Dynamic input to determine hip joint moments, power and work on the prosthetic limb of transfemoral amputees: ground reactions vs knee reactions

Study Design: Comparative analysis Background: Calculations of lower limbs kinetics are limited by floor-mounted force-plates. Objectives: Comparison of hip joint moments, power and mechanical work on the prosthetic limb of a transfemoral amputee calculated by inverse dynamics using either the ground reactions (force-plates) or knee reactions (transducer). Methods: Kinematics, ground reactions and knee reactions were collected using a motion analysis system, two force-plates and a multi-axial transducer mounted below the socket, respectively. Results: The inverse dynamics using ground reactions under-estimated the peaks of hip energy generation and absorption occurring at 63 % and 76 % of the gait cycle (GC) by 28 % and 54 %, respectively. This method over-estimated a phase of negative work at the hip (from 37 %GC to 56 %GC) by 24%. It under-estimated the phases of positive (from 57 %GC to 72 %GC) and negative (from 73 %GC to 98 %GC) work at the hip by 11 % and 58%, respectively. Conclusions: A transducer mounted within the prosthesis has the capacity to provide more realistic kinetics of the prosthetic limb because it enables assessment of multiple consecutive steps and a wide range of activities without issues of foot placement on force-plates. CLINICAL RELEVANCE The hip is the only joint that an amputee controls directly to set in motion the prosthesis. Hip joint kinetics are associated with joint degeneration, low back pain, risks of fall, etc. Therefore, realistic assessment of hip kinetics over multiple gait cycles and a wide range of activities is essential.

Product stability and sequestration mechanisms in Solanum tuberosum engineered to biosynthesize high value ketocarotenoids

To produce commercially valuable ketocarotenoids in Solanum tuberosum, the 4, 4′ β-oxygenase (crtW) and 3, 3′ β-hydroxylase (crtZ) genes from Brevundimonas spp. have been expressed in the plant host under constitutive transcriptional control. The CRTW and CRTZ enzymes are capable of modifying endogenous plant carotenoids to form a range of hydroxylated and ketolated derivatives. The host (cv. Désirée) produced significant levels of nonendogenous carotenoid products in all tissues, but at the apparent expense of the economically critical metabolite, starch. Carotenoid levels increased in both wild-type and transgenic tubers following cold storage; however, stability during heat processing varied between compounds. Subcellular fractionation of leaf tissues revealed the presence of ketocarotenoids in thylakoid membranes, but not predominantly in the photosynthetic complexes. A dramatic increase in the carotenoid content of plastoglobuli was determined. These findings were corroborated by microscopic analysis of chloroplasts. In tuber tissues, esterified carotenoids, representing 13% of the total pigment found in wild-type extracts, were sequestered in plastoglobuli. In the transgenic tubers, this proportion increased to 45%, with esterified nonendogenous carotenoids in place of endogenous compounds. Conversely, nonesterified carotenoids in both wild-type and transgenic tuber tissues were associated with amyloplast membranes and starch granules.

A meta-analysis of 87,040 individuals identifies 23 new susceptibility loci for prostate cancer

Genome-wide association studies (GWAS) have identified 76 variants associated with prostate cancer risk predominantly in populations of European ancestry. To identify additional susceptibility loci for this common cancer, we conducted a meta-analysis of > 10 million SNPs in 43,303 prostate cancer cases and 43,737 controls from studies in populations of European, African, Japanese and Latino ancestry. Twenty-three new susceptibility loci were identified at association P < 5 × 10(-8); 15 variants were identified among men of European ancestry, 7 were identified in multi-ancestry analyses and 1 was associated with early-onset prostate cancer. These 23 variants, in combination with known prostate cancer risk variants, explain 33% of the familial risk for this disease in European-ancestry populations. These findings provide new regions for investigation into the pathogenesis of prostate cancer and demonstrate the usefulness of combining ancestrally diverse populations to discover risk loci for disease.

The effects of parental illness and other ill family members on the adjustment of children

Background This study addresses limitations of prior research that have used group comparison designs to test the effects of parental illness on youth. Purpose This study examined differences in adjustment between children of a parent with illness and peers from ‘healthy’ families controlling for the effects of whether a parent or non-parent family member is ill, illness type, demographics and caregiving. Methods Based on questionnaire data, groups were derived from a community sample of 2,474 youth (‘healthy’ family, n = 1768; parental illness, n = 336; other family member illness, n = 254; both parental and other family illness, n = 116). Results The presence of any family member with an illness is associated with greater risk of mental health difficulties for youth relative to peers from healthy families. This risk is elevated if the ill family member is a parent and has mental illness or substance misuse. Conclusions Serious health problems within a household adversely impact youth adjustment.

