Midwestern Research Articles

Pearls of Wisdom from Teaching Rounds: Reconceptualizing “See One, Do One” as Social Learning

Abstract Background Experiential education is paramount to clinical instruction in medicine. During teaching rounds, faculty can assess medical knowledge and clinical reasoning while modeling evidence-based patient care and effective communication. This study aimed to describe observed traits common across faculty who contribute to favorable learning environments. Design Students completed an Internal Medicine (IM) Student Chief elective at a midwestern United States Academic Tertiary Care Center in which M4s aided Clerkship leadership in near-peer teaching and communicating with students. Chiefs participated in rounds for experiential learning in clinical teaching. For this qualitative, descriptive study, M4s were asked to provide at least three “pearls of wisdom,” on observations about teaching and learning in reflective essays during two consecutive academic years. Twenty-nine M4s participated in the elective and submitted 238 pearls. The research team undertook document review and qualitatively analyzed content of Chiefs’ reflective essays. Detailed codes were organized into primary and secondary themes by each author, and then re-evaluated until they reached consensus. Through thematic analysis, we identified faculty traits students found conducive to learning. Results Three primary themes emerged: Attributes, Autonomy, and Achieving Engagement. Conclusion Experiential educational encounters are transformative to developing new physicians. Chiefs highlighted positive aspects of teaching rounds described previously including providing clear expectations, promoting goal setting, engagement, and instilling confidence. They also valued humor, recognizing cognitive overload, displaying humility, listening skills, and mentorship. While one attending cannot replicate all described effective techniques simultaneously, faculty development that promotes refining these approaches may improve the clinical learning environment for all learners.

Evaluating Social Determinants of Health Competency of Rehabilitation Clinical Staff and Students

Background:Clinical rehabilitation providers and trainees need social determinants of health competency to support health equity and improve the quality of care for all patients.Methods:A total of 199 clinical rehabilitation providers and trainees in the Midwest United States completed the Addressing Client Needs with the social determinants of health (SDOH) scale (ACN:SDH; Johnson, 2023), which assesses social determinants of health competence, as well as professional and personal demographic questions.Results:Students reported higher SDOH competency and higher positive attitudes related to addressing SDOH. In addition, clinical staff and students who reported higher SDOH competence were also more likely to assess patient SDOH, consider SDOH when developing a plan of care, and address SDOH directly with patients versus those who reported less SDOH competence.Conclusion:SDOH competence is directly related to patient care and an important competency for staff and students to gain through curriculum and continuing education opportunities.

Effects of Photoperiod Treatments on Stock Plants and Cutting Rooting of Winecups

Production of attractive and water-efficient plants native to the plains and prairies of central North America can sometimes be limited because of problems associated with successful rooting of vegetative cuttings. Winecups (Callirhoe involucrata) is an attractive native plant, valued for its long period of bloom, drought tolerance, and winterhardiness, but can be difficult to propagate from seeds and vegetative cuttings. Seed dormancy issues can result in unreliable germination and seedling variations, which reduces crop uniformity. Although propagation from rooted cuttings maintains crop uniformity, cuttings often fail to root or root poorly. Manipulating the growing conditions of stock plants to suppress reproductive growth may improve rooting success of vegetative cuttings. Based on research conducted earlier with other ornamental perennials and programmed photoperiods, winecups plants were grown under three programmed photoperiods to determine if a particular photoperiod could be used to suppress reproductive growth and promote vegetative growth. The study consisted of three experiments, all conducted in similar fashion but at different times during the year. Results indicate that plants grown under 10-hour and 8-hour photoperiods remained vegetative longer when compared with plants grown under 12-hour photoperiod. Vegetative cuttings harvested from plants grown under 8-hour photoperiod had higher percent rooting when compared with vegetative cuttings harvested from plants grown under 10-hour and 12-hour photoperiods. Based on the findings from this research, plant propagators may be able to increase production of winecups by growing stock plants under 8-hour photoperiod.

