The Meyers Primary Care Institute (MPCI) was established in 1996, as a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group (previously Fallon Clinic), and Fallon Community Health Plan. The MPCI is committed to research across the lifespan, from childhood to advanced age. We conduct population-based research to inform policy and practice, promoting evidence-based care for the benefit of our community, and beyond. Our team is comprised of a multidisciplinary group of investigators and educators, who focus on the following topic areas: Patient safety and quality improvement; Communication in healthcare; Organization and delivery of healthcare; Healthcare policy; Epidemiology of chronic diseases; Pharmacoepidemiology and medication safety; Comparative effectiveness research.

The Meyers Primary Care Institute honors the memory of Dr. John Meyers, who served as President of Fallon Clinic from 1966-1982, and President of Fallon Community Health Plan from 1976-1985. He was an esteemed member of the faculty of the University of Massachusetts Medical School. Dr. Meyers was highly regarded as a physician leader, a caring clinician, a well-respected scholar, and an accomplished artist.

This collection showcases journal articles and other publications and presentations authored by Meyers faculty.

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Publications from 2002

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Challenges of estimating health service utilization for osteoarthritis patients on a population level, Leslie R. Harrold, Robert A. Yood, Walter Straus, Susan E. Andrade, John I. Reed, Jackie Cernieux, Barbara E. Lewis, and Jerry H. Gurwitz

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Changes over time in the use of aspirin in patients hospitalized with acute myocardial infarction (1975 to 1997): a population-based perspective, Elizabeth A. Jackson, Ramya Sivasubramian, Frederick A. Spencer, Jorge L. Yarzebski, Darleen M. Lessard, Joel M. Gore, and Robert J. Goldberg

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A model of community-based interdisciplinary team training in the care of the frail elderly., Mary Ellen Keough, Terry S. Field, and Jerry H. Gurwitz

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The impact of a brief interclerkship about substance abuse on medical students' skills, Julia Matthews, William Kadish, Susan V. Barrett, Kathleen M. Mazor, Deborah Field, and Julie A. Jonassen

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Managed care education: what medical students are telling us., Kathleen M. Mazor, Eric G. Campbell, Terry S. Field, Urip Purwono, Dawn Peterson, John H. Lockwood, Joel Weissman, and Jerry H. Gurwitz

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A demonstration of the impact of response bias on the results of patient satisfaction surveys, Kathleen M. Mazor, Brian E. Clauser, Terry S. Field, Robert A. Yood, and Jerry H. Gurwitz

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What do medicine clerkship preceptors do best, Kathleen M. Mazor, Sarah L. Stone, Michele M. Carlin, and Eric J. Alper

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Does hysterectomy without adnexectomy in patients with prior tubal interruption increase the risk of subsequent hydrosalpinx, Abraham N. Morse, Robert A. Hammer, Andrew J. Walter, Stephen P. Baker, and Paul M. Magtibay

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Use of emergency medical services for suspected acute cardiac ischemia among demographic and clinical patient subgroups: the REACT trial. Rapid Early Action for Coronary Treatment, Stavroula K. Osganian, Jane G. Zapka, Henry A. Feldman, Robert J. Goldberg, Jerris R. Hedges, Mickey S. Eisenberg, James M. Raczynski, Paul G. McGovern, Lawton S. Cooper, Dilip K. Pandey, Adriana C. Linares, and Russell V. Luepker

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Caffeine, cajoling, and other strategies to maximize clinician survey response rates, Elaine Puleo, Jane G. Zapka, Mary Jo White, Judy Mouchawar, Carol Somkin, and Stephen H. Taplin

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Chronic disease score as a predictor of hospitalization, Kathleen G. Putnam, Diana S. M. Buist, Paul Fishman, Susan E. Andrade, Myde Boles, Gary A. Chase, Michael J. Goodman, Jerry H. Gurwitz, Richard Platt, Marsha A. Raebel, and K. Arnold Chan

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Using differences between perceptions of importance and competence to identify teaching needs of primary care preceptors, Mark E. Quirk, Sarah Stone, Alan Chuman, Sarah Devaney-O'Neil, Kathleen M. Mazor, Susan Starr, and Daniel H. Lasser

