Negative Stigma Research Articles

Introducing the ELPIS scale: a novel tool for measuring emotional empathy toward cancer patients.

Empathy, defined as the ability to understand and share another person's feelings, is crucial in the healthcare setting, particularly for patients with cancer who face significant psychosocial challenges. We aimed to develop a novel tool, the Empathy, Life with Cancer, and Psychosocial Skills (ELPIS) Scale that prioritizes emotional and cognitive components in order to determine the reflection of the negative stigmatization of cancer in societies on individuals, excluding the behavioral and ethical dimensions of empathy. The study was conducted using a quantitative research design with a sample of first- and second-year medical students in Türkiye. An initial pool of 48 items was developed based on an extensive review of the literature and existing empathy scales. Following expert review and pilot testing, the scale was refined to 24 items. Exploratory factor analysis and confirmatory factor analysis were conducted to establish the scale's factor structure and validate its reliability and validity. The exploratory factor analysis revealed a three-factor structure comprising "emotional empathy," "sympathetic responses," and "realistic approaches," with a total of 20 items after refinement. Confirmatory factor analysis confirmed the model fit, with the scale demonstrating high internal consistency across all three dimensions. The scale's reliability was further supported by high Cronbach's alpha values. The results suggest that the ELPIS Scale is a reliable and valid instrument for measuring emotional empathy toward cancer patients. It offers a nuanced approach by separately assessing emotional, sympathetic, and realistic components of empathy, making it a valuable tool for both educational and clinical applications. Future research should explore the scale's application in diverse populations and settings, as well as its utility in tracking empathy development over time. In conclusion, the ELPIS Scale, which focuses on the emotional and cognitive components of empathy, a multifaceted construct, fills a critical gap in the measurement of empathy in the context of cancer care and provides a comprehensive tool that can improve both patient care and the education of healthcare providers.

Defensive Behavior and Integumentary Morphology of the Hairy Dwarf Porcupine Coendou spinosus (Rodentia: Erethizontidae).

New World porcupines (Erethizontidae) exhibit behaviors and possess integumentary structures, including the quills, that are used for self-defense. The North American porcupine (Erethizon dorsatum) has been well studied regarding these features; however, information is lacking for the South American Coendou species. We describe the defensive behavior and integumentary morphology of Coendou spinosus to understand the defensive strategies of this species and to compare with those reported for other species. We assessed the behaviors related to warning, defense, and escape of eight porcupines, as well as the characteristics of their pelage and quills. Furthermore, we microscopically analyzed skin samples of a roadkill adult male specimen. Similar to E. dorsatum, C. spinosus exhibited omnidirectional quill erection, revealing an aposematic color and, with their backs toward the perceived human threat, they performed quick tail and body movements to strike the hands of the human trying to capture them by the tail. Furthermore, C. spinosus presented an integumentary structure similar to that of E. dorsatum, and mechanisms to facilitate quill release when touched, penetration, and fixation in the opponent. The most distinct warning behavior noted was the vibration of the quills, which has not been reported for Erethizon. Our study confirms that, like other erethizontids, C. spinosus does not attack but exhibits warning, defense, and escape mechanisms and behaviors when threatened or touched. The dissemination of such information helps to counter the negative stigma associated with porcupines, as they can be the victims of attacks by dogs and humans, and to promote their conservation.

Name and Power Relation to African-American Identity in Ralph Ellison’s Invisible Man

This study aims to explore the relationship between names and African-American identity in Ralph Ellison's Invisible Man. Through a qualitative descriptive analysis, the study investigates how power relations influence the construction of African-American identity in the novel. This study used semiotic approach by applying Charles Sander Peirce’s semiotic theory in examiningg the use of name, as well as sociological approach by applying Michel Foucault's concept of power relations in analyzing power relation to social identity. The findings reveal that names, while significant, are not the sole determinants of African-American identity. The study discovers that, after the Civil War, many African-American characters in the novel chose names of European origin in an attempt to avoid negative racial stigma and discrimination. Instead, the study finds that identity construction is primarily shaped by social categorization and comparison and that power relations play a crucial role in limiting positive representations of African-American identity. This study sheds new light on the relationship between names, power, and African-American identity in literature and provides insights into the ongoing discourse surrounding these important cultural and social issues.

