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Resolved What Are the Biggest Questions Facing the BPM Market in the Year Ahead?
Now that we're in November, what do you think are the biggest questions facing the BPM market for the year ahead?
Pega realized this early, and already moved to CRM - although it's just lipstick on a pig. If you're not customer-centric and customer-focused like Salesforce - you're finished.
Users can and will dictate what they want. Decades of IT-led decision making was/is over.
What the last decades have known as "BPM" is being re-invented at present.
And it may not be called BPM at all, since no next-generation company wants to carry dead weight that never really got anywhere.
Good to meet you recently btw - Ian!
Before I comment in detail, can you please explain how in your view BPM has been known the last decade?
Is the sentence "Is BPM dead yet?" dead yet?
@Alex: not as long as there's an unexploited marketing angle to it, no.
The struggle continues to prove that BPM can truly work for large companies. Ten-plus years in, BPM should have won large IT groups over, but it hasn't.
BPM is alive and kicking in large corporates, but it is embedded in peoples heads, Visio flowcharts that noone looks at (BPM=operational approach) and corporate apps like SAP and Salesforce (BPM=technology).
Visio works "well" for folks who view "rotating file devices used to store business contact information" and "personal organiser wallets" as high-tech.
All three belong in museums.
[email protected] - haven't used it in the past 10 years.
Extending on John's response, the same thing it's always been - the people. Always the people. BPM was never the panacea some, particularly vendors, presented it as and the onus has always been on educating organizations on what it can do and how best to do that, firmly setting expectations and levels of effort attendant to accomplishing that. In short, the old adage of "you get out of it what you put into it" applies here and oh so many just don't, won't get that.
That's it! Socialization of BPM. And management taking responsibility.
1. Consolidate BPM knowledge to avoid the situation when 2 BPM experts have 3 opinions on every "tiny" aspect of BPM.
2. Evolve from the vendor-centric BPM to the customer-centric BPM to avoid vendor lock-in with BPM-suite tools.
3. Understand that even “low-code” BPM has a huge impact on any enterprise because the latter has to change many internal habits to fully use the benefits of BPM.
4. Stop the self-destruction fight BPM vs ACM, again.
6. Digest the hype brought by blockchain, smart-contracts, microservices, IoT, smart-everything, etc. and use the power of BPM to address those opportunities accordingly.
The BPM vs ACM fight is a fabricated one between vendors' and consultants' hype for market share, attention.
7. [Dedicated to Patrick] Be able (before implementation of BPM) to explain to each group of stakeholders how their concerns will be addressed and how their current working practices will be changed for the better.
Re: #7, exactly. Unfortunately I usually show up after that didn't occur and get to clean up, correct the mess.
This sounds like you are fighting for a better yesterday.
Just be prepared to clear the mess from tomorrow.
"Why do we need BPM, we just bought digital transformation?"
"Why are we even still alive?" So, then the question is, "How do we rebrand & reinvent ouselves - phoenix-like - before the final embers dim?"
Hint: The ex-BPM event organizers are calling it Operational Excellence and Business Transformation. But they are talking about the way clients think about it - not the name of the technology. The technology already exists as part of something else they already have (or think they have).
I think "Operational Excellence" promotes the formation of specialist groups with hammers going about looking for nails.
A better objective IMO is "Operational Effectiveness".
Panasonic had a good slogan which they no longer use, something like ".. slightly ahead of our time". I really liked that one.
Agree with Karl. Operational excellence always sound so army and cost cutting like.
Or to summarise many of the old friends above - What is it again?
Ultimately, because it was pegged as a technology you could buy and install, it was relegated to the technologist in the room ... as in, we have someone to look after that for us.
To Ian's point - event organisers are plugging away at OPEX, Transformation (Digital or otherwise) ... and to Emiel's point someone who thought they bought Digital Transformation, will allso similarly fail.
Yet there are still lots of people getting on with the good old hard work of change and engagement. Tools and technologies are useful, but technology never was the hard part, it was always that "All Problems Are People Problems" ... i.e. the soft stuff is the hard stuff.
It comes down to engagement and cocreation if you want long term sustainable success (as against the appearance of transformation through some reductionist application of tech to reduce costs).
I don't agree that "technology was never the hard part". Nice process diagrams get buried in SOA deployment complexity and business leaves the room. And then can't come back because change is now too expensive . . . but, on the other hand, the people problems truly are the most important and challenging. So, technology and people together are, as EAs like to say, a "wicked problem".
Biggest question facing BPM market in coming year? Lack of commitment to the "idea of BPM technology" and its potential.
(a technology which supports both careers for practitioners and leverage points for digitalization) is for that technology to become just another feature in a solution (e.g. ERP or more focused apps).
Let’s just look at the whole “big” picture as “we” try to express views on just where and how BPM works. The following was included in a summary submitted to a UK Government inquiry into “accountability”.
“BPM” (Business Process Management) is the discipline on how to think and work out what is required to create an outcome putting people first. This has been a movement in existence since late 90s as some in “IT” recognised the gap between people and large inflexible “silo” based systems (including Accounts). BPM applies to ”digitisation” evidenced by webinars titled “mastering digital transformation with BPM technologies”. This http://bpm.com/ has active forum where knowledge and views accessible.
“Adaptive” solutions are the desired outcomes with custom solutions capable of quick build and easy change. It also ensures the presentation and collection of data adapts to specific user and instance delivering real time data supporting all required reports including accounts. This may sound rather obvious but it is not how big systems including accounting systems actually work but this Adaptive capability is now recognised as a must for the future.
In this forum BPMS has been largely dismissed as out of date thinking so looking at the coming year the real challenge is to apply a tag to the software that supports BPM? Yes looks like MDE maybe the “how” but we must focus on a term that business can understand and relate to all front end support requirement not just Case Management or CRM and other of the many other TLAs! My suggestion is “Adaptive” Solutions or Applications…..?
Another challenge facing the supply chain is that the cost to build and maintain is a fraction of current cost which opens doors to “ownership” of software as an asset with lease buy contracts removing any lock-in that is a lingering concern with many business people. This will impact the revenue streams of current supply chain and question the current SaaS model ……?
BUT will the industry rise to such challenges ....it will be very painful for some? As ever time will tell but all on my agenda!
"the real challenge is to apply a tag to the software that supports BPM?"
but "MDE" is likely to cause an exodus to the hills for ordinary business folks.
1) we have for years offered "private label", then staying up nights worrying about source code proliferation.
Our tech folks find this amusing - they claim we could hand out source on street corners and it would not damage our position, given that the code base runs 1,500,000 lines and takes us a year to train a new programmer.
2) we auto-export every keystroke to a generic data exchanger, so, in theory, any customer could leave us whenever they like.
This makes we wonder how worthwhile it is for vendors to try to hold their customers hostage. We have a couple of customers who have been with us since the year 2000.
RE "I am not sure people in "business" actually manage their businesses via "processes"." Yes, some of them do! My "litmus test" - those people are able to consistently explain to any stakeholder WHY their processes are as they are now.
The answer "we always do like that" may be considered also as some kind of BPM (Big Professional Mistake).
Sure, and a good example of managing a business via a process is a cement plant.
The main focus of the stakeholders is on the process of mixing up slurry and getting it to flow through the kiln.
As far as I'm concerned, there only one big question for BPM: "WILL IT BLEND???"
Will BPM seamlessly blend in ALL business practices? At ALL price points, in ALL geographies, in ALL business scenarios?
Because frankly ubiquity and accessibility is the only thing that makes a technology / practice revolutionary.
So, how can BPM focus its message and lower its build-up and distribution costs so that it represents a meaningful economic proposal for EVERYBODY?
I have yet to hear a customer saying: "man, I'm so worried about the state of the BPM market, it looks like it's dying".
RE "So, how can BPM"
lower its build-up and distribution costs – unification of 80-90 % of current BPM-suite tools, a process-pattern-based methodology for the rest and a good architecture with “an open door” for innovations.
so that it represents a meaningful economic proposal for EVERYBODY – again, use the systems approach for the enterprise’s & EVERYBODY’s surrounding systems.
Enthusiasm, insight and vision! BPM-for-Everyone! Ubiquity, accessibility and revolution!
1) CHANNELS -- Regarding the question Dr. Samarin highlights the importance of architecture and patterns. It's worth noting that some business users will know this approach as an "Accelerator", i.e. a sales add-on for specific domains and business patterns, usually provided by major software vendors (for BPM or ERP or other major application category).
Accelerators or domain patterns could also be open sourced, and could be curated by boutique BPM consulting providers. On the topic of BPM consulting, I note that Gartner's "Hype Cycle for BPM 2015" includes an item for "Digital Business Consulting Services", still pre-peak in the "Innovation Trigger" phase.
2) RISK -- Regarding end-users not caring about the state of a market, it's not uncommon for users to make a risk assessment concerning the viability of a technology, market and of course, vendor. Jumping on a bandwagon can be rational in terms of risk perception, even if sometimes the bandwagon turns out to be a bubble. Maybe end customers won't assess the health of the BPM market, but their consulting partner proxies will . . .
We should add another axis here. If we're filtering business processes to the classic operational processes we consider BPM, we should also add an industry filter. For example, in retail and hospitality one of the biggest BPM concerns is related to the new legislation regarding overtime and contingetn workforce management, AKA the gig economy. The increase in part-time, freelance, and seasonal labor introduces new challenges to HR and operations departments like onboarding, training, and much more.

