Impact of bilateral motion control shoes with outsole adjustment on gait asymmetry in individuals with mild leg length discrepancy.

BACKGROUND: Footwear adjustment is recommended in the management plan of leg length discrepancy. However, it is not clear how the outsole of motion control shoe adjustment influences trunk symmetry and walking performance. RESEARCH QUESTION: Does bilateral adjustment of the outsole affect trunk and pelvis symmetry and ground reaction force during walking in individuals with leg length discrepancy? METHODS: 20 mild leg length discrepancy participants were recruited into a cross-sectional study. All subjects performed a walking trial with their habitual shoes to determine the outsole adjustment. Four trials of walking were carried out in the order of unadjusted and bilateral adjusted motion control air-cushion shoes. Shoulder level differences and trunk and pelvic motion were assessed, while the ground reaction force at the heel strike was reported. A paired t-test was performed to compare the differences between the conditions with a significance level at p < 0.05. RESULTS: During walking trials, mild leg length discrepancy participants with the adjusted shoe displayed lower variations in the maximum shoulder height differences (p = 0.001) and trunk rotation angle (p = 0.002) than those with the unadjusted shoe. Also, there was a significant reduction in the vertical ground reaction force (p = 0.030), but not in the anteroposterior or mediolateral directions, during walking in the adjusted shoe condition compared to the unadjusted shoe condition. SIGNIFICANCE: The outsole adjustment of the bilateral motion control shoes can improve trunk symmetry while decreasing the ground impact at the heel strike. The study provides additional information to prescribe or recommend footwear adjustment to improve walking symmetry in leg length discrepancy participants.

Levels of Toxic and Essential Elements and Associated Factors in the Hair of Japanese Young Children.

There is growing concern regarding the effects of toxic element exposure on the development of children. However, little is known about the level of toxic elements exposure in Japanese children. The purpose of this study was to assess the concentrations of multiple elements (aluminum, cadmium, lead, calcium, copper, iron, magnesium, sodium, zinc) in the hair of 118 Japanese young children and to explore the factors associated with their element levels. The element concentration was analyzed by ICP-MS, and children's food and water intake were assessed by the questionnaire. Results showed that there were no large differences between the level of elements in the hair of Japanese children and those of children in other developed countries. Girls had significantly higher levels of aluminum, copper, and iron (p = 0.000, 0.014, and 0.013, respectively), and boys had a higher level of sodium (p = 0.006). The levels of calcium, iron, magnesium, and sodium in nursery school children were significantly higher than those in kindergarten children (p = 0.024, 0.001, 0.046, and 0.029, respectively). Multiple regression analyses with controlling the confounding variables showed significant negative associations of frequency of yogurt intake with aluminum and lead levels (p = 0.015 and 0.037, respectively). When the children were divided into three groups based on the frequency of yoghurt consumption, viz. L (≤once a week), M (2 or 3 times a week), and H (≥4 to 6 times a week) group, the mean aluminum concentration (µg/g) in the L, M, and H groups was 11.06, 10.13, and 6.85, while the mean lead concentration (µg/g) was 1.76, 1.70, and 0.87, respectively. Our results suggested the validity of hair element concentrations as an exposure measure of essential elements and frequent yogurt intake as a viable measure for protecting children from toxic elements. However, these findings will need to be confirmed in more detailed studies with larger sample sizes in the future.

The changes of parental functioning of the patients with bipolar disorder and major depression since discharging from hospital: A longitudinal study.

AIMS AND OBJECTIVES: This study examined the changes in patients' parental functioning and the associated factors, including manic, depressive symptoms and social support from before discharge to 6 months post-discharge. BACKGROUND: For parents with bipolar disorder and major depression, parenting is a recovery factor for patients, but little research examines the dynamic parental functioning from acute hospitalisation to a remission stage. DESIGN: A longitudinal design was used. The STROBE Checklist were used in presenting this research. METHODS: Participants were inpatients with bipolar disorder or major depression (n = 33) recruited within one week before discharge from the acute psychiatric ward in Taiwan. Data on parental functioning was collected four times: before discharge (T1), the 1st (T2), the 3rd (T3) and the 6th (T4) months of post-discharge. Baseline parental functioning before admitting to the acute word was retrospectively assessed at T0. The questionnaires included positive and negative domains of parenting practice, hypomanic/manic symptoms, depressive symptoms and social support. Generalised estimating equations were applied for data analysis. RESULTS: The negative parenting domains (poor monitoring, inconsistent discipline) decreased during hospitalisation but increased at one month post-discharge, except corporal punishment at 3-months discharge. The positive parenting domains (parental involvement and nurturance/responsiveness) did not recovery to baseline. While clinical symptoms remained stable during 6 months post-discharge, social support decreased at 3 and 6 months post-discharge. Higher depressive symptoms and low social support were associated with positive parenting domains but not related to negative parenting domains. Manic symptoms were not associated with positive or negative parenting domains. CONCLUSIONS: Positive parenting domains did not fully return to the usual situation during 6 months post-discharge. RELEVANCE TO CLINICAL PRACTICE: Parenting functioning recovery program targeting at the impacts of depressive symptoms on the parenting functioning and insufficient social support is needed from hospitalisation to post-discharge.

