RESUMEN
INTRODUCTION: Preference signaling (program signals and geographic preference divisions) was introduced as a component of the supplemental application for internal medicine applicants applying to programs within the United States (USA) during the 2021-22 cycle. These signals were intended to address application inflation by allowing applicants to express interest in and increase their likelihood of receiving interviews from their top programs. There is little published data, however, to describe the impact of preference signaling on the likelihood of receiving interviews from a program. This study thus sought to analyze, in a small subset of US applicants, whether preference signals were associated with a higher likelihood of obtaining a residency interview. METHODS: A survey was distributed in March 2023 to US MD seniors from the four allopathic medical schools in North Carolina who applied to categorical internal medicine residency programs during the 2022-23 application cycle. The survey was developed by the research team to provide respondents with the opportunity to report data from the electronic residency application service (ERAS) application and provide data on interviews received, actions taken throughout the application season, and outcomes of the National Residency Match Program (NRMP) using a combination of free response and multiple choice questions. RESULTS: Forty-seven out of a total of 85 contacted (55%) applicants completed some or all of the survey. Of those who completed the entirety of the survey, 39 (82.98%) completed the supplemental portion of the application and the available preference signaling. Applicants in this study were 2.95 (Odds ratio, 95% confidence interval [CI] 2.20 - 3.97, p<0.01) times as likely to receive an interview invitation from a program if they used a program signal. Applicants were 1.75 (odds ratio, 95% CI 1.38 - 2.21, p<0.01) times as likely to receive an interview invitation from a program in an indicated geographic preference division. Forty-seven percent (95% CI 31 - 64%) matched to a program they had sent a program signal to, and 97% (95% CI 78 - 100%) matched to a program in an indicated geographic preference division. CONCLUSIONS: The program signals and geographic preference division components of the supplemental application increased the likelihood of receiving an interview invitation but did not have a clear impact on match outcomes. Further research with larger sample sizes will be necessary to determine how these signals actually modify the outcomes of the NRMP.
RESUMEN
Sphingolipids are required for diverse biological functions and are degraded by specific catabolic enzymes. However, the mechanisms that regulate sphingolipid catabolism are not known. Here we characterize a transcriptional axis that regulates sphingolipid breakdown to control resistance against bacterial infection. From an RNAi screen for transcriptional regulators of pathogen resistance in the nematode C. elegans, we identified the nuclear hormone receptor nhr-66, a ligand-gated transcription factor homologous to human hepatocyte nuclear factor 4. Tandem chromatin immunoprecipitation-sequencing and RNA sequencing experiments revealed that NHR-66 is a transcriptional repressor, which directly targets sphingolipid catabolism genes. Transcriptional de-repression of two sphingolipid catabolic enzymes in nhr-66 loss-of-function mutants drives the breakdown of sphingolipids, which enhances host susceptibility to infection with the bacterial pathogen Pseudomonas aeruginosa. These data define transcriptional control of sphingolipid catabolism in the regulation of cellular sphingolipids, a process that is necessary for pathogen resistance.