lowercased:
resolved what are the biggest questions facing the bpm market in the year ahead?
now that we're in november, what do you think are the biggest questions facing the bpm market for the year ahead?
pega realized this early, and already moved to crm - although it's just lipstick on a pig. if you're not customer-centric and customer-focused like salesforce - you're finished.
users can and will dictate what they want. decades of it-led decision making was/is over.
what the last decades have known as "bpm" is being re-invented at present.
and it may not be called bpm at all, since no next-generation company wants to carry dead weight that never really got anywhere.
good to meet you recently btw - ian!
before i comment in detail, can you please explain how in your view bpm has been known the last decade?
is the sentence "is bpm dead yet?" dead yet?
@alex: not as long as there's an unexploited marketing angle to it, no.
the struggle continues to prove that bpm can truly work for large companies. ten-plus years in, bpm should have won large it groups over, but it hasn't.
bpm is alive and kicking in large corporates, but it is embedded in peoples heads, visio flowcharts that noone looks at (bpm=operational approach) and corporate apps like sap and salesforce (bpm=technology).
visio works "well" for folks who view "rotating file devices used to store business contact information" and "personal organiser wallets" as high-tech.
all three belong in museums.
[email protected] - haven't used it in the past 10 years.
extending on john's response, the same thing it's always been - the people. always the people. bpm was never the panacea some, particularly vendors, presented it as and the onus has always been on educating organizations on what it can do and how best to do that, firmly setting expectations and levels of effort attendant to accomplishing that. in short, the old adage of "you get out of it what you put into it" applies here and oh so many just don't, won't get that.
that's it! socialization of bpm. and management taking responsibility.
1. consolidate bpm knowledge to avoid the situation when 2 bpm experts have 3 opinions on every "tiny" aspect of bpm.
2. evolve from the vendor-centric bpm to the customer-centric bpm to avoid vendor lock-in with bpm-suite tools.
3. understand that even “low-code” bpm has a huge impact on any enterprise because the latter has to change many internal habits to fully use the benefits of bpm.
4. stop the self-destruction fight bpm vs acm, again.
6. digest the hype brought by blockchain, smart-contracts, microservices, iot, smart-everything, etc. and use the power of bpm to address those opportunities accordingly.
the bpm vs acm fight is a fabricated one between vendors' and consultants' hype for market share, attention.
7. [dedicated to patrick] be able (before implementation of bpm) to explain to each group of stakeholders how their concerns will be addressed and how their current working practices will be changed for the better.
re: #7, exactly. unfortunately i usually show up after that didn't occur and get to clean up, correct the mess.
this sounds like you are fighting for a better yesterday.
just be prepared to clear the mess from tomorrow.
"why do we need bpm, we just bought digital transformation?"
"why are we even still alive?" so, then the question is, "how do we rebrand & reinvent ouselves - phoenix-like - before the final embers dim?"
hint: the ex-bpm event organizers are calling it operational excellence and business transformation. but they are talking about the way clients think about it - not the name of the technology. the technology already exists as part of something else they already have (or think they have).
i think "operational excellence" promotes the formation of specialist groups with hammers going about looking for nails.
a better objective imo is "operational effectiveness".
panasonic had a good slogan which they no longer use, something like ".. slightly ahead of our time". i really liked that one.
agree with karl. operational excellence always sound so army and cost cutting like.
or to summarise many of the old friends above - what is it again?
ultimately, because it was pegged as a technology you could buy and install, it was relegated to the technologist in the room ... as in, we have someone to look after that for us.
to ian's point - event organisers are plugging away at opex, transformation (digital or otherwise) ... and to emiel's point someone who thought they bought digital transformation, will allso similarly fail.
yet there are still lots of people getting on with the good old hard work of change and engagement. tools and technologies are useful, but technology never was the hard part, it was always that "all problems are people problems" ... i.e. the soft stuff is the hard stuff.
it comes down to engagement and cocreation if you want long term sustainable success (as against the appearance of transformation through some reductionist application of tech to reduce costs).
i don't agree that "technology was never the hard part". nice process diagrams get buried in soa deployment complexity and business leaves the room. and then can't come back because change is now too expensive . . . but, on the other hand, the people problems truly are the most important and challenging. so, technology and people together are, as eas like to say, a "wicked problem".
biggest question facing bpm market in coming year? lack of commitment to the "idea of bpm technology" and its potential.
(a technology which supports both careers for practitioners and leverage points for digitalization) is for that technology to become just another feature in a solution (e.g. erp or more focused apps).
let’s just look at the whole “big” picture as “we” try to express views on just where and how bpm works. the following was included in a summary submitted to a uk government inquiry into “accountability”.
“bpm” (business process management) is the discipline on how to think and work out what is required to create an outcome putting people first. this has been a movement in existence since late 90s as some in “it” recognised the gap between people and large inflexible “silo” based systems (including accounts). bpm applies to ”digitisation” evidenced by webinars titled “mastering digital transformation with bpm technologies”. this http://bpm.com/ has active forum where knowledge and views accessible.
“adaptive” solutions are the desired outcomes with custom solutions capable of quick build and easy change. it also ensures the presentation and collection of data adapts to specific user and instance delivering real time data supporting all required reports including accounts. this may sound rather obvious but it is not how big systems including accounting systems actually work but this adaptive capability is now recognised as a must for the future.
in this forum bpms has been largely dismissed as out of date thinking so looking at the coming year the real challenge is to apply a tag to the software that supports bpm? yes looks like mde maybe the “how” but we must focus on a term that business can understand and relate to all front end support requirement not just case management or crm and other of the many other tlas! my suggestion is “adaptive” solutions or applications…..?
another challenge facing the supply chain is that the cost to build and maintain is a fraction of current cost which opens doors to “ownership” of software as an asset with lease buy contracts removing any lock-in that is a lingering concern with many business people. this will impact the revenue streams of current supply chain and question the current saas model ……?
but will the industry rise to such challenges ....it will be very painful for some? as ever time will tell but all on my agenda!
"the real challenge is to apply a tag to the software that supports bpm?"
but "mde" is likely to cause an exodus to the hills for ordinary business folks.
1) we have for years offered "private label", then staying up nights worrying about source code proliferation.
our tech folks find this amusing - they claim we could hand out source on street corners and it would not damage our position, given that the code base runs 1,500,000 lines and takes us a year to train a new programmer.
2) we auto-export every keystroke to a generic data exchanger, so, in theory, any customer could leave us whenever they like.
this makes we wonder how worthwhile it is for vendors to try to hold their customers hostage. we have a couple of customers who have been with us since the year 2000.
re "i am not sure people in "business" actually manage their businesses via "processes"." yes, some of them do! my "litmus test" - those people are able to consistently explain to any stakeholder why their processes are as they are now.
the answer "we always do like that" may be considered also as some kind of bpm (big professional mistake).
sure, and a good example of managing a business via a process is a cement plant.
the main focus of the stakeholders is on the process of mixing up slurry and getting it to flow through the kiln.
as far as i'm concerned, there only one big question for bpm: "will it blend???"
will bpm seamlessly blend in all business practices? at all price points, in all geographies, in all business scenarios?
because frankly ubiquity and accessibility is the only thing that makes a technology / practice revolutionary.
so, how can bpm focus its message and lower its build-up and distribution costs so that it represents a meaningful economic proposal for everybody?
i have yet to hear a customer saying: "man, i'm so worried about the state of the bpm market, it looks like it's dying".
re "so, how can bpm"
lower its build-up and distribution costs – unification of 80-90 % of current bpm-suite tools, a process-pattern-based methodology for the rest and a good architecture with “an open door” for innovations.
so that it represents a meaningful economic proposal for everybody – again, use the systems approach for the enterprise’s & everybody’s surrounding systems.
enthusiasm, insight and vision! bpm-for-everyone! ubiquity, accessibility and revolution!
1) channels -- regarding the question dr. samarin highlights the importance of architecture and patterns. it's worth noting that some business users will know this approach as an "accelerator", i.e. a sales add-on for specific domains and business patterns, usually provided by major software vendors (for bpm or erp or other major application category).
accelerators or domain patterns could also be open sourced, and could be curated by boutique bpm consulting providers. on the topic of bpm consulting, i note that gartner's "hype cycle for bpm 2015" includes an item for "digital business consulting services", still pre-peak in the "innovation trigger" phase.
2) risk -- regarding end-users not caring about the state of a market, it's not uncommon for users to make a risk assessment concerning the viability of a technology, market and of course, vendor. jumping on a bandwagon can be rational in terms of risk perception, even if sometimes the bandwagon turns out to be a bubble. maybe end customers won't assess the health of the bpm market, but their consulting partner proxies will . . .
we should add another axis here. if we're filtering business processes to the classic operational processes we consider bpm, we should also add an industry filter. for example, in retail and hospitality one of the biggest bpm concerns is related to the new legislation regarding overtime and contingetn workforce management, aka the gig economy. the increase in part-time, freelance, and seasonal labor introduces new challenges to hr and operations departments like onboarding, training, and much more.


