Medical Alumni and Faculty Newsletter No. 12

December 2013

Contents Diary in Pictures

p2 Introduction / Welcome

p3 The Hunt for Dicer 1 – Dr. Paul O’Brien

p4 Is it a Boy or a Child – Dr. Fergus Moylan

p7 Alumni Interview – Prof. Tony Gallagher, Professor of Technology Enhanced Learning

Dr. Dan Burke, Prof Katy Keohane Prof. Michael Molloy, Dr. Con Murphy, p9 Jennings Gallery – Dr. Bridget Maher Dr. Will Fennell

p10 Summer Elective Report – Rory Crotty

p10 Dr. Henry Hutchinson Stewart Scholarships – Dr. Bridget Maher

p11 €6 million CU Cystic Fibrosis Research Award – Dr. Barry Plant

p12 Today’s research is tomorrows health care Dr. Pat Cogan-Tangney, Prof Paul Finucane Dr. Jim O’Regan, Dr. Rory O’Brien, – Prof. Jonathan Hourihane Mr. Peter Ga ney, Mr. Fionnan O’Carroll

p13 Improving Care for People with Diabetes: A Population Approach to Prevention and Control – Prof . Patricia Kearney

p14 Charles Donovan Memorial Lecture - Introduction – Prof. Katy Keohane

p15 Charles Donovan Memorial Lecture – Prof .Fergus Shanahan Prof. Barry Ferriss, Dr Eamann Breatnach Prof. Cillian Twomey, Dr. Bill O’Dwyer p16 Medical Alumni & Faculty Scientific Conference 2013

p18 Appreciations

Dr. Pat Sullivan, Dr Tom Crotty Dr. Colm Quigley, Dr Dan Burke Prof. Catherine Keohane

Introduction Welcome to the 12th newsletter of the UCC Medical Alumni and Faculty Association am delighted to represent the UCC Medi- the Western Gateway Building, the Glucks- Sadly, we have been informed of the deaths Ical Alumni and Faculty as Chairman of the man Gallery and main campus can be of former teachers and colleagues in the Alumni Committee. arranged. Put the date in your diaries quickly!! past year, and I would like to thank those who have kindly prepared appreciations. Dr. Will Fennell, my predecessor, along with the Prof. George Shorten achieved a great deal as Our sympathy goes to all those who have Committee, deserve both thanks and praise former Dean, and the School has now grown lost loved ones. for their hard work over the past few years, for to nearly 1000 students, including the Direct organising the Annual Scientific meetings, Entry and Graduate Entry programmes. Re- The Committee look forward to meeting as publishing the newsletter and staying in touch cently, our Alumni from Malaysia have grown many Alumni as possible, and hearing your with Alumni. to significant numbers, and we also have the news. Special thanks to Rachel Hyland and first 2 years of the Graduate Entry Alumni, many Bridget Maher for preparation of the newslet- I would like to encourage all UCC Medical of whom originate from North America, ex- ter. Alumni and UCC College of Medicine and panding the influence of UCC School of Medi- Health Staff to actively get involved with us, cine abroad. We have many distinguished and let us know your up to date contact de- alumni working in all fields of medicine, or For contact details: tails. For those with special anniversary years prominent in other areas of public life. We Catherine.keohane@ ucc.ie of graduation, it is a great idea to plan your would like to maintain and build on these links [email protected]. class reunions around the Scientific Meet- for the benefit of the school and its alumni. I ing which will be held on Thursday Sept 11, wish Prof. Mary Horgan every success in her See you in September! n 2014, in Brookfield Health Sciences Com- term as Dean. plex, followed by the Annual Dinner in the Aula Max. It is a wonderful opportunity to The newsletter includes several articles on renew acquaintances with your own class- recent developments inthe School, items of mates and those of other years, as well gain- interest, and some highlights of the Scientific ing valuable continuing medical education Conference. ‘’points’’. Returning classes have been both impressed and keenly interested to see the develop- ments in UCC and quick tours of Brookfield,

Prof. Mary Horgan

Welcome Medical Alumni 2013

have had the opportunity to reflect on the The development of the Hospital Ipast decade of the School of Medicine in Network has formally partnered UCC with UCC. The changes cover the spectrum in edu- the South/Southwest Hospital Network. I am privileged to have been ap- cation, research and clinical care. The School of Medicine warmly wel- pointed to the role of Dean of the comes Waterford to the network School of Medicine in November 2013. The campus has expanded beyond rec- and looks forward to the education, I look forward to the further development of ognition with the building of state of the research and innovation opportunities this the Medical Alumni and its network in this art teaching facilities at Brookfield Health partnership provides. world of modern communication. n Sciences Complex and Western Gate Build- ing that has facilitated the expansion of De- The School took advantage of opportunities partments in the School of Medicine and in the good times to develop the campus the College of Medicine and Health. The but continued to successfully seek out other School is proud of its world class research opportunities in leaner times particularly in groups whose excellent track record has been medical research. acknowledged by significant Science Founda- And the developments continue! tion Ireland funding.

2 Dr. Paul O’Brien

The Hunt For - DICER 1

ne day in 2010, ten years after retirement My patient had been operated on at least Insurance numbers. Alas, further searches Ofrom my 30-year tenure as Chief Patholo- thirty years ago; the cut-off dates for retain- through various data bases, including the Pro- gist/Laboratory Director at a Toronto hospital, ing old records, path reports and blocks/slides vincial Health Plan, drew a resounding blank. I got a message from my old Department. had long passed. Everything from that era had This worried me as I thought the patient may A non-staff doctor had phoned the lab asking been discarded. I told Marc he was out of luck. have died. Some arrhenoblastomas can be- to speak with me; he left his phone number. One evening at dinner, I was telling the story have in an aggressive fashion; I had given her a I phoned the number and was mildly sur- to my wife Elizabeth, MB 1959. In response to good prognosis based on the cellular charac- prised to find myself speaking to a cancer my comment that no records were available, teristics of the growth. I hoped the lack of data cytogenetics researcher at McGill University she suggested that I check out the contents of may have meant that she had married and Medical School in Montreal. He said that his an old packing box I had stored in the garage switched her insurance cover to her spouse’s group was researching a mutation of a gene after cleaning out my desk on retirement ten account. named ‘DICER 1’ which they suspected played years before. I suspected that this was a ploy On looking again at the copy of the original a role in the development of certain rare to remind me of her many fruitless requests report, I noted that a second surname had tumour combinations which seemed to have over the years to dump the box. Nevertheless, been handwritten in beneath the original pa- a genetic predisposition. He had read a paper I had a look. I was astonished to find a slide tient identity data which is directly transcribed I had published in 19811 on an unusual com- folder containing a Kodachrome of the ovar- from the Pathology requisition form accompa- bination of lesions in a young girl-she had ian tumour with its unique Surgical Pathology nying the original specimen when it arrives in presented with a masculinising ovarian neo- accession number from 1979, as well as some the lab from the operating room. To this day, plasm, then known as an arrhenoblastoma, glass H & E slides of both the tumour and thy- I don’t know how, when or by whom this was now classified as Sertoli-Leydig Cell Tumour roid nodules. I then recalled that I’d read a pa- done. I entered this second name into the hos- (SLCT). A short while before this, she had per on the case to the Canadian Association of pital computer and got a more recent, but still been operated on for benign thyroid nodules. Pathologists’ meeting held in St. John’s, New- quite old entry containing my patient’s first On examining her family history, I noted that foundland, in 1980. As I remember, my pre- name and the same date of birth but noth- several of her relatives had a history of thyroid sentation at the time was received with what ing else. I presumed my patient had married, nodules. A review of the literature revealed which relieved me somewhat; at least my a report2 of such a combination, apparently good prognosis was correct. However, I real- the first time that this association had been ized I had reached a dead end. Shortly after, described. It seemed appropriate to write up while pursuing my hobby of the true history of the findings which I did, in association with her the Old West, (specifically the Lincoln county, endocrinologist and my good friend and col- New Mexico, troubles 3 of the late 1870’s which league, Dr. Douglas Wilansky. In those relaxed gave the world that enduring ornament W.H. times, one of the pleasures of publishing lay McCarty aka Billy the Kid), I was cruising the in counting the number of mail requests for website of Frederick Nolan, pre-eminent his- reprints, hopefully from important places with torian of the era. I read that many years ago, interesting stamps affixed. As I recall, we only he had found an old lady in London, a sister received one such request. There was also a I can only describe as polite apathy. of Billy’s boss John Tunstall, by dialling all the letter to the Editor that disputed our claim that That didn’t bother me one bit at the time as Tunstalls he could find in the London phone- the combination was another genetically-de- my main objective in going to the conference book. This simple but insightful expedient termined endocrine organ tumour complex. was to enjoy the scenic delights of that some- resulted in a treasure trove of historical ma- Our observations caused no ripple and sank what Irish part of Canada, and to dine on their terial coming to light. The murder of Tunstall into obscurity. fabulous fresh lobster. Have paper, will travel, in 1878 triggered the conflict that launched I was therefore intrigued to discover that at was the motto of those of us who sought to Billy on his wild career and subsequent rise to this late juncture, someone had actually read write off trips to pleasant places as a business global legend status. I immediately Googled the article. The caller was Dr. Marc Tischowitz; expense. Canada 411, entered the second surname he asked if any pathological material was still Armed with the unique accession number, I on the old path report, found five Toronto- available. Modern techniques can harvest use- went to the Hospital Medical Records com- area entries and started making my phone ful genomic data from unlikely sources, even puter but drew a blank. No records that old calls. The first person who answered was my from ancient glass slides gathering dust in had been uploaded when computerisation patient’s mother-in-law. Yes, the patient was old files. Marc told me that very few similar took place several years before. On the outside alive and well, had married and had a family, cases had been reported and that any ma- chance that I might have reported the ovarian here’s her number. I called her, explained who terial could prove invaluable in investigating tumour to the Ontario Cancer Registry, I sent I was, how the McGill researchers were keen their thesis of a germline mutation of DICER 1 them an email with the number and asked to contact her, and asked if this would be OK. playing a causal role. Germline mutations can them to check. Their response was that basi- Sure, she said. I told Marc Tischowitz, who was be passed along from one generation to the cally there wasn’t a hope, quickly followed surprised and intrigued by the turn of events; I next and so are of immense interest to disease by another message saying they had found a think he made a passing reference to Sherlock researchers. The DICER 1 gene codes for a pro- copy of my original pathology report, which Holmes. I told him that it was my wife’s advice tein that acts as a molecular ruler to ensure they forwarded to me. Now at least, I had the to check out the contents of the old box in the pre-mRNAs are cut to the correct length. patient’s name, age, Hospital chart and Health garage which had put me on the right track,

3 thus again proving that wives are ALWAYS ing a significant role in the development of 2) Jensen RD, Norris HJ, Fraumeni JF. Familial arrhe- RIGHT. He agreed with me, and said that in his this rare familial tumour combination, as well noblastoma and thyroid adenoma. Cancer 1973; 31: 1440-1450. expert opinion, this was due to a gene on the as in familial multinodular goitre per se4. On X chromosome. a practical level, it meant that carriers of the 3) O’Brien Paul. The Lincoln County War. Giant Bea- The outcome of this was that his team tested mutation were offered genetic counselling ver Publications, Toronto; 2010. my patient and her relatives and found that and could be monitored for the development 4) Rio Frio T, Bahubeshi A, Kanellopolou C, et al. Dic- several family members had the suspect of associated lesions. The hunt for DICER 1 was er 1 mutations in familial multinodular goiter with DICER 1 mutation. Together with their other over. n and without ovarian Sertoli-Leydig cell tumours. material, this gave them enough evidence to JAMA 2011; 305(1): 68-77. make a scientific case for the mutation play- 1) O’Brien PK, Wilansky DL. Familial thyroid nodula- tion and arrhenoblastoma. Am J Clin Pathol. 1981; 75(4) : 578-581.

