Happy head, happy heart: Positive emotions may promote heart-healthy behaviors

What do you think of this article by NIMH? "People with heart disease may benefit from maintaining positive emotions, according to health researchers. Over the course of five years the researchers tracked more than 1,000 patients with coronary heart disease. Patients who reported higher positive psychological states were more likely to be physically active, sleep better and take their heart medications and were also less likely to smoke, compared to patients with lower levels of positive states. "Negative emotions and depression are known to have harmful effects on health, but it is less clear how positive emotions might be health-protective," said Nancy L. Sin, postdoctoral fellow in the Center for Healthy Aging and in the department of biobehavioral health at Penn State. "We found that positive emotions are associated with a range of long-term health habits, which are important for reducing the risk of future heart problems and death." The researchers assessed psychological well-being of participants at baseline and again at a five-year follow-up by asking the participants to rate the extent that they had felt 10 specified positive emotions, including "interested," "proud," "enthusiastic" and "inspired." Physical activity, sleep quality, medication adherence and alcohol and cigarette use were also measured at baseline and again five years later. The researchers report their findings in the today's (Oct. 2) issue of the journal Psychosomatic Medicine. "Higher levels of positive emotions were associated with less smoking, greater physical activity, better sleep quality and more adherence to medications" at baseline, said the researchers. They found no correlation between positive emotions and alcohol use. The results took into account patients' demographic factors, depressive symptoms and the severity of their heart conditions. Though positive emotions at baseline did not predict changes in health behaviors five years later, increases in positive emotions across the five-year period were associated with improvements in physical activity, sleep quality and medication adherence. There are a number of reasons why positive emotions are linked to optimal health habits, the researchers suggest. People with greater positive well-being may be more motivated and persistent in engaging in healthy behaviors. They might have more confidence in their abilities to maintain routines such as physical activity and sleep hygiene. Positive emotions may also enable people to better adjust their health goals and to proactively cope with stress and setbacks. "Efforts to sustain or enhance positive emotions may be promising for promoting better health behaviors," said the researchers. This research sets the stage for future work on interventions to improve health habits, Sin noted. Further research with other chronic disease populations and with electronic tracking of health behaviors should be conducted, she said. ### Judith Tedlie Moskowitz, professor, medical social sciences at the Feinberg School of Medicine, Northwestern University, and Mary A. Whooley, professor, medicine, epidemiology and biostatistics at the University of California San Francisco and physician at the San Francisco Veterans Affairs Medical Center, also worked on this research. The National Institute on Aging, the National Institute of Mental Health, the department of Veterans Affairs, the National Heart, Lung and Blood Institute, the Robert Wood Johnson Foundation and the American Federation for Aging Research supported this work. Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system." For more on this and other mental health subjects, please visit our course listing page Continuing Education Online Courses

Study finds family-based exposure therapy effective treatment for young children with OCD

