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  • Korkiakangas, Timo (Helsingin yliopisto, 2016)
    The object of this study is the case marking of the subject in early medieval charter Latin. The work explores whether and how the nominative/accusative-type morphosyntactic alignment changed into a semantically motivated (active/inactive) alignment in Late Latin before the disappearance of the case system. It is known that the accusative originally the case of the direct object extended in Late Latin to the subject function in which Classical Latin allowed only the nominative. On this basis, it has been postulated that in Late Latin the nominative/accusative contrast was (re)semanticized so that the nominative came to encode all the Agent-like arguments and the accusative all the Patient-like arguments. The study examines which semantic and syntactic factors determine the selection of the subject case in each subject/finite verb combination in the Late Latin Charter Treebank (LLCT). The LLCT is an annotated corpus of Latin charter texts (c. 200,000 words) written in Tuscany between AD 714 and 869. The central result of the study is that the Latin of the LLCT shows a semantically based morphosyntactic alignment in those parts of nominal declension where the morphological contrast between nominative- and accusative-based forms is morphophonologically intact. The following picture of intransitivity split turns up: the low-animacy subjects of the LLCT occur more often in the accusative than do the agentive high-animacy subjects. Likewise, the accusative percentage of SO subject constructions is higher than that of A/SA subject constructions. The common denominator of the examined semantic variables is likely to be the control exercised by the subject over the verbal process. Syntactic factors seem to influence the case distribution pattern as well. For example, the immediate preverbal position of the subject implies a high retention of the nominative. The immediate preverbal position of SV(O) language is a canonical subject position where the syntactic complexity measured as dependency lengths is at its lowest and the cohesion of the verbal nucleus at its highest. Thus, a by then already marked nominative form results. The control of the subject over the verbal process (semantic variable) and the cohesion of the verbal nucleus (syntactic variable) may be partly conflated, i.e., both may affect the subject case selection in certain conditions.
  • Reponen, Elina (Helsingin yliopisto, 2016)
    Background: Preoperative risk assessment and reliable outcome reporting are vital for improving quality of care and patient safety. Studies on neurosurgical patients are surprisingly scarce, and no prospective reports on unselected elective craniotomy patients exist. The objectives of this study were to review the literature on the use of preoperative risk-assessment scores in elective cranial neurosurgery and to study preoperative risk prediction, short-term outcome reporting, and patient satisfaction in the first unselected, prospective cohort of adult elective craniotomy patients. Patients and Methods: We performed a systematic review of 25 studies on five preoperative scores [The American Society of Anesthesiologists physical status classification (ASA) score, the Karnofsky Performance Score (KPS), the modified Rankin Scale (mRS), the Sex, Karnofsky, ASA, Location, and Edema (SKALE) score, and the Charlson comorbidity score] in predicting outcome in elective cranial neurosurgery. We enrolled a prospective, unselected cohort of 418 adult elective craniotomy patients in the Department of Neurosurgery, Helsinki University Hospital. Evaluation of routinely collected preoperative data, original ASA score, Helsinki ASA score, and their combinations revealed their ability to predict in-hospital new central nervous system (CNS) deficits as well as systemic and infectious complications after elective craniotomy. We evaluated the reliability and accuracy of patient-reported outcomes, postoperative mRS scores, and mRS-score differences in reflecting short-term outcome. Overall patient satisfaction rate was determined, as were associations between high or low patient satisfaction and short-term postoperative outcome. Results: Evidence as to the applicability of preoperative risk-assessment scores in elective cranial neurosurgery is scarce, with KPS receiving the most support in the literature. None of the scores predicted all postoperative outcomes; the most applicable risk score varied with the outcome measure selected. The in-hospital mortality rate was 1.0% and the 30-day rate was 2.4%. In-hospital systemic and infectious complications occurred in 6.7% of patients, and new CNS deficits in 11.2%. Advanced age, preoperatively elevated C-reactive protein (CRP) level, and high Helsinki ASA class were independent predictors of systemic and infectious complications. A combination of these variables identified one-fourth of the patients with systemic and infectious complications (p=0.005, OR 4.8, CI 1.5-15.9, AUC 0.766) and was associated with prolonged intensive care unit (ICU) stay (p=0.018) and hospital stay (p=0.004). The rate of overall complications was 46.4%, and the rate of major complications was 18.2%. Perioperative changes in mRS scores were inconsistent: among patients with no complications, the mRS score increased for 17.1% at hospital discharge and for 23.8% at 30 days. Moreover, 28.0% of patients with major complications showed no increase in mRS scores at hospital discharge. Associations between patient-reported postoperative subjective deterioration in functional status and both major and overall morbidity were significant. Furthermore, a simple unweighted composite score of PROs was more sensitive and specific than was 30-day dependent functional status (mRS score ≥3) in detecting both major and overall morbidity. In our cohort, 93.8% rated their overall satisfaction as good or excellent. Even 9 of 10 patients with postoperative major morbidity rated their satisfaction as high. Low patient satisfaction was associated neither with major (p=0.054) nor with overall (p=0.215) morbidity. Conclusions: Strong evidence supporting the use of any preoperative risk score in elective cranial neurosurgery is lacking. The Helsinki ASA score seems more suitable than the original ASA score for elective craniotomy patients, especially in combination with other preoperative risk predictors, but only for systemic and infectious complications. The rate of major complications in our cohort was moderately low considering the average age, comorbidities and operated lesions of the patients in our unselected study cohort. The postoperative mRS score and mRS-score differences were inconsistent with recorded complications, whereas PROs seem promising tools for outcomes reporting. Overall patient satisfaction was high, even in patients with complicated outcomes, and thus patient satisfaction is a poor proxy for treatment outcome and quality of care in elective cranial neurosurgery.
