Another HCA Houston hospital hit a major milestone in robotics-assisted surgery. Photo courtesy of HCA

HCA Houston Healthcare Medical Center has successfully completed a robotic-assisted coronary angioplasty — the first of its kind, the hospital reports.

Dr. Pranav Loyalka, cardiologist with Houston Heart, completed the procedure using the first and only FDA-cleared robotic-assisted technology. The process includes placing stents and balloons in patients with coronary artery disease.

"The first case was very successful. Sitting away from the patient in a radiation-protected cockpit, I was able to use a joystick to advance the catheter, millimeter by millimeter through the artery," says Dr. Loyalka in a news release. "Additionally, the enhanced visualization of the technology provided me with better measurement of the blockage and placement of the stent. In my opinion, the enhanced control, visualization and measurement of this technology will transform how we perform angioplasty procedures and ultimately improve patient care."

CAD, a common but deadly disease, is the leading cause of death in America. The treatment — angioplasty procedures — remains one of the most frequently performed in the country with nearly one million cases annually, but the procedure has remained unchanged for decades.

"An aging baby boomer population is driving demand for new innovative technologies to treat CAD," continues Dr. Loyalka. "Vascular robotics offers physicians and patients a minimally-invasive technology that may improve the precision of stent and balloon placements and reduce radiation of the procedure for physicians."

The robotics technology allows interventional cardiologists to perform the procedure away from the patient's bedside and seated in a radiation-protected cockpit. The physician uses a joystick to robotically move the procedure's tools — including catheters, angioplasty balloons, and stents — to clear the blockage and restore blood flow. Additionally, the technology allows interventional cardiologists to accurately measure blockages and precisely position stents, which may lead to fewer stent implants.

"We are proud to be one of the first medical centers in the area to perform this advanced procedure," says Chris Osentowski, chief executive officer at HCA Houston Healthcare Medical Center. "It emphasizes our continuous commitment to delivering state-of-the-art technology to our patients and clinical community."

In March, HCA Houston Healthcare Clear Lake performed its first peripheral lung biopsy using robotic-assisted technology, making it the first hospital in the area to perform that procedure.

This hospital has conducted a unique and innovative procedure using robotics. Photo via hcahoustonhealthcare.com

Houston-area hospital performs first robotic-assisted lung surgery

robots in health care

HCA Houston Healthcare Clear Lake performed its first peripheral lung biopsy using robotic-assisted technology this month, making it the first hospital in the area to perform the minimally-invasive and innovative procedure.

Pulmonologist Dr. Alfred Maksoud performed the first two robotically-assisted procedures on March 1 and was attended by thoracic surgeon Dr. Melissa Korb and pulmonologist Dr. Maher Dahdel.

The procedures were conducted via an ultra-thin, easily maneuverable catheter that's able to navigate tight airways and pass through tight bends. A three-dimensional module of the patient's lung (created prior to surgery through a CT scan) was displayed on a computer screen to serve as a reference point for the doctors, as well as a live camera footage inside the lung.

The technology allows doctors to now reach nodules in any airway segment in the lung and extract more precise biopsies from the peripheral lung areas.

It will make the treatment easier on patients, which traditionally would require a CT scan and needle inserted into the patient's chest wall from outside of the body to reach these abnormal spots. This presented high risks of lung collapses for those with advanced lung disease.

“The technology allows us to go through the natural airways of the lung, so there is no puncturing of the lung tissue from the outside of the lining of the lung,” Maksoud said in a statement. “It is a safer way to approach lesions that are in the periphery of the lung for patients who have fairly advanced underlying lung disease.”

Additionally, this technology will support early diagnosis of lung disease when used for screenings due to its ability to reach previously unreachable areas of the lung.

“Approximately 75 percent of lung cancer cases are diagnosed in an advanced stage. Early lung cancer detection is imperative to increase the survival rate,” Todd Caliva, CEO at HCA Houston Healthcare Clear Lake, said in a statement. “We're excited to implement new innovations that allow us to enhance the level of care our patients receive.”

Houston-area hospitals have become hubs for robotic-assisted surgery in recent years.