What do you think of this article on kids and OCD? "Bradley Hasbro Children’s Research Center study finds family-based exposure therapy effective treatment for young children with OCD 5/5/2014 • Children five to eight years old with emerging OCD can benefit from therapies used for older children A new study from the Bradley Hasbro Children’s Research Center has found that family-based cognitive behavioral therapy (CBT) is beneficial to young children between the ages of five and eight with Obsessive-Compulsive Disorder (OCD). The study, now published online in JAMA Psychiatry, found developmentally sensitive family-based CBT that included exposure/response prevention (EX/RP) was more effective in reducing OCD symptoms and functional impairment in this age group than a similarly structured relaxation program. Jennifer Freeman, PhD, a staff psychologist at the Bradley Hasbro Children’s Research Center and clinical co-director of the Intensive Program for OCD at Bradley Hospital, led the study. “CBT has been established as an effective form of OCD treatment in older children and adolescents, but its effect on young children has not been thoroughly examined,” said Freeman. “These findings have significant public health implications, as they support the idea that very young children with emerging OCD can benefit from behavioral treatment.” During the 14-week randomized, controlled trial, which was conducted at three academic medical centers over a five-year period, the team studied 127 children between the ages of five and eight with a primary diagnosis of OCD. Each child received either family-based CBT with EX/RP or family-based relaxation therapy. The family-based CBT focused on providing the child and parent “tools” to understand, manage and reduce OCD symptoms. This includes psychoeducation, parenting strategies, and family-based exposure treatment, so children can gradually practice facing feared situations while learning to tolerate anxious feelings. The family-based relaxation therapy focused on learning about feelings and implementing muscle relaxation strategies aimed at lowering the child’s anxiety. At the end of the trial period, 72 percent of children receiving CBT with EX/RP were rated as “much improved” or “very much improved” on the Clinical Global Impression-Improvement scale, versus 41 percent of children receiving the family-based relaxation therapy. According to Freeman, the traditional approach for children this young presenting with OCD symptoms has been to watch and wait. “This study has shown that children with early onset OCD are very much able to benefit from a treatment approach that is uniquely tailored to their developmental needs and family context,” said Freeman. “Family-based EX/RP treatment is effective, tolerable and acceptable to young children and their families.” Freeman hopes that the family-based CBT model will become the first-line choice for young children with OCD in community mental health clinics where they first present for treatment. Earlier intervention may better address the chronic issues many children have with OCD, as well as the impact the debilitating illness can have on their overall development. “We use this family-based CBT model for treating children in this age range in both our Pediatric Anxiety Research Clinic and our Intensive Outpatient Program with much success,” said Freeman. “My hope is that others will utilize this treatment model to the benefit of young children at the onset of their illness.” “The findings from this study support extending downward the age range that can benefit from CBT with EX/RP for pediatric OCD treatment,” said Freeman. “With appropriate parental support, young children with OCD can make significant gains beyond what can be expected from having parents attempt to teach relaxation strategies to their children with OCD.” This study was funded by the National Institute of Mental Health (NIMH) under grant number 1R01MH079217. Freeman’s principal affiliation is the Bradley Hasbro Children’s Research Center, a division of the Lifespan health system in Rhode Island. She is also co-director of the Pediatric Anxiety Research Clinic at the Bradley Hasbro Children’s Research Center and clinical co-director of the Intensive Program for OCD at Bradley Hospital. She is an associate professor (research) at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior." For more information on PTSD and other mental health resources, please visit, Aspira Continuing Education Online Courses or our Anxiety Disorders CE Course

