Low level laser Therapy in Treatment of Androgenic Alopecia - Free Essay Example

ABSTRACT Alopecia is a common disease affecting more than half of the world population. Alopecia exists in different types. One of the common types of Alopecia diseases is the Androgenic Alopecia. A recent research has shown this type of Alopecia disease to have been affected approximately fifty-one percent of the total number of males of between the ages of forty and seventy-five years. This type of alopecia is more common in females who are above the age of sixty-five years. Despite the widespread of this disease, much has not been done regarding identifying the possible drugs for treating the disease. Currently, there are only two possible medications that have been scientifically approved to cure this disease. These medications include finasteride and minoxidil (1).Another possible form of medication that has been proposed for the treatment of this disease has been the case of hair transplanting. This treatment entails the transplanting of hair from a person who is not affected by the person who is affected by the disease. This research paper tries to evidence the effectiveness of using the low-level laser therapy commonly abbreviated as LLLT as a possible treatment for Androgenetic alopecia. Moreover, the paper is going to discuss the other possible mechanisms for the treatment of the hair loss. Despite the new possible treatment options available for treatment of different types of hair loss, there is a need for the invention of more efficient management and treatment options that are less costly, environmentally friendly and most importantly human consumption friendly. Due to the recent evaluation that low-level laser therapy stimulated hair growth, (2), this research paper reviewed the current possible evidence on the effects of the use of low-level laser therapy. Evidence –supported approach has been employed with much focus directed towards randomized controlled studies. The evidence-supported approach critically evaluates the effects of low-level laser therapy taking all the possible fact ors into consideration. Some earlier studies had shown that the use of low-level laser therapy stimulates hair growth. in research carried out when mice were treated with chemotherapy which was induced by the alopecia and also the other type of alopecia called alopecia areata (2). The researchers hypothesized that the primary mechanism of treating Androgenetic alopecia as the stimulation of the epidermal stem cells. The epidermal stem cells are located in the hair follicle. These epidermal stem cells make the hair follicle to bulge and shift them into the antigen phase (11). This is because hair growth in both men and women appears to be both efficient and much safer. INTRODUCTION A lot of information has been generated concerning the use of laser technology in the treatment of diseases. It is well known that the use of red or near infrared light promotes the mechanism of tissue repairing while the use of low-intensity light which is called low-level laser therapy abbreviated as LLLT stimulates cell activities within the body of an organism. Since the discovery of laser in the mid of the nineteenth century, tremendous interests have been made towards its use in the treatment of diseases. The recent discovery has shown that, apart from a low-level laser, AGA can be treated by the alpha-reductase inhibitor finasteride and the antihypertensive minoxidil (1). However, low-level laser technology is commonly used because it not only treats AGA but also used for the cases of transplantation in the surgical medicine. However, the use of low-level laser technology is faced with a number of drawbacks. These drawbacks include limited effectiveness in use of a low-level l aser, cases of unwanted side effects, and the high cost of utilization of this technology (11) hence making it not readily available to many people. Androgenetic Alopecia (AGA) has been commonly recognized to have a high negative impact on the patients’ life. As such, this contributes to the adverse effects and thus affecting the quality of life and their psychological setting (1). According to the research carried out by Monck et al, (2014, 405), it is revealed that a number of women affected by the Androgenetic Alopecia reported being discontented with the idea of the appearance and concern about the loss of hair on their head. Moreover, these women are also about the fear of other people noticing their loss of hair. The emotional aspects of these women have been ranked high. This includes self-consciousness, embarrassment and also the feeling of being not able to control and stop the act of them losing hair. The patients’ expectations should be put into consideration when anticipating when to use these devices in the treatment of Androgenetic Alopecia (11).The following photographs show the condition of AGA that occurs in a large population. LITERATURE REVIEW Hair and types of Hair loss Human hair is considered to be one of the fastest growing body tissues. The hair follicle, which is one of the features that give mammals a unique characteristic, mainly represents a cell-rich stem, prototypic neuroectodermal-mesodermal interaction system (16). The hair follicles go through regenerative cycles that are said to be repetitive. Each of these regenerative cycles has three stages; anagen, catagen, and telogen. The anagen stage is the rapidly growing stage and the most active among the three stages. The catagen stage is also known as the physiological involution stage is an apoptosis-driven regression stage. The telogen stage is the resting stage and which is accompanied by little cell growth (8). The region of the outer root sheath which is located beneath the sebaceous glands is mainly made up of bulge stem cells which then concede with the point of support with the arrestor pili muscle (16). As the cell growth develops from telogen stage to anagen stage, the activation of these bulge epithelial is tightly controlled and also at the same time transient amplifying progeny cells are given rise from the secondary hair germ cells (10). A robust proliferation of the TA cells takes place throughout the anagen phase in the epithelial matrix of the hair follicle. The proliferating trichocysts then terminate in a differential manner giving rise to the formation of bulk hair filaments which becomes the final product of the hair cycle (16). The most common hair loss in men is the Androgenetic Alopecia (AGA) contributing to around 50% hair loss to male population (4). This type of hair loss refers to the hair loss that occurs in those individuals who are genetically susceptible. The hair loss is caused by the effects of androgens which includes testosterone as well as its derivative dihydrotestosterone (DHT). Testosterone can be defined as a lipophilic compound with the ability to diffuse across the cell membrane. This hormone is then converted to DHT by a cytoplasmic enzyme which is more active than before. These types of reductase are of two types namely type 1 which is found in the keratinocytes, sweat glands, sebocytes as well as in the fibroblasts (10). Type 2 is then found in the skin as well as in the inner root sheath of the hair follicle. The DHT then causes binding of the nuclear androgen receptor which regulates the rate of gene expression (4). Disruption of the epithelial progenitor as well as TA cell prolife ration due to abnormal levels of androgens signaling forms the important pathophysiological component of the above condition. This component then leads to the continuous miniaturization of sensitive terminal hair follicles as well as their conversions to vellus hair follicles (4). The other forms of hair loss include Alopecia Areata (AA), chemo-therapy-induced alopecia as well as telogen effluvium (TE). LLLT for Prevention and reversal of Hair Loss Research on the carcinogenic potential of the lasers was started back in the 1960s. A low power ruby laser of measurement 694 nm on the mice was used. The mice were shaved in such a way that they were the part of the experimental protocol. The research showed that the laser did not cause cancer but instead it caused an improvement of the hair growth around the region on the back of the animal (10). This was the first demonstration to be done and it opened a pathway in the photo-biostimulation pathway of medicine field (4). The increase in the hair density, the color of the hair as well as the combination of these variables has been confirmed at those sites that have been treated for the removal of hair. This occurrence is known as Paradoxical hypertrichosis (16). The incidence of occurrence of this phenomenon varies from 0.6% to about 10% for a given group of people. Terminalization is a term given to a situation whereby small vellus hairs are transformed into larger terminal hairs together with low fluency diode laser treatment (10). Although the temperature that is released by the laser is lower than that necessary to cause thermolysis of hair follicles, it is enough to induce follicular stem cell proliferation. This temperature may also cause an increase of the level of the heat shock proteins which is very important in regulating the level of the heat shock proteins. The laser also causes sub-therapeutic injury which can lead to the cycling of the cells (10). LLLT for hair regrowth FDA approved LLLT as an appropriate safe treatment to both male and female patients who has pattern loss (4). Laser photography stimulates anagen phase re-entry in the telogen hair follicles, increase the duration of the anagen phase, activate the anagen hair follicles and also prevent premature development of catagen (8). Although the mechanism that is used in the LLLT is not well known, what is well know is that LLLT acts on the mitochondria and in one way or another it may change the functioning of the cell metabolism through a process known as photo dissociation of the nitric oxide. This process acts as an inhibitory and it arises from cytochrome c oxidase (CCO) (8).   