Design and analysis of solitary AC-AC converter using reduced components for efficient power generation system

Considering different applications that require varied power and voltage conversion levels between AC grids and AC loads, AC-AC power conversion between AC grids has become an inevitable technology of energy management systems. An isolated converter for performing AC-to-AC transmission is proposed with minimal components for reduced losses and enhanced system efficiency. Single-phase direct buck-boost AC to AC converter with minimum components constituted with two dual IGBT control units (IGBT 1-IGBT 4), inductor (Lf), and capacitor (Cf) is proposed in this work. The MATLAB/Simulink platform is used to provide in-depth analysis of the circuit and components along with the design guidelines, and simulation outcomes of this proposed model. The voltage gains of G = 2.13, power factor of 0.97, and overall efficiency of 98% are achieved in the proposed system with minimum components of 4 switches, 2 conductors, and 1 capacitor and inductor respectively. The obtained results are compared with existing technology to evaluate the proposed system.

Development of grey wolf optimization based modified fast terminal sliding mode controller for three phase interleaved boost converter fed PV system

The conventional MPPT method has drawbacks, such as that under partial shading conditions, several peaks occur and identifying the global peak is difficult. It may converge to a local peak and lead to poor conversion efficiency and tracking efficiency. Implementation of a hybrid algorithm by integrating P&O and metaheuristic algorithms can perform better under partial shading conditions. But the tracking speed is low and the response time is longer. To mitigate the issues mentioned above, a new hybrid algorithm has been suggested that integrates GWO and a modified fast terminal sliding mode controller (MFTSMC). The suggested method with three phase ILBC is incorporated into the PV system. The MATLAB tool is employed to experiment with this study. The performance of GWO-MFTSMC is analysed through MATLAB/ SIMULINK and compared with the performance of ANN-FTSMC and PSO-FTSMC algorithm based MPPT techniques. A hardware prototype is developed and tested for 5 × 200 W solar PV modules with the GWO-MFTSMC algorithm. The proposed method conversion efficiency is 99.72% and 96.15% under simulation and hardware realisation, respectively, which is higher than the ANN-FTSMC and PSO-FTSMC methods.

Performance optimization of interleaved boost converter with ANN supported adaptable stepped-scaled P&O based MPPT for solar powered applications

Solar energy is the most promising among many renewable energy sources to meet the increasing demand. Photovoltaic (PV) based power generating solutions are expected to gain popularity as a power source for different applications, including independent and grid connected loads, due to their cleanliness, high performance, and high dependability. The efficacy of photovoltaic systems is impacted by several elements, including geographical location, positioning, shadowing effects, and local climate conditions. In order to fulfil the demands of loads, an interleaved boost converter is utilized, which has a reduced number of filters with less stress on the devices. Solar powered systems employ several maximum power point tracking (MPPT) methodologies. However, when there is partial shading, many power peaks arise, which complicates the identification of the overall peak. Although MPPT approaches are designed to measure and maintain the global maximum power point (GMPP), there are still significant oscillations observed around the GMPP with subpar settling time, tracking efficiency, and conversion efficiency. In this work, novel hybrid MPPT technique called artificial neural network supported adaptable stepped-scaled perturb and observe (ANN-ASSPO) method and water cycle optimization based perturb and observe (WCO-PO) have been proposed. Artificial neural network (ANN) has been used to determine the best scaling factor in ANN-ASSPO MPPT. Performance is enhanced in ANN-ASSPO MPPT by using the optimum scaling factor, particularly in situations when the irradiance is rapidly changing/partial shading conditions. Similarly, in WCO-PO MPPT water cycle optimization is used to determine the peak power when the PV panel is subjected to partial shading conditions. The performances of proposed hybrid MPPT ANN-ASSPO and WCO-PO techniques have been compared in terms of power generated, output voltage, average settling time and conversion efficiency. The MATLAB/Simulink tool is employed to carry out the experiment for this study.

