OREGON STATE UNIVERSITY

heath and nutrition

California’s new mental health system helps people live independently

CORVALLIS, Ore. – A new analysis by Oregon State University researchers of California’s mental health system finds that comprehensive, community-based mental health programs are helping people with serious mental illness transition to independent living.

Published in the October issue of the American Journal of Public Health, this study has important implications for the way that states finance and deliver mental health programs, and speaks to the effectiveness of well-funded, comprehensive community programs.

In November of 2004, California voters passed the Mental Health Services Act, which allocated more than $3 billion for comprehensive community mental health programs, known as Full Service Partnerships (FSP). While community-based, these programs are different from usual mental health services programs in most states because they provides a more intensive level of care and a broader range of mental health services and supports, such as medication management, crisis intervention, case management and peer support.

It also provides services such as food, housing, respite care and treatment for co-occurring disorders, such as substance abuse.

“We found that these programs promoted independent living in the community among people who had serious mental illness but had not been served or underserved previously,” said Jangho Yoon, an assistant professor of health policy and health economist in OSU’s College of Public Health and Human Sciences and lead author of the study. “Overall, it reduced their chance of living on the street or being incarcerated in jails and prisons.”

The researchers looked at data from 43 of California’s 53 counties, resulting in a sample of 9,208 adults over the course of four years. They found that participants who stayed enrolled in the program continuously, without interruption, were 13.5 percent more likely to successfully transition to independent living.

However, they found that non-white patients were less likely to live independently, and more likely to end up in jail or homeless.

“Although FSPs represent the most well-funded comprehensive community-based programs in the country, they are still community programs and therefore program participation is voluntary,” Yoon said.  “My guess is that minorities may not benefit fully from these programs in their communities possibly due to greater stigma, and less family/social supports. But it needs further investigation.”

Patients with schizophrenia and bipolar disorders were also less likely to benefit from the community programs, because of the nature and severity of their mental health issues.

Yoon is an expert on health management policy, specifically policy around the area of mental health. He said other states haven’t followed California’s lead, in part because of the cost of such extensive programming. Yoon said some of the funding made possible by the federal Patient Protection and Affordable Care Act, which includes $460 million for community mental health services for states to use, may help other states to create similar programs.

“Nobody would disagree that the public mental health system has historically been under-funded in the U.S.,” he said. “The message for other states is clear: investment in well-funded, recovery-oriented, comprehensive community mental health programs clearly improves lives of people with serious mental illness, and may also save money from reduced dependency and incarcerations in this population.”

Tim Bruckner of the University of California, Irvine, and Timothy Brown of the University of California, Berkeley, contributed to this study, which was jointly funded by the California Department of Mental Health and the California Health Care Foundation.

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Jangho Yoon, 541-737-3839

Gut microbes closely linked to range of health issues

CORVALLIS, Ore. –A new understanding of the essential role of gut microbes in the immune system may hold the key to dealing with some of the more significant health problems facing people in the world today, Oregon State University researchers say in a new analysis.

Problems ranging from autoimmune disease to clinical depression and simple obesity may in fact be linked to immune dysfunction that begins with a “failure to communicate” in the human gut, the scientists say. Health care of the future may include personalized diagnosis of an individual’s “microbiome” to determine what prebiotics or probiotics are needed to provide balance.

Appropriate sanitation such as clean water and sewers are good. But some erroneous lessons in health care may need to be unlearned – leaving behind the fear of dirt, the love of antimicrobial cleansers, and the outdated notion that an antibiotic is always a good idea. We live in a world of “germs” and many of them are good for us.

“Asked about their immune system, most people might think of white blood cells, lymph glands or vaccines,” said Dr. Natalia Shulzhenko, author of a new report in Clinical Reviews in Allergy and Immunology, and assistant professor and physician in the OSU Department of Biomedical Sciences. “They would be surprised that’s not where most of the action is. Our intestines contain more immune cells than the entire rest of our body.

“The human gut plays a huge role in immune function,” Shulzhenko said. “This is little appreciated by people who think its only role is digestion. The combined number of genes in the microbiota genome is 150 times larger than the person in which they reside. They do help us digest food, but they do a lot more than that.”