Nurturing may protect kids from brain changes linked to poverty

Growing up in poverty can have long-lasting, negative consequences for a child. But for poor children raised by parents who lack nurturing skills, the effects may be particularly worrisome, according to a new study at Washington University School of Medicine in St. Louis. Among children living in poverty, the researchers identified changes in the brain that can lead to lifelong problems like depression, learning difficulties and limitations in the ability to cope with stress. The study showed that the extent of those changes was influenced strongly by whether parents were nurturing. The good news, according to the researchers, is that a nurturing home life may offset some of the negative changes in brain anatomy among poor children. And the findings suggest that teaching nurturing skills to parents — particularly those living in poverty — may provide a lifetime benefit for their children. The study is published online Oct. 28 and will appear in the November issue of JAMA Pediatrics. Using magnetic resonance imaging (MRI), the researchers found that poor children with parents who were not very nurturing were likely to have less gray and white matter in the brain. Gray matter is closely linked to intelligence, while white matter often is linked to the brain's ability to transmit signals between various cells and structures. The MRI scans also revealed that two key brain structures were smaller in children who were living in poverty: the amygdala, a key structure in emotional health, and the hippocampus, an area of the brain that is critical to learning and memory. "We've known for many years from behavioral studies that exposure to poverty is one of the most powerful predictors of poor developmental outcomes for children," said principal investigator Joan L. Luby, MD, a Washington University child psychiatrist at St. Louis Children's Hospital. "A growing number of neuroscience and brain-imaging studies recently have shown that poverty also has a negative effect on brain development. "What's new is that our research shows the effects of poverty on the developing brain, particularly in the hippocampus, are strongly influenced by parenting and life stresses that the children experience." Luby, a professor of psychiatry and director of the university's Early Emotional Development Program, is in the midst of a long-term study of childhood depression. As part of the Preschool Depression Study, she has been following 305 healthy and depressed kids since they were in preschool. As the children have grown, they also have received MRI scans that track brain development. "We actually stumbled upon this finding," she said. "Initially, we thought we would have to control for the effects of poverty, but as we attempted to control for it, we realized that poverty was really driving some of the outcomes of interest, and that caused us to change our focus to poverty, which was not the initial aim of this study." In the new study, Luby's team looked at scans from 145 children enrolled in the depression study. Some were depressed, others healthy, and others had been diagnosed with different psychiatric disorders such as ADHD (attention-deficit hyperactivity disorder). As she studied these children, Luby said it became clear that poverty and stressful life events, which often go hand in hand, were affecting brain development. The researchers measured poverty using what's called an income-to-needs ratio, which takes a family's size and annual income into account. The current federal poverty level is $23,550 for a family of four. Although the investigators found that poverty had a powerful impact on gray matter, white matter, hippocampal and amygdala volumes, they found that the main driver of changes among poor children in the volume of the hippocampus was not lack of money but the extent to which poor parents nurture their children. The hippocampus is a key brain region of interest in studying the risk for impairments. Luby's team rated nurturing using observations made by the researchers — who were unaware of characteristics such as income level or whether a child had a psychiatric diagnosis — when the children came to the clinic for an appointment. And on one of the clinic visits, the researchers rated parental nurturing using a test of the child's impatience and of a parent's patience with that child. AUDIO: Poverty can interfere with healthy development in children and can have long-lasting, negative consequences. Now researchers at Washington University School of Medicine in St. Louis have found that if poor... Click here for more information. While waiting to see a health professional, a child was given a gift-wrapped package, and that child's parent or caregiver was given paperwork to fill out. The child, meanwhile, was told that s/he could not open the package until the caregiver completed the paperwork, a task that researchers estimated would take about 10 minutes. Luby's team found that parents living in poverty appeared more stressed and less able to nurture their children during that exercise. In cases where poor parents were rated as good nurturers, the children were less likely to exhibit the same anatomical changes in the brain as poor children with less nurturing parents. "Parents can be less emotionally responsive for a whole host of reasons," Luby said. "They may work two jobs or regularly find themselves trying to scrounge together money for food. Perhaps they live in an unsafe environment. They may be facing many stresses, and some don't have the capacity to invest in supportive parenting as much as parents who don't have to live in the midst of those adverse circumstances." The researchers also found that poorer children were more likely to experience stressful life events, which can influence brain development. Anything from moving to a new house to changing schools to having parents who fight regularly to the death of a loved one is considered a stressful life event. Luby believes this study could provide policymakers with at least a partial answer to the question of what it is about poverty that can be so detrimental to a child's long-term developmental outcome. Because it appears that a nurturing parent or caregiver may prevent some of the changes in brain anatomy that this study identified, Luby said it is vital that society invest in public health prevention programs that target parental nurturing skills. She suggested that a key next step would be to determine if there are sensitive developmental periods when interventions with parents might have the most powerful impact. "Children who experience positive caregiver support don't necessarily experience the developmental, cognitive and emotional problems that can affect children who don't receive as much nurturing, and that is tremendously important," Luby said. "This study gives us a feasible, tangible target with the suggestion that early interventions that focus on parenting may provide a tremendous payoff." Aspira Continuing Education Online Courses ### Funding for this research comes from the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH). NIH grant numbers 2R01 MH064769-06A1, PA-07-070 NIMH R01 and 5K01 MH090515-04. Luby J, Belden A, Botteron K, Marrus N, Harms MP, Babb C, Nishino T, Barch D. The effects of poverty on childhood brain development: The mediating effect of caregiving and stressful life events. JAMA Pediatrics vol. 167 (11), November 2013, published online Oct. 28, 2013. http://archpedi.jamanetwork.com/journal.aspx Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

