Chaperonins are protein-folding machinery found in all cellular life. Chaperonin genes have been documented within a few viruses, yet, surprisingly, analysis of metagenome sequence data indicated that chaperonin-carrying viruses are common and geographically widespread in marine ecosystems. Also unexpected was the discovery of viral chaperonin sequences related to thermosome proteins of archaea, indicating the presence of virioplankton populations infecting marine archaeal hosts. Virioplankton large subunit chaperonin sequences (GroELs) were divergent from bacterial sequences, indicating that viruses have carried this gene over long evolutionary time. Analysis of viral metagenome contigs indicated that: the order of large and small subunit genes was linked to the phylogeny of GroEL; both lytic and temperate phages may carry group I chaperonin genes; and viruses carrying a GroEL gene likely have large double-stranded DNA (dsDNA) genomes (>70 kb). Given these connections, it is likely that chaperonins are critical to the biology and ecology of virioplankton populations that carry these genes. Moreover, these discoveries raise the intriguing possibility that viral chaperonins may more broadly alter the structure and function of viral and cellular proteins in infected host cells.
OBJECTIVES: The aim of the study was to understand how US payers obtain information, specifically using digital methods, for decision making in addition to face-to-face interaction with pharmaceutical companies. METHODS: An online survey was conducted in August/September 2017 in the US. Respondents needed to be voting members, advisors or pharmacists contributing to a pharmacy and therapeutic (P&T) committee in their organization. RESULTS: In total, 189 P&T committee members were surveyed; 62 in hospitals, 45 in integrated delivery networks (IDNs) without health plans, 26 in IDNs with health plans, 41 in managed care organizations, and 15 in pharmacy benefit management. The majority (85%) of payers surveyed agreed that digital resources are essential to the process of making formulary decisions. Search engines and websites for healthcare professionals (HCPs) informed payers' committee work more frequently than any other source, with 63% using HCP websites weekly to access professional information. In lieu of resource availability, online live webcasts with experts (64% of payers) and ondemand online presentations about prescription drugs (60%) have overtaken faceto-face conversations with pharmaceutical company representatives (59%) as a factor influencing formulary decisions. A total of 75% of payers stated that partnerships with pharmaceutical companies to develop patient support solutions may influence formulary placement if improvements in outcomes are demonstrated. In particular, payers were interested in working with pharmaceutical companies on patient-centered digital tools to reduce readmissions (74%), improve adherence (66%), address disease management (56%), improve care coordination (56%), perform patient self-tracking (50%), promote general health and wellness (50%), and enable remote monitoring (48%). CONCLUSIONS: This study shows that payers in the US rely heavily on digital sources for formulary decisions, and are open to partnering with pharmaceutical companies to develop digital patient support solutions to optimize outcomes. Further work in this area is planned among EU and other global payers.
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