An emerging theory of disease, Shulzhenko said, is a disruption in the “crosstalk” between the microbes in the human gut and other cells involved in the immune system and metabolic processes.

“In a healthy person, these microbes in the gut stimulate the immune system as needed, and it in turn talks back,” Shulzhenko said. “There’s an increasing disruption of these microbes from modern lifestyle, diet, overuse of antibiotics and other issues. With that disruption, the conversation is breaking down.”

An explosion of research in the field of genomic sequencing is for the first time allowing researchers to understand some of this conversation and appreciate its significance, Shulzhenko said. The results are surprising, with links that lead to a range of diseases, including celiac disease and inflammatory bowel disease. Obesity may be related. And some studies have found relevance to depression, late-onset autism, allergies, asthma and cancer.

In the new review, researchers analyzed how microbe dysfunction can sometimes result in malabsorption and diarrhea, which affects tens of millions of children worldwide and is often not cured merely by better nutrition. In contrast, a high-fat diet may cause the gut microbes to quickly adapt to and prefer these foods, leading to increased lipid absorption and weight gain.

The chronic inflammation linked to most of the diseases that kill people in the developed world today – heart disease, cancer, diabetes – may begin with dysfunctional gut microbiota.

Understanding these processes is a first step to addressing them, Shulzhenko said. Once researchers have a better idea of what constitutes healthy microbiota in the gut, they may be able to personalize therapies to restore that balance. It should also be possible to identify and use new types of probiotics to mitigate the impact of antibiotics, when such drugs are necessary and must be used.

Such approaches are “an exciting target for therapeutic interventions” to treat health problems in the future, the researchers concluded.

The study, supported by OSU, included researchers from both the College of Veterinary Medicine and the College of Pharmacy.

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Dr. Natalia Shulzhenko, 541-737-1051

Working longer may lead to a longer life, new OSU research shows

CORVALLIS, Ore. – Working past age 65 could lead to longer life, while retiring early may be a risk factor for dying earlier, a new study from Oregon State University indicates.

The researchers found that healthy adults who retired one year past age 65 had an 11 percent lower risk of death from all causes, even when taking into account demographic, lifestyle and health issues. Adults who described themselves as unhealthy were also likely to live longer if they kept working, the findings showed, which indicates that factors beyond health may affect post-retirement mortality.

“It may not apply to everybody, but we think work brings people a lot of economic and social benefits that could impact the length of their lives,” said Chenkai Wu, the lead author of the study. He conducted the research as part of his master’s thesis at OSU, where he is now a doctoral student in the College of Public Health and Human Sciences.

The findings were published recently in the Journal of Epidemiology and Community Health. Co-authors include Associate Professor Robert Stawski and Assistant Professor Michelle Odden of OSU and Gwenith Fisher of Colorado State University. The research was supported by a grant from the National Institute on Aging.

The research was the basis for Wu’s master’s thesis in human development and family science; he’s now pursuing a doctorate in epidemiology.

Wu took an interest in the effects of retirement on health in part because of China’s mandatory laws, which are often debated. Retirement age is also an issue for debate elsewhere around the world, including the United States, he said.

“Most research in this area has focused on the economic impacts of delaying retirement. I thought it might be good to look at the health impacts,” Wu said. “People in the U.S. have more flexibility about when they retire compared to other countries, so it made sense to look at data from the U.S.”

Wu examined data collected from 1992 through 2010 through the Healthy Retirement Study, a long-term study of U.S. adults led by the University of Michigan and funded by the National Institute on Aging. Of the more than 12,000 initial participants in the study, Wu narrowed his focus to 2,956 people who began the study in 1992 and had retired by the end of the study period in 2010. 

Poor health is one reason people retire early and also can lead to earlier death, so researchers wanted to find a way to mitigate a potential bias in that regard.

To do so, they divided the group into unhealthy retirees, or those who indicated that health was a factor in their decision to retire – and healthy retirees, who indicated health was not a factor. About two-thirds of the group fell into the healthy category, while a third were in the unhealthy category.