Hybrid multimodule DC-DC converters accelerated by wide bandgap devices for electric vehicle systems

In response to the growing demand for fast-charging electric vehicles (EVs), this study presents a novel hybrid multimodule DC-DC converter based on the dual-active bridge (DAB) topology. The converter comprises eight modules divided into two groups: four Insulated-Gate Bipolar Transistor (IGBT) modules and four Metal-Semiconductor Field-Effect Transistor (MESFET) modules. The former handles high power with a low switching frequency, while the latter caters to lower power with a high switching frequency. This configuration leverages the strengths of both types of semiconductors, enhancing the converter's power efficiency and density. To investigate the converter's performance, a small-signal model is developed, alongside a control strategy to ensure uniform power sharing among the modules. The model is evaluated through simulation using MATLAB, which confirms the uniformity of the charging current provided to EV batteries. The results show an impressive power efficiency of 99.25% and a power density of 10.99 kW/L, achieved through the utilization of fast-switching MESFETs and the DAB topology. This research suggests that the hybrid multimodule DC-DC converter is a promising solution for fast-charging EVs, providing high efficiency, power density, and switching speed. Future studies could explore the incorporation of advanced wide bandgap devices to handle even larger power fractions.

A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff

Barriers and enablers to vaccination of care home (CH) staff should be identified in order to develop interventions to address them that increase uptake and protect residents. We aimed to synthesis the evidence describing the barriers and enablers that affect the influenza vaccination uptake of care home (CH) staff.

METHOD

We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, IBSS, SCOPUS to identify quantitative, qualitative or mixed-method studies. Data related to health or social care workers in CHs reported barriers or enablers were extracted and mapped to the Theoretical Domains Framework (TDF); the data within each domain were grouped and categorized into key factors affecting influenza vaccine uptake among CH staff.

RESULTS

We screened 4025 studies; 42 studies met our inclusion criteria. Thirty-four (81 %) were surveys. Five theoretical domains were frequently reported as mediators of influenza vaccine uptake: Beliefs about consequences (32 studies), Environmental context and resources (30 studies), Emotions (26 studies), Social influences (25 studies), Knowledge (22 studies). The low acceptance rate of the influenza vaccine among CH staff can be attributed to multiple factors, including insufficient understanding of the vaccine, its efficacy, or misconceptions about the vaccine (knowledge), perceiving the vaccine as ineffective and unsafe (beliefs about consequences), fear of influenza vaccine and its side effects (emotions), and experiencing limited accessibility to the vaccine (environmental context and resources).

CONCLUSION

Interventions aimed at increasing influenza vaccine uptake among CH staff should focus on addressing the barriers identified in this review. These interventions should include components such as enhancing knowledge by providing accurate information about vaccine benefits and safety, addressing negative beliefs by challenging misconceptions, managing concerns and fears through open communication, and improving accessibility to the vaccine through convenient on-site options. This review provides a foundation for the development of tailored Interventions to improve influenza vaccine uptake among CH staff.

Protocol of the process evaluation of cluster randomised control trial for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FluCare)

BACKGROUND

Influenza (flu) vaccination rates in UK care home staff are extremely low. Less than 40% of staff in care homes are vaccinated for influenza (flu), presenting risks to the health of frail residents and potential staff absence from cross-infection. Staff often do not perceive a need for vaccination and are unaware they are entitled to free flu vaccination. The FluCare study, a cluster randomised control trial (RCT), uses behavioural interventions to address barriers. Videos, posters, and leaflets are intended to raise awareness of flu vaccination benefits and debunk myths. On-site staff vaccination clinics increase accessibility. Financial incentives to care homes for improved vaccination rates and regular monitoring influence the environment. This paper outlines the planned process evaluation which will describe the intervention's mechanisms of action, explain any changes in outcomes, identify local adaptations, and inform design of the implementation phase.

METHODS/DESIGN

A mixed method process evaluation to inform the interpretation of trial findings.

OBJECTIVES

• Describe the intervention as delivered in terms of dose and fidelity, including adaptations and variations across care homes. • Explore the effects of individual intervention components on primary outcomes. • Investigate the mechanisms of impact. • Describe the perceived effectiveness of relevant intervention components (including videos, leaflets, posters, and flu clinics) from participant perspectives (care home manager, care home staff, flu clinic providers). • Describe the characteristics of care homes and participants to assess reach. A purposive sample of twenty care homes (ten in the intervention arm, ten in the control arm) for inclusion in the process evaluation. Data will include (1) study records including care home site profiles, (2) responses to a mechanism of action questionnaire, and (3) semi-structured interviews with care home staff and clinic providers. Quantitative data will be descriptively reported. Interview data will be thematically analysed and then categories mapped to the Theoretical Domains Framework.

