Journal articles on the topic 'Indonesian imprints'

Abstract Sea surface temperature (SST) variability at intraseasonal time scales across the Indonesian Seas during January 1998–mid-2012 is examined. The intraseasonal variability is most energetic in the Banda and Timor Seas, with a standard deviation of 0.4°–0.5°C, representing 55%–60% of total nonseasonal SST variance. A slab ocean model demonstrates that intraseasonal air–sea heat flux variability, largely attributed to the Madden–Julian oscillation (MJO), accounts for 69%–78% intraseasonal SST variability in the Banda and Timor Seas. While the slab ocean model accurately reproduces the observed intraseasonal SST variations during the northern winter months, it underestimates the summer variability. The authors posit that this is a consequence of a more vigorous cooling effect induced by ocean processes during the summer. Two strong MJO cycles occurred in late 2007–early 2008, and their imprints were clearly evident in the SST of the Banda and Timor Seas. The passive phase of the MJO [enhanced outgoing longwave radiation (OLR) and weak zonal wind stress) projects on SST as a warming period, while the active phase (suppressed OLR and westerly wind bursts) projects on SST as a cooling phase. SST also displays significant intraseasonal variations in the Sulawesi Sea, but these differ in characteristics from those of the Banda and Timor Seas and are attributed to ocean eddies and atmospheric processes independent from the MJO.

Without us knowing, it turns out that Indonesia has been following quite a long time in globalization. There have been many changes that have occurred, starting from the cultural, political, economic system, transportation, lifestyle, especially in the field of technology, and many more. Globalization does have a good influence on Indonesia, but it cannot be denied, globalization also has a bad influence. We can see the culture of westernized life is already widespread among Indonesian people. One of them is selfishness and self harm and is detrimental to the interests of others. A concrete example of this is the act of corruption that seems to have been entrenched in Indonesia. And most of these acts of corruption are actually carried out by people who hold important positions of government, both from the legislative, executive, and judiciary institutions, where they should have received sufficiently higher education and have sufficiently understood that acts of corruption are acts of violation existing community laws and norms. Seeing the current condition of Indonesia, our nation needs future leaders who are free from corruption. Therefore, the nation's children are the hope of the next generation who will later hold the Indonesian government. This anti-corruption character is very good to be instilled in children at an early age of course they start from simple things. This article has been compiled with the aim of exploring ways to develop an anti-corruption culture, especially for Indonesian children at an early age. With the anti-corruption character that has been imprinted in itself since early, it is not impossible that Indonesia will be free from corruption in the future.

The trend of horror genre has spread towards Indonesian literature, marked by the emergence of light noves for teenagers aged 13-18 under the label of Fantasteen, an imprint of DAR! Mizan starting in 2011, a division of PT Mizan Pustaka, one of the biggest publishing companies in Indonesia. Among various printed Fantasteen light novels, the Ghost Dormitory series became the most prominent work as each story is set in one foreign city such as Tanzania, Den Haag, etc. The study reveals the interconnecting phenomenon between literary works and commercial ways through the perspective of Pierre Bourdieu’s the field of cultural production and Tzvetan Todorov’s Fantastic theory. Using a qualitative method, this article proves that DAR! Mizan has successfully achieved popular legitimation owing to the rising horror-themed light novels which are presented through Fantasteen brand, written by teenagers and also targeted for young readers. With the rise of the special series Ghost Dormitory among other Fantasteen works, the result of the study shows that as one of the major publishers, DAR! Mizan has successfully conducted a strategy to influnce the face of the Indonesian teenage literary world which is presenting a horror genre as its main theme.

This article discusses the possibility of re-evoking and invigorating romantic spirits to reiterate Indonesian national identity. This commences from the fact that despite its comparatively young age, Indonesia has experienced a number of heroic and romantic struggles, notable in our national history; for instance, the “national awakening movement” Boedi Oetomo in 1908, which became the first modern symbol of national struggle in Indonesia, the Sumpah Pemuda in 1928, which instilled in the youth's mind the three factors in common as our national identity, which binds our multi-cultural existence and experiences i.e. the unity of territory, language, and nation; and the third is Indonesian Declaration of Independence, 17th of August 1945. This study starts from the assumption that those three symbols of struggle and identity are imprinted with romantic spirits, i.e. the sentimental feelings and emotions, which are no longer dealing with the worldly and materialistic considerations. In this discussion, one might question whether Indonesia has ever experienced any romantic movement as what European countries and America had in the end of the 18th century, yet that might not be so critical question in this case. Instead, what might be considered more important is another question such as, “do we need that kind of movement nowadays in order to clearly pronounce our identity?” By careful readings, observations and interpretations based on historiography and other references, this article sees that an attempt to give birth to our own Romanticism might be feasible as a good solution to rebuild our nationalism, since it also deals with recognizing and recalling our lost identity.

After Indonesia became an independent country, not a few experiences conflicts that cause controversy. The year 1998 became one of the unforgettable years because of the riots that caused many victims and led to an attack aimed at the ethnic Tionghoa. Until now, the tragedy is still a question mark because there is no party willing to give responsibility or compensation for the riots that occurred. This paper is the result of a literature review that explains the riots that occurred in 1998 regarding the tragedy of the ethnic Tionghoa in Jakarta. The purpose of this paper is to examine how the ethnic Tionghoa tragedy in Jakarta began from the background, how the incident occurred, to the impact until now of the 1998 incident. The research method used is descriptive method. The riot that occurred 24 years ago resulted in the emergence of discrimination and bad prejudice, even the incident still brought up trauma that imprinted. Even so far, the perspective of Indonesian people on Tinghoa ethnic.