Dissipative Particle Dynamics Simulation of Nanoparticle Diffusion in a Crosslinked Polymer Network.

Dissipative particle dynamics simulation is conducted to investigate the diffusion of a nanoparticle in a crosslinked polymer network based on a bead-spring model. Focusing on cases where the particle is comparable in size to the network mesh, we find from rigid networks that the excluded-volume and hydrodynamic interaction effects associated with solvent beads lead to lubricity, which assists the particle to slip through an opening into the adjacent cell. For flexible networks, the hopping mechanism for particle escape becomes less pronounced with higher network flexibility due to either a smaller spring constant or slacker strands, each consisting of more beads. This behavior could be explained by the larger cell size fluctuation and its slower relaxation, whereby large enough openings temporarily formed are longer-lived, increasing the chance for particle hopping.

The experiences of family resilience from the view of the adult children of parents with bipolar disorder in Chinese society.

AIMS: This study explored how adult children perceived family resilience, barriers to develop family resilience and how cultural values influence their experience of parents with bipolar disorder in Chinese society. DESIGN: A qualitative design with an interpretive phenomenological analysis of data was employed. METHODS: Twenty adults who had lived with parents with bipolar disorder during childhood were recruited from the acute psychiatric ward when their parents were admitted to the hospital. They described their experiences of perceived family resilience and barriers to resilience (October 2013-September 2015). Semi-structured interviews were conducted in the hospital meeting room or at a convenient location. FINDINGS: Six themes were identified in family resilience: ill parents try to be good parents, parents' personal strengths, parents' positive attitudes towards mental illness, flexibility of family role, cohesive relationships between family members, and families' social connections. Three themes were identified in the barriers to develop family resilience: poor parenting/family function, conflict between parents and poor mental health literacy. CONCLUSION: Children's views of family resilience could transform their suffering from lived experiences with a mentally ill parent to a positive growth experience. Family resilience includes well and ill parents' efforts and social network's help to maintain family function. However, the conflicts between well and ill parents and poor family function result in a traumatic growth experience. IMPACT: To enhance a positive growth experience, family resilience programs for a parent with bipolar disorder aiming to cultivate both the ill and well parents' inner strength and their competence of parenting skills with connecting their social network to maintain family function is needed. Moreover, early stress-reduction intervention needs to be developed for children who did not experience family resilience.

Nanovoid-Enhanced Thin-Film Composite Reverse Osmosis Membranes Using ZIF-67 Nanoparticles as a Sacrificial Template.

In this work, nanovoid-enhanced thin-film composite (TFC) membranes have been successfully fabricated using ZIF-67 nanoparticles as the sacrificial template. By incorporating different amounts of ZIF-67 during interfacial polymerization, the resultant TFC membranes can have different degrees of nanovoids after self-degradation of ZIF-67 in water, consequently influencing their physiochemical properties and separation performance. Nanovoid structures endow the membranes with additional passages for water molecules. Thus, all the newly developed TFC membranes exhibit better separation performance for brackish water reverse osmosis (BWRO) desalination than the pristine TFC membrane. The membrane made from 0.1 wt % ZIF-67 shows a water permeance of 2.94 LMH bar-1 and a salt rejection of 99.28% when being tested under BWRO at 20 bar. This water permeance is 53% higher than that of the pristine TFC membrane with the salt rejection well maintained.

The Influence of Kinesio Tape and an Ankle Brace on the Lower Extremity Joint Motion in Fatigued, Unstable Ankles during a Lateral Drop Landing.

