Dara O Kavanagh

Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland

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Publications (54)117.85 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Acquisition of skills early in surgical training represents a significant challenge at present because of training time constraints. The aim of this study was to investigate if an intensive surgical boot camp was effective in transferring skills at the beginning of a surgical training program. New core surgical trainees (n = 58) took part in a 5-day boot camp. There were pretest and posttest assessments of knowledge, technical skills, and confidence levels. The boot camp used simulation and senior surgical faculty to teach a defined range of technical and nontechnical skills. The scores for knowledge (53.8% vs 68.4%, P < .01), technical skills (35.9% to 60.6% vs 50.6% to 78.2%, P < .01), and confidence levels improved significantly during boot camp. Skills improvements were still present a year later. The 5-day surgical boot camp proved to be an effective way to rapidly acquire surgical knowledge and skills while increasing the confidence levels of trainees. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Surgery 04/2015; 210(3). DOI:10.1016/j.amjsurg.2014.12.046 · 2.29 Impact Factor
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    J. P. Gibbons · E. Nugent · S. Tierney · D. Kavanagh ·
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    ABSTRACT: The implementation of the European work-time directive has created increased transitions of care during weekends as doctors adhere to a shift-work structure. This raises concerns over continuity of care and patient safety. To address this, doctors must develop a time efficient yet safe system of handover of patients to the team on-call. Intuitively weekend care provides the ideal setting to develop a handover tool. To develop and implement a process of surgical handover and to improve weekend discharge rate on a surgical service. Data was collected at three time-points over a 6 months period (October 2013-March 2014) encompassing development, implementation, re-evaluation and modification of the handover process. The outcomes measured were: number of inpatients, number of weekend discharges, length of stay (LOS) of inpatients recorded for the four weekends within the month, and total emergency response team (ERT) calls each month. Mean number of included patients each month was 294 (σ = 14). Following the introduction of weekend handover there was a 40 % increase in weekend discharges which was consistent for subsequent time-points (p < 0.05). Following the second intervention there was a statistically significant reduction in mean LOS from 13 to 5.4 days (p < 0.05) and the total number of ERT calls for the month reduced from 12 to 4 (p < 0.05). The standardisation of weekend handover using a combination of an electronic tool supplemented with verbal handover is feasible. It resulted in a significant improvement in surrogate markers of patient care quality.
    Irish Journal of Medical Science 03/2015; DOI:10.1007/s11845-015-1278-5 · 0.83 Impact Factor
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    ABSTRACT: Background: Simulator performance is measured by metrics, which are valued as an objective way of assessing trainees. Certain procedures such as laparoscopic suturing, however, may not be suitable for assessment under traditionally formulated metrics. Our aim was to assess if our new metric is a valid method of assessing laparoscopic suturing. Study design: A software program was developed to order to create a new metric, which would calculate the percentage of time spent operating within pre-defined areas called "zones." Twenty-five candidates (medical students N = 10, surgical residents N = 10, and laparoscopic experts N = 5) performed the laparoscopic suturing task on the ProMIS III(®) simulator. New metrics of "in-zone" and "out-zone" scores as well as traditional metrics of time, path length, and smoothness were generated. Performance was also assessed by two blinded observers using the OSATS and FLS rating scales. This novel metric was evaluated by comparing it to both traditional metrics and subjective scores. Results: There was a significant difference in the average in-zone and out-zone scores between all three experience groups (p < 0.05). The new zone metrics scores correlated significantly with the subjective-blinded observer scores of OSATS and FLS (p = 0.0001). The new zone metric scores also correlated significantly with the traditional metrics of path length, time, and smoothness (p < 0.05). Conclusion: The new metric is a valid tool for assessing laparoscopic suturing objectively. This could be incorporated into a competency-based curriculum to monitor resident progression in the simulated setting.
    Surgical Endoscopy 10/2014; 29(6). DOI:10.1007/s00464-014-3840-z · 3.26 Impact Factor