Relationships between stigma, coping styles, self-care and post-traumatic growth among colorectal cancer patients with permanent enterostomy: A cross-sectional study

Post-traumatic growth is a positive outcome that helps buffer the adverse experiences in patients after traumatic enterostomy surgery. This study aimed to investigate post-traumatic growth among patients with permanent enterostomy and explore the relationships between stigma, coping styles, self-care, and post-traumatic growth. Convenience sampling was used to enroll patients who underwent a permanent enterostomy. A total of 305 eligible participants completed self-reported questionnaires on stigma, coping styles, self-care, and post-traumatic growth, respectively. Positive coping style and self-care were positively correlated with post-traumatic growth (p < 0.001), whereas, negative coping style and stigma were negatively correlated with post-traumatic growth (p < 0.001). Serial mediation models revealed that stigma could significantly predict post-traumatic growth through five indirect pathways: (1) positive coping (effect = -0.129); (2) negative coping (effect = -0.051); (3) self-care (effect = -0.115); (4) chain mediation of positive coping and self-care (effect = -0.049); (5) chain mediation of negative coping and self-care (effect = -0.019), accounting for 17.6%, 6.9%, 15.6%, 6.7%, and 2.6% of the total effect, respectively. Our findings demonstrated that coping styles and self-care acted as separate and sequential mediators affecting the relationship between stigma and post-traumatic growth in patients who underwent enterostomy. Therefore, interventional strategies targeting coping styles and self-care may provide synergistic benefits to patients with permanent enterostomy by enhancing their post-traumatic growth.

TRANSFORMASI USAHA SAMPAN PADA KELOMPOK MASYARAKAT SUNGAI MELALUI OTOMATISASI DAN STRATEGI PEMASARAN INOVATIF

Area-based development emphasizes the optimal management of local resources to achieve community welfare. Kampung Beting, Pontianak, has great potential in transportation and river tourism but is hindered by a negative stigma as a center for drug trafficking. Through community service programs, business transformation is applied to the boat mining group with automation, installing waterproof canopies, using solar cell lights, and rebranding. The results show increased operational efficiency, revenue, and a regional image change. Innovative marketing strategies that capitalize on historical and cultural potential have successfully enhanced tourist attraction and local community welfare.

Human Rights and Mental Health: A Review of Current Awareness and Emerging Developments

Human rights are universal fundamental protections worth of all individuals, including those with mental health conditions. However, these rights are often observed violated in mental health care settings, where individuals may face forced treatment, isolation, and degrading conditions. Despite global advocacy efforts, to ensuring that these rights are respected, continues to be a challenge for healthcare professionals and the general public. This review examines the current awareness of human rights among mental health professionals and the public, identifies the knowledge gaps, and highlights the recent developments in policy and practice aimed at improving human rights in mental health care. A comprehensive search of academic databases identified relevant studies published between 2019 and 2024. Findings suggest a promising level of public knowledge about human rights, yet negative attitudes and stigma persist. While improvements in mental health services have been observed among healthcare professionals; resource limitations and a lack of social support remain challenging. A gap between knowledge and practice is evident, necessitating further education and training to ensure a deeper understanding of human rights complexities in mental healthcare. Overall, this review underscores the importance of continued efforts to raise awareness and advocate for the human rights of individuals with mental health conditions. By implementing educational and sensitization programs, a supportive environment can be created that empowers them to seek help without fear of discrimination.

Perlindungan Perlindungan Terhadap Perempuan Korban Kekerasan Berbasis Gender Online Dalam Era Digital

In today’s digital era, sexual violence crimes often occur in cyberspace. Based on the annual records of the National Commission on Violence Against Women, reports of cases of online gender-based violence have increased in the last five years. Cyberspace is currently not a safe space for women. As a basic law, the Indonesian Constitution of 1945 explicitly regulates the right to a sense of security and protection for everyone. The methods used in this study are normative juridical using a legislative approach and a case approach. The purpose of this study is to provide legal arguments regarding whether an event is right or wrong and how the event should be according to law. Based on the results of the study, in law enforcement, law enforcement officers often use the electronic information and transactions law and the pornography law which results in victims being in a vulnerable position. The negative stigma from society and criminalization of victims result in a minimum of cases being resolved through litigation so that victims do not get the right to handling and recovery as mandated by the law on sexual violence. The state must guarantee a safe space for women in cyberspace. The state must carry out its commitment to provide justice and restitution to victims as mandated by law. For the sake of legal certainty, the government must immediately ratify the implementing regulations of the law on sexual violence. Provide socialization to the public regarding the law on sexual violence to increase public legal awareness and improve the competence of law enforcement officers by providing training in handling cases of online gender-based violence.

