biotechnology research article 2020

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Extraction and analysis of high-quality chloroplast DNA with reduced nuclear DNA for medicinal plants

Obtaining high-quality chloroplast genome sequences requires chloroplast DNA (cpDNA) samples that meet the sequencing requirements. The quality of extracted cpDNA directly impacts the efficiency and accuracy o...

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Transcriptomic and targeted metabolomic analyses provide insights into the flavonoids biosynthesis in the flowers of Lonicera macranthoides

Flavonoids are one of the bioactive ingredients of Lonicera macranthoides ( L. macranthoides ), however, their biosynthesis in the flower is still unclear. In this study, combined transcriptomic and targeted metabo...

Effects of solid lipid nanocarrier containing methyl urolithin A by coating folate-bound chitosan and evaluation of its anti-cancer activity

Nanotechnology-based drug delivery systems have received much attention over the past decade. In the present study, we synthesized Methyl Urolithin A-loaded solid lipid nanoparticles decorated with the folic a...

Neq2X7: a multi-purpose and open-source fusion DNA polymerase for advanced DNA engineering and diagnostics PCR

Thermostable DNA polymerases, such as Taq isolated from the thermophilic bacterium Thermus aquaticus , enable one-pot exponential DNA amplification known as polymerase chain reaction (PCR). However, properties oth...

A solution for highly efficient electroporation of primary cytotoxic T lymphocytes

Cytotoxic T lymphocytes (CTLs) are central players in the adaptive immune response. Their functional characterization and clinical research depend on efficient and reliable transfection. Although various metho...

Adsorption of Hg 2+ /Cr 6+ by metal-binding proteins heterologously expressed in Escherichia coli

Removal of heavy metals from water and soil is a pressing challenge in environmental engineering, and biosorption by microorganisms is considered as one of the most cost-effective methods. In this study, the m...

Derivation of a novel antimicrobial peptide from the Red Sea Brine Pools modified to enhance its anticancer activity against U2OS cells

Cancer associated drug resistance is a major cause for cancer aggravation, particularly as conventional therapies have presented limited efficiency, low specificity, resulting in long term deleterious side eff...

Polyphyllin B inhibited STAT3/NCOA4 pathway and restored gut microbiota to ameliorate lung tissue injury in cigarette smoke-induced mice

Smoking was a major risk factor for chronic obstructive pulmonary disease (COPD). This study plan to explore the mechanism of Polyphyllin B in lung injury induced by cigarette smoke (CSE) in COPD.

Quantifying carboxymethyl lysine and carboxyethyl lysine in human plasma: clinical insights into aging research using liquid chromatography-tandem mass spectrometry

The objective of this study was to establish a methodology for determining carboxymethyl lysine (CML) and carboxyethyl lysine (CEL) concentrations in human plasma using liquid chromatography-tandem mass spectr...

Iron/Copper/Phosphate nanocomposite as antimicrobial, antisnail, and wheat growth-promoting agent

One of the current challenges is to secure wheat crop production to meet the increasing global food demand and to face the increase in its purchasing power. Therefore, the current study aimed to exploit a new ...

Staphopain mediated virulence and antibiotic resistance alteration in co-infection of Staphylococcus aureus and Pseudomonas aeruginosa : an animal model

Polymicrobial communities lead to worsen the wound infections, due to mixed biofilms, increased antibiotic resistance, and altered virulence production. Promising approaches, including enzymes, may overcome th...

Strain-specific features of Pleurotus ostreatus growth in vitro and some of its biological activities

The production of Pleurotus ostreatus mycelium as a promising object for use in food and other industries is hampered by a lack of information about the strain-specificity of this fungus mycelium growth and its a...

Antibacterial, antibiofilm, and anticancer activity of silver-nanoparticles synthesized from the cell-filtrate of Streptomyces enissocaesilis

Silver nanoparticles (Ag-NPs) have a unique mode of action as antibacterial agents in addition to their anticancer and antioxidant properties. In this study, microbial nanotechnology is employed to synthesize ...

Deep orange gene editing triggers temperature-sensitive lethal phenotypes in Ceratitis capitata

The Mediterranean fruit fly, Ceratitis capitata , is a significant agricultural pest managed through area-wide integrated pest management (AW-IPM) including a sterile insect technique (SIT) component. Male-only re...

Characterization, modeling, and anticancer activity of L.arginase production from marine Bacillus licheniformis OF2

L-arginase, is a powerful anticancer that hydrolyzes L-arginine to L-ornithine and urea. This enzyme is widely distributed and expressed in organisms like plants, fungi, however very scarce from bacteria. Our ...

Green and environmentally friendly synthesis of silver nanoparticles with antibacterial properties from some medicinal plants

Recently there have been a variety of methods to synthesize silver nanoparticles, among which the biosynthesis method is more noticeable due to features like being eco-friendly, simple, and cost-efficient. The...

Reaping the benefits of liquid handlers for high-throughput gene expression profiling in a marine model invertebrate

Modern high-throughput technologies enable the processing of a large number of samples simultaneously, while also providing rapid and accurate procedures. In recent years, automated liquid handling workstation...

Induction of antimicrobial, antioxidant metabolites production by co-cultivation of two red-sea-sponge-associated Aspergillus sp. CO2 and Bacillus sp. COBZ21

The growing spread of infectious diseases has become a potential global health threat to human beings. According to WHO reports, in this study, we investigated the impact of co-cultivating the isolated endophy...

A novel starch-active lytic polysaccharide monooxygenase discovered with bioinformatics screening and its application in textile desizing

Lytic polysaccharide monooxygenases (LPMOs) catalyzing the oxidative cleavage of different types of polysaccharides have potential to be used in various industries. However, AA13 family LPMOs which specificall...

Tuning spacer length improves the functionality of the nanobody-based VEGFR2 CAR T cell

The chimeric antigen receptor-expressing T (CAR-T) cells for cancer immunotherapy have obtained considerable clinical importance. CAR T cells need an optimized intracellular signaling domain to get appropriate...

Fabrication and characterization of metformin-loaded PLGA/Collagen nanofibers for modulation of macrophage polarization for tissue engineering and regenerative medicine

In tissue engineering (TE) and regenerative medicine, the accessibility of engineered scaffolds that modulate inflammatory states is extremely necessary. The aim of the current work was to assess the efficacy ...

Production of a potential multistrain probiotic in co-culture conditions using agro-industrial by-products-based medium for fish nutrition

Probiotics are viable microorganisms that when administered in adequate amounts confer health benefits to the host. In fish, probiotic administration has improved growth, and immunological parameters. For this...

Research on the targeted improvement of the yield of a new VB 12 -producing strain, Ensifer adhaerens S305, based on genomic and transcriptomic analysis

Vitamin B 12 (VB 12 ) has a wide range of applications and high economic value. In this study, a new strain with high VB 12 production potential, Ensifer adhaerens S305, was identified in sewage. Because E. adhaerens

Validation and calibration of a novel GEM biosensor for specific detection of Cd 2+ , Zn 2+ , and Pb 2+

In this study, we designed a novel genetic circuit sensitive to Cd 2+ , Zn 2+ and Pb 2+ by mimicking the CadA/CadR operon system mediated heavy metal homeostasis mechanism of Pseudomonas aeruginosa . The regular DNA m...