Background: Sentinel lymph node biopsy (SLNB) is now the gold standard procedure for early breast cancer with clinically negative lymph nodes (N0). According to the Indonesian Board-Certified oncologist surgeon, the learning curve for evaluating fellow breast surgeons to achieve this competency could have been shorter due to the COVID-19 pandemic. This study aims to see if the learning curve for sentinel lymph node (SLN) identification can be shortened and if imprint cytology (IC) can replace frozen sections (FS) for intraoperative analysis. Methods: Fellow breast surgeons were taught to perform SLNB on breast cancer patients. Intraoperative assessment and completion of axillary lymph node dissection (ALND) were performed in the first setting for standardization with the attending surgeon. Sentinel lymph node (SLN) identification was plotted on cumulative sum chart (CUSUM) limitations for evaluating the variability competency between attending surgeon and fellow surgeon based on a target identification rate of 85%. In addition, the accuracy of imprint cytology versus frozen section for identifying lymph node metastases was compared. Results: Consecutive 50 SLNBs were conducted during this period with attending and trainees split into two groups. After 13 consecutive tests, the CUSUM plot positively identified SLN as a significant achievement level of competency. Imprint cytology was shown to be inferior to frozen section cytology. The accuracy of imprint cytology is 91.8%, while the accuracy of frozen sections is 95.9%. Conclusion: According to a CUSUM chart based on a reasonable set of parameters, the learning curve for SLNB using methylene blue dye is reached after 13 consecutive positively detected SLN. Meanwhile, the frozen section is still the gold standard for determining the disorder of axillary lymph nodes, but the accuracy between the two methods can be comparable.

The national anthem Indonesia Raya, created by Wage Rudolf Supratman, appeared to encourage the struggle for the independence of the Republik Indonesia. Religious zeal accompanied the ideology of nationality to release the archipelago from the grasp of colonialism. The spirit of the warriors imprinted from the holy book of the Koran, really became a shield of power derived from the Creator. The Quran is the preserved holy book of the Almighty, thus being the only source of information and theological inspiration for freedom. Because the ideology of social liberation has been closed by the invaders. The Living Quran is one of the contemporary research methods that requires strengthening in order to be increasingly recognized for its existence as one of the scientific work processes in the field of Quranic Science. This method is rooted in the phenomenology that makes social phenomena the object of study. Along with its increasingly massive development, normative values in the study of interpretation need to be maintained so that the results of their research remain in line with the function of the Quran as a lifeline. The results showed that the lyrics of the national anthem Indonesia Raya, have content derived from verses of the Quran. The incarnation of the spirit of the archipelago in the form of oceans and land, is depicted in the Quran so that the Indonesian people have the power to realize natural management for mutual prosperity. The stories of the prophets and apostles contained in the Quran became a form of social ideology that became the glue of nationality.

Brand name insurance in Indonesia holds fast to the constitutive guideline (enlistment) with the standard of first to document. This implies that an imprint possibly gets security if the imprint is enlisted with the public authority through the Service of Law and Basic freedoms and for this situation is in the Licensed innovation Directorate. Vans is an organization that was established in 1966 as a notable brand that is in extraordinary interest by general society with legitimate insurance as a notable brand. The motivations behind this investigation are 1) To know the methodology for enrolling a brand name as a work to ensure the Vans brand dependent on Law Number 20 of 2016. 2) To know the lawful assurance endeavors against the holder of the Vans brand rights dependent on Law Number 20 of 2016. 3) To realize the hindrances experienced in the brand name enlistment measure Dependent on Law Number 20 of 2016. The exploration approach utilized in this examination is a standardizing juridical methodology. This exploration is engaging examination. The sort of information utilized is auxiliary information utilizing essential, optional and tertiary legitimate materials. This writing research is completed via looking, gathering and examining laws and guidelines and other legitimate materials identified with the object of examination. The information investigation technique utilized elucidating subjective. The consequences of the examination are 1) Vans is a worldwide imprint whose enlistment should go through the Madrid convention. Imprint accommodation through the Madrid Convention is helped out through the DJKI office as the Workplace of Beginning which acts to complete custom actually takes a look at 2) Brand name enrollment will give more grounded security, particularly on the off chance that it clashes with the imprint indistinguishable or comparative 3) Deterrents experienced during the time spent enlisting an imprint Dependent on Law Number 20 of 2016 are government factors, law variables, and local area and social factors just as the execution of Law Number 20 of 2016 concerning marks and geological signs still not compelling. Asuransi nama merek di Indonesia berpegang teguh pada aturan konstitutif (pendaftaran) dengan standar pertama yang didokumentasikan. Ini berarti bahwa suatu jejak mungkin akan mendapatkan jaminan jika cetakan tersebut diberikan kepada otoritas publik melalui Layanan Hukum dan Kebebasan Umum dan untuk situasi ini berada di Direktorat Inovasi Berlisensi. Vans adalah sebuah organisasi yang didirikan pada tahun 1966 sebagai merek terkenal yang sangat diminati oleh masyarakat umum dengan jaminan hukum sebagai merek terkenal. Motivasi yang melatarbelakangi pemeriksaan ini adalah 1) Mengetahui sistem pendaftaran sebagai upaya untuk menjamin ketergantungan merek Vans pada Undang-Undang Nomor 20 Tahun 2016. 2) Mengetahui upaya pengamanan yang sah terhadap pemegang merek Vans berdasarkan Undang-Undang Nomor 20 Tahun 2016. 3) Menyadari permasalahan yang dialami dalam tindakan pendaftaran nama merek Bergantung pada Undang-Undang Nomor 20 Tahun 2016. Pendekatan pemeriksaan yang digunakan dalam penelitian ini adalah metodologi yuridis regularisasi. Pemeriksaan ini adalah eksplorasi yang mencerahkan. Jenis informasi yang digunakan adalah informasi opsional yang menggunakan bahan-bahan sah yang esensial, tambahan, dan tersier. Penelitian penulisan ini dilakukan dengan cara mencari, mengumpulkan dan merenungkan undang-undang dan pedoman-pedoman serta bahan-bahan lain yang sah yang diidentifikasikan dengan objek pemeriksaan. Teknik pemeriksaan informasi menggunakan subyektif yang menarik. Hasil dari pemeriksaan tersebut adalah 1) Vans bersifat global yang pendaftarannya harus melalui konvensi Madrid. Pemanfaatan merek melalui Konvensi Madrid dilakukan melalui kantor DJKI sebagai Tempat Kerja Permulaan yang bertindak untuk melengkapi adat benar-benar terlihat 2) Pendaftaran merek akan memiliki jaminan yang lebih membumi, terutama jika berhadapan dengan merek yang tidak dapat dibedakan atau komparatif 3) Imperatif yang dialami selama pendaftaran nama merek Tergantung pada Undang-Undang Nomor 20 Tahun 2016 adalah variabel pemerintah, daerah setempat dan komponen sosial dan pelaksanaan Undang-Undang Nomor 20 Tahun 2016 tentang merek dan geologi masih belum berhasil.