A randomized controlled trial of targeted vs. General direct-to-consumer marketing to address psychotherapy attitudes and stigma in military service members and Veterans

ABSTRACT Many military service members and Veterans who experience a psychological need do not seek psychotherapy, which may be due to negative attitudes and stigma toward mental health services. In this study, we investigated the effectiveness of a general vs. military-specific direct-to-consumer psychotherapy marketing video to address psychotherapy attitudes in a nationwide sample of military service members and Veterans (N = 262). Participants were randomly assigned to watch a general commercial produced by the American Psychological Association (APA Video), a military-specific commercial produced by the Department of Veteran Affairs (VA Video), or a control video. After watching the video, they were asked to complete measures assessing public and self-stigma, attitudes, intentions, and preferences for psychotherapy. Consistent with our hypotheses, participants in the direct-to-consumer marketing conditions reported experiencing significantly less self-stigma and more positive attitudes and preferences for psychotherapy after watching their videos, compared to participants in the control condition. Participants who viewed the APA video also reported significantly less public stigma than those in the control condition. Contrary to our hypotheses, the targeted VA video did not outperform the general APA video on any of the dependent variables. These results support the use of direct-to-consumer psychotherapy marketing videos, general or targeted, with military service members and Veterans. Limitations and future directions are discussed.

Elevating property management in public housing: A systematic literature review

Public housing (PH) focuses on assisting low-income households with housing stability. However, the inefficiency of property management in PH gives rise to a range of challenges in both physical and internal operational management, leading to negative stigmatisation towards tenants living in PH. Various initiatives have been launched to address the inefficiencies of property management. This study categorised and elaborated these initiatives under three main categories: reconceptualisation, externalisation, and managerialisation. There is currently no systematic literature review that provides a comprehensive overview of the initiatives aimed at enhancing property management in PH on a global scale, despite the fact that an overwhelming number of initiatives have been proposed in various studies. Therefore, the present systematic literature review was conducted to provide a comprehensive understanding of the existing research and initiatives pertinent to PH property management. This thorough examination will not only inform the current state of property management practices but also provide valuable insights to guide future research endeavours and decision-making processes in this domain. The outcome of this study revealed the positive impact of managerialisation, showcasing its pivotal role in problem identification and as a strategic indicator for proposing solutions aimed at continuous improvement.

Development and Validation of a Workshop-Based Educational Module: "Basic Course in Electroconvulsive Therapy" for Medical Students.

Electroconvulsive therapy (ECT) is a safe and effective treatment option for various psychiatric disorders. However, its widespread use is limited by prevalent negative attitudes and stigma, not only within the general public but also among healthcare professionals. This study aimed to develop and validate a workshop-based educational module, titled the "Basic Course in ECT," for medical students. The curriculum development framework was used to develop the educational module. The content of the educational module was developed through expert consensus involving two rounds of the Delphi method. Faculty members provided feedback to validate the workshop content. A total 33 interns participated in the workshop. Student satisfaction was assessed using a feedback questionnaire. Eight content areas were identified through a literature review. The Delphi consensus with 15 experts resulted in 10 topics being incorporated into the educational module. The module demonstrated strong face validity, as indicated by a content validity index of 1. Participants expressed high satisfaction with the workshop module regarding content, teaching methods, and time allocation. Feedback indicated an improvement in knowledge and a positive attitude toward ECT. The "Basic Course in ECT" was developed using expert consensus and validated for use with medical students. It can be integrated into the undergraduate curriculum.

