Azafran Capital INSIGHTS — Vol. 16 by James F. Kenefick

YOUR EYE ON INNOVATIVE MACHINE LEARNING SOLVING REAL WORLD PROBLEMS

Azafran Capital Partners

INSIGHTS Voice and Acoustics Now Front and Center on the Healthcare Mainstage The power of the human vocal instrument enters a new dimension as healthcare accelerates innovation to meet the incredible demands of the COVID-19 crisis As the universal user interface, voice and acoustics have been used to great effect for arguably hundreds of thousands of years, patiently waiting in the wings for their next evolution. With the exponential advancements in natural language processing, machine learning, and augmented AI over recent years, coupled with the proliferation of devices and sensors in the ﬁeld, and now the COVID-19 crisis, the table is set for a sea change. Alongside basic communications and other expressions of the vocal instrument, there lies the acoustical information surrounding all our sounds and speech. The intelligence contained in these acoustic elements has laid dormant but now can be used in various innovative and augmented platforms, from customer care, to marketing, helping root out key indicators from mood to satisfaction. However, it is in the purview of healthcare where the game-changing developments come to the forefront - from screenings as an area of focus for early detection and diagnosis to the determination of patient care, we are just beginning to see the tip of the iceberg in terms of the potential of acoustics / sensory in healthcare.

SPECIAL REPORT SERIES Part One

issue seventeen FOCUS Azafran Capital Partners is a 2020 vintage early stage venture fund investing in deep transformational technology companies ($2M to $8M) that are using deep learning and machine learning, emphasizing voice, acoustics/sensory and imagery datasets in the health, wellness, and enterprise markets. Issue Seventeen focuses on how the Voice, Acoustics/Sensory modalities have become dominant in the healthcare industry. Already following a signiﬁcant arc pre-Covid-19, they have now become essential elements of the New Normal, especially in the healthcare sector and are core elements of the Azafran Investment Thesis. We are excited to feature in Issue Seventeen one of our partners as well, Business Finland, that has had a strong hand in elevating Finland to the forefront of Healthcare innovation in the world.

(Continued on Page Four) There are no barriers when it comes to how voice and AI can usher us through a human-centered healthcare renaissance. Who knows? Maybe we can even erase “healthcare” from the political podium as a result.

Business Finland: Rethinking Healthcare, Pushing Innovation Accelerating healthcare innovation by promoting the latest technologies via a leading research & development infrastructure At a high level, Business Finland is the Finnish government organization for innovation funding and trade, travel and investment promotion. Business Finland's 600 experts work in 40 offices globally, with 16 regional offices in Finland and is part of the Team Finland network. Azafran is excited to be working alongside Business Finland, which has prioritized the healthcare sector and has a goal to make Finland a pioneer in the personalized healthcare field. In practice, they facilitate Finnish companies developing and exporting deep tech health and wellbeing solutions/services to the global market. Azafran INSIGHTS © Azafran Capital Partners 2020 - All Rights Reserved

Our work connecting with the impassioned community at large focused on voice, AI, and tech in healthcare is further convincing us that the changes we’re experiencing are here to stay. And rest assured, the enterprising and pioneering minds focused on solving our modern healthcare problems will not cease in wowing us with their solutions.” - Dr. Matt Cybulsky, Understanding Voice Technology & Its Impact in Healthcare

(Continued on Page Three) Issue Seventeen - Page One

Voice and Acoustic Use Cases in Healthcare

Following are voice and acoustics/sensory use cases, some from companies that Azafran has discovered from events like the The Voice of Healthcare Summit, Azafran Research and other sources: Voice ●

Azafran Watchlist Company that serves as a Voice Assistant for electronic medical records with a focus on eliminating the need for extra “hands” to enter or recall patient health data during exams.

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Azafran Pipeline Company that processes voice recordings through algorithms that can detect a variety of voice-effected health conditions: including respiratory, cognitive, neurological, and cardiovascular condition, ﬂags unusual speech patterns to screen for diseases and track existing disorders.

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Hardin Memorial Health has implemented voice-activated communication in its emergency department enabling staff without a free hand to communicate and can stay in touch with their teams.