AbstractDuring the past 220 years, prominent signals of non-sea salt sulfate ion (nssSO42–) concentration exceeding the background level, including both marine biogenic and anthropogenic SO42–, were found in shallow ice cores from site H15 in East Antarctica and Site-J in southern Greenland. They were mostly correlated with past explosive volcanic eruptions. on the basis of this result and published results of shallow ice cores and snow pits at various locations on the Antarctic and Greenland ice sheets, eight common signals were found, of which six were assigned to the following explosive eruptions: El Chichόn, Mexico, in 1982; Agung, Indonesia, in 1963; Santa Maria, Guatemala, in 1902; Krakatau, Indonesia, in 1883; Cosiguina, Nicaragua, in 1835; an unknown volcano between 1831 and 1834; Tambora, Indonesia, in 1815; and an unknown volcano in 1809. Volcanic eruptions which have a potential to imprint their signals in both the Antarctic and Greenland ice sheets were characterized by (1) location in low latitudes between 20˚N and 10˚ S, and (2) eruption column height ≥25 km, corresponding to a volcanic explosivity index (VEI) ≥5.

<p><span lang="EN-US">Implementation of the learning system at Islamic Boarding Schools (<em>Pondok Pesantren – </em>commonly called in Indonesia) usually leaves an imprint in the memory of the students who in turn will make it perspective that can be applied in their everyday lives, both in their ways of thinking and when they make good deeds blessed by the God. In addition, the Islamic Boarding School that plays strategic roles and has long been rooted in the Indonesian society has its own force in arousing the spirit and passion of the students to advance towards more prosperous and independent life. The values learned in the school, in particular its values of self-reliance, have encouraged the <em>santri</em> to practice these values in the society. Coming from such background, this research aims to provide an overview of the boarding schools that teach independent life to the students who in turn, when they graduate, they may empower the community in which they live.</span></p><p><span lang="EN-US">Penerapan sistem pembelajaran di Pondok Pesantren biasanya meninggalkan jejak dalam ingatan para santri yang pada gilirannya akan menjadikannya cara pandang yang dapat diterapkan dalam kehidupan sehari-hari, baik dalam cara berpikirnya. dan ketika mereka melakukan perbuatan baik yang diberkati oleh Tuhan. Selain itu, Pondok Pesantren yang memiliki peran strategis dan telah lama mengakar dalam masyarakat Indonesia memiliki kekuatan tersendiri dalam membangkitkan semangat dan gairah santri untuk maju menuju kehidupan yang lebih sejahtera dan mandiri. Nilai-nilai yang dipelajari di sekolah, khususnya nilai-nilai kemandirian, telah mendorong santri untuk mengamalkan nilai-nilai tersebut di masyarakat. Berangkat dari latar belakang tersebut, penelitian ini bertujuan untuk memberikan gambaran tentang pesantren yang mengajarkan kehidupan mandiri kepada para santrinya yang pada gilirannya kelak ketika mereka lulus dapat memberdayakan masyarakat di mana mereka tinggal.</span></p><p> </p>

The communication strategy is a giver of direction in communication planning with communication management to achieve predetermined goals. Brand awareness is one of the goals that requires a communication strategy because brand awareness is related to the brand's ability to provide an imprint in memory. For a company that has just been established in the last few years, of course, it is a challenge to increase brand awareness among internet service users. Moreover, for the company engaged in internet service which has fierce competition. This research aimed to describe the communication strategy of the first digital internet service provider company in Indonesia to increase brand awareness in internet service users. Through qualitative approach with case research on By.U Indonesia, which was founded in 2019 and claims to be the first digital internet service provider in Indonesia. The result showed that By.U Indonesia is in a brand recognition position where users can recognize By.U Indonesia brand by identifying the visual elements used by By.U Indonesia at each stage and part of the communication strategy. Researchers concluded that Communication Strategy of By.U Indonesia as the first digital internet service provider in Indonesia in increasing brand awareness among internet service users has been shown various developments, proven by the increasing number of downloads of By.U application, and also proven by 7 (seven) awards that achieved from 2020 to 2021. This research impact is to provide overview for newly established companies in planning communication strategy that can boost brand awareness in internet service users