text:
FOWS Newsletter: August/September 2015 - Is Lake Tahoe really on the cutting edge of environmental planning?
Is Lake Tahoe really on the cutting edge of environmental planning?
Tahoe plans include more parking spaces as groups undertake efforts to remove them.
Making matters worse, the proposed 2015 Lake Tahoe Restoration Act would amend the TRPA Compact to weaken TRPA's role in environmental protection by requiring TRPA to consider the (presumed) economic impacts of plan regulations. Keep in mind this is often what the corporations and large developers claim to be 'economic.' Their ideas of 'economic' (increasing their immediate [short-term] profits) are not based on truly helping our locally-owned/small businesses and communities, or long-term protection of Lake Tahoe. TRPA is currently the only agency with land use authority in the Lake Tahoe Basin charged with protecting Tahoe's environment; the economics of the Basin are already being monitored and prioritized by local entities (e.g. Counties), along with numerous groups (e.g. Resort Associations). Notably, the original TRPA Compact was strengthened in 1980 because local governments eyeing tax dollars were approving projects that harmed Tahoe's environment (although TRPA has, unfortunately, returned most project approval authority back to the counties, oversight is still required). The proposed Compact amendment will leave us with no land use authority that truly prioritizes Lake Tahoe's environment.
As depicted in our "Tahoe Regional Overgrowth" map, the North Tahoe Region is already facing substantial development proposals that will bring more people, more cars, and more crowding. We are not opposed to new development, but believe it should complement and respect Lake Tahoe's fragile environment and our unique communities - not overwhelm them. We will continue to keep you informed as these plans and projects proceed.
On August 7th, the TCPUD issued a "Notice of Intent to Adopt a Mitigated Negative Declaration and Notice of Public Hearing." After previously focusing on three properties, the Lodge site has been identified as the preferred location, which is on state-owned land managed by the California Tahoe Conservancy [CTC]. The CTC and TCPUD are considering a land swap involving a TCPUD-owned parcel off Lagoon Street. FOWS supports this project's proposed location and the associated land swap (read FOWS comments to the TCPUD).
Comments on the draft environmental document are due by 4:30pm on September 9, 2015, and may be provided in writing to Matt Homolka by email at mhomolka@tcpud.org or by mail to TCPUD, P.O. Box 5249, Tahoe City, CA 96145 or by hand delivery to the TCPUD offices at 221 Fairway Drive.
You can also ask questions by contacting Kurt Althof, Grants and Community Information Administrator, anytime at: kalthof@tcpud.org or (530) 580-6057.
"Restricting access and use of the area during treatment...may not be acceptable."
"Actively dewatering the Tahoe Keys lagoon could interfere with the recreational use of the facility."
"The cost of removing nutrient-laden sediments is high, would require permits, and impair the use of the coves during operations."
The report also fails to take a harder look at reducing the amount of nutrients released into the channels (which causes more weeds to grow), like addressing fertilizer use. Comments on the TKPOA's proposed Plan are due September 25.
The proposed project will include almost 1,500 new bedrooms (hotels, condos, and timeshares), a 90,000 sq. ft. indoor amusement park, and roughly 300,000 additional sq. ft. of new commercial uses.
FOWS is extremely concerned about the proposed project's impacts to the Lake Tahoe Basin, including traffic (FOWS submitted comments on 7/14/2015). The draft Environmental Impact Report (EIR) concludes 'significant and unavoidable' impacts to congestion in Tahoe City. Further, traffic impacts to the Basin (and West Shore) were not fully examined. For example, although the draft EIR identifies increased traffic on SR 89 along the West Shore, the impacts of these increases are not assessed. Comments from other organizations also identified significant problems with the analysis in the draft EIR, and an overwhelming majority of the nearly 315 public comments submitted opposed the size and scale of the proposed project. No release date for the Final EIR has been provided.
The inclusion of the Tahoe City Lodge "Pilot Project" and lack of defined criteria regarding "Pilot Projects."
The upcoming TBAP environmental impact study/report (EIS/EIR) states it will analyze the area plan at a 'policy level' and the TC Lodge at a 'project level.' We believe the project should be analyzed separately from the Area Plan.
The 112 homes were proposed via a new Area Plan.
When the public (including Realtor groups, Tahoe residents and groups, and Truckee residents) expressed concern, the idea for a new campground emerged.
Meanwhile, the developer quietly attempted a boundary line amendment to have land on the ridge declared outside of the Lake Tahoe Basin, and thus not subject to TRPA regulations. FOWS strongly opposed this amendment, and it was dropped earlier this summer.
Now, the precedent-setting, 550-unit "Brockway Campground" is proposed, with substantial development, including a general store, cafe/restaurant, swimming pool, family pavilion, and other structures.
Whether the campground is a serious proposal, or a means to an end (such as the 112 luxury homes), like many others, we are concerned with any substantial development on Tahoe's famous ridgelines. The scenic impacts from Lake Tahoe and surrounding mountains should be enough to warrant ridgeline protection; add in the fire danger, limited roadway system, traffic, water demand, and other impacts, and protecting our ridgelines should be an easy decision, but requests to do so have not been addressed. We will keep you updated as more information becomes available.
* If you haven't yet signed the Petition to Protect Tahoe's Ridgelines, we encourage you to do so.
Annual Report from Lake Tahoe Scientists: Keep Tahoe Blue, or Keep Tahoe Clear?
The 2015 State of the Lake Report, released by the Tahoe Environment Research Center (TERC) last month, includes new findings about Lake Tahoe's 'blueness' and clarity. Until now, improving clarity was assumed to also benefit the Lake's 'blueness'. But blueness and clarity are actually controlled by different things - blueness is controlled by the amount of algae in the water, while clarity is controlled by fine inorganic particles.
The key take-home message: if we want to have blue water, we have to reduce the nutrients that contribute to algae growth. The only proven way to do this is through natural ecosystem processes. Researchers warned: "[We] need watershed restoration if [we] really want a blue [Lake]."
For years, FOWS has advocated for the reduction of nutrients known to increase the algae along Tahoe's shorelines; in fact, it's one reason we challenged TRPA's 2012 Regional Plan Update, which encourages more pavement closer to the Lake, where watershed restoration is needed.
Concentrations of attached algae 'near the shore' (called "periphyton") appear to have declined this year, but measurements were taken at different (lower) spots in the lake due to drought, so they aren't measuring the same locations or plant species as previous years.
We are pleased with the ongoing support from our existing and new members and supporters. We look forward to ongoing interaction with all who share the desire to protect the West Shore and Lake Tahoe. That said, we kindly include this 'gentle request' for your annual membership dues , and encourage new supporters to join. Your tax-deductible dues will help support ongoing efforts of the only organization providing a collective voice for West Shore communities (and beyond). If you aren't a member already, here's how your membership helps . Individual memberships are as low as $25 (although additional donations are welcome), and information for Homeowners Associations can be found here . If you have questions, ideas, suggestions, or just want to shoot the breeze on Tahoe issues, please feel free to contact us ! Dues may be paid online or mailed to FOWS .
We invite you to contact us to learn more, ask questions, or simply get to know the FOWS Board. Also, don't forget to follow us on Facebook!
Please contact Jennifer Quashnick, FOWS Conservation Consultant, at: jqtahoe@sbcglobal.net , or Susan Gearhart, FOWS President, at: susan@friendswestshore.org (530) 525-0368.