BACKGROUND: An unstable ankle along with plantar flexor muscle fatigue may exacerbate landing performance. External support may be an option to control the ankle motion and protect joints from injuries. Research goal: To investigate the immediate changes in the joint motion of a lower extremity under ankle plantar flexors fatigue conditions in athletes with unstable ankles using different external supports. METHODS: A total of 44 participants were allocated to a control (Cn) group, an ankle brace (AB) group, and a kinesio tape (KT) group, and were asked to perform a lateral drop landing before and after a fatigue protocol. The outcome measures were fatigue-induced changes in the maximal joint angle and changes in the angle ranges of the hip, knee, and ankle. RESULTS: Smaller changes in the maximal hip abduction were found in the AB group (p = 0.025), and the KT group exhibited smaller changes in the maximal ankle dorsiflexion (p = 0.009). The AB group landed with a smaller change in the range of hip flexion and knee flexion (p = 0.008 and 0.006). The Cn group had greater fatigue-induced changes in the COM range than AB and KT group (p = 0.002 and 0.028). SIGNIFICANCE: Despite the beneficial effect in the postural control in the frontal plane, the use of AB might constrain the distal joint motion which might lead to an extended knee landing posture resulting in secondary injuries to the knee joint. Therefore, the use of AB in conjunction with an additional training of landing strategy might be recommended from the injury prevention perspective.

Underground Pipeline Leakage Risk Assessment in an Urban City.

Underground pipeline safety is a concern among civilians in populated urban cities. Due to the potential for considerable damage from underground pipeline leakages, it is critical to identify potential risk areas. This study developed a simplified risk value using risk assessment software (ALOHA) and geography information systems (SuperGIS and Surfer) to produce potential risk maps for underground pipeline leakage in a major urban city. A risk assessment of areas affected by underground pipeline leakage was performed for vapor diffusion, thermal radiation from combustion, and overpressure from an explosion. The results are applicable to disaster management departments and agencies in highly populated cities.

Effects of Different Ankle Supports on the Single-Leg Lateral Drop Landing Following Muscle Fatigue in Athletes with Functional Ankle Instability.

BACKGROUND: Ankle support has been utilized for athletes with functional ankle instability (FAI), however, its effect on the landing performance during muscle fatigue is not well understood. This study aimed to examine the effects of ankle supports (ankle brace vs. Kinesio tape) on athletes with FAI following fatigued single-leg landing. METHODS: Thirty-three young FAI athletes (CAIT scores < 24) were randomly allocated to control (Cn), ankle brace (AB) and Kinesio tape (KT) groups. All athletes performed single-leg lateral drop landings following ankle fatigue protocol. The fatigue-induced changes in kinetic parameters were measured among three groups. RESULTS: A significant increase in peak vertical ground reaction force (vGRF) was found in the AB group (0.12% body weight (BW)) compared to that of the KT (0.02% BW) and Cn (median = 0.01% BW) groups. Significant decrease in both COP medial-lateral (ML) and anterior-posterior (AP) ranges were also found in the KT group (median = -0.15% foot width (FW) & median = -0.28% foot length (FL)) than those of the Cn group (median = 0.67% FW& median = 0.88% FL). CONCLUSIONS: Ankle braces might hamper the ability to absorb the impact force during landing. On the other hand, Kinesio tape might be beneficial for the postural control during landing.

Continuous flow, large-scale, microbial fuel cell system for the sustained treatment of swine waste.

Microbial fuel cells (MFCs) have long held the promise of being a cost-effective technology for the energy-neutral treatment of wastewater. However, successful pilot-scale demonstrations for this technology are still limited to very few. Here, we present a large-scale MFC system, composed of 12 MFCs with a total volume of 110 L, successfully treating swine wastewater at a small educational farm. The system was operated for over 200 days in continuous mode with hydraulic residence time of 4 hr. Very stable electrochemical and waste treatment performance was observed with up to 65% of chemical oxygen demand (COD) removed and a maximum treatment rate of 5.0 kg COD/m3 .day. Robust microbial enrichment was performed and adapted to metabolize and transform a diversity of compounds present. The Net Energy Recovery (NER = 0.11 kWhr/kg COD) is not only competitive with conventional cogeneration processes, but is in fact sufficient to sustain the operational energy requirements of the system. PRACTITIONER POINTS: This study demonstrates the design and operation of a large-scale microbial fuel cells (MFC) system for continuous treatment of swine wastewater. The system achieved a high chemical oxygen demand removal rate within a short hydraulic residence time. This study moves one-step closer to applying MFC technology for real wastewater treatment.