Baylor St. Luke's has become a top cardiac robotics program since 2019. Meanwhile, others, like Houston Methodist, have developed AI technologies to simulate entire surgeries artificially with a goal of allowing surgeons to practice and plan their technique.
From new tech jobs in Houston to an entrepreneurship minor at Rice University, here are some short stories in Houston innovation. Shobeir Ansari/Getty Images

Rice creates entrepreneurship minor, Houston tech jobs grow, and more innovation news

Short stories

While much of the city's news — along with the rest of the country — has been focused on COVID-19, headlines are starting to resemble some sense of normalcy again.

For this roundup of short stories within Houston innovation, there's a mix of news items pertaining to the coronavirus, as well as news items outside of the pandemic — from a new minor program at Rice University to Baylor College of Medicine testing for a COVID treatment.

Rice University introduces entrepreneurship minor

Rice University plans to offer undergraduate students an opportunity to minor in entrepreneurship. Courtesy of Rice University

Three of Rice University's programs — the Liu Idea Lab for Innovation and Entrepreneurship, Jones Graduate School of Business, and Brown School of Engineering — are teaming up to provide undergraduate students an opportunity to minor in entrepreneurship.

"Entrepreneurship and the creation of new businesses and industries are critical to Houston and Texas' future prosperity and quality of life," says Yael Hochberg, Rice finance professor who leads Lilie, in a release. "Rice students continuously seek to lead change and build organizations that can have real impact on our world. In today's new and uncertain world, the skills and frameworks taught in the new minor are particularly important."

According to a news release, the minor's curriculum will provide students with professional skills within entrepreneurship, such as problem solving, understanding customers and staff, communication, and more. The program will be housed in Lilie, which features a coworking space, graduate and undergraduate entrepreneurship courses, the annual H. Albert Napier Rice Launch Challenge, and other courses.

Houston named No. 12 for tech jobs

Houston's tech jobs are growing — just not at an impressive rate, according to a new report. Christina Morillo/Pexels

CompTIA has released its Cyberstates 2020 report that identifies Houston as No. 12 in the country for tech jobs. However, the Bayou City was ranked No. 38 for job percent growth. Austin and Dallas appear in the top 10 of each of the Cybercities rankings.

According to the report, Houston has a net total of 235,802 tech jobs, an increase of 826 jobs between 2018 and 2019. This figure means a growth of 25,904 jobs between 2019 and 2010. The full report is available online.

While Houston misses the top 10 metros, Texas ranks No. 2 for net tech employment and net tech employment growth. The Lone Star State came in at No. 4 for projected percent change in the next decade. The state was also recognized as No. 2 for number of tech businesses.

Baylor College of Medicine tests existing drug for COVID-19 cure

A Houston institution is looking into an existing vaccine for coronavirus treatment. Andriy Onufriyenko/Getty Images

Baylor College of Medicine researchers — along with colleagues at four other institutions — are testing to see if the bacille Calmette-Guerin vaccine, known as BCG, can work against COVID-19.

"Epidemiological studies show that if you're BCG vaccinated, you have a decreased rate of other infections," says Dr. Andrew DiNardo, assistant professor of medicine – infectious diseases at Baylor, in a news release.

The vaccine has been found to help protect against yellow fever and influenza, and, according to DiNardo, the vaccine could show 30 to 50 percent improvement in immune response in patients with the coronavirus. The team is currently looking for subjects to participate in a clinical trial to test the vaccine.

While research is preliminary, the theory is that BCG changes the way the body responds to a pathogen, according to the release.

"Think of DNA like a ball of yarn," DiNardo explains in the release. "Some pieces of the ball of yarn are open and able to be expressed. Other pieces are wrapped up tight and hidden away, and those genes are repressed. It's a normal way for cells to turn certain genes on and off. BCG opens up certain parts of this ball of yarn and allows the immune system to act quicker."

Plug and Play announces physical space in Houston

Plug and Play Tech Center's local team will work out of the Ion. Courtesy of Rice University

Since entering the Houston market last year, Silicon Valley's Plug and Play Tech Center has hosted numerous events, named its first cohort, and hired Payal Patel to lead the local operations. However, the local operations still, until recently, lacked a plan for a physical space in town.

"Plug and Play intends to set up its permanent office in Houston in Rice's Ion development," says Patel in a statement. "We have engaged in preliminary discussions with Rice Management Company to secure office space for the building's expected Q1 2021 opening."