National Institute of Mental Health (NIMH) Grantees To Receive 2013 Lasker Award

A current and a former National Institute of Mental Health (NIMH) grantee recently collected the prestigious 2013 Albert Lasker Basic Medical Research Award for their meticulous mapping of the molecular mechanisms involved in neurotransmitter release, the process by which the brain sends and receives chemical messages. Richard H. Scheller, Ph.D. Richard H. Scheller, Ph.D Genentech Thomas C. Südhof, M.D., at Stanford University School of Medicine, and Richard H. Scheller, Ph.D., at Genentech, parsed the proteins that enable one neuron to speak to another. This communication occurs across the synapse, a gap that separates the two neurons. Collectively called the “SNARE complex,” these proteins include vesicle-associated membrane protein (VAMP/synaptobrevin), synaptogamin, syntaxin, and SNAP-25. The complex allows for the preparation and release of the neurotransmitters into the synapse. Defects in this process contribute to mental disorders such as schizophrenia, depression, bipolar disorder, epilepsy, and many other pathological conditions. Thomas C. Südhof, M.D. Thomas C. Südhof, M.D. Stanford University School of Medicine Dr. Südhof is a current NIMH grantee and has served on several study sections at the NIH Center for Scientific Review, in addition to the Molecular, Cellular, and Developmental Neuroscience study section at NIMH. Dr. Scheller received research support from NIMH, and served on both the NIMH Molecular, Cellular, and Developmental Neuroscience study section, and the National Advisory Mental Health Council. Both have received the NIMH MERIT Award. Known as “America’s Nobels” because many recipients go on to win the Nobel Prize, the Lasker Awards are among the most respected science prizes in the world. Congratulations, Drs. Südof and Scheller Aspira Continuing Education Online Courses

Fat-free See-through Brain Bares All

Method Enables 3-D Analysis of Fine Structure and Connections – NIH-funded Study Slicing optional. Scientists can now study the brain’s finer workings, while preserving its 3-D structure and integrity of its circuitry and other biological machinery. A breakthrough method, called CLARITY, developed by National Institutes of Health-funded researchers, opens the intact postmortem brain to chemical, genetic and optical analyses that previously could only be performed using thin slices of tissue. By replacing fat that normally holds the brain’s working components in place with a clear gel, they made its normally opaque and impenetrable tissue see-through and permeable. This made it possible to image an intact mouse brain in high resolution down to the level of cells and molecules. The technique was even used successfully to study a human brain. “CLARITY has the potential to unmask fine details of brains from people with brain disorders without losing larger-scale circuit perspective,” said NIH Director Francis S. Collins, M.D., Ph.D., whose NIH Director’s Transformative Research Award Program helped to fund the research, along with a grant from the National Institute of Mental Health NIMH. “CLARITY will help support integrative understanding of large-scale, intact biological systems, explained Karl Deisseroth, M.D., Ph.D., of Stanford University in California. “It provides access to subcellular proteins and molecules, while preserving the continuity of intact neuronal structures such as long-range circuit projections, local circuit wiring and cellular spatial relationships.” Deisseroth, Kwanghun Chung, Ph.D., and other Stanford colleagues report on their findings April 10, 2013 in the journal Nature. “This feat of chemical engineering promises to transform the way we study the brain’s anatomy and how disease changes it,” said NIMH Director Thomas R. Insel, M.D. “No longer will the in-depth study of our most important three-dimensional organ be constrained by two-dimensional methods.” Until now, researchers seeking to understand the brain’s fine structure and connections have been faced with tradeoffs. To gain access to deeply buried structures and achieve high enough resolution to study cells, molecules and genes, they had to cut brain tissue into extremely thin sections (each a fraction of a millimeter thick), deforming it. Loss of an intact brain also makes it difficult to relate such micro-level findings to more macro-level information about wiring and circuitry, which cuts across slices. In tackling this challenge, the researchers saw opportunity in the fact that the fats, or lipids, that physically support the brain’s working components, such as neurons and their connections, also block chemical probes and the passage of light. So replacing the lipids with something clear and permeable – that would also hold everything else in place – might make it possible to perform the same tests in an intact brain that previously could only be done with brain tissue slices. Deisseroth’s team infused into brain a high-tech cocktail, including a plastic-like material and formaldehyde. When heated, it formed a transparent, porous gel that biochemically integrated with, and physically supported, the brain’s working tissue – while excluding the lipids, which were safely removed via an electrochemical process. The result was a brain transformed for optimal accessibility. They called the new method Clear Lipid-exchanged Anatomically Rigid Imaging/immunostaining-compatible Tissue Hydrogel – CLARITY, for short. Using CLARITY, the researchers imaged the entire brain of a mouse that had been genetically engineered to express a fluorescent protein. A conventional microscope revealed glowing details, such as proteins embedded in cell membranes and individual nerve fibers, while an electron microscope resolved even ultra-fine structures, such as synapses, the connections between neurons. In a series of experiments using CLARITY in mouse brain, the researchers demonstrated that, for the first time, standard immune- and genetics-based tests can be performed repeatedly in the same intact brain. Tracer molecules, such as antibodies, can be readily delivered for staining tissue – or removed – leaving brain tissue undisturbed. The researchers found that CLARITY outperformed conventional methods across a range of previously problematic technical challenges. When they used CLARITY to analyze a post-mortem human brain of a person who had autism, even though it had been hardening in formaldehyde for six years, they were able to trace individual nerve fibers, neuronal cell bodies and their extensions. Free continuing education course material at Aspira Continuing Education Online Courses

