2024
Disability and Recurrent Stroke Among Participants in Stroke Prevention Trials
de Havenon A, Viscoli C, Kleindorfer D, Sucharew H, Delic A, Becker C, Robinson D, Yaghi S, Li V, Lansberg M, Cramer S, Mistry E, Sarpong D, Kasner S, Kernan W, Sheth K. Disability and Recurrent Stroke Among Participants in Stroke Prevention Trials. JAMA Network Open 2024, 7: e2423677. PMID: 39028666, PMCID: PMC11259901, DOI: 10.1001/jamanetworkopen.2024.23677.Peer-Reviewed Original ResearchConceptsPrevention trialsPoststroke disabilityRecurrent stroke ratesRecurrent strokeCohort studyRate of recurrent strokeStroke Prevention TrialIncreased hazardInsulin Resistance InterventionSecondary prevention trialsBaseline disabilityAssociated with increased ratesStroke rateMain OutcomesFunctional statusResistance InterventionStudy baselineSecondary outcomesPrimary outcomeWorsening heart failureModified Rankin ScaleProfession's participationLong-term followVascular deathDisabilitySecondary Prevention in Patients With Stroke Versus Myocardial Infarction: Analysis of 2 National Cohorts
Rivier C, Acosta J, Leasure A, Forman R, Sharma R, de Havenon A, Spatz E, Inzucchi S, Kernan W, Falcone G, Sheth K. Secondary Prevention in Patients With Stroke Versus Myocardial Infarction: Analysis of 2 National Cohorts. Journal Of The American Heart Association 2024, 13: e033322. PMID: 38639369, PMCID: PMC11179946, DOI: 10.1161/jaha.123.033322.Peer-Reviewed Original ResearchMeSH KeywordsAgedAntihypertensive AgentsBlood PressureCross-Sectional StudiesFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedMyocardial InfarctionPlatelet Aggregation InhibitorsPractice Guidelines as TopicRisk AssessmentRisk FactorsSecondary PreventionStrokeUnited KingdomUnited StatesConceptsMyocardial infarctionPrevention scoreSecondary preventionImplementation of preventive therapyNational cohortUK BiobankAntiplatelet therapy useGuideline-directed therapyPrevention profilesBlood pressure controlAdherence to guideline-directed therapyLow-density lipoprotein controlNeighborhood deprivation levelHistory of strokeVascular risk profileStatin useAntiplatelet useTherapy usePreventive therapyComparison to participantsPrevention criteriaCross-sectional analysisBlood pressurePatientsPressure control
2021
Primary Care of Adult Patients After Stroke: A Scientific Statement From the American Heart Association/American Stroke Association
Kernan WN, Viera AJ, Billinger SA, Bravata DM, Stark SL, Kasner SE, Kuritzky L, Towfighi A, Arteriosclerosis T. Primary Care of Adult Patients After Stroke: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2021, 52: e558-e571. PMID: 34261351, DOI: 10.1161/str.0000000000000382.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAmerican Heart AssociationHumansMiddle AgedPrimary Health CareStrokeUnited StatesConceptsRecurrent strokePoststroke carePrimary careAmerican Heart Association/American Stroke AssociationOngoing functional impairmentPatient-centered primary careAmerican Stroke AssociationHigh blood pressureEvidence-based carePrimary care practicesPrimary care teamsPatient-centered careQuality of lifePoststroke managementLifestyle modificationAdult patientsLate complicationsQuality improvement strategiesBlood pressureAtrial fibrillationCarotid stenosisStroke AssociationOngoing careRisk factorsCare team
2020
Adherence to study drug in a stroke prevention trial"?>
