Testing Interventions to Address Bias About Patients with Opioid Use Disorder in the Emergency Department.

INTRODUCTION: Reducing nurse bias about patients with opioid use disorder in the emergency department is critical for providing nonjudgmental care, enhancing patient outcomes, supporting effective communication, and promoting a holistic approach to care. Emergency nurses can make a positive impact on the lives of individuals diagnosed as having opioid use disorder by providing care that is free from stigma and discrimination. METHODS: The study used an observational, pretest-posttest design to compare educational sessions addressing bias and stigma toward patients with opioid use disorder. The study population consisted of emergency nurses who self-selected into a virtual learning experience consisting of e-modules or simulation-based experience consisting of simulation-based experience consisting of simulation, discussion, and a speaker. RESULTS: After the intervention, the simulation-based experience group showed an increase in total score postintervention from a mean of 118.6 to a mean of 127.1 (P < .001). The virtual learning experience group also showed an increase in total score postintervention from a mean of 116.3 to 120.7 (P < .001). Although both groups showed an increase in scores over time, the simulation-based experience group had a greater increase (P = .0037). Within the simulation-based experience, there was an increase in scores across all age groups (P < .05) but a significantly greater increase in scores among younger nurses (18-29 years) than the older age groups (P = .006). DISCUSSION: Opioid use disorder is a complex condition that requires a comprehensive and holistic approach to care. Study results indicate that providing an educational experience to address stigma about patients diagnosed as having opioid use disorder can significantly affect nurse perceptions about these patients and their self-efficacy when working with them. However, investing in a simulation-based educational experience provides a stronger experience and results in greater change, particularly for younger, less experienced emergency nurses.

Engaging Emergency Nurses in Strategies to Address the Social Determinants of Health.

INTRODUCTION: For patients with social needs, emergency departments can be an essential bridge between the health care system and the community. Emergency nurses' knowledge of and engagement in this work need to be examined to ensure that efforts for social determinants of health screening and the resulting community connections are effective. However, there is limited research in this area of nursing practice. The purpose of this study is to describe emergency nurses' knowledge about social needs in their community, assess their knowledge of existing community resources, and examine their perceived confidence to respond to the social needs of their patients. METHODS: A cross-sectional survey was conducted with 243 nurses employed in a large regional health care system. Data were collected using an adapted 81-item social determinants of health survey instrument to measure knowledge of social determinants of health, confidence, and frequency of discussing social determinants of health with emergency department patients and awareness of social resources available in the community. Survey participants were asked about barriers to incorporating social determinants of health into their emergency department workflow and to provide general demographic information. Descriptive statistics were used to analyze study results. RESULTS: Most of the 243 emergency nurse participants believed that addressing social determinants of health was important and that emergency nurses should be involved in issues around social determinants of health. However, most nurses reported limited knowledge about social determinants of health and had very limited knowledge about the resources available in their community to help patients with needs related to food, housing, medical care, and transportation. Nurses reported that although they know that their patients are unlikely to ask for help with social needs during an emergency department visit, they are still unlikely to ask their patients about social needs owing to low confidence about having social needs conversations, limited time, and competing care priorities. Participants advocated for greater case manager presence. Feeling connected to the community was significantly correlated to increased knowledge, confidence, and likelihood to ask about social needs (P < .05). DISCUSSION: The emergency department is a logical place for screening for social determinants of health and connecting patients with social needs to community resources. Emergency nurses included in this study acknowledged that they want to address the social needs of their patients but reported that they lack knowledge about both social determinants of health and more importantly about the resources available to help patients with social needs. In general, they did not feel confident discussing social determinants of health with their patients in the emergency department and are unlikely to ask about social needs. Barriers to screening include time, competing care priorities, and lack of knowledge and support needed from case managers. Findings from this study have implications for supporting emergency nurses employed in institutions that seek to address social influences of health for the patients in their communities.

Evaluating a Global Assessment Measure Created by Standardized Patients for the Multiple Mini Interview in Medical School Admissions: Mixed Methods Study.

