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Carbon footprinting of products and services is getting increasing attention due to the growing emphasis on carbon related policies in many countries. As a result, many enterprises are focusing on the design of green supply chains (GSCs) with research on supply chains (SCs) focused not only on cost efficiency, but also on its environmental consequences. The review presented in this paper focuses on the implications of carbon policies on SCs. The concept of content analysis is used to retrieve and analyze the information regarding drivers (carbon policies), actors (for example, manufacturers and retailers), methodologies (mathematical modeling techniques), decision-making contexts (such as, facility location and order quantity), and emission reduction opportunities. The review shows a lack of emissions analysis of SCs that face carbon policies in different countries. The research also focuses on the design of carbon policies for emissions reduction in different operating situations. Some possible research directions are also discussed at the end of this review.

Type of the article: Research Article AbstractThis paper examines the concept of loyalty as a flexible principle and a motivational factor that influences an individual’s interest in the existence and development of the state. Loyalty significantly contributes to social cohesion and national resilience, especially in the current turbulent geopolitical climate. The aim of this study is to analyze the factors influencing Latvian students’ loyalty to the state, including civic engagement, a sense of being needed by the country, and education about civic responsibility. The study also examines the impact of education and family upbringing on the formation of loyalty to the state.Data were collected through a survey conducted in 2024, which included multiple-choice and Likert-scale questions. The sample consisted of 437 students in grades 9–12 from Liepaja, Latvia. The findings demonstrate that Pearson’s chi-square analysis revealed a positive association between loyalty to the state and the following factors: knowledge of state history (χ² = 33.28, p < 0.001), teaching of civic responsibility at school (χ² = 40.24, p < 0.001), discussing state politics with family members (χ² = 12.48, p = 0.001), and discussing civic responsibility within the family (χ² = 16.86, p < 0.001).Overall, 54.1% of respondents considered themselves civically engaged, and 81.4% reported feeling loyal to the state. A multiple logistic regression analysis revealed that being civically engaged, feeling needed by the country, and receiving education about civic responsibility significantly increase the likelihood of students expressing loyalty to the state. AcknowledgmentsThe authors sincerely thank the survey participants (pupils) and management teams of educational institutions.

Background and Purpose: The development of research knowledge, skills, and attitudes among postgraduate vocational-health education students is a crucial outcome of their degree program. This study focuses on the research competences of vocational-health education students and their use of web 2.0 technologies to enhance research productivity. The study employs the Vitae Researcher Development Framework (RDF) and examines the use of web 2.0 technologies. Method: The study surveyed 390 postgraduate vocational-health education students enrolled in universities in Pakistan. Of the participants, 50.5% were male, 49.5% were female, 45.1% were from private universities, and 54.9% were from public sector universities. Moreover, 68.2% were Master’s students, while 31.8% were doctoral students. The data were analyzed through both symmetrical and asymmetrical modeling techniques, including Partial least square equation modeling (PLS-SEM) and fuzzy set Qualitative Comparative Analysis (fsQCA), to measure the direct and indirect specific relationships among the constructs. Results: The results confirmed that research competences and web 2.0 technologies have a direct effect on research productivity. Furthermore, the results revealed that web 2.0 technologies mediate in the relationship between research competences and research productivity. Conclusions: The study concludes that research competences and web 2.0 technologies predict research productivity. Additionally, web 2.0 technologies have an intervening role in the relationship between research competences and research productivity during the COVID-19 pandemic emergency. Implications: This study highlights the broader implications for health education policymakers and institutions to include web 2.0 technologies in their development plans. Future studies can develop web 2.0-based instructional strategies for the professional development of advanced vocational-health education researchers. Originality: This study contributes to the knowledge of research competences, web 2.0 technologies, and research productivity for vocational-health education researchers.