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    ABSTRACT: Within surgery, several specialties demand advanced technical skills, specifically in the minimally invasive environment. Two groups of 10 medical students were recruited on the basis of their aptitude (visual-spatial ability, depth perception, and psychomotor ability). All subjects were tested consecutively using the ProMIS III simulator until they reached proficiency performing laparoscopic suturing. Simulator metrics, critical error scores, observed structured assessment of technical skills scores, and Fundamentals of Laparoscopic Surgery scores were recorded. Group A (high aptitude) achieved proficiency after a mean of 7 attempts (range, 4-10). In group B (low aptitude), 30% achieved proficiency after a mean of 14 attempts (range, 10-16). In group B, 40% demonstrated improvement but did not attain proficiency, and 30% failed to progress. Distinct learning curves for laparoscopic suturing can be mapped on the basis of fundamental ability. High aptitude is directly related to earlier completion of the learning curve. A proportion of subjects with low aptitude are unable to reach proficiency despite repeated attempts.
    American journal of surgery 02/2014; 207(2):263-70. DOI:10.1016/j.amjsurg.2013.08.037 · 2.29 Impact Factor
  • Christina E Buckley · Dara O Kavanagh · Oscar Traynor · Paul C Neary ·
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    ABSTRACT: Simulated surgical training offers a safe and accessible way of learning surgical procedures outside the operating room. Training programs have been developed using simulated laboratories to train surgical trainees to proficiency outside the operating room. Despite the global enthusiasm among educators to enhance training through simulation-based learning, it remains to be elucidated whether the skill set obtained is transferrable to the operating room. Using standardized search methods, the authors searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web-Based Knowledge, as well as the reference lists of relevant articles, and retrieved all published randomized controlled trials. Sixteen randomized controlled trials involving 309 participants were identified to be suitable for qualitative analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The mean Consolidated Standards of Reporting Trials score was 16 (range, 12-22). The studies showed considerable clinical and methodologic diversity. Operative time improved consistently in all trials after training and was the only objective parameter measurable in the live setting. Studies that used the Objective Structured Assessment of Technical Skills as their primary outcome showed improved scores in 80% of trials, and studies that used performance indicators to assess participants all showed improved scores after simulation training in all of the trials, with 88% showing statistical significance. The current literature consistently demonstrates the positive impact of simulation on operative time and predefined performance scores. However, these reproducible measures alone are insufficient to demonstrate transferability of skills from the laboratory to the operating room. The authors advocate a multimodal assessment, including metrics, the Objective Structured Assessment of Technical Skills, and critical step completion. This may provide a more complete assessment of operative performance. Only then can it be concluded that simulation skills are transferable to the live operative setting.
    American journal of surgery 10/2013; 207(1). DOI:10.1016/j.amjsurg.2013.06.017 · 2.29 Impact Factor
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    ABSTRACT: The attainment of technical competence for surgical procedures is fundamental to a proficiency-based surgical training program. We hypothesized that aptitude may directly affect one's ability to successfully complete the learning curve for minimally invasive procedures. The aim was to assess whether aptitude has an impact on ability to achieve proficiency in completing a simulated minimally invasive surgical procedure. The index procedure chosen was a laparoscopic appendectomy. Two groups of medical students with disparate aptitude were selected. Aptitude (visual-spatial, depth perception, and psychomotor ability) was measured by previously validated tests. Indicators of technical proficiency for laparoscopic appendectomy were established by trained surgeons with an individual case volume of more than 150. All subjects were tested consecutively on the ProMIS III (Haptica) until they reached predefined proficiency in this procedure. Simulator metrics, critical error scores, and Objective Structured Assessment of Technical Skills (OSATS) scores were recorded. The mean numbers of attempts to achieve proficiency in performing a laparoscopic appendectomy for group A (high aptitude) and B (low aptitude) were 6 (range 4 to 7) and 14 (range 10 to 18), respectively (p < 0.0001). Significant differences were found between the 2 groups for path length (p = 0.014), error score (p = 0.021), and OSATS score (p < 0.0001) at the initial attempt. High aptitude is directly related to a rapid attainment of proficiency. These findings suggest that resource allocation for proficiency-based technical training in surgery may need to be tailored according to a trainee's natural ability.
    Journal of the American College of Surgeons 09/2013; 217(6). DOI:10.1016/j.jamcollsurg.2013.07.405 · 5.12 Impact Factor
  • Z S Heetun · D Kavanagh · D Keegan · H Mulcahy · J Hyland · C Mc Mahon · G A Doherty ·