BACKGROUND: Standardized patients (SPs) are essential stakeholders in the multiple mini interviews (MMIs) that are increasingly used to assess medical school applicants' interpersonal skills. However, there is little evidence for their inclusion in the development of instruments. OBJECTIVE: This study aimed to describe the process and evaluate the impact of having SPs co-design and cocreate a global measurement question that assesses medical school applicants' readiness for medical school and acceptance status. METHODS: This study used an exploratory, sequential, and mixed methods study design. First, we evaluated the initial MMI program and determined the next quality improvement steps. Second, we held a collaborative workshop with SPs to codevelop the assessment question and response options. Third, we evaluated the created question and the additional MMI rubric items through statistical tests based on 1084 applicants' data from 3 cohorts of applicants starting in the 2018-2019 academic year. The internal reliability of the MMI was measured using a Cronbach α test, and its prediction of admission status was tested using a forward stepwise binary logistic regression. RESULTS: Program evaluation indicated the need for an additional quantitative question to assess applicant readiness for medical school. In total, 3 simulation specialists, 2 researchers, and 21 SPs participated in a workshop leading to a final global assessment question and responses. The Cronbach α's were >0.8 overall and in each cohort year. The final stepwise logistic model for all cohorts combined was statistically significant (P<.001), explained 9.2% (R2) of the variance in acceptance status, and correctly classified 65.5% (637/972) of cases. The final model consisted of 3 variables: empathy, rank of readiness, and opening the encounter. CONCLUSIONS: The collaborative nature of this project between stakeholders, including nonacademics and researchers, was vital for the success of this project. The SP-created question had a significant impact on the final model predicting acceptance to medical school. This finding indicates that SPs bring a critical perspective that can improve the process of evaluating medical school applicants.

Discrimination is associated with poor sleep quality in pregnant Black American women.

BACKGROUND: Heightened exposure to racial/ethnic discrimination is associated with poorer sleep health among non-pregnant adults. This relationship has received limited research attention among pregnant women, despite the importance of prenatal sleep quality for optimal maternal and child health outcomes. METHODS: We utilized perinatal data from a sample of Black American women (n = 600) participating in a cohort study who reported their lifetime experiences of racial/ethnic discrimination and gendered racial stress during early pregnancy and reported on their sleep quality and depressive symptoms during early and mid-pregnancy. Hierarchical multiple linear regression models were fit to examine associations between lifetime experiences of racial/ethnic discrimination or gendered racial stress and sleep quality during early and mid-pregnancy. We also adjusted for women's concurrent depressive symptoms and tested whether the discrimination/sleep quality association varied by socioeconomic status. RESULTS: Greater exposure to racial/ethnic discrimination was associated with poorer sleep quality during early (ΔR2 = 0.04, ΔF = 26.08, p < 0.001) and mid-pregnancy (ΔR2 = 0.02, ΔF = 9.88, p = 0.002). Similarly, greater gendered racial stress was associated with poorer sleep quality during early (ΔR2 = 0.10, ΔF = 65.72, p < 0.001) and mid-pregnancy (ΔR2 = 0.06, ΔF = 40.43, p < 0.001. These findings largely held after adjustment for concurrent prenatal depressive symptoms. Socioeconomic status did not modify the observed relationships. CONCLUSIONS: Efforts to decrease institutional and interpersonal experiences of racial/ethnic discrimination and gendered racism would benefit the sleep quality of pregnant Black American women, particularly during early pregnancy.

Blood flow restriction training for an individual with relapsing-remitting multiple sclerosis: a case report.

BACKGROUND AND PURPOSE: Individuals with Multiple Sclerosis (MS) often present with weakness, poor balance, and increased fatigue that affects physical function. Blood flow restriction training (BFRt) is a popular treatment method to improve strength in orthopedic patients. However, research is limited on the use of BFRt for individuals with MS. This case report describes the effects of BFRt for an individual with relapsing-remitting MS (RRMS). CASE DESCRIPTION: A 30-year-old female with RRMS presented to physical therapy (PT) with weakness and balance difficulty. Initial PT interventions were ineffective at improving balance and strength to achieve specific functional standing and balance goals. BFRt was introduced at reevaluation and performed 2×/week for 8 weeks. Activities-specific Balance Confidence Scale, Modified Fatigue Impact Scale, Berg Balance, strength, and 10-meter walk were assessed at 4 and 8 weeks. OUTCOMES: Measures of strength and balance improved with the addition of BFRt and no adverse events occurred. The addition of BFRt resulted in a meaningful improvement in the individual's ability to achieve her standing and balance goals. DISCUSSION: This case report describes the successful application of BFRt to improve function in an individual with RRMS. Further research is warranted for the use of BFRt for individuals with MS.

A structured approach to Shared Decision Making training and assessment of knowledge, attitudes and perception of second year medical students.