Dr. Fergus Moylan

Is it a Boy or a Child?

ne of my required rotations in medical the local village, the father was asked: “Who influence the outcome. Oschool was two months in a maternity does the little fellow look like?” To which he The process involves four factors: the sex unit. In addition to the usual expected obstet- answered: “Sure, we haven’t looked at his face chromosomes, the anatomical and functional rical services, there was an anesthesiologist on yet!” Though, I doubt, as is often assumed, that development of the internal organs (ovaries call for the more complicated deliveries. Since times were simpler then, the questions were and testes), external organs (breasts, vagina such events are by their nature unpredict- certainly simpler. and penis), which in turn must be capable of able, there was always the occasion when his More often than not, when a baby is born maturing into adult functioning organs, and rush to attend a delivery was greeted by lusty the first question asked is not: “Is it OK?” or “Is it finally the psyche, also referred to as the gen- cries from the other end of the delivery suite breathing?” but “What is it?” So, before it is any- der. Since there is a lack of unanimity in termi- announcing that all was well and had been thing, its sex must be established. Needless to nology and classification of the multiplicity of managed without his services. In an attempt say, a baby whose sex cannot be assigned at disorders, it is necessary here to try to clarify to either deflect attention from his failure to birth has an essential part of its identity sus- some of the issues. provide pain relief for the happy event, or to pended, a truly shocking event for any fam- The terms Sex and Gender, though often used handle the accusatory looks that he might en- ily. Though an uncommon event, even when interchangeably, are not quite the same. Sex is counter, he would inquire of the nurses: “Is it a all does go well, it may not be the end of the used to describe biological categories while boy or a child?” While I was always amused by story. gender is used to refer to social/cultural cat- this little scenario, I did notice that the nurses egories. For example, there is a significant were less so. difference between sexual roles and gender roles. Later, when I related these events to my The term “intersex,” though in common use mother who had grown up on a farm, she to describe those caught in the interface explained that girls were a limited liability on between male and female, tends to be fa- a farm since they could neither work it nor voured by those affected but not by those inherit it, thus accounting for the wording of who study the issue. In addition, the “intersex” the question: “Is it a boy or a child?” Girls were community resents being seen as constituting expected to go off and become nurses. That a disorder or a disease, preferring instead to explained a lot. see themselves as unique. Likewise, the term To further illustrate the state of affairs in mid- The physical definition of the sex of a child “ambiguous genitalia” is unacceptable and in twentieth century rural Ireland, she told me a is based upon its genetic template. However, recognition the scientific community now story involving my father. As a dispensary doc- the presumption that a genetically normal fe- uses either “Disorders of Gonadal Dysgenesis” tor he was expected to be available for home male (46XX) mating with a genetically normal or “Disorders of Sexual Development” (DSD), deliveries. On one such occasion he was called male (46XY), each contributing one haploid the preferred term. Gender issues, formerly re- to a farmer’s wife who had already delivered cell (23X on the maternal side, 23X or 23Y on ferred to as “transsexual” are now called “trans- six girls. When he eventually emerged with the the paternal side) will result in either a geneti- gender.” The diagnostic term “gender identity seventh, in an attempt to break the tension, he cally normal diploid or zygote (46XX, female) disorder” has been replaced by “gender dys- asked the anxiously awaiting family: “Will you or (46XY, male), and that this in turn will result phoria.” rear it?” in a phenotypical female or male is only true Eventually their prayers for a boy were an- in 98.3% of cases. In addition, the ability of the Under normal circumstances the swered. Understandably, there was tremen- embryo to respond to the cascade of stimuli zygote has no sex. It divides and multiplies, dous excitement which sustained the fam- initiated by its genetic programing and the developing into an embryo. The embryo has ily for months. One day while shopping in hormonal milieu it is exposed to will further an undifferentiated gonad and all the cellular

4 components for either male or female devel- Hormonal defects can be either total or partial cause there may be mosaicism of the chro- opment. However, should anything go wrong and the effect on the phenotype is propor- mosomes resulting in a mixture of ovarian it is automatously programmed to develop tional to the severity of the defect. and testicular cells within the same individual, into a female phenotype. Oestrogen drives The most familiar hormonal fail- while partial versus whole enzyme defects can the embryonic cells down the female pathway. ure in the female is congenital adrenal result in either minor or major abnormalities. Because the female embryo is autonomous, hyperplasia where an enzyme defect in the Chromosomal analysis includes evaluation of it is anatomically complete even before the foetal adrenals results in increased production the total number, isolation of the SRY locus full development of the ovaries. Testosterone of testosterone (with decreased production and the presence of Barr bodies (only one X drives the process down the male pathway. To of cortisol and aldosterone) and virilization chromosome is activated at conception, all prevent the development of a female, it is nec- of the external genitalia. Maternal hormones, others are deactivated, appearing as clumps of essary to introduce a Y chromosome and its progesterone, either iatrogenic or excessive DNA within the cell. These clumps are referred SRY gene locus. It is this gene that determines production, can have similar effects. to as Barr bodies after their discoverer). An ab- whether the outcome is either male or fe- Enzyme defects in the male can cause a failure dominal ultrasound will identify the presence male. Under its influence the undifferentiated in testosterone production, failure to convert or absence of intra-abdominal organs, while a gonad secretes two hormones, testosterone testosterone to dihydrotestosterone or failure genitogram will demonstrate what is involved and mullerian- inhibiting hormone (MIH). The of androgen receptor molecules within the in a vaginal pouch. Laparoscopy and biopsies Mullerian cells account for the female line of cells to respond. Any of these will result in will help to define the identity of the abdomi- internal organs e.g. Fallopian tubes and uterus. feminization of the fetus. There are two classic nal organs. Hormone levels will cast light on The secretion of MIH removes them examples. where the enzyme block lies. from all further consideration. Testoster- one enters the genital tissues where it The first involves an autosomal recessive con- Since the issues of DSD are social emergencies is converted by enzymatic action into dition whereby there is a deficiency in the for the families, there is considerable pressure dihydrotestosterone (DHT), which is enzyme 5-alpha-reductase (5-ARD) which is to establish the sex as soon as possible. Forty a considerably stronger androgen. responsible for the conversion of testoster- years ago, the approach was to identify the sex The male genital cells develop in turn, being one to DHT. This condition which occurs in of the infant before leaving the hospital and sensitive to its androgen effects. By 7 weeks small isolated communities in The Domini- initiate correction. To temporize, the baby was gestation the testes must be organized to can Republic, Turkey and New Guinea where usually given a gender ambivalent name such secrete testosterone and MIH so that by 12 the possibility of consanguinity is increased, as Toni/Tony to minimize any readjustment. It weeks the male anatomy is complete. Testos- predominately affects males. Though, geneti- was also felt that a sexually inadequate female terone, in addition to the above, is thought cally 46XY, there is a failure of the male foetus could function better in society than a sexually to have an imprinting effect upon the brain to become virilized, resulting in microphallus, inadequate male. When the sex was unclear, which will subsequently establish the sense of cryptorchidism, hypospadias and a blind end- the bias was to assign it as female and raise maleness (gender). ing introitus. Wolffian duct differentiation is all it as such. In some cases, this had disastrous Finally, the child is identified at birth as either normal except for a small prostate. The embry- results since it did not take into consideration a boy or a girl and when old enough to under- onic secretion of MIH is normal so there is no the child’s gender. The practice today is to sus- stand the difference, they in turn are informed uterus or Fallopian tubes. Because the combi- pend major surgery until about 5 years when of their gender. This knowledge will give them nation of the hypophallus and the pouch look the child’s gender, based on its behavior, will the license to exhibit the behaviour appropri- like cliteromegaly with a vagina, the genetic be more apparent. ate to that gender. Any failure along the way male is raised female. However, partial viriliza- will result in a disorder of development. tion may occur at puberty when there may The issue of gender has become the focus be an increase in type 1 enzyme activity. It is of much attention not just in the scientific There are the two typical examples of chro- then that the confusion becomes apparent. community but also in the general media. mosomal abnormalities in clinical medicine: (In “Middlesex” by Jeffrey Eugenides, winner of Transgender or gender dysphoria is a feel- Turner’s Syndrome (45XO) and Klinefelter’s the Pulitzer Prize in Literature, the protagonist ing of being trapped in the wrong body and Syndrome (47XXY). In Turner’s Syndrome there has 5-ARD). The differential diagnosis includes it is estimated to occur in about 1 in 10,000 is a failure to develop functioning ovaries due ten different conditions, attesting to the com- males and females. But that is where unanim- to a defect in the X chromosome, resulting plexity of DSD. ity ends. Even in institutions that specialize in in nonfunctioning streak gonads. Mosaicism, the condition, there remain considerable res- where some cells are a mixture of 45XO and Failure of the androgen receptor molecules ervations as to the diagnosis and treatment. 46XX is common since many of the 45XO cells within the male embryonic cells can be either Certain things, however, are becoming clearer. die off. In Klinefelter’s Syndrome there is a partial of complete. This is referred to as Tes- The younger the individual exhibiting signs of combination of hypogonadism, gynaecomas- ticular Feminization Syndrome or “Complete cross-gender behaviour, the more likely that tia and eunochoidism. Androgen Insensitivity.” The result is a genetic the diagnosis is correct. Gender variance in Mosaicism, where there is a mixture of cells male (46XY) with phenotypical female exter- adolescence and the processing of emerging within the tissues, is not uncommon. What is nal genitalia. homosexual desires in the younger child may uncommon, at least in humans, is chimerism. both be grounds for feelings of gender confu- This is the fusion of two separate zygotes or In summary, genetically male infants can be sion. Transgender surgery is radical, irrevers- embryos, one male and the other female, re- born with female phenotypes and genetic fe- ible and often inadequate, especially in what sulting in portion of the foetus being male and males born with male phenotypes. is referred to as FTM (Female to Male) correc- the other female (hermaphrodism). Evaluation of these children is complex be- tion where building a phallus is expensive, difficult and often ultimately disappointing.

5 MTF correction, by contrast, is relatively inex- Syndrome (45XO), though female, may have ing asked: “Is it a boy or a child?” A clear “boy pensive. However, in both situations there is no Barr body, while those with Klinefelter’s preference” prevails especially in India and an undesirable loss of tissue sensitivity. Cur- Syndrome (47XXY), who are male, have a China where abdominal sonograms are used rent thinking is that surgery should be de- Barr body and thus pass the test). Finally, in to establish the sex of the foetus to facilitate ferred until the child has reached the age of the 1990s, a polymerase chain reaction (PCR) selective abortion. Also, mortality rates for consent. In the interim, gradual transition can test was developed to detect the SRY locus. young girls continue to parallel poverty levels, be initiated by hormonal blockage of the on- In the 1996 Atlanta Olympics, 3,000 female attention to their nutrition and health needs set of puberty and in the case of FTM, binding athletes were screened for the SRY locus. Eight being preferentially ignored. of the breasts to reduce growth and produce were positive. Seven of these had complete The good news is that the response to the call the more desired appearance. However, the androgen insensitivity (Testicular Feminization for gender equality in education has resulted “intersex” community has ambivalent feelings Syndrome). The eighth had 5-ARD. All were in a significant fall in fertility rates and a con- for what is referred to as “bottom” surgery and genetically male but phenotypically female. comitant fall in poverty. In Bangladesh, family many prefer to be left within their uniqueness. And none of them were aware of their condi- size has fallen from nearly 7 to 2.2 (2.1 being tion. the rate to sustain the population). Similar falls It would be remiss to discuss the identity of Because of this experience, the IOC aban- have been seen in most of India. It has been the individual purely on the basis of sex and doned screening since it was clear that none postulated that the fall in the fertility rate in gender. The issue of sexual preference is a of the athletes were aware of their conditions China (which is currently below replacement distinct component which helps to define and were only competing within the gender level), might have been achieved without a group of people in which one is likely to assigned to them at birth. resorting to its draconian law of “one-child find fulfilling emotional, romantic and sexual policy” and its resultant carnage for baby girls. relationships. Although sexual preference is So where are we today? On the political front, The change in family size has been most strik- seen as a continuum, three basic groups are there have been increasing appeals, at least ing in Brazil where television presentation of recognized: heterosexual, bisexual and homo- in the Western Hemisphere, for recognition family dramas has opened the possibility of sexual. Female homosexuals are referred to of same sex marriage. While a wave of ac- other life-style options. As a consequence, “the as “lesbian”, male as “gay” and bisexuals as “bi” ceptance is growing amongst the younger factory is closed” has entered its vernacular. (these are usually grouped with transgender generation, there has been considerable resis- and referred to as LGBT). There is good reason tance from religious conservatives. This has an Recently, while writing up the admission of to believe that there is a genetic basis to ho- ironic twist since in America, this constitutes a patient in the emergency room, I was privy mosexuality because of a 52% concordance a sizeable segment of the Black community, to a nurse waxing eloquent about how great within homozygous twins and a high familial no stranger itself to discrimination. In a mat- her teenage son was. Maybe it was because it incidence. Though homosexuality is no longer ter that lends itself to those seeking the moral was 3 o’clock in the morning, or I was all too viewed as a diagnosis but as a sexual prefer- high-ground, there has been a strange silence familiar with mothers going on about how ence, there are a couple of points that require from certain high profile conservatives. Seem- lucky they were, followed by a litany outlining clarification. Homosexuals can enjoy hetero- ingly, there is a very personal epiphany when their son’s inexcusable behaviour, or maybe it sexual sex but they cannot establish a satisfac- a much loved son or daughter reveals their was just me needing to burst her bubble, so I tory intimate relationship with the opposite homosexuality. asked her: sex. In addition, there is a commonly held be- In recent years, advances in Medicine have “Does he have a girlfriend?” When she lief that paedophilia is part of homosexuality. transformed the previously rather isolated answered in the negative, I said to her with a While paedophiles may be disproportionally existence of the gay community, into a far straight face: homosexual, the vast majority of boys molest- richer family experience to parallel that of “So he’s gay.” She burst out laughing and said: ed are molested by heterosexual males. their straight brethren. As an illustration of “No, he’s not! And even if he were, we would this, I found myself a few years ago consoling a still love him.” Though sex, gender, sexual preference are member of my staff who had just learned that I guess we have come a long way from the all deeply private matters, they do enter the her daughter was lesbian. Shortly afterwards, days when the burning concern was who forum of public discussion. The sexual pref- the girl married another woman, marriage would be there to take over the farm. n erences of many of the giants of Art and Lit- being permitted in the state. Wishing to have erature maintain a fascination for biographers, children, they persuaded a brother-in-law ostensibly to cast light on their work. One are- to be a sperm donor. In just a few years, my na where the sex of the individual has reached nurse went from being inconsolable to be- Olympic proportions is in the Olympics them- ing a blissfully happy grandmother of twins. selves. Since the genetic pool involved Caucasian and Throughout most of the 20th Century, ques- Asian blood lines, the twins reflect both family tions have been raised about the sex of cer- genes, facilitating an immediate acceptance tain female athletes. The International Olympic from both grandparents; grandparents, who, Committee (IOC) has sought ways to detect under ordinary circumstances, would have males masquerading as females. Certificates had no reason to blend and bond. of gender and “nude parades” were introduced in the 1960s. These were followed by screen- But not all the news is good. Over great ing the athletes for Barr bodies (this approach swathes of the globe, from North Africa was basically flawed since those with Turner’s through Asia, the age-old question is still be-