<p>This article discusses the concept of Islamization of knowledge promoted by Ismail Raji Faruqi. This concept aims to defeat secularism that blinds Muslims and brings misfortune. The spread of secularism has encouraged Muslims to make concessions to what the West offers them. Therefore, reading the Islamization of knowledge in the context of scientific integration-interconnection becomes essential to raise awareness among Muslims who are considered to glorify secular science so that people are too far from the concept of tawhid (monotheism). This research used a literature review method through several textual sources related to the topic discussed, primarily Faruqi's work entitled "Islamization of Knowledge," and secondary in the form of similar articles on the theme of Islamization of knowledge. Then, it is to consider the aims and objectives of the Islamization of knowledge, linking it with the concept of integration-interconnection, and considering the contextualization of the Islamization of knowledge in the Indonesian science. The results of this paper are as follows: Islamization of knowledge becomes an inclusive concept if we consider the existence of two disciplines. As a Muslim scientist, the realm of Islamization of knowledge must be imprinted in him to achieve the ideals of Islam. Islamization of knowledge is closely related to integration-interconnection, namely integrating sciences without legitimizing that one science with another cannot be merged. Islamization of knowledge is also a step in creating an Islamic civilization in the world of science. In the context of Indonesia, the Islamization of knowledge can be seen in the concept of science integration in several Islamic universities in Indonesia which has different concepts, but the same essence. The purpose of Faruqi's thought is to demand Muslims to be creative.</p>

Bali is an island and a province with a beautiful culture. Most Balinese are Hinduism. Like in any other country, Balinese Hinduism also adopts the caste system. The caste system in Hinduism means that people are classified based on their social status. Balinese people live in a complex caste system relationship that has continued to exist since the days of the kingdom in Indonesia. This research aims to know the perception of the Balinese local people against the caste system in the modern era. The method used in this research is by interviewing one local Balinese person from each caste who might be related and an expert from each caste, analyzed uy using the perspective of Arjun Appadurai. This research finds that the caste system is no longer a determinant of success in the modern era. However, the caste system still affects the way of communication among the people of Bali, and the imprints can still be found in the daily life of the locals.

This study aimed to examine students' perceptions of an ideal Arabic lecturer’s personality competence. This study used an exploratory approach with the data collection technique deploying an online questionnaire distributed via a Google Form. After completing the online questionnaire, the researchers also selected three students for individual interviews based on their availability and willingness to participate. This study revealed several important findings: First, Arabic language lecturers must act according to the prevailing norms and feel proud of their profession. Second, an Arabic lecturer must be independent in acting without being influenced by interventions from anyone and have a high work ethic. Third, an Arabic lecturer must be neutral in treating students in the classroom. Fourth, an Arabic lecturer must use polite language when delivering materials and not be arrogant, which could create a tense/scary atmosphere during the learning process. Fifth, an Arabic language lecturer must set an example for students, such as getting used to speaking Arabic in everyday life so that students could imprint the lecturer.

The capacity of an interior to adapt and transform through time has imprinted interior with the consequences from its past occupancies. This paper argues that the trace of the past is imprinted within the layers of interior surfaces. The interior surfaces become the medium to trace the inhabitation throughout the life of the building and its interior, from the lens of Anthropocene. In particular this paper attempts to speculate the progression of inhabitation through the interior surface of the buildings in Semarang Old Town, Central Java, Indonesia that are presented through the stories of the facade, the paint and the tiles, and reveal how these layers narrate the idea of the deep time in which the past inhabitation is embedded. These layers of interior surfaces suggest the role of time, continuous transformation, and the traces of inhabitation in affecting and producing the current interior spaces. The understanding of deep time as reflected in the layers of interior surfaces suggests the agency of human inhabitation and culture within the transformation of interior space and highlights the ability of interior space to manoeuvre in time.

Indonesia is widely known as one accumulated national entity consisting of many differences of tribes, cultures and religions. As a result of unity in diversity, Indonesia possessed a significant impact in the history aiming to educate youth generations. The article describes a historical background of the nation running education specifically to build the nation character. Meanwhile based on that reason, the effort to implement trustworthy behaviors through whole aspect of religious characteristics imprinted in the deep heart of the nation. To add some more, Indonesia which is well-known for its addressing religious nation must set up the goal of the nation which is definitely in harmony with the values of religious teachings. The article also provides an effort to educate the nation by focusing and paying great attention to the program of civilizing people. Clearly, the article in detail discusses a successful progress of bulding character education in Indonesia. Besides, this article utilizes analysis methid focusing on causal effectual method correlating Character Education as a result of national character building using literature review model. This article then finds out that there is a similar pattern between bulding nation character and character education. Moreover, the term retrospection is used merely to reflect the implementation of noble values of Indonesia through what is called by education principle. Keywords: Retrospection, Educarion, Character

Abstract The peace process between the Philippine government and the separatist Moro Islamic Liberation Front provided breathing space for many communities and opportunities for calibrated civilian protection practices by the military and non-governmental organisations (ngo s). While the principle of non-intervention largely kept the imprint of the Association of Southeast Asian Nations (asean) to a minimum, Indonesian and Malaysian brokering enabled the establishment of bridging mechanisms such as ceasefire monitoring committees to moderate the armed violence. A more permissive environment allowed ngo s to deliver humanitarian aid and acquire improved capacities for risk mitigation in the Bangsamoro region, aided in part by a shift in the Philippine military’s approach toward putting a premium on civilian consultation and dialogue. Despite these normative gains, the uptick in horizontal violence among rival clans and the military’s preference for the use of artillery fire as a conflict de-escalation strategy create enduring challenges for civilian protection on the ground.

Maintaining collaboration across the whole catfish fisheries supply chain to achieve sustainability is difficult. All participants in the activities must prioritize their financial gains while also considering social growth and environmental responsibility. Jember's catfish fisheries actors come from various educational, social, and psychological backgrounds. Because of this diversity, it is challenging to apply traceability to Jember catfish fishery goods, resulting in a lack of competitiveness in the worldwide market. This study aims to examine current research in the catfish business on sustainable supply chains, collaborative models, and traceability on a large scale. The economic, environmental, and social aspects of sustainability are investigated and a model for a sustainable supply chain. Collaboration in the sustainable catfish supply chain is examined from vertical and horizontal perspectives. According to the findings, few studies have focused on integrated collaboration to establish a long-term supply chain system. The best feature of power to develop the drafting of search data is knowledge. The correctness of the meeting point of upstream search data with downstream traceability can be designed using simple and applicable information that spreads across all lines and is imprinted in consumers from an early age

The Series' trail is a series of web series advertisements created by outdoor equipment products uploaded by Eiger Adventure Indonesia's official Youtube account. Youtube is one of the most common social media platforms accessed by the people of Indonesia. This research is a quantitative study using a survey method with data analysis techniques calculated using SPSS 25 software with skewnes and kurtosis techniques, Pearson correlation coefficient and simple linear regression. Based on the results of the study, the value of the relationship between variables is (0.575) and the value (R) or correlation is (0.591). Through this value it is also known that the value of (R Square) or the coefficient of determination is (0.349) which means there is an influence from watching the web series advertisement version of "Imprint" on Youtube to the buying interest of Eiger products by 34.9% or included in the relationship category " Medium ".