Shared decision making (SDM) has been acknowledged in the last decade. Literature has shown that when physicians are engaged in SDM and form a relationship with their patients, there is higher patient satisfaction of care. Moreover, SDM has been reported to improve patient outcomes and clinical measures. Despite this clear benefit of implementing SDM into clinical practice, there is little evidence for including SDM learning into preclinical medical education. We integrated an exercise for second year medical students to practice the steps of shared decision making. In this paper, the quantitative and qualitative results from a survey of medical students following the SDM learning exercise will be discussed. Students were more educated regarding SDM after this exercise and were motivated to use it in their future clinical careers. They also expressed overall positive attitudes towards SDM tools such as decision aids. Feedback to improve this SDM learning experience included the use of standardized patients, and to expand such education to the clinical environment training. This research provides a model of SDM practice integration into medical education. Similar programs can be beneficial for the development of SDM and other interpersonal skills.

Prenatal distress links maternal early life adversity to infant stress functioning in the next generation.

Maternal stress in pregnancy exerts powerful programming effects into the next generation. Yet it remains unclear whether and how adversity from other times in the woman's life influences her prenatal stress and her offspring's stress functioning. In a sample of 217 Black American mother-infant dyads, we examined whether different types of maternal stress were differentially related to her infant's stress functioning within the first few months after birth. We prospectively assessed maternal distress (perceived stress, depression, and anxiety) early and late in pregnancy, infant behavioral adaption in the context of a mild stressor at 2 weeks of age, and infant diurnal cortisol at 3-6 months of age. We additionally collected retrospective reports of maternal experiences of lifetime discrimination and childhood adversity. Maternal distress experienced late, but not early, in pregnancy predicted lower infant attention in the context of a stressor. Moreover, lifetime experiences of discrimination indirectly impacted infant attention by increasing maternal distress late in pregnancy. These effects were specific to infant behavioral adaptation and were not related to infant diurnal cortisol levels. However, infant diurnal cortisol levels were associated with maternal experiences of discrimination from prior to pregnancy and adversity from the mother's childhood even after controlling for prenatal distress. Our results underscore the cascading nature of stress across the mother's life span and across generations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

COVID-19 Vaccine Willingness and Hesitancy Among Marshallese Pacific Islanders.

COVID-19 has disproportionally burdened racial and ethnic minorities. Minority populations report greater COVID-19 vaccine hesitancy; however, no studies document COVID-19 vaccine willingness among Marshallese or any Pacific Islander group, who are often underrepresented in research. This study documents United States (US) Marshallese Pacific Islanders': willingness to get the COVID-19 vaccine, willingness to participate in vaccine trials, and sociodemographic factors associated with willingness. From July 27, 2020-November 22, 2020, a convenience sample of US Marshallese adults were recruited through e-mail, phone calls, and a Marshallese community Facebook page to participate in an online survey. Of those surveyed (n = 120), 32.5% were extremely likely to get the COVID-19 vaccine; 20.8% were somewhat likely; 14.2% were unlikely or very unlikely; and 26.7% stated they did not know or were not sure. Only 16.7% stated they were willing to participate in a COVID-19 vaccine trial. Vaccine willingness was positively associated with older age, higher income, and longer US residence. Health insurance status and having a primary care provider were positively associated with vaccine willingness. Findings demonstrate within-group variation in COVID-19 vaccine willingness.

Gallium Plasmonic Nanoantennas Unveiling Multiple Kinetics of Hydrogen Sensing, Storage, and Spillover.

Hydrogen is the key element to accomplish a carbon-free based economy. Here, the first evidence of plasmonic gallium (Ga) nanoantennas is provided as nanoreactors supported on sapphire (α-Al2 O3 ) acting as direct plasmon-enhanced photocatalyst for hydrogen sensing, storage, and spillover. The role of plasmon-catalyzed electron transfer between hydrogen and plasmonic Ga nanoparticle in the activation of those processes is highlighted, as opposed to conventional refractive index-change-based sensing. This study reveals that, while temperature selectively operates those various processes, longitudinal (LO-LSPR) and transverse (TO-LSPR) localized surface plasmon resonances of supported Ga nanoparticles open selectivity of localized reaction pathways at specific sites corresponding to the electromagnetic hot-spots. Specifically, the TO-LSPR couples light into the surface dissociative adsorption of hydrogen and formation of hydrides, whereas the LO-LSPR activates heterogeneous reactions at the interface with the support, that is, hydrogen spillover into α-Al2 O3 and reverse-oxygen spillover from α-Al2 O3. This Ga-based plasmon-catalytic platform expands the application of supported plasmon-catalysis to hydrogen technologies, including reversible fast hydrogen sensing in a timescale of a few seconds with a limit of detection as low as 5 ppm and in a broad temperature range from room-temperature up to 600 °C while remaining stable and reusable over an extended period of time.

