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The restaurant industry is dealing with diversity in terms of its workforce, international customers and multinational business operations. Acknowledging diversity through multicultural training is beginning to appear in some restaurant companies. This study investigates how franchised restaurants utilize multicultural training programs from a training cycle approach. The findings indicate that high employee turnover rates are the primary reason that the majority of companies do not have a cultural diversity training program. Companies with a diversity training program report that such training is successful in improving interpersonal cross‐cultural skills.

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uring the past 20 years, the incidence, 1,2 cause and associated clinical conditions, 2-8 and clinical course 2,9 of obstetric pulmonary edema have been reported. Pulmonary edema during pregnancy can be lifethreatening and patients are usually transferred to tertiary care centers, so most of the medical literature is based on the experiences of the tertiary care centers. Hence, there is limited information on the natural history of pulmonary edema from its onset to its resolution because of a possible selection bias in previous studies.The primary purpose of our study was therefore to determine the incidence, etiology and course of pulmonary edema in all obstetric patients at our primary -secondary care center during the past 3.5 years. We analyzed (1) the clinical conditions associated with the onset of pulmonary edema, (2) the etiologic diagnosis made by echocardiography within 2 days of onset and (3) the X-ray pattern and rate of resolution. MethodsWe studied prospectively patients with pulmonary edema among 29,621 obstetric cases at the Samsung Cheil Hospital and Women's Healthcare Center between March 1, 1998 and June 31, 2001. Pulmonary edema was diagnosed on the basis of a history of dyspnea, pulmonary rales, hypoxemia (PaO2 <80 mmHg or SataO2 <90% with room air), and airspace opacities on the chest radiograph consistent with Circulation Journal Vol.66, July 2002 pulmonary edema. Cases of initially atypical X-ray presentation were also included when clinical symptoms and signs and the X-ray infiltration improved rapidly with treatment for pulmonary edema such as diuretics, inotropics, or both.We collected data from the time when pulmonary edema was suspected. The chest was radiographed and pulse oximetry was monitored for all patients with severe dyspnea and pulmonary rales. To elucidate the cause we reviewed the medical history for the presence of pre-existing cardiac or hypertensive disease, diagnosis of twin gestation, preterm labor, pre-eclampsia, treatment with steroids, MgSO4 ormimetics, evidence of infection, and volume overload. Within 2 days of the onset of pulmonary edema, 2-dimensional and M-mode echocardiography with Doppler study were performed using a Hewlett-Packard (Sonos 1000, USA) echocardiograph to assess left ventricular systolic and diastolic function. Peripartum cardiomyopathy was diagnosed on the basis of the echocardiographic findings. 10 Diastolic heart failure was diagnosed from a transmitral flow study when the E/A ratio was less than 1 in the presence of a deceleration time (DT) greater than 220 ms, or if the isovolumetric relaxation time (IVRT) was greater than 100 ms with normal systolic function. 11 Pre-eclampsia was diagnosed on the basis of ACOG clinical criteria. 12 During treatment of pulmonary edema, a chest X-ray was performed every 1 or 2 days. When patients were transferred to tertiary centers, we obtained follow-up information from the doctors by telephone contact. ResultsPulmonary edema developed in 18 cases (0.06%) of all obstetric patients (Table 1). The mean ma...