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Voice interfaces are also being applied to in-home care - one example is Libertana Home Health that is utilizing Orbita’s voice platform to make an Alexa skill that lets seniors check daily schedules, get reminders and conﬁrm they’re taking their medications.

market PREDICTIONS Voice-based apps for healthcare sector take up 47% of the voice recognition tech presented on the market It is highly likely that soon speech recognition will take over as the major channel of patient engagement service. Implementation of speech recognition technology in healthcare is more than promising as studies conﬁrm that, due to the beneﬁts of voice technologies, they can contribute to identifying Parkinson’s disease at an early stage, thus, better treatment: ‘...speech carries information relevant to an accurate and differential diagnosis of Parkinson’s...and speech features of interest can be automated and assessed, with diagnostic reliability’ Apart from clinical usage, it is apparent that healthcare can deliver more effective results in case it provides instant feedback and prompt communication.

Acoustics/Sensory ●

Azafran Watchlist Company that identiﬁes the presence of subjects’ disease and health conditions using speech and language technologies and machine learning algorithms. In the process, simplifying the diagnosis and assessment of conditions through speech rather than use of MRIs/CT scans.

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Azafran Watchlist Company that uses Natural Language Understanding to recognize contextual and emotional patterns in words and phrases within a conversation with the goal of detecting issues ahead of when they occur.

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Researchers are analyzing recordings of patient voices for diagnostic clues - one example is the Mayo Clinic studying voice biomarkers of coronary artery disease.

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DigiPsych Lab at University of Washington is discovering voice biomarker connections with 13 neuropsychiatric conditions like depression, Alzheimer’s and Parkinson’s. (Sources: Azafran Research, Fierce Healthcare)

Source: Code IT

Therefore, making hands-free access to health-related data a top priority may have a considerable impact on patient-doctor interaction efﬁciency. In a nutshell, voice activated assistants can help patients, managers and caregivers alike: ● ● ● ● ● ● ●

retrieve information from medical records instruct nurses on speciﬁc procedures pertaining to treatment provide information on schedule, waiting lists, available units in the hospital, etc. check on prescription detail conﬁrm appointments and follow-ups assist patients with upper limb problems in satisfying health-related needs remove extra load from doctors’ work by facilitating the admin routine. Source: Code IT

Issue Seventeen - Page Two

Business Finland: Rethinking Healthcare, Pushing Innovation (Continued from Page One) One of the megatrends of healthcare is that the treatment is transformed from mass-oriented care towards individual care. Identifying individual effects through, for example, genetic research enables the move from "one disease – one drug" thinking in the development of medicines into identifying the individual effects of treatment. Personalized medicine provides the opportunity to anticipate and prevent diseases as well as ﬁnd the right care at the right time to the right people. The Personalized Health Program supports Finnish innovation and top-level research and creates new business around personalized healthcare area, promotes growth and renews and creates new business life. The program also helps growth companies to raise venture capital and R&D funding, grows new know-how and attracts international venture capital, R&D and business units to Finland.

Living Labs for Global Cures: ●

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Proven global commercial innovation ecosystem powered by Europe’s largest AMC- critical mass of resources to solve big problems New approach to solving global healthcare problems using 100% of real world data, AI, and machine learning in a real-time clinical and R&D setting Fastest track for scalable digital health and wellbeing innovations yielding new therapies, products, solutions, and services based in mobile, digital, and genomics Develop and exploit health and social data creating world-class clinical solutions

A couple facets of the Business Finland Portfolio are the the Personalized Health and Clever Health Programs that focus on Finnish innovation and top-level research. The aim is to create a new business around individualized healthcare platforms. Following are two examples of Business Finland’s Clever Health Network Portfolio:

Focus

AI-application for treatment of Gestational diabetes

Objective

Develop an easy-to-use mobile application and service concept to treat gestational diabetes

Partners

HUS, Elisa, Fujitsu, Aalto University, University of Helsinki, Business Finland

Focus

AI-assisted solutions for early disease detection, automated diagnostics and treatment selection, and comprehensive home care.

Objective

Projects target the early identiﬁcation of rare diseases, personalised treatment of cancer, and optimization of home dialysis

Partners

HUS, Elisa, Fujitsu, Aalto University, University of Helsinki, Business Finland

in the HEADLINES The Future of Voice in Healthcare is Now In the past 20 years alone, we’ve had five waves of disruption in healthcare: the web, search engine, mobile, social media, and now voice and AI. What sets this most recent wave apart is the record-breaking adoption rate of voice-first tech: While the radio took 20 years to reach the majority of the American public and the color TV took about 12 years, the smart speaker took a mere five years, the highest adoption of technology in the history of the US. The development of voice technology brings profound world impact. Voice and AI represents 20 years worth of innovation and provides an exciting new technological pathway to transform healthcare.