6 Dr. Bridget Maher

Alumni Interview – Prof. Tony Gallagher, Professor of Technology Enhanced Learning

hat influenced your decision to return Gerry wrote the preface of the book and there What is proficiency based progression Wto Ireland? is a paragraph at the end that perfectly sum- training? I promised my wife, Liz, that as soon as our marises our relationship. There is probably not Simulation is a tool, and only as powerful as children were school age, we would return a day that passes that I do not think of him or the curriculum it is embedded in. The ap- to Ireland. Conor (our eldest boy) was three miss him, particularly now that I am located in proach that I have developed and validated months old when I went to work at Yale in Cork. I think that individuals like Ted, George, has become known as proficiency-based 2000. Cullen, now 9, was born in Atlanta in Peter and Gerry represent the potential of Cork progression training. A quantitatively defined 2004. I think Irish people do not realise the and UCC. From my observations whilst a vis- performance level is established based on the high quality of so many aspects of life here. iting Professor at UCC, I think there are many objectively assessed performance of experi- I always knew I would come back to Ireland. more like them. enced practitioners. Trainees are then required The other thing that attracted me to UCC was to train on the simulation until they have un- that there appeared to be a very ‘real world’ ambiguously and quantitatively demonstrat- ethos underpinning much of the work and ac- ed the mean performance level of the experi- tivity in the University. I believe that this mind- enced practitioners (consistently). This means set will pay dividends for UCC and Ireland. that simulation based training becomes a vehicle for ‘deliberate’ practice rather than just How did an experimental psychologist repeated practice. Deliberate practice means become involved in this research area? that trainees receive quantitative feedback on It was very much by accident. In the mid- their performance, particularly on deviations 1990s, I saw an in-depth Newsnight item on from optimal performance (i.e., performance ‘Keyhole Surgery’ describing how straightfor- errors). This approach to skill acquisition is Cork and UCC ward laparoscopic surgical procedures had more efficient and effective than the tradition- Over the years, I have been greatly impressed gone wrong. It appeared that surgeons didn’t al approach of repeated practice. Furthermore, by people from Cork and UCC. Prof. Ted Dinan really know why some of their colleagues had performance at the end of training is quality (Psychiatry, UCC) was a young consultant at St difficulty learning keyhole surgery. As a psy- assured by the simple fact that training is not James’s Hospital in Dublin when I was doing chologist, the reasons were abundantly clear deemed completed until the trainee has dem- my PhD on psychological interventions for to me. Then a junior academic, I asked permis- onstrated the performance benchmark. This chronic auditory hallucinations in schizophre- sion to pursue the problem. Within three years, relatively simple idea has radical implications nia. Ted was very helpful and had it not been I had published quantitative demonstrations in for training, competency and patient safety. for him, I probably wouldn’t have a PhD. prospective randomised studies. The main rea- I met Professor George Shorten and Dr.. Peter sons were primarily human-factor (e.g., loss of Kearney (CUH) at conferences after I had re- important information on depth of field, coun- turned to work at the RCSI. With both, it was a terintuitive movement of surgical instruments meeting of minds. We talked for hours about caused by fulcruming against the body wall, simulation and a whole new approach to degradation in haptic and tactile feedback etc). training, skill acquisition, skills assessment, de- I quickly moved on to training solutions. In vice development and implications for mod- 1998, I started to investigate a new technologi- ern medicine. This led to numerous discus- cal solution to the problems posed by learning sions about how precisely this new paradigm laparoscopic surgical skills, i.e., virtual reality would impact on Medicine and Healthcare. (VR) simulation. Although VR simulation had been mooted in surgery since the late 80s Professor Gerry O’Sullivan and early 90s, no robust evidence had been The late Prof. Gerry O’Sullivan In 2005, (the late) Prof. Gerry O’Sullivan intro- published regarding efficacy as a training ve- and Prof. Tony Gallagher. duced my talk at the RCSI Millin meeting on hicle. In 2000, when I was Fulbright Distinguish proficiency-based progression (PBP) simula- Scholar in the Department of Surgery at Yale Medical training – a paradigm shift tion training for surgeons. Gerry immediately University, I was lead investigator in the first We are experiencing a paradigm shift in how grasped how important and fundamental this prospective, randomised, double-blind clinical healthcare workers are trained. The College approach was for surgery and for medicine trial of VR simulation training for the operator of Medicine and Health at UCC is, as Prof. and that it had ramifications far beyond train- room. Results showed that VR trained surgeons John Higgins correctly stated, ‘ahead of the ing. For the two years of his Presidency at RCSI, performed significantly better than tradition- curve’ in this regard. UCC has committed to I tutored Gerry on PBP and we discussed the ally trained surgical residents.This study was build the ASSERT (Application of Science to latest research and ideas for future research. published in Annals of Surgery and was a cita- Simulation, Education and Research on Train- This was the backbone of our book ‘Funda- tion classic in just over a year. On the basis of ing) for Health Centre and my appointment is mentals of Surgical Simulation; Principles and this study and a number of replications which a significant part of that commitment. Simula- Practices’. We had a similar sense of humour, followed, the American College of Surgeons tion and Technology-Enhanced Learning (TEL) liked the same sort of people and shared a established a network of simulation training are the core ‘business’ of this centre. Professional love of science and the scientific method. centres across the US. organisations around the world responsible

7 for the training of healthcare professionals Device Manufacture Opportunities for ASSERT for Health have almost unanimously agreed that tech- Procedure characterisation requires that the ASSERT for Health at UCC provides a unified nology must be better harnessed for more steps of the procedure, the devices used approach to the problems faced by a variety efficient and effective education and training. during those steps and procedure errors are of health care disciplines. ASSERT for Health In particular, technologies such as virtual real- identified, operationally defined and quanti- can lead the way in educating and training a ity simulation and e-learning must be used to tatively validated. This level of understanding broad spectrum of professional groups in TEL. shorten the learning curve and to supplant could possibly lead to the conclusion that this Specifically, we will show how TEL is optimally the skill acquisition process that was previ- approach/devices may not be the best way developed, applied and validated. This will re- ously acquired in clinical situations. A learning to treat a clinical problem. Procedure charac- quire the ASSERT for Health Centre to rapidly curve on patients is no longer acceptable, par- terisation requires the definition of an optimal expand the number and types of courses. This ticularly for common procedures. procedure outcome. This information gives an expansion has already commenced as I am in This poses challenges but also offers enor- opportunity to develop or invent a new de- the early stages of developing a postgraduate mous opportunities. Ireland has a well-de- vice to perform the procedure in a better/safer course in TEL for Health to commence in 2014. served reputation for producing outstanding way. Given Ireland’s relationship with leading In order to maximise this opportunity, a key el- doctors, nurses and other healthcare profes- medical device manufacturers, the opportuni- ement will be to have a systematic approach sionals. The challenge is to identify what it is ties offered here are breathtaking. to the implementation and quantitative vali- that we do so well in our education and train- dation of TEL. We need to provide evidence ing of health care professionals and then apply that TEL is a better way to train for proficiency. it more systematically. Simulation and other Part of my vision for ASSERT for Health is that a technologies allow the trainee to engage in procedure-based focus would seem a sensible deliberate rather than repeat practice and is place to start. However, this should rapidly more efficient, effective and quality assured. expand to less tangible but equally important However, building an effective simulation and areas such as decision-making and acquisition embedding it in a curriculum first requires that of practice wisdom. A constant consideration the precise details of specific procedures are should be the development of new and bet- fully understood and characterised. This is ter methodologies and new instruments and not a simple as it sounds. Once a procedure devices. has been appropriately characterised and detailed operational definitions of procedure Challenges The Future steps and sub-optimal performance identified, One of the things that could limit or impede Ireland has demonstrated the capacity to appropriate simulations and curriculum can the success of ASSERT for Health is its percep- punch above its weight in a number of pur- be designed and implemented. tion purely as a training centre by regional and suits. Healthcare is one of them. I firmly believe national healthcare organisations. ASSERT for that TEL is a new but rapidly expanding area Procedure Characterisation Health is far more than this and represents an where UCC and Ireland can excel. We have al- Training is important and ASSERT must offer investment by the College of Medicine and ready demonstrated expertise and capacity. It first class training and continuing professional Health and UCC in the future. At the core is a is my intention that ASSERT for Health should development for healthcare professions in Ire- culture and philosophy of improved patient be at the forefront of international develop- land and internationally. Integral to this is an safety brought about by a genuine under- ments and should commercialise and exploit in-depth understanding and validated charac- standing of what training is and what it should the good ideas derived from the scientific terisation of the skills being trained, irrespec- be. From this understanding emanates effec- process. TEL for health, although not new, has tive of the procedure or discipline. The next tive and efficient training across healthcare come of age. n step is to design curricula which employ simu- disciplines using validated simulations and lations for training. A better approach would curricula. Another important output will be be to first characterise the procedure to be the publication of clinical validation studies simulated, and then identify from validation accurately describing the process and facilitat- studies and clinical experts the aspects of the ing replication. The vision of Horizon 2020 (the procedure which are essential to emulate and EU Research strategy) particularly for coun- to what level of fidelity. tries like Ireland, is the successful commercial exploitation of good ideas and science. ASSERT is a vehicle to achieve that goal. The idea of proficiency-based progression training based on validated procedure charac- terisation is relatively simple but represents a paradigm shift in how doctors and healthcare workers are trained and how medicine is prac- ticed.

8 Jennings Gallery ‘Seeing is an Art that must be learned’ Visual Thinking Strategies

Visual Thinking Strategies (VTS) is a teach- Dr. Bridget Maher, Director of the Jennings ing method that uses visual observations to Gallery and Chairperson STEAM Committee, enhance critical thinking and observa- explained how medical students might ben- tion skills and is based on open-ended yet efit from VTS: ‘Observation skills are of vital highly-structured discussions of visual art of importance in medicine. Inspection should increasing complexity. In addition to teach- never be a hurried glance, but a slow, delib- ing students the importance of detailed erate, active ‘seeing’. Observation skills can be observation, VTS aims to help students culti- improved – the more one looks, the more one vate a willingness and ability to present their sees. VTS may improve observation skills and own ideas, while respecting and learning from critical thinking, and allow students under- the perspectives of their peers. VTS is thought stand difference of opinion and interpretation. Jennings’ Gallery Exhibitions to increase the frequency of supported obser- Feedback has been very positive - students The Jennings Gallery recently hosted an vations and speculations and to foster critical seem to enjoy the reflective nature of viewing exhibition Of Chinese Fine Art from Shanghai thinking strategies. Art has more than one a work of art and are very active contributors University and a Chinese calligraphy demon- ‘right’ interpretation and ambiguity invites to the discussion. We have included some im- stration. speculation. VTS requires students to focus, ages of a medical nature but is it important to become reflective and to question - the basis keep the focus on Art as an aesthetic process.’ Coming soon: ‘Pop-up Poetry’ : for thinking. College of Medicine and Health Staff and UCC is the first Medical School in Ireland Students. offering VST to students and the only univer- sity with VST trained faculty. ‘Acquainted with the Night’ : November- December 2013: Grainne Tynan. VTS programmes have also been introduced in the schools of Nursing and Midwifery, Phar- ‘It’s a Beautiful World’: macy, Dentistry and the Clinical Therapies. 20th February 2014: Exhibition.

‘Celebrating Autism’ : 2nd April 2014. A display of artistic works by children with autistic spectrum disorder.

‘The Art of Making’ : 13th May 2014. School of Occupational Therapy, UCC.

A pilot VTS programme recently commenced at UCC medical school. The sessions are led by trained VTS facilitators from the School of Medicine with the support of VTS facilita- tors from School of Nursing and Midwifery, Dentistry, Pharmacy and Clinical Therapies. The programme is offered to Third Year medi- cal students.

