Tyler Suiters
This special edition of CES Tech Talk is brought to you by Abbott. Abbott is a global healthcare company with leading products and diagnostics, medical devices, nutritionals and medicines. Their breakthrough technologies are redefining our approach to diagnosing and managing some of the world's greatest health challenges, helping people live healthier, fuller lives.
Tyler Suiters
Hey, everybody. I'm Tyler Suiters with The Consumer Technology Association. We are the owners and the producers of CES, the world's largest, the world's most influential tech event. And, we are here to help you get CES Ready. CES 2020 is coming up January 7th through the 10th in Las Vegas, as always. Today, we are talking to a major player in this space, Abbott. This is a company that is bringing life-changing health technologies to those people who really need them. Think about this. Something is straight forward is removing the pain of regular finger sticks for diabetics who need to test their blood or something as broad as connecting patients and doctors with real-time information, and that can be, monitoring your heart rhythms and health, maybe, easing chronic pain or even addressing movement disorders. A broad, diverse conversation today with Abbott's experts across cardiovascular health, diabetes, and product development. All of that is coming up on this special edition of CES Tech Talk.
Tyler Suiters
Joining us today from various parts of the country, a triumvirate of experts from Abbott. First of all, Heidi Hinrichs, is divisional vice president for Global Clinical and Regulatory Affairs at Abbott Cardiovascular. And, Heidi, great to have you with us today.
Heidi Hinrichs
Thank you. Glad to be here.
Tyler Suiters
Joel Goldsmith is the senior director of the digital platform for Abbott Diabetes Care. Joel, we're glad you're with us today.
Joel Goldsmith
Thanks for having me.
Tyler Suiters
And, finally, Ryan Lakin, is divisional vice president of product development with Abbott Neuromodulation. Ryan, great to have you here.
Ryan Lakin
Hey, thanks. Great to be here.
Tyler Suiters
Let's start with a bit of a group question. And, I want to keep it broad to begin before we really drill down, but we have so many major medical challenges both as a nation and across the world right now. Let's begin with just a bit of a state of play regarding the medical devices, the technology helping these areas that, really, at the intersection of technology and consumer-facing technology and the treatments, the therapies involved. And, Heidi, let's start with you.
Heidi Hinrichs
Oh, sure. Thank you. Over the last few years, I think we've really seen an uptick in terms of the intersection of medical devices with consumer technologies because it's really helped us manage some complex health conditions. And, at Abbott, I think you'll hear my colleagues talk about, in their space, how they're managing more complex health conditions as well through the use of consumer technology. One example we have in our cardiovascular portfolio is our insertable cardiac monitor, it's our Confirm Rx product. And, this actually monitors people's heart rhythm 24 hours a day, seven days a week for up to two years to really detect abnormal heart rhythms.
Heidi Hinrichs
And, the way that is actually interacting with a consumer technology is that we have an app that we can upload onto a patient's smartphone, and that app collects data from that person, an implantable cardiac monitor, and then will actually transmit to a website where the physician can monitor this patient's abnormal heart rhythm. And so, that allows us to monitor patients remotely without requiring them to carry handheld transmitters without requiring them to go into the physician office. And, that's how consumer technology has truly helped in our cardiovascular space.
Tyler Suiters
Joel, let's go to you next because I think that diabetes care is at the forefront of something Heidi touched on, which is, having a physical monitor. It's a real touchpoint for diabetes patients at the intersection of consumer tech and treatment.
Joel Goldsmith
Yeah. I mean, diabetes is broadly recognized as one of the showcases of the potential for digital health, and it's not really a surprise when you consider the magnitude of the condition globally. It's a growing global epidemic that currently affects an estimated 425 million people and as many as 30 million people living in the United States. In its simplest form, the disease can be described as impairing the body's natural ability to regulate its blood glucose. So, monitoring glucose is really a fundamental part of managing the condition. And, the devices that have been used to manage diabetes have always resembled consumer electronics, but in the past few years, the convergence between the two has really advanced. And, I think it can be described around three fundamental shifts that are occurring in diabetes technology in general, but in glucose monitoring in particular, the first from traditional blood glucose test strips, that have been around for decades and for many years were the standard of care for monitoring blood glucose from a droplet of blood, to body-worn sensors that are now making it possible to capture dense glucose data.
