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.
Because of the possible combinations of starting and finishing hands, and raised-legs, there are many variations on the basic under-the-legs dunk—more so than any other. For example, in a 1997 French Dunk contest, Dali Taamallah leapt with his right leg while controlling the ball with his left hand, and once airborne he transferred the ball from his left hand, underneath his right leg to his right hand before completing the dunk. NBA star Jason Richardson has also pioneered several notable variations of the between-the-legs including a lob-pass to himself and a pass off of the backboard to himself. Independent athlete Shane 'Slam' Wise introduced a cuffed-cradle of the ball prior to initiating the under the leg transfer and finishing with two-hands. While a number of players have finished the dunk using one- or two-hands with their backs to the rim, perhaps the most renowned variant of the dunk is the combination with a 360°, or simply stated: a 360-between-the-legs. Due to the athleticism and hang-time required, the dunk is a crowd favorite and is heralded by players as the preeminent of all dunks.
A Tomahawk dunk can be performed with one or two hands, and when two hands are used, it is called a backscratcher. During the jump, the ball is raised above, and often behind the player's head for a wind-up before slamming the ball down into the net at the apex of the jump. Due to the undemanding body mechanics involved in execution, the tomahawk is employed by players of all sizes and jumping abilities. Because of the ball-security provided by the use of both hands, the two-handed tomahawk is a staple of game situations—frequently employed in alley-oops and in offense-rebound put-back dunks.
Among patients with cardiogenic shock, the rate of death was significantly higher in the group treated with dopamine than in the group treated with norepinephrine, although one might expect that cardiac output would be better maintained with dopamine26-28 than with norepinephrine. The exact cause of the increased mortality cannot be determined, but the early difference in the rate of death suggests that the higher heart rate with dopamine may have contributed to the occurrence of ischemic events. Whatever the mechanism may be, these data strongly challenge the current American College of Cardiology–American Heart Association guidelines, which recommend dopamine as the first-choice agent to increase arterial pressure among patients who have hypotension as a result of an acute myocardial infarction.7
High pulls can also be done using a dumbbell or kettlebell,. When doing so, position the weight between your feet and pull with one arm at a time (switching arms halfway through the set). A trap bar (aka, hex bar) is also an option, particularly for individuals who have a hard time keeping the lower back flat; the trap bar allows the hands to be positioned behind the shins to help pull the shoulders back.
My quest to dunk started poorly. The main problem was that I could only do about half of the very long list of ercises the Jump Manual instructed at the crowded and inadequate YMCA near my place. The basketball court—the only space big enough to do some of the drills—was always occupied with classes. The Strength Shoes, meanwhile, were so absurd that I was too embarrassed to wear them in front of other gym-goers. I used them only a handful of times, in an empty stairwell on the top floor of the gym.
A predefined subgroup analysis was conducted according to the type of shock — septic shock, which occurred in 1044 patients (542 in the dopamine group and 502 in the norepinephrine group); cardiogenic shock, which occurred in 280 patients (135 in the dopamine group and 145 in the norepinephrine group); or hypovolemic shock, which occurred in 263 patients (138 in the dopamine group and 125 in the norepinephrine group). The overall effect of treatment did not differ significantly among these subgroups (P=0.87 for interaction), although the rate of death at 28 days was significantly higher among patients with cardiogenic shock who were treated with dopamine than among those with cardiogenic shock who were treated with norepinephrine (P=0.03) (Figure 3). The Kaplan–Meier curves for the subgroup analysis according to type of shock are shown in Figure 7 in the Supplementary Appendix.
Jumping Rope – A skipping rope is the only piece of equipment involved in the program. If you don’t have one a piece of rope will do just ﬁne. If you don’t have a piece of rope either jumping up and down on the spot without much bending in the knees will achieve a similar result. Jumping rope involves holding a rope with both hands and swinging it around your body continuously.