How to Keep Your Kids Safe This Summer and All Year Round: Tips From the ER

Aug 8, 2023 | Featured, Your Health

Summer is a time for kids to have fun, enjoy vacations, and especially their favorite outdoor activities. It’s also a time for parents to take notice, as many outdoor injuries and health hazards are preventable.

Chris Strother, MD, and Lauren Zinns, MD, emergency medicine specialists at The Mount Sinai Hospital and associate professors in emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai, share five key takeaways to help parents, caregivers, and families recognize and avoid common injuries and health hazards.

Young children are at a high risk of choking

  • Common things they choke on are hot dogs, grapes, and small round toys. Ensure that food is cut into small pieces and that young children are supervised when they are eating.
  • If your child is unable to cough or breathe while choking, call 911 first, then try these maneuvers:
    • For children younger than one year old: Place the infant face down on your arm resting on your thigh. With the palm of your other hand, give the baby five short, yet forceful, blows between the shoulder blades. If that is unsuccessful, place the infant on the back, put two of your fingers in the center of the chest below the nipples and press five times.  Continue five back blows and five chest thrusts until the foreign body is removed. Never place your finger inside the infant’s mouth as that could push the foreign body in further.
    • For children older than one year of age: Stand behind the child with your arms around the child’s waist. Make a fist and place it below the chest just above the navel.  Grab the fist with your other hand and push upward repeatedly until the food particle or toy is removed.

Click here for more information about how to help someone who is choking and for helpful illustrations.

Bug bites and insect stings can cause mild to severe allergic reactions in kids

  • Experts recommend bug spray on all exposed areas of skin, especially in the evenings when flying bugs are out the most, or in wooded areas where ticks are more likely to be found.
  • If your child has a tick, try to remove it as soon as possible.
  • Call your pediatrician if you notice a target-like lesion, as this could represent early signs of Lyme disease.
  • Mosquito bites will often cause a local allergic reaction at the site, this is usually not dangerous. If the area becomes very large, is very painful, or if your child develops a fever, the site might be infected. Call your pediatrician or go to the Pediatric Emergency Department.

Practice safety in the water

The American Academy of Pediatrics (AAP) reports that drowning is the single leading cause of death among children ages 1 to 4. Adult supervision is critical at all times.

  • Always swim with others.
  • Learn to swim at a young age and practice.
  • Wear a life jacket.
  • Be aware of weather conditions.
  • Make sure there is a lifeguard. If you aren’t watching the water, make sure someone else is watching for you, particularly with young children.
  • Here are more tips from the AAP.

Riding bikes and scooting can be great exercise

  • Wear a helmet when riding a bike or scooting. Accidents can happen fast.
  • Keep your bike “tuned up.” Make sure brakes work well and tires are inflated and in good condition.
  • Always obey traffic laws; ride with traffic if riding in the street.
  • Wear bright colors when in the street so cars can see you.

Heat awareness: Make sure to hydrate

  • Hydrate before and after you are in the heat. People don’t often think to drink before they go out, but it makes a huge difference to prevent dehydration.
  • Look for shade if possible, and take frequent breaks from activity to rest.
  • Sunblock is essential. Ensure that children are covered with sunscreen 30 SPF or greater to prevent burns, pain, and skin cancer later in life. Reapply frequently after swimming.
Learn more about Pediatrics at Mount Sinai

COVID-19 Cases Have Been Rising. Here’s What You Need to Know.

Updated on Jan 9, 2024 | COVID-19, Featured

If you are noticing that people you know are getting COVID-19, you are probably not alone. In fact, the number of cases in the New York area has risen recently. But this type of periodic fluctuation has been expected and is generally not a reason for concern, experts say.

“There is no reason to dramatically change our behavior when it comes to basic safety precautions and protecting vulnerable people,” says Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System.

Among the possible reasons for an uptick in hospitalizations could be the recent extreme hot weather that pushed people to stay indoors, or that people are gathering more because of summer travel.

The New York City Department of Health and Mental Hygiene reports hospitalizations in New York surged in July, but the number is still a small fraction of what it was in January of 2022 during the last big surge. There have been virtually no deaths for several months.

