PrismRA identifies patients 6.6 times less likely to respond to TNFi therapy

Scipher Medicine, a precision immunology company that helps match patients with their most effective therapy, today announced successful results from the PrismRA clinical validation study. The publication titled "Clinical validation of a blood-based predictive test for stratification of response to tumor necrosis factor inhibitor therapies in rheumatoid arthritis patients" was published in Network and Systems Medicine.

The study, co-authored by scientists from Scipher Medicine and experts in the field of clinical rheumatology, met the endpoint of determining a molecular signature that accurately predicts rheumatoid arthritis (RA) patients who will fail to respond adequately to tumor necrosis factor inhibitor (TNFi) therapies. Empowered with this information, healthcare providers can prescribe alternative therapy from day one without first having to cycle through and fail multiple TNFi drugs.

PrismRA uses whole blood gene expression data to identify if a patients molecular disease biology is suited to TNFi therapy. PrismRA is expected to be introduced to rheumatology practices later this summer and has the potential to improve treatment decisions and reduce trial-and-error attempts with treatments that are unlikely to be effective based on a patients unique biology.

"About 90% of patients with rheumatoid arthritis are prescribed TNFi therapy after failing disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate. However, a majority of patients fail to achieve a clinically meaningful change," said Dr. Slava Akmaev, Chief Technology Officer of Scipher Medicine. "The need for precision medicine in RA and other complex diseases has never been more obvious, particularly now with provider access being severely limited due to heightened COVID-19 pandemic concerns. PrismRA has the ability to limit TNFi drug cycling and help patients manage their disease more effectively."

"In this study, TNFi therapies failed to help nearly 70% of the unstratified patient population reach an adequate response. The PrismRA disease signature test could have prevented many of these individuals from taking a drug that did not adequately ameliorate the signs and symptoms of their disease," said Jeffrey Curtis, M.D., M.S., MPH, Professor of Medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham. "RA is a complex disease with multiple biological factors implicated in disease progression and severity. A test such as PrismRA has the potential to be a powerful tool for treating patients with the right treatment at the right time."

PrismRA was validated using the Comparative Effectiveness Registry to Study Therapies for Arthritis and Inflammatory Conditions (CERTAIN) data set of 175 biologic-nave RA patients from the Consortium of Rheumatology Researchers of North America (CORRONA). PrismRA identified patients who were unlikely to have an adequate response to TNFi therapies with a positive predictive value (PPV) of 89.7% and specificity of 86.8%. Overall, a patient identified by PrismRA to be a non-responder is 6.6 times more likely to inadequately respond to a TNFi therapy compared to someone lacking that molecular signature.

About PrismRA

PrismRA, a molecular signature test, is a revolutionary advancement bringing precision medicine to the treatment of rheumatoid arthritis, which affects 1.3 million patients in the United States alone. From a routine blood draw, PrismRA analyzes an individual's molecular signature, helping identify who is unlikely to adequately respond to TNFi therapy, the worlds largest selling drug class. Providers now have objective data to guide therapeutic decision-making and give patients the best chance of achieving treatment targets and improving clinical outcomes. For more information, please visit http://www.PrismRA.com.

About Scipher Medicine

Scipher Medicine, a precision immunology company, holds the fundamental belief that patients deserve simple answers to treatment options based on scientifically backed data. Leveraging our proprietary Network Medicine platform and artificial intelligence, we commercialize blood tests revealing a patients unique molecular disease signature and match such signature to most effective therapy, ensuring optimal treatment from day one. The unprecedented amount of patient molecular data generated from our tests further drives development of novel and more effective therapeutics. We partner with payers, providers and pharma along the health care value chain to bring precision medicine to autoimmune diseases.

Scipher Medicine is backed by Khosla Ventures, Northpond Ventures and UnitedHealth Group. Visit http://www.sciphermedicine.com and follow Scipher on Twitter, Facebook and LinkedIn.

View source version on businesswire.com: https://www.businesswire.com/news/home/20200728005364/en/

Contacts

Media Contact: Cassidy McClainCassidy@canalecomm.com 619.849.6009

Company contact:Andrea Mooreandrea.moore@sciphermedicine.com 801-209-1175

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Scipher Medicine Announces Publication of Clinical Study Validating PrismRA, a Blood Test Predicting Non-Response to TNF Inhibitor Therapies in...