Kiprah KH. Sahal Suhana Tokoh Pendiri Pendidikan Islam Modern di Kabupaten Kuningan Jawa Barat, 1994-2016

Education in Indonesia has a long history of producing intellectual figures from local to national. In the Kuningan region, West Java, there are intellectual figures who are active in the field of education. This thesis aims to find out how KH. Sahal Suhana in driving education in the Kuningan Regency area, West Java in 1994-2016. This research uses historical research methods. The steps include heuristics, verification, interpretation, and historiography. The results of this research are the role of KH. Sahal Suhana, a person who was not born from Kyai descent, was able to take part in becoming a Kyai by becoming the pioneer of the founder of the largest Modern Islamic Education in Kuningan Regency, West Java and growing rapidly, including the Husnul Khotimah Foundation and the Al-Multazam Husnul Khotimah Islam ic Education Foundation. As a pioneer figure who is active in the world of education, he has succeeded in creating new breakthroughs in eliminating the negative stigma of Islamic boarding schools, such as dirty students, dirty water, always wearing sarongs, lagging behind in technology and other problems. In modernizing Islamic education through the Islamic Boarding School KH. Sahal Suhana has succeeded in changing the public's mindset towards the negative stigma of Islamic boarding schools, and in the curriculum has succeeded in developing science and technology for the students, and in terms of facilities and infrastructure has succeeded in completing the foundation's facilities to support learning.

Evaluation of the psychometric properties of the homophobia scale in religious-based university students in Indonesia

This study aims to evaluate the psychometric properties of the homophobia scale in students attending religion-based universities in Indonesia. This research is important as homosexuality is a controversial issue in the country and is still a topic of debate. The Homophobia Scale is a tool that assesses attitudes towards homosexuality through 17 items measuring positive affirmation, negative cognition, and the perceived threat of homosexual behavior. The scale was adapted for the Indonesian context, which is predominantly religious, based on The Heterosexual Attitudes Towards Homosexuality (HATH) Scale and Items, originally translated by bilingual experts. The translated scale was then reviewed for content by psychologists and communication experts, and field-tested for reliability and validity. Data from 327 students aged 18–35 from both state and private religion-based universities were analyzed using Rasch model analyses, including principal component analysis (PCA), reliability analysis, and differential item functioning (DIF) assessment. The study found that the homophobia scale accounted for 42.4 % of the raw variance, indicating its unidimensionality. The scale demonstrated an acceptable level of personal reliability and excellent reliability for individual items. Results revealed significant demographic effects, with age and study program showing more differential item functioning (DIF). Male students were more tolerant towards homosexuals than females. Additionally, students at state universities tended to be more tolerant but held negative views of homosexuality when associated with AIDS. In conclusion, the homophobia scale assessed in this study exhibits promising construct validity and sufficient psychometric properties. The findings indicate that negative stigma towards homosexuals and homophobia still persist among students at religion-based universities in Indonesia, despite limited interaction with homosexuals.

Teladan Misi Yesus Terhadap Kaum Marginal Menurut Injil Lukas dan Implikasinya Bagi Citra Diri Penyandang Disabilitas

The existence of people with disabilities is still not taken into account. Their role and involvement are still doubtful and often receive negative stigma from the community. This makes people with disabilities feel marginalized from the reality of social life because they are considered weak and useless. Biblically speaking, people with disabilities are the ones who have Jesus' attention. Jesus' mission is not reserved for people who are physically healthy and strong, but for people who are sick, suffering, and helpless. In other words, He is God for all people. This article aims to explain how the mission of Jesus, which transcends social boundaries, is influential in shaping a good self-image for people with disabilities and their role in the public space. The research method used is a literature study. This paper certainly aims to emphasize that Jesus' mission applies to everyone so that people with disabilities can also play a role in their limitations with their God-given talents. Keywords: the example of Jesus; the mission of Jesus; disability; self-image; marginalized people; people with disabilities

Implementasi Manajemen Konseling Kesehatan Mental bagi Mahasiswa Institut Teknologi dan Kesehatan Muhammadiyah Kalimantan Barat

Undergraduate students are individuals who experience a transition period that focuses on searching for self-identity. During this transition period, students will experience changes in their behavior, emotions and cognition. This change will affect the mental health status of students. Mental health problems in students are a serious problem to be handled because students' mental health problems are invisible but can have bad consequences if not treated immediately. Negative stigma towards mental health has an impact on students' awareness and initiative to resolve their mental health problems. Students feel embarrassed and think that this mental health problem can heal by itself. In fact, mental health problems will get worse if they are not handled well. The importance of mental health counseling services for students as a medium for early detection of mental health problems. Mental health screening can detect several mental health problems so that existing problems can be prevented and students' mental health status can improve. The role of the academic community is very important to support the existence of mental health counseling services. Moreover, policies and service standards do not yet exist at ITEKES Muhammadiyah West Kalimantan. Thus, this underlies strategic planning activities for mental health services that can be beneficial for students and have an impact on student welfare in maintaining their mental status.