Joel Goldsmith
The second, really, the shift from proprietary handheld devices that had been used to monitor glucose to connected consumer electronics, primarily phones, and watches, that are serving as the primary user interface. And then, the third is, really, the shift from isolated desktop software that's historically been used as a form of clinical decision support to distributed cloud-based services that will really enable new forms of clinical decision support that's powered by advances in machine learning.
Ryan Lakin
So, I think you can tell from the other two, it's an exciting time for health technology. And, as we started a new decade, we're at a transformative time in medical technology. Technology is becoming a natural part of who we are and how we manage our health. We are at the tip of the iceberg, from our perspective, at Abbott. We're at the forefront of addressing some of the world's most prevalent and costly and difficult to manage chronic diseases, including the ones that were already talked about, heart disease, diabetes, and then, in our neuromodulation businesses, specifically, chronic pain and movement disorders. In the neuromodulation business, we're studying and developing new technologies at Abbott that will help us identify new innovative solutions that fit seamlessly into the patient's lifestyle, but also by allowing them to discreetly manage their pain using consumer technologies that we have today. And these are to manage implantable, what we call active implantable devices, using things such as Apple mobile devices and Bluetooth wireless technology. And then, also, beginning to leverage artificial intelligence as well.
Tyler Suiters
So, Ryan, you're bringing up an interesting point about the pace of innovation, and especially in the greater digital health space. Thinking back over the last 10 years, talk about the evolution in technology here. And, I want to keep in mind that 10 years ago the iPhone was nascent, self-driving vehicles, drones, not yet, remotely deployed to the scale they are now, and even voice recognition has come so far in that decade. So, Heidi, let's start with you. I mean, what have you seen as far as the growth, the exponential evolution within your space in 10 years?
Heidi Hinrichs
It's been pretty phenomenal. If I look at my role in developing clinical trials and therapy, new therapies in the cardiovascular space, what we've seen, if we look back, let's just start with taking those basic pacemakers and looking back 50 years. In the past 50 years, a pacemaker really hasn't changed in terms of its current form factor that it has. But, in the last 10 years, from a technology perspective, we've gone from only being able to capture basic battery information about our pacemaker over the telephone to today's world, which is, collecting significant diagnostic information that the physician can then access allowing them to truly understand how well that device is performing on that day for that patient and how well that patient is responding to that therapy. So, we're getting real-time information through the newer technology that's been developed just in the last 10 years.
Tyler Suiters
And, Joel, you already delved into that somewhat, regarding the diabetes sector, when you're talking about, and I'll use some of the shorthand here, but going from test strips, actually, pricking your finger and doing a manual blood test to full-time glucose measurement monitors, right?
Joel Goldsmith
Yeah. I mean, that's probably the most notable advancement in the last decade, is that body-worn sensors that are used to continuously monitor glucose have now really started to become mainstream and our product, FreeStyle Libre, is now used by over 1.6 million people in 46 countries. This is in a category that essentially didn't exist a decade ago. And then, more recently, of course, the emergence of mobile medical apps that operate on phones and tablets and watches, they fulfill the primary intended use and they're treated as medical devices, even though those apps are running on consumer electronic products that themselves are not regulated nor their operating systems. So, that's a pretty fundamental change.
Joel Goldsmith
Now, one other I think is worth noting that has a little less to do with the product itself, but is equally as important, is our ability to capture and analyze real-world evidence now, on a global basis. And, this is quickly becoming an expectation of the clinical community, of the payer community, and because of the tools that I've been describing that are persistently connected, it gives us the ability to capture data, analyze it on an aggregated and de-identified basis, and really demonstrate the clinical effectiveness of it. So, just as an example, with the FreeStyle Libre system that I mentioned, we've been able to show that people are using that routinely on a daily basis, around 11 times per day.
Tyler Suiters
Ryan, what about your view, specifically from product developments within the last decade?
Ryan Lakin
Yeah. I think, from our perspective, it's, you have to start with the reality that millions of people live with pain and pain is a complex chronic condition that people with it endure it for a long time, really, without adequate relief from both, I think, what people think about a lot is the physical symptoms, but the psychological symptoms are really paramount to that population many times. And, in many times, the psychological symptoms are actually greater than that of the physical pain in terms of quality of life. Therefore, as we think about what we've done and how the market has evolved over the last 10 years, leveraging digital and wearable technologies such as physiological sensors, including insights from implantable devices, wearables, health data, even contextual information, can be brought together to create real unique solutions improving overall quality of life.