Kiran A, Viscoli CM, Furie KL, Gorman M, Kernan WN. Adherence to study drug in a stroke prevention trial"?>. Journal Of Stroke And Cerebrovascular Diseases 2020, 29: 105048. PMID: 32912514, PMCID: PMC7487071, DOI: 10.1016/j.jstrokecerebrovasdis.2020.105048.Peer-Reviewed Original ResearchConceptsRate of discontinuationStudy drugDrug holidayTreatment groupsActive study drugAdverse effectsInsulin Resistance InterventionPremature drug discontinuationRecent ischemic strokeStroke Prevention TrialDouble-blind trialTransient ischemic attackClinical trial researchPhases of adherenceDrug discontinuationIschemic attackStroke preventionDiscontinuation ratesIschemic strokeActive therapyMedical therapyPatient adherencePrevention trialsStroke trialsPharmacodynamic effects
2019
Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity
Dearborn JL, Viscoli CM, Young LH, Gorman MJ, Furie KL, Kernan WN. Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity. Stroke 2019, 50: 713-717. PMID: 30786849, PMCID: PMC6391736, DOI: 10.1161/strokeaha.118.024008.Peer-Reviewed Original ResearchConceptsTransient ischemic attackBody mass indexProportion of patientsIschemic strokeMass indexVascular eventsBaseline weightWeight lossAchievement of guidelineDays of randomizationRecent ischemic strokeAcute ischemic strokeFuture vascular eventsIschemic attackPlacebo groupObese patientsDiabetes mellitusMedian ageTrial entryIRIS trialMedian timeFunctional outcomeInsulin resistanceClinical trialsPatients
2017
Targeting Pioglitazone Hydrochloride Therapy After Stroke or Transient Ischemic Attack According to Pretreatment Risk for Stroke or Myocardial Infarction
Kernan WN, Viscoli CM, Dearborn JL, Kent DM, Conwit R, Fayad P, Furie KL, Gorman M, Guarino PD, Inzucchi SE, Stuart A, Young LH. Targeting Pioglitazone Hydrochloride Therapy After Stroke or Transient Ischemic Attack According to Pretreatment Risk for Stroke or Myocardial Infarction. JAMA Neurology 2017, 74: 1319-1327. PMID: 28975241, PMCID: PMC5710663, DOI: 10.1001/jamaneurol.2017.2136.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic attackMyocardial infarctionIschemic strokeHigh riskPioglitazone groupInsulin resistanceLower riskCox proportional hazards regression modelProportional hazards regression modelsMedian riskEfficacy of pioglitazoneInsulin Resistance InterventionQualifying ischemic strokePlacebo-controlled trialHazards regression modelsLow baseline riskType 2 diabetesGreater absolute benefitDay of entryFuture strokeHydrochloride therapyPlacebo groupHazard ratioSecondary preventionPioglitazone Prevents Stroke in Patients With a Recent Transient Ischemic Attack or Ischemic Stroke
Yaghi S, Furie KL, Viscoli CM, Kamel H, Gorman M, Dearborn J, Young LH, Inzucchi SE, Lovejoy AM, Kasner SE, Conwit R, Kernan WN. Pioglitazone Prevents Stroke in Patients With a Recent Transient Ischemic Attack or Ischemic Stroke. Circulation 2017, 137: 455-463. PMID: 29084736, DOI: 10.1161/circulationaha.117.030458.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic strokeIschemic attackNondiabetic patientsStroke outcomeStroke eventsInsulin resistanceRecent transient ischemic attackCox proportional hazards modelQualifying ischemic strokeEffect of pioglitazoneFirst stroke eventProportional hazards modelPrevents strokeHemorrhagic eventsComposite outcomeSecondary preventionRecent strokeIRIS trialMyocardial infarctionTreatment groupsHazards modelPioglitazoneConsensus criteriaSurvival analysisEffects of pioglitazone on cognitive function in patients with a recent ischaemic stroke or TIA: a report from the IRIS trial