DISCUSSION

Adopting this systematic and comprehensive process evaluation approach will help ensure data is captured on all aspects of the trial, enabling a full understanding of the intervention implementation and RCT findings.

TRIAL REGISTRATION

ISRCTN ISRCTN22729870. Registered on 24 August 2022.

Experience of Sudden Shift from Traditional to Virtual Problem-Based Learning During COVID-19 Pandemic at a Medical College in Saudi Arabia

Background

COVID-19 pandemic has resulted in a sudden shift to online education. PBL was one of the components that was transformed to online. The aim of the present study was to investigate the impact of the sudden shift to virtual PBL during COVID-19 pandemic in achieving the intended learning objectives of the PBL and to explore the students' perception of the virtual versus traditional PBL.

Methods

This is a retrospective study that was conducted in the college of medicine, King Saud University. We compared the perception of third year students who participated in traditional face-to-face PBL in 2019-2020 and in the virtual PBL in 2020-2021. We compared the performance of the students in the traditional face-to-face and in virtual PBL. An online survey was distributed from October to December 2021. The survey contained 7 sections. Each section included several questions comparing virtual and traditional PBL in that aspect.

Results

Out of 284 third year medical students, 124 students responded with a response rate of 43.66%. More than half of the students (n = 77, 63%) felt significantly motivated to actively participate in PBL sessions in a virtual learning environment, motivated to learn and support group work and gained critical thinking skills (mean = 3.54 ± 0.12 versus 3.59 ± 0.14, p < 0.001). The majority of students (n = 82, 66%) felt significantly more satisfied about their learning during the virtual PBL versus traditional PBL (mean = 3.48 ± 0.42 versus 3.91 ± 0.59, p < 0.001). There was no significant difference in the students' performance in traditional versus virtual PBL (mean = 4.77 ± 0.22 versus 4.79 ± 0.29, p = 0.2).

Conclusion

The results of this study showed that students were significantly more satisfied with the experience in the virtual versus traditional PBL. Medical students' performances in virtual PBL were comparable to the traditional face-to-face approach.

Molecular Screening via Sanger Sequencing of the Genetic Variants in Non-Alcoholic Fatty Liver Disease Subjects in the Saudi Population: A Hospital-Based Study

Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases, along with steatosis and non-alcoholic steatohepatitis (NASH), and is associated with cirrhosis and hepatocellular carcinoma. Candidate gene and genome-wide association studies have validated the relationships between NAFLD, NASH, PNPLA3, TM6SF2, and HFE. The present study utilized five polymorphisms in three genes: PNPLA3 (I148M and K434E) TM6SF2 (E167K), and HFE (H63D and C282Y), based on undocumented case−control studies in the Saudi Arabian population. A total of 95 patients with NAFLD and 78 non-NAFLD subjects were recruited. Genomic DNA was isolated, and polymerase chain reaction and Sanger sequencing were performed using specific primers for the I148M, K434E, E167K, H63D, and C282Y. NAFLD subjects were older when compared to controls and showed the significant association (p = 0.0001). Non-significant association was found between gender (p = 0.26). However, both weight and BMI were found to be associated. Hardy−Weinberg equilibrium analysis confirmed that H63D, I148M, and K434E polymorphisms were associated. Genotype analysis showed only K434E variant was associated with NAFLD and non-NAFLD (OR-2.16; 95% CI: 1.08−4.31; p = 0.02). However, other polymorphisms performed with NAFLD and NASH were not associated (p > 0.05), and similar analysis was found when ANOVA was performed (p > 0.05). In conclusion, we confirmed that K434E polymorphism showed a positive association in the Saudi population.

Evaluation of the Experience of Peer-led Mock Objective Structured Practical Examination for First- and Second-year Medical Students

BACKGROUND

The objective structured practical examination (OSPE) is used as an assessment tool of laboratory practical sessions. This study described the design and implementation of peer-led mock OSPE for first- and second-year medical students, investigated the perception of the students of the peer-led mock OSPE and the impact of attending the mock OSPE on the performance.