Targeted Funding for Anti-Trafficking Initiatives: An evidence-based anti-oppressive approach

Community-driven research is key to creating evidence-based collaborative systems that meet the multifaceted needs of human trafficking survivors and address oppressions that create vulnerabilities to human trafficking. Programmes and solutions require money and evidenced-informed processes, or they risk investing in systems that will not meet the needs of the intended target populations. This paper reflects on how a community-initiated research project influenced funding to enhance anti-trafficking work in a Midwestern US state. We urge other regions to adopt this model of research and resource allocation in their own anti-trafficking efforts.

The impact of operational police stress on affective commitment: the mediating role of psychological safety

PurposePolice stress is a critical concern for public safety agencies. This study proposes a research model to examine the relationship between police operational stress and affective commitment, mediated by psychological safety.Design/methodology/approachA survey was developed and administered to law enforcement professionals from two large police agencies in a Midwestern US state and Rio de Janeiro state, Brazil.FindingsThe results suggest the research model applies similarly in both countries. A significant relationship between police operational stress and lower affective commitment was found. Psychological safety mediated this effect, suggesting its importance in mitigating stress. The focus on psychological safety offers valuable insights for understanding officer well-being in high-stress environments.Research limitations/implicationsQualitative methods might be used to help better understand the contextual elements around police stress and its consequences. Results indicate that supportive work environments that foster psychological safety can be a powerful tool to buffer the negative effects of stress and promote officer well-being and retention.Practical implicationsA comprehensive understanding of the psychological factors influencing officer morale and engagement is essential for developing interventions to enhance law enforcement effectiveness. Psychological safety helps create a supportive work environment, reducing stress’s negative impact on officer commitment.Originality/valueThis study makes a distinctive contribution by examining the mediating role of psychological safety in the relationship between operational stress and affective commitment among police officers in two countries. Building upon prior research that has examined the impact of stress and psychological safety, this study is among the first to investigate how psychological safety specifically mitigates the negative impact of stress on officer commitment.

COMPUTATION OF RAIN-INDUCED ATTENUATION AT CENTIMETRIC WAVE BAND FOR SLANT PATH COMMUNICATION IN NORTH CENTRAL NIGERIA

In this paper, five globally recognised rain attenuation models for slant path communication are considered in order to compute the amount of attenuation and obtain the optimal rain attenuation models for North Central region of Nigeria. The models are Bryant, Garcia-Lopez, ITU-R P.618-9, Simple Attenuation and Svjatogor. These models were evaluated at Ku and Ka-bands and at three elevation angles of 55o, 42.5o and 23o. 5-minute integration time rainfall data obtained from the Tropospheric Data Acquisition Network (TRODAN), Anyigba, Nigeria was converted to 1-minute integration time using Lavergnat and Gole rain rate model. Predictions were made for circularly polarised signals at different percentages of time of the year. The cumulative distribution of rain attenuation computed showed that attenuation values generally ranged between 9 and 19 dB at time percentage exceedance of 0.01% for the Ku-band, while it ranged between 21 and 41 dB at 0.01% for the Ka-band. Also, computations by the Garcia-Lopez and Bryant models were in agreement with the ITU-R P.618-9 model, while the Simple Attenuation and Svjatogor models underestimated the computed rain attenuation values at every percentage of time in all the stations considered

Registration of ‘MN‐Rothsay’ spring wheat with high grain yield and lodging resistance

Abstract‘MN‐Rothsay’ (Reg. No. CV‐1208, PI 702731) hard red spring wheat (Triticum aestivum) was released by the University of Minnesota Agricultural Experiment Station in 2022 because of its high grain yield and lodging resistance. MN‐Rothsay is a medium‐late maturity cultivar with below average plant height, containing the semi‐dwarfing alleles Rht‐B1b and Rht24b. The lodging resistance of MN‐Rothsay is similar to ‘Linkert’, a 2013 release that was the most widely grown cultivar in Minnesota from 2016 to 2020, largely due to its superior lodging resistance. MN‐Rothsay has moderate resistance to Fusarium head blight (caused primarily by Fusarium graminearum Schwabe), good resistance to prevalent races of pathogens causing leaf rust (Puccinia triticina Eriks.) and stem rust (P. graminis Pers.: Pers. f. sp. tritici Eriks. & E. Henn.), and is well‐adapted to the north central United States.