Exploring the microbial diversity and characterization of cellulase and hemicellulase genes in goat rumen: a metagenomic approach

Goat rumen microbial communities are perceived as one of the most potential biochemical reservoirs of multi-functional enzymes, which are applicable to enhance wide array of bioprocesses such as the hydrolysis...

The transcriptional factor Clr-5 is involved in cellulose degradation through regulation of amino acid metabolism in Neurospora crassa

Filamentous fungi are efficient degraders of plant biomass and the primary producers of commercial cellulolytic enzymes. While the transcriptional regulation mechanisms of cellulases have been continuously exp...

An online soft sensor method for biochemical reaction process based on JS-ISSA-XGBoost

A method combining offline techniques and the just-in-time learning strategy (JITL) is proposed, because the biochemical reaction process often encounters changing features and parameters over time.

Preparation, purification, and biochemical of fat-degrading bacterial enzymes from pig carcass compost and its application

A lot of kitchen waste oil is produced every day worldwide, leading to serious environmental pollution. As one of the environmental protection methods, microorganisms are widely used treating of various wastes...

Coupling fermentation of glutamic acid and γ-polyglutamic acid and preparation of poly(amino acid) superabsorbent polymers

γ-polyglutamic acid (γ-PGA) is a biomarker that can be directly obtained by microbial fermentation. Poly(amino acid) superabsorbent polymers (SAPs) were prepared with purified γ-PGA as raw material and ethylen...

Serodiagnosis of human brucellosis by an indirect ELISA test using recombinant outer membrane protein 19 kDa (rOMP19) as an antigen

Brucellosis remains one of the global health concerns that reemerges in recent years. Delayed or inaccurate diagnosis end to a long treatment duration and financial burden; therefore, finding a good antigen fo...

A magnetic solid phase chemiluminescent immunoassay for quantification of Cystatin C in human serum

A chemiluminescent immunoassay for human serum Cystatin C (Cys C) was established using a direct-antibody sandwich model. The immunoassay kit uses magnetic separation technology, using magnetic particles as th...

Target identification of small molecules: an overview of the current applications in drug discovery

Target identification is an essential part of the drug discovery and development process, and its efficacy plays a crucial role in the success of any given therapy. Although protein target identification resea...

Engineered FGF19 ΔKLB protects against intrahepatic cholestatic liver injury in ANIT-induced and Mdr2-/- mice model

The major safety concern of the clinical application of wild type FGF19 (FGF19 WT ) emerges given that its extended treatment causes hepatocellular carcinoma. Therefore, we previously generated a safer FGF19 varian...

Use of immunoinformatics and the simulation approach to identify Helicobacter pylori epitopes to design a multi-epitope subunit vaccine for B- and T-cells

Helicobacter pylori  cause a variety of gastric malignancies, gastric ulcers, and cause erosive diseases. The extreme nature of the bacterium and the implantation of this bacterium protects it against designing a ...

Antifungal screening of selenium nanoparticles biosynthesized by microcystin-producing Desmonostoc alborizicum

Metal nanoparticles exhibit excellent antifungal abilities and are seen as a good substitute for controlling different kinds of fungi. Of all known taxa, cyanobacteria have received significant consideration a...

Expanding the genetic toolbox for Cutaneotrichosporon oleaginosus employing newly identified promoters and a novel antibiotic resistance marker

Cutaneotrichosporon oleaginosus is an oleaginous yeast that can produce up to 80% lipid per dry weight. Its high capacity for the biosynthesis of single cell oil makes it highly interesting for the production of ...

Effect of poly (lactic-co-glycolic acid) polymer nanoparticles loaded with vancomycin against Staphylococcus aureus biofilm

Staphylococcus aureus is a unique challenge for the healthcare system because it can form biofilms, is resistant to the host's immune system, and is resistant to numerous antimicrobial therapies. The aim of this ...

A novel allogeneic acellular matrix scaffold for porcine cartilage regeneration

Cartilage defects are common sports injuries without significant treatment. Articular cartilage with inferior regenerative potential resulted in the poor formation of hyaline cartilage in defects. Acellular ma...

Development of short hairpin RNA expression vectors targeting the internal ribosomal entry site of the classical swine fever virus genomic RNA

Classical swine fever (CSF) is a fatal contagious disease affecting pigs caused by classical swine fever virus (CSFV). The disease can be transmitted by pigs and wild boars, and it is difficult to prevent and ...

Solubility of lamotrigine in age-specific biorelevant media that simulated the fasted- and fed-conditions of the gastric and intestinal environments in pediatrics and adults: implications for traditional, re-formulated, modified, and new oral formulations

Lamotrigine is an effective antiseizure medication that can be used in the management of focal and generalized epilepsies in pediatric patients. This study was conducted to quantify and compare the solubility ...

Comparison of the effects of nitrogen-, sulfur- and combined nitrogen- and sulfur-deprivations on cell growth, lipid bodies and gene expressions in Chlamydomonas reinhardtii cc5373-sta6

Biofuel research that aims to optimize growth conditions in microalgae is critically important. Chlamydomonas reinhardtii is a green microalga that offers advantages for biofuel production research. This study co...

Development of an itaconic acid production process with Ustilaginaceae on alternative feedstocks

Currently, Aspergillus terreus is used for the industrial production of itaconic acid. Although, alternative feedstock use in fermentations is crucial for cost-efficient and sustainable itaconic acid production, ...

Whole-cell catalyze L-dopa to dopamine via co-expression of transport protein AroP in Escherichia coli

Dopamine is high-value compound of pharmaceutical interest, but its industrial scale production mostly focuses on chemical synthesis, possessing environment pollution. Bio-manufacturing has caused much attenti...

An effective device to enable consistent scratches for in vitro scratch assays

The in-vitro scratch assay is a useful method in wound healing research to assess cell migration. In this assay, a scratch is created in a confluent cell layer by mechanically removing cells through manual scr...

Highly multiplexed targeted sequencing strategy for infectious disease surveillance

Global efforts to characterize diseases of poverty are hampered by lack of affordable and comprehensive detection platforms, resulting in suboptimal allocation of health care resources and inefficient disease ...

Determination of serum CA724 levels using fluorescence immunochromatography

Carbohydrate antigen 724 (CA724) is a sensitive and specific indicator for multiple malignant tumors. The aim of this study was to establish a Eu-time resolved fluorescence immunochromatography (Eu-TRFICO) met...

Efficient delivery of a large-size Cas9-EGFP vector in porcine fetal fibroblasts using a Lonza 4D-Nucleofector system

Porcine fetal fibroblasts (PFFs) are important donor cells for generating genetically modified pigs, but the transfection efficiencies of PFFs are often unsatisfactory especially when large-size vectors are to...

A nano-Liposomal formulation potentiates antioxidant, anti-inflammatory, and fibrinolytic activities of  Allolobophora caliginosa  coelomic fluid: formulation and characterization

Coelomic fluid, a pharmacologically active compound in earthworms, exhibits a range of biological activities, including antioxidant, anti-inflammatory, and anticancer. However, the biological activities exerte...

Prediction and optimization of indirect shoot regeneration of Passiflora caerulea using machine learning and optimization algorithms

Optimization of indirect shoot regeneration protocols is one of the key prerequisites for the development of Agrobacterium -mediated genetic transformation and/or genome editing in Passiflora caerulea . Comprehensi...

The impact of applying various de novo assembly and correction tools on the identification of genome characterization, drug resistance, and virulence factors of clinical isolates using ONT sequencing

Oxford Nanopore sequencing technology (ONT) is currently widely used due to its affordability, simplicity, and reliability. Despite the advantage ONT has over next-generation sequencing in detecting resistance...