METHODS

This is a cross-sectional study. Two mock OSPEs were designed and conducted by third-, fourth- and fifth- year medical students for year one and two. Each mock OSPE involved six stations. Thirty-three medical students facilitated the OSPE. The OSPEs were conducted prior to the summative end of block exams. Following the mock OSPEs, an online survey was sent to the participants to assess their satisfaction, quality and benefits of the mock OSPE. The study also evaluated the impact of the mock OSPE on students' performance.

RESULTS

Out of 313 first-year students, 279 (89.1%) attended the mock OSPE and out of 298 second-year students, 213 (71.5%) attended. A total of 192 (68.8%) first-year medical students and 102 (47.9%) second-year medical students completed the questionnaire. There was no significant difference between attending and non-attending the mock OSPE in the students' performance in the summative OSPE. The majority of students felt more confident, less anxious, and lowered the levels of stress after attending the mock OSPE. More than half of the students felt that attending the mock OSPE helped in easing the steps, better preparation, provided sufficient orientation, well explained the materials and helped them to learn the concept of the final OSPE. The majority of students found the mock OSPE stimulating.

CONCLUSION

Attending the mock OSPE did not affect the students' performance in the summative OSPE. However, the peer-assessed mock OSPE improved the medical students' confidence and lowered the anxiety associated with OSPE.

Management of Delayed Eruption in Permanent Incisor Following Intrusion Injury of Primary Dentition: A Case Report

This article describes the clinical management of delayed eruption of the upper left permanent central incisor of an eight-year-old child with a history of overlooked intrusive trauma to the primary maxillary incisors. Initial conservative management involved simple extraction of the over-retained upper right primary left incisor. At the recall visit, the decision was made to expose permanent incisors surgically aiming to facilitate its eruption. Two years later, the upper right central and lateral incisors have been erupted into the oral cavity, improving patient aesthetics. This case report aims to demonstrate the clinical diagnosis and intervention for delayed eruption of maxillary permanent central incisor as a consequence of an overlooked intrusive trauma in the primary dentition. Additionally, to emphasize the importance of periodic radiographic examination in monitoring the sequence of eruption in mixed dentition.

High seroprevalence of SARS-CoV-2 among high-density communities in Saudi Arabia

Background

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) infection had been investigated utilizing serology.

Materials and methods

This community-based sero-survey was carried out in the neighborhoods of three cities in Saudi Arabia.

Results

Of 5629 participants, 2766 (49.1%) were women; and 2148 (38.1%) were 18–34 years of age, and 3645 (64.7%) were from South East Asia. Positive serology was seen in 2825 (50.2% (95% CI: 48.8–51.5%) for SARS-CoV-2 anti-S1 IgG antibodies by ECLIA. Being in the age category of 18–34 years and being from Eastern Mediterranean Region (country A) were associated with higher COVID-19 seropositivity with estimated odds ratio of 1.3 [95% CI 1.1–1.8] and 2.5 [95% CI 1.1.5–4.2] respectively. Gender, social status, education, nationality, symptoms, presence of comorbidities and activity style were positively associated with increased seropositivity. Factors associated negatively with the rate of seropositivity were higher education and having outdoor activity with estimated OR of 0.92 [95% CI 0.46–0.95] and 0.59 [95% CI 0.47–0.74], respectively.

Conclusion

The study showed high seroprevalence of SARS-CoV-2 among high density population. Health education campaigns should target middle-aged, those with low education, those living in lower standards and indoor workers.

A 16-Year-Old Saudi Boy with a Symptomatic Large Splenic Epidermoid Cyst

Patient: Male, 16-year-old

Final Diagnosis: Splenic epidermoid cyst

Symptoms: Abdominal asymmetry • abdominal distention • decreased oral intake

Medication: —

Clinical Procedure: Open splenectomy

Specialty: Surgery

Seroprevalence of antibodies to SARS-CoV-2 among blood donors in the early months of the pandemic in Saudi Arabia

BACKGROUND

Serologic testing provides better understanding of SARS-CoV-2 prevalence and its transmission. This study was an investigation of the prevalence of antibodies to SARS-CoV-2 among blood donors in Saudi Arabia.

OBJECTIVE

To estimate the seroprevalence of anti-SARS-CoV-2 antibodies among blood donors in Saudi Arabia during the early phase of the COVID-19 pandemic.

