The World Health Organization’s (WHO’s) World Health Report 2010, "Health systems financing, the path to UNIVERSAL coverage," promoted UNIVERSAL health coverage (UHC) as an aspirational objective for country health systems. Yet, in addition to the dimensions of services and coverage, distribution of coverage in the population, and financial risk protection highlighted by the report, the consideration of the budget constraint should be further strengthened in the ensuing debate on resource allocation toward UHC. Beyond the substantial financial constraints faced by low- and middle-income countries, additional considerations, such as the geographical context, the underlying country infrastructure, and the architecture of health systems, determine the feasibility, effectiveness, quality and cost of healthcare delivery. Therefore, increased production and use of local evidence tied to the criteria of health benefits, equity, financial risk protection, and costs accompanying health delivery are needed so that to highlight pathways and acceptable TRADE-offs toward UHC.

This article discusses what ethicists have called “unacceptable TRADE-offs” in health policy choices related to UNIVERSAL health coverage (UHC). Since the fiscal space is constrained, TRADE-offs need to be made. But some TRADE-offs are unacceptable on the path to UNIVERSAL coverage. Unacceptable choices include, among other examples from low-income countries, to expand coverage for services with lower priority such as coronary bypass surgery before securing UNIVERSAL coverage for high-priority services such as skilled birth attendance and services for easily preventable or treatable fatal childhood diseases. Services of the latter kind include oral rehydration therapy for children with diarrhea and antibiotics for children with pneumonia. The article explains why such TRADE-offs are unfair and unacceptable even if political considerations may push in the opposite direction.

In responses to Norheim’s editorial, this commentary offers reflections from Thailand, how the five unacceptable TRADE-offs were applied to the UNIVERSAL health coverage (UHC) reforms between 1975 and 2002 when the whole 64 million people were covered by one of the three public health insurance systems. This commentary aims to generate global discussions on how best UHC can be gradually achieved. Not only the proposed five discrete TRADE-offs within each dimension, there are also TRADE-offs between the three dimensions of UHC such as population coverage, service coverage and cost coverage. Findings from Thai UHC show that equity is applied for the population coverage extension, when the low income households and the informal sector were the priority population groups for coverage extension by different prepayment schemes in 1975 and 1984, respectively. With an exception of public sector employees who were historically covered as part of fringe benefits were covered well before the poor. The private sector employees were covered last in 1990. Historically, Thailand applied a comprehensive benefit package where a few items are excluded using the negative list; until there was improved capacities on technology assessment that cost-effectiveness are used for the inclusion of new interventions into the benefit package. Not only cost-effectiveness, but long term budget impact, equity and ethical considerations are taken into account. Cost coverage is mostly determined by the fiscal capacities. Close ended budget with mix of provider payment methods are used as a tool for TRADE-off service coverage and financial risk protection. Introducing copayment in the context of fee-for-service can be harmful to beneficiaries due to supplier induced demands, inefficiency and unpredictable out of pocket payment by households. UHC achieves favorable outcomes as it was implemented when there was a full geographical coverage of primary healthcare coverage in all districts and sub-districts after three decade of health infrastructure investment and health workforce development since 1980s. The legacy of targeting population group by different prepayment mechanisms, leading to fragmentation, discrepancies and inequity across schemes, can be rectified by harmonization at the early phase when these schemes were introduced. Robust public accountability and participation mechanisms are recommended when deciding the UHC strategy.

This article provides a commentary to Ole Norheim’ s editorial entitled "Ethical perspective: Five unacceptable TRADE-offs on the path to UNIVERSAL health coverage." It reinforces its message that an inclusive, participatory process is essential for ethical decision-making and underlines the crucial importance of good governance in setting fair priorities in healthcare. Solidarity on both national and international levels is needed to make progress towards the goal of UNIVERSAL health coverage (UHC).

Introduction: The aim of this study was to investigate the fraction rate of Pro Taper UNIVERSAL and Neoniti rotary files during the preparation of simulated severely-curved root canals.Materials & Methods: A total of 70 resin blocks with simulated severely-curved canals were randomly divided into two groups and prepared with Pro Taper UNIVERSAL and Neoniti files. Each set of files was used for cleaning and shaping five canals; the files were sterilized after each application. Afterwards, the number of deformed and fractured files was recorded.Results: Deformation was reported in 11.4% and 19% of Pro Taper and Neoniti files, respectively (P>0.05). Also, fraction was found in 11.4% of Pro Taper files, while no fracture was reported in the Neoniti group; overall, no statistically significant difference was found between the groups (P>0.05).Conclusion: Based on the present findings, there was no significant difference between Pro Taper UNIVERSAL and Neoniti files with respect to the incidence of deformation or fracture during the preparation of severely-curved canals.