lowercased:
fows newsletter: august/september 2015 - is lake tahoe really on the cutting edge of environmental planning?
is lake tahoe really on the cutting edge of environmental planning?
tahoe plans include more parking spaces as groups undertake efforts to remove them.
making matters worse, the proposed 2015 lake tahoe restoration act would amend the trpa compact to weaken trpa's role in environmental protection by requiring trpa to consider the (presumed) economic impacts of plan regulations. keep in mind this is often what the corporations and large developers claim to be 'economic.' their ideas of 'economic' (increasing their immediate [short-term] profits) are not based on truly helping our locally-owned/small businesses and communities, or long-term protection of lake tahoe. trpa is currently the only agency with land use authority in the lake tahoe basin charged with protecting tahoe's environment; the economics of the basin are already being monitored and prioritized by local entities (e.g. counties), along with numerous groups (e.g. resort associations). notably, the original trpa compact was strengthened in 1980 because local governments eyeing tax dollars were approving projects that harmed tahoe's environment (although trpa has, unfortunately, returned most project approval authority back to the counties, oversight is still required). the proposed compact amendment will leave us with no land use authority that truly prioritizes lake tahoe's environment.
as depicted in our "tahoe regional overgrowth" map, the north tahoe region is already facing substantial development proposals that will bring more people, more cars, and more crowding. we are not opposed to new development, but believe it should complement and respect lake tahoe's fragile environment and our unique communities - not overwhelm them. we will continue to keep you informed as these plans and projects proceed.
on august 7th, the tcpud issued a "notice of intent to adopt a mitigated negative declaration and notice of public hearing." after previously focusing on three properties, the lodge site has been identified as the preferred location, which is on state-owned land managed by the california tahoe conservancy [ctc]. the ctc and tcpud are considering a land swap involving a tcpud-owned parcel off lagoon street. fows supports this project's proposed location and the associated land swap (read fows comments to the tcpud).
comments on the draft environmental document are due by 4:30pm on september 9, 2015, and may be provided in writing to matt homolka by email at mhomolka@tcpud.org or by mail to tcpud, p.o. box 5249, tahoe city, ca 96145 or by hand delivery to the tcpud offices at 221 fairway drive.
you can also ask questions by contacting kurt althof, grants and community information administrator, anytime at: kalthof@tcpud.org or (530) 580-6057.
"restricting access and use of the area during treatment...may not be acceptable."
"actively dewatering the tahoe keys lagoon could interfere with the recreational use of the facility."
"the cost of removing nutrient-laden sediments is high, would require permits, and impair the use of the coves during operations."
the report also fails to take a harder look at reducing the amount of nutrients released into the channels (which causes more weeds to grow), like addressing fertilizer use. comments on the tkpoa's proposed plan are due september 25.
the proposed project will include almost 1,500 new bedrooms (hotels, condos, and timeshares), a 90,000 sq. ft. indoor amusement park, and roughly 300,000 additional sq. ft. of new commercial uses.
fows is extremely concerned about the proposed project's impacts to the lake tahoe basin, including traffic (fows submitted comments on 7/14/2015). the draft environmental impact report (eir) concludes 'significant and unavoidable' impacts to congestion in tahoe city. further, traffic impacts to the basin (and west shore) were not fully examined. for example, although the draft eir identifies increased traffic on sr 89 along the west shore, the impacts of these increases are not assessed. comments from other organizations also identified significant problems with the analysis in the draft eir, and an overwhelming majority of the nearly 315 public comments submitted opposed the size and scale of the proposed project. no release date for the final eir has been provided.
the inclusion of the tahoe city lodge "pilot project" and lack of defined criteria regarding "pilot projects."
the upcoming tbap environmental impact study/report (eis/eir) states it will analyze the area plan at a 'policy level' and the tc lodge at a 'project level.' we believe the project should be analyzed separately from the area plan.
the 112 homes were proposed via a new area plan.
when the public (including realtor groups, tahoe residents and groups, and truckee residents) expressed concern, the idea for a new campground emerged.
meanwhile, the developer quietly attempted a boundary line amendment to have land on the ridge declared outside of the lake tahoe basin, and thus not subject to trpa regulations. fows strongly opposed this amendment, and it was dropped earlier this summer.
now, the precedent-setting, 550-unit "brockway campground" is proposed, with substantial development, including a general store, cafe/restaurant, swimming pool, family pavilion, and other structures.
whether the campground is a serious proposal, or a means to an end (such as the 112 luxury homes), like many others, we are concerned with any substantial development on tahoe's famous ridgelines. the scenic impacts from lake tahoe and surrounding mountains should be enough to warrant ridgeline protection; add in the fire danger, limited roadway system, traffic, water demand, and other impacts, and protecting our ridgelines should be an easy decision, but requests to do so have not been addressed. we will keep you updated as more information becomes available.
* if you haven't yet signed the petition to protect tahoe's ridgelines, we encourage you to do so.
annual report from lake tahoe scientists: keep tahoe blue, or keep tahoe clear?
the 2015 state of the lake report, released by the tahoe environment research center (terc) last month, includes new findings about lake tahoe's 'blueness' and clarity. until now, improving clarity was assumed to also benefit the lake's 'blueness'. but blueness and clarity are actually controlled by different things - blueness is controlled by the amount of algae in the water, while clarity is controlled by fine inorganic particles.
the key take-home message: if we want to have blue water, we have to reduce the nutrients that contribute to algae growth. the only proven way to do this is through natural ecosystem processes. researchers warned: "[we] need watershed restoration if [we] really want a blue [lake]."
for years, fows has advocated for the reduction of nutrients known to increase the algae along tahoe's shorelines; in fact, it's one reason we challenged trpa's 2012 regional plan update, which encourages more pavement closer to the lake, where watershed restoration is needed.
concentrations of attached algae 'near the shore' (called "periphyton") appear to have declined this year, but measurements were taken at different (lower) spots in the lake due to drought, so they aren't measuring the same locations or plant species as previous years.
we are pleased with the ongoing support from our existing and new members and supporters. we look forward to ongoing interaction with all who share the desire to protect the west shore and lake tahoe. that said, we kindly include this 'gentle request' for your annual membership dues , and encourage new supporters to join. your tax-deductible dues will help support ongoing efforts of the only organization providing a collective voice for west shore communities (and beyond). if you aren't a member already, here's how your membership helps . individual memberships are as low as $25 (although additional donations are welcome), and information for homeowners associations can be found here . if you have questions, ideas, suggestions, or just want to shoot the breeze on tahoe issues, please feel free to contact us ! dues may be paid online or mailed to fows .
we invite you to contact us to learn more, ask questions, or simply get to know the fows board. also, don't forget to follow us on facebook!
please contact jennifer quashnick, fows conservation consultant, at: jqtahoe@sbcglobal.net , or susan gearhart, fows president, at: susan@friendswestshore.org (530) 525-0368.


text:
Movies by Flixster is an Android app developed by Flixster Inc. for ticket booking purposes. The app displays all the scheduled films in the theaters and the movies that are out on Netflix and DVDs. Download Flixster to book movies tickets instantly.
While testing the design and interface of Flixster app, we noticed that the accessibility and navigation are quite easy. In the movies section, all the movies are displayed on the same page. However, it is difficult to sort the films based on parameters like date, format, and so on.
The integration of Flixster app with Google Maps for directions and Fandango app for ticket booking enhances the functionality of the app. We did not notice any abnormalities while performing the tasks.
For all the movie buffs, Flixster app is the most suitable option for browsing latest movies and purchasing theater tickets at your convenience. While the basic task of the app is booking tickets, there are various parameters that make it the most favorable app.
The Box Office tab displays all the movies on the interface. The videos can be sorted by toggling across two categories – In Theatres and Coming Soon. To judge the film on the basis of ratings, you can check out the Rotten Tomatoes Tomatometer scores and reviews left by critics. In addition to this, you can check out the movie trailers, images, casts, synopsis, and much more.
Ticket booking mechanism on Flixster app is powered by Fandango app. You can avail easy payment options like Google Pay and PayPal, check out theater amenities, find and connect with the nearby theaters, and so on. Besides watching movies in theaters, you can check out the latest Netflix launches and DVD launches.
Watching movies in the theaters, home theaters, and in the television streaming services is the most sought-after entertainment. The app aims at fulfilling your desires in the most effective manner. You can book the tickets at the nearby theaters after carefully analyzing the reviews.
To facilitate better user experience, the app incorporates features like Rotten Tomatoes ratings, Google Maps, Google Pay, Fandango app, and so on. In addition to these, easy navigation and well-structured layout influences user experience as well. The responsive design of the app adjusts comfortably on devices with varying screen sizes.
Flixster app works seamlessly on all the Android smartphones and tablets. However, the usability is restricted to the American subcontinent only. The app requires Android 4.1 and above to function properly.
Flixster app is a highly recommended app for ticket booking purposes. As it incorporates reviews from Rotten Tomatoes and the critics, you can judge the movie based on genuine viewpoints. Further, you can search for the nearby theatres based on show timings, proximity, and so on.
Fandango app works seamlessly when it comes to ticket bookings. If you have VIP access, you can avail benefits such as discounts, free screenings, refunds, exchanges, and so on.
According to some users, the new navigation mechanism appears complicated. But as per our analysis, the navigation and accessibility are easy to comprehend. As you can check out the latest releases on DVDs and Netflix, you can enjoy movies from the comfort of your home as well.

lowercased:
movies by flixster is an android app developed by flixster inc. for ticket booking purposes. the app displays all the scheduled films in the theaters and the movies that are out on netflix and dvds. download flixster to book movies tickets instantly.
while testing the design and interface of flixster app, we noticed that the accessibility and navigation are quite easy. in the movies section, all the movies are displayed on the same page. however, it is difficult to sort the films based on parameters like date, format, and so on.
the integration of flixster app with google maps for directions and fandango app for ticket booking enhances the functionality of the app. we did not notice any abnormalities while performing the tasks.
for all the movie buffs, flixster app is the most suitable option for browsing latest movies and purchasing theater tickets at your convenience. while the basic task of the app is booking tickets, there are various parameters that make it the most favorable app.
the box office tab displays all the movies on the interface. the videos can be sorted by toggling across two categories – in theatres and coming soon. to judge the film on the basis of ratings, you can check out the rotten tomatoes tomatometer scores and reviews left by critics. in addition to this, you can check out the movie trailers, images, casts, synopsis, and much more.
ticket booking mechanism on flixster app is powered by fandango app. you can avail easy payment options like google pay and paypal, check out theater amenities, find and connect with the nearby theaters, and so on. besides watching movies in theaters, you can check out the latest netflix launches and dvd launches.
watching movies in the theaters, home theaters, and in the television streaming services is the most sought-after entertainment. the app aims at fulfilling your desires in the most effective manner. you can book the tickets at the nearby theaters after carefully analyzing the reviews.
to facilitate better user experience, the app incorporates features like rotten tomatoes ratings, google maps, google pay, fandango app, and so on. in addition to these, easy navigation and well-structured layout influences user experience as well. the responsive design of the app adjusts comfortably on devices with varying screen sizes.
flixster app works seamlessly on all the android smartphones and tablets. however, the usability is restricted to the american subcontinent only. the app requires android 4.1 and above to function properly.
flixster app is a highly recommended app for ticket booking purposes. as it incorporates reviews from rotten tomatoes and the critics, you can judge the movie based on genuine viewpoints. further, you can search for the nearby theatres based on show timings, proximity, and so on.
fandango app works seamlessly when it comes to ticket bookings. if you have vip access, you can avail benefits such as discounts, free screenings, refunds, exchanges, and so on.
according to some users, the new navigation mechanism appears complicated. but as per our analysis, the navigation and accessibility are easy to comprehend. as you can check out the latest releases on dvds and netflix, you can enjoy movies from the comfort of your home as well.