METHODS

Serology results and epidemiological data were analyzed for 837 adult blood donors, with no confirmed SARS-CoV-2 infection, in Saudi Arabia from 20th to 25th May 2020. Seroprevalence was determined using electrochemical immunoassay to detect anti-SARS-CoV-2 antibodies.

RESULTS

The overall seroprevalence of anti-SARS-CoV-2 antibodies was 1.4% (12/837). Non-citizens had higher seroprevalence compared with citizens (OR 13.6, p = 0.001). Secondary education was significantly associated with higher seroprevalence compared with higher education (OR 6.8, p = 0.005). The data showed that the highest seroprevalence was in Makkah (8.1%). Uisng Makkah seroprevalence as the reference, the seroprevalence in other areas was: Madinah 4.1% (OR 0.48, 95% CI 0.12-1.94), Jeddah 2.3% (OR 0.27, 95% CI 0.31-2.25), and Qassim 2.9 % (OR 0.34, 95% CI 0.04-2.89) and these were not statistically different from seroprevalence in the Makkah region.

CONCLUSIONS

At the early months of the COVID-19 pandemic in Saudi Arabia, the seroprevalence of antibodies to SARS-CoV-2 among blood donors was low, but was higher among non-citizens. These findings may indicate that non-citizens and less educated individuals may be less attentive to preventive measures. Monitoring seroprevalence trends over time require repeated sampling.

Medical students' perception of the learning environment at King Saud University Medical College, Saudi Arabia, using DREEM Inventory

BACKGROUND

The students' perception of the learning environment is an important aspect for evaluation and improvement of the educational program. The College of Medicine at King Saud University (KSU) reformed its curriculum in 2009 from a traditional to a system-oriented hybrid curriculum.

OBJECTIVE

The objective of the present study was to determine the perception of the second batch (reformed curriculum) of medical graduates about the educational environment at the College of Medicine, KSU, using the Dundee Ready Education Environment Measure (DREEM) scale.

METHODS

The fifth year medical students were asked to evaluate the educational program after graduation in May 2014. The questionnaire was distributed to the graduate students electronically. The DREEM questionnaire consisted of 50 items based on Likert's scale; and five domains, namely, students' perceptions of learning, perceptions of teachers, academic self-perceptions, perceptions of atmosphere, and social self-perceptions. Data were analyzed using SPSS.

RESULTS

A total of 62 students participated in the study. The score for students' perception of learning among medical students ranged from 2.93 to 3.64 (overall mean score: 40.17). The score for students' perception of teachers ranged from 2.85 to 4.01 (overall mean score: 33.35). The score for students' academic self-perceptions ranged from 3.15 to 4.06 (overall mean score: 28.4). The score for students' perception of atmosphere ranged from 2.27 to 3.91 (overall mean score: 41.32). The score for students' social self-perceptions ranged from 2.85 to 4.33 (overall mean score: 24.33). The general perceptions of the students in all five sub-scales were positive.

CONCLUSION

The overall student's perception about the educational environment was satisfactory. This study was important to evaluate the students' perception of the learning environment among medical graduates of the reformed curriculum and provided guidance on areas of improvement in the curriculum.

Cytologic diagnosis of gastric submucosal lesions by endoscopic ultrasound-guided fine-needle aspiration: A single center experience in Saudi Arabia

BACKGROUND AND AIMS

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) sampling has become standard practice for the diagnosis of submucosal gastrointestinal (GI) lesions. The aim of this study was to determine the utility of EUS-guided FNA cytology in the diagnosis of deeply seated gastric mass lesions.

MATERIALS AND METHODS

Thirteen patients with deeply seated gastric mass lesions were diagnosed by EUS-FNA. Adequate cytology material was present in all cases. Cell blocks were available in 10 cases. Surgical resections were performed in 8 cases. Immunohistochemical (IHC) studies were done on cell blocks in 9 cases and on 6 resected specimens. Seven cases has proved to be GI stromal tumors (GIST), in four of them, cell blocks were available, and resection for GIST was performed in 5 cases. IHC stains that were performed in cytology, as well as resection specimens, revealed similar results in each patient.