Purpose: To determine the effect of a capsular tension ring (CTR) implantation in preventing posterior capsular opacification (PCO) after cataract surgery in patients with high myopia. Materials and Methods: In this prospective single-surgeon standardized-surgical-procedure fellow-eye comparison trial, 34 patients with high myopia had phacoemulsification surgery. Although one eye received an acrylic intraocular lens (IOL) and CTR, other eye received only an IOL as control. PCO, within the capsulorhexis overlap, was documented by standardized digital retroillumination images at least 2 years post-operatively, and the percentage area of PCO was scored (scale 0%-100%) using the POCOman software system. The PCO score and the incidence of neodymium-doped yttrium aluminum garnet (Nd: YAG) capsulotomy of groups, and correlations between PCO score and presence of CTR, age, phaco time, refraction, and axial length (AL) were determined. Results: The mean time interval from surgery to PCO measurement was 43.4 ± 11.2 months for the eyes with a CTR and 43.1 ± 11.6 months for the controls (P = 0.91). The PCO score of the eyes with a CTR was significantly lower than in the controls (5.9 ± 4.3 vs. 22.3 ± 12.2, respectively; P < 0.001). There were statistically insignificant correlations between PCO score and pre-operative refraction (r = 0.02; P = 0.90), AL (r = 0.03; P = 0.80), phaco time (r = 0.11; P = 0.53), and patient′s age (r = 0.23; P = 0.55). No patient with a CTR had a Nd: YAG laser capsulotomy, but it was six in controls (P = 0.025). Conclusions: CTR implantation seems to be effective in reducing the PCO and Nd: YAG laser capsulotomy rates in high myopic eyes.

Purpose To compare outcomes of phacoemulsification combined with a Kahook Dual Blade (KDB) goniotomy in eyes with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). Methods This retrospective comparative study was conducted in a tertiary medical center. Sixty eyes of 60 patients (27 with POAG, 33 with PXG) underwent phacoemulsification combined with a KDB goniotomy. Intraocular pressure (IOP), number of medications used, best corrected visual acuity preoperatively and at 1 day, 1 week and 1, 3, 6 and12 months postoperatively, surgical success, and surgical complications were reviewed. If IOP reduction was >%30 or postoperative IOP < 18 mmHg, the procedure was considered as surgical success. Results The mean IOP reduced from 26.4 ± 5.9 mmHg at baseline to 17.9 ± 6.1mmHg at 12 months for POAG ( p  < 0.01) and from 27.1 ± 7.9 at baseline to 15.1 ± 2.3 mmHg at 12 months for PXG ( p  < 0.01). Medication use reduced from 3.4 ± 0.9 to 2.0 ± 1.3 for POAG ( p  < 0.01) and from 3.7 ± 0.5 to 1.8 ± 1.3 for PXG ( p  < 0.01) at 12 months. Mean IOP was significantly lower in PXG than POAG at week 1 and months 1, 3, 6 and 12 (all p  < 0.05). Surgical success rate was 74% for POAG and 84% for PXG ( p  = 0.30) at 12 months. No vision-threatening complications occurred. Conclusion KDB goniotomy combined with cataract surgery was safe and effectively reduced the IOP and drug burden in patients with POAG and PXG. In the first year, significantly lower IOPs were noted in PXG compared with POAG.

Optic disc pits (ODP) are an uncommon congenital abnormality. Patients remain asymptomatic unless they develop maculopathy. The use of optic coherence tomography has critical benefits in the follow-up of patients who are at the amblyogenic age. The aim of this study is to present a case of double ODP in the right eye and single ODP in the left eye in a partially accommodative esotropia patient followed for 21 years. To our knowledge, multiple ODP has never been described in a patient with partially accommodative esotropia.

