount of fluids (at least 1000 ml of crystalloids or 500 ml of colloids) had been administered (unless there was an elevation in the central venous pressure to >12 mm Hg or in pulmonary-artery occlusion pressure to >14 mm Hg) and if there were signs of tissue hypoperfusion (e.g., altered mental state, mottled skin, urine output of <0.5 ml per kilogram of body weight for 1 hour, or a serum lactate level of >2 mmol per liter). Patients were excluded if they were younger than 18 years of age; had already received a vasopressor agent (dopamine, norepinephrine, epinephrine, or phenylephrine) for more than 4 hours during the current episode of shock; had a serious arrhythmia, such as rapid atrial fibrillation (>160 beats per minute) or ventricular tachycardia; or had been declared brain-dead.
Yet, rate of force development is likely less important for vertical jumping than for faster athletic movements, such as sprinting. This is because the time that is available for force production is *ten times* longer in the vertical jump than in sprinting. Sprinters often take their foot off the ground before their lower body muscles have achieved maximum force (which takes approximately 150ms), but this early period of rising force production plays only a very small role during vertical jumping.
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Other obstruction-dunks are worth noting: Haneef Munir performed a Dubble-Up, dunking with his right-hand and then caught and dunked a second ball with his left hand—a yet to be duplicated dunk pioneered by Jordan Kilganon on a lower, non-regulation rim. Jordan Kilganon, a Canadian athlete, approached from the baseline a person standing, holding the ball above their head. Kilganon leaped, controlled the ball in front of his torso and raised it above the horizontal plane of the rim before bringing the ball downward into the hoop and hooking both elbows on and hanging from the rim.
An important component of maximizing height in a vertical jump is attributed to the use of counter-movements of the legs and arm swings prior to take off, as both of these actions have been shown to significantly increase the body’s center of mass rise. The counter-movement of the legs, a quick bend of the knees which lowers the center of mass prior to springing upwards, has been shown to improve jump height by 12% compared to jumping without the counter-movement. This is attributed to the stretch shortening cycle of the leg muscles enabling the muscles to create more contractile energy. Furthermore, jump height can be increased another 10% by executing arm swings during the take off phase of the jump compared to if no arm swings are utilized. This involves lowering the arms distally and posteriorly during the leg counter-movements, and powerfully thrusting the arms up and over the head as the leg extension phase begins. As the arms complete the swinging movement they pull up on the lower body causing the lower musculature to contract more rapidly, hence aiding in greater jump height. Despite these increases due to technical adjustments, it appears as if optimizing both the force producing and elastic properties of the musculotendinous system in the lower limbs is largely determined by genetics and partially mutable through resistance exercise training.