Evaluation of Reduced Fungicide Applications for Disease Management in Cold-Climate Wine Grapes in Wisconsin.

Cold-climate wine grapes are produced on 8,000 ha in the North Central region of the United States. Wisconsin has experienced considerable growth, with a 26% increase in acreage since 2017. Chemical management of fungal diseases in cold-climate, interspecific hybrid grapes mirrors that of traditional Vitis vinifera cultivars despite significant differences in disease susceptibility. Most cold-climate cultivars display disease tolerance or resistance to key pathogens such as Plasmopara viticola (downy mildew), Erysiphe necator (powdery mildew), and Phyllosticta ampelicida (black rot). Current fungicide programs in Wisconsin's cold-climate grape industry underutilize genetic resistance, resulting in overreliance on at-risk fungicides and an increased threat of fungicide resistance development. In vineyard trials, the impacts of a reduced fungicide application number compared to current grower "Standard" programs was assessed for disease incidence and severity for five diseases: anthracnose, black rot, downy mildew, Phomopsis cane and leaf spot and powdery mildew. In 2022, with moderate disease pressure at both vineyard sites, there were no significant differences observed when fewer fungicides (six or five applications vs. four applications) were applied. In 2023, higher disease incidence was observed in the "Standard" spray program at one study location which received a greater number of fungicide applications. In both years, grape cultivar was a significant factor with the 'LaCrosse' displaying greater average disease severity than the 'St. Pepin' in both the "Standard" and "Reduced" Programs. These findings present a promising opportunity for cold-climate grape growers to reduce the number of fungicide applications while maintaining disease control and marketable yield.

"Moral spaces": A feasibility study to build nurses' ethical confidence and competence.

Background: Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress. Objectives: To assess the feasibility and acceptability of a nursing ethics education program that included simulated case-based ethics competencies as a form of evaluation. The program aimed at building nurses' ethical knowledge and confidence to respond to ethical challenges in practice. Research design: A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data. Participants and research context: Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States. Ethical considerations: IRB approval was obtained. Participants could complete the educational program regardless of research process participation. Findings: Of 20 participants, 19 (95%) provided post-program surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the program to colleagues. Of factors, an increase in ethics knowledge had the highest "always agree" (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0]. Discussion: The education program developed nurses' ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate program value. Conclusion: This novel ethics education program was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method.

Association of Race or Ethnicity With Extended-Spectrum Beta-Lactamase Production in Escherichia Coli: A Case Control Study.

There are limited and conflicting data regarding the impact of race or ethnicity on the rate of gram-negative antimicrobial resistance. This study was performed to determine whether there is a difference in extended-spectrum beta-lactamase (ESBL) Escherichia coli infection or colonization in minoritized patients when compared to White patients from a diverse US Midwestern city. A case control study was performed, with controls with non-ESBL E. coli matched 1:1 to patients with ESBL-producing E coli based on age, sex, and ZIP code. A variety of other evidence-based factors for ESBL Enterobacterales infection and colonization were collected via chart review. Multivariate conditional logistic regression assessed the odds of minoritized patients as compared to White patients, while controlling for other common risk factors for ESBL Enterobacterales. A total of 364 matched pairs were included in the analysis. Females were the majority of the sample (91%), with median age of 65 years. The majority of the sample identified as White (73%), followed by Hispanic (14%) and Black (10%). Urine cultures made up the majority of the cultures in the sample (97%), and this was similar between ESBL and non-ESBL groups. While controlling for these risk factors for ESBL E coli, minoritized patients had a statistically significant greater odds of ESBL-producing E coli (odds ratio, 2.53; 95% confidence interval, 1.68-3.82). In our sample, which is demographically similar to the United States, minoritized patients had higher odds of ESBL-producing E coli. Further research on the drivers for this disparity is needed.

Factors Related to the Rise of Congenital Syphilis From the Perspectives of Prenatal Providers and Birthing Parents in Chicago, IL, USA.