Do Psychopathic Traits Statistically Protect Against PTSD? A Retrospective Study of Vietnam Veterans.

Although psychopathy traits are traditionally associated with maladaptivity, certain traits may statistically buffer against risk for posttraumatic stress disorder (PTSD). Research suggests that psychopathy traits are differentially associated with PTSD, as boldness traits are negatively related to PTSD whereas disinhibition features are positively related. The authors sought to clarify the relations between psychopathy and PTSD in a large sample of Vietnam veterans (N = 2,598) and to examine the statistical interactions among (a) psychopathy traits and (b) combat exposure and psychopathy traits in predicting PTSD. Results indicate that psychopathy traits are differentially associated with PTSD in combat-exposed veterans, although the authors found little evidence that boldness was protective against PTSD. Nonetheless, meanness was significantly, albeit weakly, protective against PTSD in the presence of combat exposure. The authors consider the implications of these findings for future research, including the need to consider fearlessness as a heterogeneous construct, and they examine whether the findings generalize to PTSD in DSM-5.

Adolescent Behavioral Characteristics Mediate Familial Effects on Alcohol Use and Problems in College-Bound Students.

BACKGROUND: Studies suggest a broad spectrum of behaviors associated with drinking. Consequently, it is unclear whether patterns of familial risk for psychopathology are directly or indirectly related to patterns of alcohol use and problems in late adolescence or mediated by behavioral characteristics, such as temperament, mood. OBJECTIVES: We examined direct and indirect effects of perceived family history of psychopathology on pre-collegiate alcohol use and problems via the Transmissible Liability Index (TLI). METHODS: Participants (N = 302; 29.6% male) provided self-report data on age of onset of drinking, past 90-day frequency of alcohol use and problems (AUP), family history of internalizing and alcohol and illicit substance use, and TLI. RESULTS: Approximately 21% of participants reported having at least one relative with a history of regular and/or problematic alcohol use, compared to 12% for illicit substance use, and -55% for internalizing problems. Higher TLI scores were associated with increased family history of substance use, alcohol use, and internalizing problems, as well as earlier age of onset of drinking. Family history of internalizing problems was the most robust indicator of AUP (ß = 0.20 [95% CI = 0.04-0.36], P = .01). Path analyses suggested that the individual-level behaviors that comprise TLI mediate the effects of family history on age of initiation and regular alcohol consumption. CONCLUSIONS: Family history of internalizing, drinking, and illicit substance use reflect generalized risk for a broad set of behaviors associated with risk for alcohol initiation and use during the transition from high school to college.

Binding of Targeted Semiconducting Photothermal Polymer Nanoparticles for Intraperitoneal Detection and Treatment of Colorectal Cancer.

Nanoparticles offer many promising advantages for improving current surgical regimens through their ability to detect and treat disseminated colorectal cancer (CRC). Hybrid Donor-Acceptor Polymer Particles (HDAPPs) have recently been shown to fluorescently detect and thermally ablate tumors in a murine model. Here, HDAPPS were functionalized with hyaluronic acid (HA) to improve their binding specificity to CT26 mouse CRC cells using HA to target the cancer stem cell marker CD44. In this work, we compared the binding of HA functionalized HDAPPs (HA-HDAPPs) in in vitro, ex vivo, and in vivo environments. The HA-HDAPPs bound to CT26 cells 2-fold more in vitro and 2.3-fold higher than un-functionalized HDAPPs ex vivo. Compared to intraoperative abdominal perfusion, intraperitoneal injection prior to laser stimulation for nanoparticle heat generation provides a superior modality of HA-HDAPPs delivery for CRC tumor selectivity. Photothermal treatment of disseminated CRC showed that only HA-HDAPPs delivered via intraperitoneal injection had a reduction in the tumor burden, and these nanoparticles also remained in the abdomen following resolution of the tumor. The results of this work confirm that HA-HDAPPs selectively bind to disseminated CRC, with ex vivo tumors having bound HA-HDAPPs capable of photothermal ablation. HA-HDAPPs demonstrated superior binding to tumor regions compared to HDAPPs. Overall, this study displays the theranostic potential of HDAPPs, emphasizing their capacity to detect and photothermally treat disseminated CRC tumors.

Osteosarcoma in a Man Referred for Lumbar Radiculopathy.