LLLT may also cause an increase in production of ATP and allow induction of the transcription factors to take place. These transcription factors include factors such as hypoxia-inducible factor-1, nuclear factor cover as well as oxygen modulation of reactive species (16). These effects are of major concern especially for the health of the patients. As such, they need to be addressed keenly in order to solve these problems. The transcription factors cause protein synthesis that triggers other effects down the stream. These effects include alteration of the cytokines levels, increase of the oxygenation of the tissues, increase of cell proliferation as well as inflammatory mediators (9). The working mechanism of these transcription factors has some similarities with that of minoxidil. Minoxidil contains an N-oxide group that can release NO. NO is considered to be an important cellular signaling molecule that takes place in many pathological as well as physiological processes (8). The product is also a vasodilator. Minoxidil is also sensitive to ATP especially the ATP K which acts as a channel opener. Minoxidil responses to ATP K by causing an increase in the hyperpolarization of the cell membranes (16). As such, these issues need to be seriously addressed which calls for further study to be carried out in order to increase the efficiency of how they are evaluated. THE MECHANISM ACTION OF LLLT The use of low-level laser technology has been recently suggested to be an alternative treatment for preventing hair loss and also in the stimulation of growth of hair in both the cases of Female Pattern Hair Loss (FPHL) and Male Pattern Hair Loss) MPHL. The use of this type of technology has been argued to produce better outcomes and also cause minimal risk to patients (14).The use of low laser therapy is known to stimulate; the re-entry of anagen into the hair follicles, the prolongation of the anagen period, the increase in the frequency of proliferation that occurs in the case of the active anagen hair follicles and lastly prevent the early and premature development of catagen (Hopkins et al., 2004, 102). The use of LLLT acts on the mitochondria alters the rate of cell metabolism that occurs through the photo-dissociation of the inhibitory nitric oxide from CCO such as cytochrome oxidase (12) This acts increases production of the ATP which affect the modulation of the number of t he oxygen species present (14) and the induction of the transcription factors, for example, kappa B and hypoxia-inducible factor-one (1). These transcription factors help activate the synthesis of proteins thus triggering further the factor-down-effects such as the increased cell proliferation and migration, the alteration in terms of the levels of cytokines, the increase in the number of growth factors and the inflammatory mediators and an increased rate of tissue oxygenation(15). NO is known to be a potent vasodilator via its effects on cyclic guanine monophosphate production (14) Moreover, the use of LLLT   has been argued to cause the photo-dissociation of the nitric oxide not only from the CCO (12)   but also the intracellular stores such as the two goblin forms of the nitrosylated i.e. The hemoglobin and myoglobin thus leading to vasodilatations (15) and the increased blood flow. The result of this is stimulation of hair follicles (2) in patients suffering from AGA. It by this reason that this systematic and meta-analysis research paper aims to evaluate the already available literature on the Androgenetic Alopecia and low-level laser technology specifically in determining whether the use of low-level laser technology is indeed an effective therapy and treatment mechanism for AGA. STEP BY STEP GUIDE ON HOW THE SYSTEMATIC AND META ANALYSIS REVIEWS WERE CONDUCTED Step 1: Clear framing of the questions and the topic of the research review The research problem was specified in a clear and a structured way before the beginning of the research process. Modifications and alterations were only allowed when the outcomes, interventions and the study designs become apparent to the problem under study (Hopkins et al., 2004, 80). Step 2: Identification of the relevant work After the definition of the research problem, the next step involved the identification of the relevant sources, articles and other research papers that talked about the problem. A number of sources both in the digital and printed formats were searched with no language restrictions in mind. Step 3: Assessing the quality of the studies After identification of the relevant resources talking about the problem of the study, general critical appraisal guides, and design –based quality checklists were used to subject the resources to a more refined quality assessment with the help of the use of the (Hopkins et al., 2004, 80). This point by point quality evaluation was utilized for investigating heterogeneity and illuminating choices with respect to the appropriateness of meta-examination. Furthermore, they help in surveying the quality of deductions and making proposals for future research Step 4: Summary of the evidence This step involved the synthesis of the data obtained from the resources. This involved cross tabulations, analysis of the characteristics, the quality, and the effects, and the use of statistical methods in exploring the differences among the studies   (15). In cases where an overall meta-analysis was not possible, subgroup meta-analysis was used. Step 5: Interpretation of the research findings After all the above steps were followed to the latter, there was need to interpret the findings so as to answer the problem of the study. Investigation for heterogeneity helped to decide if the general synopsis can be trusted, and, if not, the impacts seen in superb examinations ought to be utilized for creating derivations. Any suggestions ought to be reviewed by reference to the qualities and shortcomings of the confirmation were stated in this step. METHODS (a)  Ã‚  Ã‚   Literature review, search and the research procedure Studies published up to the year December 31, 2016, were obtained. These reseach were obtained from the medical and health journals websites which include the medicine and health website, Medline, Embase, American Journal of Medicine, the tropical medicine and Health website and the Google scholar homepage. The research focused on reports or journals that talked about Low-level laser technology as a treatment for the Androgenetic Alopecia (Hopkins et al., 2004, 82). Furthermore, the reference lists of the original articles and journals and the review articles were also jotted down for reference and also for quality assurance purposes of this research paper. (b)  Ã‚  Ã‚   The inclusion and the exclusion criteria. To determine which article and journals were to be included in the study process, all the research hits were viewed and screened. After examination of these articles for the relevance and the possibility of them being included in the study was done, those articles which were potentially relevant were then read thoroughly and fully analyzed to determine the possibility and the eligibility for them being included in the final inclusion. Those articles that seemed not to provide enough relevant studies on the use of LLLT for treatment of AGA were excluded from the list. Articles and journals were marked as eligible for inclusion if they at least satisfied two of the following criteria proposed by (13) In the article, there were adults included in the study of the Androgenetic Alopecia (AGA) The article in its study investigated at least one type of the low level laser technology (LLLT) The article must have been written in English for us to critically review it. The article must have been written on or before 31st December 2016. (c)  Ã‚  Ã‚   The study quality assessment To ensure the achievement of quality results, the study was divided accordingly using a criterion referred to us as the Cochrane Based Medicine pyramid. This division criterion allows the study designs with the greater or strong evidence to be ranked at the top. To prevent the risk of bias from happening when assessing the quality of the study, the evaluation of the following study design characteristics was taken into consideration. Blinding of outcome assessment for example through the use of a computer software for the outcome assignment Randomization of the group assignment to reduce bias The investigator and subject blinding of the group given assignment and The standardization of the outcome assessments such as through the provision of the same lighting to all the sample subjects, the use of the same head hair position, use of the same hair style when assessing hair count among many others (d)  Ã‚  Ã‚   Data extraction To minimize the chances of bias, the data regarding the study design, the type of the intervention and the outcome were independently extracted by the reviewers. The study design characteristics were extracted using the outlines stipulated in the Agency for healthcare and research Quality’s manuscript (13). These agency outlines down the essential and necessary study elements that are both critical and also important when incorporating and designing the study assessment tool. The assessment is suitable for use in the randomized controlled trials abbreviated as RCTs and also that are suitable for use in the observational studies (Hopkins et al., 2004, 90). In this research, the following study characteristics were recorded; Study designs which include case reports, case series, randomized control trials, prospective cohort study, and retrospective cohort study Blinding and The number of participants to be used as the sample size. RESULTS Study selection procedure From the literature review study, a total of one hundred and sixty-two studies were reviewed. From that number, fifteen of the studies were strongly relevant based on their title and also the data from the abstracts. Among these fifteen related and relevant titles and abstracts, two out of the fifteen titles investigated animals (2).   Other two studies out of the fifteen did not study the Androgenetic Alopecia (AGA).This left us with only eleven possible studies. After a further evaluation, one was found to be a case report. Another study was a case series and four others were found to be cohort studies. The remaining five were randomized controlled trials (RCTs) The study characteristics The studies yielded a total of four hundred and forty-four males and a total of two hundred and forty-six females. From the eleven possible studies, nine of them exclusively used the wavelength ranging between 625nm and 655nm (5) where the most popular wavelength was being 650nm.One of the remaining studies utilized a wavelength of between 650nm and 780 nm (15). The remaining study did not specify the amount of wavelength of the laser device used in the survey. Moreover, an approximate of eighty-one percent of the eleven studies utilized a power setting of 5megawatts and lower while at the same time one study used a power setting of between 25 and 30MW. The remaining study did not specify the power rating it used during its study (13). Considering the irradiance setting of the laser device used, one out of the eleven studies reported an irradiance environment while the remaining ten did not record their irradiance setting of the laser device they were using. The one study that report ed an irradiance environment, it valued it at 90mW/cm2 (5).Among the eleven studies, only one provided the energy value of the laser device used. That value was at 3.0J per session. Six of the eleven studies utilized a length of time of either twenty-two or twenty-five weeks however the treatment length varied between two months and two years (13). Considering the frequencies per week and the time duration per session, we can say that the differences were negligible. Considering the changes in the hair, a number of different methods were utilized which include the use of the area trichogram (UAT), phototrichogram, global photography, investigator global assessment and without forgetting the use of the direct scalp hair count (2). After this was done, the hair analysis was done by the experts and also with the help of an investigator. Computer software was also used for analysis. Using this different hair analysis and counting tools, a number of outcomes were achieved. However, the important aspect to this research paper is the total hair count, the hair thickness and the tensile strength. Furthermore the study included the secondary outcomes which were aimed at determining the level of the patient’s satisfaction and also the global assessment of the subject under study (14). Study quality control All the randomized controlled trials (RCTs) were done randomly as the name itself suggests. Many observational studies blinded their outcomes assessors. The assessors were blinded through either the side of the patient that received treatment or through the reviewers in chronological order of the way in which the photographs of the scalp were taken. Doing this ensured that the reviewers of the photographs were not aware of which photographs were either pre or post treatment (14). Among the observational groups, two of them did not blind their outcome assessors’. Out of the