Rates of congenital syphilis (CS) in the United States have risen sharply in recent years. There has been sparse research centering the voices and experiences of birthing parents who have delivered infants with CS and prenatal providers in Chicago or the surrounding Midwestern United States to date. Additionally, there has been little research on the role of extrinsic factors, such as stigma and attitudes surrounding CS in an individual's community, in their entry into and retention in the CS prevention cascade. Semistructured interviews seeking to gather perspectives and factors related to the rise of CS were conducted with birthing parents who delivered infants with CS at a major academic medical institution (AMI) and the prenatal providers who served them. This was supplemented by retrospective data of birthing parent outcomes. Barriers elicited during the interviews included insufficient penicillin uptake, limited transportation, poor communication between providers and patients, gaps in patient understanding or knowledge around CS contraction and treatment, missed appointments, appointment burden for patients, life stressors of patients, housing instability, childcare difficulties, and stigma related to the CS diagnosis. The quantitative data revealed differing proportions of CS outcomes and care between those with care within the AMI, those with care outside the AMI, and those who had no prenatal care. This study found numerous perspectives and factors that may explain the rise of CS along various stages of the syphilis care continuum through in-depth interviews of prenatal providers and birthing parents.

Sexual choking/strangulation and its association with condom and contraceptive use: Findings from a survey of students at a university in the Midwestern United States.

Consensual sexual choking has become prevalent among young United States (US) adults. In sex between women and men, women are overwhelmingly the ones choked, perhaps reproducing traditional heteronormative power dynamics. No research has examined the relationship between being choked during consensual sex and the use of external condoms and other contraceptives. We administered a cross-sectional campus-representative survey to 4989 undergraduate students at a large public Midwestern US university. Half of respondents (n = 1803) had ever been choked during sex. Having been choked was associated with a significantly lower likelihood of event-level condom use (OR = 0.32 [0.19, 0.54] for >5 times lifetime choking among men and OR = 0.35 [0.27, 0.45] for >5 times lifetime choking among women compared to those with no choking experiences) and in the past 6 months (OR = 0.42 [0.24, 0.72] for >5 times lifetime choking among men and OR = 0.59 [0.43, 0.81] for >5 times lifetime choking among women compared to those with no choking experiences). Also, having ever been choked was associated with a significantly greater likelihood of having used an implant/intra-uterine device in the past 6 months (OR = 1.85 [1.28, 2.68] for >5 times lifetime choking compared to those with no choking experiences). Recognition that sexual choking is prevalent among young people has only recently emerged and educational programs are lacking. Study findings could be used to engage people in discussions about choking in relation to gender, power, and reproductive health agency.

Sex differences in state level prevalence of alcohol use among Black women and men in the United States

ABSTRACT Background To investigate differences in alcohol use among Black men and women across U.S. states, using data from the Behavioral Risk Factor Surveillance System. Methods Measured any alcohol use, heavy drinking (i.e., 8+/15+ drinks for women/men in a 7-day period), and binge drinking (i.e., 4+/5+ drinks in one session). Weighted prevalence estimates were age-standardized to the 2000 US population. Results Binge drinking among Black men in Midwestern states was high, ranging from 40% in Minnesota to 45.8% in Iowa. Black women in Southern states had 6–10% points higher prevalence of heavy drinking than Black men. Conclusions Drinking prevalence in Southern states was higher than expected, especially among Black women.

Integrated Management of Sclerotinia Stem Rot of Soybean Including Organically-Allowed Fungicides in the Midwest United States

Sclerotinia stem rot (SSR) is an economically important disease of soybean, especially in the Great Lakes region of the United States. Few studies on SSR have considered organic management practices and how integrated management techniques best apply in these systems. Trials in Wisconsin and Indiana aimed to evaluate management techniques available to organic farmers for their efficacy in SSR control while preserving yield. The practices evaluated included genetically resistant cultivars, tillage techniques, and the application of Organic Materials Review Institute (OMRI) listed foliar fungicides. The resistant cultivar had significantly lower SSR than the susceptible cultivar in three site-years (P < 0.01). The resistant cultivar also had significantly greater yield than the susceptible cultivar in two site-years (P < 0.05). Using a roller-crimped rye cover crop resulted in mixed results on SSR and yield. No effect on SSR or yield by OMRI listed foliar fungicides was observed (P > 0.05). Overall, the results emphasize the importance of planting a resistant soybean cultivar to manage SSR in organic farming systems in the Midwestern United States.