You may have heard about a new variant of COVID-19, known as Eris. Mutations or changes in the virus are normal and expected, and experts track them closely. In this case, there does not seem to be anything significantly different about this new subvariant. It causes the same symptoms, and people do not get sicker when infected by it.

Most important, Dr. Camins’ recommendations remain unchanged:

  • Those at risk of complications from COVID-19 may want to wear a protective mask (N95 or KN95) in crowded areas.
  • Always wash your hands when you get home or arrive at work.
  • Individuals at high-risk should talk with their health care provider and have a plan for how to get antiviral medications if they become infected, as these prescription medications must be taken within the first five days of symptom onset. Those at high-risk include older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers.
  • If you feel stick, stay at home.

Bernard Camins, MD, MSc

Here are four key takeaways from Dr. Camins and heath care experts about how we are all living with COVID-19 now.

It’s endemic

COVID-19 is now considered endemic in our society, which means it is a constant presence, and we should expect it to come and go, such as the common cold or the seasonal flu. The U.S. Centers for Disease Control and Prevention (CDC) officially declared the end of the pandemic in May, 2023. A pandemic refers to a disease that spreads rapidly and beyond control around the world.

Be sure to check the right number

Since the official end of the pandemic, health authorities are no longer reporting the daily cases of COVID-19. One reason is those figures are no longer an accurate measure because so many people are testing at home if they suspect they may be infected. Hospitalizations are still being reported. Ongoing measurements of the level of SARS-CoV-2 virus in wastewater may be a better measure of how widespread the virus is in the population, and that has shown a slight uptick in recent weeks, according to Dr. Camins.

New vaccines are on the way

The U.S. Food and Drug Administration (FDA) is working with vaccine manufacturers to prepare a new COVID-19 vaccine booster for the fall that will target the latest variants. Any new vaccine must be approved for use by the FDA and then recommended by the CDC and state health authorities before you can get it.

Don’t forget your flu shot

Now is the time to begin thinking about getting your flu shot. September and October are the best times to get the flu shot, according to the CDC. In addition, you may want to talk with your provider about the a vaccine against Respiratory Syncytial Virus (RSV), a common respiratory virus that usually causes mild, cold-like symptoms but can be serous for infants and older adults. The CDC is recommending the vaccine for older adults, adults with chronic heart or lung disease, with weakened immune systems, or those living in nursing homes or long-term care facilities. A CDC advisory committee has recommended the vaccine for infants under eight months.

Mount Sinai’s Role in Hemodialysis: From the First Treatment in the United States to Continuing Innovations

Updated on Sep 14, 2023 | Featured, Research

It has been more than 75 years since Mount Sinai conducted the first hemodialysis treatment in the United States in 1948, a monumental accomplishment, and Mount Sinai continues to play a leading role in research to help patients in need of this lifesaving treatment.

The first type of dialyzer, called the artificial kidney, was built in 1943 by a Dutch physician, Willem Kolff, MD, PhD, working in the Netherlands during World War II. He attempted to treat more than a dozen patients with acute kidney failure over the next two years and continuously improved his machine design.

In 1947, Dr. Kolff came to the United States to demonstrate his model artificial kidney at The Mount Sinai Hospital. On January 1948, Alfred Fishman, MD, and Irving Kroop, MD, who had been trained by Dr. Kolff, used his machine for the first time to treat a patient with acute renal failure who eventually recovered completely. That first dialysis took place at 11 pm on January 26, 1948. It lasted for six hours, and it represents the first clinical use of the artificial kidney in the United States.

As this showcased the latest technology, many visitors came to the operating room galleries to see the machine in action. It was the only one in New York City at the time. Patients from other hospitals were transferred to Mount Sinai to receive treatment. When a patient was too ill to travel, they packed up the machine and drove it over.

Dr. Kolff later shared his machines with other hospitals. When he returned to Holland, one of his machines stayed at Mount Sinai.

Over the next two years, the same team continued using this machine for dialytic therapy in patients with acute renal failure.  As a result of this work, The Mount Sinai Hospital opened the first artificial kidney center in New York in 1957, which included new designs that were engineered by staff. This was led by Sherman Kupfer, MD, who spent his career at Mount Sinai and made several contributions to the study of kidney disease.

