http://hdl.handle.net/20.500.14342/6 2026-05-01T16:19:19Z http://hdl.handle.net/20.500.14342/6211 Clinical predictors of speaking valve use in neurological patients: A retrospective cohort study Otto Yáñez, Matías; Monge Martínez, Gonzalo; Torres Castro, Rodrigo; Muñoz, I. Tamara; Segovia, Erico; Sanchez-Ramirez, Diana C.; Vera-Uribe, Roberto; Vasconcello, Luis; Resqueti, Vanessa R.; Fregonezi, Guilherme Augusto de Freitas Introduction Speaking valves (SVs) restore phonation and may support airway protection in people with a tracheostomy, yet tolerance varies widely in neurological rehabilitation. We aimed to identify clinical factors associated with SV use and duration in a neurological rehabilitation setting. Methods We retrospectively analyzed 117 adults with neurological conditions and tracheostomy admitted to a rehabilitation center. Two internally validated multivariable models were developed: logistic regression for SV use (yes/no) and a quasi-Poisson regression for target daytime SV duration (hours/day), using routinely available bedside clinical variables. Results Of 117 patients, 64 (54.7%) used an SV during hospitalization. In the multivariable logistic model, higher level of consciousness (eMCS vs VS/MCS; OR 6.26, 95% CI 1.53–23.14), a positive blue dye test (OR 0.05, 95% CI 0.01–0.30), and endotracheal suction requirement (vs spontaneous cough; OR 0.07, 95% CI 0.003–0.879) were independently associated with SV use. Model performance was strong (AUC 0.856; accuracy 79.5%). Among SV users, longer daytime duration for SV use was associated with younger age, greater inspiratory and expiratory muscle strength, higher consciousness level, mild dysphagia, spontaneous cough, and neuromuscular or spinal cord injury diagnoses. In contrast, moderate-to-abundant secretions were associated with fewer hours. Conclusion In a single-center neurological rehabilitation cohort, SV adoption and sustained tolerance were associated with bedside indicators of neurological responsiveness, secretion management, swallowing safety, and respiratory muscle strength. Findings should be interpreted as predictive associations and warrant external validation in contemporary multicenter cohorts. 2026-02-01T00:00:00Z http://hdl.handle.net/20.500.14342/6210 Predicting decannulation success in patients with neurological conditions: development and validation of the NEURODECANN Clinical Score Otto Yáñez, Matías; Monge Martínez, Gonzalo; Muñoz, Tamara; Segovia, Erico; Villalobos, Paola; Vera-Uribe, Roberto; Resqueti, Vanessa R.; Fregonezi, Guilherme Augusto de Freitas; Torres Castro, Rodrigo Decannulation is crucial in improving outcomes and quality of life for patients with tracheostomy and neurological injuries. This study aimed to develop and retrospectively assess the NEURODECANN Clinical Score to predict decannulation success. A retrospective cohort of patients with a tracheostomy (n = 117) was analyzed, distinguishing those who achieved decannulation from those who did not. Logistic regression and Random Forest analysis identified key predictors: level of consciousness, diagnosis, blue dye test, amount of secretions, speaking valve use, secretion management, dysphagia, maximum inspiratory pressure, and cough. Model performance was assessed using the area under the curve (AUC), sensitivity, and specificity. NEURODECANN demonstrated excellent predictive accuracy (AUC = 0.95, 95% CI: 0.91–0.98), with a sensitivity of 92.6% and specificity of 87.3%. Patients scoring ≥ 13 points had a high probability of successful decannulation. The NEURODECANN Clinical Score provides a structured, evidence-based framework to support clinician-driven decannulation decisions, optimizing tracheostomy management in people with neurological conditions. Further validation is needed to confirm its applicability across diverse clinical settings. 2025-09-01T00:00:00Z http://hdl.handle.net/20.500.14342/6209 The Long Road to the Armenia-Azerbaijan Peace Agreement: The prevalence of the Principle of Territorial Integrity Over the Right of Self-Determination Xuclà, Jordi On March 13, 2025, Armenia and Azerbaijan announced a peace agreement toconclude a conflict that began in 1988. The disputed region of Nagorno-Karabakh exemplifies a paradigmatic case where the principle of territorialintegrity and the right to self-determination have been in conflict for nearly fourdecades. Ultimately, the principle of territorial integrity has prevailed. Thisarticle examines the aspects of the peace agreement that are known so far,particularly the mutual recognition of both countries' territorial integrity basedon Soviet-era borders, the necessity to reform the Armenian Constitution toeliminate any territorial claims on Azerbaijan, the prohibition of militarydeployments from third countries, the renunciation of any future internationallitigation, and the disbanding of the OSCE Minsk Group.This text analyses relevant treaties, resolutions from international organizations,and the historical roles of external actors such as Russia, the European Union,and the United Nations. Special attention is given to the legal frameworksestablished by the UN Charter, the Helsinki Final Act, and the principle of utipossidetis juris.Measures to strengthen the peace agreement are being studied. The analysisemphasizes the importance of combining economic cooperation and inter-community dialogue to promote long-term stability in the South Caucasus. 2025-01-01T00:00:00Z http://hdl.handle.net/20.500.14342/6208 Citizen perception of artificial intelligence: impact and applications in journalism Yeste Piquer, Elena; Suau Martínez, Jaume The integration of Artificial Intelligence (AI) into journalism has significantly reshaped the news industry, enabling automation in news production, data analysis, and content personalization (Ufarte-Ruiz, Murcia-Verdú, & Túñez-López, 2023; Newman et al., 2024). Media organizations are increasingly relying on AI-driven tools to generate financial reports, sports summaries, and other data-driven content, with some platforms fully automating certain news categories. While AI is often seen as a means to enhance efficiency and optimize newsroom workflows, its growing presence raises fundamental questions about trust, credibility, and the evolving role of journalists (Sonni et al., 2024). One of the key debates in AI-generated journalism concerns its impact on audience trust. Some studies suggest that AI-authored articles can be perceived as equally credible as human-written content, particularly when the AI’s role is disclosed (Hofeditz et al., 2022). However, other research points to significant concerns regarding transparency, accuracy, and potential biases in automated news production (Forja-Pena et al., 2024). AI-generated journalism operates within existing corporate and media structures, which means that its neutrality cannot be assumed (Bender et al., 2021). Scholars have argued that algorithmic content creation may still reflect biases from the data it is trained on, the interests of its developers, or the influence of the prompts used by human journalists (Mehrabi et al., 2021). These factors make the perception of AI as an objective news source highly contested, particularly among audiences with a deeper understanding of AI technologies. 2025-01-01T00:00:00Z