eleven studies that showed high positive correlation, one showed no signs of standardization in their measurements (13) The important of standardizing the measurements is to ensure that the measurements are comparable. The changes in the hairstyles, the hair color, the lighting and the head positioning during the follow-up studies can result in changes of total number of hair count and the hair strength. Furthermore, the lack of standardization may lead to differences in techniques among the multiple outcome assessors. These technique differences have the potential of causing a measurement bias when a misappropriate number of participants from only one group were evaluated by one of the outcome assessors (2). Although standardization is necessary, in most scenarios, there is no gold standard for the measuring the irradiation parameters. Moreover, there was no standard measurement for the dose used regarding the minutes taken per session, the frequency of the meetings and also the treatment lengths for Androgenetic Alopecia AGA (18). Furthermore, it was hard to assess the studies considering the regime n treatment. Also, there is no standard for the hair analysis criteria thus making it difficult to gauge how best the results were, basing only on the measurement tools that are implemented in each of the studies. THE PRIMARY OUTCOMES Hair count i.e. the hair density Out of the eleven studies which assessed hair count i.e. the hair density as the endpoint, nine of the studies recorded a statistically significant improvement in the way in which both the females and the males’ respondent to the low-level laser therapy treatment (14). Among these, three studies had a positive correlation concerning the results and showed an increase in the hair density on the vertex regions (Hopkins et al., 2004, 104). The three studies also showed an increase in the overall hair count by an estimated ninety percent in the temporal regions and also the vertex. Among the retrospective cohort study, one study found a significant increase regarding the subjects from the previous value of twenty-five to a new value of thirty subjects (18). Considering the randomized control trials (RCTs), five of them recorded an improvement in the hair density when treated using the low-level laser therapy as compared to the sham-treated individuals. A multi-centered randomized control trials which consisted of four trials, discovered that there was an increase in the terminal density of the hairs in both genders averaging to a 16 hairs/cm2 for those who were treated using the LLLT (14) as compared to the control individuals. Another study also revealed an increase in the terminal hair density where the low-level laser therapy group experienced an increase by an average of 20 hairs per cm squared (19) as compared to those subjects who were treated using sham. Similarly, two separate studies in males and females among the eleven studies carried out by the same group of researchers revealed that the subjects treated with LLLT recorded an increase of approximately forty percent in the case of males and an increase of forty-two percent in the case of females compared to the control subjects. Furthermore two out of the eleven studies did not record a statistically significant increase in the number of hair density in their subjects of study when treated with the low level laser therapy. Also one study recorded a no difference between the areas irradiated for a period of six months using the Hair Max Laser Comb device compared to the areas which were non-irradiated in the case of their investigation of two males with the Androgenetic Alopecia. A second study where the subjects were six females and one male showed an increase of 7.8 terminal hairs (11). However this value was statistically insignificant. Among the eleven studies, four of them examined hair thickness following treatment using the low-level laser therapy. Out of these four, two studies demonstrated a significant statistical improvement in the tensile strengths and also the level of the hair thickness. However, the remaining two studies did not find any difference (18).The table below summarizes the primary findings from these systematic and Meta-analysis reviews. From the table, it can be seen that the hair texture for the entire group grew by 0.84 and 1.08 in the case of women alone. For men, it was at 0.58. It is clear from the findings that hair texture growth rate was higher for the case of women than men. This signifies that women responded more positively than men in the use of LLLT. The same case applies for the case of hair loss and also the level of satisfaction. For the case of hair loss, the entire group reduced hair by 0.62. The hair loss for women reduced by 0.55 while that of men reduced by 0.69. The level of satisfaction in terms of the use of LLLT in the treatment of AGA was 0.28 on a four point scale for the whole group. On an individual scale, women were much satisfied at 0.46 compared to men whose satisfaction level was 0.10. In a prospective cohort study which consisted of twenty-eight male subjects and seven female subjects revealed a positive improvement in the tensile strength of approximately eighty percent (1). In the randomized controlled trials, the males who were treated using the low-level laser therapy were found to have a higher mean of the standard of the hair thickness (Hopkins et al., 2004, 45) as compared to those subjects who have been submitted to the treatment using the sham-treated males However, one among the eleven studies did not show any change in the case report of two male patients who were suffering from Androgenetic Alopecia (AGA) while also at the same time, a second study among the eleven studies revealed a no statistical significance when comparing the extent of the hair thickness in their study which involved a number of six females and also one male suffering from Androgenetic Alopecia AGA (1). The results obtained from this study may not be so accurate and thus they are m uch of approximation and averaging. The TOPHAT results Out of the five studies carried out, there were a total number of four hundred and four participants, out of which two hundred and fifty-four participants were male. The rest of the participants were female. All of the participants were using the Hair Max Laser Comb (18). Two RCTs trials and two cohort studies showed positive results. The results implied an increase in the number of hair counts, an increase in the tensile strength, increase in the terminal hair density and also a tremendous decrease in the rate at which hair loss occurred (16).   Furthermore, one study which involved two males as the subjects did not find the HairMax Laser Comb to be an effective treatment method for MPH (16). SECONDARY OUTCOMES To assess the secondary outcomes, five studies were used to determine the level of the patients’ satisfaction and also the subject assessment as a secondary endpoint. Out of these five studies, one study revealed that two patients found the use of the low-level laser treatment as helpful, at the same time two of the patients also were not sure if the use LLLT was necessary or not (2). Also, three patients reported that the use of low-level laser therapy treatment did not help them in one way or another. In another study which consisted of twenty-four male patients, the reviewers found out that approximately eighty-four percent of the subjects to have contended with the results that the use of LLLT provided (5). However, a randomized controlled trials study yielded varying results concerning the use of LLLT for the treatment of Androgenetic Alopecia in both the males and the females (6). One of the trials which used only females as its subject demonstrated that there was a statistically significant improvement in the subjects. For instance, the hair loss and thickness of the strands following the use of low-level laser therapy as compared to those subjects which were under the control experiment improved. The second trial which also contained females only produced results which were statistically insignificant in either of the two categories of subjects (6). The Bar graph below shows how the subjects under study availed themselves for the study during the study duration. Considering the third and the fourth tests which were conjoined showed statistically significant results in the subject perceived thickness and also fullness. However, the overall hair loss improvement did not reach a statistically significant level (12). Another randomized controlled trial found out that relationship between the subject global assessments and also the satisfaction level between the two groups did not reach a statistically significant level. This implies they were no significant differences despite their being positive findings in the primary outcomes earlier discussed above. Other secondary outcomes included patients reporting a slower rate of the hair loss, an overall increase in the hair growth, scalp health, the presence of some level of thickness and also the presence of shine and hair improvements (12). Despite all these findings, the study, however, did not find any statistical significance relating the to the patient’s perception. As such, it never showed if there was an increase in the length of hair growth or even the manageability of the condition in both the males and the females. Costs, safety, and adverse effects From the eleven studies selected, it was discovered that majority of the subjects that were under study did not report any severe or adverse injuries on them although there were a few cases of minor injuries that were reported in some studies (6). Some symptoms of these minor injuries involved headache, skin drying, scalp tenderness, acne, irritations and redness in the head, pruritus and warm sensation in the areas subjected to LLLT among the subjects. Concerning the costs, there are commercially available devices which include the Hair Max Laser Comb, TOPHAT 655 among many others of which their prices vary according to the brand name, quality of the instrument and also according to the model type (6). DISCUSSION The primary aims of this systematic and meta-analysis review research paper was to determine whether the use of low-level laser therapy is an effective therapy for the treatment of the Androgenetic Alopecia (11). The paper also aims to some degree review the expectations the patients should have when they are planning to use these devices. In summary, using the results of the eleven studies which were investigating the safety and also the effectiveness of LLLT showed LLLT was favorable and efficient in the treatment of AGA. At least more than half of the eleven studies showed an improvement in the hair regrowth and also the prevention of the causes of hair loss among the subjects on which the studies were carried out. Furthermore, there was an enough evidence to support this claim since most of the patients reported no severe or adverse effects encountered during their treatment of the Androgenetic Alopecia (7). The great success of this Meta-analysis and systematic research review paper is that to our knowledge the first to systematically review all the evidence which is regarding the use of low-level laser therapy for the treatment of the Androgenetic alopecia. When analyzing the previous reviews concerning the effectiveness of using LLLT for the treatment of the hair loss, all the studies that have investigated the condition of AGA were not included. However, that does not prevent us making the main conclusion that the use of Low-level laser therapy is safe and effective as it is depicted in our results. Out of the