Furie KL, Viscoli CM, Gorman M, Ford GA, Young LH, Inzucchi SE, Guarino PD, Lovejoy AM, Conwit R, Tanne D, Kernan WN. Effects of pioglitazone on cognitive function in patients with a recent ischaemic stroke or TIA: a report from the IRIS trial. Journal Of Neurology Neurosurgery & Psychiatry 2017, 89: 21. PMID: 28939682, DOI: 10.1136/jnnp-2017-316361.Peer-Reviewed Original ResearchConceptsTransient ischemic attackRecent ischemic strokeIschemic strokeCognitive functionHomeostasis model assessment insulin resistance scoreModified Mini-Mental State Examination scoresAssessment-insulin resistance scoreMini-Mental State Examination scoreInsulin Resistance InterventionPoststroke cognitive functionVascular risk factorsEffect of pioglitazoneInsulin-resistant patientsState Examination scoreIschemic attackPioglitazone groupPlacebo groupIRIS trialStroke trialsCerebrovascular diseaseInsulin resistanceRisk factorsCognitive dysfunctionPatientsResistance InterventionSmoking cessation and outcome after ischemic stroke or TIA
Epstein KA, Viscoli CM, Spence JD, Young LH, Inzucchi SE, Gorman M, Gerstenhaber B, Guarino PD, Dixit A, Furie KL, Kernan WN, Bladin C, Davis S, Wijeratne T, Levi C, Parsons M, Brodtmann A, Ng S, Archer J, Delcourt C, Winder T, Berger L, Boulanger J, Chan R, Spence J, Durocher A, Mackey A, Verreault S, Minuk J, Penn A, Shuaib A, Cote R, Selchen D, Bayer N, Sweet M, Malik S, Stotts G, Griewing B, Soda H, Weinhardt R, Berrouschot J, Stoll A, Witte O, Günther A, Bodechtel U, Schminke U, Hobohm C, Hetzel A, Lambeck J, Wartenberg K, Huttner H, Dittrich R, Nabavi D, Gröschel K, Thomalla G, Rosenkranz M, Jander S, Meisel A, Ludolph A, Althaus K, Huber R, Lorenz M, Tanne D, Merzlyak O, Bornstein N, Telman G, Lampl Y, Streifler J, Weller B, Ifergane G, Wirgin Y, Carolei A, Toni D, Stanzione P, Micieli G, Agnelli G, Caso V, Gandolfo C, Comi G, Consoli D, Rasura M, Di Lazzaro V, Dixit A, Jupp B, Shaw L, Salih I, Esisi B, Power M, Strain W, Elyas S, Manawadu D, Kalra L, O'Brien E, Warburton E, Chatterjee K, Hargroves D, Blight A, Moynihan B, Markus H, Macleod M, Broughton D, Rodgers H, Hlaing T, Muir S, Sajid M, Bath P, Price C, Sekaran L, Vahidassr D, Muir K, McIlmoyle J, Datta P, Davey R, Langhorne P, Stott D, Datta P, England T, Muhidden K, O'Connell J, Majmudar N, Schindler J, Clark W, Sethi P, Rordorf G, Kleindorfer D, Silliman S, Gorman M, Kelly M, Singleton L, Meyer B, Jackson C, Walker J, Ehtisham A, Goodpasture H, Wang D, Fayad P, Cordina S, Naritoku D, Chiu D, Lukovits T, Goddeau R, Clark‐Arbogast R, Leigh R, Wityk R, Pettigrew L, Tayal A, Jarouse J, Friday G, Sen S, Kim A, Johnston S, Elkins J, Barrett A, Leira E, Kelly A, Burgin S, Rempe D, Jacoby M, Hughes D, Majersik J, Skalabrin E, Lee J, Hsu C, Sundararajan S, Slivka A, Minagar A, Alicic R, Geraghty M, Kase C, Lansberg M, Albers G, Dietrich D, Hanna J, Gentile N, Santiago F, Katzan I, Ching M, Sawyer, Warwick T, Yilmaz E, Pedelty L, Schneck M, Coull B, Solenski N, Johnston K, Lee V, Prabhakaran S, Johnson M, Silverman I, Salgado M, Birkhahn R, Strawsburg R, Altafullah I, Cohen D, Zweifler R, Lee Kwen P, Hammer M, Vora N, Tietjen G, Albakri E, Dandapani B, Jickling G, Verro P, Roller M, Hughes R, Simpson J, Vidic T, Lash S, Sigsbee B, Rosenbaum D, Fonzetti P, Fleck J, Goldszmidt A, Alexandrov A, Halsey J, Hart R, Sattin J, Kumar S, Book D, Torbey M, Poock J, King M, Graham G, Sung G, Mirsen T, Dromerick A, Runheim A, Jackson C, Feen E, Reichwein R, Waters M, Amory C, Bernardini G, Bell R, Diamond B, Rosenbaum D, Palestrant D, Segal A, Burger K, Schwartz R, Mitsias P, Kramer J, Kramer J, Robbins D, Silver B, Easton J, Feldmann E, Rymer M, Dorssom J, Ali L, Ovbiagele B, Kirshner H. Smoking cessation and outcome after ischemic stroke or TIA. Neurology 2017, 89: 1723-1729. PMID: 28887378, PMCID: PMC5644463, DOI: 10.1212/wnl.0000000000004524.Peer-Reviewed Original ResearchConceptsMyocardial infarctionIschemic strokeIndex eventProspective observational cohort studyInsulin Resistance InterventionHistory of hypertensionObservational cohort studyDiastolic blood pressureHistory of strokeCoronary artery diseaseTime of randomizationTobacco use historySignificant health benefitsRecurrent strokeNondiabetic menCohort studyCurrent smokersTrial cohortArtery diseaseBlood pressurePrimary outcomeIRIS trialStroke trialsCigarette smokingSmoking cessationCardiac Outcomes After Ischemic Stroke or Transient Ischemic Attack