Continuous UiO-66-Type Metal-Organic Framework Thin Film on Polymeric Support for Organic Solvent Nanofiltration.

For the first time, continuous polycrystalline UiO-66-NH2 thin film supported by a cross-linked Matrimid substrate was successfully fabricated via in situ solvothermal synthesis at room temperature for organic solvent nanofiltration. The integrated structure of the formed UiO-66-NH2 selective layer was inferred by various characterizations including X-ray diffraction, field-emission scanning electron microscopy, energy-dispersive X-ray, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. We have demonstrated that pretreatment of the substrate by an organic ligand, the number of solvothermal synthesis cycles, and the reaction time play important roles in MOF film formation. The newly developed UiO-66-NH2 membrane possesses high surface hydrophobicity and mean pore size of 0.89 nm in diameter. It shows an exceptional rejection of 96.33% to Rose Bengal with moderate ethanol permeance of 0.88 L m-2 h-1 bar-1. Benefiting from the extraordinary chemical stability of Zr-MOF crystals, the UiO-66-NH2 membrane shows excellent stability in different solvents, implying their great potential for real applications. This work provides useful insights into the fabrication of continuous UiO-66-type MOF membranes on polymeric substrates, which are very promising in practical separations involving organic solvents.

Polyelectrolyte Translocation through a Tortuous Nanopore.

Although nanopores have shown tremendous promise for use in DNA sequencing, the rate of translocation through most pores studied previously is too rapid for the genetic information to be read accurately. In this study, dissipative particle dynamics simulations were employed to investigate the feasibility of using tortuous nanopores to control the rate of polyelectrolyte translocation. Unlike many previous studies, our simulation method incorporates the effects of hydrodynamic and electrostatic interactions and the spatial variation of electric field strength. The average translocation time, ⟨τ⟩, increases with the pore length and tortuosity but decreases as the pore width increases. For the longest pore investigated, the introduction of tortuosity results in ⟨τ⟩ increasing by as much as 187% as compared to a straight pore. The temporal variation of bond tension indicates that slower translocation in tortuous nanopores is caused by inhibition of tension propagation.

Flow-Induced Translocation of Star Polymers through a Nanopore.

The flow-induced translocation of star polymers through a cylindrical nanopore has been studied using dissipative particle dynamics (DPD) simulations. The number of arms, f, was varied with the total number of monomers, N, kept constant. The effect of simulating the capture of the polymer into the pore upon the mean translocation time, <τt>, has been investigated by varying the chain's initial location. The results indicate that the incorporation of the capture process results in a reduction of <τt> by up to 15%. This is because the chain's initial location affects the extent of its stretching along the flow direction during translocation. <τt> exhibits nonmonotonic variation with f, in agreement with recently reported results for electric field-driven translocation of star polymers. Its value is larger and shows greater variation with f when the solvent quality is better. For the same value of f, the capture occurs faster in a good solvent. In addition, <τt> is greater for a semiflexible chain than its flexible counterpart as the time required for the branch point to enter the nanopore is longer in the former case.

Translocation of Star Polyelectrolytes through a Nanopore.

The electric field driven translocation of charged star polymers through a cylindrical nanopore has been studied using dissipative particle dynamics simulations. The critical field strength required to induce translocation depends on both the number of arms and the number of beads per arm. It may therefore be possible to separate star polyelectrolytes of different arm lengths using electric field driven translocation through a nanopore. The average translocation time exhibits nonmonotonic variation with the number of arms for good solvent conditions. During translocation, a star polymer with many arms is stretched along the pore axis to a lesser extent as compared to its linear counterpart. Unlike a linear chain that shows tension propagation with large tensions for bonds about to enter the pore, a star has the tensest bonds closest to the branch point whose connectivity to multiple arms raises difficulty for its entry and passage.

The Impact of First Complete Remission by PET-CT and Time to Next Treatment on Survival of Follicular Lymphoma Patients.

