The political and scientific challenges in evaluating compulsory drug treatment centers in Southeast Asia

BACKGROUND: In Vietnam, like many countries in Southeast Asia, the commonly used approach of center-based compulsory drug treatment (CCT) has been criticized on human rights ground. Meanwhile, community-based voluntary methadone maintenance treatment (MMT) has been implemented for nearly a decade with promising results. Reform-minded leaders have been seeking empirical evidence of the costs and effectiveness associated with these two main treatment modalities. Conducting evaluations of these treatments, especially where randomization is not ethical, presents challenges. The aim of this paper is to discuss political challenges and methodological issues when conducting cost-effectiveness studies within the context of a non-democratic Southeast Asian country. METHODS: A retrospective analysis of the political and scientific challenges that were experienced in the study design, sample size determination, government approval and ethics approvals, participant recruitment, data collection, and determination of sources, and quantification of cost and effectiveness data was undertaken. As a consequence of the non-randomized design, analysis of patient characteristics for both treatment types was undertaken to identify the magnitude of baseline group differences. Concordance between self-reported heroin use and urine drug testing was undertaken to determine the reliability of self-report data in a politically challenging environment. RESULTS: We demonstrate that conducting research around compulsory treatment in a non-democratic society is feasible, yet it is politically challenging and requires navigation between science and politics. We also demonstrate that engagement with the government decision makers in the research conception, implementation, and dissemination of the results increases the likelihood of research evidence being considered for change in a contentious drug policy area. CONCLUSIONS: Local empirical evidence on the comparative cost-effectiveness of CCT and MMT in a Southeast Asian setting is critical to consideration of more holistic, humane, and effective drug-dependence treatment approaches, but the garnering of such evidence is very challenging.Thu Vuong, Nhu Nguyen , Giang Le, Marian Shanahan, Robert Ali and Alison Ritte

Analysis of the Shuttle Orbiter reinforced carbon-carbon oxidation protection system

Reusable, oxidation-protected reinforced carbon-carbon (RCC) has been successfully flown on all Shuttle Orbiter flights. Thermal testing of the silicon carbide-coated RCC to determine its oxidation characteristics has been performed in convective (plasma Arc-Jet) heating facilities. Surface sealant mass loss was characterized as a function of temperature and pressure. High-temperature testing was performed to develop coating recession correlations for predicting performance at the over-temperature flight conditions associated with abort trajectories. Methods for using these test data to establish multi-mission re-use (i.e., mission life) and single mission limits are presented