From Letters to Logistics - The enabling role of a lean transformation programme in a national postal service: The case of An Post, Ireland

From Letters to Logistics - The enabling role of a lean transformation programme in a national postal service: The case of An Post, Ireland Seamus O’Reilly (Cork University Business School), David Murray (An Post) and Joe Aherne (Leading Edge Group) Abstract Purpose This paper investigates the role of a lean transformation programme in supporting the transition of a national postal (mail) service from a traditional letter delivery service to a competitive parcel delivery service. Methodology Given the objective an intrinsic case study (Stake, 2005) approach was adopted, as this specific case was of interest. To support this approach the researchers had access to a range of data sources including, archives (e.g. strategy documents), reports (e.g. project reports and outputs), and access to management involved in the transformation programme. Findings The findings highlight the fundamental role of leadership, at all levels, and organisational culture in supporting a LSS transformation programme. The balance between dedicated experts and larger projects on one hand and wider engagement throughout the organisation on the other hand was instrumental to embedding an LSS culture. In this regard frontline managers had a key role to play. Limitations As with any case study research we must be careful when generalising the findings. Furthermore, given the relatively recent strategy deployment within the case organisation, further follow-up studies are required to establish the sustainability of the culture change and benefits achieved. Originality On the basis of a systematic literature review, Danese et al. (2018) call for exploratory case studies/action research to better understand how lean could be implemented in public sector. This intrinsic case approach adopted responds to this. Practical Implications The study links research and practice through assessment of the organisational journey and consideration of the findings in the context of success factors identified in the literature. Management behaviour and practices at all levels were fundamental to achieving a LSS transformation culture, including ‘go and see’ for senior management and active daily huddles facilitated by frontline management. Key Words: Lean Six Sigma, Public Sector, Service Sector, National Mail Service

Insulin resistance in type 1 diabetes: what is ‘double diabetes’ and what are the risks?

In this review, we explore the concept of ‘double diabetes’, a combination of type 1 diabetes with features of insulin resistance and type 2 diabetes. After considering whether double diabetes is a useful concept, we discuss potential mechanisms of increased insulin resistance in type 1 diabetes before examining the extent to which double diabetes might increase the risk of cardiovascular disease (CVD). We then go on to consider the proposal that weight gain from intensive insulin regimens may be associated with increased CV risk factors in some patients with type 1 diabetes, and explore the complex relationships between weight gain, insulin resistance, glycaemic control and CV outcome. Important comparisons and contrasts between type 1 diabetes and type 2 diabetes are highlighted in terms of hepatic fat, fat partitioning and lipid profile, and how these may differ between type 1 diabetic patients with and without double diabetes. In so doing, we hope this work will stimulate much-needed research in this area and an improvement in clinical practice

Differential roles of epigenetic changes and Foxp3 expression in regulatory T cell-specific transcriptional regulation

Naturally occurring regulatory T (Treg) cells, which specifically express the transcription factor forkhead box P3 (Foxp3), are engaged in the maintenance of immunological self-tolerance and homeostasis. By transcriptional start site cluster analysis, we assessed here how genome-wide patterns of DNA methylation or Foxp3 binding sites were associated with Treg-specific gene expression. We found that Treg-specific DNA hypomethylated regions were closely associated with Treg up-regulated transcriptional start site clusters, whereas Foxp3 binding regions had no significant correlation with either up- or down-regulated clusters in nonactivated Treg cells. However, in activated Treg cells, Foxp3 binding regions showed a strong correlation with down-regulated clusters. In accordance with these findings, the above two features of activation-dependent gene regulation in Treg cells tend to occur at different locations in the genome. The results collectively indicate that Treg-specific DNA hypomethylation is instrumental in gene up-regulation in steady state Treg cells, whereas Foxp3 down-regulates the expression of its target genes in activated Treg cells. Thus, the two events seem to play distinct but complementary roles in Treg-specific gene expression

Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature

The original version of this article unfortunately contained a mistake. Oliver Hanemann name was incorrect in the in the acknowledgements section of this paper