Maintenance hemodialysis therapy for patients with advanced chronic kidney disease would not start until several years later in 1960 by Belding Scribner, MD, at the University of Washington in Seattle. The main problem for chronic maintenance hemodialysis was, and still is, maintenance of an open vascular access to perform the dialysis. Long-term use of native veins for dialysis blood access leads to eventual fibrosis and disappearance of veins; therefore the need for a special vascular access to secure long-term hemodialysis (HD).

The first meaningful breakthrough for vascular access came from Dr. Scribner’s group with the advent of the externalized Quinton-Scribner shunt. This access, first described in 1960, used the newly available material Teflon in an externalized circuit with cannulas placed in the radial artery and a peripheral vein in the arm that could subsequently be attached to the dialysis circuit. Although this method proved the first reliable, longer-term access for hemodialysis, it was still prone to the many infectious and hemorrhagic sequelae of its forebears.

The real answer to this problem also came from the Mount Sinai family when in 1966 Michael J. Brescia, MD, and colleagues at the Bronx VA Hospital published their seminal paper on how to perform hemodialysis using venipuncture of a surgically created arteriovenous fistula. The implementation of the surgically created arteriovenous fistula (AVF) allowed the development of modern chronic hemodialysis with about half a million of patients undergoing in-center hemodialysis three times weekly in the United States by 2020.

Over the past 75 years, many technological improvements have been done in hemodialysis machines, but the essence of the process remains unchanged since the early 1960s. Home hemodialysis very prevalent in the 1960s, became very uncommon afterwards, but there has been a recent surge of interest in it again. During this period of time we have also seen significant development of chronic peritoneal dialysis as another modality to provide long-term dialysis as well as the establishment and improvement of kidney transplantation as another therapy for chronic kidney disease.

“During all these years, The Mount Sinai Hospital has been at the forefront of all of these changes in the area of dialysis, making sure we offer all modalities of therapy as well as best level of care to all our patients,” says Jaime Uribarri, MD, Professor of Medicine (Nephrology). In this Q&A, Dr. Uribarri talks about the future of dialysis.

Jaime Uribarri, MD,

What research is currently being done at the Icahn School of Medicine at Mount Sinai in hemodialysis? Why is it important?

Several areas of research in hemodialysis are currently being performed at Mount Sinai. For example, Evren Azeloglu, PhD, Associate Professor of Medicine (Nephrology), and Pharmacological Sciences, and a team of researchers have invented a new implantable vascular access port that diminishes the risk of bleeding and infection in preclinical studies. The port also reduces pain and discomfort and allows easy self-cannulation, which enables safe home hemodialysis. This device is currently being perfected for future clinical use.

In addition, on a different front, Lili Chan, MD, Associate Professor of Medicine (Nephrology and Internal Medicine) has been working trying to use artificial intelligence to identify symptoms and social determinants of health from the electronic health records of patients on dialysis. This would potentially allow for measures to improve treatment and management of symptoms and other unmet social determinant of health, which are associated with adverse clinical outcomes in these patients.

Hemodialysis is needed because of the inexorable progression of some forms of chronic kidney disease. The Renal Division has been intensively studying and assessing potential therapies to slow progression to end stage renal disease and therefore delaying or avoiding the eventual need for dialysis.

What challenges remain in the delivery of hemodialysis, and how is Mount Sinai addressing those?

Many challenges remain in this arena. One challenge is there is limited access to dialysis centers in the community. Mount Sinai is addressing this by expanding our outpatient dialysis units to the outer boroughs. Also, limited access to home dialysis therapies, especially for minority populations remains a concern. Overall, the United States does not have enough home hemodialysis patients, and in-center hemodialysis is burdensome. Mount Sinai is addressing this by growing its home program and bringing a significant equity lens into it. Despite the great success with arteriovenous fistulas, vascular dialysis access patency, maintaining a way to access a patient’s veins, remains a problem. Mount Sinai is addressing this with its new implantable vascular access port.

How does the future of hemodialysis look like? 

The future of hemodialysis can be seen in several developments:

  • Technological advances of the machines should make the procedure easier.
  • An increasing proportion of patients are using home dialysis instead of in-center dialysis and are using peritoneal dialysis. Mount Sinai is positioned to help response to these changes.
  • Advances in pharmacological therapies are helping to slow the progression of chronic kidney disease as well as to increase the long-term survival of kidney transplants. This should decrease the need for hemodialysis in the future.