eleven studies, two of them did not provide beneficial results using the laser therapy technique. The first of the results found out that there was no significant difference in those areas treated with the help of Hair Max Laser Comb and those areas which were untreated (11). However considering the amount of hair count, both areas showed an increased level in the amount of hai r count and also the level of the hair thickness from the baseline. The Following Bar Graph shows the overall results of the study. The second study yielded results which showed there is an increase in the amount of hair count and also the diameter of the hair shaft after the treatment with the use of the laser therapy technique, however, these increases were statistically insignificant (11). Comparing how the use of the LLLT is relating with the commonly prescribed pharmacological AGA treatments. The meta analysis and systematic review showed that approximately thirty-five of the hair improvements for the patients with a long term use of the finasteride was of the time significantly detected at after around six months however in the case of females, the use of finasteride failed to show improvements in the hair loss especially for those women who were in their postmenopausal. For the women in their premenopausal, it was found to be effective. Taking into considerations the comparisons and the contrasting of the subject assessment with the quantitative results were useful in defining the realistic expectations for the patients who were using the low-level laser therapy (19). A good number of the studies showed a positive assessment of the patients while a few of the studies recorded a negative response concerning the patients satisfaction despite the positive findings realized from the use of LLLT (11).This is clearly shown using the Bar Graph below. From the graph below, it is clear that the number of patients who reported that the use of LLLT for the first time affected them severely and also moderately severely was 35.7% in total whereas those who reported a slight effect was at 31.8% and considering the value of those who did not report any effect on the bodies was 31.5% of the total number of patients treated using LLLT. After thirty days, the proportion of patients affected severely and moderately more severely by us e of LLLT reduced to 18.0% and this value dropped to 5.4% after ninety days. The proportion of those who reported slight and no effects also increased from 45.4% after thirty days to 67.6% after ninety days. The two possible reasons for the existence of this discrepancy between the qualitative and the quantitative can be attributed to the presence of a placebo effect or the effect of the observed changes following the laser device failing to achieve the expectations of the patients thus the negative feedback from the patients concerning its use (12). These research paper has put much emphasis on the importance of setting up achievable goals and expectations for the patients and also when recommending the use of the low-level laser therapy as the possible treatment. In this research paper, the importance of integrating the use of personalized medicine was addressed fully when considering using laser therapy. One of the studies found that patients with an AGA responded best because the amount of the hair that was present in this individuals was much sufficient for the biomodulation while not exceeding the threshold level for which the absorption of the laser was impeded by the existing hairs (17). Another study found out that the older patients/subjects of the experiment experienced a strong linear trend of hair growth as compared to the young subjects (11). Considering the effectiveness, the cost and the safety of these laser devices, it was found out that the majority of the subjects did not report any serious adverse effects (19). One of the studies reported that patients developed basal cell carcinomas on their scalp (11). However, the authors of that article did not equate this condition as relating to the use of laser therapy. Despite these, it was found out that the cost of purchasing these devices is friendly and also advantageous. The reports showed that there is a one-time cost as compared to the cases of medications where one is supposed to purchase the drugs now and then, turning out to be more expensive in the long run (17). Also, the initial cost of purchasing these devices was found to be somehow affordable to a larger population compared that of carrying out hair transplantation (7). The topic of the light sources and the wavelength is also an important part that one needs to understand the use of LLLT. Wavelength, the irradiance measured in watts per square centimeters, the time taken, pulses and the possible coherence and polarization influence the final results produced from the low-level laser treatment. The ideal range for using LLLT ranges between 650nm and 750 nm (12). This range has been proven and used to treat the superficial tissues. Cases of insufficient irradiation can result in there being no results from the LLLT therapy. In other cases, if the irradiation time is too long, then it can inhibit the response thus becoming unreliable (7). The limited and varying information that was available on the parameters and the treatment dose of each study made it difficult to identify the possible patterns that can help identify the possible dissymmetry in the use of LLLT for the treatment of Androgenetic Alopecia. In order to identify the most effective dissy mmetry, a suggestion is made that future studies should incorporate all the irradiation parameters and the treatment done in order to perform a standardized comparison (12). Looking into subject appraisal/persistent fulfillment with quantitative outcomes is helpful for characterizing sensible desires for patients when utilizing LLLT treatment. A few reviews detailed positive subject appraisals, while a couple thinks about did not locate a similar patient fulfillment in spite of positive target discoveries (19). Two conceivable methods of reasoning for the inconsistency between the quantitative and subjective subject results are the nearness of a misleading impact as well as the watched changes taking after laser treatment neglected to meet the desires of the patients. These discoveries stress the significance of setting practical objectives and desires for patients while suggesting LLLT as a conceivable treatment (19). The Androgenetic Alopecia pathogenesis is characterized by a step by step miniaturization of the hair follicle which results in the transformation of the villus of the hair terminal (3). The exact mechanism in which the therapeutic effects on the use of LLLT have on the hair growth and the hair cycle is not clearly elaborated (17). For example, the laser light is thought to be activating of the re-entry of the anagen in the telogen hair follicles. Previous studies have found out those one hundred and eleven genes to be affected by the use of LLLT therapy that coincides with the increase in the rate of proliferation, migration and tissue oxygenation (3). In any research process, there are always limitations. In our meta-analysis and systematic reviews, these challenges included the limited number of studies that have been carried out on the effects of LLLT in the treatment of AGA. Another disadvantage was that there was the lack of research on this same topic using a larger sample size. Most of the articles reviewed were using a smaller sample which may not give the representation of the whole population which is under study that could lead to unreliable results and conclusions (12). Another limitation was the challenge of comparing and contrasting the different AGA treatment methods. It took the research a lot of time and some keenness to come up with conclusive conclusions. The use of various devices was also a limitation as it lacked the consistency thus making it hard to make standardizations (19). These devices include the length of treatment of the subjects, the irradiation parameters used, treatment doses and the treatment fre quencies. Out of the eleven studies selected; six of them reported the existence of a conflict of interest. A suggestion to avoid this conflict of interest will be through the use of large samples (19). CONCLUSION In conclusion, the use of the low-level laser therapy (LLLT) is a promising area that needs to be embraced for use in the treatment of Androgenetic Alopecia (AGA).The use of LLLT if fully utilized can be a better alternative for those individuals who are unwilling to use the medical therapy currently available which is much expensive or the possibility of undergoing through the hair transplantations and the surgical options that are currently available. Many of the results covered in this review showed that there is an overall improvement in the hair regrowth, thickness, the level of the patient’s satisfaction following treatment using the low-level laser therapy technology. The use of LLLT devices is safe and is seen as an effective way of treating AGA. However, more is needed to be done to help identify which patients are suitable and those not suitable for treatment using LLLT (11).Lastly, more extensive research needs to be done in this field so as to help determine which patients are the ideal for this type of treatment and those which are ideal for the alternative treatment methods.

World War I And The Great War - 1829 Words

World War One has been constantly referred to as a watershed point in the history of the Western world. Argue this position by drawing on examples from political, economic and cultural spheres. World War I, also known as the First World War or the Great War, was a global war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918. More than 9 million soldiers and 7 million civilians died as a result of the war.It was one of the deadliest conflicts in history, paving the way for major political changes, including revolutions in many of the nations involved. The war involved all the world s economic great powers, which were assembled in two opposing alliances: the Allies(based on the Triple Entente of the United†¦show more content†¦These were mainly situated along its eastern and western borders. The most important of these concessions was probably the surrender of Alsace-Lorraine to France. The area had been accountable for many disputes between France and Germany for a long time. This area had been bordering the two countries and had been given to Germany following their victory in the Franco-Prussian War in 1871.France though, had always w anted it back. The French Emerging as victorious powers in World War I, they alongside Great Britain jointly controlled Saarland (Alsace-Lorraine) for a period of fifteen years, the whole time exploiting the goods they had ie. coal fields . Also, other parts of Germany were taken and gifted to the newly independent countries of Poland and Denmark. Concurrent with the end of World War I, a socialist revolution broke out across German nation. The German Revolution of 1918-1919 resulted in the creation of the left-leaning Weimar Republic, which lasted until Adolf Hitler s Nazi Party seized power in the early 1930s. It is believed by many historians that Germany s not only defeat in World War One, but the harsh terms imposed by the Treaty of Versailles, candidly prompted the rise of Hitler and the Nazi Party.After the Germans defeat, the Austro-Hungarian Empire was divided into several independent states. Among the most prominent of these independent states were Poland, Czechoslovakia, Yugoslavia,

The Effects Of Child Abuse And Neglect Affect A Child s...