5 Most Common Mental Illnesses Share the Same Genes

From Autism to Depression: Largest Genetic Study Shows Mental Disorders Share Genetic Kinks --Associated Press Mental Illnesses Share Common DNA Roots, Study Finds --nbcnews.com An NIMH-funded study published online today in Lancet reveals that the five most common disorders—autism, attention deficit hyperactivity disorder, bipolar disease, schizophrenia, and major depression—all share similar genetic components. “These disorders that we thought of as quite different may not have such sharp boundaries,” said Dr. Jordan W. Smoller of Massachusetts General Hospital, one of the lead study authors. The results suggest that a rethink in how these disorders are defined might be in order. Rather than focusing on symptoms, which can be attributed to one or more disorder, physicians could one day start to rely on specific gene mutations or biologic pathways to make a formal diagnosis Aspira Continuing Education Online Courses And it also could lead to better treatments, said Dr. Bruce Cuthbert, director of the NIMH’s Division of Adult Translational Research and Treatment Development. “We are finally starting to make inroads where we have actual physiological mechanisms that we can target,” he said. “We can really start to understand the biology instead of having to guess at it.” Reference Cross-Disorder Group of the Psychiatric Genomics Consortium. Identification of Risk Loci with Shared Effects on Five Major Psychiatric Disorders: A Genome-wide Analysis. Lancet, published online February 28, 2013.