Medical free-text to concept mapping as an information retrieval problem

Concept mapping involves determining relevant concepts from a free-text input, where concepts are defined in an external reference ontology. This is an important process that underpins many applications for clinical information reporting, derivation of phenotypic descriptions, and a number of state-of-the-art medical information retrieval methods. Concept mapping can be cast into an information retrieval (IR) problem: free-text mentions are treated as queries and concepts from a reference ontology as the documents to be indexed and retrieved. This paper presents an empirical investigation applying general-purpose IR techniques for concept mapping in the medical domain. A dataset used for evaluating medical information extraction is adapted to measure the effectiveness of the considered IR approaches. Standard IR approaches used here are contrasted with the effectiveness of two established benchmark methods specifically developed for medical concept mapping. The empirical findings show that the IR approaches are comparable with one benchmark method but well below the best benchmark.

Turun linna kerrottuna ja kertovana tilana

The Turku castle, founded c. 1300, has changed over the centuries from a medieval defensive structure into a Renaissance palace and from a derelict jailhouse in the late 19th century into a prime example of the Medieval built heritage in Finland. Today, it is first and foremost a monument to the Medieval and Renaissance heyday of the castle. This is apparent in the architectural forms that have been carefully restored and reconstructed. It also becomes clear in all kinds of narratives, both visual (like the set of miniatures about the different stages of the construction of the castle) and textual (as during the guided tours). For the first time in the architectural history of the Turku castle, the Medieval, the Renaissance, the Modern, and the Present as architecturally constructed or reconstructed spaces can all be visited within the same hour. As a result, the monumental Turku castle may even be deemed anachronistic or inauthentic. In this study I look at the ways in which the Turku castle is, indeed, anachronistic and inauthentic. My main objective, however, is to find ways in which the anachronisms and inauthenticities are overcome in a positive way. I base my analysis of the Turku castle on three theoretical standpoints. First, I am studying the castle as space, described by Michel de Certeau as a practiced place (de Certeau 2002). Second, I am approaching the numerous narrative aspects of the castle following Paul Ricoeur s analysis of narrative as a threefold mimetic process (Ricoeur 1990). From these two theoretical settings I have summoned the concept of narrative space. The life and work at the castle are based on expectations and understandings of the historical surroundings. My third theoretical choice is to study this applied knowledge of the place as the management of blocks of knowledge in communication (Robert de Beaugrande 1980). Combining the theoretical starting points of space and narrative , I am approaching the castle as if it were an evolving set of narratives, narrated in space but also through space. Seeing e.g. the restoration teams of the mid-20th century and the present day tour guides as creative narrators, I am looking beyond the dilemma of the anachronistic spaces. What transpires is an inter-connected web of texts and spaces, tangible and intangible narratives. My analytical key to these narrative relationships is the threefold mimetic process of pre-figuration, con-figuration, and re-figuration, inspired by the writings of Paul Ricoeur (1990). This way, the past can be seen as a pool of endless possibilities to emplot place, time, and action into a narrative space. The narratives convey images of the past that may be contested by other images, and the power to narrate in the first place can be challenged and re-distributed.