My research question was â€Å"How might the impact of child abuse and neglect affect a child’s growth and development?† †¢ Act of child abuse and neglect results in a child’s harms, including physical, emotional, exploitation or death (S6) †¢ Children are some of the most vulnerable members of our society, because of dependence on others to get their needs met (S6) †¢ Child abuse and neglect is one of Australia’s biggest and most misunderstood social problems. Despite being under-reported, Australian authorities confirmed 40,844 children were abused or neglected in one year alone*. †¢ That’s one child every 13 minutes suffering physical, sexual, emotional abuse or neglect, often by someone they know and should be able to trust; most often in their own home. Thousands of more cases go unreported, and the number of children and young people in out-of-home care is increasing. What is considered child abuse and neglect? (300 words) (S1) (S5) Child abuse and neglect are caused by any types of intentional behaviour by caregivers, adults, adolescents that occur over time and may cause a risk of physical, psychological or emotional injury to a child or young person (S2) (S1) (S5) There are different types of child abuse and neglect including physical, emotional, sexual abuse, physical or emotional neglect. Other forms of child maltreatment include parental mentally illness, incarceration, substance dependence, parental separation or divorce, domestic violence (S7) Neglect isShow MoreRelatedEffects Of Maltreatment On Brain Development And Its Consequences1150 Words   |  5 Pages Effects of Maltreatment on Brain Development and its Consequences Abuse and neglect is , unfortunately, not an unusual occurrence in the lives of young children. The maltreatment that they experience often have harmful long-term effects that depend on many factors. These factors are dependent on the age of the infant/child at the time of the occurrence, the question of whether the abuse was a single event or a ritual norm, and the relationship with and the identity of the abuser, as well as whetherRead MoreIt Is General Knowledge That Being Abused As A Child Will1332 Words   |  6 Pagesabused as a child will leave lasting impressions on them even into their adult life. The severity of the abuse does change how much of an impression was made, but, nonetheless, abuse leaves nothing but negative results. It will affect how children handle issues and communicate with others. It will likely worsen their grades in school and, if the child’s relationship with their parents is still bad, they will continue into a downward spiral later on in life . 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These outrageously large numbers reveal the extent to which child abuse and neglect impact society; however, they do not acknowledge the effect abuse can have on a child’s life and the repercussions that may occur in both the individual’s childhoodRead MoreThe Effect of Child Abuse on The Emotional Development of the Infant1229 Words   |  5 PagesThe Effect of Child Abuse on the Emotional Development of the Infant to Five Years Old in the United States A Review of the Literature Child abuse is one of the most serious issues in the United States today. Child abuse is the physical, emotional/ psychological or sexual maltreatment of a minor. Neglecting a child is another type of abuse, and includes malnutrition, abandonment, and/or inadequate care of a child’s safety. Additionally, any neglectful act can lead to physical or emotional harmRead MoreChild Neglect Is An Unfortunate Reality For Children1297 Words   |  6 Pagesbehavioral development. The most critical integral aspect in this regard is the child’s relationship with his or her parents in the formative years. However, that is not always the case. Neglect-the maltreatment related to the failure to provide needed, age-appropriate care-has a power capability of comprising a child’s development. Child neglect is an unfortunate reality for children in our community. In addition, not only does it negatively impact the child, its repercussions affect people aroundRead MoreChildren Suffer Under The Pressures Of Poverty1617 Words   |  7 PagesChildren Suffer Under the Pressures of Poverty Throughout history Poverty has been a problem that affects the world. There are multiple dimensions that are the result from living at or below the poverty level. Children suffer under the pressures of poverty, they are helpless victims. Poverty does not cause Child Abuse or neglect but it does contribute or exasperates an already dire situation. The effects of poverty rains down on our society like a disease with no plausible cure. Around the worldRead MoreChild Neglect Within The United States1707 Words   |  7 PagesChild neglect refers to the continued failure to offer a child with the necessary protection, and care. Such protection and attention involve the necessities such as food, medical care, clothing, as well as shelter (Conte 7). In addition, lack of proper supervision for the young children for an extended duration of time is also child neglect. There are various signs of possible neglect. These include; inconsistent school attendance, evidence that health care is not being provided for in a child,Read MoreChild Abuse And Neglect Of Children Essay944 Words   |  4 Pages Everyday, approximately 5 children die from abuse and neglect. Child abuse is when a child is physically injured or sexually abused. Sadly, there are many different forms of child abuse and neglect. There is physical abuse, sexual abuse, neglect, substance abuse, and emotional abuse. This abuse is very well known but most people don t realize that the people around you could be in that situation. Imagine being a young child, old enough to understand right from wrong, being abused and having to

The Role Of Alcohol Abuse And Academic Performance

Emerging Adulthood, a stage of human development that takes place during the age of 18 to 25. This is our golden age. This is a time when we are stepping into the real world and fully grow as a human being. This is the most important stage of our life. However, this is also the time when we are in college, where drinking has been glorified as a popular culture. Although people have a good time at parties and such, Alcohol abuse poses a negative effect on our college experience in many different way. During college, men and women are highly exposed to Alcohol use. According to a study from the Center for the Study of Collegiate Mental Health at Penn State University (2009), there is a clear linkage between Alcohol abuse and academic performance. From their result, there is an inverse correlation between student’s Grade Point Average and the amount of Alcohol consumption. Every year, many students face Alcohol problems and eventually drop out of school or even get into life-thre atening situations. My topic and focus are important because it points out the possible outcome of alcohol usage during college and how it will affect our future growth. To give an overview of this paper, I will be discussing how alcohol negatively impacts college students through the four domains of human development. Within human development, there are four domains, cognitive; social; emotional; and physical. I will start with cognitive and follow the order above in the remainder of this paper. TheShow MoreRelated The Problem of Teen Alcoholism in the United States Essay1102 Words   |  5 Pagesmay not in particular. 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Whether these people be their parents, their peers, teachers, or just strangers of the community, they all play huge roles in the young generation’s development, health and their ability to learn. Home-life is important, this may seem obvious, but to some it is all but clear. 1. Students are now spending about 15 percent (1,108 hours) of th eir time at school, which means for younger children who only spend at homeRead MoreEffects Of Depression On College Students1335 Words   |  6 Pagesaffected (Jennifer E. Merrill, 2014). Depression in college tends to lead to alcohol abuse because they are experiencing extreme depression. When college students have depression it affects their ability to perform in academics. 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The Importance Of Effective Communication For Health...