text:
20 Fun Outdoor Games For Youth - SUPER FUN GAMES!
If you are a young person or live with teenagers at home, we recommend giving cellphones a break and taking advantage of those lovely sunny days! Growing up in this technology filled world requires effort in making sure that your life is well-balanced. The benefits of playing outdoors include an increase in energy levels, promotion of a healthy lifestyle, socialization, strengthening of relationships and exercise!
So why not replace your family Saturday inside with an outdoor adventure? To help keep you and your kids entertained, take a look at this oneHOWTO list of 20 fun outdoor games for youth.
Do the same thing you would do inside, but outside: search your cupboards for your favorite board game, go outside, place a blanket on the grass and play! Whether it's Monopoly, Pictionary, Trivial Pursuit, etc., we recommend leaving your phones at home, prepare a delicious picnic and go play at your nearest park.
Traditional games: some games never go out of style, such as hide and seek! Grant one person the role of organizer, have some rewards prepared for the winners and enjoy some quality time with family and friends.
Outside games for adults: you know those drinking games that you normally play inside with your friends on a Friday night? Why not play them outside in the sun? For more, take a look at our article where we list some great DYI party game ideas for adults.
‘‘Would you rather,’’ is one of the most popular group games in the world, and the best part? You can play this game inside and outside! For more, we recommend taking a look at our list of over 120 of the best would you rather questions.
Not only do these games encourage teamwork, but they’re also super fun!
Feet-tied: You have to get to the end of the race as quick as you can but, both of your feet are tied with a rope.
Wheelbarrow: Pick a partner, one partner places their hands on the floor while the other holds onto their feet and lifts them by the ankles and go! If any ankles or legs are dropped the couple is eliminated from the race.
Walking backwards:a very simple variation sure to make everyone involved laugh.
If you want to keep this game running, you can play by constantly eliminating the loser. In the end, you should have two people or two couples racing, the last to that win the final race wins the overall day!
3 people in a group. Place bucket filled with marbles and water onto the floor. In turns, each member of the team has to try to remove as many marbles as they can with their feet.
After three turns (one for each member) the group with the most marbles wins!
All members participate at the same time.
You cannot use your hands (tie them behind your back).
If your egg breaks, you are disqualified.
To make this game run longer, you can play it in groups (like a tag team). Once the first person goes and places their non-broken egg into the bucket, they will run back to their team member and high five them, then that person grabs a new egg and spoon and goes! In the end, the team who gets the most eggs in the bucket the fastest wins!
This is a great game that promotes teamwork. Form two or more groups (depending on the total amount of people). Design a route with pauses and, in each stop, set a task or challenge which needs to be fulfilled (such as a series of sit-ups, squats, etc.) Each person from a team will be placed at each stop.
The first person will run their bit of the race, fulfill their challenge, and then the next person (in their team) can go. The race ends with the last person in the group to pass the finish line.
Tug of war is another classic game that should never be forgotten. All participants must be divided into two groups. A line is drawn on the ground between the two groups and a rope should be held horizontally all team members. Each team needs to pull onto their own side of the rope and the first team to get pulled across the line loses! This activity, besides being very entertaining and fun, is ideal for born competitors and strong contestants.
This game needs an organizer who writes a list of objects onto pieces of paper. According to how many people are playing, you will divide the group into equal numbers. Each group will get the same piece of paper and will need to find the objects on the paper without buying them. The group that ticks of all of the objects first, wins!
For more, we recommend reading our article where we list fun competitive games for large groups.
If there is a protagonist in outdoor games, it is the ball. In fact, there are so many ball games to choose from. Most traditional ball sports can be played outdoors.
One person needs to be responsible for the music. While the music is playing, the rest of the participants will pass the ball, but the moment the music stops or the singer stops singing,everyone must freeze. Whoever has the ball in their hands in that moment should receive a penalty.
This game is very similar to the previous one, except this time, the ball should be a balloon filled with water. This time everyone can be divided into groups. In each group, 5 water-filled balloons need to be passed in a large circle as fast as possible (remember the music pauses). In the end, the team that has burst the least balloons wins. We recommend wearing a bathing suit for this game!
For this game, you will need a soft ball. One person (ball king/queen) has the ball and throws the ball to as many people as possible, trying to hit them. If the ball hits a person, they then become the ball king/queen. The aim for the other people is to run and dodge the ‘‘hot potato’’.
Each person will hold a ball above their head (arms straight) and the person who can do the most squats in the shortest amount of time without stopping wins! Remember, if you drop your arms, you’re out!
In this game, all members must stand together in a close circle. Then, each person should stretch their right arm and take the hand of someone opposite them, repeating the same action with the left arm.
In a few minutes, everyone should be tangled. The aim then is too untangle yourselves back into a circle without letting go of any hands. To avoid everyone falling down, everyone needs to be patient and negotiate this task in a group.
Traditional charades is very fun and easy to play. Someone needs to pick a movie, book, series or song in their head (don’t tell anyone). Then, this chosen person has to go up in front of their sitting audience and try to get the audience to guess the chosen movie, book, series or song through gestures. The first person to guess the riddle wins something and is the next to ‘perform.’ For more, we recommend reading our article where we discuss how to have fun at a party without drinking.
Walking is not only fun, but it’s a great form of exercise. So, pick a fun hiking path to go on! While walking and enjoying each other’s company, a twig needs to move around the group. The minute a person gets the twig they have to share something about themselves that nobody else knows.
All participants are placed in a circle facing the center and, at a signal, everyone must close their eyes. One person who is outside of the circle must carry an object (previously chosen) in the hand. This person will then place the object in the hands (behind the back) of one of the chosen people in the circle. Then, the person outside of the circle must signal everyone to open their eyes. As they do this, the person who has been given the object needs to chase the ‘outside’ person around the circle. The aim of this outside person is to ‘steal’ the place of the person chasing them without being caught. If the chaser cannot catch the person, they will then be next in offering the salt shaker (object).
Each group chooses a representative who, with his/her eyes closed, must follow the instructions of the rest of his/her companions to find a hidden object: using orders such as "up", "down", "right", etc.
The object needs to be placed in an area which is complicated to get to. The first blindfolded person to find and guess their object (without taking off the blindfold), wins!
Everyone should be sat in a circle with something to drink or eat. Once person chooses a thing that they have never done, for example, never have I ever lied. They then say this line out loud to the group and whoever HAS done this thing needs to take a sip or bite of their food. They then have to explain to the group when and why they did this thing.
Never have I ever taken the food out of the trash and eaten it.
Never have I ever tried to cut my hair and regretted it.
Never have I ever lied to my parents.
For more never have I ever ideas, we recommend reading our article where we list the best never have I ever questions.
For this game, everyone in the group will get a turn to choose someone they want to ask a question to. The first person will then ask a person in the group if they choose ‘truth or dare.’ If the recipient chooses a dare, the person asking the questions needs to set them a dare (make it fun, not dangerous!). If the recipient chooses truth, they will be asked a question whereby they need to reveal the truth.
The best thing about all of the outdoor games on our list is that they can be modified to group sizes and ages. So, go outside and have some fun!
If you want to read similar articles to 20 Fun Outdoor Games For Youth, we recommend you visit our Recreational activities category.

