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Objective: To assess whether multifocal, high-frequency repetitive transcranial magnetic stimulation (rTMS) of motor and prefrontal cortex benefits motor and mood symptoms in patients with Parkinson disease (PD). Methods:Patients with PD and depression were enrolled in this multicenter, double-blind, shamcontrolled, parallel-group study of real or realistic (electric) sham rTMS. Patients were randomized to 1 of 4 groups: bilateral M1 ( 1 sham dorsolateral prefrontal cortex [DLPFC]), DLPFC ( 1 sham M1), M1 1 DLPFC, or double sham. The TMS course consisted of 10 daily sessions of 2,000 stimuli for the left DLPFC and 1,000 stimuli for each M1 (50 3 4-second trains of 40 stimuli at 10 Hz). Patients were evaluated at baseline, at 1 week, and at 1, 3, and 6 months after treatment. Primary endpoints were changes in motor function assessed with the Unified Parkinson's Disease Rating Scale-III and in mood with the Hamilton Depression Rating Scale at 1 month.Results: Of the 160 patients planned for recruitment, 85 were screened, 61 were randomized, and 50 completed all study visits. Real M1 rTMS resulted in greater improvement in motor function than sham at the primary endpoint (p , 0.05). There was no improvement in mood in the DLPFC group compared to the double-sham group, as well as no benefit to combining M1 and DLPFC stimulation for either motor or mood symptoms. Conclusions:In patients with PD with depression, M1 rTMS is an effective treatment of motor symptoms, while mood benefit after 2 weeks of DLPFC rTMS is not better than sham. Targeting both M1 and DLPFC in each rTMS session showed no evidence of synergistic effects. Parkinson disease (PD) presents with both motor and nonmotor features. Motor symptoms can respond to pharmacologic and other therapies such as deep brain stimulation, 1 but these treatments are often ineffective for nonmotor symptoms. Depression is particularly common, with a prevalence ranging from 40% to 70%.2 Not infrequently, depression in PD is resistant to medication and affects patients' quality of life.

Objective Guided by the vulnerable population framework, the aim was to describe the risks and protective strategies for COVID-19 spread and infections in a Skilled Nursing Facility (SNF). Method We conducted a retrospective cohort (March 1st–August 31st, 2020) study. Data were collected from internal COVID-19 documents and resident electronic health records. Data were summarized and analyzed using descriptive statistics, relative risk calculations, and cases charted by week onset. Results There were 325 residents who lived in and 296 staff who worked at the SNF during the study period. There was a total of 2 confirmed cases among residents and 4 confirmed cases among staff. Cases were isolated and all were living at their baseline health status at the end of the study. Conclusion Understanding the vulnerability to and protective strategies for COVID-19 within SNFs could strengthen resident care, resiliency among the SNF community, and improve health policies.