ObjectivesTo develop and validate a simple clinical prediction rule, based on variables easily measurable at admission, to identify patients at high risk of developing delirium during their hospital stay on an internal medicine ward.DesignProspective study of two cohorts of patients admitted between 1 May and 30 June 2008 (derivation cohort), and between 1 May and 30 June 2009 (validation cohort).SettingA tertiary hospital in Donostia-Gipuzkoa (Spain).ParticipantsIn total 397 patients participated in the study. The mean age and incidence of delirium were 75.9 years and 13%, respectively, in the derivation cohort, and 75.8 years and 25% in the validation cohort.Main outcome measuresThe predictive variables analysed and finally included in the rule were: being aged 85 years old or older, being dependent in five or more activities of daily living, and taking two or more psychotropic drugs (antipsychotics, benzodiazepines, antidepressants, anticonvulsant and/or antidementia drugs). The variable of interest was delirium as defined by the short Confusion Assessment Method, which assesses four characteristics: acute onset and fluctuating course, inattention, disorganised thinking and altered level of consciousness.ResultsWe developed a rule in which the individual risk of delirium is obtained by adding one point for each criterion met (age≥85, high level of dependence, and being on psychotropic medication). The result is considered positive if the score is ≥1. The rule accuracy was: sensitivity=93.4% (95% CI 85.5% to 97.2%), specificity=60.6% (95% CI 54.1% to 66.8%), positive predictive value=44.4% (95% CI 36.9% to 52.1%) and negative predictive value=96.5% (95% CI: 92% to 98.5%). The area under the receiver operator characteristic (ROC) curve was 0.85 for the validation cohort.ConclusionsThe presence or absence of any of the three predictive factors (age≥85, high level of dependence and psychotropic medication) allowed us to classify patients on internal medicine wards according to the risk of developing delirium. The simplicity of the variables in our clinical prediction rule means that the data collection required is feasible in busy medicine units.

Taxi cabs are a key feature of daily life in Madrid, which is one of the most important European cities. An exploratory study was undertaken in order to evaluate the quality of Madrid's taxi cab industry.This paper analyses the current situation by using the Taxi Cab Management Model (TCMM) which identifies the key processes for managing and operating a taxi cab service in any international city. The model provides a benchmark for measuring performance against other capital cities in developed nations. By comparing the results of this analysis with similar case studies of London, New York and Paris, areas of best practice are identified, as well as possible operational improvements.The study concludes that the Madrid taxi cab industry is ahead of cities like London, New York and Paris in terms of IT integration within the industry, but that some key issues need to be reviewed e.g. the potential for a more centralised fleet management system. One of the best features of the Madrid taxi cab industry was found to be the test for candidate drivers. It is well designed in terms of its user interface (candidates do not need to be computer literate), it has a large bank of questions (up to 6000) that are used randomly to generate examinations, and it offers a highly efficient way to assess candidates. Copyright # 2010 John Wiley & Sons, Ltd. MADRID TAXI CAB INDUSTRY OVERVIEWThe main means of transport in Madrid are the national rail network, the bus service and one of the largest underground networks in the world. In that context, Madrid's taxi cab industry has the challenge of retaining existing customers and acquiring new ones. In order to do this, the 15 646 taxi cabs (FPTM, 2005) that compose Madrid's taxi fleet need to continuously improve their service by innovation in areas such as security and emergency services e.g. installation of CCTV and GPS to support security and improve response times (El Pais, 22 October 2007); the requests of taxi drivers for higher weekend and nighttime fares and the introduction of clean technologies within the taxi cabs such as the compressed natural gas (CNG) engines that will be partially subsidised by the government (Sustainable Affairs, 2007).The main stakeholders involved in Madrid's taxi cab industry are the government that regulates the industry and its fares, taxi associations, the drivers and customers.Licences are held by the taxi drivers, rather than by companies; most of the drivers are selfemployed. This clearly has an impact in the industry and how it is organised and managed e.g. taxi associations are essential to defend and support drivers. On the other hand, government public transport departments have an obligation to protect the general interests of Madrid's citizens by regulating fares, times and guaranteeing sufficient capacity to cover the demand. Problem definitionThe General Subdivision of the Taxi Office is the main regulatory body run by Madrid City Council. There are other departments with competences on the industry. Due to the administration structure i...

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El Gobierno de Paraguay, a través del Ministerio de Obras Públicas y Comunicaciones, ejecuta varios proyectos de desarrollo de infraestructura con el objetivo de mejorar la calidad de vida de la población y promover el desarrollo sustentable, con acompañamiento y financiamiento del Banco Interamericano de Desarrollo. Estos proyectos son desarrollados en distintos departamentos del país y varias obras de infraestructura, actualmente en ejecución, comprenden territorios de comunidades indígenas en sus áreas de influencia directa o indirecta. El presente documento incorpora los aportes de los técnicos y especialistas sociales de las unidades ejecutoras del sector transporte, energía, agua y saneamiento con proyectos en ejecución que tienen dentro de su área de influencia a comunidades indígenas, e incluye las principales reflexiones que generó un taller de intercambio de experiencias. Asimismo se incluyen otras experiencias de la región sobre pueblos indígenas. El contenido resultante constituye una herramienta de consulta y referencia que podría guiar a responsables de la gestión de proyectos de infraestructura cuando en el área de influencia de los mismos hay presencia de pueblos indígenas.