September 14, 2023: This post has been updated to include corrections regarding the history and development of the dialysis device at Mount Sinai.

 

Learn more about dialysis services at Mount Sinai

A Medical Student Who Believes in the Healing Power of Music

Updated on Aug 4, 2023 | Featured

Iain Forrest, PhD, uses the stage name “Eyeglasses,” which refers to a favorite piece of music by Beethoven called “Eyeglasses Duet.” The name also refers to his love of ophthalmology to restore lost eyesight to patients, as well as a nod to his fans who say his music gives them much-needed clarity and joy in an otherwise hectic world. Photo: Derek Srisaranard

Iain Forrest, PhD, is an MD-PhD student at the Icahn School of Medicine at Mount Sinai. He has been studying medicine since 2018. But he has been practicing healing since he was 10. That’s when his music teacher wheeled a cart into his fourth-grade classroom and asked every student to pick an instrument.

This was his introduction to the cello. He only had to draw the bow along those four strings for a few moments and hear that low rich bass sound resonate to know he had discovered something joyful and enduring. He would later study with a private teacher in the suburbs of Washington, D.C., where he grew up. He played first-chair cellist with the Maryland All-State Orchestra and the University of Maryland Repertoire Orchestra and won several competitions. This foundation allowed him to start playing modern music on the cello, including hit pop songs and famous movie soundtracks that delighted audiences at restaurants, weddings, and on city streets.

His two loves—music and medicine—came together when he was attending the University of Maryland.

“I started performing music for patients in the hospital next to our university and saw how the music had the power to uplift them. And it made me realize I could help them even more through medicine. That’s how my love of music and medicine came together,” he says.

“My goal is to delve deeper, to unravel the mysteries of the human body and pioneer new avenues of discovery,” Dr. Forrest says.

In May, 2023, Dr. Forrest graduated from Mount Sinai’s Graduate School of Biomedical Sciences, where he studied genetics and artificial intelligence in medicine. He is on track to receive his MD degree from Icahn Mount Sinai in two years, completing an eight-year journey to become a physician-scientist.

“My goal is to delve deeper, to unravel the mysteries of the human body and pioneer new avenues of discovery,” he says. Working with a physician-scientist at the National Institutes of Health showed him there can sometimes be a gap between what happens at the research bench and at a patient’s bedside.

Click here to watch a dramatic video of of Dr. Forrest playing in the New York City subway

“It is my goal as a physician-scientist to bridge that divide and help not just a few patients each day in the clinic but potentially thousands of patients with transformative biomedical innovation, including genetics, ophthalmology, and artificial intelligence,” he says.

Meanwhile, Dr. Forrest continues with his music. He has performed at venues ranging from Radio City Music Hall to Yankee Stadium. One of his more unusual gigs is underground: He performs regularly in the NYC subways as part of the MTA’s Music Under New York program.

“My dream used to be a classical musician playing at Carnegie Hall and other concert halls, until I realized that you can find gems of music anywhere in New York, including a hospital room or even a subway station,” he says.

His commitment to performing in the subway continues despite a recent incident in which he was assaulted while performing at Times Square during rush hour. The police apprehended a suspect. But it took him more than a month to return to playing in the subway.

He credits Emergency Department nurses and physicians at Mount Sinai with caring for him and ensuring he didn’t have any lasting physical injuries, along with the personal support of Kenneth L. Davis, MD, CEO, Mount Sinai Health System; Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of Icahn Mount Sinai and President for Academic Affairs, Mount Sinai Health System; and David Muller, MD, Dean for Medical Education.

“It is my goal as a physician-scientist to bridge that divide and help not just a few patients each day in the clinic but potentially thousands of patients with transformative biomedical innovation, including genetics, ophthalmology, and artificial intelligence,” Dr. Forrest says.

And he experienced the power of music firsthand.

“Embracing my studies in the MD-PhD course gave me strength to heal,” he says. “Gradually, I picked up the cello and started playing again. First, in the privacy of my apartment, where I felt the music cathartically and was reminded of its power to heal both myself and others. Then at a Manhattan venue where my fans’ overwhelming support led to a sold-out show. Finally, I ventured back to the subway stations.”