  • Quintero, Ileana B. (Helsingin yliopisto, 2015)
    Prostatic acid phosphatase (PAP) has been linked to prostate cancer since the mid-1930s. The main research approach of PAP over that time has been based on its role in the human prostate. The regulatory mechanisms of expression of the PAP gene have also been studied, giving us information about the regulatory elements in the gene and the transcription factors that affect the gene expression in the prostatic tissue. However, little was known until recently about this protein s role and physiological function in other tissues. Our group generated and used a PAP-deficient mouse and was able to show that PAP is expressed in dorsal root ganglia (DRG) and spinal cord in mice. This is the same protein as thiamine monophosphatase (TMPase) whose enzymatic activity has been used for five decades to mark primary sensory neurons. In these tissues, PAP acts as an ecto-5'-nucleotidase and is able to dephosphorylate AMP to adenosine, and therefore produce an anti-nociceptive effect due to the binding of adenosine to the A1-adenosine receptor. We analyzed the ACPP gene, which enabled us to describe a new transmembrane isoform for PAP (TMPAP). This novel PAP isoform is produced by alternative splicing of the 11th exon of the ACPP gene. The alternative splicing is present in species such as the human, mouse and rat. The newly discovered isoform is widely expressed in human and mouse tissues and contains a tyrosine sequence (YxxΦ) in its carboxyl-terminus, which directs the protein to endocytosis. We have also corroborated its functionality by co-localization studies with different organelle markers in the endosomal/lysosomal pathway (I). The generation of a PAP-deficient mouse also enabled us to study the function/s of PAP in vivo. The lack of PAP in this mouse model led to the gradual changes in the mouse prostate that finally culminated with the development of prostate adenocarcinoma at the age of 12 months. Microarray analyses of different tissues that compared the PAP deficient mouse with the wild type (WT) mouse revealed changes in genes related to the vesicular trafficking, which support our previous results and led us to the conclusion that TMPAP could be involved in the regulation of the vesicular trafficking. We also detected the interaction between TMPAP and snapin, a SNARE (Soluble NSF Attachment Protein Receptor) associated protein, by yeast two-hybrid screening, co-localization and FRET (Förster resonance energy transfer) analysis. We concluded that, the disruption of this interaction in the PAP-deficient mouse leads to a disturbance in the vesicular transport of the cell and to the development of prostate adenocarcinoma in the PAP-deficient mouse prostate (II). Furthermore, we showed that the PAP-deficient mice present multiple behavioral and neurochemical alterations including increased size of brain lateral ventricles, hyperdopaminergic deregulation, and altered GABAergic transmission, symptoms that indicate that PAP also disturbes the normal function of the central nervous system (III). Snapin protein in the brain has been described as a protein important for the vesicular transport and for the fusion of vesicles with the plasma membrane, and we observed that the lack of PAP in GABAergic neurons leads to a change in the localization of snapin in the PAP-deficient mouse (III), which could indicate that as in the prostate a dysregulated vesicular trafficking could be the reason for the detected phenotype. The discovery of the new TMPAP and its localization in the endosomal/lysosomal pathway enabled an understanding of the phenotypic changes that occur in the PAP-deficient mouse. We hypothesized that TMPAP regulates vesicular trafficking by interacting with snapin, and its deficiency leads to a dysregulation of the endo-/exocytosis cycle, which produces the observed alterations in the mouse organs and tissues. The results obtained throughout this research project have opened up new lines of research related to PAP physiological function, and a deeper understanding of the expression, regulation and function of this protein could lead to new clinical applications.
  • Lehtonen, Irma (Helsingin yliopisto, 2015)
    English abstract This dissertation deals with the development process of bisexuality, identifying oneself as bisexual, acknowledging bisexuality in a heterosexual relationship, and the disclosure of bisexuality in a relationship assumed to be heterosexual. Bisexuality as a phenomenon is, to a large extent, both unacknowledged and invisible, and has been largely ignored in studies of relationships. Within the context of social work, customers who identify themselves as bisexuals often experience feelings of fear and anxiety because of their sexual orientation especially in terms of interacting with the social workers, being labelled as something different, and hence having to conceal their sexual orientation. Because of these anxieties, social workers need more diverse models and practices that enable them to help their customers with empathy and respect regardless of their sexual orientation. This dissertation is based on three main research questions: first, through what kind of a process does an individual disclose and identify bisexuality, second, what kind of phases does an individual go through when acknowledging bisexuality in someone close to them, and third, what happens in a relationship when it turns out that a person who identifies as bisexual has a relationship with a third party of the same gender. In addition to these, I am also interested in what emotions are experienced in a relationship when an individual´s bisexuality is disclosed to the partner, and how relationships are influenced and shaped by heteronormativity. One of the key concepts in this dissertation is heteronormativity, which describes a process dividing individuals into two separate genders and assuming romantic emotions to take place only between individuals of different genders. Heteronormative practices are experienced by and limited mostly to individuals whose sexuality deviates from the norm. For them, heteronormativity is regarded as imposing a set of norms regarding what is the status quo, natural, normative, and the only way to live a meaningful life. Within the public domain, heteronormativity is seldom questioned or challenged, and it is closely related to issues such as power and secrecy. Heteronormativity aims at shaping and maintaining our collective understanding of relationships in contemporary societies as something taking place between a man and a woman. As a counterforce to this, queer theories aim at challenging and questioning our norms and assumptions related to relationships by broadening the scope of relationships outside theas purely heterosexual. Methodologically, this dissertation approaches bisexuality from the narrative point of view. This dissertation thus assumes that bisexuality can be investigated through data collected from individual life stories. Life stories enable us to identify events and stories that shape an individual s understanding of bisexuality and relationships. The narrative approach served as a window to the authors of the life stories, their lives, as well as their life stories. Through the stories, the authors discussed their feelings and how they experienced the disclosure of bisexuality in their relationships. The data for this dissertation consists of sixty such life stories that deal with experiences related to bisexuality, its impact on the heterosexual relationship, and emotions and feelings closely related to bisexuality. This data was qualitatively analysed by means of both narrative and content analysis. Stories about bisexuality blend together numerous overlapping stories about relationships, emotions, memories, social relations, fears, secrecy, acknowledging and identifying bisexuality, as well as being bisexual. The authors narrate their stories through interactive processes by inviting the listener to be an active participant. Storytelling is inherently not only about making sense, but also about identity building and peer support. Within this context, narratives can either support or inhibit the emergence of stories. The main finding of this dissertation is that bisexuality develops over time. This development can be seen as a trajectory with separate, yet overlapping, phases. Bisexuality is seldom easily voiced or revealed to others, which is why secrecy closely shadows it. This is partially explained by flexibility: the ability to portray oneself either as heterosexual or homosexual. Bisexuality, then, seems to be something that is seldom publicly shared with other members of the society. People who identify themselves as bisexual often conceal it from their spouses and loved ones mostly because they are afraid of rejection and of being cast in the pariah class. However, it seems that a change is taking place in the Finnish society: especially younger generations especially are more open about their bisexuality, and it is becoming more common to share it with a prospective partner in the beginning of a relationship. Keywords: sexuality, bisexuality, heteronormativity, emotions, narratives