Ryan Lakin
People living with chronic pain are really now able to control their system with a very consumer-friendly solution. Their leverage is the iOS platform. And, with some of our latest innovations, we have a strong opportunity to really address unmet needs of people living with chronic pain. And so, in conclusion, today, more people are getting implanted because of not having to think about the chronic condition and, more importantly, not thinking about the implanted device they have for both pain and for movement disorders, for people with Parkinson's disease as an experience, and because of these positive experiences, really, more people are coming into the market through the ease of use. And so, as we find increasing importance for people to share their experiences and as health becomes something that people manage more themselves, the stories and the positive outcomes are really allowing more people to have access as well as gain the benefits of technologies that Abbott offers.
Tyler Suiters
So, Ryan, that brings up a good point when you're talking about the patient side of this equation, as technology has evolved so rapidly. Heidi and Joel, where do you think that people, patients are in terms of their willingness to engage, to try to be connected full time? In other words, are they wide open to this brand new technology that helps them monitor, that keeps them more connected with their physicians and healthcare providers? Is there still something of a hill to climb there or are we more broadly embracing it year by year?
Heidi Hinrichs
Well, certainly, in the cardiovascular space we have found patients, people embracing this. And, if you think about it, it makes sense, right? Because, as a society, we feel the need to be connected more and more these days. We are... Certainly, in the cardiovascular space, majority of our patient population is Medicare age, right? However, even if I look at my grandparents and my parents, they are also connected with smartphones. And so, as you think about our society aging, this is going to become more and more prevalent. And, certainly, today, with our Confirm Rx remote monitoring technology, this has been highly positive. Patients are using it because they feel like they're more empowered and have more control over their cardiovascular health and that they're using a tool that they use in their everyday life, in every aspect of their life. I mean, certainly, Joel's going to have a lot more experience with FreeStyle Libre.
Tyler Suiters
Yeah. Joel, is the sell to patients as simple as, "This is easier, this is better, this keeps you healthier?"
Joel Goldsmith
That's certainly part of it. Diabetes is largely a self-managed disease, so, people that are living with this condition day in and day out are forced to confront it whether they like it or not. And, I think the adoption of new technology, it has benefited from the halo effect that's been created by the popularity of consumer electronics like phones and watches and tablets that are now used by billions of people worldwide daily for lots of other reasons. So, the adoption of products like that are actually benefiting us because we're utilizing the user experience and the development platforms that those provide. In terms of the connection that it creates between patients and healthcare providers, that's part of it, but it's as much about personal empowerment as it is about facilitating the flow of information between people and their healthcare providers.
Joel Goldsmith
So, I think that it's both of those benefits. Certainly, the clinical community is benefiting from making those, what tend to be pretty short-lived in-office encounters, more productive. And, that's by simply automating the process of capturing data and then transforming that data in the actionable information, which allows the clinician to focus more on the interaction with the person that they're working with rather than simply spending time acquiring the data, converting the data into something useful, and then, when they have only a few minutes left, trying to translate that for use by that individual.
Tyler Suiters
Ryan, I want to be clear, this doesn't happen in a vacuum. This evolution isn't purely organic. So much goes into the R&D process. Given your role on the product development side, again, can you walk through the process over the last 10 years or just the process that's in place now as far as developing this technology that changes lives so profoundly?
Ryan Lakin
Yeah. Happy to. So, neuromodulation has been around for several decades at this point, but we're seeing a larger number of companies that are really coming into this space, and, obviously, that always drives innovation, competitiveness and, at the same time, awareness and interest in our space and other spaces within Abbott as well. And so, that really forces us to think about innovation and stretch the boundaries for how we do it. And so, the importance of research and development is paramount to Abbott to really make life-changing technology. And so, a few years ago, take an example, a few years ago, scientists... So, in our organization, we have neuroscientists doing a lot of amazing work on how the body works, and engineers restudied and developed a new method to really think about, how do we use less energy for our implantable devices? And so, less energy translates to less power requirements.