Traumatic experiences in childhood and adolescence based on 65 international studies show that almost 20% of women and 8% of men experience sexual experiences before the age 18. Regarding physical violence in the West and European countries, ranging from 3.6% to 16.3% . In Indonesia alone cases of violence against men and women aged 13-17 years ranged from 13.5% with the dominance of the victims were women. The literature method used is the search for information from several sources of articles, books, journals, which are in accordance with their relation to the problems studied in the discussion of this article. Children and adolescents who experience sexual and physical violence will certainly create trauma or symptoms of PTSD (Post Traumatic Stress Disorder). an imprint that he will carry with him to old age. The right therapy strategy will certainly be faster and more effective to restore their mental health. Several studies have shown that CBT (cognitive behavior therapy) is effective in reducing PTSD symptoms.

Purpose of the study: Language is a productive communication tool for teachers to interact with learners. The use of non-verbal Language in speaking becomes strong support when the speech event takes place. This study aims to determine the elements of kinesics and politeness of the Language of the instructor in learning. Methodology: The method used in this study uses descriptive methods. The subjects involved in the research were one lecturer in Indonesian language courses andMahasaraswati university students who were taking Indonesian language courses. The study was conducted in 6 different classes for three meetings. Main Findings: The results showed that non-verbal Language is inherent and contributes to the application of the instructor’s politeness principle in learning. Utilization of kinesics in the politeness of Language perfects a speech that is based on the politeness of Language so that the care of speech harmony can be sustained and to the success in maintaining the face of the speech partner especially emotional closeness between learners and instructors. Application of this study: Learning includes embedded values ​​and imprinted into a role model for learners. The attitude that is no less important and inherent in the instructor’s self is the kinesic attraction that causes the learner’s pleasure and comfort when learning takes place. Novelty/Originality of this study: Research in Indonesian has not yet led to politeness in Language. The utilization of non-verbal Language in speaking becomes strong support when the speech event takes place, this is because Language is the main communication tool for interaction in learning.

Abstract We undertook an extensive analysis to examine the geochemical imprints encapsulated within the samples of the 2004 Indian Ocean tsunami deposits procured from the Seungko Mulat coastal region, nestled in the western section of Aceh Besar Regency, Aceh Province, Indonesia. In order to induce the formation of micro-plasma, a Transversely Excited Atmospheric Carbon Dioxide-Laser Induced Breakdown Spectroscopy (TEA CO2-LIBS) has been employed as the excitation source. Our investigation unveils distinct spectral signatures within every layer of the stratified tsunami deposit. We observed the unmistakable presence of salt elements (Ca, K, Mg, Na, Al), transition metals, heavy metals (Si, Fe, Ti, Ba, Sr, Cu, Cr, Pb, Mn, Ni, V), and also organic constituents (C, H, O, and N). The emission intensities of these elements exhibited a significant increase within the layers of the tsunami deposit, unequivocally setting them apart from their non-tsunami equivalents. In addition, we performed a vertical analysis of LIBS elemental emission intensity ratios, unveiling unique values for the Ca/Ti, and Si/Ti, ratios, which significantly distinguish them from all other ratios scrutinized in this exhaustive investigation. This research serves to highlight the effectiveness of TEA-LIBS as a promising and efficient optical technique for discerning the chemical profile associated with the renowned 2004 Indian Ocean tsunami deposits from Seungko Mulat Village in Aceh Province.

The concept of One Nation in the vastly diverse population that inhabits the Indian sub-continent, is unique among world civilizations. This feeling of nationalism is as old as the Vedas, and was inculcated and nurtured by some ancient seers and saints. Foremost among them is Rishi Markandeya, whose imprint is not just found all over the Indian landmass, but also traverses all the way to Indonesia and Bali. Markandey is also unique among seers because he is venerated among all the mainstream Indian religious traditions, namely Vaishnavism, Shaivism, Devi cults and ascetic orders. From his birth in the Himalayas, to his severe penance in the dense jungles of the Western Ghats of peninsular India, to the ashrams along the Narmada and Ganges, and going upto the Eastern coast at Jagannath Puri, the Indian sub-continent is strewn with sites named after the great Rishi. The present paper attempts to list out some of these sites, and the accompanying geographical features, in an effort to highlight the immense accomplishments of the Rishi, encompassing fields as diverse as geology, hydrology, philosophy, herbal medicine, music, sacred chanting, goddess worship, astrology and horticulture.

The architectural style of the mosque without the dome is becoming a phenomenon in the development of Islamic architecture this decade. The dome, which has been a symbol of Islam for hundreds of years, seems to no longer be the main target of mosque design, both in the world and in Indonesia. Seen by the increasing number of architects who build mosques without domes. What underlies this change? What is the change in thinking or intellectual power of the Muslim community, underlying this change? This study uses descriptive analysis method, namely the analysis process is carried out based on theoretical studies with literature studies, journals, magazines, and observations in the field. The result is, the pattern of Muslim intellectual thought in the Islamic reform era resulted in the Islamization of science, namely, adapting Islamic thought to modern knowledge. This era of Islamic reform, left an imprint on the architectural design of the mosque in accordance with the principles of architectural science and the purification of the philosophy of the mosque of the era of Rasulullah SAW, namely honest, simple, geometric, with little ornamentation and without a dome, and adapted to the local culture.