The multiple, unique perspectives of mechanical engineering undergraduates about their program of study and their persistence

ABSTRACT The purpose of this study was to uncover and describe the multiple, divergent student viewpoints about an undergraduate mechanical engineering program at a public university in the US Midwest and their persistence in that program. This study uses Q methodology which mixes qualitative and quantitative research aspects to reveal and describe the multiple, unique viewpoints about any topic. Four unique views emerged from the study: ‘Smart, successful, but unhappy with program,’ ‘Faculty, scholarships, and co-ops are key,’ ‘Excited about engineering but discouraged by curving and grades,’ and ‘Well prepared but there’s a belonging problem.’ Consensus across these views indicates a shared desire of these students to have a successful career as a reason to choose engineering as a degree program and to persist in that program. This study demonstrates the diversity of perspectives regarding an undergraduate engineering program and has implications for all engineering undergraduate programs, regardless of their geographic location.

Online media sentiment analysis of shrimp and salmon in the United States

There is a growing interest in the U.S. seafood and aquaculture market; however, studies utilizing online information to understand this market are limited. This study employs online media analytics to obtain insights into consumer perceptions and potential demand signals for shrimp and salmon in the U.S. Our results show that platform X is the preferred medium for shrimp and salmon discussions, with shrimp's physical quality and salmon's environmental impact being the two major perception drivers. Additionally, autoregressive modeling is conducted to explore the dynamics of net sentiments. Farmed shrimp and salmon consistently exhibit lower net sentiments compared to their wild counterparts, indicating that production methods (aquaculture-raised versus wild-harvested) significantly influence people's preferences. Both wild shrimp and salmon sentiments show a more positive trajectory compared to their farmed counterparts. Negative drops in wild shrimp sentiment are linked to boat incidents, while negative wild salmon sentiments are associated with climate change. Regional analysis demonstrates that public attitudes toward farmed shrimp in East South Central and Mountain regions are unstable, as are attitudes toward farmed salmon in the East North Central, Pacific, and West South Central regions. The fitted forecast model serves as a supplementary tool for industry stakeholders to quickly respond to negative sentiments, preparing for possible public perception changes and potentially enhancing demand. Regional statistics also assist the seafood industry in tailoring business strategies to address geographical differences.

No-tillage farming enhances widespread nitrate leaching in the US Midwest

Abstract Conservation tillage has been promoted as an effective practice to preserve soil health and enhance agroecosystem services. Changes in tillage intensity have a profound impact on soil nitrogen cycling, yet their influence on nitrate losses at large spatiotemporal scales remains uncertain. This study examined the effects of tillage intensity on soil nitrate losses in the US Midwest from 1979–2018 using field data synthesis and process-based agroecosystem modeling approaches. Our results revealed that no-tillage (NT) or reduced tillage intensity (RTI) decreased nitrate runoff but increased nitrate leaching compared to conventional tillage. These trade-offs were largely caused by altered water fluxes, which elevated total nitrate losses. The structural equation model suggested that precipitation had more pronounced effects on nitrate leaching and runoff than soil properties (i.e. texture, pH, and bulk density). Reduction in nitrate runoff under NT or RTI was negatively correlated with precipitation, and the increased nitrate leaching was positively associated with soil bulk density. We further explored the combined effects of NT or RTI and winter cover crops and found that incorporating winter cover crops into NT systems effectively reduced nitrate runoff but did not significantly affect nitrate leaching. Our findings underscore the precautions of implementing NT or RTI to promote sustainable agriculture under changing climate conditions. This study provides valuable insights into the complex relationship between tillage intensity and nitrate loss pathways, contributing to informed decision-making in climate-smart agriculture.