9 Rory Crotty

Summer Elective Report

he summer before Final Year is one of the ond day reviewing the slides with the resident keen to teach. They were extremely support- Tmost keenly anticipated times in a UCC and the consultant. This allowed me to see ive of my interests in pathology, and strongly medical student’s course. For most students, how the pathology laboratory functions, and encouraged me to pursue them further. One of this is their first dedicated opportunity to meant that I could follow a specimen from the greatest perks of working at these centres embark on a medical elective, working at a its arrival in the laboratory to the final report was having a chance to interact with individu- hospital of their choice in a field that they are being issued. als who were truly world-renowned. Sitting passionate about - and to get some sightsee- down to work with people who have syn- My time at Massachusetts General comple- ing done on the side. This year, UCC students dromes named after them, or whose names mented this experience wonderfully. The pa- spread out all across the globe, with some are on the front cover of WHO guidelines thology elective at MGH was centred more of my classmates travelling as far abroad as was a very special experience, made all the on working with consultants than shadowing Argentina, Australia, and Zambia for their elec- more enjoyable by how down-to-earth and residents, and placed a stronger emphasis on tives. Due to my own interest in pursuing a approachable they were. clinical pathology. A typical day would involve career as a pathologist, I decided to spend my signing out cases with the consultants in the Once I had completed my electives, three summer working in pathology. After months morning, and previewing the following day’s weeks remained to unwind and reflect before of enquiries and an endless barrage of emails, cases in the afternoon. This elective was based returning to college. The thorough exposure I was fortunate enough to secure electives at on four week-long rotations in fields such as to pathology I received during the summer the Mayo Clinic in Rochester, Minnesota, and haematopathology, microbiology, dermato- made me realise how much I would enjoy a the Massachusetts General Hospital in Boston. pathology, and transfusion medicine. When career in pathology. I loved the work itself, After celebrating the end of the summer ex- I wasn’t at sign-out or preparing for the next which was calm, focused, and analytical, with ams, I headed for Minnesota. The Mayo Clinic day, I was expected to attend resident lectures each specimen requiring an entirely new elective was focused on resident shadowing. and grand rounds, or to study for my case frame of thought. The specialty was a refresh- Every day, I was assigned to a certain resident, presentation at the end of the month. In addi- ing and very personally appealing way to from the 7am morning lectures to the end of tion, I was also encouraged to sign up for and approach medicine, where you really get a the day. This was a great way to see first-hand attend working groups that were focused on chance to stretch your mental legs, combin- what the work of a pathology resident was exciting new areas of research, especially in ing the challenge of a logic puzzle with the like, and, just as importantly, to find out what the rapidly growing areas of bioinformatics satisfaction of playing an important role in the residents really enjoyed about the spe- and computational pathology. patient care. In addition, I was able to see how cialty. The main focus of the elective was his- much the pathologists and residents enjoyed A very important aspect of the experience topathology, with some time in cytology and their work, and how personally satisfying it that was identical between the two electives autopsy services. Two-day surgical pathology was to them. All in all, I enjoyed the experi- was the calibre of the residents, fellows, and rotations formed the basis of the experience. ence so much that I am now counting down consultants. Without exception, they were The first day was spent assisting the resident the days until I can apply for a pathology train- dedicated, motivated, friendly individuals at specimen dissection in the lab, and the sec- ing scheme, whether that be here in Ireland or who greatly enjoyed their work and were very across the Atlantic. n

Dr. Henry Hutchinson Stewart Scholarships 2013

UCC medical students had an outstand- Medical Microbiology - Kiran Reddy; In 1829 he obtained the licence of the Royal ing performance in this year’s NUI Dr. Henry Medicine - Orla Houlihan; College of Surgeons, Ireland and MD of Ed- Hutchinson Stewart Medical Scholarships Paediatrics - Daniel Crowley; inburgh. In 1888, a bequest was received by and Prizes. UCC medical students received 19 Physiology - Alexandra Britto. Trinity College, Dublin and the Royal Univer- awards, including 8 first place scholarships. sity of Ireland, from the estate of Dr. Henry Third places Hutchinson Stewart, for the establishment of Biochemistry - David Vaughan; First Places Medical and Literary Scholarships. The recipi- Pathology - Laura Corkery; Biochemistry - Dennis Hopkinson; ents of the Medical Scholarships and Prizes are Pharmacology - Kieran Mullins. Pharmacology - Francis Delaney; determined by an agreed Extern Examiner in Physiology -Siobhan Rafferty; Commendation: each subject. n General Practice - Patrick Mitchell; Medicine – Karen McCarthy; Ophthalmology - Ming Yong Lee; Paediatrics - Anne Mary O’Mahony Medicine - Sheila McSweeney; Paediatrics - Karen McCarthy; The students received their medals and Surgery - Helen O’Brien. awards at an NUI ceremony in Royal Hospital Kilmainham, Dublin in November. Second Places Gynaecology and Obstetrics - Aoife Hurley; Dr. Henry Hutchinson Stewart was born in Clinical Radiology - Anne Mary O’Mahony; Wicklow in 1799, the son of a clergyman.

10 Dr. Barry Plant

UCC leads the way with a €6 million EU Cystic Fibrosis Research Award-CFMATTERS. n international consortium of Cystic Cystic Fibrosis affects over 70,000 people This approach may potentially revolutionize AFibrosis clinicians and scientists, led by worldwide with over 90% dying prematurely the practice of antibiotic prescription in other Dr. Barry Plant of the College of Medicine and from respiratory infections which have over- acute and chronic infections also. Antibiotic Health, Alimentary Pharmabiotic Centre and lapping chronic and acute bacterial compo- resistance is one of the most significant chal- the HRB - Clinical Research Facility, University nents caused by a multitude of infective and lenges facing the EU health care system owing College Cork/Cork University Hospital, Ireland potentially resistant microorganisms. Mr. Philip to unnecessary and inappropriate use of anti- has launched a major EU-funded collabora- Watt, CEO of the Cystic Fibrosis Association of biotics. CFMATTERS is one of 15 new research tion project focused on the development and Ireland stated, “This is a tremendous oppor- projects funded by the EU to combat- micro- trial of personalized antibiotic treatment for tunity for Ireland to become a world leader bial resistance. Personalized antibiotic treat- patients with CF during respiratory infections. in Cystic Fibrosis care and drug resistance. ment using next generation technology such CFMATTERS an acronym for ‘Cystic Fibrosis The success of CFMATTERS will have impor- as that employed by the CFMATTERS project Microbiome-determined Antibiotic Therapy tant positive implications for all patients with could limit the development of antimicrobial Trial in Exacerbations: Results Stratified’ will CF and their families”. Denis Coughlan an Irish resistance globally, by only prescribing those receive approximately €6 million in funding patient with Cystic Fibrosis added, “This new antibiotics that are necessary for an individual from the European Union’s Seventh Frame- approach to treating infection, I believe of- patient. work Programme. fers all patients a new radical approach with potentially significant benefits”. At the launch of European Antibiotic Aware- The CFMATTERS consortium brings together ness Day 2013 European Commissioner for a diverse international group of renowned Research and Innovation, Máire Geoghegan- CF experts from both academic institutions/ Quinn, added: “Research and innovation are hospitals from across Europe and the Unit- essential if we are to turn the tide against ed States of America. CFMATTERS partners antimicrobial resistance. These new proj- include; University College Cork and Teagasc ects will add to the excellent work on-go- Agriculture and Food Development Author- ing to develop new drugs and treatments.” ity (Ireland), Queen’s University of Belfast, She acknowledged that Cystic Fibrosis (CF) Papworth Hospital NHS Foundation Trust and represents a unique disease model to study the University of Dundee (United Kingdom), bacterial resistance and to explore therapeu- the Université Paris Descartes and Assistance tic strategies for same, as chronic lung infec- Publique – Hôpitaux de Paris (France), Univer- tion overlaps with acute lung exacerbations sitätsklinikum Heidelberg (Germany), Katho- caused by a multitude of organisms that lieke Universiteit Leuven (Belgium), and the traditionally evolve various mechanisms of University of Washington in Seattle (USA). resistance. n These academic institutions will also cooper- ate with small business enterprises including clinical data management specialists, Clininfo S.A. (France) and a research project manage- ment company, GABO:milliarium (Germany). CFMATTERS will evaluate the potential ben- The unique project is the first randomized, efits of a multi-center clinical trial using next- controlled trial comparing the use of micro- generation DNA sequencing of the bacteria biome-directed antibiotic treatment versus in patient mucus samples compared to cur- standard therapy for patients with CF (PWCF) rent culture media protocols, to guide anti- experiencing respiratory infections. Announc- biotic treatment of Cystic Fibrosis patients. ing the funding Dr. Barry Plant, CFMATTERS co- This personalized, microbiome-derived antibi- ordinator and Director of the Adult CF Center, otic treatment will be evaluated by recording Cork University Hospital commented, “CFMAT- the speed of patient recovery and the length TERS offers a personalized approach to antibi- of time elapsed before the next infection. otic treatment. It will enhance individual pa- In parallel, scientists will also analyze the tient responses and decrease drug resistance genetic makeup or microbiome of the resi- by employing next generation technologies. dent microflora in the mucus and gut, and CFMATTERS brings together a powerhouse of their interaction with the host. Cell and murine international expert clinicians and scientists to models of Cystic Fibrosis disease will also be further enhance the understanding on how used. Collectively, these studies will pave the best to treat all chronic and acute infections”. way for more effective therapeutic regimes and ultimately contribute to the development of personalized Cystic Fibrosis treatment.

11 Prof. Jonathan Hourihane

Today’s Research is Tomorrows Health Care

“Today’s research is tomorrows health care” to less than 70 with reconfiguration, when St The Academic Building capacity to lead Paediatric research Anne’s Ward in MUH moves to the single pae- Department is and clinical care in Cork diatric site at CUH. currently very Intravenous and oral rehydration is still a main- successful in winning non-Exchequer funds for Introduction stay of our general activity but all our paedi- research. It has the highest per capita income The Department of Paediatrics is undertak- atric subspecialties (unheard of in 1979!) such in the School of Medicine and is undoubtedly ing its first major investment in infrastructure as endocrinology, diabetes, and allergy, day the most active Paediatric academic unit in since CUH opened its doors in the Regional surgery etc. have more need for ambulatory the country, but it is working in space wrested Hospital, Wilton in 1979. While the RGG Barry space than inpatient beds. How times have from others when paediatric research was in Day unit was added through public subscrip- changed. its infancy. Our 1,900 children in the BASELINE tion in 1990, the core of the unit is unchanged birth cohort study will be coming to see us and is tired and worn out, just like some of the The students we teach and how we teach regularly (>4000 visits to the Discovery Centre staff! The delivery of healthcare to children them have changed too since it opened) and our bio-bank of samples has changed drastically in the last 4 decades UCC’s teaching space is still the same as when from them is a national scientific treasure that as the burden of gastroenteritis and pneumo- it opened and many graduates will remember deserves the best possible facilities for its cura- nia has decreased and survivors of neonatal it from their own student days. Esteemed tion. Other studies will need space too, look- intensive care need complex care, unimagi- graduates who have visited us and given talks, ing at immunomodulation of allergic disor- nable in 1979. The spaces we need now are have entered the tutorial room with mixed ders, neurocognitive follow up of survivors of for ambulatory care. Our clinical and teach- emotions! New teaching space is needed to neonatal hypoxic ischaemic encephalopathy ing spaces must change to reflect the needs simply cope with current numbers and with and neonatal hypotension etc. of our clients, who are children, their families recently proposed expansion of student num- and our students. bers, we will already have to look elsewhere for clinical placements again. UCC must invest in paediatric-specific simulation technology and expertise to cope. Just when you finally fix one problem, another one comes along…

How we are changing - Delivery of Clinical Care In the HSE reconfiguration we will be build- ing a new 2-floor extension placed above our current bungalow accommodation. In-patient facilities will remain on the refurbished ground floor, though we will still not be able to of- fer single bed accommodation or adequate parental accommodation. Haematology will take over the current Seahorse Day Unit and all clinical day services including outpatients, day surgery, ambulatory CF, diabetes, neurology, allergy and cardiology care (we have them all The diseases we treat have changed, so we in-house now!) and outreach clinics from the Summary must change how and where we work. “imminent” National Paediatric Hospital will This accretion of clinical and research activity Retired colleagues in Limerick tell me that take place on the first floor, with separate ac- into an integrated space is a perfect example in the 1970s the first question the Consul- cess from the main hospital corridor. of the HSE and university sectors’ ambition to tant asked the Sister each morning was “How forge Academic Health Centres to deliver re- many children died last night?” Our Paediat- How we are changing - Teaching and search led health care, shown to be the best ric morbidity and mortality meetings in CUH Research model of care. show less than 5 children die in CUH each UCC’s Dept. of Paediatrics and Child Health year now, as we transfer severe cases to PICU will be housed on the second floor with a larg- Paediatrics is a different specialty now. UCC in Dublin (approx. 40 cases per annum) and er lecture room, small meeting rooms, a com- and its HSE partners have recognised this and manage terminal care at home. Nonetheless, puter suite, and clinical skills lab and research are backing the single-site integration of the overall deaths in children who have medical accommodation. The HRB-funded Children’s acute and ambulatory care with the academic care in our services is still <20 per annum. Discovery Centre (whose ribbon was cut in and research activities which have exploded in When the current unit was being planned in 2010, not by a politician but by Dan O’Keefe, Cork since 2005. These are exciting times for the early 1970s, Prof. Barry bid for a 400 bed aged 4), which is the paediatric-specific part of children’s health in Cork and I am delighted to unit for children in Cork, to deal with the bur- UCCs’ clinical research centre, will move into know that UCC and its alumni have invested den of cases of infectious disease. We current- the second floor too, and a laboratory will be in our most important national resource, the ly have just 80 beds in the city, which will drop fitted out. health of our children. n