Ryan Lakin
And so, for our devices that are implanted, they have batteries to power them. And so, if we can be more efficient with power, we ultimately can allow those devices to last longer and people gain benefit for a longer period of time. And then, also, study new way forms, really, way form is how the stimulation or electrical pulses are delivered to the area of interest for us, and so, to really mimic the natural responses to things like pain. So, as a result of that, that work that we started a few years ago, we were able to develop, and, actually, we just launched recently, a couple months ago, what we're calling the Proclaim XR system, which is really a breakthrough solution for people living with chronic pain. And, it's really different than any other pain device on the market. And, for the 50 million people just in the United States who live with chronic pain, they're really looking for new options that provide them the relief they need.
Ryan Lakin
And so, the Abbott Proclaim XR system uses a very low energy, BurstDR stimulation, as I said, the stimulation are these electrical pulses that can be dosed without sacrificing the efficacy of pain relief, which is really amazing. And, additionally, people with these devices no longer need to recharge their device. And so, really, a lot of solutions on the market require people to be reminded that they have a chronic disease and charge their devices. And so, by being able to reduce power requirements and maintain efficacy, people can really seamlessly integrate these solutions into their life. Really, allowing them to live without this, as I said before, this constant reminder of chronic pain. And, we've really just started rolling out these devices, but they've really received positive feedback from physicians as well as the people that have been implanted. And, in some clinics, there's actually a waiting list for these solutions.
Tyler Suiters
All right. Ryan, I'm glad you bring up the Proclaim XR. That's a great gateway into some of Abbott's products that are really changing the game right now. And, if we could do a bit of a lightning round, and if I could send a product to each one of you by name and let you talk about the development of it and how it's really helping people in the marketplace right now. And, Ryan, let's stay with you and talk a bit about DBS.
Ryan Lakin
Yeah. So, for deep brain stimulation, so, DBS stands for deep brain stimulation. It's really used for people who are living with Parkinson's disease or also essential tremor. And so, we're looking at a lot of things from computer-brain interfaces in conjunction with artificial intelligence to really help people with Parkinson's disease and essential tremors and things like new lead technologies, different waveforms and different stimulation targets. So, where the stimulation is delivered really helps address some really key things that these people struggle with, which is tremors, rigidity, slowed movement, and a lot of walking problems. And so, the technologies help minimize the experiences that people have, specifically, Parkinson's disease, with our deep brain stimulation technology to help them live, move, and be much more of fit into the community and feel just fundamentally much better about themselves.
Tyler Suiters
Heidi, what about Confirm Rx?
Heidi Hinrichs
Yeah. So, Confirm Rx, which is our implantable cardiac monitor we were talking about earlier, uses Bluetooth communication. And, that allows the implantable cardiac monitor to send the data directly to a patient's app, which then can get sent to the physician's office. And, the benefit that we see with this in particular to the patient is that, from an outcomes perspective, a health outcomes perspective, their data along with their documented symptoms on the app is sent immediately to the physician. And what results in this is the patient doesn't have to be at home, they don't have to drive into the clinic or the office visit to have their device interrogated by the physician.
Heidi Hinrichs
So, they get a diagnosis sooner and a more accurate diagnosis because, again, they're taking their app, they're documenting the time that they felt those symptoms and they're putting in the symptoms that they felt and that's sent to the doctor's office versus a traditional world of simply saying, when the physician asks you, "Well, when did you feel that?" And you're trying to remember in your head the date or the time, or you're trying to maintain a diary of your health symptoms. So, that's how this technology truly does empower the patient and help the physician diagnose their deadly heart rhythms sooner.
Tyler Suiters
And, Joel, those same benefits seem to be paralleled by the device you mentioned earlier, the FreeStyle Libre, in terms of taking some of the patient error, and I use that term loosely, out of it because the data is captured, the data that physicians need to know, does that an oral transmission, the objective numbers and information is right there within the device?
Joel Goldsmith
Yeah. FreeStyle Libre has really disrupted the glucose monitoring category completely. It consists of a fully disposable glucose sensor that's worn on the back of the upper arm for up to 14 days, and it really solves for two primary problems. For anyone who has tested their blood glucose using test strips, it's cumbersome, it's painful, it's inconvenient, and because of that, many people don't test as frequently as they should. But, with a sensor, like the FreeStyle Libre sensor, to get information out of it, you simply hold a handheld device, we call it the Freestyle Libre reader or your phone running the FreeStyle Libre link mobile app next to the sensor, and in a fraction of a second, you get three pieces of information. You get your current glucose as of that moment in time, you get a trend arrow which indicates how your glucose is changing, and you get up to eight hours of glucose history so you know where you were, where you are and where you're going.