Young LH, Viscoli CM, Curtis JP, Inzucchi SE, Schwartz GG, Lovejoy AM, Furie KL, Gorman MJ, Conwit R, Abbott JD, Jacoby DL, Kolansky DM, Pfau SE, Ling FS, Kernan WN. Cardiac Outcomes After Ischemic Stroke or Transient Ischemic Attack. Circulation 2017, 135: 1882-1893. PMID: 28246237, PMCID: PMC5511545, DOI: 10.1161/circulationaha.116.024863.Peer-Reviewed Original ResearchConceptsAcute coronary syndromeType 1 myocardial infarctionTransient ischemic attackMyocardial infarctionCoronary syndromeInsulin resistanceIschemic attackIschemic strokeDiabetes mellitusSerum troponinAcute coronary syndrome episodeMean age 63 yearsAcute coronary syndrome eventIndependent clinical events committeeType 2 myocardial infarctionIRIS participantsImpact of pioglitazoneRecent cerebrovascular eventsRecent ischemic strokeClinical events committeeAge 63 yearsEffect of pioglitazoneSmall myocardial infarctionCoronary artery diseaseST-segment elevation
2016
Pioglitazone and Risk for Bone Fracture: Safety Data From a Randomized Clinical Trial
Viscoli CM, Inzucchi SE, Young LH, Insogna KL, Conwit R, Furie KL, Gorman M, Kelly MA, Lovejoy AM, Kernan WN, Investigators F. Pioglitazone and Risk for Bone Fracture: Safety Data From a Randomized Clinical Trial. The Journal Of Clinical Endocrinology & Metabolism 2016, 102: 914-922. PMID: 27935736, PMCID: PMC5460686, DOI: 10.1210/jc.2016-3237.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic strokeFracture riskBone fracturesRisk/benefit ratioAbsolute fracture riskInsulin Resistance InterventionPlacebo-treated patientsIschemic attackNondiabetic patientsPlacebo groupCardiovascular riskBone healthStroke trialsNondiabetic participantsPrevent fallsClinical trialsRelative riskSafety dataFracture classificationQuarterly interviewsPioglitazonePatientsResistance InterventionRisk incrementTaking care of volunteers in a stroke trial: a new assisted-management strategy
Stuart AC, Sico JJ, Viscoli CM, Tayal AH, Inzucchi SE, Ford GA, Furie KL, Cote R, Spence JD, Tanne D, Kernan WN. Taking care of volunteers in a stroke trial: a new assisted-management strategy. Stroke And Vascular Neurology 2016, 1: 108. PMID: 28959471, PMCID: PMC5435205, DOI: 10.1136/svn-2016-000029.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnticholesteremic AgentsAntihypertensive AgentsBiomarkersBlood CoagulationBlood PressureCholesterol, LDLDouble-Blind MethodEuropeFemaleFibrinolytic AgentsHumansHypoglycemic AgentsInsulin ResistanceIschemic Attack, TransientIschemic StrokeIsraelMaleMiddle AgedNorth AmericaPioglitazoneRecurrenceRisk AssessmentRisk FactorsRisk Reduction BehaviorSecondary PreventionTime FactorsTreatment OutcomeConceptsPersonal healthcare providerBlood pressureStroke trialsPreventive careTrial participantsLow-density lipoprotein cholesterolPrevention goalsInsulin Resistance InterventionTransient ischemic attackPrevention of strokeSecondary prevention goalsEvidence-based careProportion of participantsIschemic attackAntithrombotic therapyIschemic strokeLipoprotein cholesterolSecondary preventionAntithrombotic useStroke therapyInsulin sensitisersMyocardial infarctionAnnual visitsHealthcare providersResistance InterventionPioglitazone Prevents Diabetes in Patients With Insulin Resistance and Cerebrovascular Disease.