Olen maa johon tahdot : Timo K. Mukan maailmankuvan poetiikkaa

The dissertation deals with the prose texts of the Finnish writer Timo K. Mukka, renowned for his depictions of his native Lapland. This research concerns the creation of world view in Mukka s prose, which is approached by studying what Mikhail Bakhtin calls generic change. Such genre change is the most characteristic feature of Mukka s prose. His prose is permeated with two genres in particular and changes between them: the ballad-like, archaistic and romantic prose-poem style and naturalistic, even grotesque expressions. In addition, these genres are associated with sublime and grotesque styles so that generic change tends to involve also stylistic changes in Mukka s prose. This study probes the tension-filled interrelationships between the ballad and naturalistic prose by examining the discourse of Mukka s characters. It is shown that these characters invariably find themselves in what Bakhtin calls the chronotope of the threshold; that is, the plots of Mukka s novels and short stories depict situations in which the characters are faced with decisions and deeds that will profoundly impact their lives. The discourse of the threshold affects the characters speech by filling it with dialogical dimensions. This makes their communication ethically loaded and polyphonic. This study is based on Mikhail Bakhtin s theory of the novel and international Bakhtin s studies. I also take into consideration the theoretical developments of Bakhtin s work; for example, the concept of ressentiment, adapted from the Bakhtin scholar Michel André Bernstein, plays an important role. In order to explicate on the psychology of Mukka s characters such as melancholy, abjection, sadism, and taboo I use the concepts familiar from Freudian psychoanalysis. The corpus of my research consists of the following texts: the long prose texts Maa on syntinen laulu. Balladi (1964), Tabu (1965), Täältä jostakin. Romaani (1965), Laulu Sipirjan lapsista. Romaani (1966), Ja kesän heinä kuolee. Kertomus sairaudesta (1968) ja Kyyhky ja unikko (1970) and the short story collections Koiran kuolema (1967) ja Lumen pelko (1970), and with Tabu published short story Sankarihymni , the short story Katkelma laajemmasta laulelmasta from the collection Rakastaa: Kaksitoista novellia rakkaudesta (1965) and also the short stories which were published in various Finnish journals: Yöt (1965), Liisa (1967), Tyttö (1967) ja Näin hetki sitten ketun (1970). I pay particular attention to the novel Maa on syntinen laulu, because it expresses the generic change characteristic of Mukka s world view in a specifically clear and lively way. The dissertation is in Finnish. Key words: Timo K. Mukka, world view, genre change, ballad, naturalism, grotesque realism, Mikhail Bakhtin, dialogism, polyphony, chronotope, sublime, grotesque, ressentiment, Sigmund Freud, melancholy, taboo, abject, sadism, reduced laughter, modern parody.

Herrana metsässä : Kansatieteellinen tutkimus metsänhoitajuudesta

The aim of the research is to interpret the professional culture of Finnish university-educated foresters in historical perspective. The main material of this research consists of biographical interviews, altogether 226 life stories of Finnish foresters, as well as foresters private photograph collections and articles in forest students' magazines. This study is the first published Ph. D. dissertation of a large oral history project "Forestry Professions in a Changing Society" 1999 2002 collected by The Finnish Forest History Society, the University of Helsinki (Ethnology) and The Finnish Forest Museum Lusto. The forester education was organized in the Evo Forest Institute 1862 1908, at the University of Helsinki since 1908 and additionally at the University of Joensuu since 1982. At first all the vacancies were in the service of the Board of Forestry, but during the 20th century the working opportunities of foresters significantly expanded, even outside the traditional areas of forestry or abroad. At the same time the whole area of Finnish forestry had integrated more versatile values concerning the forests and their use. The male-dominated profession gained its first female members already in the 1920s, and the number of female students rose gradually from the 1970s onwards. In the 1990s almost half of the new forest students were women. The content of both work and education of Finnish forest professionals has faced huge changes during the 19th and 20th centuries. Despite this however, there has been a long-term vision of a firm profession based on joint experiences, shared memories and the common task of foresters in the Finnish forestry. The feeling of togetherness the forester spirit which was created in a tight-knit student group which kept in touch also later as professionals was needed to make the work possible. Through foresters' own attitudes and narratives of themselves, the study is focused on forest professionalism as a cultural process of successive generations of foresters. How have foresters socialized themselves into their profession? How has forest professionalism been maintained? What is the meaning of joint experiences and shared memories in the profession? By studying the manifestations of a culture it is possible to interpret the culture itself. There seems to be an astounding consensus of opinion concerning forest professionalism in the oral, visual and written stories of foresters. Even if all the individuals and some separate groups, such as female foresters and the younger generation of foresters, did not always share the same experiences, the vision of forest professionalism was collectively recognized and often even approved. The shared idea of "a real forest professionalism" is like a model narrative, a point of comparison, which is needed while looking for one s own professional identity.