Potato (Solanum tuberosum) is an important vegetable crop in Indonesia. A small survey was conducted for virus diseases in November 2011 in Lembang, West Java, as part of assessing the sanitary status of potatoes produced in farmers' fields. Among the six potato fields surveyed, one field had nearly 20% of plants displaying stunted growth with leaves showing mild chlorotic spots and reduced size of lamina. Tubers harvested from symptomatic plants showed no necrosis symptoms. Symptomatic leaves from three representative potato plants were positive for Potato virus Y (PVY) when tested with PVY-specific immunostrips (Agdia Inc., Elkhart, IN). Leaf samples from virus-positive plants were imprinted on FTA Classic Cards (Whatman International Ltd., Maidstone, UK), air dried, and shipped to Washington State University for confirmatory diagnostic tests. Total nucleic acids were eluted from FTA cards (1) and subjected to reverse transcription (RT)-PCR using primers (PVY/Y4A and PVY/Y3S) specific to the coat protein (CP) of PVY (3). Nucleic acid extracts from samples infected with PVY ordinary strain (PVYO), tuber necrosis strain (PVYNTN), tobacco veinal necrosis strains (PVYEU-N and PVYNA-N), and a recombinant strain (PVYN:O) were included as standards to validate RT-PCR assays. The approximately 480-bp DNA fragment, representing a portion of the CP, amplified in RT-PCR was cloned into pCR2.1 (Invitrogen Corp., Carlsbad, CA). DNA isolated from four independent recombinant clones was sequenced from both orientations. Pairwise comparison of these sequences (GenBank Accession Nos. KF261310 to 13) showed 100% identity among themselves and 93 to 100% identity with corresponding sequences of reference strains of PVY available in GenBank (JQ743609 to 21). To our knowledge, this study represents the first confirmed report of PVY in potato in West Java, Indonesia. Studies are in progress to assess the prevalence of PVY in other potato-growing regions of Indonesia and document the presence of different strains of the virus (2). Since the majority of farmers in Indonesia plant seed selected from their previous potato crop, there is an increased risk of primary and secondary spread of PVY through the informal seed supply system, leading to its increased significance to potato production in Indonesia. Therefore, strengthening foundation seed potato and supply chain programs will promote the production of virus-free potatoes in Indonesia. References: (1) O. J. Alabi et al. Plant Dis. 96:107, 2012. (2) A. Karasev and S. M. Gray. Am. J. Potato Res. 90:7, 2013. (3) R. P. Singh et al. J. Virol. Methods 59:189, 1996.

Abstract As the capital city of the Central Java Province, Semarang has a very unique regional profile. Economic activity in Semarang has accelerated rapidly and many industrial estates have been established, but the latent problem of inundation and subsidence has been a threat in the northern region of the city for almost a century. Under these conditions, the burden of pollution as a by-product of various activities in the coastal and upland areas becomes a threat magnification for ecological sustainability of coastal waters and surrounding areas. This review will reveal the ecological vulnerability of coastal waters based on biogeochemical aspects. The major references for the review were several research papers dan repots based on the research activities of The Research Centre for Oceanography, Indonesian Science Institute (LIPI) in Semarang coastal water on the last decade. Geological studies, heavy metal contamination and retrospection study using benthic foraminifera as proxies based on two core samples are the major aspects on the review. The results show that the eastern coastal of Semarang was more susceptible to ecological disasters such as accretion, pollution of several metals and total suspended solids compared to the western coastal waters. Retrospective study based on core sample showed that Pb and Zn contaminations were occurred higher at the East Flood Canal estuary since 1910, so was the imprint of hypoxia was found since 1939.

The purpose of this paper is to know the existence and acquisition Seni Lais from the older generation to the younger generation. In this study analyzed model of inheritance Seni Lais as a form of preservation. From the result of this research is expected to realize the mapping of inheritance model Seni Lais from the older generation to the younger generation and so it can be known synergic and continuous preservation efforts. Therefore, the mastery and understanding of Seni Lais must be imprinted in the soul and body of the older generation and the younger generation for socialization art in particular of Seni Lais can be done optimally and thoroughly within the scope of local, national, regional, and international. In addition, the regeneration is also a reflection of the identity of the Sundanese community which is one among the cultural treasures of Indonesian society. The method used in this paper is an ethnographic method that refers to qualitative research. Source of data used in this research is primary data and secondary data. The primary data source is data in the field through participant observation. Furthermore, for secondary data used literature sources. Keywords: Model of Inheritance, Regeneration, Seni Lais

People are not born with the genetic imprint of particular culture because it is the set of knowledge and behavior and the interpretation of both as habits acquired and learned by the members of society through interaction and socialization by using different media such as film. Lilting is a film that presents the issue of cultural value. It is a British drama that cultivate a vibrant dynamic between Western way of life and Asian stories. This qualitative descriptive research focused on the exploration of intercultural values from the perspective of Western-Asian Way of Life to find out the differences among British, Chinese and Indonesian culture. Data were obtained from audio visual material of lilting film and other documents, e.g. newspaper and journal about lilting film. The techniques of data analysis were done by watching, writing some notes, data reduction, data display, and drawing conclusion. The result shows that lilting contains some cultural knowledge especially the difference of western and Asian way of life, language used by England and China, cultural biases (ethnocentric, stereotype, discrimination and prejudice), people’s perception about homosexual, the way people look at kissing in public place, the way to offer food, the way people speak up in direct conversation, the process of assimilation and acculturation to a new culture, the function of a professional translator, and the most important lesson of how difficult to communicate when we do not have little bit knowledge and information of other language and culture.