lowercased:
20 fun outdoor games for youth - super fun games!
if you are a young person or live with teenagers at home, we recommend giving cellphones a break and taking advantage of those lovely sunny days! growing up in this technology filled world requires effort in making sure that your life is well-balanced. the benefits of playing outdoors include an increase in energy levels, promotion of a healthy lifestyle, socialization, strengthening of relationships and exercise!
so why not replace your family saturday inside with an outdoor adventure? to help keep you and your kids entertained, take a look at this onehowto list of 20 fun outdoor games for youth.
do the same thing you would do inside, but outside: search your cupboards for your favorite board game, go outside, place a blanket on the grass and play! whether it's monopoly, pictionary, trivial pursuit, etc., we recommend leaving your phones at home, prepare a delicious picnic and go play at your nearest park.
traditional games: some games never go out of style, such as hide and seek! grant one person the role of organizer, have some rewards prepared for the winners and enjoy some quality time with family and friends.
outside games for adults: you know those drinking games that you normally play inside with your friends on a friday night? why not play them outside in the sun? for more, take a look at our article where we list some great dyi party game ideas for adults.
‘‘would you rather,’’ is one of the most popular group games in the world, and the best part? you can play this game inside and outside! for more, we recommend taking a look at our list of over 120 of the best would you rather questions.
not only do these games encourage teamwork, but they’re also super fun!
feet-tied: you have to get to the end of the race as quick as you can but, both of your feet are tied with a rope.
wheelbarrow: pick a partner, one partner places their hands on the floor while the other holds onto their feet and lifts them by the ankles and go! if any ankles or legs are dropped the couple is eliminated from the race.
walking backwards:a very simple variation sure to make everyone involved laugh.
if you want to keep this game running, you can play by constantly eliminating the loser. in the end, you should have two people or two couples racing, the last to that win the final race wins the overall day!
3 people in a group. place bucket filled with marbles and water onto the floor. in turns, each member of the team has to try to remove as many marbles as they can with their feet.
after three turns (one for each member) the group with the most marbles wins!
all members participate at the same time.
you cannot use your hands (tie them behind your back).
if your egg breaks, you are disqualified.
to make this game run longer, you can play it in groups (like a tag team). once the first person goes and places their non-broken egg into the bucket, they will run back to their team member and high five them, then that person grabs a new egg and spoon and goes! in the end, the team who gets the most eggs in the bucket the fastest wins!
this is a great game that promotes teamwork. form two or more groups (depending on the total amount of people). design a route with pauses and, in each stop, set a task or challenge which needs to be fulfilled (such as a series of sit-ups, squats, etc.) each person from a team will be placed at each stop.
the first person will run their bit of the race, fulfill their challenge, and then the next person (in their team) can go. the race ends with the last person in the group to pass the finish line.
tug of war is another classic game that should never be forgotten. all participants must be divided into two groups. a line is drawn on the ground between the two groups and a rope should be held horizontally all team members. each team needs to pull onto their own side of the rope and the first team to get pulled across the line loses! this activity, besides being very entertaining and fun, is ideal for born competitors and strong contestants.
this game needs an organizer who writes a list of objects onto pieces of paper. according to how many people are playing, you will divide the group into equal numbers. each group will get the same piece of paper and will need to find the objects on the paper without buying them. the group that ticks of all of the objects first, wins!
for more, we recommend reading our article where we list fun competitive games for large groups.
if there is a protagonist in outdoor games, it is the ball. in fact, there are so many ball games to choose from. most traditional ball sports can be played outdoors.
one person needs to be responsible for the music. while the music is playing, the rest of the participants will pass the ball, but the moment the music stops or the singer stops singing,everyone must freeze. whoever has the ball in their hands in that moment should receive a penalty.
this game is very similar to the previous one, except this time, the ball should be a balloon filled with water. this time everyone can be divided into groups. in each group, 5 water-filled balloons need to be passed in a large circle as fast as possible (remember the music pauses). in the end, the team that has burst the least balloons wins. we recommend wearing a bathing suit for this game!
for this game, you will need a soft ball. one person (ball king/queen) has the ball and throws the ball to as many people as possible, trying to hit them. if the ball hits a person, they then become the ball king/queen. the aim for the other people is to run and dodge the ‘‘hot potato’’.
each person will hold a ball above their head (arms straight) and the person who can do the most squats in the shortest amount of time without stopping wins! remember, if you drop your arms, you’re out!
in this game, all members must stand together in a close circle. then, each person should stretch their right arm and take the hand of someone opposite them, repeating the same action with the left arm.
in a few minutes, everyone should be tangled. the aim then is too untangle yourselves back into a circle without letting go of any hands. to avoid everyone falling down, everyone needs to be patient and negotiate this task in a group.
traditional charades is very fun and easy to play. someone needs to pick a movie, book, series or song in their head (don’t tell anyone). then, this chosen person has to go up in front of their sitting audience and try to get the audience to guess the chosen movie, book, series or song through gestures. the first person to guess the riddle wins something and is the next to ‘perform.’ for more, we recommend reading our article where we discuss how to have fun at a party without drinking.
walking is not only fun, but it’s a great form of exercise. so, pick a fun hiking path to go on! while walking and enjoying each other’s company, a twig needs to move around the group. the minute a person gets the twig they have to share something about themselves that nobody else knows.
all participants are placed in a circle facing the center and, at a signal, everyone must close their eyes. one person who is outside of the circle must carry an object (previously chosen) in the hand. this person will then place the object in the hands (behind the back) of one of the chosen people in the circle. then, the person outside of the circle must signal everyone to open their eyes. as they do this, the person who has been given the object needs to chase the ‘outside’ person around the circle. the aim of this outside person is to ‘steal’ the place of the person chasing them without being caught. if the chaser cannot catch the person, they will then be next in offering the salt shaker (object).
each group chooses a representative who, with his/her eyes closed, must follow the instructions of the rest of his/her companions to find a hidden object: using orders such as "up", "down", "right", etc.
the object needs to be placed in an area which is complicated to get to. the first blindfolded person to find and guess their object (without taking off the blindfold), wins!
everyone should be sat in a circle with something to drink or eat. once person chooses a thing that they have never done, for example, never have i ever lied. they then say this line out loud to the group and whoever has done this thing needs to take a sip or bite of their food. they then have to explain to the group when and why they did this thing.
never have i ever taken the food out of the trash and eaten it.
never have i ever tried to cut my hair and regretted it.
never have i ever lied to my parents.
for more never have i ever ideas, we recommend reading our article where we list the best never have i ever questions.
for this game, everyone in the group will get a turn to choose someone they want to ask a question to. the first person will then ask a person in the group if they choose ‘truth or dare.’ if the recipient chooses a dare, the person asking the questions needs to set them a dare (make it fun, not dangerous!). if the recipient chooses truth, they will be asked a question whereby they need to reveal the truth.
the best thing about all of the outdoor games on our list is that they can be modified to group sizes and ages. so, go outside and have some fun!
if you want to read similar articles to 20 fun outdoor games for youth, we recommend you visit our recreational activities category.


text:
Family Care Centers Medical Group Inc.
Office staff is friendly and helpful. Back office staff is friendly and thorough. Alison is a gem! She is very thorough and knowledgeable as well as adding the personal touch. She always remembers things about my family and adds stories about her own family.
Love this place. The staff, nurses, nurse practitioners and physicians that I have met are all so friendly and professional. I really love how they coordinate care with each other and myself.
I just love Dr. Greenberg. She’s been my family physician for over 20 years.
The waiting room is spotless, the office people are polite & courteous. The back office is great also. Doctor Coyen is an excellent Doctor. He is very professional and very courteous, listens to me. Thanks Doctor Coyen for your wonderful care. .
Leave a review for Family Care Centers Medical Group Inc.

lowercased:
family care centers medical group inc.
office staff is friendly and helpful. back office staff is friendly and thorough. alison is a gem! she is very thorough and knowledgeable as well as adding the personal touch. she always remembers things about my family and adds stories about her own family.
love this place. the staff, nurses, nurse practitioners and physicians that i have met are all so friendly and professional. i really love how they coordinate care with each other and myself.
i just love dr. greenberg. she’s been my family physician for over 20 years.
the waiting room is spotless, the office people are polite & courteous. the back office is great also. doctor coyen is an excellent doctor. he is very professional and very courteous, listens to me. thanks doctor coyen for your wonderful care. .
leave a review for family care centers medical group inc.


text:
BLAKELY, Pa. --More than 170,000 pounds of food was handed out to those in need in Lackawanna County.
Newswatch 16 found cars lined up outside Peckville Assembly of God Church waiting to take advantage of the generosity.
The church gave out hundreds of hams, turkeys and other meat as well as fresh produce and toiletries.
"I do not know how to explain it to you but the food helps me pay medical bills because I save money here and I pay my bills, ya know?" said William Carter of Dickson City.
Peckville Assembly of God Church gives out free food every Friday.
Anyone who lives in Lackawanna County can sign up.

lowercased:
blakely, pa. --more than 170,000 pounds of food was handed out to those in need in lackawanna county.
newswatch 16 found cars lined up outside peckville assembly of god church waiting to take advantage of the generosity.
the church gave out hundreds of hams, turkeys and other meat as well as fresh produce and toiletries.
"i do not know how to explain it to you but the food helps me pay medical bills because i save money here and i pay my bills, ya know?" said william carter of dickson city.
peckville assembly of god church gives out free food every friday.
anyone who lives in lackawanna county can sign up.


text:
Capture critical infrastructure failures that are keeping your build from passing.
Request that a successful build be deployed to the next environment.
Create a searchable knowledge base of failure causes and solutions.
Log time spent on build failures and use Jira Software dashboard gadgets to discover trends over time.
When you create an issue from Bamboo, the issue in Jira Software links back to the build result it was created from.
A link to the new issue is displayed in the 'Jira Issues' section of the Build Result Summary, and on the Issues tab, in Bamboo.
You require Jira 5.0, or higher.
There must be an application link already set up between Jira Software and Bamboo.
Your Jira application administrator needs to have enabled fully reciprocal issue linking in Jira Software Server.
On the Build Result Summary, choose Actions > Create Issue.

lowercased:
capture critical infrastructure failures that are keeping your build from passing.
request that a successful build be deployed to the next environment.
create a searchable knowledge base of failure causes and solutions.
log time spent on build failures and use jira software dashboard gadgets to discover trends over time.
when you create an issue from bamboo, the issue in jira software links back to the build result it was created from.
a link to the new issue is displayed in the 'jira issues' section of the build result summary, and on the issues tab, in bamboo.
you require jira 5.0, or higher.
there must be an application link already set up between jira software and bamboo.
your jira application administrator needs to have enabled fully reciprocal issue linking in jira software server.
on the build result summary, choose actions > create issue.


text:
Returns can be sent back within 7 days of receipt, all returned items must never been used and in new condition. All returned packages must be insured. As for returning right items for a refund: all returned items are subject to a 15% restocking fee. Buyers are always responsible for the shipping charges.
We only accept exchanges for new and never used items with all accessories and packaging. Please send back the items within 7 days of receipt. All return packages must be insured, exchanges will be sent within 5-7 days once your return has been received. Buyers are always responsible for the shipping charges.

lowercased:
returns can be sent back within 7 days of receipt, all returned items must never been used and in new condition. all returned packages must be insured. as for returning right items for a refund: all returned items are subject to a 15% restocking fee. buyers are always responsible for the shipping charges.
we only accept exchanges for new and never used items with all accessories and packaging. please send back the items within 7 days of receipt. all return packages must be insured, exchanges will be sent within 5-7 days once your return has been received. buyers are always responsible for the shipping charges.