Joel Goldsmith
So, it's made it effortless to capture dense glucose data. And then, the second problem that it solved is, really, transforming that data into something that's actionable because, even people who tested frequently using test strips and endured the pain and inconvenience that it comes with, it only provided a discrete value that represented a moment in time. Lastly, more recently we've introduced a family of digital health tools that really expand the capabilities of the core FreeStyle Libre system to mobile medical apps and a cloud-based service which now allow users to take advantage of the device that they're carrying with them for dozens of other reasons every single day to get data out of their sensor. That data then gets instantly and automatically uploaded to a cloud-based service known as LibreView, which enables clinicians to access that data on demand in a format that allows them to make much faster and more informed treatment decision.
Tyler Suiters
Joel, you very casually and appropriately mentioned the device that is worn on the upper arm. It brings to mind the idea that wearable devices, which were foreign or seem foreign a decade ago, are now so casually referred to the next element, maybe, implantable devices, which was referenced earlier. Is there a crossover period where more than half the population is using a wearable or an implantable to monitor or improve our health and wellness?
Joel Goldsmith
Well, in my opinion, that's essentially already started considering how many people use smartphones, which, while it's not attached to your body, is something that people carry with them most of the time and access frequently throughout the day, and that's setting the new standard for devices that are really adjacent to that or work in combination with that device, like the FreeStyle Libre sensor. So, certainly within the world of people living with diabetes, sensor-based glucose monitoring, it's starting to become very mainstream and, in my opinion, will overtake conventional forms of glucose monitoring over the next five years or so.
Tyler Suiters
Ryan, do you agree with that assessment and that projection about where we're heading?
Ryan Lakin
Yeah. I do. I agree with Joel completely. I think people are continuing to always look at different options, especially when it comes to our area as well as in pain management and the more data and information people have at their fingertips, and people have their smartphones around, the more we can integrate those with implantable devices that have sensors or wearable sensors. I think we're going to continue to see people take control of their health and really improve the outcomes of their health and take control.
Tyler Suiters
Well, we've spent a lot of time looking backward a bit at the last 10 years or so regarding the evolution in digital health. What about the next 10 years or even the next 20 years? Question to the entire group. And, Heidi, why don't we start with you? Where is this field going and what do we need to bring the innovations that you envision and that Abbott and envisions to the marketplace where we are all able to experience them?
Heidi Hinrichs
Well, I do see apps as a connectivity tool between people and their healthcare provider and empowering the patient to better manage their own health. And, I think this will continue to evolve in new and exciting ways. I also see, if a person has multiple medical devices, which we often see in the cardiovascular space, patients actually, most of them do also have diabetes. And, as we think about this possibility of apps and technology and holistic care, I can see how we have connectivity between these products as well as activity sensors that we have in our devices as well as understanding heart-healthy nutrition and how all of this can be connected through apps and through smartphones.
Heidi Hinrichs
I also see, and this was mentioned earlier in the discussion, where people are no longer going to have to be traveling for their cardiovascular health and their active implantable devices such as pacemakers and defibrillators, they won't have to travel to the clinic or the hospital to have changes made to the programming of their cardiac device. I can see where we could eventually have remote programming available for those patients. And, I can see where artificial intelligence starts play a much larger role in bringing better outcomes to patients through data analytics and others where we can understand better how to program our products, how to design our products, and how our products can actually improve and save lives in the future.
Tyler Suiters
Joel, you mentioned a bit about your vision regarding wearables and implantables and the direction we're heading. Over the next five, 10 years, what else is within your field division?
Joel Goldsmith
Sure. I mean, the adoption of body-worn sensors will continue to expand, and like most consumer electronics, you'll see reduction in size, improvement in performance, wearability, all the things that come along with volume, scale, and maturity. So, we're looking forward to that. Certainly, the advancements that we're seeing in machine learning and artificial intelligence represents a lot of potential within healthcare. And, there's a lot of hype about that right now. In diabetes, I think there's great potential around it because it's a data-intensive disease state, and now we have these types of devices which make it really effortless to capture that data, to transport it to central repositories that then can be used to utilize that data to deliver much more personalized treatment recommendations first to the clinicians that prescribed the devices and help manage and treat the condition, but ultimately, maybe, to the person living with that disease directly.