The importance of effective communication for health professionals cannot be overemphasised as communication skills are crucial foundation of health professionals. Communication extremely influences not only the successful patient health treatment outcomes but also the safety, satisfaction and relationship of both the profession and the patient (Kirby, 2010) The context of the recorded video for this essay is about the conversation between a physiotherapist and a young woman who feels pain from her wrist for 1 week. They discuss the patient’s concerns about the process she will be going through to recover her painful wrist. The two communication skills, demonstrated in the video, discussed in this essay are sending congruent verbal and non-verbal messages, and reflecting and paraphrasing of content and feeling to check understanding which both significantly contributed to improve the effectiveness of communication in the video. 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Pros and Cons Erp Free Essays

Akhilesh Nair Deepesh Chatterjee Mithun Vishnu Nikhil Kumar OPEN SOURCE ERP PROS and CONS Contents Introduction3 Commercial and Open Source ERP Software6 Open Source ERP Solution Pros8 Open Source ERP Solution Cons10 Open Source ERP Success Story11 Company Overview11 Issue At Hand11 The Solution11 Results12 The Bottom Line12 Top Open Source ERP Applications to Look Out for13 ?Goodness of Open Source ERP Packages13 ?Open Source ERP Packages13 ?Java-Based Open Source Finance Apps13 ?Latest Developments13 ?GnuCash: The Ultimate Free Open Source Accounting Software14 Introduction Open source ERP is an enterprise resource planning (ERP) software system whose  source code  is made publicly available. The  open source  model allows companies to access the ERP system’s code and customize it using their own IT department instead of paying extra for vendor customization services and licensing, as is typically the case with closed source programs. Open source ERP can be particularly attractive to small to mid-sized businesses (SMBs) that want to upgrade or customize their ERP systems without paying large licensing and support fees. We will write a custom essay sample on Pros and Cons Erp or any similar topic only for you Order Now Open source brings an alternative which addresses many of the key problems of both custom and commercial enterprise software. It begins by offering the user a freely available code base as a starting point. The user can try it for free to see if it meets his needs. There is no risk of upfront licensing fees for software that may not work. If no modifications are required, open source software can be implemented with the same rapid time-to-market as commercial packages. If customizations are required, the user has a head start with an existing code base. Furthermore, he can leverage the expertise of both in-house and open source community developers. An open source project brings with it the domain knowledge and business requirements of many contributing organizations, significantly reducing the specification risk typical of custom software. Open source communities also offer user-developers collaborative help in developing and debugging of his software. The net result is better software in less time. Longer term, open source offers the user the control of custom software and the external resources previously available only with commercial software. With the source code in hand, the user can decide on future support and upgrades. There is no one to â€Å"discontinue† the software for him. At the same time, because the software shares the common roots with open source, he can obtain support and upgrades from the open source community or purchase professional-quality support from a range of vendors in the community. Thus, the risks of becoming â€Å"stranded† due to the loss of vendor support or key employees are significantly reduced with open source. Selection of ERP system Ease/Speed  of  Implementation There exist a sentiment that implementation takes too long. It is hard to state whether proprietary or open source ERP systems are faster and easier to implement. On one hand, open source solutions are, in general, believed to be less user-friendly. On the other hand, ERP vendors (or their partners) implement proprietary ERPs, so there is no clear need for them to make ERP systems easy to install. However, it can be stated that if the ERP system is easier to implement then it would be possible for the ERP vendor to sell more licenses, since it can be assumed that there is a lack of  implementing consultants. Moreover, ease and speed of implementation does not depend only on the graphical user interface and number of settings one needs to select from but  mainly on the amount of required customizations. Further development does not depend only programmer’s speed of writing code but also on requirements collection, their analysis and correct understanding Price Unless the company has the capabilities to implement an open source ERP system and program all the necessary customizations, open source ERP is not really for free. Consultants for open source ERP systems may charge significantly more than e. g. consultants for MS EPR systems, since there are rather only a few of them. On the other hand, an open source ERP system can be a perfect solution for a starting company, which has no established business processes – the company can adapt to the system, i. e. it does not require customization, so consultants need to be hired only to install the system. Another advantage is that an open source ERP system can be adjusted directly to the intended business processes in case at least one of the employees has a good  computer science background Vendor  Support Though this criterion seems to be more important for proprietary ERP systems, since it is customers of proprietary ERP systems, who are locked in with the vendors but on the other hand, they have security that the support exists. In the open source world, this criterion can be interpreted as having a large enough community, which could support the organization implementing a particular open source ERP system. Reliability Vendors providing proprietary ERP systems try to achieve as high reliability as possible but community using an open source ERP system might be able to find errors faster, since it is larger in numbers and each of them tries to make sense of code. While in proprietary ERP system vendor organization, it is always the same people looking into the code, so it is much harder for them to spot a mistake, especially in the code, which was written by them. Ease  of  Use It is unclear whether proprietary or open source ERP systems are easier to use. On one hand, ERP system vendors try to achieve competitive advantage providing ERP systems that are easier to use. On the other hand, open source solutions are, in general, believed to be less user-friendly [51, 52]. But the community of users (with programming skills) is likely to improve the system to the level that is more-or-less acceptable for most of the users. Customization Proprietary ERP systems are often programmed in vendor-specific languages. Companies can be sure that vendors (or their partners) will customize and set up their ERP systems. But it also means that they are locked to the vendor (or its partners). Since open source ERP systems are programmed in widely known programming languages, there is a greater pool of potential programmers, who can do it. Openness of code is not a domain of OSS ERPs anymore. E. g. MS Dynamics AX allows users to change a significant percentage of the code. Integration Customers are often searching for means of integration of their systems/data. Many proprietary ERP systems inherently allow for usage of data warehouses. It is possible that there fewer proprietary than open source ERP systems, which allow for communication to other systems through API. On the other hand, this communication can be solved even by less standard means (through customization). Organizational  Fit Existing ERP systems try to focus on business processes, however it can be suggested that they do not explicitly describe the business processes that are supported. Besides that, ERP systems are not easily adjustable to changes in business processes. Unfortunately, it seems that this is a problem of both open source and proprietary ERP systems. Flexibility Flexibility is required because of rapidly changing environment, which is likely to lead to new business models, which need to be supported without disturbing the end-users and on-going business. This requires an ERP system to have a robust architecture, which would allow for these requirements. Many existing proprietary ERP systems arose from MRP systems through small iterations. So systems, which were created more recently and do not carry this burden, are more likely to be more flexible, which could be the case ith open source ERP systems. Training First, it can be said that the amount of training required depends on the ERP systems  Ã¢â‚¬â€œhow self-explanatory it is and how many functions it offers. Secondly, users of  proprietary ERP systems are more-or-less dependent on the vendor or partner’s related to the specific ERP system. On  the other hand, users of open source ERP  systems may have a hard time to find a consultancy company offering training for a particular system. Latest  Technologies There is no reason why proprietary ERP systems should be better in using latest technology but it is mostly vendors of proprietary ERP systems, who claim that their competitive advance (over other (regardless whether open source or proprietary) ERP systems) is usage of latest technology. Proprietary vendors may promote them more but similar solutions may exist  in the open source world. OpenERP is a full suite of business software, including the following modules: Accounting: Record your operations in a few clicks and manage all your financial activities in one place. Application Builder:   The OpenERP application builder lets you customize every module of OpenERP directly from the web interface without any development required. CRM: Track leads and opportunities customized your sales cycle, controls statistics and forecasts and marketing campaign automation to improve your sales performance. Human Resources:   The module is for personnel information management, leave, time tracking, attendance‚ expenses, payroll, periodic evaluations and recruitment. Invoicing:  Create and supervise your entire supplier and customer invoices. Manufacturing:  Plan and control your supply chain through different applications in the Manufacturing module. Marketing:  Marketing campaigns can help you automate email and email sending, qualify leads and encourage customers to contact the right department. Point of Sale:  The OpenERP touch screen point of sale allows you to manage your shop sales. It’s fully web-based so you don’t need to install or deploy any software. Project Management: Keep track and manage your projects using tasks for short term project execution or plan phases for long term planning. Purchase:  Create and track your purchase orders, manage your suppliers’ info, control your products reception process and check suppliers’ invoices. Warehouse Management:  An inventory management system to easily manage complex needs: tracking stocks of suppliers/customers, full traceability, accounting links, and more. OpenERP supports multi-warehouse management based on hierarchical location structure. Because OpenERP is open source and backed by a large community, you can take advantage of more than 700 OpenERP modules on the  OpenERP Apps website. These applications extend functionality of the ERP software and provide more business apps for things like manufacturing, localization, project management and more. The other benefit to users is that you do not need to use all the business apps. You can choose only the modules that you need for your business from the suite (e. g. just CRM or CRM and invoicing). This keeps your OpenERP tidy and less overwhelming if you do not need all the business apps. You can add additional modules (at no cost) as you need them. Architecture Compiere and ERP5 are two of the top notch open source ERP systems that are widely accepted and implemented. The architecture of an Open Source ERP