  • Arola, Teppo (Helsingin yliopisto, 2015)
    Increase of greenhouse gas concentrations in the atmosphere, the limits of conventional energy reservoirs and the instability risks related to energy transport have forced nations to promote the utilisation of renewable energy reservoirs. Groundwater can be seen as an option for renewable energy utilisation and not only a source of individual or municipal drinking water. Finland has multiple groundwater reservoirs that are easily exploitable, but groundwater energy is not commonly used for renewable energy production. The purpose of this thesis study was to explore the groundwater energy potential in Finland, a region with low temperature groundwater. Cases at three different scales were investigated to provide a reliable assessment of the groundwater energy potential in Finland. Firstly, the national groundwater energy potential was mapped for aquifers classified for water supply purposes that are under urban or industrial land use. Secondly, the urbanisation effect on the peak heating and peak cooling power of groundwater was investigated for three Finnish cities, and finally, the long-term groundwater energy potential was modelled for 20 detached houses, 3 apartment buildings and a shopping centre. The thesis connects scientific information on hydro- and thermogeology with the energy efficiency of buildings to produce accurate information concerning groundwater energy utilisation. Hydrological and thermogeological data were used together with accurate data on the energy demands of buildings. The heating and cooling power of groundwater was estimated based on the groundwater flux, temperature and heat capacity and the efficiency of the heat transfer system. The power producible from groundwater was compared with the heating and cooling demands of buildings to calculate the concrete groundwater energy potential. Approximately 20% to 40% of annually constructed residential buildings could be heated utilising groundwater from classified aquifers that already are under urban land use in Finland. These aquifers contain approximately 40 to 45 MW of heating power. In total, 55 to 60 MW of heat load could be utilised with heat pumps. Urbanisation increases the heating energy potential of groundwater. This is due anthropogenic heat flux to the subsurface, which increases the groundwater temperatures in urbanised areas. The average groundwater temperature was 3 to 4 °C higher in city centres than in rural areas. Approximately 50% to 60% more peak heating power could be utilised from urbanised compared with rural areas. Groundwater maintained its long term heating and cooling potential during 50 years of modelled operation in an area where the natural groundwater temperature is 4.9 °C. Long-term energy utilisation created a cold groundwater plume downstream, in which the temperature decreased by 1 to 2.5 °C within a distance of 300 m from the site. Our results demonstrate that groundwater can be effectively utilised down to a temperature of 4 °C. Groundwater can form a significant local renewable energy resource in Finland. It is important to recognise and utilise all renewable energy reservoirs to achieve the internationally binding climatological targets of the country. Groundwater energy utilisation should be noted as one easily exploitable option to increase the use of renewable energy resources in a region where the natural groundwater temperature is low. The methods presented in this thesis can be applied when mapping and designing groundwater energy systems in nationwide- to property-scale projects. Accurate information on hydro- and thermogeology together with the energy demands of buildings is essential for successful system operation.
  • Purkamo, Lotta (Helsingin yliopisto, 2015)
    Microbial life in the deep subsurface contributes significantly to overall biomass on Earth. Although the microbial communities inhabiting the deep subsurface are abundant, little is known about their diversity, activity, interactions and role in global biogeochemical cycles. The diversity of microbial life in the deep terrestrial subsurface of the Fennoscandian shield was studied with molecular biological methods. The Outokumpu Deep Drill Hole provides access to crystalline bedrock fluids that are estimated to be tens of millions of years old. Characterization of the indigenous bacterial and archaeal communities in addition to microbial communities with important functional properties in bedrock fluids was done from a depth range of 180 m to 2300 m. Microbial community profiling and assessment of possible functional processes was done with molecular fingerprinting, cloning and sequencing methods combined with suitable statistical and bioinformatics analyses. Low cell numbers but high diversity was characteristic to the microbial communities of the Outokumpu deep subsurface. The microbial communities in the fracture zones had in general fewer cells than those in the mixed fluids of the drill hole. Comamonadaceae, Peptococcaceae and Anaerobrancaceae were prevalent bacterial members of the microbial communities in the fracture fluids. Archaea were a minority in microbial communities. Sulfate-reducing bacteria and methanogens were detected at several depths. Microbial communities resembled those detected from other deep Fennoscandian Shield subsurface sites. Furthermore, sulfate reducing communities and archaeal communities resembled those found from the deep subsurface of South Africa. Investigation on carbon assimilation strategies of the microbial communities revealed that mainly heterotrophic Clostridia were responsible for CO2 fixation in this habitat. Representatives of Burkholderiales and Clostridia formed the core microbial community and these were also identified to be the keystone genera. The microbial communities of Outokumpu fractures share similarity with those of serpentinization-driven ecosystems. Energy and carbon substrates formed in serpentinization reactions of ophiolitic rocks in Outokumpu may sustain the microbial communities in this deep subsurface environment.
  • Weiste, Elina (Helsingin yliopisto, 2015)
    The quality of the therapeutic relationship is highly significant for treatment outcomes in mental healthcare. While the value of the relationship has been clearly documented, the various aspects of how the relationship is actualized in clinical practice have remained unclear. This dissertation breaks new ground in understanding how the therapeutic relationship is manifested in three forms of therapeutic interaction: psychoanalysis, cognitive psychotherapy and resource-centred counselling. The method of conversation analysis is applied to compare these approaches and reveal how specific aspects of the therapeutic relationship are managed in interaction: 1) how therapists express empathy and respond to clients talk on their subjective emotional experiences, 2) how therapists work with experiences that belong to clients personal domains of knowledge, and 3) how disagreements are expressed and relational stress managed in therapeutic interaction. The data comprise audio- and video-recorded encounters from each therapeutic approach (86 encounters in total). The data analysis reveals the fine-grained interactional practices used in the management of the therapeutic relationship. In all the therapeutic approaches, formulating the client s emotional experience allowed the therapists to display empathic understanding, and prosodic features were important for marking the formulation as either empathic or challenging. In psychoanalysis and cognitive psychotherapy, the client s emotional experiences were typically validated, interpreted or challenged. In the resource-centred approach, the clinicians sought to focus on successful experiences and praised clients agency and competence, while shifting the focus away from their difficult emotional experiences. The data analysis also highlights the complex relationship between emotions and epistemics and describes how a delicate balance between empathic and challenging interventions is manifested in therapists supportive and unsupportive moves during extended disagreement sequences. This dissertation contributes to three areas of research: 1) clinical research, as it underlines the importance of investigating the actions of the therapist and client in a relational way, furthering comprehension of how the processes associated with the therapeutic relationship appear in the context of interaction between therapist and client; 2) sociological studies on mental health, as this study illustrates some important institutional differences between psychotherapy and psychiatric outpatient care; 3) conversation analysis, as this research provides the first broader systematic comparison of interactional practices in different therapeutic approaches.