CONCLUSION

EUS-FNA cytology, when combined with a histologic assessment of cell blocks provides accurate and efficient tissue diagnosis of a wide variety of deeply seated gastric mass lesions.

Colorectal cancer liver metastasis trends in the kingdom of Saudi Arabia

BACKGROUND/AIM

To elucidate colorectal cancer (CRC) disease patterns, demographics, characteristics, stage at presentation, metastases, and survival rates of patients, particularly those with liver metastases, at our center as the first report from the Kingdom of Saudi Arabia.

PATIENTS AND METHODS

We performed a retrospective, single-center database study based on the histological diagnosis of CRC in patients seen at the King Khalid University Hospital between 2007 and 2011.

RESULTS

427 cases of CRC with a mean age at diagnosis of 55.47 ΁ 12.85 years, out of which 96% were resected. Stage II was predominant at presentation, followed by both stage III and IV, with the remainder being stage I. One hundred patients had distant metastases, of which the liver was the only location in 54 patients. Mean survival was 3.0 years. Overall survival rates for CRC patients with liver metastases who underwent resection were 30% at 2 years and 17% at 5 years, and the mean survival rate was 1.4 years.

CONCLUSIONS

Both the mean survival rate of our CRC patients with resectable liver metastases and the 5-year survival rate of these patients are lower than global averages. This discrepancy is likely due to late diagnoses rather than more aggressive disease.

Clinical predictors of resectability of pancreatic adenocarcinoma

BACKGROUND/AIMS

Identifying patient-related factors as well as symptoms and signs that can predict pancreatic cancer at a resectable stage, which could be used in an attempt to identify patients at an early stage of pancreatic cancer that would be appropriate for surgical resection and those at an unresectable stage be sparred unnecessary surgery.

MATERIALS AND METHODS

A retrospective chart review was conducted at a major tertiary care, university hospital in Riyadh, Saudi Arabia. The study population included individuals who underwent a computed tomography and a pancreatic mass was reported as well as the endoscopic reporting database of endoscopic procedures where the indication was a pancreatic mass, between April 1996 and April 2012. Any patient with a histologically confirmed diagnosis of adenocarcinoma of the pancreas was included in the analysis. We included patients' demographic information (age, gender), height, weight, body mass index, historical data (smoking, comorbidities), symptoms (abdominal pain and its duration, anorexia and its duration, weight loss and its amount, and over what duration, vomiting, abdominal distention, itching and its duration, change in bowel movements, change in urine color), jaundice and its duration. Other variables were also collected including laboratory values, location of the mass, the investigation undertaken, and the stage of the tumor.

RESULTS

A total of 61 patients were included, the mean age was 61.2 ± 1.51 years, 25 (41%) were females. The tumors were located in the head (83.6%), body (10.9%), tail (1.8%), and in multiple locations (3.6%) of the pancreas. Half of the patients (50%) had Stage IV, 16.7% stages IIB and III, and only 8.3% were stages IB and IIA. On univariable analysis a lower hemoglobin level predicted resectability odds ratio 0.65 (95% confidence interval, 0.42-0.98), whereas on multivariable regression none of the variables included in the model could predict resectability of pancreatic cancer. A CA 19-9 cutoff level of 166 ng/mL had a sensitivity of 89%, specificity of 75%, positive likelihood ratio of 3.6, and a negative likelihood ratio of 0.15 for resectability of pancreatic adenocarcinoma.

CONCLUSION

This study describes the clinical characteristics of patients with pancreatic adenocarcinoma in Saudi Arabia. None of the clinical or laboratory variables that were included in our study could independently predict resectability of pancreatic adenocarcinoma. Further studies are warranted to validate these results.

Pylorus preserving pancreaticoduodenectomy for peri-ampullary carcinoma, is it a good option?

Pancreaticoduodenectomy (PD) is the standard surgical treatment for resectable peri-ampullary tumors. It can be performed with or without pylorus preservation. Many surgeons have a negative opinion of pylorus preserving PD (PPPD) and consider it an inferior operation, especially from an oncological point of view. This article reviews the various aspects of PD in the context of operative factors like blood loss and operation time, complications such as delayed gastric emptying and anastomotic leaks, and the impact on quality of life and survival. We aim to show that PPPD is at least as good as classic PD, if not better in some aspects.