The American Journal of Obstetrics & Gynecology, edited at the Wayne State University School of Medicine and the Perinatology Research Branch, has received the highest Impact Factor of all journals within the discipline reporting original research.

Last month, Journal Citation Reports announced that the Impact Factor of AJOG is now 6.502, placing it first among journals publishing original research in obstetrics and gynecology.

The Impact Factor, the yearly average number of citations that articles published in the last two years in a given journal received, is provided annually by Journal Citation Reports. The measure is considered an index of prestige of a journal.

AJOG ranked top in Eigenfactor score, a sophisticated measure of journal impact, calculated by taking into account the impact factor of the citing journal and adjusting for self-citations. AJOG also had the highest number of citations among all journals in the discipline for 2019, with a total of 41,245.

AJOGs editor-in-chief for Obstetrics is Roberto Romero, M.D., D.Med.Sci., chief of the Perinatology Research Branch of the National Institute of Child Health and Human Development/National Institutes of Health, and professor of Molecular Obstetrics and Genetics at the Wayne State University School of Medicine. The editor-in-chief for Gynecology is Catherine Bradley, M.D., MSCE, professor of Obstetrics and Gynecology, Epidemiology, and Urology at the University of Iowa.

"With a distinguished past, AJOG is deeply committed to innovation and publishing the best groundbreaking research that improves the health care of women, Dr. Romero said.

Known as the Gray Journal, the American Journal of Obstetrics & Gynecology has been the premier academic journal in the discipline for more than 150 years. More than 41,000 obstetricians and gynecologists worldwide receive the print version.

Among the groundbreaking discoveries that have changed the practice of medicine and the lives of women and their families that have been published on its pages include:

The Pap smear for the detection of cervical cancer; The assay for the detection of early pregnancy (pregnancy test), used worldwide; Polycystic ovarian disease, which affects 5% to 10% percent of women of reproductive age; The first graphic display of the labor curve, which has led to partograms in every labor and delivery unit; and The importance of progesterone in pregnancy maintenance.

This year, AJOG has published:

A randomized clinical trial of cervical cerclage in twin gestations with a dilated cervix; Vaginal progesterone for the prevention of preterm birth in twin gestations; The use of a rapid point-of-care test to assess intra-amniotic inflammation in patients with ruptured membranes; and The outcome of COVID-19 in pregnant women.

The PRB of NICHD/NIH is housed at Wayne State University and the Detroit Medical Center, strategically located to serve a high-risk pregnant population. The Perinatology Research Branch has produced groundbreaking clinical and translational research, and cared for more than 25,000 mothers in Detroit.

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Biomedical journal edited at School of Medicine and Perinatology Research Branch receives top ranking - The South End

SALT LAKE CITY, July 29, 2020 (GLOBE NEWSWIRE) -- Myriad Genetics, Inc. (NASDAQ: MYGN), a leader in molecular diagnostics and precision medicine, announced today that the company has launched its proprietary AMPLIFY technology, which further increases the performance of its Prequelnoninvasive prenatal screening (NIPS) test. The proprietary AMPLIFY process increases the fetal fraction of a NIPS sample by preferentially sequencing the fetal cell-free DNA fragments that circulate in a mothers blood. AMPLIFY technology enables more accurate detection of fetal chromosome abnormalities. In the analytical validation involving samples from more than 1,000 pregnant women, fetal fraction is 2.3 times greater on average with AMPLIFY than with standard NIPS. This improvement reduces false positive and false negative resultsincluding for common aneuploidies, expanded aneuploidies, microdeletions and a babys sex. For instance, false negative performance in common aneuploidies improves 45x with AMPLIFY technology. Additionally, no samples powered by AMPLIFY technology had a fetal fraction below four percent. Other laboratories may fail samples with less than four percent fetal fraction.

Prequel already provided highly accurate results and this proprietary technology further increases the sensitivity of our test, said Nicole Lambert, president of Myriad International, Oncology and Womens Health. With AMPLIFY, Prequel maintains an industry-leading low rate of failed samplesdelivering results to 99.9 percent of patients. The important clinical benefits are that each woman who receives the test can expect highly accurate NIPS results, regardless of body mass index (BMI), race, or ethnicity.