Joel Goldsmith
What won't change and what's important for us is to make sure that everything we do is very much user-centered, and putting the person living with the condition at the center of everything we do, it's the hallmark of what led to FreeStyle Libre and why it's been embraced so quickly by the patient community. That's been a big... It's highlighted the importance of making it user-centered for us. And, that's a pattern now that we will continue
Tyler Suiters
Ryan, product development over the next five to 10 years.
Ryan Lakin
Yeah. So, if you're thinking about a person who's implanted with a device from Abbott and living with chronic pain, that device is collecting a vast amount of data across a number of different parameters and attributes, others really specific to that individual and their use of that therapy. And, at Abbott, because we're the company that today leverages consumer Bluetooth communication between the implanted device and the user programmer, this capability really is allowing us for seamless transfer of information with our technology. And, you can imagine how therapy can be more personalized in the future, leveraging this data in conjunction with other datasets, large population data, physician data, lifestyle and other attributes. Using this data, we can really leverage and set specific and more personalized therapies.
Ryan Lakin
And so, as we think about moving forward beyond that, and we're really looking at smaller, smarter, easier to use solutions that allow people to live what their expectations are without the thought that they have chronic pain, without the thought that they have an implanted device and so that they can really manage their, not just their physical symptoms, but their psychological symptoms. And then, in closing, I would say that there's the tech consumer technologies with purpose-built AI processors and other things, are really going to allow the handheld to be optimized so that that person can really enable the use of machine learning and artificial intelligence right there in the palm of their hand, which is really powerful as we think about helping people manage their chronic diseases in the future.
Tyler Suiters
Yeah. And, I think another factor to consider is the confluence of AI and the future of healthcare and digital health, and CES is such a key element of AI across the show floor and the conversations and everyone who is exhibiting there, but also where it touches upon and intersects with the digital health space. So, looking ahead to CES 2020, Joel, you're the CES veteran, at least the most experienced among the group. How do you describe this to your team back home who doesn't come and discuss what digital health is at the show and how prevalent it is there for at least four days?
Joel Goldsmith
Yeah. I mean, health and wellness as a category has had a growing presence at CES, especially over the past five years or so. When I first started going it was sort of hidden on the side in one of the smaller exhibit halls, and now the digital health summit is a very prominent part of the overall experience. And, we're starting to see the lines between regulated medical devices and health, wellness, lifestyle devices converge. And so, it's a fun experience. It's overwhelming, but it's definitely worth checking out.
Tyler Suiters
And, Heidi, this is your first show coming up, CES 2020. What are the veterans, Joel and Ryan as well, telling you to expect?
Heidi Hinrichs
Apparently, I said, "Where are my running shoes," when I go to the show so that I have the comfort getting around to all of the different...
Tyler Suiters
All of us are nodding along. Yes.
Heidi Hinrichs
No. But, I actually am excited to see the latest and greatest in the digital health space and how we can continue to innovate in the healthcare space to bring better outcomes to our patients and better workflow to our physicians.
Tyler Suiters
Heidi Hinrichs is with Abbott Cardiovascular. Joel Goldsmith is with Abbott Diabetes Care. And, Ryan Lakin is with Abbott Neuromodulation. All of you, thank you for the time and for taking the moments to have a conversation with us from various parts around the country. And, we look forward to seeing all three of you coming up and CES 2020 in Las Vegas.
Heidi Hinrichs
Thank you. My pleasure.
Joel Goldsmith
Thank you.
Ryan Lakin
Thank you.
Tyler Suiters
That does it for this edition of CES Tech Talk. As always, we want you to be CES Ready. So, do yourself a favor. Well, you're doing us a favor too, but, subscribe to the CES Tech Talk Podcast. That way you won't miss a single episode as you're gearing up for CES 2020. Speaking of the big show, you can go to CES.tech, our website, and get the information you need to make your plans for this coming show. It is January 7th through the 10th in Las Vegas. None of this podcast is even remotely possible without our true stars. Our executive producer, Tina Anthony, and our senior studio engineer, John Lindsey, y'all are the very best in the business. I'm Tyler Suiters. Let's talk tech again soon.