12 Research Professor Award

Improving Care for People with Diabetes: A Population Approach to Prevention and Control

n 2013, Professor Patricia Kearney was one sionals and the wider health system. The rising care and complications in Ireland. The infor- Iof the first recipients of the Health Research prevalence of diabetes has increased inter- mation compiled on the prevalence of diabe- Board (HRB) Research Leader Awards. est in it’s overall economic and societal costs. tes and diabetes related complications will be Cost estimates vary depending on the accuracy utilized to estimate the costs of providing care These were developed in response to the of the methods used to identify people with to people with diabetes and to therefore cost- need identified by the HRB to build capacity diabetes, its’ population prevalence, and health effectively prioritize service provision. Thirdly, to conduct high quality Population Health and care costs. Strategies are being developed to diabetes care delivery in Ireland is in the early Health Services Research (PHHSR) in Ireland improve quality of care for people with diabe- stages of reform and reorganisation with the including an urgent need to invest in senior tes which need to be evaluated. The increased establishment of the HSE’s National Clini- academic research leaders in PHHSR, working prevalence of diabetes worldwide, particularly cal Programme in Diabetes. However, there in close collaboration with key clinicians and at the dynamic life stages, including older age has been no process evaluation of change health managers engaged in policy and/or and pregnancy, and the concomitant costs, and implementation to date and this will be practice. Patricia’s award, in partnership with have increased interest in prevention strate- addressed in the programme of research. the National Clinical Programme in Diabetes, gies in particular lifestyle modification. It is now Finally, given the increasing prevalence of dia- is to lead a project titled: Improving Care for widely accepted that the traditional model betes, feasible approaches to lifestyle modi- People with Diabetes: A Population Approach of acute episodic care will not cope with the fication are urgently required. Gestational to Prevention and Control. The overarching future burden of chronic conditions such as diabetes mellitus is one of the most common vision of the research programme funded by diabetes, so greater attention has been paid complications of pregnancy and is associated the HRB is to improve care for people with dia- to ways of reorganising services, including the with significant short and long-term risks for betes in Ireland and to reduce the preventable reorientation of care towards the primary care the mother and offspring. Pregnancy is a time economic and societal burden of diabetes. The setting. of rapid change and provides an opportunity programme of research is based on maximiz- for behavioural change particularly if the life- ing existing collaboration between academic Prior to the development and implementation style changes impact on the health of the foe- Epidemiology and Public Health, Health Ser- of new prevention, treatment or reimburse- tus. The research programme will include the vices Researchers, Health Economists and ment strategies for diabetes care, the first development of an appropriate evidence- Clinical Medicine. The award will fund Profes- necessary step is to quantify the burden of based lifestyle intervention to improve the sor Kearney’s work over the next 5 years and disease in the community. At present in diet and physical activity levels of pregnant will develop additional capacity in this area Ireland there is a lack of reliable information women in Ireland. by supporting the training of doctorate and on the prevalence of diabetes, including both post-doctorate researchers. In recognition of diagnosed and undiagnosed individuals and The research programme led by Professor Patricia’s outstanding track record in terms of associated risk factors, as well as a dearth of Kearney has the potential to directly and rap- publications and peer reviewed research grant information on the complications of diabetes idly impact on diabetes care in Ireland and the funding and her recent success in securing this and related conditions. The first component of quality of life and outcomes of people with prestigious HRB Research Leader Award, UCC the programme of research will be to develop diabetes. n has appointed her as Research Professor. valid estimates of the prevalence of diabetes Diabetes is a major public health problem and diabetes- related complications in Ireland worldwide which places a significant burden using existing datasets. Secondly, there is no of care on the individual, health care profes- reliable information on the cost of diabetes

13 Prof. Katy Keohane

Charles Donovan Memorial Lecture - Introduction

Charles Donovan 1863-1951

Charles Donovan combined all that is good His main scientific discoveries were due to his him. He was a very hard worker and not only in clinical and laboratory medicine and as a careful microscopic studies and clinico-path- taught students about medicine, but how human being he contributed hugely to com- ological correlation. In 1903 he identified the to prepare meals for their patients and how fort patients. As a scientist and teacher he agent causing the infectious disease kala-azar to give enemas. advanced understanding of infectious dis- or leishmaniasis, from a biopsy of the spleen eases, and it is wholly fitting that UCC , and in a living patient. The protozoan parasite was He retired from the Indian medical Service in the Medical Alumni acknowledge his contri- named Leishmania Donovani in recognition of 1920 and thereafter pursued his interest in the bution to world medicine, in a named lecture. both Donovan and Sir William Boog Leishman, study of butterflies and birds, and reported the The Charles Donovan Prize in Dermatology is a Scottish pathologist who had identified the occurrence of malaria in monkeys. After retire- also named in his memory, an award the late organisms in post-mortem tissue. Kala-azar is ment he wrote a Catalogue of the Macrolepi- Fergus Lyons was instrumental in establishing. also known as ‘’black fever’’, (from the blacken- doptera of Ireland (1936), for which he studied The life of Charles Donovan is described in ing of the skin that can occur) and the cutane- mainly in Timoleague, near Bandon, where his the excellent book ‘’Irish Masters of Medi- ous form of the disease affects about 1.5 mil- sisters lived. Charles Donovan died in 1951 in cine’’ by another distinguished UCC Medical lion new people annually, while the systemic Bourton on the Water, Gloucestershire. n Alumnus, Davis Coakley (1) and in an article form affects 0.5 million annually. by S. Tharakaram delivered to the Liverpool 1 Coakley D. In ‘’Irish Masters of Medicine’’ ; 1992 Medical History Society in 1999 (2). Donovan was In 1905 Donovan identified the micro- Town House Publishers, Dublin. pp233-240 born in India in 1863, the eldest of 9 children. organism responsible for the venereal 2 Tharakaram S. Charles Donovan, MD, Indian Medi- His father was Irish and so Charles was educat- disease granuloma inguinale which also cal Service. Paper delivered to the Liverpool Medical ed in Ireland from the age of 13. He was sent to bears his name, Donovania granulomato- History Society , 6 May, 1999. his grandfather in Cork and studied medicine sis., now renamed Klebsiella granulomatis. at UCC, then Queen’s College . He later stud- Granuloma inguinale is endemic in the trop- ied in Trinity, graduating in 1889 . He entered ics of Western New Guinea, the Caribbean, the Indian Medical Service, reaching Bombay India, South Africa, SE Asia, Australia,and Brazil. in 1891, and subsequently he was posted Donovan’s bedside manner is described to Mandalay, Burma where his first daughter as ‘’perfect’’ by Tharakaram, and he is also was born. He became a professor of Biology at described as being greatly admired and Madras University, Superintendent of Roya- adored by his Indian assistants, to whom he pettah Hospital Madras, and also served was most kind and courteous. Whilet he is also actively as a Captain in Afghanistan, for which described as being rather blunt and outspo- he was awarded the Tirah medal. ken, he was deeply loved by those who knew

14 Prof. Fergus Shanahan

“Making microbes work for mankind - a century after Donovan”

t is fitting that Charles Donovan be honoured human genome will deliver all that was prom- (‘Microbes maketh man’), and an earlier issue Iby Cork’s medical alumni. Charles Donovan ised, but in the decade that has elapsed, the featured work from the APC on the mecha- is arguably one of the most accomplished cli- potential and promises of the human micro- nism by which the microbiota may influence nicians from Cork. His work almost a century biome have moved centre-stage. The Nobel the brain and behaviour. It is noteworthy that ago is still relevant today, and his dedication prize awarded to Warren and Marshall in 2005 the APC is no latter-day entrant to this field. and work ethic are an inspiration to all. One of was a timely reminder that the solution to A decade ago, when the APC was launched, Donovan’s biographers declared that “Charles some chronic diseases may not reside solely we predicted that the gut microbiota would Donovan’s footprints on the shores of India within the host. If it were not for attention emerge centre-stage in biology as a repository and on the sands of time will remain to inspire shifting toward the interface between the for drug discovery, a source of functional food all future generations in the medical profes- host and the luminmicroenvironment, a cure ingredients, a potential target for therapeutic sion” (S. Tharakaram). Donovan is remembered for peptic ulcer disease would never have manipulation in certain diseases, and a health for his work on chronic infectious disorders, become a reality. resource which might be manipulated by such as leishmaniasis and granuloma ingui- Although the microbiota is an essential health dietary measures. All of this has been proven nale, and for his attention to detail in caring asset, conferring protection against infections, correct. The Guardian newspaper found it suf- for his patients. He was a remarkable clinician- priming mucosal immunity, and producing ficiently important to write an editorial draw- scientist, who identified important clinical vitamins, nutrients, and other bioactives, some ing attention to a paradigm shift in nutritional problems and brought the scientific method components of the microbiota may become science highlighted by a discovery at the APC to their resolution. Like many of our heroes, a liability depending on host susceptibil- published in Nature which showed that food we admire him because of what he achieved ity. Thus, the distinction between pathogens diversity is as important as its calorific and under adverse conditions, against the odds. and commensals is variable and depends on nutritional value in maintaining health in the Donovan epitomises much of what we have context. To comprehensively study gastroin- elderly. attempted to achieve with the Alimentary testinal physiology and pathophysiology or Pharmabiotic Centre (APC) in Cork. to model human disease, the gut microbial environment and the modifying influence of food ingredients must be taken into account. The scale and complexity of the microbiota within the gastrointestinal tract is tantamount to a hidden inner organ, with a metabolic activity matching that of the liver. The micro- biota is not only critical for optimal gastroin- testinal development but also has a regula- tory influence on mucosal homeostasis. This In conclusion, the spirit of Charles Donovan involves continual microbe-host signalling lives on in Cork medical science. The APC has Prof. Fergus Shanahan which represents a rich repository of bioac- been part of the emerging story of the gut tive microbial metabolites that can be ‘mined’. microbiome, contributing over a thousand Charles Donovan would be disappointed to Therefore, understanding the molecular peer-reviewed articles to the literature on hear that infectious diseases remain a world- details of host-microbe interactions within this topic and rising to a top world ranking wide scourge and a continual threat to the the gut promises to yield new therapeutic in several areas as determined by citations by survival of the species. However, he would targets with the potential to move from ‘bugs external authorities such as Thomson Reuters. marvel at the emerging interest in the indig- to drugs’. In each of these areas, the APC has It has also matched or exceeded international enous or commensal microbiota, particu- made important contributions. metrics of commercial achievement in terms larly that of the gut. Although 2013 marks of inventions, licences, patents and spin-out th the 10 anniversary of the completion of the The commercial importance of the microbiota companies. Furthermore, the APC has added human genome project, it is the microbiome has not escaped the business world and lay value to Irish tax-payer support by doubling that has emerged as the story of the decade. press. For example, the human microbiota it from non-exchequer sources, mostly from The APC has been a substantial part of that adorned a recent cover of the The Economist foreign direct investment and overseas grants. story. Time will tell whether sequencing the The spirit of the APC entails much of what Charles Donovan exhibited during his won- derful career. Like Donovan, success has come with perseverance and hard work, and like Donovan, we are driven by the belief that we can make a difference. n

15 UCC Medical Alumni and Faculty Scientific Conference 2014

The Natural History of a Series of Trisomy 18 and Trisomy 13 Pregnancies - Dr. Orla Houlihan

Abstract Methods Background and Literature Review A retrospective review was performed of con- Forty-eight percent (T18) and 46% (T13) sur- Trisomy 18 (T18) and trisomy 13 (T13) are the firmed cases of trisomies 18 and 13 from 2001 vived following birth, for a median of 1.5 days second and third commonest autosomal an- to 2012. Following case identification, individ- (T18) and 7 days (T13). euploidy syndromes respectively. The effec- ual charts were examined. tiveness of prenatal screening, low proportion Discussion and Conclusions of live births and short survival time for both Results This study provides information for profes- trisomies have been reported in the literature A total of 46 trisomy 18 and 24 trisomy 13 sionals and patients regarding the natural as have inconsistencies in parental counsel- pregnancies were identified. Most T18 cases histories of trisomy 18 and trisomy 13. These ling. Few studies document the overall natural (65%) were diagnosed prenatally, however, pregnancies can go undiagnosed antenatally history of the trisomies. only one third of T13 cases (33%) were prena- if anomaly screening is not undertaken. While tally diagnosed. many fetuses die in-utero, postnatal survival is Aim and Objectives Thirty-six percent (T18) and 18% (T13) of live- possible. n To study the natural history (including diag- born infants were delivered by emergency nosis, pregnancy outcome, complications and caesarean section, the commonest indication survival) of trisomy 18 and trisomy 13 pregnan- for this being distress in undiagnosed fetuses. cies in a setting where elective termination of Only three T18 pregnancies and one T13 pregnancy for fetal abnormality is illegal. pregnancy were electively terminated.