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• Avicenna J Med Biotechnol
• v.13(3); Jul-Sep 2021

Medical Biotechnology in the Service of Coronavirus Vaccine Discovery and Production

Coronavirus pandemic.

Coronavirus 2019 (COVID-19) is a highly contagious infectious disease with a broad spectrum of symptoms caused by a novel virus, now named SARS-CoV-2, from the coronavirus family 1 . Its outbreak, above all, has cast a shadow over the health and economic spheres of communities 1 , 2 . From the earliest days of disease reporting, hypotheses emerged for prevention, legislation, vaccine, and treatment as solutions. In the case of vaccines, in particular, decision-makers and researchers in all fields, including medical biotechnology, began studying and trying to develop vaccines from the very beginning of the outbreak, even before the epidemic was reported in their country. Although the outbreak was reported about a year and a half ago, and since then prevention methods have been taught to the people, legislation has been more or less enacted in countries, and relatively effective treatments have been proposed, people in some countries are experiencing the deadliest days due to COVID-19 3 . Therefore, the highest hopes were for the production of vaccines as the most effective solution, which falls within the field of medical biotechnology 4 , 5 .

Medical biotechnology

Modern biotechnology provides breakthrough products and technologies by utilizing biological systems and living organisms or parts of them. In medical biotechnology, pharmaceutical and medical products are produced using biotechnological tools to prevent, diagnose, and treat diseases. Antibiotics, genetic testing, genome mapping, and artificial tissue growth are among the most well-known products in this field 6 . However, among medical biotechnology products, vaccines have been the focus of attention during the pandemic 4 , 7 . The genome-based approach achieved theoretically acceptable candidates for the vaccine by genomic analysis and investigating virulence factors 8 .

Vaccines are biological preparations that are produced using the science and tools of the medical biotechnology field. Both organisms-living or dead-and parts of them are used to produce vaccines in medical biotechnology 5 , 6 . Although they have long been an effective and safe way to prevent infectious diseases (prevention), they are now being investigated for anti-cancer therapeutic purposes (treatment) 9 . There is a long-established scientific process to validate the use of biotechnology-produced products 10 , but following a routine process would continue the coronavirus invasion in the current emergency.

Vaccines licensure during the pandemic

Licensure of a vaccine routinely occurs after obtaining the result of long-term efficacy at an effective dose in the target population from phase I to III trials. After the licensure and the introduction of the vaccine on the market, investigations continue like other medical and pharmaceutical products (post-licensure vaccine safety surveillance) 11 . In addition, there is a mechanism called Emergency Use Authorization (EUA) that facilitates the availability and use of vaccines-as well as other medical products and procedures-in this pandemic-as well as in other emergencies - but this does not mean that vaccines are not rigorously and carefully tested. In fact, in this mechanism, all three phases of clinical trials that are conducted in the routine process of evaluating medical biotechnology products are performed, but for example, to receive it from The United States Food and Drug Administration (FDA), at least 3,000 people must participate in phase III and be followed for a median two months completion of an investigational Covid-19 vaccine regimen 12 .

Concluding remark

As previously noted, medical biotechnology has so far achieved many promising avenues; one of the highlights is vaccine production for overcoming the pandemic. However, it is still early to judge whether vaccines are the foremost solution to overcoming the pandemic, and there is even a notable report of a new outbreak in a vaccinated country 13 . Of course, the effectiveness and safety of coronavirus vaccines must be measured over time. In addition, the importance of basic sciences has been received attention in this pandemic 14 , 15 .

Conflict of Interest

The authors have no conflict of interest.

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April 15, 2024

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Millions of gamers advance biomedical research by helping to reconstruct microbial evolutionary histories

by Katherine Gombay, McGill University

Leveraging gamers and video game technology can dramatically boost scientific research, according to a new study published today in Nature Biotechnology .

4.5 million gamers around the world have advanced medical science by helping to reconstruct microbial evolutionary histories using a minigame included inside the critically and commercially successful video game Borderlands 3. Their playing has led to a significantly refined estimate of the relationships of microbes in the human gut.

The results of this collaboration will both substantially advance our knowledge of the microbiome and improve on the AI programs that will be used to carry out this work in the future.

Tracing the evolutionary relationships of bacteria

By playing Borderlands Science, a mini-game within the looter-shooter video game Borderlands 3, these players have helped trace the evolutionary relationships of more than a million different kinds of bacteria that live in the human gut, some of which play a crucial role in our health.

This information represents an exponential increase in what we have discovered about the microbiome up till now. By aligning rows of tiles that represent the genetic building blocks of different microbes, humans have been able to take on tasks that even the best existing computer algorithms have been unable to solve yet.

The project was led by McGill University researchers, developed in collaboration with Gearbox Entertainment Company, an award-winning interactive entertainment company, and Massively Multiplayer Online Science (MMOS), a Swiss IT company connecting scientists to video games), and supported by the expertise and genomic material from the Microsetta Initiative led by Rob Knight from the Departments of Pediatrics, Bioengineering, and Computer Science & Engineering at the University of California San Diego.

Humans improve on existing algorithms and lay the groundwork for the future

Not only have the gamers improved on the results produced by the existing programs used to analyze DNA sequences, but they are also helping lay the groundwork for improved AI programs that can be used in the future.

"We didn't know whether the players of a popular game like Borderlands 3 would be interested or whether the results would be good enough to improve on what was already known about microbial evolution . But we've been amazed by the results," says Jérôme Waldispühl, an associate professor in McGill's School of Computer Science and senior author on the paper published today.

"In half a day, the Borderlands Science players collected five times more data about microbial DNA sequences than our earlier game, Phylo, had collected over a 10-year period."

The idea for integrating DNA analysis into a commercial video game with mass market appeal came from Attila Szantner, an adjunct professor at McGill's School of Computer Science and CEO and co-founder of MMOs.

"As almost half of the world population is playing with video games, it is of utmost importance that we find new creative ways to extract value from all this time and brainpower that we spend gaming," says Szantner. "Borderlands Science shows how far we can get by teaming up with the game industry and its communities to tackle the big challenges of our times."

"Gearbox's developers were eager to engage millions of Borderlands players globally with our creation of an appealing in-game experience to demonstrate how clever minds playing Borderlands are capable of producing tangible, useful, and valuable scientific data at a level not approachable with non-interactive technology and mediums," said Randy Pitchford, founder and CEO of Gearbox Entertainment Company.

"I'm proud that Borderlands Science has become one of the largest and most accomplished citizen science projects of all time, forecasting the opportunity for similar projects in future video games and pushing the boundaries of the positive effect that video games can make on the world."

Relating microbes to disease and lifestyle

The tens of trillions of microbes that colonize our bodies play a crucial role in maintaining human health. However, microbial communities can change over time in response to factors such as diet, medications, and lifestyle habits.

Because of the sheer number of microbes involved, scientists are still only in the early days of being able to identify which microorganisms are affected by or can affect which conditions.

This is why the researchers' project and the results from the gamers are so important.

"We expect to be able to use this information to relate specific kinds of microbes to what we eat, to how we age, and to the many diseases ranging from inflammatory bowel disease to Alzheimer's that we now know microbes to be involved in," adds Knight, who also directs the Center for Microbiome Innovation at the UC San Diego.