Using voice technology in healthcare and voice AI, and AI health assistants—as well as healthcare solutions and innovations that will be created from these breakthrough technologies—the industry can solve a host of issues that strain the system. And the technology is here and expanding rapidly. What we’ve learned over the years of The Voice of Healthcare Summit—an annual conference held at Harvard Medical School exploring the emerging dynamic solutions provided through voice-first technology and artificial intelligence in healthcare—is that the prevailing voice-first platforms in healthcare might be lead by Alexa, Google Assistant, Pullstring, Apple, SoundHound, Samsung, and others. Think: A dedicated clinician available to an at-home patient via voice at all times. LifePod tools for in-home connection to patients as well as Suki AI are excellent examples of dedicated support for clinicians and care continuity. Voice technology in healthcare truly has the potential to instigate an industry-wide renaissance. -

An excerpt from Understanding Voice Technology & Its Impact in Healthcare, By Dr. Matt Cybulsky Issue Seventeen - Page Three

Detection of COVID-19 Via Voice and Acoustic Biomarkers Following is an excerpt from a recently published paper in the IEEE Open Journal of Engineering in Medicine and Biology (May 2020). While a bit deeper into the technical aspects than we typically travel in INSIGHTS editions, the paper shows the leading edge of thinking around the power and full spectrum of the acoustic instrument that humans now have at our disposal. The fact that we can go this deep, this soon into the COVID-19 crisis bodes well as a proof point towards the power of voice and acoustics in the future of healthcare, opening the door for non-invasive, real-time analysis of our condition and changes in those conditions by the minute, hour, day, in a doctor’s ofﬁce, hospital or at home. Welcome to the future, today - please visit this link for a full copy of the paper. The excerpt below has not been modiﬁed and is available via Creative Commons license - link here.

Figure 1

A Framework for Biomarkers of COVID-19 Based on Coordination of Speech-Production Subsystems Contributors: Thomas F. Quatieri , Fellow, IEEE, Tanya Talkar , Member, IEEE, and Jeffrey S. Palmer , Senior Member, IEEE COVID-19 is often characterized by specific dysfunction in respiratory physiology including the diaphragm and other parts of the lower respiratory tract, thereby affecting patterns of breathing during inhalation and exhalation of air from the lungs. In speech production, during the exhalation stage, air from the lungs moves through the other essential vocal subsystems, i.e., through the trachea and larynx and into the vocal tract pharyngeal, oral and nasal cavities (Fig. 1). The manner in which we breathe in speaking, including the rate and length of an exhalation (coupled to the number of words in a phrase or sentence), and its intensity and variability, highly influences the quality of our voice. For example, the loudness, aspiration (‘breathiness’), steadiness of fundamental frequency or ‘pitch’ during phonation, and the mechanism by which we alter speaking rate all effect vocal quality. Furthermore, the respiratory system is highly coordinated with these primarily laryngeal-based subsystems. Likewise, in turn, laryngeal activity is finely coupled to articulation in the oral and nasal cavities. Although impact on speech subsystems and their coordination are often perceptually obvious with a condition involving inflammation, these changes can be subtle in the asymptomatic stage of an illness, i.e., incubation and early prodromal periods, or in recovery. We have established a framework for discovery of vocal biomarkers of COVID-19 based on the coordination of subsystems of speech production involving respiration, phonation, and articulation. Our preliminary results, using a very limited data set, hint at support of the hypothesis that biomarkers derived from measures of vocal subsystem coordination provide an indicator, possibly in its asymptomatic stage, of COVID-19 impact on respiratory function. Given a sample size of five subjects and a growing list of COVID-19 symptoms, however, validation of our hypothesis will clearly require additional data and analysis to address potential confounders such as different recording environments and channels, unbalanced data quantities, and changes in underlying vocal status from pre-to-post time recordings. It will also be important to expand the suite of vocal features, introducing neurophysiological modeling of subsystem interactions, to address the increasing evidence of neurological insult arising from COVID-19 and feature specificity relative to typical flu and flu-like symptoms.

Issue Seventeen - Page Four

from the “ROAD” The Azafran team continues to be active in virtual conferences, pitch days and online events As we shift to attending and helping host virtual events, this dynamic continues to be a crucial element helping us to deliver on the Azafran investment thesis. Through this work, our team stays on top of the latest trends, companies and partner opportunities, especially away from the obvious venues in the world.