A 48-year-old man reported right hip pain and low back pain and was referred to physical therapy by an orthopaedic surgeon after magnetic resonance imaging revealed an L1-2 symmetrical disc bulge. His chief complaint was worsening right groin pain. Following examination, the patient attended 3 treatment visits; however, each visit exacerbated the patient's groin pain, so the physical therapist recommended the patient return to his surgeon for hip imaging. Radiographs revealed a right proximal femur osseous lesion. Magnetic resonance imaging was subsequently performed, and a biopsy established the diagnosis of osteosarcoma.J Orthop Sports Phys Ther 2020;50(4):214. doi:10.2519/jospt.2020.9131.

Sustainable and Tunable Mg/MgO Plasmon-Catalytic Platform for the Grand Challenge of SF6 Environmental Remediation.

Sulfur hexafluoride (SF6) is one of the most harmful greenhouse gases producing environmental risks. Therefore, developing ways of degrading SF6 without forming hazardous products is increasingly important. Herein, we demonstrate for the first time the plasmon-catalytic heterogeneous degradation of SF6 into nonhazardous MgF2 and MgSO4 products by nontoxic and sustainable plasmonic magnesium/magnesium oxide (Mg/MgO) nanoparticles, which are also effective as a plasmon-enhanced SF6 chemometric sensor. The main product depends on the excitation wavelength; when the localized surface plasmon resonance (LSPR) is in the ultraviolet, then MgF2 forms, while visible light LSPR results in MgSO4. Furthermore, Mg/MgO platforms can be regenerated in few seconds by hydrogen plasma treatment and can be reused in a new cycle of air purification. Therefore, this research first demonstrates effectiveness of Mg/MgO plasmon-catalysis enabling environmental remediation with the concurrent functionalities of monitoring, degrading, and detecting sulfur and fluorine gases in the atmosphere.

More Than Their Test Scores: Redefining Success with Multiple Mini-Interviews.

INTRODUCTION: Medical schools are shifting to a holistic approach for admissions. As non-cognitive abilities become more valued in the medical field and admissions become more competitive, multiple mini-interviews (MMI) are becoming increasingly common in selection criteria. The purpose of this article is to examine the relationship among admissions criteria to create a predictive model of acceptance to medical school. This article also aims to examine, among matriculated students, the relationship between MMI and traditional academic success, and the relationship between MMI scores and clinical competence and academic accolades. METHODS: This longitudinal study followed a cohort of students from the MMI process through the first two pre-clinical years at a medical school in the southeastern USA. Multiple logistic regression with backward elimination variable selection was used to examine the relationship between admission criteria and acceptance. A multivariate multinomial ordered probit model was used to assess the relationship between MMI and traditional academic success among matriculated students. Simple linear regression models were used to assess relationships between MMI and Objective Structured Clinical Examination (OSCE) scores and honors nomination. RESULTS: MMI are among eight significant predictors of acceptance. Among matriculated students, there were weak negative associations between MMI and traditional academic success; however, all but one relationship was statistically non-significant. There was not a significant association between MMI and OSCE scores or academic accolades. CONCLUSIONS: While MMI can identify students with non-cognitive skills needed to be a good physician, continued assessment needs to be incorporated in their education.

Optically addressing interaction of Mg/MgO plasmonic systems with hydrogen.

Magnesium-based films and nanostructures are being studied in order to improve hydrogen reversibility, storage capacity, and kinetics, because of their potential in the hydrogen economy. Some challenges with magnesium (Mg) samples are their unavoidable oxidation by air exposure and lack of direct in situ real time measurements of hydrogen interaction with Mg and MgO surfaces and Mg plasmonic nanoparticles. Given these challenges, the present article investigates direct interaction of Mg with hydrogen, as well as implications of its inevitable oxidation by real-time spectroscopic ellipsometry for exploiting the optical properties of Mg, MgH2 and MgO. The direct hydrogenation measurements have been performed in a reactor that combines a remote hydrogen plasma source with an in situ spectroscopic ellipsometer, which allows optical monitoring of the hydrogen interaction and results in optical property modification. The hydrogen plasma dual use is to provide the hydrogen-atoms and to reduce barriers to heterogeneous hydrogen reactions.

Murine Models of Intraperitoneal Perfusion for Disseminated Colorectal Cancer.