The Role of Islamic Religious Counselors in Providing Premarital Guidance at the Religious Affairs Office of Sultan Daulat District, Subulussalam City, Aceh Province

This study aims to analyze the implementation of premarital guidance at the Religious Affairs Office of Sultan Daulat District, the materials provided in premarital guidance at the Religious Affairs Office of Sultan Daulat District, and the SWOT analysis of premarital guidance at the Religious Affairs Office of Sultan Daulat District. The study used a nautical qualitative approach with data collection techniques in the form of observation, interviews and documentation studies. This study revealed several important findings regarding premarital guidance at the Religious Affairs Office of Sultan Daulat District. The implementation of this guidance follows the requirements for marriage registration in accordance with the latest regulations. Participants were very satisfied with the ease and flexibility of time provided during the guidance, which was arranged according to the agreement between the presenter and participants. Religious counselors showed responsibility and consistency in their duties, making positive contributions to the community by being active in discussions and question and answer sessions. The guidance material was delivered by two groups of presenters: Islamic religious counselors and representatives from the National Population and Family Planning Agency and health agencies. The material covered the management of psychology and family dynamics, reproductive health, and the foundations of a harmonious family. Religious counselors used an independent method in delivering their material. The SWOT analysis shows that religious counselors play a role in reducing the divorce rate in the area. They are also effective in reducing the spread of hoax news about premarital counseling. The guidance methods applied and the flexibility of implementation time help simplify the process and overcome the negative stigma that is often associated with premarital counseling at the Sultan Daulat Religious Affairs Office.

Why do Patients with Severe Mental Illness Smoke Cigarettes?

The disparity in rates of cigarette smoking between patients with severe mental illnesses (SMIs) and the general population is a well-documented phenomenon. With over 30% of tobacco sales annually being accounted for by patients with SMIs, smoking is a significant modifiable risk factor within this population. Previous research has hypothesized that this increased rate of smoking may be linked to genetic predisposition, self-medication, and as a means of coping with the negative stigma towards those with SMI. This study focuses on the motivating factors that drive these patients to start smoking as well as the emotional changes that take place once smoking becomes routine. Qualifying patients included those who currently smoked cigarettes and had a previous diagnosis of an SMI. Two surveys were administered to patients, one of which gathered objective reasons for smoking (i.e. imitation, distraction, pleasure) while the other gathered subjective changes in their emotional states as they continued to smoke (i.e. changes in happiness, calmness, sociability, etc). Our study found that the two primary reasons these patients began smoking were imitation and feelings of calmness while the two primary reasons for continuing to smoke were addiction and habit. Our study also found that patients felt significantly less happy and less sociable now compared to when they first started smoking cigarettes. This data challenges the belief that using cigarettes provides positive emotional reinforcement and can be used by healthcare professionals to create effective cessation strategies that will likely be different than those used for the general population.

Analysis of the effect of Boezem development as flood control in Dukuh Kupang Surabaya

Background: Flooding is a frequent problem in Dukuh Kupang, Surabaya, causing material losses and disrupting daily activities. The construction of boezems, which are retention ponds to temporarily store rainwater, is considered a potential solution to control flooding in this area. This study aims to analyze the effect of boezem construction on flood control in Dukuh Kupang with the hope of providing new insights into the effectiveness of boezem as flood control infrastructure and providing recommendations for improved flood management strategies in the future. Methods: This study used a descriptive method. Data were collected through questionnaires and scored using a Likert scale. Finding: The results revealed that the feasibility score of boezem construction was 60.2%, indicating that boezem construction is considered quite feasible as a flood control solution, but there is still room for improvement. Conclusion: Respondents in this study recognized the benefits of boezem construction, but also expressed concerns or factors that are not yet fully supportive. There is a negative stigma among the community regarding the construction of boezems, which is largely due to the lack of socialization and community participation in the development process. Novelty/Originality of this study: A study on the effectiveness of booze in Surabaya evaluates technical aspects and considers community perceptions, providing a holistic approach to assessing flood control infrastructure.