"Because evolution is a great guide to function, having a better tree relating our microbes to one another gives us a more precise view of what they are doing within and around us."

Building communities to advance knowledge

"Here we have 4.5 million people who contributed to science. In a sense, this result is theirs too, and they should feel proud about it," says Waldispühl. "It shows that we can fight the fear or misconceptions that members of the public may have about science and start building communities who work collectively to advance knowledge."

"Borderlands Science created an incredible opportunity to engage with citizen scientists on a novel and important problem, using data generated by a separate massive citizen science project," adds Daniel McDonald, the Scientific Director of the Microsetta Initiative. "These results demonstrate the remarkable value of open access data and the scale of what is possible with inclusive practices in scientific endeavors."

Journal information: Nature Biotechnology

Provided by McGill University

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This paper is in the following e-collection/theme issue:

Published on 22.4.2024 in Vol 26 (2024)

ChatGPT’s Performance in Cardiac Arrest and Bradycardia Simulations Using the American Heart Association's Advanced Cardiovascular Life Support Guidelines: Exploratory Study

Authors of this article:

Original Paper

• Cecilia Pham 1 , BS, EMT   ; 
• Romi Govender 1 , BSN   ; 
• Salik Tehami 1 , BS   ; 
• Summer Chavez 1, 2, 3 , DO, MPH, MPM   ; 
• Omolola E Adepoju 1, 2, 3 , MPH, PhD   ; 
• Winston Liaw 1, 2, 3 , MD, MPH  

1 Tilman J Fertitta Family College of Medicine, University of Houston, Houston, TX, United States

2 Humana Integrated Health Sciences Institute, University of Houston, Houston, TX, United States

3 Department of Health Systems and Population Health Sciences, Tilman J Fertitta Family College of Medicine, Houston, TX, United States

Corresponding Author:

Cecilia Pham, BS, EMT

Tilman J Fertitta Family College of Medicine

University of Houston

5055 Medical Circle

Houston, TX, 77204

United States

Phone: 1 713 743 7047

Email: [email protected]

Background: ChatGPT is the most advanced large language model to date, with prior iterations having passed medical licensing examinations, providing clinical decision support, and improved diagnostics. Although limited, past studies of ChatGPT’s performance found that artificial intelligence could pass the American Heart Association’s advanced cardiovascular life support (ACLS) examinations with modifications. ChatGPT’s accuracy has not been studied in more complex clinical scenarios. As heart disease and cardiac arrest remain leading causes of morbidity and mortality in the United States, finding technologies that help increase adherence to ACLS algorithms, which improves survival outcomes, is critical.

Objective: This study aims to examine the accuracy of ChatGPT in following ACLS guidelines for bradycardia and cardiac arrest.

Methods: We evaluated the accuracy of ChatGPT’s responses to 2 simulations based on the 2020 American Heart Association ACLS guidelines with 3 primary outcomes of interest: the mean individual step accuracy, the accuracy score per simulation attempt, and the accuracy score for each algorithm. For each simulation step, ChatGPT was scored for correctness (1 point) or incorrectness (0 points). Each simulation was conducted 20 times.

Results: ChatGPT’s median accuracy for each step was 85% (IQR 40%-100%) for cardiac arrest and 30% (IQR 13%-81%) for bradycardia. ChatGPT’s median accuracy over 20 simulation attempts for cardiac arrest was 69% (IQR 67%-74%) and for bradycardia was 42% (IQR 33%-50%). We found that ChatGPT’s outputs varied despite consistent input, the same actions were persistently missed, repetitive overemphasis hindered guidance, and erroneous medication information was presented.

Conclusions: This study highlights the need for consistent and reliable guidance to prevent potential medical errors and optimize the application of ChatGPT to enhance its reliability and effectiveness in clinical practice.

Introduction

In March 2023, OpenAI, an artificial intelligence (AI) research laboratory, released GPT-4, an experimental version of ChatGPT, a large language model chatbot [ 1 ]. Compared with prior models including its predecessor GPT-3.5, GPT-4 has higher accuracy, greater reasoning capabilities, superior confidence, and more safety features with company data demonstrating improved performance on the Uniform Bar Exam and Biology Olympiad [ 2 , 3 ]. Compared with other types of learning models, deep learning models use multiple processing layers and artificial neural networks to process large amounts of data in order for the AI to learn [ 4 ]. In health care, ChatGPT shows promising applications including passing the United States Medical Licensing Examination, individualized health advice, improved diagnostic care, faster pharmacologic discovery, task automation, and clinical decision support [ 5 - 10 ]. However, limited evidence exists regarding ChatGPT’s ability to perform in advanced clinical scenarios, including cardiac emergencies.

Currently, the standard of care follows algorithms from the 2020 American Heart Association (AHA) advanced cardiovascular life support (ACLS) guidelines. Learners enrolled in the AHA course take a multiple-choice cognitive examination followed by a series of scenario-based patient cases and skills demonstrations [ 11 ]. Although an early study by Fijačko et al [ 12 ] concluded ChatGPT was unable to pass the AHA’s basic life support and advanced cardiovascular life support (ACLS) examinations, they demonstrated ChatGPT was able to provide relevant and accurate explanations for scenario-based questions without learning from an AHA course. With modification, Zhu et al [ 13 ] determined ChatGPT was able to pass the AHA’s examinations after changing the research protocol in which 3 responses were generated for each question instead of 1, and assessments were turned into open-ended questions. While rudimentary tests find ChatGPT can quickly give well-tailored answers to questions and scenarios regarding cardiopulmonary resuscitation (CPR) based on published guidelines, this has not been rigorously applied to more complex clinical scenarios requiring higher levels of expertise and training [ 8 ].

Even with advances in modern health care, heart disease has remained the leading cause of death for several decades [ 14 ]. Approximately 436,000 Americans die from cardiac arrest each year, making it a significant public health issue [ 15 ]. Past efforts at reducing cardiac arrests include establishing cardiac arrest registries, increasing public awareness and educational efforts, improving the quality of resuscitation care, strengthening emergency medical services, quality improvement programs, and implementing accreditation standards [ 16 ]. ACLS protocols have been well-proven to improve cardiac arrest outcomes, with deviations from the guidelines associated with poorer survival and neurologic outcomes [ 17 - 22 ]. Thus, identifying technologies that can improve adherence to ACLS protocols and in turn, cardiac arrest outcomes, is critical. Cognitive aids, such as pocket cards, mobile apps, and augmented reality glasses, have been shown to increase adherence to ACLS guidelines and the quality of resuscitation in adult simulations for in-hospital cardiac arrests [ 23 - 28 ]. ChatGPT could prove to be a valuable resource by providing real-time decision support in resource-limited settings or augmenting clinical decision-making. Our study aims to analyze the accuracy of ChatGPT’s performance in following the AHA’s ACLS algorithms in 2 cardiac event simulations—cardiac arrest and bradycardia.

We evaluated the accuracy of ChatGPT’s responses to 2 simulations based on the 2020 AHA ACLS guidelines with 3 primary outcomes of interest as follows: the mean individual step accuracy, the accuracy score per simulation attempt, and the accuracy score for each algorithm.

Ethical Considerations

In accordance with 45 CFR 46, Subpart A, also known as the Common Rule, our research project involving educational tests, such as ACLS simulations, falls under the exemption outlined in 46.104(d)(1). This exemption applies because the interactions in our study are limited to educational tests and do not involve identifiable human subjects. Because of this, no ethics board review was required for this research.