Up to 50 percent of pregnant women present with high BMI to their healthcare provider. Studies have demonstrated that BMI is not evenly distributed across ethnicities, and up to 24 percent of women with high BMI will not receive a result on standard NIPS platforms due to low fetal fraction. Women who dont receive a result may do no further prenatal screening at all; they may go through subsequent rounds of NIPS, or they may undergo invasive procedures such as an amniocentesis or chorionic villus sampling, which can increase the risk of miscarriage and add unnecessary expense to the US healthcare system. Prequel with AMPLIFY technology overcomes the limitations of standard NIPS in order to provide equity of care to pregnant women.

About Prequel Prenatal ScreenThe Myriad Prequel Prenatal Screen is a non-invasive prenatal screen (NIPS) that uses cell-free DNA (cfDNA) to determine if a pregnancy is at an increased risk for chromosome abnormalities, such as Down syndrome. Compared to screening methods which use maternal age, ultrasound and serum screening, Prequel has been shown to be superior than by achieving a lower false-positive rate and false-negative rate than these other methods. Among other NIPS, Prequel has an industry leading test failure rate of 0.1 percent. The Prequel Prenatal Screen can be ordered with the Foresight Carrier Screen and offered to all women, including those with high body mass index, and ovum donor or a twin pregnancy.

About Myriad GeneticsMyriad Genetics Inc., is a leading personalized medicine company dedicated to being a trusted advisor transforming patient lives worldwide with pioneering molecular diagnostics. Myriad discovers and commercializes molecular diagnostic tests that: determine the risk of developing disease, accurately diagnose disease, assess the risk of disease progression, and guide treatment decisions across six major medical specialties where molecular diagnostics can significantly improve patient care and lower healthcare costs. Myriad is focused on three strategic imperatives: transitioning and expanding its hereditary cancer testing markets, diversifying its product portfolio through the introduction of new products and increasing the revenue contribution from international markets. For more information on how Myriad is making a difference, please visit the Company's website: http://www.myriad.com.

Myriad, the Myriad logo, BART, BRACAnalysis, Colaris, Colaris AP, myPath, myRisk, Myriad myRisk, myRisk Hereditary Cancer, myChoice, myPlan, BRACAnalysis CDx, Tumor BRACAnalysis CDx, myChoice CDx, Vectra, Prequel, Foresight, GeneSight, riskScore and Prolaris are trademarks or registered trademarks of Myriad Genetics, Inc. or its wholly owned subsidiaries in the United States and foreign countries. MYGN-F, MYGN-G.

Safe Harbor StatementThis press release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995, including statements related to launch of the Companys proprietary AMPLIFY technology; and the Companys strategic directives under the caption "About Myriad Genetics." These "forward-looking statements" are based on management's current expectations of future events and are subject to a number of risks and uncertainties that could cause actual results to differ materially and adversely from those set forth in or implied by forward-looking statements. These risks and uncertainties include, but are not limited to: uncertainties associated with COVID-19, including its possible effects on our operations and the demand for our products and services; our ability to efficiently and flexibly manage our business amid uncertainties related to COVID-19; the risk that sales and profit margins of our molecular diagnostic tests and pharmaceutical and clinical services may decline; risks related to our ability to transition from our existing product portfolio to our new tests, including unexpected costs and delays; risks related to decisions or changes in governmental or private insurers reimbursement levels for our tests or our ability to obtain reimbursement for our new tests at comparable levels to our existing tests; risks related to increased competition and the development of new competing tests and services; the risk that we may be unable to develop or achieve commercial success for additional molecular diagnostic tests and pharmaceutical and clinical services in a timely manner, or at all; the risk that we may not successfully develop new markets for our molecular diagnostic tests and pharmaceutical and clinical services, including our ability to successfully generate revenue outside the United States; the risk that licenses to the technology underlying our molecular diagnostic tests and pharmaceutical and clinical services and any future tests and services are terminated or cannot be maintained on satisfactory terms; risks related to delays or other problems with operating our laboratory testing facilities and our healthcare clinic; risks related to public concern over genetic testing in general or our tests in particular; risks related to regulatory requirements or enforcement in the United States and foreign countries and changes in the structure of the healthcare system or healthcare payment systems; risks related to our ability to obtain new corporate collaborations or licenses and acquire new technologies or businesses on satisfactory terms, if at all; risks related to our ability to successfully integrate and derive benefits from any technologies or businesses that we license or acquire; risks related to our projections about our business, results of operations and financial condition; risks related to the potential market opportunity for our products and services; the risk that we or our licensors may be unable to protect or that third parties will infringe the proprietary technologies underlying our tests; the risk of patent-infringement claims or challenges to the validity of our patents or other intellectual property; risks related to changes in intellectual property laws covering our molecular diagnostic tests and pharmaceutical and clinical services and patents or enforcement in the United States and foreign countries, such as the Supreme Court decisions in Mayo Collab. Servs. v. Prometheus Labs., Inc., 566 U.S. 66 (2012), Assn for Molecular Pathology v. Myriad Genetics, Inc., 569 U.S. 576 (2013), and Alice Corp. v. CLS Bank Intl, 573 U.S. 208 (2014); risks of new, changing and competitive technologies and regulations in the United States and internationally; the risk that we may be unable to comply with financial operating covenants under our credit or lending agreements; the risk that we will be unable to pay, when due, amounts due under our credit or lending agreements; and other factors discussed under the heading "Risk Factors" contained in Item 1A of our most recent Annual Report on Form 10-K for the fiscal year ended June 30, 2019, which has been filed with the Securities and Exchange Commission, as well as any updates to those risk factors filed from time to time in our Quarterly Reports on Form 10-Q or Current Reports on Form 8-K. All information in this press release is as of the date of the release, and Myriad undertakes no duty to update this information unless required by law.