During the study period, about 12 percent of the healthy and 25.6 percent of the unhealthy retirees died. Healthy retirees who worked a year longer had an 11 percent lower risk of mortality, while unhealthy retirees who worked a year longer had a 9 percent lower mortality risk. Working a year longer had a positive impact on the study participants’ mortality rate regardless of their health status.

“The healthy group is generally more advantaged in terms of education, wealth, health behaviors and lifestyle, but taking all of those issues into account, the pattern still remained,” said Stawski, senior author of the paper. “The findings seem to indicate that people who remain active and engaged gain a benefit from that.”

Additional research is needed to better understand the links between work and health, the researchers said. As people get older their physical health and cognitive function are likely to decline, which could affect both their ability to work and their longevity.

“This is just the tip of the iceberg,” Stawski said. “We see the relationship between work and longevity, but we don’t know everything about people’s lives, health and well-being after retirement that could be influencing their longevity.”

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Chenkai Wu, wuche@oregonstate.edu; Robert Stawski, robert.stawski@oregonstate.edu, 541-737-9052

OSU study: Silicone breast implants may absorb harmful pollutants from body tissues

CORVALLIS, Ore. – Silicone breast implants may absorb environmental pollutants from surrounding tissues and possibly reduce their concentrations within the body, according to a new study by Oregon State University.

OSU environmental chemist Kim Anderson and her colleagues found that silicone implants are a “sink” for environmental chemicals that build up in the fatty tissues of humans and animals. Over time they can become a long-term record of a person’s exposure to environmental toxins.

The study, which appeared in the journal Environmental International, was partly inspired by recent studies showing that silicone implants may reduce risk of breast cancer by as much as 50 percent, Anderson said. “That research piqued our interest in looking at implants as a potential sink for contaminants,” she said. She cautioned that her findings don’t prove that breast implants protect against cancer or any other disease.

In a two-part experiment, Anderson, a professor in OSU's College of Agricultural Sciences, and her colleagues screened eight discarded silicone breast implants—surgically removed from women for medical or personal reasons—for some 1,400 environmental chemicals. For controls, they also screened unused silicone “sizers,” used in fitting breast implants or prostheses.

The implants contained 14 common compounds used in foods and personal-care products, commercial and industrial products, and pesticides. The most common one detected was caffeine, found in all eight samples. Next was p,p’-DDE, a suspected cancer-causing agent that results from the breakdown of the now-banned insecticide DDT. It was found in five of the samples.

Nine of the chemicals showed up in only one sample. That was not surprising, said Anderson, because individual exposure to environmental chemicals varies widely depending on where a person lives and what kind of work he or she does. “People are exposed to different chemicals in Burns, Oregon, than in Portland,” she said, “and there are differences even between neighborhoods in Portland.”

In the second phase of the study, to determine how silicone implants respond to a known chemical exposure, the researchers surgically implanted tiny silicone disks into anesthetized laboratory mice. The mice received as much silicone, in proportion to their body mass, as would be used in a range of typical human breast implants or reconstructions.

The mice then were given injections of two compounds: p,p’-DDE and also PCB 118, which belongs to a class of once widely used industrial chemicals and is also a probable carcinogen. These two substances are known to accumulate in fatty tissues. A group of control mice received surgical implants but no chemicals; another control group received chemicals and surgery but no implants.

After nine days, the researchers analyzed the silicone that had been implanted in the mice along with the surrounding fatty tissue. They found that the silicon and the tissue contained both chemicals. This, said Anderson, indicated that the chemicals had passed from the tissue into the silicone until the concentrations may have reached a balance.

Silicone is known to absorb organic-based pollutants in much the same way human cells do. “Silicone is lipophilic—meaning it loves fat,” Anderson explained. “Our bodies’ cells are also lipophilic. In order for a chemical to do us harm, it has to cross our cell barriers. So silicone is a good surrogate for an organism’s cell.”

Anderson’s lab pioneered the use of silicone wristbands as passive samplers of environmental pollution in air and water. “However, those environments are hydrophilic—water-loving—which is the opposite of lipophilic,” she said. “We wanted to demonstrate that silicone would also pull contaminants out of a fat-rich environment.”