Phosphorus dynamics across a 450 ka vertical chronosequence of loess derived (paleo)soils in central US

Pedogenesis entails profound changes in terrestrial phosphorus (P) dynamics, yet means to understand how time- and climate-induced soil weathering impacts P-cycling over geologic timescales remain relatively limited to space-for-time substitution approaches with multi-site chronosequences. We tested an alternative approach for evaluating terrestrial P dynamics described by the Walker-Syers model by measuring P pools in a ~ 450 ka loess–paleosol sequence. This vertical chronosequence reflects episodic proglacial loess deposition during multiple glaciations and interglacial soil development in central North America in a four-stage loess–paleosol sequence that initiated with the pre-Illinois Episode glaciation. Changes in P pools estimated by sequential fractionation aligned with the Walker-Syers P model for interglacial periods but not glacial periods, possibly reflecting limited soil weathering in cooler and drier conditions of the latter. Total P decreased from 797 to 328 mg/kg with depth and was higher in paleosols than underlying loess parent materials. During glacial periods, primary P increased due to loess deposition and decreased during interglacial periods concomitantly with increased non-occluded and occluded secondary P pools, the extent of which reflected differences in weathering environments of paleoclimatic conditions and loess accumulation rates. That P fractions reflected the Walker-Syers model demonstrates that single-site vertical chronosequences have potential for evaluating long-term soil P dynamics.

Twenty‐Years of Anti‐Climate Change and Anti‐Evolution Education Legislation in the United States

ABSTRACTBoth evolution and climate change have broad scientific consensus, and yet they are the most contested scientific concepts in the US K‐12 education system. This study aimed to explore trends in proposed US state legislation employed from 2003 to 2023 by anti‐evolution and anti‐climate change education movements to constrain the teaching of these sciences. Using a historical qualitative research design, document analysis was used to evaluate state legislation and reports from the National Center for Science Education (NCSE). Two hundred and seventy‐three climate and evolution‐related House and Senate bills, concurrent resolutions, and joint resolutions were identified, coded, and analyzed. Eleven anti‐science education legislative tactics were employed from 2003 to 2023. Five were first identified in the literature review: academic freedom (42.1%), rebranding (12.1%), balanced treatment (12.1%), censorship (2.6%), and disclaimers (2.6%). Six new tactics were revealed in the analysis: anti‐indoctrination (16.8%), standards (12.1%), instructional materials (10.3%), religious liberty (8.8%), avoidance (4.4%), and religious instruction (4.0%). One‐quarter of bills and resolutions employed a combination of tactics. The most ubiquitous tactics were academic freedom bills, which urge science teachers to introduce ideas like intelligent design or climate change denial under the mantle of academic freedom, and anti‐indoctrination bills, which prevent teachers from advocating for controversial topics deemed political. Since 2017, anti‐indoctrination has become the preferred tactic. Southern, southeastern, and midwestern states were the most prolific in their contribution to anti‐science education legislation. Qualitative analysis revealed bill and resolution language was often recycled across years and states with slight changes to wording. From 2003 to 2023, the total number of anti‐science education state legislative efforts increased, as did the number of passed bills and resolutions. The implications of these tactics and trends are considered.

Using natural language processing approaches to characterize professional experiences of child welfare workers

High turnover rates among child welfare workers, including caseworkers and supervisors, are associated with negative attitudes and perceptions about work (NAPW). Our study aimed to (a) explore how child welfare workers’ demographic characteristics, professional attributes, and their work narratives are related to NAPW and (b) extract themes from these narratives to understand their professional needs and concerns. In 2022, a statewide online survey was administered to active child welfare caseworkers and supervisors in a large Midwestern state. This survey, combining standardized scales and an open-ended question about work experiences, yielded numeric (N = 551 survey respondents) and text data (N = 2,193 words). We analyzed the numeric data using general linear modeling and the text data using natural language processing (NLP) techniques. Results showed that workers associated with higher NAPW were female, younger, from racial and ethnic minority backgrounds, less tenured, and more likely to be employed in public agencies and to work longer hours. They are predominantly caseworkers rather than supervisors. Worker role and agency affiliation had the largest effect sizes. NLP analysis showed that workers with more NAPW frequently used third-person pronouns and emotionally negative language, suggesting a disconnection from colleagues and job dissatisfaction. Caseworkers often used first-person singular pronouns, indicating feelings of isolation. Two key themes emerged: a) the need for better agency support during home visits and b) concerns over traumatic experiences and ineffective trauma-informed practices. The findings suggest that future interventions should prioritize the well-being of caseworkers in public agencies and consider language patterns in workers’ narratives to understand their vulnerability to NAPW.