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After reports of dysfunction in the vice president’s office, the administration is trying to stop a drama-filled narrative from taking hold

Two people close to Harris’ team said some individuals inside the vice president’s office are frustrated with what they see as a dysfunctional operation that has been at times waylaid by internal conflict. Some of that ire is directed squarely at Harris’ chief of staff, Tina Flournoy, those people said. Another source close to the staff said there were “challenges and struggles” and heard complaints about Flournoy from staff, but denied it amounted to dysfunction or that the tensions were directly Flournoy’s fault.
Sabrina Singh, deputy press secretary to the vice president, told CNN in a statement that Harris’ focus remains on her work.
“The Vice President and her office are focused on the Biden-Harris Administration’s agenda to build an economy from the middle out and the bottom up, not the top down, to making sure racial equity is at the core of everything the Administration does, to combatting the existential threat of climate change, and to continue protecting the American people from the Covid-19 pandemic,” Singh said.
And White House press secretary Jen Psaki on Friday said, “I will say that the vice president is an incredibly important partner to the President of the United States. She has a challenging job, a hard job, and she has a great supportive team of people around her. But other than that, I’m not going to have any more comments on those reports.”
Still, conversations are now underway in the West Wing about how to better support Harris’ team, one source close to the White House said.
That help from the West Wing is a sign that the spiraling narrative could start to affect Harris, who is considered the next in line to lead the Democratic Party — with a potential for a presidential run coming as soon as 2024 if President Joe Biden decides not to seek reelection. Biden has said he does intend to run.
Top White House officials and aides to the vice president went on the record to defend Harris and Flournoy, calling reports of infighting and dysfunction overblown or simply untrue. And Harris’ outside allies and advisers — like influential adviser Minyon Moore and Democratic strategist Bakari Sellers — quickly took to Twitter, looking to drown out the criticism.
On Friday, Biden’s chief of staff, Ron Klain, a longtime friend of Flournoy, said in a statement to CNN: “Vice President Harris and her team are off to the fastest and strongest start of any Vice President I have seen. She’s Delivering for the American people on immigration, small business, voting rights, and economic growth. The President’s trust and confidence in her is obvious when you see them in the Oval Office together.”
“The results speak for themselves: a decline of border arrivals from the Northern Triangle, improved vaccine equity, and increased economic opportunities for women. Anyone who has the honor of working closely with the Vice President knows how her talents and determination have made a huge difference in this Administration already,” Klain’s statement added.
As the frustrations bubbled to the surface this week and damage control commenced, the full-court defense also served to amplify the clear concern inside and around the Biden administration about the drama unfolding in Harris’ office. The latest reports are seen as part of a pattern of stories about staff infighting and low morale, which have followed Harris from her Senate office to her presidential campaign and now to the vice presidency.
One administration official described the current efforts by the West Wing as an attempt to help with any issues any staff might be facing.
“Ron, Anita (Dunn), Cedric (Richmond), others, have certainly expressed their solidarity with our team, internally and externally,” the administration official said.
But some of those efforts actually helped solidify reports of staff discontent. Rather than denying the existence of complaints about morale inside Harris’ office, Dunn — a White House senior adviser — told Politico the complaints were “not anywhere near what you are describing” and acknowledged that there “may be people whose feelings were a little hurt on her staff” after many staffers weren’t told of her trip to the southern border ahead of it being announced publicly.
The departure of Harris’ top two advance officials has also served to compound a chaotic narrative, even though some officials insisted the pair had always planned for early exits from the administration.
It does not help that Harris has come under fire for multiple missteps in her first few months in office, starting after just a few weeks when she gave an interview to a West Virginia TV station that angered crucial moderate Democratic Sen. Joe Manchin, who hails from the state. That tension reached its apex last month during her first international trip as vice president, a two-day visit to Guatemala and Mexico, during which she likened not going to the border to also not having visited Europe.
“I, and I haven’t been to Europe. And I mean, I don’t — I don’t understand the point that you’re making,” Harris said with a laugh to NBC’s Lester Holt when pressed about the fact that she hadn’t visited the US-Mexico border.
The trip to El Paso, Texas, last week was without incident and some people close to Harris called reports alleging dysfunction overblown. But others told CNN that the office is rife with frustration and occasional infighting.
“I think everybody is just feeling overwhelmed,” a source close to the White House said of the dynamics in the vice president’s office.
“It’s a tough place, obviously,” the administration official said, not just of the vice president’s office but of all administration jobs, which operate at a high level of stress and pressure. “But for the most part, people are focused on the mission.”
That official contended that Flournoy has been asset to Harris as her chief of staff, and a source close to Flournoy credited her with keeping Harris’ circle tight, saying her role “is to be the gatekeeper, it is to keep the principal on task and it is to be the person that is the last voice before the principal’s make the decision, so in that regard, she is doing the job that she’s supposed to be doing.” Some of the complaints voiced in media reports alleged that Flournoy has limited access to Harris too much.
“There’s not infighting between the teams,” the administration official said. “The office is united together as part of the larger goal of the OVP. People are working together to make sure that she is executing on like the tasks she’s been assigned.”