Suomi kasvitieteen kieleksi : Elias Lönnrot termistön kehittäjänä

The development of botanical Finnish: Elias Lönnrot as the creator of new terminology In the 19th century the Finnish language was intentionally developed to meet the demands of civilised society and Finnish-language science. The development of the language involved several people from different fields of science. This study examines this enormous project in the field of botany. By which methods were scientific terms formed, and for which reasons were those terms used? Why has a certain word been chosen to represent a particular concept? The material of this study is the terminology of plant morphology in Finnish that Elias Lönnrot developed in the middle of the 19th century. The terms of plant morphology denote and describe the parts of the plant and the relationships between those parts. For instance, the terms emi pistill , hede stamen , terälehti petal and verholehti sepal , which are nowadays familiar in the general language, were used for the first time in Lönnrot s texts. The study integrates the methods of lexicology and terminology. In lexicology, the word and its various meanings serve as the focus, whereas the theory of terminology focuses on the concept and concept systems. A new, consciously developed terminology can be understood through the old, familiar vocabulary and structures as well as through the new, logical term system. Lönnrot s botanical terminology can be divided into three groups depending on their origin: 1) 19% of all terms have been accepted from the existing vocabulary and used in their original meanings, 2) 11% of all terms have been chosen from the existing vocabulary and used in the new, specific botanical meanings, and 3) 70% of all terms have been created on the basis of the existing vocabulary and used in the new, specific botanical meanings. Therefore, the study reveals that domestic materials primarily morphosemantic neologisms form the Finnish terminology of plant morphology. Characteristic of Lönnrot s botanical terms is the utilisation of the vocabulary of various Finnish dialects and particular repeating elements. Repeating elements include, for example, the prefixes that come from botanical Latin or Swedish as well as the particular Finnish derivation types. Such structures form term systems that reflect scientific concept systems. Two thirds of the created new words are formed loosely or precisely according to either Latin or Swedish terms; one third is formed completely differently from its equivalents in the foreign languages. Approximately half of the chosen terms are formed differently from the Latin and Swedish terms. It is worth noting that many loan translations use rare vocabulary from Finnish dialects as equivalents to foreign parts of terms. Lönnrot aimed to inspire scientific terminology with Finland s own language, thus making scientific text accessible to the Finnish agricultural population.

Naiset rajalla : Kyöpeli, Nainen, Naara(s), Neitsyt, Morsian, Akka ja Ämmä Suomen paikannimissä

Women at the boundary. Kyöpeli ( ghost, devil, elf, fairy, enchantress, witch ), Nainen ( woman ), Naara(s) ( female animal, derogatory term for a woman ), Neitsyt ( young, [virgin] woman ), Morsian ( bride ), Akka ( old woman, wife, grandmother ) and Ämmä ( [old] woman, wife, grandmother ) in Finnish place names This study examines a total of about 4,000 Finnish place names which include a specific that refers to a woman: Kyöpeli, Nainen, Naara(s), Neitsyt, Morsian, Akka or Ämmä. The study has two main objectives. First, to interpret the place names in the data, that is, to examine the words included in the data and establish their background and to differentiate names of different ages. In establishing the background of a name, the type of place (e.g. lake, hill or marsh) and its location, as well as the semantics of the feminine specific, are taken into account. The connotations of words referring to a woman are also studied. Words that refer to a woman are often affective and susceptible to changes in meaning, which is reflected in the history of place names. The second main objective is to recognise and highlight mythological place names. Mythology is pivotal for the interpretation of many place names with a feminine specific. The criteria for mythological names have not been explicitly discussed in Finnish onomastics until now, and I seek to determine such criteria in this study with the help of the data. Mythological place names often refer to large and significant natural localities, which are in many cases important boundaries for the community. Names for smaller localities may also be mythological if they refer to a place with a key location or a special topography (e.g. steep or rocky places). I also discuss the stories involved with specific places in the data, such as stories about supernatural beings. Each of the name groups discussed in the study has its own profile. For example, Naara(s) names are so old that naara is no longer understood to refer to a woman. These names have thus often been misinterpreted in onomastics. Names beginning with Morsian, on the other hand, appear to be of fairly recent origin and may be attributed to an international cautionary tale. Names beginning with Nais, Neitsyt, Akka and Ämmä highlight the duality of the data. They include both old names for important natural localities or boundaries and more recent names for modest dwellings, small cultivated areas and useless marshy ponds. This distribution of place names may reflect a cultural shift that changed the status of women in the community.