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Comparison of review articles published in peer-reviewed and throwaway journals., Paula A. Rochon, Lisa A. Bero, Ari M. Bay, Jennifer L. Gold, Julie M. Dergal, Malcolm A. Binns, David L. Streiner, and Jerry H. Gurwitz

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Health care for older people., Paula A. Rochon, Susan E. Bronskill, and Jerry H. Gurwitz

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Adjuvant tamoxifen prescription in women 65 years and older with primary breast cancer, Rebecca A. Silliman, Edward Guadagnoli, William Rakowski, Mary Beth Landrum, Timothy L. Lash, Robert Wolf, Aliza Fink, Patricia A. Ganz, Jerry H. Gurwitz, Catherine Borbas, and Vincent Mor

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Effectiveness of thrombolytic therapy for acute myocardial infarction in the elderly: cause for concern in the old-old., Stephen B. Soumerai, Thomas J. McLaughlin, Dennis Ross-Degnan, Cindy L. Christiansen, and Jerry H. Gurwitz

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Heterogeneity in the management and outcomes of patients with acute myocardial infarction complicated by heart failure: the National Registry of Myocardial Infarction, Frederick A. Spencer, Theo E. Meyer, Joel M. Gore, and Robert J. Goldberg

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Temporal trends and associated factors of inpatient cardiac rehabilitation in patients with acute myocardial infarction: a community-wide perspective, Frederick A. Spencer, Bobak Salami, Jorge L. Yarzebski, Darleen M. Lessard, Joel M. Gore, and Robert J. Goldberg

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Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE), Phillippe Gabriel Steg, Robert J. Goldberg, Joel M. Gore, Keith A. A. Fox, Kim A. Eagle, Marcus Flather, Immad Sadiq, Rachel Kasper, Sophie K. Rushton-Mellor, and Frederick A. Anderson

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Liver abnormalities in rheumatic diseases, Nancy J. Walker and Robert B. Zurier

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Perioperative changes in serum creatinine after gynecologic surgery, Andrew J. Walter, Paul M. Magtibay, Abraham N. Morse, Robert A. Hammer, Joseph G. Hentz, and Javier F. Magrina

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Laparoscopic versus open Burch retropubic urethropexy: comparison of morbidity and costs when performed with concurrent vaginal prolapse repairs, Andrew J. Walter, Abraham N. Morse, Robert A. Hammer, Joseph G. Hentz, Javier F. Magrina, Jeffrey L. Cornella, and Paul M. Magtibay

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Pap smear testing among homeless and very low-income housed mothers, Linda F. Weinreb, Robert J. Goldberg, and Darleen M. Lessard

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A community-wide survey of physician practices and attitudes toward cholesterol management in patients with recent acute myocardial infarction, Jorge L. Yarzebski, Carmen F. Bujor, Robert J. Goldberg, Frederick A. Spencer, Darleen M. Lessard, and Joel M. Gore

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Healthcare system factors and colorectal cancer screening, Jane G. Zapka, Elaine Puleo, Maureen Vickers-Lahti, and Roger S. Luckmann

Publications from 2001

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Death or nonfatal stroke in patients with acute myocardial infarction treated with tissue plasminogen activator. Participants in the National Registry of Myocardial Infarction 2., Brad G. Angeja, A C Rundle, Jerry H. Gurwitz, Joel M. Gore, and Hal V. Barron

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A survey of primary care physicians' perceptions and needs regarding the precepting of medical students in their offices, Robert A. Baldor, W. Blair Brooks, Marji Erickson Warfield, and Kathleen O'Shea

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Using the "Question of Scruples" game to teach managed care ethics to students, Robert A. Baldor, Terry S. Field, and Jerry H. Gurwitz

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The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2, Hal V. Barron, Nathan R. Every, Lori S. Parsons, Brad G. Angeja, Robert J. Goldberg, Joel M. Gore, and Tony M. Chou

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Educating the next generation of physicians about stroke: incorporating stroke prevention into the medical school curriculum, Susan Billings-Gagliardi, Nancy M. Fontneau, Merrill K. Wolf, Susan V. Barrett, George J. Hademenos, and Kathleen M. Mazor