Anderson added that discarded breast implants could be a gold mine for public-health researchers. “Tens of thousands of implants are removed from women every year, and they’re typically burned as waste,” she said. “Instead, they could be an important resource for quantifying the types and amounts of environmental chemicals absorbed by the human body and for assessing long-term toxic exposure.”

The research was funded by the National Institute of Environmental Health Sciences and OSU's Food Safety and Environmental Stewardship Program.

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Kim Anderson, 541-737-8501, kim.anderson@oregonstate.edu

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Silicone breast implants may pick up chemical pollution from the body's tissues. Researcher Kim Anderson, environmental chemist at Oregon State University, wears a silicone pollution-sampling wristband. Photo by Stephen Ward.

Kim Anderson

Doctor, investigative journalist to speak at OSU

CORVALLIS, Ore. – Dr. Richard Besser, a physician, former administrator for the Centers for Disease Control and Prevention, and nationally-known investigative journalist will speak at Oregon State University on Monday, April 13, as part of the Provost’s Lecture Series.

Besser will present “A View From Both Sides of the Camera: Using Television to Promote Public Health.” The lecture will begin at 7:30 p.m. in Austin Auditorium of the LaSells Stewart Center, 875 S.W. 26th St., on the Corvallis campus. It is free and open to the public.

Besser has covered major medical news stories around the world for ABC, including several recent trips to Liberia to cover the Ebola outbreak. At the CDC, Besser was director of the Coordinating Office for Terrorism Preparedness and Emergency Response. His previous medical work included the epidemiology of food-borne diseases and pediatric tuberculosis.

His reporting has received numerous awards, including an Emmy nomination in 2011 for a piece on umbilical cord blood banking. He received two Peabody Awards as part of his work at ABC, and published his first book, “Tell Me the Truth, Doctor: Easy-to-Understand Answers to Your Most Confusing and Critical Health Questions,” in 2013.

Creating healthy people, a healthy planet and a healthy economy are top priorities for OSU, which has the state’s first accredited school of public health. For more on health-based research at the university, see the winter edition of Terra Research Magazine.

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Shelly Signs, 541-737-0724; shelly.signs@oregonstate.edu

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Richard Besser Dr. Richard Besser

Low vitamin D levels and depression linked in young women, new OSU study shows

CORVALLIS, Ore. – A new study from Oregon State University suggests there is a relationship between low levels of vitamin D and depression in otherwise healthy young women.

OSU researchers found that young women with lower levels of vitamin D were more likely to have clinically significant depressive symptoms over the course of a five-week study, lead author David Kerr said. The results were consistent even when researchers took into account other possible explanations, such as time of year, exercise and time spent outside.

“Depression has multiple, powerful causes and if vitamin D is part of the picture, it is just a small part,” said Kerr, an associate professor in the School of Psychological Science at OSU. “But given how many people are affected by depression, any little inroad we can find could have an important impact on public health.”

The findings were published recently in the journal Psychiatry Research. Co-authors are Sarina Saturn of the School of Psychological Science; Balz Frei and Adrian Gombart of OSU’s Linus Pauling Institute; David Zava of ZRT Laboratory and Walter Piper, a former OSU student now at New York University.

Vitamin D is an essential nutrient for bone health and muscle function. Deficiency has been associated with impaired immune function, some forms of cancer and cardiovascular disease, said Gombart, an associate professor of biochemistry and biophysics, principal investigator with the Linus Pauling Institute and international expert on vitamin D and the immune response.

People create their own vitamin D when their skin is exposed to sunlight. When sun is scarce in the winter, people can take a supplement, but vitamin D also is found in some foods, including milk that is fortified with it, Gombart said. The recommended daily allowance of vitamin D is 600 IU per day. There is no established level of vitamin D sufficiency for mental health.

The new study was prompted in part because there is a widely held belief that vitamin D and depression are connected, but there is not actually much scientific research out there to support the belief, Kerr said.

“I think people hear that vitamin D and depression can change with the seasons, so it is natural for them to assume the two are connected,” he said.

According to Kerr and his colleagues, a lot of past research has actually found no association between the two, but much of that research has been based on much older adults or special medical populations.