Initial Observations of ChatGPT’s Responses and Adherence to AHA Guidelines

The research team underwent an initial testing phase involving several procedures to observe ChatGPT’s responses before developing the scripts used for testing. Initially, two types of trials were proposed: (1) assessing ChatGPT’s ability to accurately identify rhythm strips, and (2) evaluating ChatGPT’s capability to execute the algorithm provided by the AHA. However, from January to May 2023, ChatGPT lacked the ability to recognize images, including rhythm strips or electrocardiograms (ECGs). Due to this limitation, specific ECG rhythms were provided to ChatGPT without the need for correct identification. The team then tested ChatGPT’s ability to execute basic algorithms, including those for bradycardia, tachycardia with a pulse, and cardiac arrest, based on the 2020 AHA Guidelines. At the beginning of the trials, it was confirmed by ChatGPT that it would refer to the 2020 AHA Guidelines for information. During these initial trials, testers observed significant differences between the responses generated by GPT-3.5 and GPT-4. GPT-4 demonstrated greater adherence to the 2020 AHA Guidelines by being able to interpret the algorithmic pathways more accurately. Additionally, testers noted that prompting ChatGPT led to lengthy outputs, unlike the step-by-step approach used in real-life simulations. To emulate real-life testing conditions in ACLS training, the command “What is the next step? Give me one step at a time” was included. This method also mimics how ChatGPT could be used in the real world. As GPT-4 closely followed the 2020 AHA Guidelines and was able to respond to the step-by-step command, it was selected for the actual simulations.

Development of Scripts for User Input and ChatGPT Output

Following the completion of the initial trials, the study authors with prior ACLS training (SC, WL, and CP) developed scripts based on the testers’ observations, the AHA’s algorithms, and clinical experience. SC and WL are both physicians in emergency medicine and family medicine, respectively, while CP holds an EMT license with paramedic-level training. The 2 scripts exclusively focused on testing 2 categories of cardiac arrhythmias: bradycardia and cardiac arrest ( Multimedia Appendices 1 and 2 ). To validate the scripts, 3 physicians with ACLS and emergency medicine backgrounds assessed them to ensure they accurately depict real-world clinical scenarios and management practices. The study authors developed a scoring guide to measure the accuracy of the responses of ChatGPT to prespecified prompts. The number of attempts given to ChatGPT was matched to the required correct outputs for each group. For instance, if 5 correct outputs were expected, ChatGPT was prompted 5 times, allowing it the same number of opportunities to provide accurate responses. In instances where ChatGPT’s outputs diverged from the predefined script, the authors responded by typing “Give me one step at a time” or “Give me another option.”

Data Collection

Testing was conducted between May to August 2023 using the public web user chat interface by OpenAI, with upgraded accounts to use GPT-4. All inputs and outputs for 1 simulation are saved within a single conversation thread, and each simulation was conducted in a separate thread. Three testers underwent training to adhere to the scripts, ensuring standardized procedures for the simulations. Each scenario was tested 20 times to evaluate the variability of ChatGPT’s responses and its ability to provide correct outputs. For each simulation step, ChatGPT was scored for correctness (1 point) or incorrectness (0 points), and these scores were recorded in an Excel (Microsoft Corp) spreadsheet. Partially correct responses were considered incorrect. Within each scoring section, qualitative comments regarding the incorrect responses were also recorded. Additionally, instances where the prompt “Give me one step at a time” requiring repeated inputs were recorded. The full transcripts for each simulation were collated into separate document files for each simulation attempt. The authors of the scripts independently reviewed the recorded accuracy scores in the spreadsheets and the transcripts saved in the document files to ensure the validity of the results and to maintain accurate record-keeping.

Data Analysis

Using the data recorded in the Excel spreadsheets, accuracy scores for individual steps, individual simulation attempts, and overall simulation attempts for each algorithm were calculated. The overall score per simulation attempt was calculated by summing the correct responses and dividing them by the number of steps (12 for bradycardia and 39 for cardiac arrest). For each step in the simulation, we similarly summed the correct responses and divided them by the number of simulations (n=20). Mean overall simulation accuracies were determined by averaging 20 simulation scores. The median accuracies for each algorithm were also calculated. Qualitative comments recorded for each simulation were also analyzed to identify recurring themes to describe ChatGPT’s performance.

The individual step accuracy per simulation attempt for the cardiac arrest and bradycardia algorithms are reported in Tables 1 and 2 , respectively. ChatGPT’s median accuracy for each step was 85% (IQR 40%-100%) for cardiac arrest and 30% (IQR 13%-81%) for bradycardia. The accuracy scores per simulation attempt for each algorithm are described in Table 3 . ChatGPT’s median accuracy for over 20 simulation attempts for cardiac arrest was 69% (IQR 67%-74%) and for bradycardia was 42% (IQR 33%-50%). Four key findings were identified after analyzing the results from the 2 sets of simulations: (1) ChatGPT’s outputs varied despite consistent input, (2) the same actions were persistently missed, (3) repetitive overemphasis hindered guidance, and (4) erroneous medication information was presented.

a Median accuracy is 85% (IQR 40%-100%); mean accuracy is 69%.

b CPR: cardiopulmonary resuscitation.

a Median accuracy is 30% (IQR 13%-81.3%); mean accuracy is 42%.

b ECG: electrocardiogram.

a Median accuracy of cardiac arrest is 69% (IQR 67%-74%).

b Median accuracy of bradycardia is 42% (IQR 33%-50%).

ChatGPT’s Outputs Varied

ChatGPT gave varying responses to identical inputs, sometimes providing unexpected responses. ChatGPT generated multistep instructions, prompting the request “give me one step at a time.” It would sometimes provide entirely different steps that were not in its original multistep output. There were, on average, 0.5 instances per simulation of repetitive loops of “check heart rhythm” and “resume CPR.” Even when “one step at a time” was requested, ChatGPT was unable to consistently execute algorithms step by step, often generating multistep instructions. ChatGPT was instructed to give “one step at a time” 3.6 times per simulation in the cardiac arrest case and 1.5 times per simulation in the bradycardia case. Other unexpected outputs include 0.5 instances per simulation of oxygen and medication delivery instructions preceding necessary steps such as applying a monitor to the patient or starting an intravenous (IV) line. ChatGPT provided additional instructions that were not part of the ACLS algorithms, including 0.3 instances per simulation of “start an isoproterenol infusion.”

Some Actions Were Persistently Missed

Throughout the simulations, there were several notable omissions to ChatGPT’s output. ChatGPT frequently skipped the instruction to establish IV or intraosseous (IO) access, before directing IV or IO medication administration at 0% accuracy in cardiac arrest and 35% (n=7) accuracy in bradycardia. ChatGPT also struggled to incorporate additional dosages of medications in its responses. For epinephrine administration, ChatGPT was accurate 95% (n=19) of the time regarding the first dose, but its accuracy decreased to 75% (n=15) and 70% (n=14) for the second and third doses, respectively. In the bradycardia simulations, ChatGPT consistently recommended a second dose of atropine at 95% (n=19) accuracy but rarely advised a third dose at 15% (n=3) accuracy. Furthermore, ChatGPT was never prompted to obtain a 12-lead ECG with 0% accuracy. ChatGPT did not provide any instructions for checking vital signs and only suggested pulse checks for the patient with bradycardia, omitting other vital signs such as blood pressure and oxygen saturation.