We retrospectively analyzed the impact of initial positron emission tomography and computed tomography (PET-CT) complete remission (CR) and time to next treatment (TTNT) on patient outcome in follicular lymphoma. Between 2002 and 2014, 150 patients could be evaluated for treatment response and long-term outcome. The CR after first line treatment with either rituximab-cyclophosphamide, oncovin, and prednisolone (R-COP) or rituximab-cyclophosphamide, doxorubicin, oncovin, and prednisolone (R-CHOP) was 89% and partial response (PR) was 7%. The 5- and 10-year survival rates were 86.0% and 62.6%, respectively. In five years, 11% of patients had died of lymphoma and 3% from other causes. Forty-seven patients (31%) underwent a second line of treatment comprising 19 (40%) with a TTNT shorter than 24 months and 28 (60%) longer than 24 months. There was no difference in overall survival (OS) between R-COP (86%) and R-CHOP (77%) at 5 years, but there were more next treatment events in the R-COP compared with the R-CHOP group on longer follow-up (60% versus 35% at 8 years). For PET-CT response, there was a significant OS difference between initial CR and PR patients (88% versus 70%, p < 0.01), and a longer TTNT was seen in initial CR patients. Patients with a TTNT longer than 24 months had better OS compared with patients with a shorter TTNT (93% versus 54% at 5 years, p < 0.01). In conclusion, patients with initial PET-CT CR and TTNT longer than 24 months had better OS compared with those achieving only PR and shorter TTNT. PET-CT CR should be considered the treatment goal during initial treatment, and more aggressive treatment should be considered for patients with a TTNT of less than 24 months.

Seasonal variation of refractive error change among young schoolchildren in a population-based cohort study in Taipei.

PURPOSE: To investigate the relationship between seasonal variation of daylight length and spherical equivalent (SE) progression among the schoolchildren participating in the Myopia Investigation Study in Taipei. METHODS: We used the first-year data from grade 2 schoolchildren who completed all the baseline and two follow-up examinations (n=6790). There were two 6-month intervals between visits over winter and summer, respectively. For each interval, we calculated average daily daylight length using data from Taiwan's Central Weather Bureau and measured 6-month SE progression rate based on right eye cycloplegic autorefraction data. The midpoint month was defined as the month midway between two consecutive visits. RESULTS: By the midpoint month, average daily daylight length was the shortest in December (671±7 min/day) and the longest (785±7 min/day) in June, and SE progression rate was the fastest (-0.23±0.48 D) in December and the slowest (-0.17±0.51 D) in June. Significant variation of SE progression rate with season can be observed only among the schoolchildren (n=1905) whose midpoint months for the winter and summer intervals were December and June (winter rate, -0.25±0.47 D; summer rate, -0.17±0.49 D; p<0.001). Of those, the summer progression rate was approximately 80%, 65% and 61.5% of that measured in winter for myopic (p=0.252), emmetropic (p=0.012) and hyperopic (p=0.012) schoolchildren, respectively. CONCLUSION: Our data demonstrate a seasonal variation of minus shift in refractive error among Taipei schoolchildren who had significant daytime fluctuation during the 1-year follow-up. Of those, non-myopic children had significant and more pronounced variation of SE progression than myopic children.

Network-based and cohesion-based social capital and variations in depressive symptoms among Taiwanese adults.

BACKGROUND: Network- and cohesion-based social capital may play an important role in improving mental health. However, there is limited understanding about these relationships among adults in Taiwan. AIM: The aim of this study was to examine the association between individual-level network and cohesion-based social capital and depressive symptoms among a population-based sample of Taiwanese adults. METHODS: Data were obtained from the 1997 Taiwan Social Change Survey (n = 2,598). The 20-item Center for Epidemiological Studies Depression Scale was used to measure depressive symptom scores; ⩾16 represented high depressive symptoms. Network-based social capital was measured using a position generator. Two dimensions of cohesion-based social capital were assessed: cognitive (perceived neighborhood trust and reciprocity) and structural (local community participation and organizational participation). Multivariable log-binomial regression models, weighted to account for the complex sampling design and adjusted for confounders, estimated prevalence ratios and 95% confidence intervals (CIs) to examine the association between each social capital measure and depressive symptoms. RESULTS: In this study, 29.6% of respondents were classified as having high depressive symptom scores. Higher scores of composite cognitive social capital (adjusted Prevalence Ratios (aPR) = 0.92, 95% CI = [0.90, 0.95]) and structural social capital (aPR = 0.80, 95% CI = [0.65, 0.99]) were associated with a lower likelihood of high depressive symptom scores after controlling for confounders. However, there was no association between network social capital and depressive symptoms. CONCLUSION: The findings suggest that the relationship between social capital and depressive symptoms in Taiwan differs according to the specific dimension of social capital assessed. Differentiating between network- and cohesion-based social capital merits greater attention to inform our understanding of building social capital to promote and improve mental health outcomes.