text:
Believe it or not, our pets need dental care too! If your pet has bad breath, visible tartar or loose/missing teeth, they probably need a dental cleaning. Because dental health varies widely depending on your pet’s breed, size, and age, we recommend that you bring your pet in for a consultation. Doctors can then evaluate their teeth and give you an assessment and estimate of cost.
Dental cleanings can be scheduled Tuesday through Friday and are usually an outpatient procedure. A routine dental includes ultrasonic scaling, hand scaling, polishing and sealing. A doctor then evaluates your pet’s teeth for pocketing, mobility, discoloration or fracture. Teeth that need to be removed will be extracted by a doctor.
Since our pets have to go under general anesthesia for a dental cleaning, we recommend pre-anesthetic blood work to make sure that they are healthy enough for the procedure. The need for pain medications or fluids during the procedure is tailored to each patient.

lowercased:
believe it or not, our pets need dental care too! if your pet has bad breath, visible tartar or loose/missing teeth, they probably need a dental cleaning. because dental health varies widely depending on your pet’s breed, size, and age, we recommend that you bring your pet in for a consultation. doctors can then evaluate their teeth and give you an assessment and estimate of cost.
dental cleanings can be scheduled tuesday through friday and are usually an outpatient procedure. a routine dental includes ultrasonic scaling, hand scaling, polishing and sealing. a doctor then evaluates your pet’s teeth for pocketing, mobility, discoloration or fracture. teeth that need to be removed will be extracted by a doctor.
since our pets have to go under general anesthesia for a dental cleaning, we recommend pre-anesthetic blood work to make sure that they are healthy enough for the procedure. the need for pain medications or fluids during the procedure is tailored to each patient.


text:
Essence Colour & Go nail polish review and swatches - 172 Splash | gingerbread smiles.
Thanks! It's such a lovely aquatic colour!

lowercased:
essence colour & go nail polish review and swatches - 172 splash | gingerbread smiles.
thanks! it's such a lovely aquatic colour!


text:
Get ready to rock with Thor and Hulk!
Each includes a piece to construct an awesome build-a-figure, Gladiator Hulk!
Get ready for the battle of the century! Thor travels the galaxy to find hope, hammers, and Hulks. Spanning the history of the comics and the movies, these 6-inch scale action figures include pieces to build an amazing larger figure!

lowercased:
get ready to rock with thor and hulk!
each includes a piece to construct an awesome build-a-figure, gladiator hulk!
get ready for the battle of the century! thor travels the galaxy to find hope, hammers, and hulks. spanning the history of the comics and the movies, these 6-inch scale action figures include pieces to build an amazing larger figure!


text:
Dr. Matthew J. Budoff, Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California.
Since its emergence in 2005, coronary computed tomography angiography (CTA) has matured into a robust method for direct visualization of the coronary arteries and atherosclerotic plaque. Early prospective multicenter studies reported high diagnostic performance for coronary CTA in the identification and exclusion of high-grade coronary stenoses compared with the reference standard of invasive coronary angiography (ICA) (1–3). Both direct and historical comparison data have established the superiority of coronary CTA over functional stress testing for identification of anatomically obstructive coronary artery disease.
Despite diagnostic sensitivities of coronary CTA that approached 100% for coronary artery disease, specificities were markedly lower, ranging between 64% and 90% for coronary CTA–determined stenosis severity and reflecting a non-negligible rate of false-positive findings wherein coronary CTA diagnoses overestimate the severity of the luminal narrowing. This reduced performance has been attributed to limitations mainly caused by motion and calcium artifacts; the former has largely been overcome with the use of pre-procedural beta-blockers and higher temporal resolution CT scanners.
However, coronary calcification, which occurs from partial volume effects, has remained problematic. The magnitude of the adverse diagnostic effects of coronary calcification on coronary CTA was highlighted in a recent meta-analysis of 1,634 patients from 19 studies that examined the performance of coronary CTA across different thresholds of coronary artery calcium (CAC) scores (4). Subgroups at CAC scores <10 and <100 demonstrated high specificities of 90% (94% to 100%) and 88.5% (81% to 91.5%), respectively, whereas at CAC scores >400, the specificity declined significantly to 42% (28% to 56%) while retaining a high sensitivity of 97.5% (94% to 99%). These may, in part, explain the equally concerning findings that among stenoses considered high-grade according to coronary CTA, nearly 75% are not ischemia-causing compared with invasive fractional flow reserve (FFR).
The study by Nørgaard et al. (5) in this issue of iJACC represents findings from the prospective, international, multicenter NXT (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps) trial, which evaluated the diagnostic performance of fractional flow reserve derived from coronary computed tomography angiography (FFRCT), a novel method approved by the US Food and Drug Administration that uses computational fluid dynamics applied to typical coronary CTA images for calculation of FFR (6). Importantly, FFRCT enables calculation of “3-vessel” FFR because it can interrogate any point within the coronary vascular bed for its hemodynamic significance. In NXT, the primary endpoint was 1 of discrimination (i.e., the area under the receiver-operating characteristic curve [AUC]) because this metric allows identification of the optimal sensitivity and specificity for any given test. On a per-patient basis, the AUC was 0.90 for FFRCT, with a >2-fold increase in diagnostic specificity for ischemia-causing coronary lesions by FFR. These data evoked optimism for a technique that allows for direct visualization of coronary artery anatomy (by coronary CTA) and precise identification of the coronary artery stenoses that cause ischemia (by FFRCT). Notably, the average CAC score in NXT was 302 Agatston units, which places the study population in the prognostically worst risk category when defined according to the Multi-Ethnic Study of Atherosclerosis (7).
However, the detailed breakdown of FFRCT accuracies across coronary calcium score ranges was not detailed in the original NXT paper (6) and is the subject of the paper by Nørgaard et al. (5). For 214 patients who underwent CAC scoring in NXT, with 333 vessels directly examined by using FFR, the diagnostic performance of FFRCT was evaluated for study-specific quartiles of CAC scoring. Interestingly, the investigators observed no differences in diagnostic accuracy, sensitivity, or specificity of FFRCT across any CAC score quartiles, including no differences at even the highest quartile of patients with Agatston CAC scores ranging from 416 to 3,599. For these patients, FFRCT showed marked improved discrimination of ischemia compared with coronary CTA alone (AUC: 0.91 vs. 0.71; p = 0.0004). Indeed, in this highest quartile, FFRCT reclassified 60% of cases, leading to a significant reduction in false-positive findings. These results emphasize the immunity of FFRCT to the largest imaging limitation of coronary CTA and demonstrate that the test is not affected by even the most severe calcifications.
Before the introduction of FFRCT, there was no noninvasive method for simultaneous detection of coronary stenosis and determination of whether that stenosis causes ischemia. This ability to precisely locate a lesion that may benefit from coronary revascularization represents a significant advancement in diagnostic imaging. Added to the visualization of atherosclerotic plaque features that augment the diagnosis of coronary lesion–specific ischemia, the use of FFRCT may enable pre-procedural planning in a manner that other modalities do not. In addition, its general immunity to coronary calcification represents a major advance compared with coronary CTA imaging.
These data (5), although from a substudy of a larger parent trial, are of considerable import in today’s health care milieu, in which false-positive noninvasive imaging test results commonly beget unnecessary ICA for subjects who are subsequently found not to have disease. In a recent report from the National Cardiovascular Data Registry of 661,063 patients undergoing elective ICA after functional stress testing, more than one-half of patients did not have any actionable coronary stenosis, with the majority of patients having normal coronary arteries, confirming the low diagnostic accuracy of stress testing that is observed in current clinical practice (8). Among the 302,651 patients who underwent myocardial perfusion imaging (the most commonly used test in the United States today), only 134,670 (44.4%) had obstructive disease at ICA. Exercise treadmill testing, stress echocardiography, and magnetic resonance imaging yielded similarly low rates of obstructive disease. These findings are in direct accordance with a recent 47-center study of the Advanced Cardiovascular Imaging Consortium by Chinnaiyan et al. (9), in which stress test results did not predict the presence of anatomically obstructive coronary artery disease at ICA.
Numerous other clinical and economic assessment studies for FFRCT are ongoing. In the recently reported RIPCORD (Does Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain) study, which was presented in abstract form at the 2015 EuroPCR Scientific Sessions, FFRCT was evaluated for its ability to influence clinical decision making in salutary fashion (10). In 200 consecutive patients in stable condition with chest pain, cardiologists’ decision making was tested when using standard coronary CTA versus coronary CTA plus FFRCT. In this study by Curzen et al., 12% of patients who would have been treated with medical therapy alone would have been sent for ICA with intended revascularization if the FFRCT results were known. Conversely, 30% of patients who would have been referred to ICA were reassigned to medical therapy alone when using FFRCT added to coronary CTA. Nearly 20% of patients who were chosen for coronary revascularization were found to have different vessels needed for treatment, a finding highlighting the ability of FFRCT to perform 3-vessel evaluation.
Two additional ongoing FFRCT trials are notable. The multicenter PLATFORM (Prospective Longitudinal Trial of FFRCT: Outcome and Resource Impacts [NCT01943903]) trial of nearly 600 patients (whose enrollment is completed; results are expected to be reported in 2015) is a 2-period prospective evaluation of current practice versus FFRCT-based practice. It has a 90-day primary endpoint of ICA normalcy; secondary endpoints will include major adverse cardiac events, quality of life, medical radiation, and resource consumption. Finally, the multinational CREDENCE (Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia [NCT02173275]) trial of >600 patients is comparing coronary CTA and FFRCT head-to-head against stress testing for definitive determination of which methods are best for the diagnosis of ischemia. These trials will further inform the clinical cardiovascular imaging community on the use of FFRCT. At present, however, the technology seems to have taken 1 large step closer to a “1-stop shop” of anatomic identification of coronary stenoses as well as determination of their physiologic significance.
Dr. Min has served as a consultant to GE Healthcare, HeartFlow, the Cardiovascular Research Foundation, NeoGraft Technologies, MyoKardia, CardioDx, and Abbott Vascular; is on the advisory board for Arineta; reports ownership in MDDX and Autoplaq; and has received grants from the National Institutes of Health (R01 HL111141, R01 HL 115150, and R01 HL 118019), as well as a gift from the Dalio Foundation. Dr. Budoff has received grants from the National Institutes of Health and General Electric.
(2012) Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. Int J Cardiovasc Imaging 28:943–953.
(2014) Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J 167:846–852.
(2012) Coronary computed tomography angiography after stress testing: results from a multicenter, statewide registry, ACIC (Advanced Cardiovascular Imaging Consortium). J Am Coll Cardiol 59:688–695.
Curzen N. The FFRCT RIPCORD study: does the routine availability of computed tomography (CT)-derived fractional flow reserve influence management strategy of patients with stable chest pain compared to CT angiography alone? Presented at: EuroPCR; May 19, 2015; Paris, France.

