Circulatory shock is a life-threatening condition that is associated with high mortality.1,2 The administration of fluids, which is the first-line therapeutic strategy, is often insufficient to stabilize the patient's condition, and adrenergic agents are frequently required to correct hypotension. Among these agents, dopamine and norepinephrine are used most frequently.3 Both of these agents influence alpha-adrenergic and beta-adrenergic receptors, but to different degrees. Alpha-adrenergic effects increase vascular tone but may decrease cardiac output and regional blood flow, especially in cutaneous, splanchnic, and renal beds. Beta-adrenergic effects help to maintain blood flow through inotropic and chronotropic effects and to increase splanchnic perfusion. This beta-adrenergic stimulation can have unwanted consequences as well, including increased cellular metabolism and immunosuppressive effects. Dopamine also stimulates dopaminergic receptors, resulting in a proportionately greater increase in splanchnic and renal perfusion, and it may facilitate resolution of lung edema.4 However, dopaminergic stimulation can have harmful immunologic effects by altering hypothalamo–pituitary function, resulting in a marked decrease in prolactin and growth hormone levels. 5


I scoured the Internet looking for guidance. There are dozens of sites promising a path to dunking, most of them coded at the dawn of the Web. It was daunting finding one that seemed legit. I ended up paying $67 for the Jump Manual, an online program offered by Jacob Heller, a trainer with a 42-inch vertical who counts NBA players among his clients, according to his website. Next, I ordered a pair of Strength Shoes. You’ll remember these if you’re a basketball player of a certain age—the ridiculous-looking training kicks popular in the ’90s, with a platform under the toe that places your bodyweight on the balls of your feet.
In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 μg per kilogram of body weight per minute for dopamine or a dose of 0.19 μg per kilogram per minute for norepinephrine, open-label norepinephrine, epinephrine, or vasopressin could be added. The primary outcome was the rate of death at 28 days after randomization; secondary end points included the number of days without need for organ support and the occurrence of adverse events.
Slow-Motion Squats – Involves standing with your feet shoulder width apart. From this position slowly lower down until you are in a deep squat making sure your heels are flat on the ground. Hold for 2 seconds before slowly rising back to the starting position. The descent and rise should each take 4 seconds to complete. Throughout the entire exercise make sure to keep your head up and your back straight.
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.
If anything came to surprise me about this journey, it was the sheer volume of physical pain involved. I had taken on impressive physical feats before. I had run a sub-3:30 marathon back in 2003 (my first and only attempt) after put­ting in the hundreds of training miles required. I’d done some of the most grueling weight training on offer, most of it either on the beach or at The Yard, a nearby temple of athletic performance where Maria Sharapova, Kobe Bryant and Tom Brady, among many others, have kneeled with exhaustion. But the physical toll of trying to dunk made the marathon and the semipro football and the parenting and everything else I’d ever attempted seem like mere rubber band snaps to the wrist. The lifting didn’t hurt as much as the jumping, the banging of my quadragenarian appendages into the ground, taking off and landing 50 to 200 times a day. My legs never got used to this bludgeoning, never got better at recovering from it, despite my daily foam-rollering, stretching, icing and hydrating. Even on my off days, a quick game of tag with my kids or a bike ride to the park meant daggers in my thighs and a gait like Fred Sanford’s.

Janik was available by text whenever I needed him, like my very own dunk training app. The important thing, he said, was to work out hard and smart. When my knees or back were sore, he advised lowering the weight for a few sessions and eliminating depth jumps. "Listen to your body," he told me. And I did: I took a day off here or there if I needed it; I added more weight when I felt good. When, after five weeks, I started to worry that I wasn’t going to dunk again, he kept me motivated. "Leg strength is the key. Squat deep. Ass to grass," he told me, unsympathetic to the known fact that squats are fucking terrible.
I just got the bike on Friday and used it twice over the weekend so this isn't a long-term review but my initial impression is highly favorable. I am a "serious" cyclist, which is not to say I'm a professional or anything like that but I log a lot of miles on my road bike and use high-end equipment. I've always hated hooking a bike up to an indoor trainer and I've avoided that type of training for many years. I finally went in on a spinning bike and I am very impressed with the results.

After four months of failing to pull off anything even resembling a real dunk, the planets aligned on Aug. 9: After at least 19 failed attempts that afternoon, I dunked a soccer ball on a middle school court whose rim measured 9' 11". (The original basketball, incidentally, was a soccer ball, property of Dr. Naismith’s employer, Springfield College.) Video from that afternoon shows me standing there, looking confused, in the moment afterward. Did that just happen? Failing had become so routine that even this small success felt foreign.
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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.
Squats – start with the bar behind your neck, resting on your shoulders and make sure you’re standing with your feet shoulder width apart. From this position, slowly lower your body by bending at your knees. You’ll go all the way down until you’re in a deep squat and holding that position for two seconds. Then you can slowly rise back up to your starting position. Make sure you keep your back straight and you’re bending at your knees.

4. verb By extension, to achieve a forceful, dramatic success or accomplishment handily or easily, often at the expense of someone or something else. Sometimes hyphenated. The incumbent president has slam dunked his opponent in every televised debate so far. If we can slam-dunk this proposal, we'll get enough funding to see us through to the end of next year.


High-Reach Jumps – Are similar to tuck jumps, but instead of brining your knees to your chest, you just reach as high as you can. This is done best under a basketball ring or near a wall so that you can tell how much lower your reach becomes as you fatigue. Try to reach the same height through all repetitions. if you don’t have anything to measure against, that’s fine. Just jump as high as you can each repetition.
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