  • Kauppinen, Saara (Helsingin yliopisto, 2015)
    This study discusses the language, especially the communicative structures, of Greek dialogue epigrams. The central research questions include: Who are the speakers? How are they identified? How does the recipient know when the speaker changes? How is the turn-division implied? What are the functions of the speakers? In the study, all the dialogue verse inscriptions are collected and divided according to typology that was created for this study and which is based on the pair structure. The most common adjacency pair of dialogue epigrams is a question answer pair, and many of the elements studied here are features of question structures, but other pairs, such as greeting pairs, are also taken into account. The dialogues contain either one adjacency pair (type 1), several of them (type 2) or longer, often narrative units that form pair-like structures (type 3). The types, their variants and features of the language characteristic of each are discussed using examples. Elements such as addresses, imperatives and particles are central to my argument, and speaker roles and pair structure variants are also discussed. Non-inscriptional epigrams are given as parallels for each type, and the mutual influence between them and the verse inscriptions is discussed using examples. The reception situation and possible performance of the epigrams is also discussed, and on the basis of various examples, it is stated that the representation of the speakers often implies the complex reception situation, part of which was most probably reading the epigram aloud. Epigraphic methods are used and combined, and the linguistic aspect brings a new perspective to epigraphic studies. The comparison of the verse inscriptions and the literary ones contributes to ongoing discussions on the epigram genre and its inscriptional counterparts. The material discussed is mainly from the Roman period, a phase less well discussed in recent epigram studies, and the study thus adds to our knowledge of the genre and the mutual influence between the post-Hellenistic verse inscriptions and non-inscriptional epigrams.
  • Häikiö, Kaarina (Helsingin yliopisto, 2015)
    The purpose of this study is to shed light on the status of the patient in health policies implemented in order to secure patients access to care and to improve the quality of the care. The study focuses on patients and the treatment guarantee from the viewpoints of government and nongovernmental organisations in 2004-2010. The treatment guarantee is the only segment of legislation that gives patients concrete assurance of access to treatment and quality care. The experiences of patients and organisations in combination with inconsistencies in official follow-up data reinforce the need for this study. The three-level theoretical framework of the study based on the discourse-historical approach in Ruth Wodak s linguistic model. It builds on the impressive background of period pieces and modern-day diagnostics (zeitdiagnose), special phenomena such as the notion of patients as actors in the health policy debate, and language management. The task of the study is to describe the status of patients in the context of the treatment guarantee, as well as to outlines the relationship of public health organisations and government authorities to the reform in national health policy over the period 2004-2010. The study addresses questions about the status of patients and questions about the viewpoints of government and public health organisations concerning the treatment guarantee. The research material comprises documents from government and organisations, data from interviews with experts, and articles from the Helsingin Sanomat daily newspaper. Content analysis occasionally shifts to discourse analysis in the course of the study. The government authorities expected the treatment guarantee as a major health care reform, but according to the experts' interviews it did no turn out that way partly due to the weak implementation. National government authorities and public health organisations differ in use of the concept of a treatment guarantee. The public health organisations were not concerned about a usage threshold for use the concept of a treatment guarantee. Government authorities had different practices in use the concept. At the beginning of the research period, the Ministry of Social Affairs and Health , unlike other government authorities, shunned the concept. When the matter was dealt with in Parliament, however, the opposition referred to the concept of a treatment guarantee. Perceptions about the content of the treatment guarantee varied among the actors, and its application changed during the research period. Narrowly speaking it meant that access to treatment was only provided within a certain time frame. The treatment guarantee was usually written without mentioning the patient. If the patient was mentioned in the documents from the government and public health organisations he or she was usually referred to as an object. There were signs of imminent change in the preparatory documents of the Health Care Act in 2010. The documents still described the patient as an object, but they were also described as an actor. In documents from public health organisations, the patient was perceived as an active player in a generally positive way. In documents from the government, the patient was positively perceived as an object. In parliament, when the legislative process for the treatment guarantee drew to a close, members of parliament began speaking more about the economy and less about the patients, nor were the patient viewed as a potential voter. Public health organisations discussed the empowerment of patients just before the reform, but the trend quickly diminished after the legal reforms were initiated in March 2005.These organisations wrote about the treatment guarantee as a patient right as late as 2006. According to the data from experts interviews the treatment guarantee did not give protection to patient.
  • Kivikangas, J Matias (Helsingin yliopisto, 2015)
    Arguably, the emotions elicited by playing are the reason why people play digital games. Social interaction is an important source of emotion during game play, but research on it is rather sparse. In this dissertation I briefly review the emotion-theoretic literature in order to better understand what emotion means in the context of games, and how this should be taken into account when measuring emotions related to a game experience. Study I presents a review of the use of psychophysiological methods in game research. I show that the theoretical background behind these methods generally tends to be neglected. This could be remedied by a theoretical framework that integrates the understanding of emotions and explicitly describes the links between different emotion measures and the theoretical concepts they are professed to reflect. I present my proposition for the first step towards such a framework in Study II. I employ the sociality characteristics framework by de Kort and IJsselsteijn (2008) and my interpretation of the social factors in order to study the effect of the central social context factors on the emotional game experience. Study III presents evidence that in addition to tonic physiological levels, the relationship between the participants also affects the momentary, phasic responses to the key game events victory and defeat. In particular, although physiological signals can, to a certain extent, be used to assess emotional experiences (such as positive responses to a victory), in some cases the typical psychophysiological mappings may even be completely opposite. Interpreting these signals requires a broader theoretical understanding than what is typically acknowledged. Study IV supports the earlier findings that competition is experienced more positively than cooperation but that the effect is dependent on gender, as this was found only in males. For females, there was no difference between the two modes, and no difference in negative activation. In addition, self-reports concerning social presence suggested that this concept is not always associated with higher positive emotions, while a form of friendly rivalry (associated with lower social presence) might be experienced positively a finding apparently new in existing literature. Finally, Study V provides insight into the practical significance of the measurements with a predictive validity study, showing practical effects how the certain kinds of game experiences may lead to greater game use and preference, but that these links are not as simple as previously suggested. In sum, this work offers new knowledge on how social context factors are generally related to the game experience, on how emotions can be studied in game research and what theoretical considerations should be taken into account, and on the emotional effects of particular social context factors during play. The results are mainly useful for further basic game research, but they have also potential implications for general emotion research, the game industry, and in the long run, society at large.