Tekstit viraston työssä : Tutkimus etuuspäätösten kielestä ja konteksteista

Texts in the work of a city department: A study of the language and context of benefit decisions This dissertation examines documents granting or denying the access to municipal services. The data consist of decisions on transport services made by the Social Services Department of the City of Helsinki. The circumstances surrounding official texts and their language and production are studied through textual analysis and interviews. The dissertation describes the textual features of the above decisions, and seeks to explain such features. Also explored are the topics and methods of genre studies, especially the relationship between text and context. Although the approach is linguistic, the dissertation also touches on research in social work and administrative decision making, and contributes to more general discussion on the language and duties of public administration. My key premise is that a text is more than a mere psycholinguistic phenomenon. Rather, a text is also a physical object and the result of certain production processes. This dissertation thus not only describes genre-specific features, but also sheds light on the work that generates the texts examined. Textual analysis and analyses of discursive practices are linked through an analysis of intertextuality: written decisions are compared with other application documents, such as expert statements and the applications themselves. The study shows that decisions are texts governed by strict rules and written with modest resources. Textwork is organised as hierarchical mass production. The officials who write decisions rely on standard phrases extracted from a computer system. This allows them to produce texts of uniform quality which have been approved by the department s legal experts. Using a computer system in text production does not, however, serve all the needs of the writers. This leads to many problems in the texts themselves. Intertextual analysis indicates that medical argumentation weighs most heavily in an application process, although a social appraisal should be carried out when deciding on applications for transport services. The texts reflect a hierarchy in which a physician ranks above the applicant, and the department s own expert physician ranks above the applicant s physician. My analysis also highlights good, but less obvious practices. The social workers and secretaries who write decisions must balance conflicting demands. They use delicate linguistic means to adjust the standard phrases to suit individual cases, and employ subtle strategies of politeness. The dissertation suggests that the customer contact staff who write official texts should be allowed to make better use of their professional competence. A more general concern is that legislation and new management strategies require more and more documentation. Yet, textwork is only rarely taken into account in the allocation of resources. Keywords: (Critical) text analysis, genre analysis, administration, social work, administrative language, texts, genres, context, intertextuality, discursive practices

Heräämisten poetiikkaa : Lajeja ja intertekstejä Arvid Järnefeltin romaaneissa Isänmaa, Maaemon lapsia ja Veneh'ojalaiset

Poetics of Awakenings. Genres and Intertexts in Arvid Järnefelt s Novels Isänmaa, Maaemon lapsia and Veneh ojalaiset This doctoral dissertation focuses on Arvid Järnefelt s (1961 1932) novels Isänmaa (1893), Maaemon lapsia (1905) and Veneh ojalaiset (1909). The study applies the genre theory and concepts Alastair Fowler has introduced in his Kinds of Literature (1982). Fowler s theory of the novel is developed further and applied to Finnish realist novels. The generic analysis is supplemented by intertextual analysis, which is mainly based on the idea of specific intertextual relations as presented by Kiril Taranovsky. Generic and intertextual analyses form the basis for hermeneutic interpretation, in which attention is paid to the fact that the novels are written by the designated writer in specific historical and cultural circumstances. Instead of the author s intention , the study focuses on the realised intention , in other words the novels as they are published. Järnefelt s first novel Isänmaa is understood to be a classical Bidungsroman that depicts the socialisation of a young male protagonist. From an intertextual point of view, the novel appears to be a novel of conversion, too, due to the biblical allusions concealed in the depiction of the events. Furthermore, Isänmaa is seen to stand in an intertextual relation to Hegel s, Snellman s and Topelius s writings. Maaemon lapsia is argued to be a thesis novel, which persuades the reader to adopt a certain ideological and political stance, namely Henry George s view on the private ownership of land. The novel is modulated by the generic repertoires of fairy tale and tragedy. The mythical frame of the novel supports the thesis novel, as it gives universal validity to the particular events depicted in the novel. Maaemon lapsia also comments on the contemporary political debate on the relations between Finland and Russia by presenting the relationship as analogous to the relationship between tenant farmer and landowner. Veneh ojalaiset exhibits a wide range of genres. Comic, tragic and mythical mode is combined with, for example, family novel, romance, conversion novel and revolutionary novel. From a rhetorical viewpoint, the novel is an apology, which accuses society of generating criminality by means of unjust laws and procedures. The novel discusses the question of resistance to evil by using the themes of Faust and Job, as well as by confronting the philosophies of Epictetus and Nietzsche. The novel is a thesis novel, which disputes the possibility of violent revolution as a way to a better society and recommends passive resistance for an individual living in an unjust society. The poetics of Järnefelt s novels is regarded as the poetics of conversion, as all the novels in focus depict the protagonist s awakening to see the society in a new light, be it a patriotic vision of the reality or a conception of the unfairness of society.