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Myriad Launches Proprietary AMPLIFY Technology, Further Increasing the Performance of its Prequel NIPS Test - GlobeNewswire

SALT LAKE CITY, July 28, 2020 (GLOBE NEWSWIRE) -- Myriad Genetics, Inc. (NASDAQ: MYGN), a leader in molecular diagnostics and precision medicine, announced today that the company has launched a new enhancement that is now available on its Vectra test report. The new test report provides an individualized estimate of a patients one-year risk of rapid radiographic progression (RP). The RP result in every report is personalized based on the patients age, gender and adiposity.

We previously presented data demonstrating that Vectra is the best single predictor of joint damage. Inclusion of information on RP risk in the Vectra test report now gives clear insight into both the patients current rheumatoid arthritis (RA) inflammation and the future risk of joint damage, said Mark S. Verratti, president of Myriad Neuroscience and Myriad Autoimmune. With this new product enhancement, Vectra as a prognostic tool can help further guide medical management decisions for patients with RA.In a combined analysis of patients from three studies, 42 percent of patients thought to be in low or moderate disease activity assessed by a traditional disease activity measure were in high disease activity as measured by Vectra, and thus were at risk of irreversible joint damage within one year. Each patient will receive an individualized percentage risk prediction for radiographic progression within one year (see Example 1 below), helping physicians and patients make treatment decisions.

To view Example 1: The Vectra Score correlates to the risk of radiographic progression, please visit the following link: https://www.globenewswire.com/NewsRoom/AttachmentNg/1ed33a2f-4c29-4cbb-8b86-c12f819b9910

RA is an inflammatory autoimmune disease that attacks a patients joints and often affects other organ systems. RA is a contributing condition that leads to increased disability, significant morbidity, increased mortality and financial burden. Lost productivity associated with RA is substantial, with approximately 20-70 percent of individuals working at the time of their RA diagnosis were disabled after seven to 10 years. RA affects roughly more than one million people in the United States. The Vectra Score measures the concentrations of 12 serum biomarkers and an algorithm is applied to these biomarker concentrations to calculate a disease activity score on a scale of 1 to 100. Vectra Disease Activity Levels are as follows: Green = Low: 1 to 29, Orange = Moderate: 30 to 44, Red = High: 45 to 100. The risk of RP is shown as a function of Vectra Score. The definition of RP is a 1-year total Sharp score change of >5 units. Increased risk of RP means a greater chance of irreversible joint damage.

Three out of four rheumatologists have used Vectra and have ordered more than one million tests for their RA patients. The American College of Rheumatology (ACR) includes Multi-Biomarker Disease Activity Score (Vectra) as a disease activity measure that meets minimum standards for regular use for patients with rheumatoid arthritis. Those recommendations were published in the journal Arthritis Care & Research.