  • Vogt, Robert (Helsingin yliopisto, 2015)
    Theory and Typology of Narrative Unreliability (Theorie und Typologie narrativer Unzuverlässigkeit) „The theory of unreliable narration is obviously one of the current boom-sectors of what Manfred Jahn and Ansgar Nünning have called the ‘narratological industry’“, Tom Kindt (2008: 129) writes. In a similar vein, D’hoker and Martens (2008: 2) detect „an almost uncanny centrality and importance“of the concept in the field of narratology. Indeed, debates concerning the categorization of different forms of unreliable narration, the scope of the concept and explanation models based on different approaches enjoy wide currency. In the study, I aim to develop a theory and typology of narrative unreliability. Following McHale (1981: 185) that “[b]efore a phenomenon can be explained it must first exist for those who would explain it, which means that it must be constituted as a category with boundaries and a name“, chapter II establishes a typology of narrative unreliability. Claiming that the concept of unreliability is used in different ways in narratology, I distinguish three basic forms. First, unreliability can be understood as a trait of a homodiegetic narrator or a focalizer which manifests as a questionable account or interpretation of the events in the narrative world (ironic unreliability). Second, unreliability can be regarded as a feature of the narrative discourse which leaves open whether or not a narrator or a focalizer depicts or evaluates the narrative world in an adequate way (ambiguous unreliability). Third, unreliability can designate a feature of the narrative discourse which leads the reader astray about the actual events in the fictional world (alterated unreliability). Having defined the field of inquiry, chapter III sets out to develop a model to describe and explain these different forms of narrative unreliability. After addressing some of the theoretical stumbling blocks narratologists face when theorizing narrative unreliability in fictional works, chapters IV and V I outline how insights from literary possible-worlds and cognitive narratology might help to develop a better understanding of how readers construct fictional universes in texts featuring ironic, ambiguous, and alterated unreliability. According to literary possible-worlds theory, fictional works create their own modal system of reality which consists of a multitude of worlds. In the center of each fictional universe is the so-called ‘textual actual world’ (TAW) which is surrounded by the different characters’, focalizer’s or narrator’s mental worlds. Within this theoretical framework, narrative unreliability occurs in literary works when the narrator’s or focalizer’s mental world is in conflict with TAW. As the relations between different worlds within a fictional universe are the result of interpretative processes, I argue that the main difference between the three forms of narrative unreliability lies in the way a reader makes sense of world conflicts: how he distinguishes different worlds, how he detects conflicting worlds and how he puts conflicting worlds in a hierarchical order to determine what is fact in the fictional universe. Since „possible-world approaches do not ultimately treat fictional worlds as cognitive products and do not deal with cognitive processing“ (Semino 2003: 89), chapter V addresses the question of how a reader constructs fictional universes in unreliable narratives. By recourse to insights from cognitive science – including approaches belonging to the “information processing paradigm” as well as those belonging to the mental “disposition paradigm” – I explain how readers distinguish different worlds, detect conflicting worlds and put these into a hierarchical order. In order to illustrate the scope and variety of narrative unreliability, I discuss six British and American literary works in chapters VI to VIII. Chapter VI focuses on ironic unreliability in Charles Dickens’ David Copperfield and in Kazuo Ishiguro’s The Remains of the Day. Chapter VII analyses ambiguous unreliability in Ford Madox Ford’s The Good Soldier and in Bret Easton Ellis’ American Psycho. Ambrose Bierce’s “An Occurrence at Owl Creek Bridge” and Chuck Palahniuk’s Fight Club serve as examples of alterated unreliable narration (chapter VIII). In chapter IX, I discuss the metacognitive dimension of narrative unreliability. Assuming that „[narratives] operat[e] as an instrument of mind in the construction of reality“ (Bruner 1991: 6), I claim that narrative unreliability highlights and reflects cognitive processing of a narrator, of a focalizer, or of a reader in different ways. While ironic unreliability puts the emphasis on the idiosyncratic ways of world-making of a cognitive center (either of a homodiegetic narrator or of a focalizer), alterated unreliability with its surprising plot twist stimulates readers to go backwards and monitor how he or she was led down a garden path. I analyse Ian McEwan’s Atonement to demonstrate that the characters’ (mistaken) attempts to construct reality (ironic-unreliable focalization) is mirrored by the reader’s mistaken reconstruction of the facts and events in the fictional world (alterated-unreliable narration). The study concludes with a summary of the most important insights and a brief reflection on how the theory can be applied to other media such as film, comics or video games (chapter X).
  • Klein, Ottilie ([according to German regulations a publication prior to the public examination is not permitted], 2015)
    The doctoral thesis investigates the cultural function of dramatic narratives of female murder. For this purpose, the study offers textual analyses of plays that feature female murder as a central event. Paying close attention to each play s plot, form, and dramaturgy, the study seeks to attach meaning to the dramatic function of women s homicidal action. The survey of women who kill in modern American drama that is at the heart of the study covers a seventy-year span (1910s - 1980s) that allows a mapping out of continuities and transitions in dramatizations of female murder. Given the politically charged nature of the figure of the female murderer, the study argues that there are two types of narratives of female murder in modern American drama (and beyond): one that uses women s homicidal action as a mechanism to create disorder at the level of plot to ultimately contain women s lethal threat by re-establishing order and thereby reinforcing dominant ideology, so-called narratives of containment; and one that exploits the ideologically disruptive potential of the female murderer to comment on social ills or to dismantle ideological contradictions, so-called lethal performances. The study concludes that the cultural function of narratives of female murder is intricately connected with the cultural and historical moment from which they emerge and the type of narrative they respond to.