Until then, says Patel, who is director of corporate partnerships for Plug and Play in Houston, the Plug and Play team will have its base at Station Houston, which recently merged with Austin-based Capital Factory. At present, the local team is hiring to build up its team and has five open jobs on HTX Talent, a job portal for Houston tech.

UH professor named a Guggenheim fellow

A University of Houston professor has been honored with a prestigious award. Photo courtesy of University of Houston

A University of Houston mechanical engineer has been selected for a Guggenheim Fellowship. Pradeep Sharma is the only recipient in the engineering category.

The M.D. Anderson Chair Professor of mechanical engineering and chairman of the department, Sharma uses mathematics and technology to breakdown physical phenomena across a number of disciplines.

The Guggeinheim Foundation has funded more than $375 million in fellowships to over 18,000 individuals since its inception in 1925. This year, the organization selected 173 individuals.

"It's exceptionally encouraging to be able to share such positive news at this terribly challenging time," Sharma says in a news release from UH. "The artists, writers, scholars and scientific researchers supported by the fellowship will help us understand and learn from what we are enduring individually and collectively."

Houston health system to participate in coronavirus plasma study

HCA Houston Healthcare is participating in a plasma treatment program. Getty Images

HCA Healthcare Gulf Coast Division has announced that it will be participating in a national study to see if plasma from recovered COVID-19 patients can help current COVID patients in severe conditions.

"We are proud to take part in this important study. We are asking for the help of our community to spread awareness about plasma donation for patients facing COVID-19 not only in Houston, South Texas and Corpus Christi, but also around the world," says Mujtaba Ali-Khan, chief medical officer at HCA Healthcare Gulf Coast Division, in a news release.

Per the study, the following HCA Healthcare Gulf Coast Division Hospitals will be participating:

  • HCA Houston Healthcare Clear Lake
  • HCA Houston Healthcare Conroe
  • HCA Houston Healthcare Kingwood
  • HCA Houston Healthcare Southeast
  • HCA Houston Healthcare West
  • HCA Houston Healthcare Tomball
  • HCA Houston Healthcare North Cypress
  • HCA Houston Healthcare Northwest
  • HCA Houston Healthcare Mainland
  • HCA Houston Healthcare Medical Center
  • Corpus Christi Medical Center
  • Rio Grande Regional Hospital
  • Valley Regional Medical Center

"This trial is just the first step, but hopefully it will help us determine if plasma transfusions can be a treatment for critically ill patients with COVID-19," says Carlos Araujo-Preza, MD, critical care medical director at HCA Houston Healthcare Tomball, in the release.

Dr. Araujo-Preza safely discharged his first plasma patient last week. The patient is recovering from home following their treatment.

The hospital system is looking for eligible volunteers to donate plasma via the American Red Cross to help treat current patients.

Early stage energy venture firm calls for startups

Industrial software

BBL Ventures is looking for energy companies to pitch. Getty Images

Houston-based BBL Ventures, which looks to connect tech startups to industrial and energy corporations, is seeking energy tech startups to pitch.

"Digital transformation, automation, emerging technologies and sustainability have never been more important to these industries than in this challenging macro environment," says Patrick Lewis, founding managing partner of BBL Ventures, in an email. "We are launching a 6-week challenge campaign to find BEST in class solutions to BIG pain points in the energy and industrial sectors."

In the email, Lewis lists over a dozen challenges or pain points from the organization's corporate partners. The goal would be to find startups with to solutions to any of these identified pain points. Winners of the pitch competition are eligible for POCs, pilots, and funding.

For more information and to submit a pitch, visit BBL's website. BBL is also introducing the program with a virtual kick-off panel on May 21 at 2 pm. Registration is available online.

Hospital systems and nonprofits are looking for ways to reach patients virtually as face-to-face interactions continue to be limited due to the coronavirus. Getty Images

Houston medical organizations pivot to telemedicine and remote care amid COVID-19 crisis

online care

Hospitals across the country are trying their best to limit the number of people coming in and out — but how does that affect patients in need of non-COVID-19 treatment? Hospital systems are implementing new technology and training so that physicians can use telemedicine to connect virtually.

In March following telemedicine training, Houston Methodist began seeing hundreds more daily telemedicine sessions across its system, Josh Sol, administrative director of Innovation and Ambulatory Clinical Systems at Houston Methodist, previously told InnovationMap. And other hospital systems are following suit.