Repetitive Overemphasis Hindered Guidance

ChatGPT consistently overemphasized specific steps to the detriment of other important interventions. During the cardiac arrest simulations, ChatGPT became fixed in repetitive cycles when given the prompt, “CPR resumed. It’s been two minutes. What is the next immediate step?” ChatGPT would then incessantly advise to “check the heart rhythm” and “resume CPR” on average 4 times per simulation without providing any other instructions such as considering advanced airway management at 65% (n=13) accuracy and exploring reversible causes with 25% (n=5) accuracy. Similarly, in the bradycardia simulation, ChatGPT emphasized transcutaneous and transvenous pacing methods on average 1.8 times per simulation, disregarding other reasonable alternatives for bradycardia management, such as pharmacologic interventions.

Erroneous Medication Information Was Presented

Two medication instructions given in the bradycardia simulations were consistently inaccurate. In all bradycardia simulations, ChatGPT advised administering 0.5 mg of atropine instead of the recommended 1 mg dose in the most recent 2020 AHA ACLS guidelines (0% accuracy). Despite being corrected and acknowledging the accurate dosage as 1 mg, ChatGPT persisted in administering the incorrect dose of atropine in subsequent outputs. In 95% (n=19) of bradycardia simulations, ChatGPT provided incorrect guidance to administer 2-20 µg/kg/minute of dopamine, deviating from the correct range of 5-20 µg/kg/minute. However, in all cardiac arrest simulations, all medication dosages were correctly identified by ChatGPT.

Principal Findings

This study sought to examine the accuracy of ChatGPT’s performance in adult cardiac event simulations for cardiac arrest and bradycardia. Although the overall accuracy of ChatGPT was lower than the standard passing threshold in academics of 70%, the demonstrated accuracy of ChatGPT was comparable to one other study of complex cardiac clinical vignettes which had 50% accuracy (50/100). Compared with experts, ChatGPT gave inaccurate or incomplete responses [ 29 ]. Even with these caveats, this proof-of-concept study illustrates the potential and perils of using ChatGPT for real-time decision support in clinical settings.

Our study adds to the small but growing body of literature analyzing the potential clinical role of ChatGPT and other AI technologies, with a special focus on cardiac emergencies and complex decision-making. While this field may be in its infancy, ChatGPT builds upon prior generations of more low-tech cognitive aids such as apps or paper cards by offering faster responses, tailored answers, and the ability to work through far more complicated scenarios. In several steps of the simulations, ChatGPT’s accuracy was as high as 100% (n=20), an impressive benchmark.

In practice settings with limited resources, ChatGPT, AI, and related technologies may still help fill a crucial gap by acting as a more advanced cognitive aid compared with previously studied solutions. They can also be used in medical education, quality initiatives, and simulation training exercises. However, the findings from this study highlight several key issues that need to be addressed before implementing this decision aid in patient care.

In our study, ChatGPT exhibited a wide range of clinical accuracy, which can be due in part to outdated or unreliable training data. If AI is used to augment clinical decision-making, physicians must ensure the appropriateness and validity of the training data. Without this level of accountability, health care professionals could accept hallucinations, or AI responses that are incorrect or misleading. While subject matter experts may detect these mistakes, those with less training and experience may fail to recognize these inconsistencies, which can lead to missing steps or delivering inaccurate medication doses. Additionally, if the training data contains inaccuracies or reflects certain biases, ChatGPT may replicate those errors or biases in its responses. It is also unclear how frequently ChatGPT updates or how it decides to include new or controversial scientific findings in its model. This is especially salient in cardiac emergencies, where quick and accurate decision-making is crucial for patient survival.

Our findings suggest that ChatGPT has difficulty learning from past scenarios. For example, ChatGPT would acknowledge the correct dosage if it initially gave an incorrect one, but persistently administered the same incorrect doses across subsequent trials. Real-life ACLS scenarios involve complex medical situations with multiple possible interventions depending on the patient’s status. Patients with cardiac arrest secondary to hyperkalemia or pulmonary embolism are managed differently than the simpler cases created for this simulation. Achieving higher levels of accuracy would either require the ability for ChatGPT to learn or a different AI model altogether.

Some experts recommend asking probing questions to AI as a possible solution to verify responses from ChatGPT. In clinical scenarios where time directly correlates with myocardial health and patient outcomes, this may be unrealistic. Continuing to prompt the AI or slightly modifying responses to see how responses change is also not practical. In our study, ChatGPT was prompted dozens of times for responses. During an actual episode of cardiac arrest, where intervals of CPR are done in 2 minutes, spending most of the time repeatedly prompting ChatGPT for an accurate response is probably not time well spent during the resuscitation.

Several limitations should be considered when interpreting these results. First, our study focused only on 2 ACLS scenarios: bradycardia and cardiac arrest. Because this is a proof-of-concept study, the authors decided to test just 2 scenarios. In the overall ACLS framework, there are many other emergencies covered, including the management of tachyarrhythmias, opioid overdose, and stroke. Given that ChatGPT’s performance could vary in these alternative scenarios, broadening the scope of simulations might provide a more thorough insight into ChatGPT’s capabilities by evaluating its performance across a broader range of ACLS conditions. Our study analyzed the accuracy of ChatGPT only, making it difficult to generalize the results to other large language models. During the study period, ChatGPT could not recognize images, requiring the study authors to specify the cardiac rhythm in the model, potentially affecting the accuracy. There are growing concerns that the quality of ChatGPT has decreased over time as it has become more widely used by the public, which could also impact the results [ 30 ]. Additionally, given the potential evolution of ChatGPT’s capabilities over time, the reliability and validity of the study’s results may be affected. Exploring how AI models can update their knowledge could provide insights into their long-term utility in real-world medical emergency settings.

Conclusions

Bridging the gap between AI and human language is a multifaceted challenge, balancing advancements, data quality, and human oversight to maximize ChatGPT’s benefits and minimize risks in health care. This study highlights the need for consistent and reliable guidance to prevent potential medical errors and optimize the application of ChatGPT to enhance its reliability and effectiveness in clinical practice. To enhance ChatGPT’s real-world effectiveness, significant improvements are needed, particularly in accuracy and consistency across diverse medical situations. While ChatGPT holds promise as a decision support tool that can provide structured clinical guidance, it should complement, not replace, qualified health care professionals. Future research also should aim to address these limitations and further investigate the challenges of AI in health care to ensure its safe and effective use. Additionally, future studies comparing ChatGPT’s performance with other AI models or with human performance could offer valuable insights.

Data Availability

The data sets generated during or analyzed during this study are available from the corresponding author upon reasonable request.

Conflicts of Interest

None declared.

ChatGPT ACLS Testing Algorithm for Bradycardia.

ChatGPT ACLS Testing Algorithm for Cardiac Arrest.

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Abbreviations

Edited by Q Jin; submitted 30.11.23; peer-reviewed by D Wright, TAR Sure, L Zhu, S Kommireddy; comments to author 08.02.24; revised version received 22.02.24; accepted 10.03.24; published 22.04.24.

©Cecilia Pham, Romi Govender, Salik Tehami, Summer Chavez, Omolola E Adepoju, Winston Liaw. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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A-state biotechnology major awarded surf internship at uams.

JONESBORO – Arkansas State University junior biotechnology major Faith Stephens of Malvern has been awarded a Summer Undergraduate Research Fellowship (SURF) by the University of Arkansas Medical School (UAMS). She will intern with the UAMS College of Medicine Department of Molecular Biology.   