  • Ylivuori, Soile (2015)
    My doctoral dissertation examines the complex relationship of gender construction and politeness in eighteenth-century England. It contributes to a vibrant field of historical research, examining politeness as an intellectual and cultural construct that was used to create individual and group identity. The study combines intellectual and cultural-historical methods with poststructuralist gender studies; through this interdisciplinary methodology, my goal is to introduce a novel approach to the historical research of politeness traditionally reluctant to utilise theoretical apparatuses as an aid of analysis and to suggest that such methods provide fruitful new readings of politeness and its intersection with gender, thus opening up new areas of research. The dissertation is divided into two parts. In the first part, I analyse politeness as a disciplinary practice that produced polite femininity defined in terms of softness, gracefulness, and modesty by regulating the movements and appearances of individuals bodies. This analysis is based on a wide selection of printed source material, such as conduct books, periodicals, sermons, and novels. My main argument is that the female body had a central role in the construction of normative polite femininity, both on a discursive and an individual level. Women of the social elite were urged to internalise a gendered polite identity by exercising and disciplining their bodies to meet the norms of polite femininity deemed natural despite the fact that within the heterogeneous politeness discourse, there was no consensus on what these natural norms exactly were. Moreover, I want to suggest that the ambiguous position of the body as both the means through which an identity is produced and worked on, as well as the allegedly truthful and unerring indicator of an individual s level of polite ideality created a fundamental conflict within the culture of politeness, forcing women into hypocritical positions in practice while simultaneously advocating honesty as the essential emblem of femininity. However, seeing politeness solely as a disciplinary regime provides a one-sided understanding of politeness, since it ignores individual subjectivity. Therefore, the second part of my dissertation examines the journals and letters of four eighteenth-century elite women Catherine Talbot, Mary Delany, Elizabeth Montagu, and Fanny Burney and looks at how these women dealt with the discursive ideals and demands imposed upon them. I argue that individuals had a complex relationship with discursive ideality, and that politeness was not solely a disciplinary regime that lorded over women s behaviour and identity. The profound heterogeneity of the culture of politeness gave, in itself, individuals some freedom of movement within it. More importantly, individuals engaged in specific strategies, or techniques of the self, in order to gain freedom from and within the restrictive norms of polite femininity. These strategies can be seen as clever utilisations of some of the central aspects of politeness with a subversive intent. They concentrate on challenging and redefining the naturalised formulations regarding authenticity, identity, femininity, and politeness, and include such practices as self-discipline, multiplicity of identity, play between exterior and interior, and hypocrisy.
  • Puranen, Taija (Helsingin yliopisto, 2015)
    Nutritional problems such as poor appetite and unintentional weight loss are common among individuals with Alzheimer’s disease (AD), and their older spousal caregivers with comorbidities may also be at risk of malnutrition. The objective was to study the nutrition of people with AD and their spouses, and to compare nutrient intake to recommended levels, and to investigate the association between the caregiver’s gender and the couples’ nutrition. A randomized, controlled trial was conducted to examine the effectiveness of nutritional guidance on the AD victim’s weight, nutritional status (MNA), energy and nutrient intake (three-day food diaries), quality of life (HRQoL with 15D) and falls. A total of 99 couples were randomized into this trial. The intervention group (IG) received tailored nutritional guidance 4-8 times at their homes over one year, and the control group (CG) received booklet on healthy nutrition. The primary outcome measure was the AD sufferer’s weight change. The mean age of AD was 77.4 years (SD 5.6), and spouses 75.2 years (SD 7.0). At baseline, 44% of the AD, and 16% of the spouses were at risk of malnutrition, whereas 56% and 84% had a good nutritional status. At baseline, the mean energy intake among those with AD was 1897 kcal (SD 416) among the men and 1313 kcal (SD 340) among the women, and the respective figures for spousal caregivers were 1605 kcal (SD 458) and 1536 kcal (SD 402). Among AD, 47% of the men and 71% of the women had a protein intake below 1g /bodyweight/kg, the respective figures for the spouses being 71 and 49%. In addition, almost half of the participants had a vitamin C intake of less than the recommended. The male gender of the caregiver was associated with poor energy and nutrient intake in the couple. Tailored nutritional guidance had no effect on the weight of those with AD, but improved their nutrient intake and HRQoL. The mean change in protein intake was 0.05 g per body/kg in kg (95% CI -0.06 to 0.15) in the IG, and -0.06 g per body/kg in the CG (95% CI -0.12 to 0.02), p = 0.031. The respective changes in mean calcium intake were 85 mg (95% CI -24 to 194) and -17 mg (95% CI -98 to 65), p = 0.025. HRQoL improved by 0.006 (95% CI -0.016 to 0.028) in the IG, and declined by -0.036 (95% CI -0.059 to 0.013) in the CG, p = 0.007. In addition, those in the IG with AD had a significantly lower number of falls than those in the CG during the one year: 0.55 (95% 0.34 to 0.83) and 1.39 (95% CI 1.04 to 1.82) falls per person, p < 0.001, respectively. The community-dwelling ID sufferers and their spousal caregivers were very heterogeneous in terms of nutrition. Male caregivers may need tailored guidance on food-related activities. Tailored nutritional guidance improves both nutrition and the quality of life among those with AD, and may also prevent falls, and should therefore be part of their everyday care.
  • Viholainen, Aila (Viholainen, Aila, 2015)
    My dissertation research concentrates on medieval Western Christian pictorial material presented in religious contexts. The common perspective of the different articles included in my research is make to believe/faire croire : the ways in which pictorial materials in medieval times persuaded, enticed and instructed viewers. My study is characterized by a rhetorical approach that focuses especially on the visuality of medieval images and its analysis. I participate in the study of the past. I see the past that I study as an alien entity located in its own historical context. I am looking for answers from a vantage point that feels strange from the position of the contemporary re-searcher. Questions that arise from consideration of this reveal a gap between the researcher s understanding of today and how things were under-stood in medieval times, a gap which motivates this research. In the first two articles of my work, the medieval world of imagery is perceived as a phenomenon on an abstract level. Here I study and evaluate discussions and studies that have been done in medieval times and subsequently: conceptually, theoretically and methodologically. In the latter two articles, the abstract phenomenon becomes concrete and the focus of analysis is actual pictorial material selected from the medieval world of imagery found in the Holy Cross Church of Hattula. In these articles, the mermaid motif functions as an object of analysis. Imagining is an important practice in the context of medieval art and religion, and it is presented in my work as a supporting theme. First, imagination has operated in the background of my study as a guiding frame of interpretation, as the researcher s own resource. In this case, as Markku Hyrkkänen describes it, imagination can be thought of as an imagining of possible contexts. Second, imagination has worked as a concrete conceptual tool: as Benedict Anderson's imagined communities and later as Barbara Newman's imaginative theology. Third, it is also a medieval concept (imaginatio), the primary task of which was to determine truth. Thus, imagination was a multi-leveled and many-faceted cognitive skill. I locate my research, as well as international studies that I use for dialogue, in a broader humanistic tradition and the research trends of the last decades. Used as the starting point are critical evaluations of previous studies in art history, the study of visual culture and medieval art history over the last decades. I also connect my work to the latest Finnish studies on medieval pictorial material, as well as to the latest research discussions in my own field of religious studies. These findings are definitively presented in the compilation.
