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In this paper, a realistic interpretation (REIN) of the wave function in quantum mechanics is briefly presented. We demonstrate that in the REIN, the wave function of a microscopic object is its real existence rather than a mere mathematical description. Specifically, the quantum object can exist in disjointed regions of space just as the wave function is distributed, travels at a finite speed, and collapses instantly upon a measurement. Furthermore, we analyze the single-photon interference in a Mach-Zehnder interferometer (MZI) using the REIN. Based on this, we propose and experimentally implement a generalized delayed-choice experiment, called the encounter-delayed-choice experiment, where the second beam splitter is decided whether or not to insert at the encounter of two sub-waves along the arms of the MZI. In such an experiment, the parts of the sub-waves, which do not travel through the beam splitter, show a particle nature, whereas the remaining parts interfere and thus show a wave nature. The predicted phenomenon is clearly demonstrated in the experiment, thus supporting the REIN idea.
The article Realistic interpretation of quantum mechanics and encounter-delayed-choice experiment, written by GuiLu Long, Wei Qin, Zhe Yang, and Jun-Lin Li, was originally published online without open access. After publication in volume 61, issue 3: 030311 the author decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed to The Author(s) 2017 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
The American alligator was once very common in rivers, creeks, and backwater sloughs of East and South Texas. Unregulated market hunting and habitat alteration resulted in near extirpation of the species in Texas by the 1950's. Legal protection, enhanced habitat conditions, and new water impoundment projects have resulted in a rapid repopulation of Texas by alligators during the past 20 years. To complicate matters, an ever-expanding human population continues to encroach upon the alligator's domain. These factors contribute to increased encounters between alligators and people.
Studies consider the clinical encounter as linear, comprising six phases (opening, problem presentation, history-taking, physical examination, diagnosis, treatment and closing). This study utilizes formal conversation analysis to explore patient-physician interactions and understanding diagnostic utterances during these phases.
We identified 62 diagnostic communication utterances in 12 different clinical situations. In most (24/28, 86%) encounters, the diagnosis process was initiated before the diagnosis phase (57% during history taking and 64% during physical examination). In 17 encounters (61%), a distinct diagnosis phase was not observed. Findings show that the diagnosis process is nonlinear in two ways. First, nonlinearity was observed when diagnostic utterances occurred throughout the encounter, with the six encounter phases overlapping, integrating elements of one phase with another. Second, nonlinearity was noted with respect to the resolution of diagnostic uncertainty, with physicians acknowledging uncertainty when explaining their diagnostic reasoning, even during brief encounters.
The structure and flow of the acute care visit has been traditionally conceptualized as comprising six linear phases: the opening, problem presentation, history-taking, physical examination, diagnosis and, treatment plan and closing [4, 5]. However, the process of clinical reasoning - the gathering and analysis of clinical information and deciding about diagnosis, prognosis, and treatment - is often not linear and involves non-analytic decision-making by clinicians; diagnostic hypotheses are often generated very early in encounters and, likewise, clinicians make many diagnoses by pattern recognition rather than hypothetico-deductive reasoning [6]. Although many researchers agree that the diagnostic phase is where the clinician shifts from gathering information to delivering it [7], many argue that the diagnosis process occurs at different times during the encounter as preliminary, speculative, or hypothetical [8].
A final important construct is diagnostic uncertainty, which in recent years has become a focus of attention in better understanding diagnosis and diagnosis-related communication. Diagnostic uncertainty is both ubiquitous and poorly understood, particularly in terms of how it plays out in clinical encounters [14]. Recent studies show that clinicians negotiate diagnostic uncertainty indirectly rather than explicity [15, 16] in order to safeguard against diagnostic errors without compromising their authority, credibility and ability to reassure anxious patients [17].
We conducted an analysis of the clinical encounter MD-SOS transcripts. This descriptive and qualitative analysis builds upon previous studies [19], using the art of conversation analytic to explore patient-physician interactions and better understand the structure of conversations during clinical encounters [20, 21]. For this analysis, we defined diagnostic utterances as the spoken words which involved a synthesis of clinical and investigative data aimed at generating a diagnosis. We inductively examined how diagnosis and diagnostic uncertainty were addressed during urgent care visits by (a) identifying and categorizing diagnostic utterances throughout the six traditional encounter phases; (b) noting revisions of certain/uncertain diagnostic utterances during the encounter; and (c) examining how physicians tested their diagnostic hypothesis and managed uncertainty during the communication of diagnostic information. This project received approval from the Institutional Review Board at Mass General Brigham. We used COREQ guidelines for reporting qualitative research.
Research staff approached patients of enrolled physicians in the clinic waiting room, introduced them to the study and provided written information explaining that the encounter would be recorded and reviewed. Patients were given sufficient time to read the written information and refer to the research staff for questions. To minimize interruptions to the workflow, PCPs asked for a verbal consent from patients who agreed to participate, once they were in the room. The verbal consent was recorded as part of the encounter, as approved by the ethics committee.
Before beginning the actual clinical encounter, the physician obtained verbal consent from the patient to record the visit. Two research staff members were available on site to answer any questions after the visit but were not present in the exam room during the encounter (i.e., only the digital recorder was in the room). At the end of each clinic session, recorded speech files from the encounters were collected by the research assistant and stored in a secure password-protected file area and then transcribed using Amazon Transcribe, then further de-identified and edited by the research assistant for accuracy.
The entire MD-SOS project team also was consulted during bi-weekly meetings to ensure consistent application of the codes and to identify emerging issues or disagreements discovered in adapting the clinical note tool to analyze the encounter transcripts. To acknowledge and minimize the influence of researcher bias on the data, the encounter data was triangulated with the clinical note, and findings were presented, discussed, and revised during team meetings. To enhance validity, codes and themes were reviewed throughout the coding process with reference to recordings to avoid the loss of paralinguistic information affecting meaning (e.g., hesitant voice tone).
For this analysis, we focused on the hypothesis generation process by highlighting three main codes: the location of diagnostic utterances during the encounter, whether certain/uncertain diagnostic utterances were expressed and revised throughout the course of the encounter, and how physicians tested their hypothesis generation and managed diagnostic uncertainty.
In most (24/28, 86%) encounters, the diagnosis process was initiated before the classic diagnosis phase and in some cases the diagnosis was discussed again during the treatment plan and closing. We identified 62 diagnostic communication utterances in 12 different clinical situations (ophthalmic infection, sinusitis, gastroenteritis, dyspepsia, inflamed toe, upper/lower respiratory infection, late menstrual cycle, headaches, weight loss, fall, abdominal pain, strained ankle/wrest, ear pain) within our data set.
Further, in this study, actively addressing diagnostic uncertainty was a frequent and integral component of the urgent care clinical encounter. The findings show that the process of communicating diagnostic information almost always included uncertainty expressions. This implies that sharing uncertainty may be more common than reported, a noteworthy finding especially in this time-pressured acute care setting. In our study uncertainty expressions can be depicted as a communication strategy and a way to explain diagnostic reasoning to patients, something suggested in previous studies [27, 28]. 2ff7e9595c
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