The head of Michigan State University (MSU) has resigned, hours after sports doctor Larry Nassar was sentenced for sexually abusing young athletes.
Lou Anna Simon had been facing pressure to step down. Nassar worked at MSU between 1997 and 2016.
Also a former team doctor for USA Gymnastics, he was sentenced to 40 to 175 years' imprisonment after testimony from almost 160 women.
Ms Simon denied reports that MSU knew of the abuse claims but failed to act.
She said in a statement: "To the survivors, I can never say enough that I am so sorry that a trusted, renowned physician was really such an evil, evil person who inflicted such harm under the guise of medical treatment."
The accounts of Nassar's victims are "tragic, heartbreaking, and personally gut-wrenching," she added.
On Wednesday Michigan's House of Representatives overwhelmingly approved a resolution calling on Ms Simon to quit.
About 140 young women have filed a lawsuit against Nassar, USA Gymnastics and MSU, claiming the two institutions heard the paedophilia allegations against him years ago.
The sports body and the school deny there was a cover-up.
What was Nassar sentenced for?
Nassar pleaded guilty to 10 counts of sexual assault against girls and young women, including Olympians.
Before his sentencing on Wednesday, the 54-year-old had already been sentenced to 60 years for possession of child pornography.
Judge Rosemarie Aquilina told Nassar during the sentencing: "As much as it was my honour and privilege to hear the sister survivors, it was my honour and privilege to sentence you.
"Because, sir, you do not deserve to walk outside of a prison ever again."
As the judge finished her sentence, witnesses in the packed courtroom stood and applauded her verdict.
What did the survivors say in court?
The sentencing follows a week of harrowing testimony from scores of women, including Olympic gold medal gymnasts Aly Raisman and Jordyn Weiber.
Their teammates, McKayla Maroney, Gabby Douglas and Simone Biles, also revealed they had been abused by Nassar.
In 2015, USA Gymnastics – the sport's top governing body – quietly cut ties with Nassar over allegations about his professional care.
An investigation in 2014 resulted in a three-month suspension from MSU, then his workplace.
But he continued to see patients until he was publicly accused of abuse in a 2016 report by the Indianapolis Star newspaper.
Later that year, he was arrested and charged by Michigan officials with sexual contact with a child.
A year later, he was sentenced for child abuse images found on his computer.
Why are survivors angry with MSU?
Rachael Denhollander, who was one of the first women to publicly accuse Nassar, pointed the finger at MSU in court on Wednesday.
"How much is a little girl worth? How much is a young woman worth?" Ms Denhollander, now a lawyer, asked as she described the abuse that occurred when she was 15 years old.
To Judge Aquilina : THANK YOU, YOU ARE MY HERO
Shout out to all of the survivors for being so brave & speaking like the queens that you are while looking at that monster. He will no longer have the power to steal our happiness or joy. I stand with every one of you pic.twitter.com/b5SMmjZgeW
— Simone Biles (@Simone_Biles) January 24, 2018
End of Twitter post by @Simone_Biles
"No-one believed because they did not listen," she said, recounting the several times victims told MSU of their allegations.
"Victims were silenced, intimidated, told they were receiving medical treatment, and at times sent back to be further abused.
"This is what it looks like when institutions create a culture when a predator can behave unabated."
Ms Denhollander said trauma she suffered had "cast a horrific shadow" over her medical care when she gave birth to three children, including two daughters.
What happens now?
As the court adjourned on Wednesday, the US Olympic Committee announced it would hold an independent investigation "to examine how an abuse of this proportion could have gone undetected for so long".
The committee's chief executive Scott Blackmun has called on "all current USA Gymnastics directors" to resign.
On Tuesday, the National Collegiate Athletic Association (NCAA) said it would investigate MSU's original handling of the gymnasts' abuse claims.