HCA Houston Healthcare's CareNow locations have implemented Virtual Care, a telehealth urgent care service. Patients can check in online during the urgent care center's operating hours to gain one-on-one access to care from a CareNow physician, nurse practitioner, or physician assistant. Providers, via video chat, will evaluate minor conditions and can prescribe non-narcotic medications when indicated.

If the situation calls for it, providers will tell the patient to come onsite to continue care.

"Virtual Care is an extension of our clinical urgent care services and fully supports our purpose to help people return to what they value in their lives, in an even more convenient way. We are proud to provide an easy solution for our patients' healthcare needs at their fingertips," says Dr. Mujtaba Ali-Khan, chief medical officer for HCA Houston Healthcare, in a news release.

Dallas-based CareNow was acquired by HCA in 2015 and has 16 locations in the greater Houston area.

Health care nonprofits are also taking advantage of remote ways to reach patients. Houston-based nonprofit CanCare is in the business of supporting cancer patients and their families and, despite a global pandemic, has not let up on its services to those in need. In fact, cancer patients with their weakened immune system are at greater risk of developing COVID-19 and are in need more than ever of CanCare's one-on-one matching emotional support service.

"The cancer community is in our thoughts and prayers during this time of uncertainty," says CanCare's President and CEO Cristina Vetrano in a news release. "Now more than ever, the community needs the help of our volunteers and support services. Our mission is not only to ensure the safety of clients, patients and caregivers but also to assure the community that they will continue to receive support throughout this challenging time."

Cancer patients can reach support via email at support@cancare.org or by calling the support line support line at 713-364-1652.

The Houston health care ecosystem will continue to see advances in telemedicine and remote care. One Houston startup, Medical Informatics, has created a virtual ICU program, called Sickbay, and the tech tool is being used to remotely monitor patients in Houston Methodist. The program works around the clock from a control hub to use artificial intelligence and algorithms to monitor patients.

"We designed our Sickbay platform to give lost data back to doctors, nurses and other members of the care team so they could save more lives," says Vincent Gagne, vice president of product for MIC, in a news release.

As the world emerges from COVID-19 — whenever and however that happens — telemedicine will have advanced as a viable option for physicians in a quicker way than it would have otherwise, Sol says.

"Telemedicine is here to stay now with the rapid adoption that just happened," he says. "The landscape will change tremendously."

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CultureMap Emails are Awesome

These were the most-read guest columns by Houston innovators in 2022

2022 in review

Editor's note: Every week, InnovationMap — Houston's only news source and resource about and for startups — runs one or two guest columns written by tech entrepreneurs, public relations experts, data geniuses, and more. As Houston's innovation ecosystem gets ready for 2023, here are some of this year's top guest contributor pieces — each with pertinent information and advice for startups both at publishing and into the new year. Make sure to click "read more" to continue reading each piece.

Is your New Year's resolution to start contributing? Email natalie@innovationmap.com to learn more.

Houston expert: How to navigate Gen Z's quiet quitting movement at your company

Your perspective on quiet quitting is probably generational, says one Houston expert and startup founder. Photo via Getty Images

This month, the internet has been discussing "quiet quitting," the practice of employees setting hard boundaries about when they work and to what extent they are willing to go beyond the outlined expectations of their jobs.

The conversation around quiet quitting has also been lively at the Ampersand offices. As a training company that is dedicated to training new professionals for employers both big and small, it's critically important for our team to have a good grasp on the relationship employees have with their jobs, and what motivates them to succeed. So we had a long meeting where we discussed what quiet quitting meant to each of us. Read more.

Houston expert shares how small business leaders can encourage PTO use

Retaining employees is no easy feat these days. Encouraging a healthy PTO policy can help avoid burnout. Photo courtesy of Joe Aker

As many small businesses continue to operate in a challenging, fast-paced environment, one thing that has arrived at breakneck speed is midyear, along with the summer months. Theoretically, to ensure work-life balance, most employees should have 50 percent of their PTO remaining to use for summer vacations and during the second half of the year. In reality, that is probably not the case given workers are hesitant to use their PTO, leaving approximately five days of unused PTO on the table during 2020 and 2021.

While the pandemic affected PTO usage the last two years, the labor shortage appears to be a major contributor in 2022, which has led to PTO hoarding and increasing levels of employee burnout. Although these factors can be compounded for small business owners because there are fewer employees to handle daily responsibilities, it is imperative for workers to take PTO, returning recharged with a fresh perspective on the tasks at hand. Read more.