Aim: Investigating the relationship between land surface temperature and urban land uses can be used for urban management. However, one of the main problems in this field is the low spatial resolution of thermal images. This research aims to evaluate and select the best existing algorithm for achieving a high spatial resolution of thermal images to investigate and analyze changes in land surface temperature in Region 4 of Ahvaz. Material & method: For this purpose, the split window algorithm was used as one of the most common suitable algorithms to calculate land surface temperature, and SFIM and T sharp DisTRADE algorithms in urban areas were applied to improve spatial resolution. Finding: Results show that the spatial resolution of the output image obtained by Split Window, T Sharp DisTRADE, and SFIM algorithms is 30, 100, and 45 meters, respectively. The T Sharp DisTRADE algorithm presented the output images with very good resolution so that different land uses could be separated according to their surface temperature. Split Window and SFIM algorithms did not provide acceptable results in land use evaluation. Also, the average land surface temperature values obtained from T Sharp DisTRADE, Split Window algorithm, and SFIM are equal to 17.5, 23.5, and 28.25 degrees Celsius, respectively. This temperature difference of these algorithms is due to utilizing the fusion process. Conclusion: As a result, T Sharp DisTRADE algorithm was more effective in improving the spatial resolution of thermal images. Innovation: Innovations of this research are: - simultaneous use of three mentioned algorithms for increasing spatial resolution of thermal images and discovering the best algorithm in this field, which has not been investigated in previous research, - improving spatial resolution of thermal images for evaluating urban land uses by using T Sharp DisTRADE algorithm, and detail investigation of surface temperature changes.

Postmodernism represents skepticism toward metanarratives and UNIVERSAL ideologies that dominated the modernist era. The study focuses on three key postmodernist concepts - alternative assessment, process syllabi, and self-directed learning. Alternative assessment emphasizes evaluating the learning process over summative testing. Process syllabi focus on the learning experience rather than rigid outcomes. Self-directed learning enables student responsibility in setting learning goals and processes. This paper examined the effects of postmodernist educational concepts on improving Iranian EFL learners’ autonomy. A quasi-experimental pre-test/post-test design was utilized with 60 intermediate level Iranian EFL students divided into an experimental and control group (n=30 each). The experimental group received instruction utilizing the three postmodernist concepts over 14 weeks, while the control group received traditional modernist instruction. Autonomy was measured using a validated questionnaire before and after the intervention. The results showed the experimental group demonstrated significant increases in autonomy compared to the control group. Paired sample t-tests revealed significant differences between pre-test and post-test autonomy for the experimental group across all three postmodern concepts - alternative assessment, process syllabi, and self-directed learning. This suggests postmodernist concepts that decentralize instruction and emphasize student process over outcomes can enhance Iranian EFL learners’ self-direction and responsibility for language acquisition. The study implies EFL syllabus designers and instruction should transition to postmodern models centered on individualized assessment, flexible syllabi, and student-guided learning to boost autonomy. Further research can expand sample sizes and explore additional postmodernist concepts across diverse demographics.

Background: Bacterial meningitis is a fatal disease with high mortality and morbidity that needs emergency management. But due to nonspecific signs and symptoms it's diagnosis in children is difficult. Recently procalcitonin has been used for diagnosis of serious bacterial infections like bacterial meningitis. We conducted a prospective study in children for evaluation of procalcitonin in differential diagnosis of acute bacterial and viral meningitis. The aim of this study was the Evaluation of sensitivity and specificity of CSF proca1citonin levels in differentiation between bacterial and viral meningitis in children older than two months, in Markaz Tebbi hospital, during 1382-1383.Materials and Methods: In a prospective process research, we measured CSF procalcitonin levels in 43 children older than two months referred to Markaz Tebbi hospital. According to the results of UNIVERSAL PCR the patients were divided into two groups: bacterial meningitis (n=11) and nonbacterial meningitis (n=32). To analysis the results, Mann-Whitney test was used.Results: CSF proca1citonin level in bacterial meningitis was significantly higher than viral meningitis (1.72±0.9ng/ml and 0.71±0.04 ng/ml respectively, P value= 0.00). A serum procalcitonin level> 0.5 ng/ml had high sensitivity and specificity (90.1% and 97.1% respectively) in the diagnosis of bacterial meningitis.Conclusion: CSF procalcitonin level seems to be a valuable marker in differentiating between bacterial and viral meningitis.

The stated basic goal of regional TRADE organizations (agreements) is reducing tariff barriers and improving welfare at the regional level. But there are serious questions regarding the effect of these agrreements on TRADE in member versus non-member countries If the agreement yields positive TRADE effect in member countries, the phenomenon is called “TRADE creation". If this positive effect comes at the expense of negative effect on non-member countries, the phenomenon is called “TRADE diversion”. TRADE creation is welfare improving, while TRADE diversion is welfare reducing. This paper is an attempt to measure the extent of TRADE diversion and TRADE creation in three Asian organizations, namely, the Economic Cooperation Organization (ECO), Persian Gulf Cooperation Council (GCC) and ASEAN. The model used is an extended version of the relatively well known gravity model and a total of 26 member countries were considered for data completion purposes over the time span of 2002-2006. The findings reveal an incidence of TRADE diversion in all three cases, implying that TRADE agreements are welfare reducing. JEL Classification: F51, L42.