Kerr’s study focused on young women in the Pacific Northwest because they are at risk of both depression and vitamin D insufficiency. Past research found that 25 percent of American women experience clinical depression at some point in their lives, compared to 16 percent of men, for example.

OSU researchers recruited 185 college students, all women ages 18-25, to participate in the study at different times during the school year. Vitamin D levels were measured from blood samples and participants completed a depression symptom survey each week for five weeks.

Many women in the study had vitamin D levels considered insufficient for good health, and the rates were much higher among women of color, with 61 percent of women of color recording insufficient levels, compared to 35 percent of other women. In addition, more than a third of the participants reported clinically significant depressive symptoms each week over the course of the study.

“It may surprise people that so many apparently healthy young women are experiencing these health risks,” Kerr said.

As expected, the women’s vitamin D levels depended on the time of year, with levels dropping during the fall, at their lowest in winter, and rising in the spring. Depression did not show as a clear pattern, prompting Kerr to conclude that links between vitamin D deficiency and seasonal depression should be studied in larger groups of at-risk individuals.

Researchers say the study does not conclusively show that low vitamin D levels cause depression. A clinical trial examining whether vitamin D supplements might help prevent or relieve depression is the logical next step to understanding the link between the two, Kerr said.

OSU researchers already have begun a follow-up study on vitamin D deficiency in women of color. In the meantime, researchers encourage those at risk of vitamin D deficiency to speak with their doctor about taking a supplement.

“Vitamin D supplements are inexpensive and readily available.” Kerr said. “They certainly shouldn’t be considered as alternatives to the treatments known to be effective for depression, but they are good for overall health.”

The research was supported by grants from the Good Samaritan Hospital Foundation’s John C. Erkkila Endowment for Health and Human Performance and the National Institute of Environmental Health Sciences.

 


About the Linus Pauling Institute:  The Linus Pauling Institute at OSU is a world leader in the study of micronutrients and their role in promoting optimum health or preventing and treating disease. Major areas of research include heart disease, cancer, aging and neurodegenerative disease.

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David Kerr, 541-737-1364, david.kerr@oregonstate.edu

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Students at Oregon State University enjoy a sunny winter day on the Corvallis campus.

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OSU celebrates National Nutrition Month with March 4 event

CORVALLIS, Ore. – Oregon State University’s Nutrition and Dietetics Club is celebrating National Nutrition Month on Wednesday, March 4, with an event in the Memorial Union quad from 10 a.m. to 2:30 p.m.

Its theme of “Bite Into a Healthy Lifestyle” encourages everyone to adopt eating plans focused on making informed food choices and promoting overall health. The event will feature games, prizes, free food, and tips on how to stay healthy from guests representing Bob’s Red Mill, Trader Joes, Pacific Fruit Company, Food@OSU and more.

Activities will focus around vitamins, mineral and fiber content in food, and helping students, faculty and staff learn more about what makes a healthy, balanced meal. There will be free cookbooks for the first 200 participants, a competition to win a bullet blender, and other prizes.

“Eating a healthy, well-balanced meal is crucial to success in the rest of your life, including your academic success,” said Jessica Hummel, vice president of OSU’s Nutrition and Dietetics Club. “We want students and staff to stop in and learn some fun facts about food, and maybe look at the way they eat in a new way.”

As part of this public education campaign, the academy’s National Nutrition Month website includes a variety of helpful tips, games, promotional tools and nutrition education resources, all designed to spread the message of good nutrition.  

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OSU Be Well Walk & Run on Oct. 11

CORVALLIS, Ore. – Oregon State University is holding the fourth annual Be Well Walk & Run on Oct. 11 in the Memorial Union Quad. The event is free and open to everyone.

This year’s event includes a five-kilometer running course as well as a one-mile walking course (5k Map / 1-Mile Map). The scenic route will wind participants throughout OSU’s campus, highlighting picturesque buildings and spaces. Costumes are encouraged. 

The event will feature activity stations in the Memorial Union Quad to engage participants in learning about the Healthy Campus Initiative, including physical activity, stress management, nutrition and a smoke-free campus.