Organization theory faces challenges on all sides, yet it is uniquely suited to help understand and guide our current economic transition. In order to make good on this promise, however, organization theory needs to adopt a rigorously comparative approach and to jettison “America first.” Those who organize firms require ingredients that often include capital, labor, supplies, and a rule-bound market for selling. These ingredients in turn bear the imprint of national economies and the institutions that govern and support them. We argue that innovations in information and communication technologies (ICTs) combine with national institutions to guide what firms will look like by shaping what ingredients are available; ultimately, ICTs can fundamentally reorganize institutions such as capital and labor markets. We illustrate this argument with a comparison of how the ridehailing industry (such as Uber and Lyft in the United States) is organized in the US, Sweden, Germany, India, Indonesia, China, and Nigeria. The same basic innovation—a platform that allows riders and drivers to match via smartphone—produces substantially different organizational forms depending on domestic institutions. Moreover, in the US “Uberization” is challenging fundamental aspects of labor markets and the employment relation in industries well beyond ridehailing. The “varieties of Uberization” across national contexts exemplify the kinds of phenomena that organization theorists should be examining right now, if we aim to inform a more humane future.

Indonesia is a country with many different tribes and cultures. Each region has its own characteristics that will be imprinted in the memory of each individual, which will eventually become an icon of a particular area. One of the city's icons is Ondel-Ondel from Betawi. Ondel-Ondel are giant dolls that are understood by the Betawi people as sacred culture and are used in ritual sacrifices to ancestral spirits. At first Ondel-Ondel was created as a way to repel reinforcements from the Betawi tribe. However, now everything is different. Ondel-Ondel is no longer considered sacred. The existence of Ondel-Ondel art is no longer used for cultural activities but is misused in street activities. This means that there has been a change in this Betawi Ondel-Ondel art. These changes are caused by social conditions. This is why efforts to increase awareness of local culture need to be increased. Changing times have formed new patterns of thinking about things that are traditional and not all people know the meaning behind the Betawi Ondel-Ondel art. The research method used is a qualitative method, data collection is done through literature studies, observations and interviews.

Java Island, the most populated island of Indonesia, is prone to landslide disasters. Their occurrence and impact have increased mainly as the result of natural factors, aggravated by human imprint. This paper is intended to analyse: (1) the spatio-temporal variation of landslides in Java during short term and long-term periods, and (2) their causative factors such as rainfall, topography, geology, earthquakes, and land-use. The evaluation spatially and temporally of historical landslides and consequences were based on the landslide database covering the period of 1981 – 2007 in the GIS environment. Database showed that landslides distributed unevenly between West Java (67 %), Central Java (29 %) and East Java (4 %). Slope failures were most abundant on the very intensively weathered zone of old volcanic materials on slope angles of 30O – 40O. Rainfall threshold analysis showed that shallow landslides and deep-seated landslides were triggered by rainfall events of 300 – 600 mm and > 600 mm respectively of antecedent rainfall during 30 consecutive days, and many cases showed that the landslides were not always initiated by intense rainfall during the landslide day. Human interference plays an important role in landslide occurrence through land conversion from natural forest to dryland agriculture which was the host of most of landslides in Java. These results and methods can be used as valuable information on the spatio-temporal characteristics of landslides in Java and their relationship with causative factors, thereby providing a sound basis for landslide investigation in more detail.

Learning Indonesian contains material regarding news texts that students need to master. Based on observations at SMP N 19 Semarang, especially in class VII F, it shows that learning carried out on news text material has not been carried out effectively, and the material has not been fully conveyed properly in the learning process resulting in learning that cannot be said according to learning outcomes. Educators need to carry out activities to improve learning and deal with problems in the classroom, one of which is by designing learning media that can help facilitate the learning process. This model needs to be integrated with something that is currently closely related to students so that it can provide an imprinted and memorable learning experience for students. One model that is relevant to the characteristics of students is the ASSURE model. Based on the research that was conducted on 32 students at SMP N 19 Semarang, in the first cycle the average student assessment score was below the average score of 69.53, while in the second cycle there was an increase in student assessment scores with an average score. -class average 81.25. This proves that the application of the ASSURE model for digital pocket book learning media to news texts for class VII SMP can be said to be effective.

The application of composite membranes consisting of SiO2 from the volcanic ash of Mount Sinabung, TiO2, and PVA on a laboratory scale has been investigated to improve the Silau River’s water quality in Asahan Regency. The purpose of this study is to determine the optimal combination of SiO2, TiO2, and PVA for treating river water to minimize its heavy metal content and color intensity to achieve clean water requirements. The membranes were prepared by drop-casting with varied compositions of PVA/40TiO2/60SiO2, PVA/60TiO2/40SiO2, PVA/80TiO2/20SiO2, and PVA/100TiO2/0SiO2. PVA was dissolved in aquadest, mixed with SiO2 and TiO2, then imprinted and dried for 24 h at 50 °C. A photocatalyst test was performed on each composition variation to see how the Silau River water’s color changed over time. The PVA/80TiO2/20SiO2 membrane’s composition fluctuated the highest during photocatalyst testing, with 45.95% degradation. The parameter results on the Silau River water test, namely turbidity, color, and chromium values, were reduced by photocatalysis of a PVA/80TiO2/20SiO2 composite membrane to 16 NTU, 30 TCU, and 0.013 mg/L, respectively. These results met the clean water quality criteria specified by Minister of Health of the Republic of Indonesia Decree No. 416/MENKES/PER/IX/1990.