Effectiveness of Needs-oriented Hospital Discharge Planning for Caregivers of Patients With Schizophrenia.

Hospital discharge planning for clients with schizophrenia reduces client rehospitalization rates and improves their medication adherence. The effectiveness of caregiver participation in hospital discharge planning has seldom been explored. The purpose of this study was to examine the effectiveness of caregiver participation in hospital discharge planning for clients with schizophrenia in reducing caregiver burden and improving health status. A quasi-experimental research design was adopted. The research location was in a psychiatric hospital in Northern Taiwan. The target population was caregivers of inpatients with schizophrenia. Nurses served as care coordinators and provided six-step hospital discharge planning services to caregivers. Structured questionnaires were employed to measure caregiver burden and health status. Intervention effect was tested using analysis of covariance in which outcome measure at pretest and selected demographic variables were treated as covariates. A total of 114 caregivers completed pretest and posttest evaluations, with 57 people in each group. A significant difference was found between the experimental and the control group regarding the caregiver burden and health status (P<0.001) The caregiver burden and health status of the experimental group improved more significantly compared with the control group. The caregiver-involved discharge planning process developed in this study effectively reduced the burden placed on caregivers and improved their health status. Mental health nurses can serve as the main care coordinators for assessment, planning, referral and provision of the required services. Caregiver-involved hospital discharge planning should become part of the routine care process.

Children's Hair Mercury Concentrations and Seafood Consumption in Five Regions of Japan.

Exposure to methylmercury (MeHg) during the foetal and postnatal periods is known to have adverse effects on children's development. However, little attention has been paid to MeHg exposure during early childhood in Japan. To examine the regional differences in MeHg exposure and seafood consumption and the association between MeHg exposure and seafood consumption and dental metal restorations, we measured the total mercury (T-Hg) concentration in hair as an MeHg exposure index, and using questionnaires, we measured the frequency and amount of seafood consumption and the presence of dental metal restorations in 118 children aged 3-6 years in five regions of Japan. The arithmetic and geometric means of the T-Hg concentrations in hair were 1.03 and 0.87 ppm, respectively, and approximately 40% of the children exceeded the United States Environmental Protection Agency recommendation of 1.0 ppm. Significant regional differences in the hair T-Hg concentrations were found among the five regions, and the regional differences were consistent with the traditional regional patterns of eating fatty fish. According to the regression analysis, the consumption of fatty fish, particularly tuna/swordfish, had a significant effect on hair T-Hg concentrations, whereas age, sex, the materials used for dental metal restorations, and other types of seafood or fish/shellfish had no significant effects.

The Development and Psychometric Testing on Psychiatric Nurses of a Nurse Case Management Competence Scale in Taiwan.

BACKGROUND: Case management is a complex process involving multiple activities. It is vital that nurses are competent in all related tasks for case management. A competence scale is a valuable tool for assessing task-related competency. PURPOSE: The aims of this study were to examine the reliability and validity of an assessment scale for nurse case management competence and to use this scale to assess the current competency of nurses. METHODS: A nurse case management competence scale was developed in three stages: (a) selection of assessment items according to standards of practice for case management and literature review, (b) determination of content validity using the Delphi technique with a panel of experts, and (c) psychometric testing of the developed competence scale using a cross-sectional design. Convenience sampling was used to recruit psychiatric nurses at seven psychiatric centers in Taiwan to complete the scale anonymously. An exploratory factor analysis was performed to analyze construct validity. Discriminant validity, internal consistency, and 2-week test-retest reliability were also examined. RESULTS: Two hundred eighty-five psychiatric nurses completed an assessment scale comprising 18 items (originally 25 items). The content validity index reached 0.96 after the Delphi technique was applied twice in the expert panel. Seventy-eight percent of the total variance was explained by two dimension factors: coordination facilitation competence and direct care competence. Participants who had undertaken case management courses had superior case management ability compared with those who had not, indicating that the scale possesses excellent discriminant validity. Cronbach's α and the test-retest results showed excellent reliability. Of the two competence factors, direct care competence (3.03) was better than coordination facilitation competence (2.81). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: There is a dearth of studies investigating the development and psychometric testing of case management competence scales. The results of this study provide evidence to support the reliability and validity of the developed case management competence scale among Taiwanese psychiatric nurses. It is a reliable and valid assessment instrument that may help identify educational needs and improve the case management competencies of nurses.