Houston expert: 3 emotional intelligence tips for improving patient-practitioner experience

A Houston expert shares how to improve on communication in the health care setting. Image via Getty Images

After spending hours with healthcare professionals as both a consultant and patient, I know that it takes a special kind of person to take care of others in their most distressing and vulnerable times. That responsibility has been in overdrive because of COVID, causing emotional burnout, which in turn affects patient care. By equipping yourself with emotional intelligence, you can be more resilient for yourself and patients.

Emotional intelligence is keeping your intelligence high, when emotions are high.

Health care sets up an environment for a tornado of emotions, and the rules and regulations centered around patient-provider interactions are often complex to navigate. This leaves many on the brink of emotional exhaustion, and for survival’s sake, depersonalization with patients becomes the status quo. Feeling a disconnect with their patients is another added weight, as few get into this industry for just the paycheck – it’s the impact of helping people get healthy and stay healthy that motivates them. I’ve seen it time and time again with people in my life, as well as on my own patient journey as I battled stage 3 cancer. Read more.

Here's what types of technology is going to disrupt the education sector, says this Houston founder

Edtech is expected to continue to make learning more interactive, fun, and inclusive for people around the world. Photo via Pexels

Technology has always maneuvered education in a certain direction but the COVID-19 pandemic has forced it to shift towards a new direction entirely.

What started off as a basic video lecture turned into a more hybrid and innovative form of education, enabling student engagement and interactivity like never before. Social media forums allow teachers to pay one-on-one attention to students boosting their learning process.

With an edtech boom on the rise, there is a question of what further expansion in educational technology is expected. Here are some technology breakthroughs currently underway in the education sector. Read more.

Houston expert weighs in on marketing from an investor’s perspective

What should Houston startups know about marketing? Photo via Getty Images

Just what do investors want to see from a startup with regards to the company’s marketing? I recently spoke on this topic to a cohort of early-stage technology startup entrepreneurs at Softeq Venture Studio, an accelerator program that helps founders build investable technologies and businesses. Read more.

These elite Houston researchers were named among the most-cited in their fields

MVPs

Nearly 60 scientists and professors from Houston-area universities and institutions, working in fields from ecology to immunology, have been named among the most-cited researchers in the world.

The Clarivate Highly Cited Researchers 2022 list considers a global pool of public academic papers that rank in the top 1 percent of citations for field and publication year in the Web of Science. It then ranks researchers by the number of times their work has been cited, or referenced, by other researchers, which, according to the University of Houston, helps their findings "become more impactful and gain further credibility."

This year 6,938 researchers from 70 different countries were named to this list. About 38 percent of the researchers are based in the U.S.

“Research fuels the race for knowledge and it is important that nations and institutions celebrate the individuals who drive the wheel of innovation. The Highly Cited Researchers list identifies and celebrates exceptional individual researchers who are having a significant impact on the research community as evidenced by the rate at which their work is being cited by their peers," says David Pendlebury, head of research analysis at the Institute for Scientific Information at Clarivate, in a statement. "These individuals are helping to transform human ingenuity into our world’s greatest breakthroughs.”

Harvard University was home to the most researchers, with 233 researchers making the list, far outpacing Stanford University, which had the second highest total of 126 researchers.

Texas universities and institutions had a strong showing, too. The University of Texas at Austin had 31 researchers on the list, tying UT with the University of Minnesota and Peking University in China for the No. 35 spot. MD Anderson had 30 researchers on the list, the most among organizations in Houston, earning it a 38th place ranking, tied with the University of Maryland and University of Michigan.

Below is a list of the Houston-area highly cited researchers and their fields.