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Explanations of basic medical information by students: what lay people find effective, Susan Billings-Gagliardi, Kathleen M. Mazor, and Michelle Belanger

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Outcomes and early revascularization for patients > or = 65 years of age with cardiogenic shock, Harold L. Dauerman, Robert J. Goldberg, Maciej Malinski, Jorge L. Yarzebski, Darleen M. Lessard, and Joel M. Gore

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Racial/ethnic inequities in continuity and site of care: location, location, location, Mark P. Doescher, Barry G. Saver, Kevin Fiscella, and Peter Franks

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Colorectal cancer screening in Massachusetts: measuring compliance with current guidelines, Stephen Erban, Jane G. Zapka, Elaine Puleo, and Maureen Vickers-Lahti

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Extraesophageal manifestations of gastroesophageal reflux., Stephen K. Field, Terry S. Field, and Robert L. Cowie

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Risk factors for adverse drug events among nursing home residents., Terry S. Field, Jerry H. Gurwitz, Jerry Avorn, Danny McCormick, Shailavi Jain, Marie A. Eckler, Marcia Benser, and David W. Bates

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Adherence to asthma therapy, Leslie S. Fish and Colleen Lum Lung

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Circulating monocyte-platelet aggregates are an early marker of acute myocardial infarction, Mark I. Furman, Marc R. Barnard, Lori A. Krueger, Marsha L. Fox, Elizabeth A. Shilale, Darleen M. Lessard, Peter Marchese, Andrew L. Frelinger, Robert J. Goldberg, and Alan D. Michelson

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Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non-Q-wave myocardial infarction: a multi-hospital, community-wide perspective, Mark I. Furman, Harold L. Dauerman, Robert J. Goldberg, Jorge L. Yarzebski, Darleen M. Lessard, and Joel M. Gore

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Recent magnitude of and temporal trends (1994-1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: the second national registry of myocardial infarction., Robert J. Goldberg, Joel M. Gore, Craig A. Thompson, and Jerry H. Gurwitz

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Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes, GRACE Investigators

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The treating physician as active gatekeeper in the recruitment of research subjects., Jerry H. Gurwitz, Edward Guadagnoli, Mary Beth Landrum, Rebecca A. Silliman, Robert Wolf, and Jane C. Weeks

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Identification of factors that influence the likelihood of screening for domestic violence by medical students and residents, Julie A. Jonassen, Kathleen M. Mazor, and Laura A. Sefton

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Population-based study of rotavirus vaccination and intussusception, Poitr Kramarz, Eric K. France, Frank Destefano, Steven B. Black, Henry Shinefield, Joel I. Ward, Emily J. Chang, Robert T. Chen, Deborah Shatin, Jerrold Hill, Tracy Lieu, John M. Ogren, Jerry H. Gurwitz, Susan E. Andrade, and Jackie Cernieux

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Colorectal cancer screening participation: comparisons with mammography and prostate-specific antigen screening, Stephenie C. Lemon, Jane G. Zapka, Elaine Puleo, Roger S. Luckmann, and Lisa Chasan-Taber

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Review: advice from doctors and nurses, behavioural interventions, nicotine replacement treatment, and several pharmacological treatments increase smoking cessation rates, Roger S. Luckmann

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Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction., Sumit R. Majumdar, Thomas S. Inui, Jerry H. Gurwitz, Matthew W. Gillman, Thomas J. McLaughlin, and Stephen B. Soumerai

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Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting., Danny McCormick, Jerry H. Gurwitz, Robert J. Goldberg, Richard C. Becker, Janet P. Tate, Anne Elwell, and Martha J. Radford

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Multicenter epidemiologic and health services research on therapeutics in the HMO Research Network Center for Education and Research on Therapeutics., Richard Platt, Robert L. Davis, Jonathan A. Finkelstein, Alan S. Go, Jerry H. Gurwitz, Douglas W. Roblin, Stephen B. Soumerai, Dennis Ross-Degnan, Susan E. Andrade, Michael J. Goodman, Brian C. Martinson, Marsha A. Raebel, David H. Smith, Marianne Ulcickas Yood, and K. Arnold Chan