Emergency Department Suicide Screening Tool Accurately Predicts At Risk Youth

A set of four questions that takes emergency department nurses or physicians less than 2 minutes to administer can successfully identify youth at risk for attempting suicide, reported a study by National Institute of Mental Health (NIMH) researchers that was published in the December 2012 issue of the Archives of Pediatrics and Adolescent Medicine Aspira Continuing Education Online Courses Background Each year as many as 5 to 8 percent of U.S. children and young adults attempt suicide, according to the U.S. Centers for Disease Control and Prevention. In 2010, 4867 youths between ages 10 and 24 died by suicide, making it the second leading cause of death for people in this age group. Most individuals who die by suicide have visited a health care provider 3 months to 1 year before their death. Typically these patients saw an emergency department (ED) nurse and physician for some other health concern such as abdominal pain or headaches. These at-risk individuals often go unrecognized by ED staff who either lack the time or training to properly screen patients. The Joint Commission, a leading U.S.-based nonprofit healthcare accreditation organization, and the American Academy of Pediatrics have previously recommended the creation and use of suicide screening tools for adult and pediatric patient populations. To date there are no screening instruments to assess suicide risk in children and adolescents who visit EDs for medical or surgical reasons. “Many families use the emergency department as their sole contact in the healthcare system,” said Lisa M. Horowitz, Ph.D., M.P.H., lead author of the study. “Most people don’t show up to the emergency department and say ‘I want to kill myself.’ Rather they show up with physical complaints and do not discuss their suicidal thoughts. But studies have shown that if you ask directly, the majority will tell you. Nurses and physicians need to know what questions to ask.” Horowitz, a clinician and researcher with NIMH, and her colleagues developed a quick questionnaire that ED nurses and physicians could use to assess suicide risk among youth. Their study tested 17 candidate questions in 524 patients ages 10 to 21 years who visited one of three academically-affiliated pediatric EDs and had either psychiatric problems—suicidal ideation, intense anxiety, post-traumatic stress disorder—or medical/surgical concerns—gastrointestinal diseases, sickle cell anemia, cystic fibrosis. The questions—focusing on suicidal thoughts and behavior—were reviewed and revised by a panel of mental health clinicians, health services researchers, and survey specialists. The patients also completed one of two versions of the Suicidal Ideation Questionnaire (SIQ), the “gold standard,” 30-question suicide-screening tool that is used by pediatric and adolescent psychiatrists, but which is too long for ED visits and requires additional training. As part of the study’s safety plan, individuals whose responses indicated that they were at risk for attempting suicide were referred to mental health professionals—social workers, psychiatrists, psychologists—for further evaluation Suicide Prevention CE Course Results of the Study Of the 17 candidate questions, four (used as a set) stood out as having the most accuracy for predicting suicide attempts: current thoughts of being better off dead, current wish to die, current suicidal ideation, and history of suicide attempt. Positive responses to 1 or more of these 4 questions identified 97% of the youth at risk for suicide, regardless of whether these patients came in for psychiatric or general medical concerns. Based on results from the new questionnaire, 18.7% of the ED patients (98 of the 524) screened positive for suicide risk; most of whom had come to the ED with psychiatric concerns (84 of the 524). Elevated suicide risk was detected in 4.1% of the ED patients (14 of the 344) with medical/surgical concerns. Had it not been for the new screening tool, the suicide risk in these 14 patients most likely would have gone undetected. Significance The instrument based on these 4 questions, called the Ask Suicide-Screening Questions (ASQ), is the first time such a screen has been validated for pediatric and young adult patients evaluated in EDs for medical/surgical reasons. Although the number of these patients identified as high risk for suicide is small, the screen takes less than 2 minutes to administer. The tool is freely available and accessible online (pdf). What’s Next Additional research assessing the impact of suicidal screening in pediatric EDs on referral rates to mental health services and future suicidal behavior are needed. The accuracy of the ASQ among diverse demographic populations also needs examination. Additionally, a cost-benefit analysis for the screening tool is needed, as is research studying its use in other healthcare settings such as in-patient and out-patient care. Reference Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask Suicide-Screening Questions (ASQ). A Brief Instrument for the Pediatric Emergency Department. Archives of Pediatrics and Adolescent Medicine. December 2012. 166(12):1170–1176.

Social Worker, Counselor, Nursing, and Marriage and Family Therapist Continuing Education Online

Aspira Continuing Education Online Courses Aspira's selection of continuing education courses is growing all the time. Browse through our extensive catalog of online CE courses Aspira Continuing Education Approvals and Accreditations

Aspira Continuing Education is a board approved and accredited online CEU provider. Aspira is committed to excellence in the fields of Social Work, Marriage and Family Therapy and Professional Counseling providing board approved CEUs online. We offer MFT continuing education, Social Worker continuing education and Professional Counselor continuing education. Our online CE courses are the best you'll find. We offer a broad range of CE course subjects that are board approved for many professions and states. The process is as simple as selecting an online CE course, completing and passing the online exam, and receiving/printing your certificate. Your certificate is available to view/print once payment has been processed. With Aspira, you can: **Satisfy your CE requirements conveniently anywhere you have online access. **View all CE course materials in PDF format for FREE. **View and take any exam at any time for FREE. **Take as much time as needed to complete the exam. **Take the exam as many times necessary to receive a 70% passing score. **Pay after you have passed your exam. **Purchase a subscription for unlimited units that could reduce your cost per unit to under $4. (This will vary depending on the number of units used during the 12 month subscription period.) **Print your certificate at any time after passing your exam and purchasing your units. **Earn CE hours for passing exams based on books you may have already read. (These CEU courses require purchasing a book separately, if not already owned.) **Listen to selected audio CE courses directly from your computer or MP3 player. **Keep track of CEUs earned from other sources on your own personalized myCourses page. Take some time to browse our CE courses, and become a part of the Aspira family.