“I am very happy to be one of the applicants selected. It feels great to be recognized for my hard work and I’m excited for what this internship will teach me,” said Stephens.     Stephens has participated in research at A-State. Through the Arkansas Biosciences Institute Summer Internship program, she worked in the molecular ecology lab of Dr. Kyle Gustafson, assistant professor of biology.  

“I hope to learn about molecular lab techniques and about graduate school research that I will hopefully get to utilize when I pursue higher education,” said Stephens. 

“The goal of the SURF program is to engage undergraduates in graduate-level biochemistry and molecular biology research, including lab work, scientific writing, oral presentations, and ultimately, a research publication,” said Gustafson.     Following graduation, Stephens said she plans to pursue master’s and doctoral degrees in molecular or cell biology.     “I will then find a job researching in a field relating to genetics or cell biology,” she added.     Gustafson said the SURF program is very competitive and that Stephens has acheived a great accomplishment in being selected.  

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Four Years Out, Some Voters Look Back at Trump’s Presidency More Positively

A new poll by The New York Times and Siena College finds that voters think highly of the former president’s record on the economy, but memories of his divisiveness largely remain intact.

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By Lisa Lerer and Ruth Igielnik

Views of Donald J. Trump’s presidency have become more positive since he left office, bolstering his case for election and posing a risk to President Biden’s strategy of casting his opponent as unfit for the presidency, according to a new poll by The New York Times and Siena College .

While the memories of Mr. Trump’s tumultuous and chaotic administration have not significantly faded, many voters now have a rosier picture of his handling of the economy, immigration and maintaining law and order. Ahead of the 2020 election, only 39 percent of voters said that the country was better off after Mr. Trump took office. Now, looking back, nearly half say that he improved things during his time as president.

The poll’s findings underscore the way in which a segment of voters have changed their minds about the Trump era, recalling those years as a time of economic prosperity and strong national security. The shift in views about his administration comes even as Mr. Trump faces dozens of felony counts and will appear in a New York courtroom on Monday for jury selection in one of his four criminal trials.

How respondents’ views of

Trump have changed

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Approve of his handling

of the economy

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country better off

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maintaining law & order

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Think electing him is

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How respondents’ views of Trump have changed

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Many voters still remember Mr. Trump as a divisive and polarizing figure, giving him low ratings on race relations and unifying the country. Yet, a larger share of voters see Mr. Trump’s term as better for the country than the current administration, with 42 percent rating the Trump presidency as mostly good for the country compared with 25 percent who say the same about Mr. Biden’s. Nearly half say the Biden years have been mostly bad for the country.

Many of Mr. Trump’s key constituencies, such as white voters without a college degree, are particularly likely to have a fond view of his time in office. But a broad swath of the country — including Hispanic voters, voters over 30 and most lower- and middle-income voters — now see Mr. Trump’s years in office as more good than bad.

Maya Garcia, 23, described herself as a former “Trump hater.” But now, she says, she has come to believe that Mr. Trump’s contentious style helped control crime and maintain order in the country.

“When he was first running, I was, like, what is this guy even yapping about? Like, what is he even saying? Like, he’s saying all the wrong things,” said Ms. Garcia, a restaurant worker from Canoga Park, Calif. “But to be honest, if you look deep into his personality, he actually cares about the country.” She added: “You know at first I didn’t like it. But sometimes we need that type of person in our lives.”

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Ms. Garcia voted for Mr. Biden four years ago but has been unhappy with his handling of the border, crime, mental health and the rising cost of living. She plans to back Mr. Trump in November.

The shift in the perception of Mr. Trump is not unusual: Presidents are typically viewed in a better light after leaving office. President George W. Bush’s average approval rating while in office was 49 percent; voters now give him a 57 percent approval rating for his time in the White House. And President Barack Obama received a 15 percentage point bump after leaving the White House, according to Gallup .

What’s unusual about the 2024 race is that Mr. Trump is running again, transforming sentiment about his presidency into a salient and potentially influential voting issue.

Some of the changed opinions about Mr. Trump may stem from his diminished visibility. Since leaving office, Mr. Trump has faded some from public view, spending the bulk of his time at Mar-a-Lago, his private club and residence in Palm Beach, Fla., and at court hearings. He dominated the Republican presidential primary without participating in any debates; his social media posts on his own platform get less attention than they did on Twitter; and while he still holds large rallies, they are not covered to the same extent as his previous campaigns.

The most improved views of Mr. Trump center on the economy, with several voters saying they have struggled to keep up with higher costs and increased inflation during Mr. Biden’s presidency.

Marecus Maupin, 41, said he now looked back at the Trump years as a time of economic prosperity, even though he is making more money with Mr. Biden as president. He voted for Mr. Biden and now plans to back Mr. Trump.

“We all had a little bit more money in our pockets when he was in office. I think he gave out more money than any other president that I have had in my lifetime,” he said of Mr. Trump. “It now feels like, although I’m making more, I’m not seeing it.”

When asked the one thing they remembered from Mr. Trump’s time in office, a vast majority of positive comments referred to the state of the economy. Many specifically remembered the stimulus checks with his signature printed on them that were sent to tens of millions of Americans during the waning days of his presidency.

Still, large segments of the electorate’s recollection of Mr. Trump’s presidency remain unchanged. Views of his handling of the Supreme Court are nearly identical to 2020, and Mr. Trump’s low approval ratings for unifying the country remain fairly similar. The bulk of negative comments about Mr. Trump’s time in office from participants mentioned the former president’s personality and behavior.

“He’s horrific. He’s a narcissist. He’s dishonest. He’s a misogynist,” said Dodee Firestone, 74, a Biden supporter from Boca Raton, Fla. “I could never, ever, ever vote for Trump.”

But other voters said that while they disapproved of Mr. Trump’s inflammatory style, they wondered whether they had placed too much emphasis on his personality in past elections.

While 70 percent of participants said that Mr. Trump had at one point said something they found offensive, those statements were a distant memory for many. Nearly half of that group said he had not said anything offensive recently. Young voters were especially likely to say it had been a while since Mr. Trump said something they found offensive.

President Biden has devoted a significant portion of his campaign to reminding voters of some of Mr. Trump’s most inflammatory statements and failed policies, particularly regarding his handling of the coronavirus pandemic and controversial comments about Black and Hispanic voters.

And while the issue of abortion rights has been front and center in the general election campaign, less than 2 percent of voters mentioned abortion or Mr. Trump’s role in the Supreme Court’s repeal of Roe v. Wade as the main thing they remember from his presidency.

Some of the visceral fear about Mr. Trump’s presidency also seems to have faded. In October 2016, 40 percent of voters said they were scared of what Mr. Trump might do if elected. Now, 31 percent say they are scared.

Nearly identical shares of voters also say both Mr. Trump and Mr. Biden would be a risky choice for the country.

Angie Leon, a 23-year-old Mexican American, said she never liked how Mr. Trump talked about Latinos. But looking back, she wonders whether Mr. Trump’s incendiary remarks about immigrants and building a border wall were just a political tactic to bolster his campaign. After backing Mr. Biden in 2020, she plans to switch her vote to Mr. Trump in November.

“I felt like it was just his marketing, in the way that he would get the attention of people,” said Ms. Leon, a human resources recruiter from Gilroy, Calif. “The country was better when he was running it, despite his comments toward the community.”