Inzucchi SE, Viscoli CM, Young LH, Furie KL, Gorman M, Lovejoy AM, Dagogo-Jack S, Ismail-Beigi F, Korytkowski MT, Pratley RE, Schwartz GG, Kernan WN. Pioglitazone Prevents Diabetes in Patients With Insulin Resistance and Cerebrovascular Disease. Diabetes Care 2016, 39: 1684-92. PMID: 27465265, PMCID: PMC5033078, DOI: 10.2337/dc16-0798.Peer-Reviewed Original ResearchConceptsTransient ischemic attackRecent ischemic strokeInsulin resistanceIschemic strokeHOMA-IRInsulin Resistance InterventionMajor cardiovascular eventsMean HOMA-IRHistory of diabetesSubsequent ischemic eventsHomeostasis model assessmentRisk of diabetesΜIU/mLFPG testingPioglitazone groupCardiovascular eventsIschemic attackPlacebo groupFirst medicationIschemic eventsMean FPGDiabetes onsetDiabetes preventionCerebrovascular diseaseStroke trialsPioglitazone after Ischemic Stroke or Transient Ischemic Attack
Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, Guarino PD, Lovejoy AM, Peduzzi PN, Conwit R, Brass LM, Schwartz GG, Adams HP, Berger L, Carolei A, Clark W, Coull B, Ford GA, Kleindorfer D, O'Leary JR, Parsons MW, Ringleb P, Sen S, Spence JD, Tanne D, Wang D, Winder TR. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. New England Journal Of Medicine 2016, 374: 1321-1331. PMID: 26886418, PMCID: PMC4887756, DOI: 10.1056/nejmoa1506930.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic strokeInsulin resistanceMyocardial infarctionIschemic attackPrimary outcomeRecent ischemic strokeDouble-blind trialFuture cardiovascular eventsHomeostasis model assessmentInsulin resistance indexRisk of strokeEligible patientsNonfatal strokePioglitazone groupCardiovascular eventsCause mortalityPlacebo groupPreventive therapyCerebrovascular diseaseInsulin sensitivityRisk factorsResistance indexHigh riskLower risk
2008
Disagreement Between Students and Preceptors Regarding the Value of Teaching Behaviors for Ambulatory Care Settings
Kernan WN, Hershman W, Alper EJ, Lee MY, Viscoli CM, Perry JR, O'Connor PG. Disagreement Between Students and Preceptors Regarding the Value of Teaching Behaviors for Ambulatory Care Settings. Teaching And Learning In Medicine 2008, 20: 143-150. PMID: 18444201, DOI: 10.1080/10401330801991667.Peer-Reviewed Original ResearchConceptsPercentage of studentsTeaching behaviorsTeaching effectivenessU.S. schoolsClinical instructionMedical studentsStudentsPreceptorsDelegate responsibilityAmbulatory care settingsEarly negotiationsMutual satisfactionSchoolsInstructionLearningHistory takingAmbulatory careResponsibilityDiscussionRespondentsSatisfactionNegotiationsPurposeSettingTaking
2005
Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive Sleep Apnea as a Risk Factor for Stroke and Death. New England Journal Of Medicine 2005, 353: 2034-2041. PMID: 16282178, DOI: 10.1056/nejmoa043104.Peer-Reviewed Original ResearchConceptsObstructive sleep apnea syndromeSleep apnea syndromeApnea-hypopnea indexMean apnea-hypopnea indexRisk of strokeApnea syndromeRisk factorsSleep apneaComposite end pointObservational cohort studyObstructive sleep apneaProportional hazards analysisComparison groupAlcohol consumption statusBody mass indexImportant risk factorCohort studyComposite outcomeConsecutive patientsDiabetes mellitusSmoking statusAtrial fibrillationUnadjusted analysesSyndromePatientsAltruism as a reason for participation in clinical trials was independently associated with adherence