An investigation into the role of DNA recognition in the pathogenesis of ulcerative colitis - Dr. Sheila MacSweeney

Background: Ulcerative colitis (UC) is a com- Methods: A quantitative reverse transcriptase mon form of inflammatory bowel disease. polymerase chain reaction (qRT-PCR) screen Its pathogenesis remains uncertain, although of DNA recognition pathways was performed loss of immunological tolerance to intestinal on colonic biopsies from patients with active microbiota appears central to its develop- UC (n = 32), inactive UC (n = 32) and healthy ment. Therefore, recognition of microbial DNA controls (n = 32). Regulation of DNA sensor by pattern recognition receptors known as expression in response to recombinant cyto- DNA sensors may be an important pathogenic kine treatment or colonic biopsy supernatants mechanism. was also quantified using qRT-PCR in a colonic epithelial cell line.

Results: Statistically significant up-regulation of DNA recognition pathways was observed Conclusions and Discussion: in active and inactive UC. Mean expression DNA recognition pathways are differentially of many genes was also increased by greater up-regulated in UC dependent on disease than two-fold compared to healthy controls. activity. This observation suggests a poten- Collectively, these genes demonstrated dif- tial role for DNA recognition pathways in the ferential up-regulation of DNA recognition modulation of disease activity in UC. DNA sen- pathways dependent on disease activity. sors were also up-regulated by treatment with Pathways related to AIM2, DAI and IFI16 were type I interferons in colonic epithelial cells, up-regulated in active disease, while the TLR9 although treatment with colonic biopsy super- Aim: To investigate the role of DNA recogni- signalling pathway was up-regulated only in natants failed to replicate this phenomenon. tion in the pathogenesis of UC. inactive disease. Type I interferons were also Therefore, the relevance of this mechanism shown to induce expression of DNA sensors in UC pathogenesis is uncertain, and further (DAI and IFI16) in colonic epithelial cells, while research is required to confirm and explore colonic biopsy supernatants had no observ- these findings. n able regulatory effect.

16 Cancer Pain Management - Prof. Dermot Fitzgibbon

ain is a major problem globally [1]. successful in the majority of patients [8]. Long- dure and the correct timing of use requires PDetermination of priorities in public health term opioid prescription requires careful sys- that trained pain specialists be part of interdis- is a complex, controversial, political, and eco- tematic planning and an ability to respond ciplinary teams that are dedicated to the long- nomic process. The provision of a continuum quickly to changing situations. Pharmacologi- term care of this population. in cancer care from risk assessment to end- cal decisions, particularly with the use of adju- of-life care presents considerable economic vant analgesics, should be based on evidence- challenges and portions of the total costs of based recommendations [9]. 1. Goldberg DS, McGee SJ: Pain as a global public cancer is estimated as high as $895 billion (US) health priority. BMC Public Health 2011, 11:770. worldwide [2]. However, the moral obligation Interventional pain management procedures to adequately manage all forms of pain and can be considered as those that can produce 2. American Cancer Society: Global Cancer Facts & particularly cancer-related pain, is recognized benefit at a single treatment session (i.e. neu- Figures. 2nd edn. Atlanta; 2011. worldwide. Symptom control and pain man- rolytic blocks, tractotomy, cordotomy, and ver- 3. Meuser T, Pietruck C, Radbruch L, Stute P, Lehm- agement may contribute to quality-of-life tebroplasty or kyphoplasty) versus those that ann KA, Grond S: Symptoms during cancer pain improvement [3]. Management of cancer pain require ongoing treatment (usually infusion- treatment following WHO-guidelines: a longitudinal has been problematic and despite published based therapy). follow-up study of symptom prevalence, severity guidelines for pain management, many pa- and etiology. Pain 2001, 93(3):247-257. tients with cancer have, and continue to ex- Neurolytic procedures include coeliac plexus perience, considerable pain and receive inad- block (for visceral pain), intercostal nerve block 4. Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, equate pain relief [4, 5]. (for rib metastases), superior hypogastric plex- Blum RH, Stewart JA, Pandya KJ: Pain and its treat- us block (for intractable pelvic visceral pain), ment in outpatients with metastatic cancer. N Engl J Persistent barriers to pain management in- and saddle block (for perineal pain). Med 1994, 330(9):592-596. clude poor pain assessment skills, patient reluctance to take opioids or report pain, cli- 5. Fisch MJ, Lee JW, Weiss M, Wagner LI, Chang VT, Cella D, Manola JB, Minasian LM, McCaskill-Stevens nician reluctance to prescribe opioids, and W, Mendoza TR et al: Prospective, observational perceived excessive regulation for opioid pre- study of pain and analgesic prescribing in medical [6] scription . Many clinicians report inadequate oncology outpatients with breast, colorectal, lung, or no training in pain management at both or prostate cancer. J Clin Oncol 2012, 30(16):1980- undergraduate and postgraduate levels. In ad- 1988. dition, the treatment approach for cancer pain has been largely algorithmic and one-dimen- 6. Breuer B, Fleishman SB, Cruciani RA, Portenoy RK: sional. Because pain perception involves both Medical oncologists’ attitudes and practice in cancer sensory-discriminative and affective features, pain management: a national survey. J Clin Oncol education must include these components. Cervicothoracic cordotomy (usually per- 2011, 29(36):4769-4775. formed by open hemilaminectomy in the US) 7. Institute of Medicine Report: From Cancer Patient Compared to other pain problems, cancer is an excellent procedure for patients with se- to Cancer Survivor: Lost in Transition: The National pain presents unique challenges. Patients vere unilateral lower extremity pain. Vertebro- Academies Press; 2005. may present with different components of plasty and kyphoplasty are primarily indicated acute, chronic non-malignant, and tumour- for painful contained vertebral compression 8. Zech DFJ, Grond S, Lynch J, Hertel D, Lehmann KA: related pain. Furthermore, patients face pain- fractures due to primary or metastatic spinal Validation of World Health Organization Guidelines ful non-surgical treatment strategies such as tumours. Spinal intrathecal infusion therapy for cancer pain relief: a 10-year prospective study. chemotherapy and/or radiotherapy. If cured, is an excellent choice for refractory tumour- Pain 1995, 63(1):65-76. survivorship also presents challenges with related pain. In my institution, we advocate dominant problems such as pain, depression, the use of externalized intrathecal catheters 9. Dworkin RH, O’Connor AB, Backonja M, Farrar JT, and fatigue [7]. and have used this delivery system for many Finnerup NB, Jensen TS, Kalso EA, Loeser JD, Mias- kowski C, Nurmikko TJ et al: Pharmacologic manage- years safely and successfully. The main goal in ment of neuropathic pain: evidence-based recom- Pain treatment strategies must be all-inclusive using this system is to administer intrathecal mendations. Pain 2007, 132(3):237-251. n and may require careful coordination of care bupivacaine; all other agents are considered with all providers involved in care. Strategies adjunctive. Maximal efficacy of this delivery may include a variety of approaches includ- system requires that bupivacaine be delivered ing pharmacological, behavioral, cognitive, in a target-specific manner to the area of the rehabilitative, invasive or interventional, and neuraxis where nociceptive input is consid- complementary alternative medicine. ered maximal. If appropriate, pain management may require redirection of care to anti-tumour therapies Interventional procedures for cancer patients such radiotherapy, surgery, or chemotherapy. with pain are extremely useful for symptom In all situations of tumour-associated pain, ap- management but should usually be reserved propriate pharmacotherapeutic measures as primarily for well-defined and well localized outlined by the WHO Analgesic Ladder, are pain. The selection of an appropriate proce-

17 Appreciations

...... her advanced years (the years in Aberdeen were major part of their lives, along the coast of Cork, Dr. Janet Ellis Webster Barry deeply embedded). in the Kenmare river, entertaining friends on the Janet undertook occasional “locum” general boat and off, hospitality well remembered. Dis- practice posts in Cork but her major medical From Medical School in wartime Aberdeen, to cipline, Scottish presumably, prevailed on such interest was the handicapped child. For many “house jobs” in London when the Doodlebugs occasions-attention to Radio 4 forecasts, obey- years, she was the Medical Officer to the Centre were falling, supporting her husband in setting ing the whistle commands on board, gin re- for Physically Handicapped children, originally up Children’s Hospital services in an impover- wards only when safely at anchor. Janet and Dick known as the “Spastic Clinic”, then the Lavana- ished Cork city, researching the epidemiology were sailing at the time of the Fastnet Disaster, gh Centre, and now the Cork branch of Enable of cerebral palsy and recognising the needs August 1979, and for a time, friends feared for Ireland. She had great empathy for the affected of the handicapped child, Dr. Janet Barry, had their safety but they had found a safe harbour children and their families, and particular insight a a remarkable and rewarding life, certainly in Derrynane. When time time came to part with into their everyday lives, including the often un- “ a life well lived”. Like many women of her time, their fine keel yacht, “Gentle Jane“ an apprecia- recognised and unmentioned emotional and and all times, she allowed her own career to be tive new owner for her was acquired and hospi- sexual needs. In addition, she was an integral sidelined in order to raise a family and support tably entertained at the parting. Retirement also part of the team, established by the late Profes- her husband in his professional and private life. freed more time for travel. There were regular sor Gerald Cussen, to study the epidemiology However, those who knew Janet well came to visits to Scotland in Autumn, catching up with of cerebral palsy and establish the Southern Ire- appreciate her keen intelligence, insight and friends and family in Edinburgh, Aberdeen of her land Cerebral Palsy Register which attained In- determination, and would ponder over the out- youth, and to the cottage at Lough Melfort in ternational recognition and remains associated standing medical career that might have been. Argyll. After Scotland, Italy was a favourite desti- with the Surveillance of Cerebral Palsy in Europe However, many people benefited from her nation for the culture, history and language and organisation.Colleagues warmly describe Janet warm, generous nature and wise counsel and Dick and Janet were prominent members of the as a tenacious but empathic “field-worker”. If the her tireless work with handicapped children. Cork branch of the Dante Alighieri society . job was worth doing…” She did not retire from On graduation, M.B., Ch.B. in 1944, as the inva- Tragedy struck just before Christmas, 1975. this work until 1977. sion of Normandy proceeded and Hitler’s V1- Janet’s second son, Thomas, was killed in a road All who knew Dr. Barry attest to her generous- rockets appeared, Janet commenced medical traffic accident when he was at the start of his ity of spirit. She was actively involved with the internships in the North Middlesex Hospital, medical career. Janet bore this burden stoically Vincent De Paul Society and always a lover of London and recalled being on-duty when a through the rest of her life, and was able to retain animals, especially dogs, the Cork Society for “Doodlebug”, as the V-1 Rockets were called, her zest for life and lifelong learning. She regu- the Prevention of Cruelty to Animals. After re- struck. She returned to the Aberdeen Sick Chil- larly swam in the Atlantic and learned to dive tirement in the 1980s when Dick was Chairman dren’s and Maternity Hospital and worked with in her 70’s! Her husband, Professor Richard G.G. of the voluntary organisation, SHOUT, which the legendary Sir Dugald Baird. She took D.C.H. Barry, died in 2000. She is survived by her son, was fundraising to build a new Children’s Day (R.C.P.S.) in 1946 and D.Obstet.R.C.O.G. in 1947. William, a consultant paediatrician in London, Unit for the Paediatric Dept at Cork Regional In the Queen Hospital for Children, Shadwell, his wife, Elizabeth, children, Tom and Fiona, and ( now University) Hospital, Janet was an enthu- East London, 1947-48, while the N.H.S was her brother, Bill Copland, a retired consultant siastic and charming asset to team. For many born, she met her future husband who was also radiologist in Edinburgh. n years, Janet was an acitve valued member and training to be a paediatrician, Richard G.G. Barry John McKiernan secretary of the Cork University Women Gradu- from Carrigtwohil, Co. Cork. They were married ates’ Association...... in the Brompton Oratory in January 1949 and Hospitality at home was renowned, especially proceeded to Derby where Janet worked as Dr. Michael Alexander Hogmanay events, which were celebrated in Medical Officer for Children with the County the proper Scottish tradition. There were din- Browne Council , while her husband,”Dick”, as he was ners and Summer supper parties too, which known, was in the Children’s Hospital. Dr. Michael Browne passed away peacefully sometimes concluded with a surprisingly Cork in the early 1950s was a difficult post- surrounded by family on Saturday January 5, keenly fought game of croquet on the lawn. ing for a young couple who were determined 2013. Son of the late Frank and Rose Browne On such occasions, the normally most reserved to modernise hospital medical services for of Croaghta Park, Glasheen Road, Cork, he and polite host and hostess moulted into quite Children. Dick’s Anglo-Irish and British army was born in 1927, the fifth of eleven children, belligerent opponents on the croquet lawn in heritage (he had served in WW2), his socialist, in Longford, Ireland, and grew up in Cork City. opposing teams. Janet retained her melodious if not “Red”, inclinations, and Janet’s “Protestant” He was educated at St Augustine, Dungarvan Scottish accent through all the years in Cork and background were greeted with suspicion for and Presentation Brothers College, Cork, and had a keen interest in and appreciation of mu- some time. However, their integrity and deter- earned a National Scholarship to study medi- sic. She took her singing seriously, as you would mination overcame the obstacles. Dick was the cine at University College Cork, graduating in expect, and practiced regularly. For many years, first fully trained paediatrician in Cork and the 1950. Dr. Browne’s post graduate training in she enjoyed choral singing with the East Cork South of Ireland, and the founding Professor medicine and surgery was extensive in Ireland Choral Society but memorable too were her of Paediatrics in Univeristy College Cork. Janet and England, in his chosen field of orthopaedic harmonious renderings (with Mary Wilson) of devoted her energies to her family and enthu- surgery. He earned entry into the Royal College the Barcarolle from the “Tales of Hoffman” and siastically backed her husband in all his medi- of Surgeons of England (FRCSE) and obtained a the solo party piece “Comin Thro the Rye”. cal endeavours. She always maintained her master of surgery (MCh) degree in Ireland. He Retirement allowed the Barrys time for their medical, particularly, paediatric interest. Friends then trained in the United States, where he pur- many other shared interests, including garden- were constantly amazed at her clear recollec- sued further orthopaedic training at the Massa- ing at their “Belmont” home, hill-walking, and tion of critical medical information right up to chusetts General Hospital in Boston and in New appreciation of nature. Sailing then became a