can be explained using the structured architectural design of compere and a comparison with ERP5. ERP5 offers powerful ERP solution for small businesses. ERP5 was originally developed as apparel industry solution for an organization with more than 300 employees on 5 internationally distributed sites. The special requirements of the apparel industry are mass customization of products and hence the need for handling unstructured and multimedia data. Mass customization means that many variants of a product are possible. The original modules are now generalized as business templates. It has the exact features that include customer relationship management (CRM), production management (MRP), supply chain management (SCM), product design management (PDM), accounting, human resources and e-commerce. For the small businesses, ERP5 has an Express edition which integrates ERP, CRM and KM funtionality. ERP5 uses the open source Python based ZOPE (Z Object Publishing Environment) application server and content management framework as its foundation. The web based Zope Management Interface is used as IDE for developing ERP5 modules. The application server also supports multiple languages, provides a security model, object persistence, and remote object access trough HTTP, XML-RPC and SOAP. ERP5 uses, extends or provides 5 important Zope components: Page Templates implement the web user interface and presentation logic. Workflows are used for the development of various types of decision workflows ERP5Form49 is used for web form development. XMLObjects add synchronization capabilities and autonomous activity (timed, pre- and postcondition triggers) to ERP5- Zope objects. The synchronization of distributed sites is carried out through XML export and import and also supports unreliable communication channels, which are allowed to fail. The duplication of reporting data to a relational database allows simple SQL querying. Compiere is uniquely designed to avoid the duplication of information and the need for synchronization. The design of Compiere allows customization of the application done easily. Modules in compiere include CRM, Quote to Cash, Requisition-to-Pay, Partner Relations Management, Warehouse, Supply Chain Management, Performance Analysis, Double-entry Book-keeping, Work-flow-Management and Web Store. Compiere’s architecture uses a fat Java Client (Java Webstart). The accounting engine is on the application server (JBOSS J2EE container). Thin Web clients are used for web store and some CRM functionality. There is also a beta thin client serving all forms, but it needs further work to be equivalent to the fat client. The used application server supports clustering. No cluster installation is documented. Emails can be sent and files can be attached to documents. Compiere has a built-in reporting engine. A Sourceforge side project provides Jasper Report77 integration. CSV export and import of data is provided by the commercially available migration tool. Other interfaces can be developed in Java using the briefly (Javadoc) documented APIs (application programming interfaces). The database abstraction layer is SQL-centric which was initially developed for Oracle. Commercial and Open Source ERP Software Pricing: – Most open source software is freely distributed with no up-front licensing fees. Further savings come from ease of deployment, training and integration. Companies that implement open source ERP solutions often report a 50% savings over proprietary systems. With free systematic  open source ERP training methodology like SOSE! Site you can own your software for no cost. Commercial ERP is an expensive package and suitable only for bigger corporations. The prices do vary significantly but according to the size of the company and volume of business. In any cases they have been found to be extremely costly irrespective of the quantum in which they are purchased. These packages are not subject to flexibility and molding. Their usage modalities are rarely liberal and cause troubles when they are modified. Hence the deployments also turn out to be costly and inconvenient due to the procedures involved, in the future. Another major allegation against the package is that they consist of lot of  hidden costs. Flexibility: – When you compare commercial and open source ERP, commercial systems are not flexible in nature. They let business with no other choice but to change their way of business. However when it comes to open source ERP everything was decided by the code . Therefore companies can do the necessary modifications in code and without much support from the vendor. Another advantage of open source is that it does not interfere with the regular schedule of the company during the implementation stage. This is a major difference between commercial and open source ERP applications. You should use business software for your needs, you should not change the way of your business to fit into software needs. Duration:- When you study commercial and open source ERP,The time allotted for implementing open source ERP is very less when compared with commercial ERP. The innumerable number of complexions in commercial ERP calls for longer time span. It consumes a lot of time not only during implementation but in every stage of ERP process due to the nature of work involved. With use of SITE  ERP implementation methodology  you can reduce time required for open source ERP to the minimum. Dependence: – When it comes to the question of relying on the vendor the open source ERP owners enjoys a considerable edge than the commercial ERP. Since open source are license free users having full freedom for taking care of needs by themselves. The productivity is also high in open source ERP systems and the failure rates are very low. Results: – Success rate of open source ERP are considerably more compare to proprietary ERP software’s. Read  open source ERP success stories  for more details. Training: – Lots of training is required for using commercial ERP. It calls for lots of investments in terms of time and money. If they don’t give the necessary impetus the results will be poor. Similarly validity of training sessions designed and handled exclusively by the ERP vendor is also debatable. On the other hand Open Source ERP does not require much training. The results are also bound to be effective because the user gets to learn through the process of self training. The company need not spend much on training and makes a minimal utilization of the resources. This is another way of reducing the level of dependence on the ERP vendor. You can get free  online ERP training  with SOSE!. Security: – On comparing commercial and open source ERP applications, Commercial ERP systems are less secure. They are by and large prone to the traps and pitfalls of hackers. Even though open source ERP makes everything transparent and available in the public domain it bring into the notice of user whenever something goes wrong. Visibility: – Few end users change the underlying code of an open source application. But when the need arises, open source provides access to the code to make changes to suit each distributor’s unique business needs. Open source customers enjoy a refreshing level of transparency from their vendors around activities such as bug reporting and fixing and road map planning. Longevity: – Virtually any ERP solution will work well when initially deployed, but time is the true test of every ERP solution and vendor. Unforeseen opportunities will likely drive changes to a business’ objectives and necessitate changes to its ERP solution. Independently, a vendor’s commitment to supporting a solution could change over time. An open source solution with a flexible foundation addresses today’s needs and safeguards the solution’s future. Because the user has the source code, a solution can never be bought or merged out of existence, meaning the investment lasts as long as needed. Independent services for  ERP implementation support  is also available for free with open source ERP. | Conclusion: – Functionality is the top consideration when reviewing ERP solutions, but it should be closely linked with evaluating open source and proprietary options. The demonstrable benefits of open source products reach deep into a company’s infrastructure. You can evaluate and  select business ERP software  which give functionality you need. The differences between  commercial and open source ERP  show the Edge enjoyed by open source ERP players. And independent free ERP trainer likes SOSE! Will help open source ERP to reach people. Open Source ERP Solution Pros * Negligible Investment and Maintenance Costs – Open source ERP solutions hold a big pro in the fact that there are no huge un-front licensing fees, pre-sales cost associated with them, thus, the initial cost of an Open Source ERP solution is usually far less than a comparable proprietary program. There’s minimal dependency on the ERP vendor in most cases. In a study done by Meta Group, where it surveyed 63 companies – including small, medium and large enterprises in a range of industries – it was found that the average cost of implementation of ERP was $15 million, with the highest as $300 million and lowest as $400,000. Commercial ERP also has pre-sales cost associated with them. * Widely customizable – Open Source ERP solutions are highly customizable allowing for companies to mold them to meet specific business process requirements. It is possible because it comes with two versions of code; the compiled version and the un-compiled version. There are a few reasons to do customizations, which are; functionality needed for core competencies, your front or back office systems require the customizations, you want more or less fields, or you have regulatory requirements that require the customization. So, if you need customizations, then by all means you must have them with a clear eye on the who’s who of the support of customizations and financials needed. But, commercial ERP does not provide an easy and inexpensive customization of the ERP software to fit the business model changes whatsoever. Flexibility – Open source ERP gives lots of freedom like free redistribution, freedom to access and modify the source code and freedom for the end user to use it for any purpose they wish to. GPL licensing of Open Source Software enables developer community to rapidly contribute to the software development and enhance features. * Total Cost of Ownership – TCO of Open Source ERP solution may be less given the opti on of virtually free operating systems (Linux)and databases (MySQL) and potentially lower maintenance fees. Independent Integrations – Open Source ERP solutions typically have a wide range of integration formats so that they are employable well with other software components. * Ease of Training – Open source ERP packages come with complete licenses, comprehensive documentation and user manuals, helping the users to learn and understand their usage. No special trainings or consultants may be hired. * Ease with implementation – The implementation can also be carried out separately without disturbing the regular operation of the business. Also, with open source ERP, the customers can do any sort of experimentations even while in production without losing the base or 100% availability. * Shorter implementation timings -The open source ERP packages require considerably shorter implementation time, which is another big positive aspect whereas in case of commercial ERPs , even six months are considered to be short period for implementation * Reduced or no Dependency on ERP Vendor – As the open source ERP packages have proper documentation and user manuals, there is no or reduced dependency on ERP vendor to come and fix the issue. A good programmer can handle the issue in considerably less time. * High Accuracy and Quality – The productivity and accuracy is high in the case of open source ERP systems. Also, the failure rates are often discovered to be on the lower side in comparison to commercial ERP packages. All open software has strong user community which is also very responsive and very knowledgeable. * Open source testing – The open source users in the process of development are able to thoroughly test and 99% of the bugs are reported and highly secure. Except a very few, most of the