Rosenbaum JR, Wells CK, Viscoli CM, Brass LM, Kernan WN, Horwitz RI. Altruism as a reason for participation in clinical trials was independently associated with adherence. Journal Of Clinical Epidemiology 2005, 58: 1109-1114. PMID: 16223653, DOI: 10.1016/j.jclinepi.2005.03.014.Peer-Reviewed Original ResearchConceptsClinical trialsBetter functional statusStudy medicationMedical regimenRecruitment of participantsClinical featuresStroke trialsFunctional statusWomen's EstrogenStratified analysisMultivariable regressionClinical researchEstrogenTrialsAdherenceBaseline featuresSocial supportFurther investigationWomenParticipantsAltruistic reasonsPossible contributionHigh levelsPlaceboMedicationsMajor Risk Factors for Intracerebral Hemorrhage in the Young Are Modifiable
Feldmann E, Broderick JP, Kernan WN, Viscoli CM, Brass LM, Brott T, Morgenstern LB, Wilterdink JL, Horwitz RI. Major Risk Factors for Intracerebral Hemorrhage in the Young Are Modifiable. Stroke 2005, 36: 1881-1885. PMID: 16081867, DOI: 10.1161/01.str.0000177480.62341.6b.Peer-Reviewed Original ResearchConceptsPrimary intracerebral hemorrhageIntracerebral hemorrhageMajor risk factorRisk factorsHemorrhagic strokeCase subjectsIndependent risk factorHistory of strokeCurrent cigarette smokingCase-control studyType of strokeMultivariate regression analysisCigarette smokingStroke ProjectControl subjectsStructural lesionsArteriovenous malformationsBrain lesionsEligibility criteriaStrokeYoung menAlcoholic drinksFurther studiesHemorrhageMenopauseAssociation between Impaired Insulin Sensitivity and Stroke
Bravata DM, Wells CK, Kernan WN, Concato J, Brass LM, Gulanski BI. Association between Impaired Insulin Sensitivity and Stroke. Neuroepidemiology 2005, 25: 69-74. PMID: 15947493, DOI: 10.1159/000086286.Peer-Reviewed Original ResearchConceptsHomeostasis model assessmentInsulin sensitivityGlycemic controlMultivariable logistic regression analysisStroke risk factorsLower insulin sensitivityThird National HealthImpaired insulin sensitivityLogistic regression analysisStroke historyInsulin resistancePlasma insulinPlasma glucoseRisk factorsNational HealthNutrition SurveyModel assessmentStrokeRegression analysisAssociationParticipantsClaudicationInsulinRacial Disparities in Stroke Risk Factors
Bravata DM, Wells CK, Gulanski B, Kernan WN, Brass LM, Long J, Concato J. Racial Disparities in Stroke Risk Factors. Stroke 2005, 36: 1507-1511. PMID: 15961710, DOI: 10.1161/01.str.0000170991.63594.b6.Peer-Reviewed Original ResearchConceptsStroke risk factorsRisk factorsStroke historyHigh prevalenceLow high-density lipoprotein cholesterolHigher C-reactive proteinHigh-density lipoprotein cholesterolCommunity-dwelling stroke survivorsC-reactive proteinThird National HealthSevere strokeLipoprotein cholesterolMyocardial infarctionNational HealthStroke survivorsNutrition SurveyHigh incidenceUS populationStrokeOlder ageCross-sectional samplePrevalenceRacial disparitiesEthnic differencesAssociation