For his next act, he’s working with the MTA on telling his story to share the wonder of music from a doctor’s point of view, and he is releasing his first album of original music expressing the many facets of his personal journey.

Watch a video of of Dr. Forrest playing in the New York City subway

Expert Advice on Protecting Your Kids From Ticks

Jul 27, 2023 | Featured, Your Health

Being outside is wonderful for children’s development and health. However, if your plans include being in grassy or wooded areas, remember to try to protect your family from ticks and the risk of illnesses like Lyme disease.

The best protection is prevention. You can have children help in a way that also allows them to practice their developmental skills and understand the health benefits of avoiding ticks. Blair Hammond, MD, a pediatrician and Co-Founding Director for the Mount Sinai Parenting Center, explains how and offers four things to keep in mind and to discuss with your family.

Blair Hammond, MD

Choice and Independence

Encourage your child to pick out pants and long-sleeve shirts they’d like to wear to decrease the chance that a tick will get on the skin. You can treat outdoor clothing with permethrin, an insecticide, or buy already made tick-repellent clothing. Giving choices is great for fostering independence.

 Apply and Explain

You can apply insect repellent with DEET to your child’s exposed areas. You can make a game of it: “Where are your ankles? Let’s protect them with the insect repellent.”  Follow recommended safety tips from the American Academy of Pediatrics (AAP) on choosing the right product for your child’s needs. Remember that back and forth conversations and explaining things helps your child learn language and connect with you.

Routines

You can have a consistent routine of bathing after being outside (this removes non-attached ticks).  Also, try to incorporate tick checks into your nightly routines (a tick needs to be on a person for at least 24 to 48 hours to transmit Lyme disease). Pay special attention to hiding places like under the arms, in and around ears, behind legs, in the groin area, and along the scalp and in the hair. Having consistent routines helps with children’s self-regulation and behavior. Keeping pets free from ticks will also help. The AAP suggests checking your pets every day and using appropriate pet products.

No Need for Panic

If you do find a tick on you or your child, don’t panic. You can carefully remove the tick with tweezers by squeezing at the head and gently pulling back. If the tick has likely been on your child for more than 24 hours, or if you have any questions, call your health care provider. You can get additional guidance from the Centers for Disease Control and Prevention about what you should do about tick bites.

Get more information from the CDC

What Is Leqembi (lecanemab), and Will It Revolutionize Alzheimer’s Disease Treatment?

Jul 21, 2023 | Featured, Your Health

On July 6, the U.S Food and Drug Administration (FDA) granted traditional approval to Leqembi® (lecanemab), a drug developed by pharmaceutical firms Eisai and Biogen to treat Alzheimer’s disease. This decision converts the accelerated approval Leqembi received in January, following a confirmatory trial that demonstrated verified clinical benefit.

“Up until now, no one considered this a treatable disease,” says Mary Sano, PhD, Professor of Psychiatry and Director of the Alzheimer’s Disease Research Center at the Icahn School of Medicine at Mount Sinai. The full approval of lecanemab marks an exciting chapter for treating Alzheimer’s disease, providing physicians with more options. Cognitive specialists at Mount Sinai are now offering lecanemab as a treatment.

Mary Sano, PhD, Director of the Alzheimer’s Disease Research Center at the Icahn School of Medicine at Mount Sinai

What is lecanemab and how does it tackle Alzheimer’s disease? How might a patient access it at Mount Sinai? Dr. Sano explains why this drug will make a big impact in treating this condition, which is all too common among the aging.

What is lecanemab?

Lecanemab is a monoclonal antibody treatment that’s designed to reduce amyloid beta plaques in the brain. It is delivered as an intravenous infusion, over approximately one hour, once every two weeks.

“It is widely accepted that amyloid beta is a defining agent for Alzheimer’s disease,” says Dr. Sano. While the causes of Alzheimer’s disease are not fully known, accumulations of amyloid beta and other proteins such as tau tangles have been observed in patients, and are hypothesized to cause memory and functional loss.

The drug has been approved for mild cognitive impairment (MCI) and mild dementia. Patients in this category are still able to perform daily tasks, such as driving or going to work, but might experience memory lapses, such as forgetting words or location of objects.

What does this drug mean for patients?