  • Donner, Julia (Helsingin yliopisto, 2015)
    This study examines the formation of the domestic garden in Finland 1870-1930. The purpose is to open new perspectives into how gardens, especially domestic gardens, served as a tool in building of the new nation and at the same time to explore the role of women in the process. The study is based on biographical material concerning Aino Sibelius (1871-1969) and her garden in Ainola, Järvenpää and the garden writing of Jenny Elfving (1870-1950), a teacher and prominent actor in the field of horticulture. Contemporary garden literature and articles in newspapers and magazines also served as material for this inquiry. Popular enlightenment was an essential part of the project of nation building. The notion of gardening as a tool for improving the people became one of its topics and spread widely in Finland in the last decades of the 19th century. A new type of garden for the people took shape in the popular garden literature that was published by the end of the century. This discussion links homes, gardens and women together. The analysis of Jenny Elfving´s and Aino Sibelius´s agency shows that women played vital role in the formation of the domestic garden. By hoeing and weeding, planting and tending, writing and teaching these two women defined the garden´s physical and intellectual boundaries. Their work in and for the gardens formed and reflected meanings that society assigned to gardens. Through this process the vegetable patch intended as the place for women, grew into a domestic garden, which became associated with the tools of craft and design, utility and beauty and feelings as well as the work done in the garden.
  • Knuuttila, Anna (Helsingin yliopisto, 2015)
    Aleutian mink disease virus (AMDV) is a widespread parvovirus mainly affecting American mink (Neovison vison). It can cause a progressive and persistent immune complex-mediated disease (Aleutian disease, AD) in adult mink and an acute and fatal pneumonia in mink kits. The virus has a wide geographical distribution both in farmed mink and in the wild. Aleutian mink disease virus poses a major economic threat to mink farmers and it may affect the conservation and management of indigenous mustelids and other species. Infected farms are difficult to sanitize as the virus is resistant to physical and chemical treatments, it can be transmitted through several vectors and routes, and no effective medications or vaccines currently exist. Since the 1970s, diagnosis on AMDV in farmed mink has been based on the identification of specific antibodies with a counter-current immunoelectrophoresis (CIEP) test. In 2005, the Finnish Fur Breeders Association implemented an eradication program that required the development of a new AMDV-detection protocol to screen ca. 600 000 samples per year. Although AMDV can infect and may cause disease in other mustelids and carnivores, little is known about the epidemiology and evolutionary relationships of AMDV strains in the wild in Finland and elsewhere. Thus, this study aimed to develop a modern automated test for the large-scale serodiagnosis of AMDV in mink and to elucidate the epidemiology and phylogeny of this virus in farmed mink and free-ranging mustelids in Finland. A new antigen for the serological test was developed with a recombinant DNA technique. The major capsid protein (VP2) gene of a Finnish AMDV strain obtained from a farmed mink was amplified, cloned into a baculovirus transfer vector with subsequent recombination to baculovirus genome, and expressed in insect cells. The antigen formed virus-like particles and was confirmed to be antigenic with several serological methods. Subsequently, an enzyme-linked immunosorbent assay (ELISA) was designed for the antigen and automated. Because the small glass capillaries used to collect blood samples in CIEP could not be utilized in the ELISA test, a wicking technique using a filter paper blood comb was developed. The performance of this test was compared to CIEP (an imperfect gold standard) by testing blood/serum samples from farmed mink. The results were analyzed with Bayesian modelling allowing for conditional dependence. The new automated ELISA test was found to be accurate with a diagnostic sensitivity of 96.2% (95% probability interval [PI], 91.5 99.0) and specificity of 98.4% (95% PI, 95.3 99.8), and was therefore determined suitable for the serodiagnosis of AMDV. The epidemiology and phylogenetics of AMDV were inferred from organ and/or blood samples from farmed mink and free-ranging mustelids. The samples were screened with the newly-developed ELISA (described above) or CIEP test for anti-AMDV antibodies and with previously described or newly-developed PCR assays for AMDV DNA. Test results were studied with statistical, phylogenetic, and sequence analysis methods. Aleutian mink disease virus was found to be prevalent in the wild in Finland. A new host species, the European badger (Meles meles), with a prevalence of 27% (7/26; 95% confidence interval [CI], 13 46), was identified. In addition to the badger, infection markers were found in 54% (31/57; 95% CI, 42 67) of feral American mink and in one European polecat (Mustela putorius) (1/14; 95% CI, 1 29). No infection was found in Eurasian otters (Lutra lutra) (24; 95% CI, 0 10), European pine martens (Martes martes) (183; 95% CI 0 1), least weasels (Mustela nivalis) (2; 95% CI, 0 67), stoat (Mustela erminea) (1; 95% CI, 0 85), or wolverine (Gulo gulo) (1; 95% CI, 0 85). Positive animals were distributed throughout western, southern, and eastern Finland (10/17 of sampled regions). American mink (odds ratio [OR], 335) and badger (OR, 74) had higher odds of infection compared to other species. Also, animals sampled during the first sampling period (2006 2009; OR, 5) had higher odds of infection compared to the second period (2010 2014). No significant association was detected between infection and age, sex, or region. Furthermore, mink farms were not associated with higher odds of AMDV infection nor appeared to serve as a major source of infection for free-ranging mustelids at the municipal or regional level. Based on these results, it appears that domestic and sylvatic transmission pathways are largely decoupled, but it seems probable that infections occasionally move between the farmed and wild populations (e.g., via infected escapees/intruders). A phylogenetic analysis, including Finnish, Estonian, and global strains, indicated that AMDV strains form at least five main clusters. It also inferred that the virus has been introduced to Finnish farms on at least three occasions. Unfortunately, it could not be discerned whether the occurrence of AMDV in Finland is natural or a consequence of the global mink trade. In addition to its main hosts (farmed and wild mink), similar strains of AMDV were found in pine martens, polecats, and badgers. Interestingly, Estonian badgers carried a divergent strain, possibly representing a new amdoparvovirus. Other than the strain found in Estonian badgers, and the tendency of strains from Finnish farmed and feral mink to diverge into separate clusters, AMDV strains did not cluster according to location, year, species, or pathogenicity. The nucleotide differences between Finnish AMDV sequences, based on partial non-structural protein 1 gene, ranged from 0% to 14% and similar levels of variability were observed in farmed and natural populations. As a result of these studies, an automated ELISA test for the serodiagnosis of AMDV was developed and validated with high diagnostic sensitivity and specificity. The test offers a low cost, easy sampling, rapid throughput of large sample numbers, reduced processing time, and automated data management. The new test can be utilized for the monitoring, control and eradication of the virus, calculating the seroprevalence, and confirming the infection status of farms or individual mink. In addition, new information on AMDV epidemiology and genetic variation in Finnish farmed mink and free-ranging mustelids were established with potential impact on the biosecurity of farms, outbreak investigations, and the conservation of threatened mustelid species. Moreover, the new diagnostic tools and additional sequence data generated in this study can be utilized in the future research on the epidemiology of AMDV.