    Irish Journal of Medical Science 05/2013; 183(1). DOI:10.1007/s11845-013-0969-z · 0.83 Impact Factor
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    ABSTRACT: : The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies. : The aim of the current study was to compare outcomes. : This was an observational, comparative study. : This study was conducted at a tertiary referral center and university teaching hospital. : Patients with malignant colonic obstruction (n = 49) treated by either emergency surgery (n = 26) or with stent placement (n = 23) as a bridge to surgery were identified and followed. : Short-term outcomes including stoma rates and postoperative morbidity and medium-term oncological outcomes were compared based on an "intention-to-treat" analysis. : Patients in both groups were well matched on clinicopathological parameters. Technical and clinical successful stent deployment was achieved in 91% and 83%. This did not adversely impact cancer-specific and overall survival (log rank = nonsignificant). No difference was observed in stoma rates, primary anastomosis rates, perioperative mortality rates, or reoperation rates between the 2 groups. Significantly fewer patients underwent total colectomy in the stent group in comparison with the emergency surgery group (1/23 vs 6/26: p = 0.027). There was no difference in postoperative morbidity (59% vs 66%: p = 0.09). There was a significant reduction in readmission rates in the stent group (5/26 vs 0/23: p = 0.038). : The small sample size of this study could lead to type II error. In addition, the study was nonrandomized and demonstrated a limited length of follow-up. : Despite a high rate of technical and clinical success in selected patients with colonic obstruction, stenting has no impact on stoma rates. Despite concerns about the rate of stent-associated perforation, stenting does not adversely impact disease progression or survival. Future comparative trials are essential to better define the role of stenting in this setting and to ensure that we are not using costly technology to create an elective operative situation without concomitant patient benefits.
    Diseases of the Colon & Rectum 04/2013; 56(4):433-40. DOI:10.1097/DCR.0b013e3182760506 · 3.75 Impact Factor
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    R L McDermott · D O Kavanagh · W Bartosik · C Quinn · P R O'Connell ·
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    ABSTRACT: We report a case of a lady who presented with epigastric discomfort. Physical examination revealed a large left upper quadrant mass filling the left upper quadrant. Following extensive preoperative evaluation, she underwent resection of this 9 × 10 × 11 centimeter mass with en bloc excision of a portion of the left hemidiaphragm. She made an uneventful postoperative recovery. Histopathology revealed a bronchopulmonary foregut malformation with pulmonary sequestration. This developmental anomaly of the foregut typically occurs in the thoracic cavity; however, it can occur below the diaphragm. Herein we report a case and a detailed review of the embryology, clinical features, and management of these extremely rare clinical entities.
    02/2013; 2013:740292. DOI:10.1155/2013/740292
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    ABSTRACT: Background: This study evaluated the clinicopathological features and survival rates of patients with inflammatory bowel disease who developed colorectal cancer (CRC). Methods: A retrospective review was performed on a prospectively maintained institutional database (1981-2011) to identify patients with inflammatory bowel disease who developed CRC. Clinicopathological parameters, management and outcomes were analysed. Results: A total of 2,843 patients with inflammatory bowel disease were identified. One thousand six hundred and forty-two had ulcerative colitis (UC) and 1,201 had Crohn's disease (CD). Following exclusion criteria, there were 29 patients with biopsy-proven colorectal carcinoma, 22 of whom had UC and 7 had CD. Twenty-six patients had a preoperative diagnosis of malignancy/dysplasia; 16 of these were diagnosed at surveillance endoscopy. Nodal/distant metastasis was identified at presentation in 47 and 71 % of the UC and CD group, respectively. Operative morbidity for UC and CD was 33 and 17 %, respectively. Despite the less favourable operative outcomes following surgery management of UC-related CRC, overall 5-year survival was significantly better in the UC group compared to the CD group (41 vs. 29 %; p = 0.04) reflecting the difference in stage at presentation between the two groups. Conclusions: Patients who undergo surgery for UC-related CRC have less favourable short-term outcomes but present at a less advanced stage and have a more favourable long-term prognosis than similar patients with CRC and CD.
    Techniques in Coloproctology 02/2013; 18(1). DOI:10.1007/s10151-013-0981-3 · 2.04 Impact Factor
  • Christina E. Buckley · Dara O. Kavanagh · Oscar Traynor · Paul C. Neary ·