From UT MD Anderson Cancer Center

  • Jaffer Ajani (Cross-Field)
  • James P. Allison (Immunology)
  • Jan A. Burger (Clinical Medicine)
  • George Calin (Cross-Field)
  • Jorge Cortes (Clinical Medicine)
  • Courtney DiNardo (Clinical Medicine)
  • John V. Heymach (Clinical Medicine)
  • David Hong (Cross-Field)
  • Gabriel N. Hortobagyi (Cross-Field)
  • Robert R. Jenq (Cross-Field)
  • Hagop M.Kantarjian (Clinical Medicine)
  • Marina Y. Konopleva (Clinical Medicine)
  • Dimitrios P. Kontoyiannis (Cross-Field)
  • Scott E. Kopetz (Clinical Medicine)
  • Alexander J. Lazar (Cross-Field)
  • J. Jack Lee (Cross-Field)
  • Anirban Maitra (Clinical Medicine)
  • Robert Z. Orlowski (Clinical Medicine)
  • Padmanee Sharma (Clinical Medicine and Molecular Biology and Genetics)
  • Anil K. Good (Cross-Field)
  • Jennifer A. Wargo (Molecular Biology and Genetics)
  • William G. Wierda (Clinical Medicine)

From Baylor College of Medicine

  • Erez Lieberman Aiden (Cross-Field)
  • Nadim J. Ajami (Cross-Field)
  • Christie M. Ballantyne (Clinical Medicine)
  • Malcolm K. Brenner (Cross-Field)
  • Hashem B. El-Serag (Clinical Medicine)
  • Richard Gibbs (Cross-Field)
  • Heslop, Helen Cross-Field
  • Joseph Jankovic (Cross-Field)
  • Sheldon L. Kaplan (Immunology)
  • Joseph F. Petrosino (Cross-Field)
  • Cliona Rooney (Cross-Field)
  • James Versalovic (Cross-Field)
  • Bing Zhang (Cross-Field)

From Rice University

  • Plucker M. Ajayan (Materials Science)
  • Pedro J. J. Alvarez (Environment and Ecology)
  • Naomi Halas (Materials Science)
  • Jun Lou (Materials Science)
  • Antonios G. Nikos (Cross-Field)
  • Aditya D. Mohite (Cross-Field)
  • Peter Nordlander (Materials Science)
  • Ramamoorthy Ramesh (Physics)
  • James M. Tour (Materials Science)
  • Robert Vajtai (Materials Science)
  • Haotian Wang (Chemistry)
  • Zhen-Yu Wu (Cross-Field)
  • From University of Houston
  • Jiming Bao (Cross-Field)
  • Shuo Chen (Cross-Field)
  • Whiffing Ren (Cross-Field)
  • Zhu Han (Computer Science)

From UTMB Galveston

  • Vineet D.Menachery (Microbiology)
  • Nikos Vasilakis (Cross-Field
  • Scott C. Weaver (Cross-Field)
  • From UT Health Science Center-Houston
  • Eric Boerwinkle (Cross-Field)

Overheard: Houston experts call for more open innovation at industry-blending event

eavesdropping at the Ion

Open innovation, or the practice of sourcing new technologies and idea across institutions and industries, was top of mind at the annual Pumps & Pipes event earlier this week.

The event, which is put on by an organization of the same name every year, focuses on the intersection of the energy, health care, and aerospace industries. The keynote discussion, with panelists representing each industry, covered several topics, including the importance of open innovation.

If you missed the discussion, check out some key moments from the panel.

“If we want to survive as a city, we need to make sure we can work together.”

Juliana Garaizar of Greentown Labs. "From being competitive, we’ve become collaborative, because the challenges at hand in the world right now is too big to compete," she continues.

“The pace of innovation has changed.”

Steve Rader of NASA. He explains that 90 percent of all scientists who have ever lived are alive on earth today. “If you think you can do it all yourself — and just find all the latest technology yourself, you’re kidding yourself.”

“You can’t close the door. If you do, you’re closing the door to potential opportunities.”

— Michelle Stansbury, Houston Methodist. “If you think you can do it all yourself — and just find all the latest technology yourself, you’re kidding yourself.” She explains that there's an influx of technologies coming in, but what doesn't work now, might work later or for another collaborator. "I would say that health care as a whole hasn’t been very good at sharing all of the things we’ve been creating, but that’s not the case today," she explains.

“The thing that makes Houston great is the same thing that makes open innovation great: diversity.”

— Rader says, adding that this makes for a great opportunity for Houston.

“Some of our greatest innovations that we’ve had come from other industries — not from health tech companies.”

— Stansbury says. "I think that's the piece everyone needs to understand," she says. "Don't just look in your own industry to solve problems."

“Nobody knows what is the best technology — the one that is going to be the new oil."

— Garaizar says. “All of this is going to be a lot of trial and error," she continues. “We don’t have the luxury of time anymore.”