BACKGROUND: Reproduction of the perfusion used in therapy (hyperthermic intraperitoneal chemotherapy) procedures preclinically represents a valuable asset for investigating new therapeutic agents that may improve patient outcomes. This article provides technical descriptions of our execution of closed and open "coliseum" abdominal perfusion techniques in a mouse model of peritoneal carcinomatosis of colorectal cancer. MATERIALS AND METHODS: BALB/c mice presenting with disseminated colorectal cancer (CT26-luciferin cells) underwent 30-min perfusions mimicking either the closed perfusion or the coliseum perfusion technique. Disease burden was monitored by bioluminescence signaling using an in vivo imaging system. Perfusion circuits consisted of single inflow lines with either a single or dual outflow line. RESULTS: Twelve mice presenting with disseminated disease underwent the closed perfusion technique. Surgical complications included perfusate leakage and organ constriction/suction into the outflow line(s). Nine mice underwent the coliseum perfusion technique with surgical debulking, using bipolar cauterization to remove tumors attached to the peritoneum. All mice survived the coliseum perfusion with limited intraoperative complications. CONCLUSIONS: Fewer intraoperative complications were experienced with our coliseum perfusion technique than the closed perfusion. The methods described here can be used as a guideline for developing future perfusion murine models for investigating perfusion models useful for delivery of chemotherapy or other tumor-sensitization agents, including selective targeted agents, nanoparticles, and heat.

Unidirectional lateral nanowire formation during the epitaxial growth of GaAsBi on vicinal substrates.

We report on enhanced control of the growth of lateral GaAs nanowires (NWs) embedded in epitaxial (100) GaAsBi thin films enabled by the use of vicinal substrates and the growth-condition dependent role of Bi as a surfactant. Enhanced step-flow growth is achieved through the use of vicinal substrates and yields unidirectional nanowire growth. The addition of Bi during GaAsBi growth enhances Ga adatom diffusion anisotropy and modifies incorporation rates at steps in comparison to GaAs growth yielding lower density but longer NWs. The NWs grown on vicinal substrates grew unidirectionally towards the misorientation direction when Bi was present. The III/V flux ratio significantly impacts the size, shape and density of the resulting NWs. These results suggest that utilizing growth conditions which enhance step-flow growth enable enhanced control of lateral nanostructures.

Thermally stable coexistence of liquid and solid phases in gallium nanoparticles.

Gallium (Ga), a group III metal, is of fundamental interest due to its polymorphism and unusual phase transition behaviours. New solid phases have been observed when Ga is confined at the nanoscale. Herein, we demonstrate the stable coexistence, from 180 K to 800 K, of the unexpected solid γ-phase core and a liquid shell in substrate-supported Ga nanoparticles. We show that the support plays a fundamental role in determining Ga nanoparticle phases, with the driving forces for the nucleation of the γ-phase being the Laplace pressure in the nanoparticles and the epitaxial relationship of this phase to the substrate. We exploit the change in the amplitude of the evolving surface plasmon resonance of Ga nanoparticle ensembles during synthesis to reveal in real time the solid core formation in the liquid Ga nanoparticle. Finally, we provide a general framework for understanding how nanoscale confinement, interfacial and surface energies, and crystalline relationships to the substrate enable and stabilize the coexistence of unexpected phases.

Droplet-mediated formation of embedded GaAs nanowires in MBE GaAs(1-x)Bi(x) films.

We have examined the morphology and composition of embedded nanowires that can be formed during molecular beam epitaxy of GaAs(1-x)Bi(x) using high angle annular dark field ('Z-contrast') imaging in an aberration-corrected scanning transmission electron microscope. Samples were grown in Ga-rich growth conditions on a stationary GaAs substrate. Ga-rich droplets are observed on the surface with lateral trails extending from the droplet in the [110] direction. Cross-sectional scanning transmission electron microscopy of the film reveals epitaxial nanowire structures of composition ∼GaAs embedded in the GaAs(1-x)Bi(x) epitaxial layers. These nanowires extend from a surface droplet to the substrate at a shallow angle of inclination (∼4°). They typically are 4 µm long and have a lens-shaped cross section with major and minor axes dimensions of 800 and 120 nm. The top surface of the nanowires exhibits a linear trace in longitudinal cross-section, across which the composition change from ∼GaAs to GaAs(1-x)Bi(x) appears abrupt. The bottom surfaces of the nanowires appear wavy and the composition change appears to be graded over ∼25 nm. The droplets have phase separated into Ga- and Bi-rich components. A qualitative model is proposed in which Bi is gettered into Ga droplets, leaving Bi depleted nanowires in the wakes of the droplets as they migrate in one direction across the surface during GaAs(1-x)Bi(x) film growth.