Rebuild Upstate | Venture Connect

One of the opening slides from Henry O'Connell, CEO of Canary Speech - whose solution pours through over 2,500 data points in speech and acoustics looking for info on stress, anxiety, cognitive, isolation, loneliness, and other determinants

The Azafran team also attended Rebuild Upstate 2019. The focus of the one-day event was the Outlook for Healthcare. Moderated by Alex Zapesochny, publisher of the Rochester Beacon, the conference featured UNY healthcare leaders describing how they have confronted the pandemic, and what we need to keep functioning through the anticipated second wave.

The Voice of Healthcare Summit After attending last year’s excellent Voice of Healthcare Summit at the Harvard Medical School, the Azafran team was excited to attend this year, albeit virtually, and the quality of participants and speakers was just as high as in previous years. The Voice of Healthcare Summit examines the growing intersection between modern healthcare and voice-ﬁrst technology. This year they brought together a powerful array of companies, educators and a strong audience at this timely juncture to examine how Voice is making all the difference in the Healthcare sector as we’ve discussed on the pages of this INSIGHTS edition. Participants included sessions on Reducing Risk Through Hidden Data In Our Speech given by Henry O'Connell, CEO of Canary Speech, the keynote was Aesthetic Dental: Voice Technology in Private Practice During and After COVID-19 by Dr. Chithra Durgam, Founder, Aesthetic Dental, as well as Dr. Phillip Alvelda, CEO of Brainworks.ai.

Brainworks.ai is focused on new biologically-motivated whole-brain architectures enabling real-time synthesis of sensory data in text, audio, image, and video formats with complex knowledge stores. Azafran INSIGHTS © Azafran Capital Partners 2020 - All Rights Reserved

MassChallenge Startup Showcase The MassChallenge Virtual Startup Showcase is a hallmark event for the 200+ startups participating in MassChallenge's US based early stage accelerators in Austin, Boston, Houston, and Rhode Island. The trade-show inspired experience was a two-day event that brought together business leaders, innovation enthusiasts, investors, and talent from all sides of the world to connect with game-changing startups.

Issue Seventeen - Page Five

Voice and Acoustics Take the Mainstage in Healthcare (Continued from Page One) Issue Seventeen is the first in a four-part series highlighting the core elements of Azafran’s voice, acoustics/sensory and imagery in the healthcare and enterprise markets. Just due to the sheer size and the incredible fit of these modalities in both streamlining and improving most aspects of healthcare, we have chosen to highlight this element in the first segment of the series. The healthcare industry is worth a staggering ~$2.5 trillion in just the U.S. today, with 90% of people looking for health information start with search engines. However, nearly 70% of providers use some sort of telehealth or telemedicine tool, and 71% of people prefer to search using a voice assistant (source: The Center for Digital Strategies). So it is no surprise that there is a steadily increasing amount of funding and investments being made into voice and acoustics as the new UI for healthcare. As highlighted on Page Two, the use cases are numerous and growing, from a myriad of patient onboarding and interface applications, to doctors going hands-free and focusing on the information or patient for a checkup, to applications that “listen” for breathing, changes in mood or intonation, and other biomarkers that lie within our voice instrument, buckle up as the coming decade will bring probably more changes in healthcare delivery than we’ve ever witnessed as a society. At Azafran, we are excited to be an enabling element of this movement, seeking and investing in companies that are shepherding in the next wave of healthcare innovation, creating a more efficient, Lower cost and higher quality system In the process.

in the news TRENDS Wellness Tech Is Finding Its Human Voice From wearable devices to operating systems, the ability to use, activate, and monitor these always-on devices is the “perfect storm” for vocally extracted wellness data. Look for wellness apps to pair emotion with additional health data, providing a unique look into the deep inner workings of our bodies and minds.

Over the past few decades there have been a large amount of breakthroughs in the market. Now, new platforms need to bring everything together in one centralized space via wearables. With new apps providing large scale data, this type of wellness tracking will also result in medical knowledge being able to advance at breakneck speeds. Yuval Mor, Beyond Verbal - Wired Magazine

RESEARCH

voice - acoustics imagery & AI/ML Company Tracker & Industry Snapshot At a Glance: Top 6 Markets & Global Totals

413 West 14th St. - Suite 200, New York, NY 10014 Tel: +1(212)913-0700 insights@azafranpartners.com AzafranCapitalPartners.com

Issue Seventeen - Page Six

Two Years of INSIGHTS

Below is a quick snapshot of some of the covers from Azafran’s INSIGHTS over 2019 and 2020 - please let us know if you would like PDFs of any issues - just email us at insights@azafranpartners.com and we’ll send along.