Participants can register as individuals or as part of a group.  Early registrants will receive a free 2013 Be Well Walk & Run t-shirt. To register, go to http://bit.ly/19Zo7Rk. The run starts at 3:30 p.m. in the quad, check in begins at 3 p.m.

For more information, go to http://oregonstate.edu/bewell

Accommodations for disabilities may be made by calling Joe Schaffer, 541-737-4884.

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Lisa Hoogesteger, 541-737-3343

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Traber honored for research on vitamin E

CORVALLIS, Ore. – Maret Traber, a professor in the College of Public Health and Human Sciences at Oregon State University, and principal investigator in the Linus Pauling Institute, has received an international honor for her work on vitamin E.

Traber received the DSM Nutritional Science Award 2013 on fundamental or applied research in human nutrition, which included an honorarium of 50,000 Euros. It recognizes her lifetime commitment to research on vitamin E and many new insights into its role in human nutrition and optimum health.

Traber is director of the Oxidative and Nitrative Stress Laboratory at OSU and is the Helen P. Rumbel Professor for Micronutrient Research. She has published nearly 250 professional publications on vitamin E, on such topics as its bioavailability, kinetics, metabolism, and effects of vitamin E deficiency – especially in people with particular health concerns, such as burn victims or diabetics.

She received the award in Granada, Spain at the IUNS 20th International Congress of Nutrition.

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Maret Traber, 541-737-7977

ACL injuries may be prevented by different landing strategy

CORVALLIS, Ore. – Women are two to eight times more likely than men to suffer a debilitating tear of the anterior cruciate ligament (ACL) in the knee and a new study suggests that a combination of body type and landing techniques may be to blame.

In two new studies published online this week in the Journal of Athletic Training, lead author Marc Norcross of Oregon State University documents how women who were asked to undergo a series of jumping exercises landed more often than men in a way associated with elevated risk of ACL injuries.

Both men and women tended to land stiffly, which can lead to ACL injuries, but women were 3.6 times more likely to land in a “knock-kneed” position, which the researchers say may be the critical factor leading to the gender disparity in ACL tears.

“We found that both men and women seem to be using their quad region the same, so that couldn’t explain why females are more at risk,” Norcross said. “Using motion analysis, we were able to pinpoint that this inability to control the frontal-plane knee loading – basically stress on the knee from landing in a knock-kneed position – as a factor more common in women.

“Future research may isolate why women tend to land this way,” he added, “but it could in part be because of basic biology. Women have wider hips, making it more likely that their knees come together after jumping.”

Norcross, an assistant professor of exercise and sport science in OSU’s College of Public Health and Human Sciences, is a former collegiate athletic trainer dedicating his research to the prevention of ACL tears.

“You see ACL injuries in any sport where you have a lot of jump stops and cuts, so basketball, soccer, lacrosse, and volleyball are high-risk sports,” said Norcross. “We know that people who hurt themselves tend to look stiff when they land and that the combined ‘knee loading’ from multiple directions is likely causing the injury event. But it wasn’t clear initially why women had more injuries than men.”

The researchers used motion analysis software to monitor the landing strategies of 82 physically active men and women. They found that both males and females had an equal likelihood of landing stiffly – likely from tensing the muscles in their quads before landing – putting them at higher risk of ACL tears. Women, however, were more likely to land in a “knee valgus” position, essentially knock-kneed.

Norcross said his next research project will focus on high school athletes, looking at a sustainable way to integrate injury prevention into team warm-up activities through improving landing technique.

“We are trying to create a prevention strategy that is sustainable and will be widely used by high school coaches,” he said. “A lot of athletes do come back from an ACL injury, but it is a long road. And the real worry is that it leads to early onset arthritis, which then impacts their ability to stay physically active.”

This study was supported by the NATA Research & Education Foundation Doctoral Grant Program.

Researchers from University of North Carolina at Chapel Hill and Greensboro contributed to this study.

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Marc Norcross, 541-737-6788

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ACL jumping landing
Biomechanical model of a female using a “knock-kneed” technique and experiencing high frontal plane knee loading during a jump landing.