Author: Jasmine Wright, Jeremy Diamond and Arlette Saenz, CNN
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Excessive Drooling a Sign of Greater Dysfunction in Parkinson's

Excessive drooling by patients with advanced Parkinson’s disease is an indicator of greater motor and nonmotor dysfunction, new research shows.

Sialorrhea is not just a cosmetic problem,” study investigator Francesca Morgante, MD, associate professor of neurology, St. George’s University, London, United Kingdom, told Medscape Medical News.

“We need to understand the relationship between sialorrhea and these speech and swallowing disturbances and whether treatment for sialorrhea improves that,” Morgante added.

The findings were presented at the virtual Congress of the European Academy of Neurology (EAN) 2021.

Underrecognized Symptom

Sialorrhea is an underrecognized nonmotor symptom that can affect up to 70% of patients with PD, co-investigator Ioana Cociasu, PhD, postdoctoral research fellow, Neurosciences Research Center, St. George’s University, told meeting attendees. The impact on quality of life increases with disease severity, she said.

The current study included 101 consecutive patients attending an advanced PD disorders clinic. Researchers collected demographic data that included information on gender, age, age at PD onset, and disease duration.

They also gathered data on motor symptoms by assessing total levodopa equivalent daily dose (LEDD) and LEDD dopamine agonists. They also assessed results on the Unified Parkinson’s Disease Rating Scale (UPDRS) part III and the Hoehn and Yahr scale for on- and off-medication states.

Nonmotor functioning was assessed using the Non-Motor Symptoms Scale (NMSS) and Scales for Outcomes in Parkinson’s disease–autonomic dysfunction (SCOPA-AUT) questionnaire. Among patients with PD, autonomic dysfunction can precede motor impairment and can involve orthostatic and postprandial hypotension, among other symptoms, the investigators note.

Health status and quality of life were assessed using the Parkinson’s disease questionnaire–39 items (PDQ-39). The Radboud Oral Motor Inventory for PD (ROMP) was used to measure orofacial symptoms. ROMP is a self-administered questionnaire that evaluates speech, swallowing disturbances, and drooling of saliva. The Montreal Cognitive Assessment test was also used.

Investigators compared participants with sialorrhea to those without sialorrhea, described as droolers and nondroolers. Droolers were defined as those scoring >1 on the UPDRS-II item 6. This signified slight but definite presence of saliva in the mouth and/or the possibility of nighttime drooling.

Greater Impairment

Among the participants, 65 (64.4%) were classified as droolers, and 36 (35.6%) as nondroolers.

Patients with both PD and sialorrhea were significantly more impaired in terms of motor functioning than those without sialorrhea. In these patients, the UPDRS-III was more severe in both the off- (P = .03) and on-states (P = .002), and they had less improvement with the levodopa challenge test (P = .007).