About VectraVectra is a multi-biomarker molecular blood test that provides an objective and personalized measure of inflammatory disease activity in patients with rheumatoid arthritis. Vectra demonstrates unsurpassed ability to predict radiographic progression and can help guide medical management decisions to improve patient outcomes. Vectra testing is performed at a state-of-the-art CLIA (Clinical Laboratory Improvement Amendments) facility. Test results are reported to the physician five to seven days from shipping of the specimen. Physicians can receive test results by fax or the private provider web portal, VectraView. For more information on Vectra, please visit: http://www.VectraScore.com.

About Myriad GeneticsMyriad Genetics Inc., is a leading personalized medicine company dedicated to being a trusted advisor transforming patient lives worldwide with pioneering molecular diagnostics. Myriad discovers and commercializes molecular diagnostic tests that: determine the risk of developing disease, accurately diagnose disease, assess the risk of disease progression, and guide treatment decisions across six major medical specialties where molecular diagnostics can significantly improve patient care and lower healthcare costs. Myriad is focused on three strategic imperatives: transitioning and expanding its hereditary cancer testing markets, diversifying its product portfolio through the introduction of new products and increasing the revenue contribution from international markets. For more information on how Myriad is making a difference, please visit the Company's website: http://www.myriad.com.

Myriad, the Myriad logo, BART, BRACAnalysis, Colaris, Colaris AP, myPath, myRisk, Myriad myRisk, myRisk Hereditary Cancer, myChoice, myPlan, BRACAnalysis CDx, Tumor BRACAnalysis CDx, myChoice CDx, Vectra, Prequel, Foresight, GeneSight, riskScore and Prolaris are trademarks or registered trademarks of Myriad Genetics, Inc. or its wholly owned subsidiaries in the United States and foreign countries. MYGN-F, MYGN-G.

Safe Harbor StatementThis press release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995, including statements related to launch of Radiographic Progression estimates on Vectra test reports; and the Companys strategic directives under the caption "About Myriad Genetics." These "forward-looking statements" are based on management's current expectations of future events and are subject to a number of risks and uncertainties that could cause actual results to differ materially and adversely from those set forth in or implied by forward-looking statements. These risks and uncertainties include, but are not limited to: uncertainties associated with COVID-19, including its possible effects on our operations and the demand for our products and services; our ability to efficiently and flexibly manage our business amid uncertainties related to COVID-19; the risk that sales and profit margins of our molecular diagnostic tests and pharmaceutical and clinical services may decline; risks related to our ability to transition from our existing product portfolio to our new tests, including unexpected costs and delays; risks related to decisions or changes in governmental or private insurers reimbursement levels for our tests or our ability to obtain reimbursement for our new tests at comparable levels to our existing tests; risks related to increased competition and the development of new competing tests and services; the risk that we may be unable to develop or achieve commercial success for additional molecular diagnostic tests and pharmaceutical and clinical services in a timely manner, or at all; the risk that we may not successfully develop new markets for our molecular diagnostic tests and pharmaceutical and clinical services, including our ability to successfully generate revenue outside the United States; the risk that licenses to the technology underlying our molecular diagnostic tests and pharmaceutical and clinical services and any future tests and services are terminated or cannot be maintained on satisfactory terms; risks related to delays or other problems with operating our laboratory testing facilities and our healthcare clinic; risks related to public concern over genetic testing in general or our tests in particular; risks related to regulatory requirements or enforcement in the United States and foreign countries and changes in the structure of the healthcare system or healthcare payment systems; risks related to our ability to obtain new corporate collaborations or licenses and acquire new technologies or businesses on satisfactory terms, if at all; risks related to our ability to successfully integrate and derive benefits from any technologies or businesses that we license or acquire; risks related to our projections about our business, results of operations and financial condition; risks related to the potential market opportunity for our products and services; the risk that we or our licensors may be unable to protect or that third parties will infringe the proprietary technologies underlying our tests; the risk of patent-infringement claims or challenges to the validity of our patents or other intellectual property; risks related to changes in intellectual property laws covering our molecular diagnostic tests and pharmaceutical and clinical services and patents or enforcement in the United States and foreign countries, such as the Supreme Court decisions in Mayo Collab. Servs. v. Prometheus Labs., Inc., 566 U.S. 66 (2012), Assn for Molecular Pathology v. Myriad Genetics, Inc., 569 U.S. 576 (2013), and Alice Corp. v. CLS Bank Intl, 573 U.S. 208 (2014); risks of new, changing and competitive technologies and regulations in the United States and internationally; the risk that we may be unable to comply with financial operating covenants under our credit or lending agreements; the risk that we will be unable to pay, when due, amounts due under our credit or lending agreements; and other factors discussed under the heading "Risk Factors" contained in Item 1A of our most recent Annual Report on Form 10-K for the fiscal year ended June 30, 2019, which has been filed with the Securities and Exchange Commission, as well as any updates to those risk factors filed from time to time in our Quarterly Reports on Form 10-Q or Current Reports on Form 8-K. All information in this press release is as of the date of the release, and Myriad undertakes no duty to update this information unless required by law.