Meminimalisir Terjadinya Disparitas Pidana Dengan Kitab Undang-Undang Hukum Pidana Nasional

Criminal problems recognize the existence of an inequality in the provision of criminal sentences which is called disparity. Criminal disparity is a different or unequal criminal implementation for criminals who commit similar or similar criminal acts. Criminal disparities will become a problem in the future if they are related to administrative education. Where the perpetrator will make a comparison regarding the crime that other people can afford. There will be an incident of injustice regarding criminal differences which will have implications for negative stigma by prisoners and the community which will strengthen judicial injustice in determining the imposition of criminal decisions. In this case, there are many aspects that cause criminal disparities. Criminal problems recognize the existence of an inequality in the provision of criminal sentences which is called disparity. Criminal disparity is a different or unequal criminal implementation for criminals who commit similar or similar criminal acts. Criminal disparities will become a problem in the future if they are related to administrative education. Where the perpetrator will make a comparison regarding the crime that other people can afford. There will be an incident of injustice regarding criminal differences which will have implications for negative stigma by prisoners and the community which will strengthen judicial injustice in determining the imposition of criminal decisions. In this case, there are many aspects that cause criminal disparities.

Exploring the construction of masculinity among male K-POP fans: a case study of K-POP fandom in Makassar City within the context of social environmet and education

Background: In contemporary Indonesian society, K-Pop has emerged as a significant cultural phenomenon with a unique impact on gender perceptions. This study aims to explore the social construction of masculinity among K-Pop fanboys in Makassar, Indonesia, and examine the societal positioning of this form of masculinity. It draws on the definition of masculinity as a societal construct and examines how masculinity is shaped by social influences. Method: Utilizing Peter L. Berger and Thomas Luckmann's theory of social construction, the study views masculinity as a dynamic process involving externalization, objectivation, and internalization. It also references Janet Saltzman Chafetz's identification of areas of masculinity and R.W. Connell's concept of hegemonic masculinity to understand the hierarchical nature of masculine identities. Findings: Despite the popularity of K-Pop, male fans often face negative stigma and discrimination due to perceptions of K-Pop as feminine. The study reveals how masculinity is constructed among K-Pop fanboys in Makassar and their experiences of societal discrimination. Conclusion: By analyzing these dynamics, the study contributes to a broader understanding of the diverse forms of masculinity and the impact of cultural phenomena like K-Pop on gender constructs. Novelty/Originality of this study: This study highlights the unique dynamics in the construction of masculinity among male K-Pop fans in Indonesia, revealing the complex interactions between global culture, local gender identities, and social stigma. By applying social construction theory to the K-Pop phenomenon, this study opens up new perspectives in understanding the evolution of masculinity in the era of pop culture globalization.

THE RELATIONSHIP BETWEEN THE IMPLEMENTATION OF QUALITY COSTS AND EFFORTS TO IMPROVE PRODUCT QUALITY (A CASE STUDY AT PT INDUSTRI JAMU DAN FARMASI SIDO MUNCUL TBK)

The use of herbal medicine products has seen a decline in trust due to a lack of scientific evidence proving their effectiveness, perceptions of unsafe or unhygienic ingredients, and the negative stigma that views herbal medicine as an outdated form of treatment. However, herbal medicine is believed to have fewer side effects due to the use of natural ingredients passed down through generations. Despite this, many herbal products with chemical ingredients and easily accessible imported herbal products negatively impact the development of traditional herbal medicines, especially in small-scale industries that lack standardization in line with Good Traditional Medicine Manufacturing Practices. Quality costs are the expenses incurred to perform all activities related to the development of product quality. These costs include prevention, appraisal, internal failure, and external failure costs. Quality costs serve as an indicator of product quality success and competitive advantage. PT Industri Jamu dan Farmasi Sido Muncul, the largest herbal medicine producer in Indonesia, strives to improve product quality through consistent supervision and quality enhancement. This study employs a case study method to analyze the relationship between the implementation of quality costs and efforts to improve product quality at PT Sido Muncul. The findings indicate that effective quality cost control contributes to product quality improvement, reduces defective products, lowers costs, and increases profits. Sido Muncul emphasizes the use of science, technology, and research to create high-quality products. Thus, significant investments in product quality improvement provide the company with a competitive advantage, enabling it to maintain and increase its market share. Keywords: Cost Concept, Product Quality, Quality Costs