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Age and the utilization of cardiac catheterization following uncomplicated first acute myocardial infarction treated with thrombolytic therapy (The Second National Registry of Myocardial Infarction [NRMI-2]), Frederick A. Spencer, Robert J. Goldberg, Paul D. Frederick, Judith A. Malmgren, Richard C. Becker, and Joel M. Gore

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Decade-long trends (1986 to 1997) in the medical treatment of patients with acute myocardial infarction: A community-wide perspective, Frederick A. Spencer, George Scleparis, Robert J. Goldberg, Jorge L. Yarzebski, Darleen M. Lessard, and Joel M. Gore

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HIV in primary care: an educational initiative for child health providers, Christopher J. Stille, Virginia Berrien, and Peter J. Krause

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A simple provider-based educational intervention to boost infant immunization rates: a controlled trial, Christopher J. Stille, Joan Christison-Lagay, Bruce A. Bernstein, and Paul H. Dworkin

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Treatment of Felty's syndrome with leflunomide, Frederick Talip, Nancy J. Walker, Waseem Kahn, and Bernard Zimmermann

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Patient education provided to asthmatic children: a historical cohort study of the implementation of NIH recommendations, Alexandra Ward, Cynthia J. Willey, and Susan E. Andrade

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Risk and reluctance: understanding impediments to colorectal cancer screening, Elissa R. Weitzman, Jane G. Zapka, Barbara B. Estabrook, and Karin V. Goins

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Temporal trends (1986-1997) in cholesterol level assessment and management practices in patients with acute myocardial infarction: a population-based perspective, Jorge L. Yarzebski, Frederick A. Spencer, Robert J. Goldberg, Darleen M. Lessard, and Joel M. Gore

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Prevention of glucocorticoid-induced osteoporosis: experience in a managed care setting., Robert A. Yood, Leslie R. Harrold, Leslie S. Fish, Jackie Cernieux, Srinivas Emani, Elisabeth Conboy, and Jerry H. Gurwitz

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The silent consumer: women's reports and ratings of abortion services, Jane G. Zapka, Stephenie C. Lemon, Laura E. Peterson, Heather Palmer, and Marlene B. Goldman

Publications from 2000

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Pharmacoepidemiology and the Elderly, Susan E. Andrade and Jerry H. Gurwitz

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Evaluation of a formulary switch from conjugated to esterified estrogens in a managed care setting, Susan E. Andrade, Jerry H. Gurwitz, Jackie Cernieux, and Leslie S. Fish

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Intracranial hemorrhage rates and effect of immediate beta-blocker use in patients with acute myocardial infarction treated with tissue plasminogen activator. Participants in the National Registry of Myocardial Infarction-2., Hal V. Barron, Amy Chen Rundle, Joel M. Gore, Jerry H. Gurwitz, and Jan Penney

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Discrepancies in the use of medications: their extent and predictors in an outpatient practice, Susanna E. Bedell, Samer Jabbour, Robert J. Goldberg, Helene Glaser, Susan Gobble, Yinong Young-Xu, Thomas B. Graboys, and Shmuel Ravid

Which patients are treated for glaucoma? An observational analysis., Rhonda L. Bohn, Jerry H. Gurwitz, Susan M. Yeomans, Robert J. Glynn, L. R. Pasquale, A. M. Walker, and Jerry Avorn

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Intracranial hemorrhage associated with thrombolytic therapy for elderly patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project., Lawrence M. Brass, Judith H. Lichtman, Yun Wang, Jerry H. Gurwitz, Martha J. Radford, and Harlan M. Krumholz

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Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Rapid Early Action for Coronary Treatment (REACT) study, Adam L. Brown, N.Clay Mann, Mohamud Daya, Robert J. Goldberg, Hendrika Meischke, Judy Taylor, Kevin Smith, Stavroula K. Osganian, and Lawton S. Cooper

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Inhibitors of hydroxymethylglutaryl-coenzyme A reductase and risk of fracture among older women, K. Arnold Chan, Susan E. Andrade, Myde Boles, Diana S. M. Buist, Gary A. Chase, James G. Donahue, Michael J. Goodman, Jerry H. Gurwitz, Andrea Z. LaCroix, and Richard Platt