lowercased:
dr. matthew j. budoff, department of medicine, los angeles biomedical research institute, torrance, california.
since its emergence in 2005, coronary computed tomography angiography (cta) has matured into a robust method for direct visualization of the coronary arteries and atherosclerotic plaque. early prospective multicenter studies reported high diagnostic performance for coronary cta in the identification and exclusion of high-grade coronary stenoses compared with the reference standard of invasive coronary angiography (ica) (1–3). both direct and historical comparison data have established the superiority of coronary cta over functional stress testing for identification of anatomically obstructive coronary artery disease.
despite diagnostic sensitivities of coronary cta that approached 100% for coronary artery disease, specificities were markedly lower, ranging between 64% and 90% for coronary cta–determined stenosis severity and reflecting a non-negligible rate of false-positive findings wherein coronary cta diagnoses overestimate the severity of the luminal narrowing. this reduced performance has been attributed to limitations mainly caused by motion and calcium artifacts; the former has largely been overcome with the use of pre-procedural beta-blockers and higher temporal resolution ct scanners.
however, coronary calcification, which occurs from partial volume effects, has remained problematic. the magnitude of the adverse diagnostic effects of coronary calcification on coronary cta was highlighted in a recent meta-analysis of 1,634 patients from 19 studies that examined the performance of coronary cta across different thresholds of coronary artery calcium (cac) scores (4). subgroups at cac scores <10 and <100 demonstrated high specificities of 90% (94% to 100%) and 88.5% (81% to 91.5%), respectively, whereas at cac scores >400, the specificity declined significantly to 42% (28% to 56%) while retaining a high sensitivity of 97.5% (94% to 99%). these may, in part, explain the equally concerning findings that among stenoses considered high-grade according to coronary cta, nearly 75% are not ischemia-causing compared with invasive fractional flow reserve (ffr).
the study by nørgaard et al. (5) in this issue of ijacc represents findings from the prospective, international, multicenter nxt (analysis of coronary blood flow using ct angiography: next steps) trial, which evaluated the diagnostic performance of fractional flow reserve derived from coronary computed tomography angiography (ffrct), a novel method approved by the us food and drug administration that uses computational fluid dynamics applied to typical coronary cta images for calculation of ffr (6). importantly, ffrct enables calculation of “3-vessel” ffr because it can interrogate any point within the coronary vascular bed for its hemodynamic significance. in nxt, the primary endpoint was 1 of discrimination (i.e., the area under the receiver-operating characteristic curve [auc]) because this metric allows identification of the optimal sensitivity and specificity for any given test. on a per-patient basis, the auc was 0.90 for ffrct, with a >2-fold increase in diagnostic specificity for ischemia-causing coronary lesions by ffr. these data evoked optimism for a technique that allows for direct visualization of coronary artery anatomy (by coronary cta) and precise identification of the coronary artery stenoses that cause ischemia (by ffrct). notably, the average cac score in nxt was 302 agatston units, which places the study population in the prognostically worst risk category when defined according to the multi-ethnic study of atherosclerosis (7).
however, the detailed breakdown of ffrct accuracies across coronary calcium score ranges was not detailed in the original nxt paper (6) and is the subject of the paper by nørgaard et al. (5). for 214 patients who underwent cac scoring in nxt, with 333 vessels directly examined by using ffr, the diagnostic performance of ffrct was evaluated for study-specific quartiles of cac scoring. interestingly, the investigators observed no differences in diagnostic accuracy, sensitivity, or specificity of ffrct across any cac score quartiles, including no differences at even the highest quartile of patients with agatston cac scores ranging from 416 to 3,599. for these patients, ffrct showed marked improved discrimination of ischemia compared with coronary cta alone (auc: 0.91 vs. 0.71; p = 0.0004). indeed, in this highest quartile, ffrct reclassified 60% of cases, leading to a significant reduction in false-positive findings. these results emphasize the immunity of ffrct to the largest imaging limitation of coronary cta and demonstrate that the test is not affected by even the most severe calcifications.
before the introduction of ffrct, there was no noninvasive method for simultaneous detection of coronary stenosis and determination of whether that stenosis causes ischemia. this ability to precisely locate a lesion that may benefit from coronary revascularization represents a significant advancement in diagnostic imaging. added to the visualization of atherosclerotic plaque features that augment the diagnosis of coronary lesion–specific ischemia, the use of ffrct may enable pre-procedural planning in a manner that other modalities do not. in addition, its general immunity to coronary calcification represents a major advance compared with coronary cta imaging.
these data (5), although from a substudy of a larger parent trial, are of considerable import in today’s health care milieu, in which false-positive noninvasive imaging test results commonly beget unnecessary ica for subjects who are subsequently found not to have disease. in a recent report from the national cardiovascular data registry of 661,063 patients undergoing elective ica after functional stress testing, more than one-half of patients did not have any actionable coronary stenosis, with the majority of patients having normal coronary arteries, confirming the low diagnostic accuracy of stress testing that is observed in current clinical practice (8). among the 302,651 patients who underwent myocardial perfusion imaging (the most commonly used test in the united states today), only 134,670 (44.4%) had obstructive disease at ica. exercise treadmill testing, stress echocardiography, and magnetic resonance imaging yielded similarly low rates of obstructive disease. these findings are in direct accordance with a recent 47-center study of the advanced cardiovascular imaging consortium by chinnaiyan et al. (9), in which stress test results did not predict the presence of anatomically obstructive coronary artery disease at ica.
numerous other clinical and economic assessment studies for ffrct are ongoing. in the recently reported ripcord (does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain) study, which was presented in abstract form at the 2015 europcr scientific sessions, ffrct was evaluated for its ability to influence clinical decision making in salutary fashion (10). in 200 consecutive patients in stable condition with chest pain, cardiologists’ decision making was tested when using standard coronary cta versus coronary cta plus ffrct. in this study by curzen et al., 12% of patients who would have been treated with medical therapy alone would have been sent for ica with intended revascularization if the ffrct results were known. conversely, 30% of patients who would have been referred to ica were reassigned to medical therapy alone when using ffrct added to coronary cta. nearly 20% of patients who were chosen for coronary revascularization were found to have different vessels needed for treatment, a finding highlighting the ability of ffrct to perform 3-vessel evaluation.
two additional ongoing ffrct trials are notable. the multicenter platform (prospective longitudinal trial of ffrct: outcome and resource impacts [nct01943903]) trial of nearly 600 patients (whose enrollment is completed; results are expected to be reported in 2015) is a 2-period prospective evaluation of current practice versus ffrct-based practice. it has a 90-day primary endpoint of ica normalcy; secondary endpoints will include major adverse cardiac events, quality of life, medical radiation, and resource consumption. finally, the multinational credence (computed tomographic evaluation of atherosclerotic determinants of myocardial ischemia [nct02173275]) trial of >600 patients is comparing coronary cta and ffrct head-to-head against stress testing for definitive determination of which methods are best for the diagnosis of ischemia. these trials will further inform the clinical cardiovascular imaging community on the use of ffrct. at present, however, the technology seems to have taken 1 large step closer to a “1-stop shop” of anatomic identification of coronary stenoses as well as determination of their physiologic significance.
dr. min has served as a consultant to ge healthcare, heartflow, the cardiovascular research foundation, neograft technologies, myokardia, cardiodx, and abbott vascular; is on the advisory board for arineta; reports ownership in mddx and autoplaq; and has received grants from the national institutes of health (r01 hl111141, r01 hl 115150, and r01 hl 118019), as well as a gift from the dalio foundation. dr. budoff has received grants from the national institutes of health and general electric.
(2012) influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. int j cardiovasc imaging 28:943–953.
(2014) prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. am heart j 167:846–852.
(2012) coronary computed tomography angiography after stress testing: results from a multicenter, statewide registry, acic (advanced cardiovascular imaging consortium). j am coll cardiol 59:688–695.
curzen n. the ffrct ripcord study: does the routine availability of computed tomography (ct)-derived fractional flow reserve influence management strategy of patients with stable chest pain compared to ct angiography alone? presented at: europcr; may 19, 2015; paris, france.