Objectives: The aim of this study was to show at what rate the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected in practice and how up to date they are. Materials and Methods: A questionnaire conducted using SurveyMonkey was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in subgroups according to the participants' age, occupational status, institutions, and whether they conducted relevant academic activities, and the data were compared as inadequate, standard, and contemporary approaches according to the determined criteria. Results: Optical biometry devices were used at rates of 77.7% and 67.3% for intraocular lens (IOL) power calculations and keratometric measurements in preparation for cataract surgery, respectively. For IOL power calculation, third-generation formulas, especially the SRK-T, were used most commonly (46.2%), followed by second-generation formulas (21.9%), and fourth/fifth-generation formulas and multiple evaluations for different axial lengths (31.9%). The most common incision size was 2.8 mm (51.6%), while the percentage of 2.2 mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism was 18.8%. When selecting incision location, approaches to reduce corneal astigmatism were reported by 28.9%, neutral approaches by 26.2%, and insensitive approaches by 44.9%. Additionally, 55.6% of participants never implanted toric IOLs and 50.7% did not use presbyopia-correcting IOLs. The proportion of surgeons who have experience with femtosecond laser-assisted cataract surgery was 10.3% and the rate of intracameral antibiotic injection at the end of the operation was 89.4%. Conclusion: It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rates, but this was not reflected in practice at same rate in terms of achieving contemporary standards of refractive cataract surgery Keywords: Refractive cataract surgery, cataract survey, phacoemulsification

Objectives: To determine the normal values for retinal nerve fiber layer thickness (RNFLT) in myopic patients without glaucoma and analyze the changes in their color map. Materials and Methods: A total of 245 eyes without glaucoma were included in the study. According to the degree of myopia, the cases were divided into 4 groups: control group ( + 1.00/-1.00 D; n=70), Group 1 (-1.00/-3.00 D; n=50), Group 2 (-3.00/-6.00 D; n = 75), and Group 3 (>-6.00 D; n=50). Intra-group comparisons were performed in terms of superotemporal, superonasal, nasal, inferonasal, inferotemporal, temporal, and global RNFLT (Heidelberg Spectralis, Optic Coherence Tomography, Germany) and the color coding of these quadrants (green: within normal limits, yellow: borderline, red: outside normal limits). Results: All groups were similar in age and gender (p>0.05). As the degree of myopia increased, RNFLT became thinner in the upper and lower temporal and upper and lower nasal quadrants (p<0.01). The rate of measurements considered borderline and outside normal limit in at least 1 quadrant was higher in groups with higher myopia for all quadrants (p<0.05). This rate was found to be 8/70 (11.4%) for the control group, 9/50 (18.0%) for Group 1, 21/75 (28.0%) for Group 2, and 33/50 (66.0%) for Group 3 (p<0.01). Conclusion: The high rate of RNFLT classified as borderline or outside normal limits in myopic patients is a finding to which clinicians should pay attention in order not to make a misdiagnosis, especially in cases of suspected glaucoma. Keywords: Myopia, retinal nerve fiber layer, glaucoma

To report the management outcomes of diplopia in patients with blowout fracture. Data for 39 patients with diplopia due to orbital blowout fracture were analyzed retrospectively. The inferior wall alone was involved in 22 (56.4%) patients, medial wall alone was involved in 14 (35.8%) patients, and the medial and inferior walls were involved in three (7.6%) patients. Each fracture was reconstructed with a Medpore® implant. Strabismus surgery or prism correction was performed in required patients for the management of persistent diplopia. Mean postoperative follow up was 6.5 months. Twenty-three (58.9%) patients with diplopia underwent surgical repair of blowout fracture. Diplopia was eliminated in 17 (73.9%) patients following orbital wall surgery. Of the 23 patients, three (7.6%) patients required prism glasses and another three (7.6%) patients required strabismus surgery for persistent diplopia. In four (10.2%) patients, strabismus surgery was performed without fracture repair. Twelve patients (30.7%) with negative forced duction test results were followed up without surgery. In our study, diplopia resolved in 30.7% of patients without surgery and 69.2% of patients with diplopia required surgical intervention. Primary gaze diplopia was eliminated in 73.9% of patients through orbital wall repair. The most frequently employed secondary surgery was adjustable inferior rectus recession and <17.8% of patients required additional strabismus surgery.