Droolers were also more severely affected by nonmotor problems. They had more severe speech dysfunction (P < .0001) and swallowing dysfunction (P < .05), and they had higher scores on the NMSS (P = .0008) and SCOPA-AUT (P = .003) and poorer quality-of-life scores on the PDQ-39 (P = .049).

To evaluate respiratory tract infections, the researchers used electronic health records. About 15.4% of the study population had had a documented respiratory infection since they were diagnosed with PD.

Upper and lower respiratory tract infections were more frequent among droolers than nondroolers (P = .05).

“Infections might arise from swallowing disturbances leading to aspiration and drooling,” Morgante noted.

The drooling did not appear to affect cognition or sleep in these patients.

Treatment Options?

Following the study presentation, session co-chair Philippe G. Damier, MD, PhD, professor of neurology, University Hospital, Nantes, France, asked about the best treatment for sialorrhea for these patients.

In general, those with milder disease might try chewing gum to improve swallowing; patients with more severe cases may benefit from botulinum toxin injections, said Cociasu. The treatment choice, she added, “very much depends on the severity of the sialorrhea.”

Botulinum toxin therapy involves injections into the salivary gland to reduce saliva production. It is typically administered about every 4 months.

The second session co-chair, Elena Moro, MD, PhD, director of the Movement Disorders Unit at Grenoble Alpes University, Grenoble, France, pointed out that chewing gum may be a swallowing hazard for patients with PD and severe dementia.

Asked by Moro whether patients with higher scores on balance and posture were more likely to have sialorrhea, Cociasu said she and her colleagues are currently looking into this.

Morgante told Medscape Medical News that the current study did not examine the effect of treatment on speech disorders associated with sialorrhea.

“We are running another study now to understand the effect of treatment of sialorrhea on these features,” she said.

Morgante and Cociasu have reported no relevant financial relationships.

Congress of the European Academy of Neurology (EAN) 2021: Session: Movement Disorders 1. Presented June 20, 2021.

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This post originally appeared on Medscape Medical News Headlines

Diabetes type 2 symptoms: Erectile dysfunction could be a sign of high blood sugar

Fatigue can be a key warning sign of type 2 diabetes, but it’s so easy to brush off as inconsequential. Furthermore, other subtle signs of the condition may go unchecked too. Could you have the condition? You may have heard of diabetes, but do you really know the nuts and bolts of how it works? For one reason or another, the pancreas – an organ that hides behind the stomach – starts malfunctioning.
The pancreas either can’t make enough of the hormone insulin, or the insulin it does make doesn’t work properly.

Diabetes UK explained you’re more at risk of this happening if you:

  • Have a family history of type 2 diabetes
  • Are overweight
  • White and over 40
  • African-Caribbean, Black African, or South Asian and over 25
  • You have high blood pressure

Whenever you take a bite of something to eat – regardless of what it is – the carbohydrates are transformed into glucose, a type of sugar.

Insulin then acts as the key allowing glucose into the body’s cells, so it can be used up as an energy source.

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Should not enough blood reach the penis, sensation will be lost, and there will be difficulty with getting an erection.

Erectile dysfunction is also known as impotence, which may mean you can’t get or keep an erection.

Early warning signs can include losing the morning erection, which can be down to:

  • Reduced blood flow
  • Nerve damage
  • Damaged blood vessels

Pills such as Viagra and Cialis can cause heart problems, so it’s not an easy fix.

If diabetes is the cause of erectile dysfunction, then only more damage will be done to your health the longer it’s left untreated.

Examples include: kidney problems, foot and eye problems, a stroke and heart attack.

The earliest warning signs of type 2 diabetes, most commonly missed are:

  • Increased urination
  • Increased hunger
  • Increased thirst
  • Blurred vision
  • Slow healing of cuts and wounds

Diabetes UK warned that people could be suffering from the condition for up to a decade before they finally see their GP to get tested.

The easiest way to check whether or not you have diabetes is to speak to your GP.

They can arrange a simple blood test that can check your glucose levels in your blood.

From there, you will find out if you have the condition or not, and how best to manage it.

Whatever you do, if you’re concerned you might have diabetes, don’t put off seeing a doctor.