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Six-year effect of depressive symptoms on the course of physical disability in community-living older adults., Diane Cronin-Stubbs, Carlos F. Mendes de Leon, Laurel A. Beckett, Terry S. Field, Robert J. Glynn, and Denis A. Evans

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Ten-year trends in the incidence, treatment, and outcome of Q-wave myocardial infarction, Harold L. Dauerman, Darleen M. Lessard, Jorge L. Yarzebski, Mark I. Furman, Joel M. Gore, and Robert J. Goldberg

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Physicians' advice to quit smoking. The glass remains half empty, Mark P. Doescher and Barry G. Saver

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Racial and ethnic disparities in perceptions of physician style and trust, Mark P. Doescher, Barry G. Saver, Peter Franks, and Kevin Fiscella

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Monitoring trends in severity of acute myocardial infarction: challenges for the next millennium, Robert J. Goldberg

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Age and sex differences in presentation of symptoms among patients with acute coronary disease: the REACT Trial. Rapid Early Action for Coronary Treatment, Robert J. Goldberg, David Goff, Lawton S. Cooper, Russell V. Luepker, Jane G. Zapka, Vera Bittner, Stavroula K. Osganian, Darleen M. Lessard, Carol E. Cornell, Angela Meshack, N.Clay Mann, Janice Gilliland, and Henry A. Feldman

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Improving discussion of surgical treatment options for patients with breast cancer: local medical opinion leaders versus audit and performance feedback., Edward Guadagnoli, Stephen B. Soumerai, Jerry H. Gurwitz, Catherine Borbas, Charles L. Shapiro, Jane C. Weeks, and Nora Morris

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Incidence and preventability of adverse drug events in nursing homes., Jerry H. Gurwitz, Terry S. Field, Jerry Avorn, Danny McCormick, Shailavi Jain, Marie A. Eckler, Marcia Benser, Amy C. Edmondson, and David W. Bates

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Considerations in designing an ideal medication-use system: lessons from caring for the elderly., Jerry H. Gurwitz and Paula A. Rochon

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The diffusion of a novel therapy into clinical practice: the case of sildenafil, Leslie R. Harrold, Jerry H. Gurwitz, Terry S. Field, Susan E. Andrade, Leslie S. Fish, P. David Jarry, and Robert A. Yood

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Evaluating the predictive value of osteoarthritis diagnoses in an administrative database., Leslie R. Harrold, Robert A. Yood, Susan E. Andrade, John I. Reed, Jackie Cernieux, Walter Straus, Mary Weeks, Barbara E. Lewis, and Jerry H. Gurwitz

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Impact of community intervention to reduce patient delay time on use of reperfusion therapy for acute myocardial infarction: rapid early action for coronary treatment (REACT) trial. REACT Study Group, Jerris R. Hedges, Henry A. Feldman, Vera Bittner, Robert J. Goldberg, Jane G. Zapka, Stavroula K. Osganian, David M. Murray, Denise G. Simons-Morton, Adriana C. Linares, Janet Williams, Russell V. Luepker, and Mickey S. Eisenberg

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An investigation of the impacts of different generalizability study designs on estimates of variance components and generalizability coefficients, L. A. Keller, Kathleen M. Mazor, H. Swaminathan, and Michele P. Pugnaire

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Disclosing the truth: informed participation in the Antemortem Database Project for Survivors of Srebrenica, Mary Ellen Keough, Sara Kahn, and Andrej Andrejevic

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Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial, Russell V. Luepker, James M. Raczynski, Stavroula K. Osganian, Robert J. Goldberg, John R. Finnegan, Jerris R. Hedges, David C. Goff, Mickey S. Eisenberg, Jane G. Zapka, Henry A. Feldman, Darwin R. Labarthe, Paul G. McGovern, Carol E. Cornell, Michael A. Proschan, and Denise G. Simons-Morton