Sekä että : Ironia koherenssina ja inkoherenssina

The interpretation of irony in this study is seen as being crucially dependent on the notion of coherence. Coherence depends on a complex interplay of contextual features, which is why all interpretations must be seen as socio-cultural processes. An utterance is perceived as coherent if it makes sense and if it hangs together. Incoherent utterances can result in an ironic interpretation; however, the incoherence must also be perceived as being intentional, and intentionality in turn is a sign of the ironist's rejecting stance. The study does not encompass the notion of irony of fate nor situational irony that is unintentional. Irony is defined in this study as a combination of five components. It is seen as (1) a negative attitude that reflects (2) the intention of the ironist, and (3) has a target and most often (4) a victim too. Essential to irony is its fifth component, the fact that one or more of these four components must be inferred from co- or context. The componential definition of irony is crucial in deciding whether an interpretation is ironic or not, and the definition makes it possible to discern the differences as well as the similarities between different kinds of irony. The method of the study is experimental: 12 Finnish newspaper texts that could be considered to be ironic were interpreted by 107 informants. The interpretation of one of the texts was based on unelicited feedback given by readers of a weekly magazine. The responses were analyzed to determine (a) whether the texts were perceived as being coherent or incoherent and (b) whether the informants appealed to any of the five components of irony. The results of the analyses of the informants' responses indicate that differences between the ironic and non-ironic interpretations of the texts can be explained in terms of whether or not the informant regarded the text as being coherent. The thesis also discusses the shortcomings of other accounts of irony: the Gricean theory of conversational implicature, speech act theory, irony as rhetoric, irony as pretense, irony as echoic mention, and irony as framing. In contrast to these other accounts, the study focuses on irony as a textual phenomenon and underlines the importance of socio-cultural context in the interpretation of irony. Key words: irony, coherence, incoherence, the componential definition of irony, interpretation of linguistic utterances.

Oireista puhuminen lääkärin vastaanotolla : Keskustelunanalyyttinen tutkimus lääkärin kysymyksistä

Talking about symptoms during medical consultation. A conversation analytical study of doctors questions This linguistically oriented conversation analytic study investigates doctors questions and patients answers during medical consultation. The focus is on 1) the syntactic constructions of the doctors questions concerning the patients symptoms, 2) the function of different types of syntactic constructions, and 3) the sequential placement of the questions. The data used in the study consist of 57 videotaped doctor patient encounters in Finnish primary health care. The study shows that the traditional division between open and closed questions is vague and needs to be examined further. Open wh-questions and closed yes/no questions form heterogeneous classes: some of the closed questions can be treated as open and vice versa. Wh-questions which occur during the physical examination are often constructed to elicit short answers. These questions can consist of one word (e.g. milloin when ) which does not move to a new topic but supports the unfinished activity of palpation. During the verbal examination, wh-questions are formulated to elicit long descriptions as answers. For example, by asking mites + X ( what about + X), the doctor can open up a new topic and simultaneously give the patient the opportunity to discuss the topic from his/her perspective. Almost half of the yes/no questions project longer than just a minimal answer (e.g. a short confirmation or rejection). In these questions, the doctors use verbal elements which show that more than just a minimal answer is required. They can, for example, add an indefinite element (joku some or mitään any ) to a yes/no question, add a conjunctive vai ( or ) to the end of the question and thus open a space for various types of answers, or add a suggested answer to the question. In addition, the results show that declarative questions not only check understanding, but display the doctor s diagnosing process, check whether the doctor can move on to the next topic or action, and display implicitly the doctor s idea of what is connected and what is relevant. One aim of the study is to describe how different syntactic structures work together. A typical question chain consists of two or three questions. The first question is an open wh-question that elicits a new topic and creates different types of presuppositions. Contingent questions are constructed as yes/no questions that seek an affirmative answer or as declarative sentences that seek confirmation. Contingent questions can function as repair initiators and thus support achieving mutual understanding. Therefore, they are tools for the doctor to construct a description of the medical problem collaboratively with the patient. The results add to the results of previous studies on questions in medical consultation, but also suggest some corrections. They provide additional evidence for the idea that different types of syntactic constructions are useful in different types of settings. However, they also show that the variety of questions that doctors use is more manifold and diverse than the variety introduced in earlier studies and textbooks.