commercial ERP systems are tested to a decent extent, but still are many security flaws, traps, pitfalls and loop holes, which can be easily harnessed by the hackers. * Handling security – With the ever evolving nature of technology, security has become a problem of the past. And, there are many open source security applications on the market today which can be easily used with open-source ERP, which include; Nessus, Snort, Nagios, SpamAssassin, ClamAV, Open SSL, OpenSSH, Nmap, Ossec HIDS, and Wireshark. Open Source ERP Solution Cons * Risk of over-customization – Delivering customized codes could prove troublesome for some organizations just in case you get into over-done customization and you can’t get out of it. Too many customizations can be a definite issue. * Difficulty in finding implementation and support resources – Open Source ERP solutions also calls for the best and finest programmers of open source  ERP solutions on the code. This may be difficult and may cause higher support costs at times. Compatibility Issues with Proprietary Packages – Some of the open source ERP packages are incompatible with the proprietary products of certain corporations like Microsoft, Oracle, or IBM etc (sometime due to variation in platform used for implementation). * Lack of Dedicated Support from a Specific Vendor – Despite all of the benefits of open source ERP packages, the fear of the failure of open source ERP package during crucial stages of a projec t is considerable driving forces for commercial ERPs where vendors provide dedicate support in lieu of big bucks on licensing costs. Unstructured approach to issue resolution – There are no proper defined product roadmaps and time line as most of the enhancements and bug fixes are done by freelancers and independent consulting companies and developers based on their requirements. * Devoid of feature- richness – Proprietary software are feature-lade and have more features that are not found in the case of open source ERP packages mostly and may be cited helpful by commercial ERP vendors as a tool of ease and productivity. Open Source ERP Success Story Open source ERP has had its own share of successful implementations. There is no better argument for the use of an ERP solution than a testimonial by and organization which has used the system and reaped benefits from what the software has to offer. Let us take a look at a successful implementation that happened at a Danish pharmaceutical firm named Pharma Nord. The implementation was done by a firm by the name Compiere Company Overview Denmark-based Pharma Nord is one of Europe’s largest manufacturers of preventive dietary supplements and herbal remedies. The 500-person company, founded in 1981, develops, manufactures and markets scientifically well-founded dietary supplements, herbal remedies and medical drugs with optimal bio-availability. Pharma Nord’s products are available in 50 countries throughout Europe, Asia and North America. Issue At Hand Due to market success with its initial line of dietary supplements, Pharma Nord was continually expanding its product line and markets served. Growth in the regulated pharmaceutical industry, however, requires precise inventory management to address business and regulatory complexity. Pharma Nord’s ERP solution requirements extended well beyond the standard set of distribution and accounting functionality that performs at a global scale. They viewed the selection of an ERP solution as having a 15-20 year life. For a solution to succeed for more than 15 years, product licensing, ease of customization and confidence in the vendor were as important as out-of-the-box functionality The Solution Pharma Nord uses Compiere to manage its sales orders, invoicing, cash collections, purchasing and accounting for its sales subsidiaries and also to manage receipts and shipments in its warehouses. Pharma Nord liked what they saw in the earliest versions of Compiere in 2001. Using knowledge gained at a Compiere training class, Jacob Pedersen, Compiere Project Manager, completed an initial Compiere deployment in early 2002 focused on a single subsidiary. â€Å"We did it on the basis that we would probably find things that need to change along the way. And we have. It’s been with us, it’s been upgraded and we’ve changed quite a few things. We’ve been able to migrate to new versions of Compiere all the way from 2002 and now we’re here at 2008. I find that quite impressive. Before selecting an ERP solution, Pharma Nord assessed a number of offerings, notably Compiere and Navision. Midway through the evaluation, Navision was acquired by Microsoft. A few months later, the Linux version of Navision was discontinued. These events were eyeopening for Pharma Nord’s information technology and executive teams. The result was an even stronger requi rement for the kind of open source licensing offered by Compiere to ensure Pharma Nord’s long-term ERP success. Services from the Compiere Partner Network and Compiere helped Pharma Nord succeed. For example, the 2001 version of Compiere lacked support for tracking lot/batch numbers and expiry dates—essential functionality for the pharmaceutical industry. Pharma Nord’s sponsorship accelerated the development of this general use functionality. â€Å"We wrote the specification of exactly what the software should be able to do and it was developed by the Compiere team. † – Pedersen Results Seven years after initial deployment, Pharma Nord is still going strong with Compiere. Their database has grown over the years as they’ve added business partners, products and transactions. Having transaction history available for analysis and reporting is a nice benefit from using a single product continuously over time. â€Å"What’s great about Compiere is that everything is stored at the most detailed level,† explained Pedersen. â€Å"So whenever you need to do reporting, you have a number of dimensions to work with. You can combine each product, different sizes, and different countries. All of those will be dimensions. Since you can report and group on these dimensions, you can get the answer you’re looking for by grouping and merging these data afterwards. With its sales and distribution operations productive with Compiere, Pedersen is looking toward the future: â€Å"Pharma Nord is also a manufacturing company. We manufacture all of our products ourselves. We know that Compiere is also working on manufacturing capabilities. † The Bottom Line Several unbelievably productive, efficient and highly secure open source ERP packages are not y et well recognized in the market, most of the customers are still prepared to shell out big bucks on custom commercial ERP packages. This might be due to the credibility that the big ERP producing organizations like SAP and Oracle. In times that are proving increasingly tough for organizations the world over; organizations are taking measures to tighten their operations and keeping stock of each and every penny that is spent; open source ERP packages provide a very robust and cost effective alternative for midsize companies who might not have a big budget allocated to cover their IT requirements. Even the large corporations can cut maintenance costs by making use of these brilliant packages. However, lack of support from a particular vendor is something that the open source ERP packages badly lack, and compatibility issues with other custom third party apps are one of their biggest turn-offs. Open source ERP scores higher than commercial ERP on many aspects. Yet, commercial ERP still have major share in ERP markets. This is because open source products are quite new and people are a bit conservative about choosing ERP software, because if implemented ERP software does not work, then there is serious business trouble. The first adopters of open source ERP were in Latin America, Europe, and Asian countries because of economic reasons. Now, open source ERP is gaining popularity even in US markets and one day, it will be able to challenge the domination of commercial ERP in ERP markets of USA Top Open Source ERP Applications to Look Out for The finance applications, especially the custom ERPs, can be extremely costly and burn big holes in the pockets of business owners, and as such the demand for open source apps in the field of finance has been increasing dramatically. So, let us take a look at the top open source finance applications * Goodness of Open Source ERP Packages Not only do the open source finance packages come totally free of cost, but they are also not dependant on a particular platform. However, the proprietary programs work well on only specific platforms, as they’re designed only for specific needs. As such, even after paying a lot of money on licenses, the proprietary financial packages don’t allow you to work with all platforms and require additional licenses based upon the number of machines on which, the software is used. On the contrary, the open source packages can be used on as many systems as needed, and they work well on all open source platforms like FreeBSD, UNIX, Linux, Solaris etc. * Open Source ERP Packages To cater to the needs of small business owners, countless open source finance packages were developed, such as Adempiere (an ERP Business Suite), GnuCash (a double-entry book-keeping system), ERP5 (a Zope/Python based ERP solution), and the likes of them. Turning the focus towards other popular open source ERP (Enterprise Resource Planning) packages, Compiere, an ERP solution that automates processes like accounting, managing sales orders, inventory, and supply chain is also quite popular, while packages like Grisbi, a single-entry and KMyMoney — a double-entry book-keeping program, have also gained significant levels of popularity. * FriFinans is yet another impressive open source finance application that offers facilities like taking orders, generating invoices, ordering products and doing a lot more. It is still under final stages of development, and isn’t tested completely yet, but even at this stage it looks quite promising. * Java-Based Open Source Finance Apps jFin, JGnash (double-entry book-keeping), JQuantLib (Quantitative Finance API framework), and JStock (stock market software) are some of the popular Java-based open source finance packages that have become extremely popular these days. * Latest Developments Looking at the latest developments,  n21 eBusiness Suite, a web-based ERP/CRM package is quite a powerful open source finance package that has emerged in the market, while  Mifos  Ã¢â‚¬â€ Microfinance Institution management software, Openbravo, and OpenERP have also been recently developed and gained high popularity soon enough. TurboCASH  is a popular double-entry book-keeping for Windows environment, while  GnuCash  is a treat for Linux/Unix/FreeBSD lovers. HomeBank  is an open source application for personal use, and  Marketceterais an open source trading platform for those who’re interested in stock trading, but don’t want to spend any money on using paid tools. Note:  All Linux financial tools are not necessarily free — there are some proprietary packages that require licenses, and don’t come under the GNU/GPL free distribution license, but majority of Linux/UNIX based finance packages are totally free for personal and commercial usage. GnuCash: The Ultimate Free Open Source Accounting Software Primarily coded in C,  GnuCash  is a free open source accounting software, and happens to be a part of the GNU Project. It runs on platforms such as OpenBSD, Solaris, UNIX, Linux, Mac OS X, FreeBSD, and the likes of them. Looking at the features of GnuCash, you’ll discover that the package allows you to perform double-entry bookkeeping, maintenance of Stock/Mutual Fund Portfolios, Scheduled Transact ions, and Mortgage and Loan Repayment Druid. It also offers support to HBCI and Multi-Currency Transaction Handling. GnuCash also comes with Transaction-Import Matching Support, OFX, QIF Import facilities, Small Business Accounting Features and even Multi-User SQL Support, making it an extensive open source finance application. What’s more, GnuCash can also export data to TXF format and can be used in tandem with the tax preparation programs with great ease. You can virtually perform all kinds of finance related tasks with the help of GnuCash. How to cite Pros and Cons Erp, Papers