    Journal of the American College of Surgeons 09/2012; 215(3):S116. DOI:10.1016/j.jamcollsurg.2012.06.304 · 5.12 Impact Factor
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    ABSTRACT: Although well described, there is limited published data related to management on the coexistence of prostate and rectal cancer. The aim of this study was to describe a single institution's experience with this and propose a treatment algorithm based on the best available evidence. From 2000 to 2011, a retrospective review of institutional databases was performed to identify patients with synchronous prostate and rectal cancers where the rectal cancer lay in the lower two thirds of the rectum. Operative and non-operative outcomes were analysed and a management algorithm is proposed. Twelve patients with prostate and rectal cancer were identified. Three were metachronous diagnoses (>3-month time interval) and nine were synchronous diagnoses. In the synchronous group, four had metastatic disease at presentation and were treated symptomatically, while five were treated with curative intent. Treatment included pelvic radiotherapy (74 Gy) followed by pelvic exenteration (three) and watchful waiting for rectal cancer (one). The remaining patient had a prostatectomy, long-course chemoradiotherapy and anterior resection. There were no operative mortalities and acceptable morbidity. Three remain alive with two patients disease-free. Synchronous detection of prostate cancer and cancer of the lower two thirds of the rectum is uncommon, but likely to increase with rigorous preoperative staging of rectal cancer and increased awareness of the potential for synchronous disease. Treatment must be individualized based on the stage of the individual cancers taking into account the options for both cancers including EBRT (both), surgery (both), hormonal therapy (prostate), surgery (both) and watchful waiting (both).
    International Journal of Colorectal Disease 03/2012; 27(11):1501-8. DOI:10.1007/s00384-012-1465-z · 2.45 Impact Factor
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    World Journal of Surgery 03/2012; 36(5). DOI:10.1007/s00268-012-1444-0 · 2.64 Impact Factor
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    E A Joyce · D O Kavanagh · D C Winter ·
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    ABSTRACT: Tailgut cysts, also known as retrorectal cystic hamartomas, are rare developmental abnormalities that typically occur in the retrorectal space. They are believed to arise from remnants of the embryonic hindgut (Hjermstad and Helwig, 1988). They can present as incidental findings during routine examination but over half of patients are thought to present with symptoms. MRI has become the modality of choice to image these frequently misdiagnosed cysts. Biopsy is not recommended. Complete intact surgical excision is advised to avoid the potential complications of these cysts which include infection, fistula formation, and the possibility of malignant transformation (Hjermstad and Helwig (1988), Mathis et al. (2010)). We describe the case of a 46-year-old female who presented with a 6-month history of low back pain. CT and MRI imaging demonstrated a complex retrorectal lesion with supralevator and infralevator components. This was removed using a combined transperineal and transabdominal approach. Histology confirmed a tailgut cyst.
    Case Reports in Medicine 02/2012; 2012(31):623142. DOI:10.1155/2012/623142
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    D O Kavanagh · H Imran · A Almoudaris · P Ziprin · O Faiz ·
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    ABSTRACT: A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T(3)N(2) rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision with en bloc resection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision.
    Case Reports in Medicine 01/2012; 2012(1687-9627):752357. DOI:10.1155/2012/752357
  • D C Moran · D O Kavanagh · S Sahebally · P C Neary ·
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    ABSTRACT: Potential benefits of laparoscopic surgery include decreased post-operative pain, improved cosmesis and a shorter hospital stay. However as the volume and complexity of laparoscopic procedures increase, there appears to be a simultaneous increase in complications relating to laparoscopic access. Development of a port-site hernia is one such complication. The aim of this study was to evaluate our experience relating to the incidence, presentation and interventions for early, symptomatic port-site hernias following laparoscopic surgery in a unit where minimal access surgery is the preferred approach. A retrospective review of the medical records of all patients who underwent laparoscopic procedures performed by the colorectal service over a 3-year period was conducted. Patients who developed port-site hernias were identified. Additional information on patient demographics, patient co-morbidities, the length and nature of the laparoscopic procedure, the presenting symptoms, the timing of these symptoms as well as the relative investigations and interventions were recorded. All trocars used in this series were bladed. A total of 647 patients underwent laparoscopic procedures over a 3-year period. Eight (1.23%) hernias were identified as occurring at the trocar entry site. All were symptomatic and all required surgical intervention. Development of a port-site hernia in the early post-operative period can be associated with significant morbidity. This complication should be considered in patients presenting with post-operative bowel obstruction. With meticulous closure of port sites 10 mm and bigger, the incidence of hernia may be reduced.
    Irish Journal of Medical Science 01/2012; 181(4):463-6. DOI:10.1007/s11845-011-0799-9 · 0.83 Impact Factor
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    ABSTRACT: Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient's suitability for minimally invasive surgery. For the purposes of the present study, 180 consecutive patients were included for analysis. A 5-variable model based on preoperative ionized serum calcium (>1.4 mmol/l), intact parathyroid hormone level (≥ 2 times the upper limit of normal), positive sestamibi scan for a single affected gland, positive ultrasound scan for a single gland, and concordance between the two imaging modalities for single-gland disease at a similar location was employed, where a score of 1 was allocated for each variable present. Of the 180 patients, 62 (34%) underwent bilateral exploration, 63 (36%) underwent unilateral exploration, and 55 (30%) underwent minimally invasive parathyroidectomy. The results showed that 92% had single-gland disease, 3% had double adenomas, and 5% had hyperplasia. Biochemical cure was achieved in 98.9%. Mean follow-up was 153 days (range: 80-342 days). With the predictive scoring model, a score of ≥ 3 had a positive predictive value of 100% for single-gland disease. A scoring model encompassing preoperative biochemical and imaging data can be successfully employed to predict suitability for minimally invasive surgery in the majority of patients with single-gland disease.
    World Journal of Surgery 12/2011; 36(5):1175-81. DOI:10.1007/s00268-011-1377-z · 2.64 Impact Factor
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    S Power · D O Kavanagh · G McConnell · K Cronin · C Corish · M Leonard · A Crean · S Feehan · E Eguare · P Neary · J Connolly ·
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    ABSTRACT: The practice of fasting from midnight prior to surgery is an outdated one. The aim of this study was to assess the impact of an evidence-based protocol for reduced preoperative fasting on fasting times, patient safety, and comfort. A non-randomised case-control study of preoperative fasting times among adult surgical patients undergoing elective procedures was conducted. Consecutive patients were allocated to a reduced preoperative fasting protocol allowing fluids and solids up to 2 and 6 h prior to anaesthesia, respectively (n = 21). These were compared to control patients identified from an historic study of preoperative fasting times who followed the traditional fast from midnight (n = 29). Fasting times and details of patients' subjective comfort were collected using an interview-assisted questionnaire. Incidence of intraoperative aspirations was obtained from anaesthetic records. Significant reductions in fasting times for fluids (p = 0.000) and solids (p = 0.000) were achieved following implementation of the fasting protocol. Less preoperative thirst (0.000), headache (0.012) and nausea (0.015) were reported by those who had a shorter fast. Intraoperative aspiration did not occur in either group. Implementation of this protocol for reduced preoperative fasting achieved an appreciable reduction in fasting times and enhanced patient comfort. Patient safety was not compromised. Further modifications of our protocols are necessary to meet the international best practice. We recommend its implementation across all surgical groups in our institution.
    Irish Journal of Medical Science 09/2011; 181(1):99-104. DOI:10.1007/s11845-011-0765-6 · 0.83 Impact Factor