  • Restitutti, Flavia (Helsingin yliopisto, 2015)
    This series of investigations aimed to evaluate in dogs the interaction between MK-467, a peripheral α2-adrenoceptor antagonist with poor penetration into the central nervous system, and dexmedetomidine, a selective α2-adrenoceptor agonist commonly employed in small animal clinical practice due its potent sedative effects. The objective of this study was to find an optimal dose-ratio of dexmedetomidine and the antagonist that could attenuate or prevent major cardiovascular changes without any significant effect on the sedation induced by the agonist. The effects on blood flow in abdominal organs and on plasma concentrations of glucose, insulin, non-esterified free fatty acids, lactate and cortisol of this optimal dose were then evaluated. The sedative effects were assessed subjectively by means of a composite sedation score. Simultaneously, hypnosis was evaluated through the bispectral index. Haemodynamic parameters that were evaluated comprised cardiac output, arterial blood pressure, heart rate, central venous pressure and systemic vascular resistance. Time-intensity parameters derived from contrast-enhanced ultrasound imaging were used to assess blood flow in selected abdominal organs. Three doses of MK-467 (250, 500 and 750 µg/kg) were tested against dexmedetomidine alone (10 µg/kg). All treatments were administered IV. Sedation was significantly lower and BIS significantly higher with the medium and highest doses of MK-467 than with dexmedetomidine. However, bioequivalence between dexmedetomidine and the combination was reached with all treatments for the two parameters analysed. Early cardiovascular effects of dexmedetomidine were not completely prevented with the lowest dose of MK-467, and the highest dose reduced mean arterial pressure. The middle dose of MK-467 (500 µg/kg) provided the best cardiovascular stability. Addition of the peripheral antagonist attenuated dexmedetomidine-induced changes in organ blood flow evaluated by the CEUS. An increase in plasma glucose was observed in dexmedetomidine-treated dogs, but not when MK-467 was added. Inversely, plasma insulin concentration was reduced with dexmedetomidine, but not when dexmedetomidine was combined with MK-467. Plasma non-esterified free fatty acids concentration decreased transiently with the combination, while with dexmedetomidine alone the reduction persisted throughout the observation period. Plasma lactate concentration increased with dexmedetomidine, but not with the combination. In conclusion, the addition of MK-467 attenuated or prevented the early cardiovascular effects of dexmedetomidine, not having clinically relevant effects on the sedation induced by the latter. Some metabolic changes induced by dexmedetomidine were halted by MK-467.
  • Savtschenko, Ritva (omakustanne, 2015)
    Summary The study takes a look at the factors that influenced the operating culture of the Central Organization of Finnish Trade Unions (SAK) during the first decade of incomes policy from the point of view of corporatism. The effects of the corporatist system are studied from the perspective of co-operation, resistance and democracy. The theoretical part looks at the relationship between the theory of corporatism and the trade union movement. The empirical part looks at the effect of the corporatist system on the collective labor agreement negotiations over the decades. From business, the study looks at the actions of Elinkeinoelämän valtuuskunta (EVA) and the Central Organization of Finnish Employers (STK), and from the political parties, of the Social Democratic Party (SDP) and the Communist Party of Finland / Finnish People s Democratic League (SKP/SKDL), whose goals were tangential to those of SAK. Factors that have been highlighted as having internally affected the unified SAK are the problems with the operating cultures of two different political groups. Conflicts were caused particularly by the countless unauthorized strikes of the early 1970 s, whose causes may be studied as consequences of structural change, heavy inflation or resistance to incomes policy. In terms of SAK s basic program of 1971, the corporatist system caused problems in the implementation of member democracy. Politically, SAK was divided in two. Trade union Social Democrats were oriented towards social policy reforms like their Nordic counterparts. The People s Democrats were effectively shut out of the negotiation system, and their operation had syndicalist characteristics. The change in the internal relations developed during the latter half of the decade through the labor parties collaboration in the national government. SAK was considered to be a strong player in society, and labor market solutions were considered to have bypassed the authority of the parliament. The recession at the end of the 1970 s revealed that SAK s solutions were dictated by government policy. The view that the operation of labor parties was directed by the trade union movement proved to be wrong.
  • Kandolin, Riina (Helsingin yliopisto, 2015)
    Cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) are underdiagnosed inflammatory myocardial diseases. Sarcoidosis is a systemic disease characterized by granuloma formation and subsequent tissue scarring in various organs, most commonly in the lungs. In majority of cases, lung sarcoidosis is a self-limiting disease whereas cardiac involvement carries a poorer prognosis due to heart failure and malignant arrhythmias. GCM is a rare, frequently fatal myocardial disease designated by widespread myocardial inflammation and necrosis. Prior data concerning epidemiology, outcome with contemporary treatment and ICDs, and the effect of novel diagnostic methods is scarce and I set out to study these questions. All cases with histologically confirmed CS and GCM in Finland between 1988 and 2014 were identified and analyzed. A marked increase in the detection rate of CS over the last 26 years was found. In the era of modern diagnostic imaging and increased awareness, the annual detection rate of CS is over 50 times higher than before. CS most commonly manifests with atrioventricular block (AV-block). What is more, CS and GCM together explain 25% of initially idiopathic 2nd to 3rd degree AV-blocks in adults aged 18-55 years. Other principal manifestations of CS are heart failure and ventricular arrhythmias. Two thirds of patients with CS present without prior diagnosis of sarcoidosis, an entity called clinically isolated CS. The mean age of CS patients was 51 years and two thirds were female. The diagnosis was based on endomyocardial biopsy (EMB) in 50% of cases and on extracardiac biopsy combined with cardiac imaging findings (cardiac magnetic resonance (CMR) or positron emission tomography (PET)) in 50% cases. Single EMB session had a sensitivity of approximately 30% in detecting CS, but repeated biopsies or taking histologic samples from mediastinal lymph nodes markedly improved the diagnostic yield. In majority of cases, CS is a slowly progressive cardiomyopathy. With up-to-date diagnostic methods and treatment, 99% of patients were alive without cardiac death or transplantation at 1 year and 91% after 10 years from symptom onset. The most common presentations in GCM patients were heart failure and AV-block. Moreover, ventricular arrhythmias were common with two third of patients experiencing sustained ventricular tachycardia or ventricular fibrillation during the disease course. With current diagnostic methods and therapy with a combination of immunosuppressants, the transplant free survival was 69% at 1 year and 52% at 5 years. In conclusion, the detection rate of CS and GCM in Finland is increasing and the prognosis with contemporary diagnostic and therapeutic methods seems better than previously reported.