18 Appreciations

York city at the Hospital for Special Surgery. reputation and longevity made him an impor- He was a man of the most special charm and Subsequently, he earned certification from the tant figure in the continuity and evolution of warmth. His distinctive appearance was domi- American Board of Orthopaedic Surgeons and surgery and medicine in Cork for many years . nated by impressive thick spectacles, below was elected to fellowship in both the American which there was an almost perpetual beaming College of Surgeons and the American Acad- He was born in Bandon, the youngest child of smile. He had a unique and wonderful sense emy of Orthopaedic Surgeons. Dr. Browne es- Edward and Mary Burke. His secondary educa- of fun and humour, with a razor-sharp wit, tablished a successful private practice in Stam- tion was in Presentation Brothers College Cork enhanced with eloquence and perfect timing. ford, Connecticut, and was highly regarded for He was great company . his general orthopaedic and microsurgical skill. He entered University College Cork before his He served as Director of Orthopaedic Surgery 16th birthday, and was awarded a BA in Irish Following retirement in 1984, for almost 30 at both the Stamfoed Hospital and Sait Joseph and German in 1937. In the summer of 1936 years he enjoyed a very happy time indulging Hospital from 1978 to 1983. He maintained he travelled to Bonn university with Professor his many interests with the support of his wife his academic interests by serving as an assis- Seamus Kavanagh to study Old Irish. His vivid Kay who shared his passion for music and trav- tant clinical professor for both the Hospital for memories of the Brown shirts’ marches, and el. He was an accomplished pianist. In his youth Special Surgery and New York Medical College. the atmosphere of forboding and fear that pre- he was a pupil of Frau Tilly Fleischman, a name vailed, lived with him for many years . synonymous with music in Cork. He loved to Proud of his Irish heritage, Dr. Browne co- play for guests in his home, and made many a founded the Irish American Orthopaedic He then studied Medicine in UCC and was con- party swing. He enjoyed Symphony concerts, Society, dedicated to the greater fellowship ferred MB BCh BAO in 1942 . As there were only and was a great supporter of local festivals and among Irish, American and British surgeons. two available intern posts in the Cork hospitals, musical events. He served as President of the organisation he completed his internship in the Royal Hos- from 1981 to 1983. Additionally, he was an ac- pital Sheffield. From their holiday home in Courtmacsherry, tive member of the Stamford Ancient Order of Kay and Tom enjoyed walking in the country- Hibernians and had a lifelong passion for Irish Between 1942 and 1952, he trained in Shef- side. Travel to destinations near and far contin- history and culture. He also loved the classi- field, Newcastle, and the West Sussex Hospital ued into his nineties. cal languages and was an avid golfer, enjoy- in Chichester, gaining immense experience. He Gardening however he described as” the first ing membership at golf clubs in the USA and was awarded his M.Ch in 1948 and FRCS ENG sorrowful mystery “. Ireland, including the Waterford Golf Club. in 1951. He will be remembered by his patients, former Loving father, devoted husband, dedicated The decade after his return to Ireland in 1952 students, nursing staff and colleagues as an ex- physician and tireless achiever, Dr. Browne is was difficult, and he had to depend on private ceptional surgeon, teacher, a person of integ- survived by his beloved wife of 54 years, Kath- practice in the Bons Secours Hospital Cork, rity and compassion, courteous and decent in leen Carmel Phelan of Grantstown, Waterford; medico–legal and locum work, and support every way that was important . his five children Francis (“Frank”), a lawyer in from colleagues, prior to his appointment to Stamford, CT; Rosemary, a physician in Tuscon, the South Infirmary Hospital Cork as Consultant He will be remembered by his family and many AZ; Michael, an orthopaedic surgeon in Dallas/ Surgeon in 1962 . He remained on the staff until friends as a modest self- effacing man, loyal, Fort Worth; Paul, an architect in Albuquerque, his retirement in 1984 . generous and kind with an effervescent sense NM; and Colm, a lawyer in Stamford, CT; their of humour and love of life . respective spouses, and twelve grandchildren As a surgeon at the bedside and in the oper- He is survived by Kay, his wife of 38 years, his (Caitlin, Michael , Jack, Kathryn, Marissa, Liam, ating theatre, he was self- assured, confident niece Margaret and nephew John. Fintan, Connor, Evan, Lauren, Anna Rose and El- in an understated way, and combined sound John Kelly n liott). Surviving siblings are his brother Dr. Fran- clinical judgement with excellent technique. His cis Browne of USA, and sisters Doreen Lyons personality and Surgical method were closely ...... and Sr Emmanuel Browne of Cork. He was pre- aligned; neat, meticulous and composed, he Dr. Frances Mary Lehane deseased by his brothers John, Thomas and Dr. was organised in his approach to Surgery and

Gerard Browne and Ita O’Sullivan, all of Cork. n its problems, and determined and tenacious in Dr. Frances Mary solving them. His letters and notes were models (Mary) Lehane, for- of clarity and brevity and his handwriting for a ...... merly consultant doctor perfectly legible ; always in ink with his Mr. Tom Burke anaesthetist at Cork Parker pen . His surgical range was general, but University Hospi- Thyroid, Biliary and Colon problems constituted tal, died peacefully Tom Burke who his main practice. there, in the tender died on Sept 3rd His colleagues regularly sought his opinion in care of the staff, 2013 in his 95th difficult cases. on November 18th year, was the oldest 2013. surviving member He enjoyed teaching medical students. His ap- Born and reared in England to the late Dermot of a generation of proach was one of simplicity and encourage- and Joan Lehane, Mary followed in her father’s Surgeons appoint- ment, with a dash of humour. He was regarded footsteps, graduating in medicine MB BCh BAO ed to the Cork hos- by all as a fair and patient examiner who tried to from University College Cork (UCC) in 1970. On pitals in the years get the best from each student. completion of her intern year she joined the an- after the second world war. His surgical stature,

19 Appreciations

aesthetic department at St Finbarr’s Hospital as brother John said “Mary was a beacon for us Study and examinations came easy to Fergus. a trainee and thus began a distinguished career to follow. We may never have quite matched He graduated with distinction in Summer 1971, in anaesthesia. Having being conferred with her standard but her example has helped all proceeded naturally (as a south city boy) to the Fellowship of the Faculty of Anaesthesia towards her standard”. Mary is survived by her intern in the new St.Vincents Hospital (SVH) RCSI (now the College of Anaesthetists Ireland) sister Nora and her brothers John, Barry, Tim, and settled easily to hospital life. There was Mary was appointed as Senior Registrar to the Michael and Bill. never any doubt that his career would be in Birmingham group of hospitals in 1975. In 1978 John Mc Adoo. n medicine, and from an early stage he was in- she successfully completed her Senior Registrar trigued by dermatology and its practitioners. training and returned to Cork as Consultant ...... Medical SHO posts in SVH and the “old” Jer- Anaesthetist to St Finbarr’s and Associated Hos- Dr. J Fergus Lyons vis St led eventually to Cork, (1975-1977) and pitals, later transferring to the Cork University St. Finbarr’s Hospital, where he had registrar Hospital (CUH), where she played a pivotal role Dr. J Fergus Lyons died after a brief illness on posts with Dr. Michael Hyland and the late in the establishment of the new Intensive Care June 23, 2012. Fergus was a Dublin man who Prof. Denis O’Sullivan. The membership passed, Unit in the CUH. spent two years as medical registrar in Cork in dermatology beckoned, and Fergus moved to In addition to her clinical responsibilities, Mary the 1970s, returned as Consultant Dermatolo- the UK for specialist training with leaders in distinguished herself as a researcher focusing gist in 1982, and was at the forefront in driving the field - Newcastle with Sam Schuster, and her interest on Malignant Hyperthermia, a rare the clinical and academic development of his Edinburgh with JAA Hunter. Increasingly, der- but serious complication following anaesthe- specialty. On the surface he was a quiet, re- matology was seen to suit the fastidious clini- sia in vulnerable patients. In conjunction with flective physician, but underneath there was cian he had become. her UCC colleagues Professors James Heffron a quiet determination to achieve his aims and and Thomas McCarthy, the research led to their those of his medical specialty and institutions, Fergus returned to Cork in 1982, joining the late important discovery that chromosome 19 was coupled with a perpetual mischievous sense of Dr. Donal Buckley as consultant dermatologist involved in the transmission of Malignant Hy- humour. in Cork and Munster. His main hospital base perthermia. The resulting publication in the was the South Infirmary which later incorpo- prestigious journal ‘’Nature ‘’in 1990 was a first Fergus was born in Dublin city, and grew up rated the Victoria Hospital (SIVH) in 1988, but he for Anaesthesia in Ireland. in Rathmines, which in the 50s and 60s was also attended the Regional Hospital (now CUH), In response to clinical need and demand Mary rapidly changing from suburb to integral the Mercy (now MUH), North Infirmary, and the was prevailed upon to set up and lead the part of the south city of students and beds- Bon Secours. The outpatient ‘scatter’ was even National Centre for Malignant Hyperthermia its. He could, but rarely did, claim a Cork con- wider, including Tralee, Limerick and Clonmel. in Ireland. In addition to her clinical duties, her nection - his mother was from Kinsale. Fergus The “South” as it was affectionately known, research commitments and her role as Director retained a great regard for the Dublin of his became his main base, and with SN Breda of the National Malignant Hyperthermia ser- youth and education. Secondary schooling was Bourke he developed a compact, efficiently vice Mary gave of her time to act as examiner down the road in St.Mary’s College and after run Dermatology Centre for the Munster region in the primary examination for the College of “the Leaving” he proceeded (not too far) to Uni- in 1990, growing over the next decade to be- Anaesthetists, as lecturer in the department versity College Dublin. He attended the newly- come one of the largest in the country. of Pharmacology in UCC and as a link for the opened Belfield Campus for the pre-medical Association of Anaesthetists of Great Britain and year, and then back in to town, Earlsfort Terrace, It was an interesting and challenging time to Ireland. She was a founder member of the Euro- Merrion Square and the multiple hospital and be a dermatologist with exciting new treat- pean Malignant Hyperpyrexia (Hyperthermia) other institutions of undergraduate medical ments for psoriasis, eczema, and melanoma. Group. training in Dublin. Fergus had many headstarts Fergus was instrumental in setting up the Mary’s father Dermot received the annual as a medical student-location, keen intel- specialist melanoma service at the South award of the Oliver Memorial Fund in 1975 and ligence, great application to the task in hand, Infirmary which became the largest such was appointed CBE in 1977 for his services to admirable behaviour (never in trouble), a wry, clinic in Ireland. He had a great affection for, medicine. Mary was also honoured, receiving philosophical, sense of humour-the glint in the and loyalty to the ‘South’ and was a steadfast the College of Anaesthetist’s President’s Award eye, and the quiet, restrained “chuckle”, never defender of its cause. He was deeply commit- in 2007 for her national and international con- one for the loud guffaw! Then, as ever, humour ted to undergraduate and postgraduate educa- tribution to anaesthesia and patient safety and was important to surviving the demands of tion. In conjunction with UCC, he developed a for her role in anaesthetic research and educa- the curriculum. From medical school days, he comprehensive undergraduate dermatology tion. was devoted to conversation, relaxing best programme in the South Infirmary, which is Outside of medicine, Mary had a keen passion with chat and gentle gossip , often about the the envy of the country and introduced the for gardening and was instrumental in the es- eccentricities of friends, colleagues and teach- Donovan Medal to foster the interest of medi- tablishment of a number of gardens in CUH. ers. Not actively involved with sport or physical cal students in dermatology (Dr. Charles Dono- She also enjoyed Rugby Union and loved to go recreation, he would have agreed with Joseph van, of Leishmani Donovani, and Donovania to Thomond Park to watch her beloved Mun- ddison (1711) – ‘odd and uncommon char- Granulomatosis fame, was associated with Cork ster. acters are the game that I look for and most and Queen’s College, the forerunner of UCC). An excellent clinician and teacher, Mary was delight in’. Another major asset as a medical He was keenly involved in intern and further also a loyal colleague, a most caring and com- student in Dublin was his car. Medical students postgraduate training and led by example in passionate doctor, a focused researcher and a were expected to find their way all over Dub- his regular and punctual attendance at clinical devoted and loving daughter and sister. Mary lin city and county and be seen and counted meetings.Young doctors knew they could rely fought her final illness with typical bravery, at the multitudinous clinics. Classmates were on him as an advocate and for guidance as ca- determination and optimism. In his eulogy her grateful for the lift in Lyons’ mini.