  • 07/2011; DOI:10.1002/BJUIw-2011-027-web
  • E A Joyce · D O Kavanagh · P R O'Connell · J M P Hyland ·

    International Journal of Colorectal Disease 07/2011; 27(5):679-80. DOI:10.1007/s00384-011-1266-9 · 2.45 Impact Factor

Publication Stats

547 Citations
117.85 Total Impact Points


  • 2013-2015
    • Royal College of Surgeons in Ireland
      • Department of Surgery
      Dublin, Leinster, Ireland
  • 2009-2013
    • St. Vincents University Hospital
      • Department of Radiology
      Dublin, Leinster, Ireland
  • 2003-2013
    • St Vincent's University Hospital
      Dublin, Leinster, Ireland
  • 2010-2012
    • The Adelaide and Meath Hospital Ireland
      Dublin, Leinster, Ireland
    • St Luke's General Hospital Carlow / Kilkenny
      Kilkenny, Leinster, Ireland
    • Imperial College London
      • Section of Biosurgery and Surgical Technology
      Londinium, England, United Kingdom
  • 2006-2012
    • Mayo General Hospital
      Caisleán an Bharraigh, Connaught, Ireland
  • 2011
    • Galway University Hospitals
      Gaillimh, Connaught, Ireland
  • 2007
    • St. Columcille's Hospital
      Dublin, Leinster, Ireland
  • 2005
    • University College Dublin
      Dublin, Leinster, Ireland