In the confirmatory clinical trial that helped lecanemab clinch its full approval, the drug showed a statistically significant reduction in cognitive decline compared to placebo.

What patients can expect is a slowing of cognitive and functional loss, says Dr. Sano. The outcomes measured in the study relate to instrumental activities that early-stage Alzheimer’s disease patients might struggle with—paying bills, banking, certain computer tasks.

“The demonstrated effect is modest, but it’s robust, seen across all measures,” she notes. Those benefits were seen at month three of treatment and persisted through month 18, at the end of the study.

“I don’t want to overstate that this is the be-all and end-all of treatment,” Dr. Sano adds. “I’m not telling you this is a huge effect and the person goes back to 100 percent normal. But until the lecanemab studies, we had other monoclonal antibodies and we’ve not seen such consistent benefits.”

How can I access lecanemab?

The Centers for Medicare and Medicaid Services (CMS) announced in early July that lecanemab is eligible for Part B coverage under Medicare. One of the requirements is documented evidence of amyloid beta plaque in the brain, which requires imaging.

“If you don’t have the presence of amyloid, this means this is a drug you cannot use, even if you are symptomatic with memory or other cognitive problems,” Dr. Sano says.

Side effects for lecanemab could include amyloid-related imaging abnormalities (ARIA), and take the form of either bleeding or swelling in the brain, or both. Some genetic factors, such as the apolipoprotein E (APOE) ε4 gene, may increase the risk of ARIA. Other factors, such as whether patients are on blood-thinning medications, should also be considered before accessing treatment. At Mount Sinai, each patient who is interested in lecanemab receives a personalized evaluation to determine eligibility and appropriate counseling.

There could be economic barriers to access, Dr. Sano notes. Lecanemab has been reported to cost $26,500 per year. Under traditional Medicare, patients could expect to pay a 20 percent copay for treatment, although that might be covered by a supplemental insurance plan. Eisai has also launched a patient assistance plan.

In addition to the drug, there are other associated costs, including positron emission tomography (PET) for amyloid imaging, infusion, and travel expenses. Coverage of those expenses depends on the insurance.

“We need to make sure underrepresented groups can access this treatment,” says Dr. Sano.

Will lecanemab change how we look at Alzheimer’s disease?

Prior to lecanemab, the prevailing view of patients diagnosed with MCI or mild dementia had been a wait-and-see approach, Dr. Sano says. Practitioners might be resistant to start an early-stage patient on active treatment, and similarly, patients who are highly functional might be reluctant to compromise their autonomy.

“There’s a barrier to changing our culture, but it’s clearly surmountable,” notes Dr. Sano. “The one difference we have to consider is this: people don’t stay in mild dementia forever. We need to change the culture to get this addressed early.”

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Learn more about dementia care at The Barbara and Maurice Deane Center for Wellness and Cognitive Health at Mount Sinai

What has lecanemab shown in clinical trials?

In a placebo-controlled, double-blind randomized study of 1,795 people, lecanemab showed a statistically significant and clinically meaningful reduction in decline of the Clinical Dementia Rating (CDR), a cognitive and functional measure based on patient and caretaker reports and the trial’s primary outcome. Key secondary outcomes included measurements of change in amyloid beta and other cognitive scales and measurements of daily living capabilities.

Here are the efficacy and safety highlights:

  • Lecanemab-treated patients demonstrated a 27 percent slowing of decline in CDR compared to those on placebo at 18 months.
  • Statistical significance for CDR was seen starting as early as six months, with the difference from placebo widening every three months.
  • On a 100-point Centiloids scale, with 0 being a patient with no amyloid beta and 100 being the average amount of plaque a mild-to-moderate Alzheimer’s disease patient might have, the lecanemab group saw reduced plaque burden of 55.5 at 18 months, whereas the placebo group saw an increase of 3.6.
  • Statistical significance for amyloid burden was achieved starting at three months.
  • The most common side effects in the lecanemab group were infusion effects, with 26.4 percent having experienced it. Of those, 96 percent were considered mild to moderate.
  • Other side effects include amyloid-related imaging abnormalities—which could occur from amyloid-targeting therapies—as well as headaches and falls. Serious adverse events were reported in 14 percent of the lecanemab group and 11.3 percent of the placebo group.

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