20 Appreciations

reers progressed, or seemed to stall. He was a ...... A graduate of the class of 1939, she was hon- true mentor and is fondly remembered too as Dr. Madoline O’Connell oured at last year’s medical and health confer- a punctilious tutor to younger colleagues pre- ring ceremonies by UCC president Dr. Michael th paring for clinical examinations. Artist and doctor, Murphy. He observed that “Ireland in the 20 Most of all, Fergus was the quintessential clini- Madoline O’Connell, century was not supportive of married women cian, courteous and professional in his practice, who has died at the pursuing professional careers. The potential enjoying the challenges and puzzles, and poly- age of 97, was in- contributions of many fine individuals, such as syllabic, somewhat archaic, nomenclature of his terviewed for a job Madoline, to their professions were, sadly, never ancient craft. He was proud to be a dermatolo- as a young medical fully realised. And for many women, their lives gist, served as Honorary Secretary and Presi- researcher by Sir were exclusively shaped by their position in dent of the Irish Association of Dermatologists Alexander Fleming, society as defined by their husband’s careers”. and as Irish Dermatology representative on the discoverer of Her’s was a rich past, rooted in Irish national- the European Union of Medical Specialists. In penicillin. In her late 90s, she was exploring the ist politics, law, art and writing. Her grandfa- 1997, he was a founder member of the Munster complexities of information technology, surfing ther, solicitor Michael J Horgan, was election Dermatology Group and took great pleasure in the internet and texting her grandchildren. agent for Charles Stewart Parnell while her its growth as the specialty expanded over the father, John J Horgan, solicitor, prolific writer years. Among many fine qualities, she refused to and pamphleteer, amateur artist and coroner, overplay the direct connection with Fleming pronounced the verdict of murder against the Fergus had many interests outside medicine. at his ground-breaking laboratory in London’s Kaiser at the inquest on the 1,198 victims of the Back problems from early adulthood probably Harefield Hospital where she was engaged in Lusitania. The Press Ombudsman, Prof. John precluded his partaking in sports - though he pathology research. As she said in a recent in- Horgan, is her nephew. cycled to work in SFH, long before cycling was terview: “The day I went to meet him, he could fashionable. St Mary’s College fostered an early hardly talk to me. I never saw him again until Her husband ‘s love of horses resulted in the interest in rugby and he was a season ticket the day I went to tell him I was retiring - and O’Connells buying a farm near Mallow which holder in the old Landsdowne Road. He was again, he could hardly look at me. they named Scarteen Stud and where they an avid supporter of the “Magpies” ( Newcastle kept a string of racehorses. Living life to the full, United FC) and regularly travelled to matches “He was a little, shy man, and nobody at they counted many of the country’s leading with his equally passionate son/fan, Ronan. the time thought he was anything special.­ breeders and trainers among their friends. Another activity shared with Ronan was sea We didn’t have time, you just had to get on fishing off the coasts of West Cork. The Atlan- with it.” Stylish and cultured, with a love of art, books tic fish stocks were at little risk of depletion - it and music, in latter years she became a not- was more about the pleasures of the outdoors, Following her marriage to Dr. St John O’Connell, ed amateur artist in her own right. A widely companionship and a good concluding meal. the couple worked in the UK throughout the praised exhibition of her work, entitled Passing His musical tastes were for Willie Nelson and second World War, including the Battle of Brit- the Torch, was held at UCC last November to Elvis and he was relearning the guitar in retire- ain and the “Blitz”. On their return to Ireland in illustrate the university’s policy of using art to ment. Fine dining, both at home with his wife the early 1950s, he became the consultant to enhance the observational skills of students in Cliona, or out in company and with a glass or St Mary’s Orthopaedic Hospital in Cork which medicine. two of the right wine gave him great pleasure. serves Munster, the first such appointment out- Predeceased by her son, John, she is survived After retirement, Fergus treated himself to a side of Dublin. She continued working profes- by her daughter Kate and son Michael. n beautiful classic car, a Rover P6, which gave sionally in pathology until the responsibilities of many hours of enjoyment. However P6 was also a young family prevailed...... a somewhat wayward “child” causing repeated Dr. Richard Pomeroy worries and spending hours in repair and re- That she lived a life less ordinary was reflected habilitation. In later years, he had more time in the homily of her daughter, Kate, who de- A pioneering Mid- for foreign travel, visiting new places, making scribed a mother who was both “interesting land doctor who set new friends on visits to the Middle East, South and interested, frugal but generous, sporty up the first GP sur- America and Cuba. and artistic, proud but sociable, formidable and gery in Chelmsley Retirement gave him time for his favourite pas- bossy ,a texter and silver surfer, a bridge be- Wood has died at the time, conversation with like-minded friends. He tween generations, a speedster and intolerant age of 76. would have been at ease in the London coffee driver!”. Irish-born Dr. Richard houses of Dr. Johnson, where men convened Born into a Cork legal family just 19days after Pomeroy started his to talk, seriously and frivolously, all day. Moving the Lusitania was torpedoed by a German U- first practice single- with the times he became adept at “texting”, boat off the south coast, up to her passing she handedly in a small enjoying prolonged intellectual “jousts” via the was the oldest living graduate of UCC. Unique- rented house as the Birmingham overspill estate mobile. ly, her link with the university went back to Sir was still being developed in the 1960s. His sudden death shocked many and he is sadly Bertram Windle, her maternal grandfather and missed by his wife Cliona, daughter Benvon, son first president of Queen’s College Cork, as it was He had previously worked as a locum at Alum Ronan and his many colleagues and friends. then known. He commissioned the Honan Rock in Birmingham, but when he heard about John McKenna / John Bourke n Chapel, which she greatly admired as one of the city council’s plans for the major housing Ireland’s most important repositories of arts development, he knew immediately it would and crafts. provide the challenge he wanted. “It was tough

21 going at first, frontier stuff,” Dr. Pomeroy recalled Argideen Tennis Clubs. She attended Wimble- Serious grey tones would reflect her academic in a newspaper interview years later. “The people don on occasion, was a devoted follower of skills, pursuit of excellence and professionalism. settling there had come out of Birmingham, they Roger Federer and also an enthusiastic rugby Softer hues would reflect her warmth, kindness had brand new homes but missed the old neigh- fan and Munster supporter. Fionnuala greatly and humanity. But what will be most missed are bourhoods they were so familiar with. enjoyed her skiing holidays and diligently at- the vibrant lime greens and acid pinks, accent tended ski-school to improve her skiing style. colours of her character. Her devilish eye for “Unlike other places where Birmingham people Along with her colleague, Prof. Michael Molloy, detail was often reflected in the jewellery and moved to, such as Telford or Redditch, there was she ran the Masters in Sports Medicine course accessories she wore. Her humour and great no existing social infrastructure.” Dr. Pomeroy in UCC and was also involved in undergraduate sense of occasion are a great loss. was largely instrumental in founding the Craig medical teaching. She found her interaction Croft GP practice in Chelmsley Wood in 1968 and with the undergraduate and postgraduate stu- In 2011, Fionnuala undertook the herculean by the early 1970s it had nearly 15,000 patients, dents very rewarding. task of remodelling her family home with her around a quarter of them under the age of 15. Fionnuala was the official team doctor of the usual fervour and determination, to make her under 17 Irish women’s football team. She took own impressive modernist mark. Height, light, “The health problems were of a kind endemic this role very seriously, and always considered space and functionality formed an impressive to areas of deprivation, where there was a lot of the player’s psychological, as well as physical modern envelope around the heart of the old unemployment and actual poverty,” he said. “In- well being. Her interest in sport and medicine family home. Inside, the decoration comprised fant mortality was quite high compared with the led to her involvement with the charity CRY a comfortable eclectic collage of old family fur- national average and pneumonia was a frequent (Cardiac Risk in the Young). She raised funds for niture, uber modern fixtures and fittings, lightly cause of death.” the charity, taking part in the annual women’s limed oak flooring and the typical pastels and mini marathon in Cork City. Her colleagues were acid coloured accessories which boldly declared Craig Croft went on to establish a reputation for often coerced into participating, regardless of her character. These declarations are sadly leading the way among GP surgeries with its ma- their levels of fitness. missed. ternity services and on tackling alcohol and drug Fionnuala loved travel and foreign culture. A problems. Dr. Pomeroy, who formerly served on self- confessed Francophile, she studied the The poem “Phenomenal Woman”, by Maya the West Midlands Regional Health Authority, language and holidayed in Cannes with fam- Angelou (b 1928) nicely and succinctly summa- was awarded the MBE in 1993 for “services to the ily and friends. Her arrival home was eagerly rizes the late Fionnuala Quigley, a phenomenal people of Birmingham”. anticipated, along with the customary boxes of woman. His first GP partner, Dr. Martin Allin, paid tribute to macaroons. Dr. Brendan Connolly n him. “Dick was a very caring doctor, someone who The Alumni & Faculty Committee have been in- worked for the public rather than himself. “He did She enjoyed classical music and the arts, and formed of the deaths of Dr. William Navin, aged an awful lot for the people of Chelmsley Wood.” would discourse on philosophy or the arts 100 (1940), Dr. Michael O’Shea (1957) and Prof. Another former partner, Dr. Jenny Bent, said: “en passant” during busy morning surgeries. Jack Sheehan (former Professor of Physiology). “He was a very kind man and popular with all his Fionnuala was always on the go and had a We extend our sympathy to the families and patients.” seemingly boundless energy and drive. She had friends of all deceased Medical Alumni. an uncanny and sometimes infuriating ability to Dr. Pomeroy was twice married. He leaves a wid- finish her evening clinic on time, no matter how Some of the above appreciations have been repro- ow, Michele, five daughters by his first wife, Jo, far behind she was running. duced with the kind permission of the Irish Times, who also survives him, and one stepdaughter. n Then off she went , like a whirlwind, to Sunday’s The Birmingham Post. Well for tennis. Family was of paramount importance to Fion- ...... nuala. She will be greatly missed by her brother Dr. Fionnuala Quigley Eamonn and sisters Mary, Helen and Columba. She spoke warmly about her many nieces and Dr. Fionnuala Quigley was born in Johnstown, nephew and took her role as aunt seriously, in- Co. Cork, on 17/05/1958. Her father, Dr.. teresting herself in their education and well- be- Colm Quigley, had set up practice there in the ing, and enjoying their company immensely. On 1950’s and subsequently moved to Ballineen. the 29th of December 2012, Fionnuala hosted Fionnuala attended the local national school the christening of her grandniece and name- and received her secondary education in Ban- sake, Nuala, in her home, an event attended by don. She completed her undergraduate medi- 40 family members which she had meticulously cal training at University College Cork and in- organised months in advance. It was an inspi- terned in Cork University Hospital. Following her rational focus during her difficult final months. vocational training in general practice in Cork, she took up a position in her father’s practice in Patients attending the practice are clearly heart- Ballineen. In practice, she was a progressive and broken as a result of her death. Many recount enthusiastic clinician. stories of her kindness, sincerity, her smile and Fionnuala always had a keen interest in sport, warm personality. She was an integral and high- both professionally and in her private life. She ly regarded member of her community. was an accomplished and competitive tennis A portrait of Fionnuala’s character would player, and a member of both Sunday’s Well and require a varied, complex palette of colours.

22 23 PROFESSOR DENIS O’SULLIVAN CLINICAL RESEARCH FELLOWSHIP UCC Medical Alumni Annual Scientific Conference September 11, 2014 Contact: Rachel Hyland 021 4901587 / [email protected]

Applications are invited for the above Fellowship, open to NCHD-grade doctors and tenable in a clinical department of any teaching hospital of University College Cork. The Fellowship is for one year from July 2014. It is expected that an applicant will have a specific research proposal, prepared in collaboration with his/ her nominated department. Collaboration with basic science and other departments within the University will be encouraged.

Applications will consist of the research proposal, Curriculum Vitae and two references. Applicants should submit six copies of each to:

Prof. Catherine Keohane, School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork

from whom further details may be obtained, and who may be contacted for informal discussion. Tel: 021-4901587; Fax: 021-4901594; E-mail: [email protected] Closing Date: January 17, 2014

University College Cork is an equal opportunities employer

C855 Prof Denis O’Sullivan 16x2 Examiner

Contact Details: Ms. Rachel Hyland, Medical Alumni Association, Brookf ield Health Sciences Complex, College Rd, Cork.

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UCC Medical Alumni News is intended for circulation among UCC Medical Alumni & Faculty. The opinions and views in the publication are those of the contributors and are not necessarily shared by the UCC Medical Alumni Association.