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The emergency department experience of chest pain patients and their intention to delay care seeking for acute myocardial infarction, Hendrika Meischke, Paul Mitchell, Jane G. Zapka, David C. Goff Jr., Kevin Smith, Daniel Henwood, Clay Mann, Kathleen Lovell, Elaine J. Stone, and Judy Taylor

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Factors that influence personal perceptions of the risk of an acute myocardial infarction, Hendrika Meischke, Deborah E. Sellers, Mark L. Robbins, David C. Goff Jr., Mohamud Daya, Angela Meshack, Judy Taylor, Jane G. Zapka, and Mary McDonald Hand

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Rate of heart failure and 1-year survival for older people receiving low-dose beta-blocker therapy after myocardial infarction., Paula A. Rochon, Jack V. Tu, Geoffrey M. Anderson, Jerry H. Gurwitz, Jocalyn P. Clark, Paula Lau, John Paul Szalai, Kathy Sykora, and C. David Naylor

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Determining immunization rates for inner-city infants: statewide registry data vs medical record review, Christopher J. Stille and Joan Christison-Lagay

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Changes over time in the incidence and case-fatality rates of primary ventricular fibrillation complicating acute myocardial infarction: perspectives from the Worcester Heart Attack Study, Craig A. Thompson, Jorge L. Yarzebski, Robert J. Goldberg, Darleen M. Lessard, Joel M. Gore, and James E. Dalen

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Geriatric Pharmacology, Robert E. Vestal and Jerry H. Gurwitz

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National Heart Attack Alert Program position paper: chest pain centers and programs for the evaluation of acute cardiac ischemia, Robert J. Zalenski, Harry P. Selker, Christopher P. Cannon, Helke M. Farin, W.Brian Gibler, Robert J. Goldberg, Costas T. Lambrew, Joseph P. Ornato, Robert J. Rydman, and Pamela Steele

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Commentary: On Finding Common Ground – Health Promotion in Clinical Practice, Jane G. Zapka

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Cancer control knowledge, attitudes, and perceived skills among medical students, Jane G. Zapka, Roger S. Luckmann, Sandra I. Sulsky, Karin V. Goins, Carol Bigelow, Kathleen M. Mazor, and Mark E. Quirk

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Missed opportunities to impact fast response to AMI symptoms, Jane G. Zapka, J. Michael Oakes, Denise G. Simons-Morton, N.Clay Mann, Robert J. Goldberg, Deborah E. Sellers, Barbara Estabrook, Janice Gilliland, Adriana C. Linares, Ruby Benjamin-Garner, and Paul G. McGovern

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Smoking cessation counseling with pregnant and postpartum women: a survey of community health center providers, Jane G. Zapka, Lori Pbert, Anne M. Stoddard, Judith K. Ockene, Karin V. Goins, and Debra Bonollo

Publications from 1999

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The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: the case of H2-receptor antagonists, Susan E. Andrade, Jerry H. Gurwitz, and Leslie S. Fish

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Effectiveness of antihyperlipidemic drug management in clinical practice, Susan E. Andrade, Gordon M. Saperia, Marc L. Berger, and Richard Platt

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Reperfusion therapy for acute myocardial infarction: observations from the National Registry of Myocardial Infarction 2, Hal V. Barron, Amy Chen Rundle, Jerry H. Gurwitz, and Alan J. Tiefenbrunn

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Individualizing therapy to prevent long-term consequences of estrogen deficiency in postmenopausal women, Nananda F. Col, Stephen G. Pauker, Robert J. Goldberg, Mark H. Eckman, Richard K. Orr, Elizabeth M. Ross, and John B. Wong

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The renal effects of nonsteroidal anti-inflammatory drugs in older people: findings from the Established Populations for Epidemiologic Studies of the Elderly., Terry S. Field, Jerry H. Gurwitz, Robert J. Glynn, Marcel E. Salive, J. Michael Gaziano, James O. Taylor, and Charles H. Hennekens

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The Impact of a Therapeutic Interchange Program in a Managed Care Organization, Leslie S. Fish and Barbara Edelman-Lewis

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Aging, comorbidity, and reduced rates of drug treatment for diabetes mellitus., Robert J. Glynn, Mark Monane, Jerry H. Gurwitz, Igor Choodnovskiy, and Jerry Avorn