Camille Baker contributed reporting.

Here are the key things to know about how this Times/Siena poll was conducted:

We spoke with 1,059 registered voters from April 7 to 11, 2024.

Our polls are conducted by telephone, using live interviewers, in both English and Spanish. More than 95 percent of respondents were contacted on a cellphone for this poll.

Voters are selected for the survey from a list of registered voters. The list contains information on the demographic chara cteristics of every registered voter, allowing us to make sure we reach the right number of voters of each party, race and region. For this poll, we placed nearly 127,000 calls to more than 93,000 voters.

To further ensure that the results reflect the entire voting population, not just those willing to take a poll, we give more weight to respondents from demographic groups underrepresented among survey respondents, like people without a college degree. You can see more information about the characteristics of our respondents and the weighted sample on the methodology page , under “Composition of the Sample.”

The poll’s margin of sampling error among registered voters is plus or minus 3.3 percentage points. In theory, this means that the results should reflect the views of the overall population most of the time, though many other challenges create additional sources of error. When computing the difference between two values — such as a candidate’s lead in a race — the margin of error is twice as large.

You can see full results and a detailed methodology here . If you want to read more about how and why we conduct our polls, you can see answers to frequently asked questions and submit your own questions here .

Lisa Lerer is a national political reporter for The Times, based in New York. She has covered American politics for nearly two decades. More about Lisa Lerer

Ruth Igielnik is a polling editor for The Times, where she writes and analyzes surveys. She was previously a senior researcher at the Pew Research Center. More about Ruth Igielnik

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8 facts about Black Lives Matter

In the 10 years since the #BlackLivesMatter hashtag was first used on social media, it has appeared in more than 44 million tweets, according to  a recent Pew Research Center report . On a typical (median) day, #BlackLivesMatter appears in about 3,000 tweets as users discuss topics such as racism, violence and the criminal justice system.

Use of the hashtag has often surged around specific acts of violence against Black Americans. The hashtag first appeared in July 2013, after George Zimmerman was acquitted in the 2012 shooting death of 17-year-old Trayvon Martin in Florida. Its use peaked at over 1.2 million tweets per day after Minneapolis police officer Derek Chauvin murdered George Floyd in May 2020.

As we mark 10 years since the hashtag originated, here are eight facts about the Black Lives Matter movement.

Pew Research Center sought to explore the impact and reach of the Black Lives Matter movement 10 years after the #BlackLivesMatter hashtag originated on Twitter. This post includes survey findings from Center studies conducted from 2021 to 2023, as well as a Center analysis of Twitter activity from July 2013 to March 2023. Links to the methodology for each publication, including the questions asked in each survey, can be found in the text of this analysis.

About half of adults in the United States (51%) say they support the Black Lives Matter movement, according to a 2023 Center survey . This includes 22% who strongly support it and 29% who somewhat support it.

There are significant differences in opinion by race and ethnicity, political party, and age. About eight-in-ten Black Americans (81%) support the movement, compared with 63% of Asian, 61% of Hispanic and 42% of White Americans. Democrats and those who lean toward the Democratic Party are about five times as likely as Republicans and Republican leaners to support Black Lives Matter (84% vs. 17%). And whereas most adults ages 18 to 29 (64%) support the movement, 41% of those ages 65 and older do.

Support for Black Lives Matter has decreased significantly among U.S. adults since June 2020, the same Center survey shows. Two-thirds of adults strongly or somewhat supported the movement in June 2020 – shortly after Floyd was murdered – but that share fell to 56% in March 2022 and 51% in April 2023.

The decline is largely due to a smaller share of White adults supporting the movement. In June 2020, 60% of White adults said they supported Black Lives Matter, but that share fell to 50% in 2022 and 42% this year. Support among Asian and Hispanic adults has also fallen since 2020, but not as sharply as it has among White adults. In contrast, about 80% or more of Black adults have expressed support for the movement every year since 2020.

Most teenagers support the Black Lives Matter movement, according to a separate Center survey conducted in 2022 . Seven-in-ten Americans ages 13 to 17 said they strongly or somewhat support the movement.

Black and Democratic teenagers were especially likely to support the movement. Some 92% of Black teenagers said they support it, compared with 82% of Hispanic and 57% of White teenagers. (There were not enough Asian teens in the sample to allow for separate analysis.) And 94% of Democratic teens said they support Black Lives Matter – more than twice the share of Republican teens who said the same (42%).

Among U.S. adults, 7% say they have ever attended a Black Lives Matter protest, according to the 2023 Center report . Even among the demographic groups that are most likely to support Black Lives Matter, the shares of people who have attended a protest are low.

Some 15% of Black adults say they have attended a Black Lives Matter protest; they are more likely than Hispanic, Asian or White adults to say they have done so. Similarly, adults ages 18 to 29 are about twice as likely as those 30 to 49 and five times as likely as those 50 and older to have attended a Black Lives Matter protest. And Democrats are four times as likely as Republicans to have done this.

Many Black adults in the U.S. say Black Lives Matter has done the most to help Black people in recent years. About four-in-ten Black adults (39%) said this in a 2021 Center survey . That far exceeded the share of Black adults who said the same about any other entity asked about in the survey, including the NAACP, Black churches or other religious organizations, the Congressional Black Caucus and the National Urban League. (This survey did not specify whether Black Lives Matter referred to an organization or the broader movement.)

The public is divided on how effective the Black Lives Matter movement has been at bringing attention to racism against Black people in the U.S. About a third of adults (32%) say the movement has been extremely or very effective at this. Some 35% say it has been somewhat effective, while 30% say it has been not too or not at all effective, according to the 2023 Center survey .

Black and Asian adults are more likely than other racial and ethnic groups to say the movement has been extremely or very effective at bringing attention to racism in the country. Some 48% of Black adults and 46% of Asian adults say this, compared with 33% of Hispanic and 27% of White adults.

The public gives the Black Lives Matter movement lower marks on some other questions. Only 14% of U.S. adults say the movement has been extremely or very effective at increasing police accountability; 8% say it has been effective at improving the lives of Black people; and 7% say it has improved race relations.

A large majority of social media users in the U.S. (77%) say they have seen content on social media related to Black Lives Matter, but far fewer report having ever posted or shared something about this topic, according to the 2023 Center report . Some 24% of social media users say they have posted or shared content supporting Black Lives Matter, while 10% have shared content opposing it.

Black social media users are particularly likely to have posted in support of Black Lives Matter: 52% have done so, compared with 24% of Hispanic, 22% of Asian and 18% of White users. Younger users are also more likely than older users to have posted or shared something in support of Black Lives Matter, as are Democrats when compared with Republicans.

On Twitter specifically, millions of people first engaged with the #BlackLivesMatter hashtag following Floyd’s murder. Between May and September 2020, 5.8 million distinct users shared a tweet that contained the hashtag for the first time.

A majority of social media posts that use the #BlackLivesMatter hashtag are supportive, the same report finds. Between July 2013 and March 2023, about seven-in-ten publicly available tweets that used the hashtag (72%) were positive toward the movement. Another 17% were neutral and 11% were negative.

Supportive tweets commonly include words such as together , justice , change , brutality and murder , whereas negative tweets often use words such as riot , assault , criminal and violent .

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8 facts about black americans and the news, black americans’ views on success in the u.s., among black adults, those with higher incomes are most likely to say they are happy, fewer than half of black americans say the news often covers the issues that are important to them, most popular.

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