Example 1: The Vectra Score correlates to the risk of radiographic progression

Example 1: The Vectra Score correlates to the risk of radiographic progression

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Myriad Announces the Launch of a New Radiographic Progression Prognostic Tool, Adding to Clinical Value of Vectra - BioSpace

Victor J. Thannickal, MD, will join School of Medicines John W. Deming Department of Medicine in January 2021.

Victor J. Thannickal, MD, has been named The Harry B. Greenberg Chair in Tulane University School of Medicines John W. Deming Department of Medicine. He joins the university in January 2021.

Thannickal is a professor of medicine and pathology at the University of Alabama at Birmingham (UAB); the Ben Vaughan Branscomb Chair of Medicine in Respiratory Disease; director of the Division of Pulmonary, Allergy, and Critical Care; and vice chair for research, Department of Medicine.

The Department of Medicine is one of the largest clinical departments within the Tulane School of Medicine, with an expansive research program that extends from the basic sciences of physiology and disease to the application of knowledge in clinical and community settings.

Thannickals research focuses on cellular and molecular mechanisms of lung repair and regeneration. Discoveries from this work have led to the identification of a number of drug targets for the treatment of fibrotic lung disease. He has multiple active grants from the National Institutes of Health, including a translational Program Project grant from the National Heart, Lung and Blood Institute.

I am pleased to join an outstanding group of clinicians, educators and scientists within the Deming Department of Medicine at Tulane University, Thannickal said. Tulane has a legendary history of major contributions to science and medicine. I look forward to building on this legacy by establishing leading research and training programs at both the graduate and post-graduate levels. We aspire to make scientific discoveries that address global pandemics and health inequalities, while contributing to the creation of healthier populations worldwide.

A graduate of Oral Roberts University School of Medicine in Tulsa, Oklahoma, Thannickal served a fellowship at Tufts University School of Medicine. Later, he held faculty positions at Tufts, University of Michigan and UAB, where he currently directs the Division of Pulmonary, Allergy, and Critical Care Medicine. Under his leadership, the division has grown to over 75 faculty members and expanded its research and educational programs, including the institution of a highly successful NIH T32 Training Program in Lung Biology and Translational Medicine. Research funding for the division has grown to over $25 million per year under his tenure, making it one of the top-funded divisions in the country. Thannickal has a passion for mentoring and team-building; trainees from his laboratory have moved on to independent careers at multiple academic medical centers across the United States.

We are fortunate to have attracted a leader and innovator of Dr. Thannickals caliber to head the Deming Department of Medicine, said Lee Hamm, MD, senior vice president and dean of the School of Medicine. His collaborative and forward-thinking vision will have an impact not only on our largest department, but across the entirety of Tulane University and the global community we serve.

Thannickal is an elected member of the Association of American Physicians and the American Clinical and Climatological Association. He is the recipient of the American Thoracic Society Recognition Award for Scientific Accomplishments. He currently serves on the editorial boards of the Journal of Clinical Investigation (Consulting Editor), as well those of the American Journal of Respiratory and Critical Care Medicine and the American Journal of Pathology; and is an associate editor of the American Journal of Respiratory Cell and Molecular Biology.

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Dr. Victor J. Thannickal named to lead Deming Department of Medicine - News from Tulane