The development of the marketplace is growing very rapidly and has become familiar in the lives of Indonesian people. The term marketplace has also been imprinted in the general public as a place for buying and selling online without having to meet physically. In practice, the marketplace has also provided a lot of convenience and comfort in shopping, starting from transaction security and selection of varied shopping items, also equipped with estimates in shipping. It doesn't stop there; the development of the marketplace has also penetrated almost all products, including services, food, music, books, household products, airline tickets, and even investments that can be made in the marketplace. Google Lighthouse is a complex metric where the assessment includes in terms of Performance, Accessibility, Best Practices, and SEO, which is presented with a score of 0 to 100 in other words, Google will assess a website with a predetermined metric and then audit it to improve accessibility and SEO. a website. The results of this study are expected to be able to present actual analytical information based on the matrix determined by Google Lighthouse for future improvements where the Tokopedia marketplace gets a performance value with a yellow score of 85, which can be optimized by minimizing the speed index 3.7s, time to interactive 5.9s and total blocking time is 390s to be more optimal in terms of performance and Shopee has decreased in performance with a value of 13 red on first contently paint 2.8s, speed index 16.8s, time to interactive 26.5s, largest contently paint 16.3s, cumulative layout shift 0.484 and total blocking time of 1,710ms to be further assessed for optimal results. Based on this test, it can be concluded that Tokopedia is superior to Shopee from various aspects of the matrix tested.

The emergence of the concept of religious moderation initiated by the Ministry of Religion of the Republic of Indonesia and set forth in the 2020-2024 National Medium-Term Development Plan (RPJMN) indicates that the program for internalizing and strengthening the values of religious moderation is very important and urgent to implement. The values of religious moderation consist of four points, namely national commitment, tolerance, anti-radicalism, and accommodative to local culture. The direction to internalize the four values of religious moderation is also played by the Anak Jalanan At-Tamur Islamic Boarding School, Bandung. This article aims to reveal the role of the Anak Jalanan At-Tamur Islamic Boarding School in internalizing the values of religious moderation to students. This article uses qualitative research methods that are field research. The research data were obtained from two sources, namely field data sources and library data sources. Data collection techniques used are observation, interviews, and documentaries. The data analysis techniques used are data condensation, data presentation, and drawing conclusions. The results showed that success in internalizing the values of religious moderation to students could be seen from the indicators or values of religious moderation. The four indicators (values) of religious moderation are reflected in the routine activities and attitudes of students of the Anak Jalanan At-Tamur Islamic Boarding School. Commitment to nationalism, tolerance, anti-radicalism and accommodativeness to local culture is imprinted in the personalities of the students of the Anak Jalanan At-Tamur Islamic Boarding School. This is also due to two things: firstly, interfaith dialogue events are often held and secondly, the leader of the Anak Jalanan At-Tamur Islamic Boarding School who has a broad and open view and emphasizes morality in his education.

Ahmad Dahlan is a figure in the religious reform movement in Indonesia, both in the socio-cultural, political, educational fields, as well as a national hero in the effort to pioneer the independence of the Republic of Indonesia. Efforts in reforming the field of education, he formulated an educational concept that integrates the education system of Islamic boarding schools with a modern education system that is in accordance with the demands of the times. KH. Ahmad Dahlan changed his education system, which originally consisted of dualism of education, into an education system that no longer differentiated between religious education and general education. KH. Ahmad Dahlan aspires to the formation of a generation of "intellectual Ulama, and intellectual Ulama". In formulating the concept of education, KH. Ahmad Dahlan combines faith, knowledge and charity. Because according to him, education does not only transfer knowledge, but also A. Dahlan applies education to his students, there is a balance between knowledge and charity which is imprinted in each individual and his students. In this case, A. Dahlan believes that Muslims can advance in various sciences only by returning to the Qur'an and Al-Hadith as a reference in the system of life and life. The concept of education formulated by A. Dahlan is an Islamic concept which of course is based on the Qur'an and Al-Hadith. To obtain supporting data in this study, the authors use the documentation method, namely through library research (liberary search) by collecting or taking an inventory of books, newspapers, notes, magazines, agendas, leggers, and others related to the problem. . Furthermore, as a conclusion in this study that between the concept of education according to KH. Ahmad Dahlan with the concept of Islamic education is very relevant, both of which have the same basis and purpose for the formation of a Muslim personality and both lead to the unification of the Islamic education system. ABSTRAKAhmad Dahlan adalah seorang tokoh gerakan pembaharuan keagamaan di Indonesia baik dalam bidang sosial budaya, politik, pendidikan, juga sebagai pahlawan Nasional dalam upaya merintis kemerdekaan RI. Upaya dalam pembaharuan dibidang pendidikannya, ia merumuskan suatu konsep pendidikan yang mengintegrasikan antara sistem pendidikan pondok pesantren dengan sistem pendidikan modern yang sesuai dengan tuntutan zaman. KH. Ahmad Dahlan merubah sistem pendidikannya yang semula terdiri dualisme pendidikan menjadi sistem pendidikan yang tidak lagi memilah-milah antara pendidikan agama dengan pendidikan umum. KH. Ahmad Dahlan mencita-citakan terbentuknya generasi yang “intelektual Ulama, dan Ulama yang Intelektual”. Dalam merumuskan konsep pendidikannya, KH. Ahmad Dahlan memadukan antara iman, ilmu dan amal. Karena menurutnya bahwa dalam pendidikan tidak saja hanya mengalihkan ilmu pengetahuan, tetapi juga A. Dahlan menerapkan pendidikan kepada para muridnya adanya keseimbangan antara ilmu dan amal yang terpatri dalam setiap pribadi dan anak didiknya. Dalam hal ini A. Dahlan berkeyakinan bahwa umat islam bisa maju dalam berbagai ilmu pengetahuan hanya dengan kembali kepada Al-Qur’an dan Al-Hadits sebagai rujukan didalam sistem hidup dan kehidupan. Konsep pendidikan yang dirumuskan A. Dahlan adalah konsep islam yang tentu saja berdasarkan Al-Qur’an dan Al-Hadits. Untuk memproleh data yang menunjang dalam penelitian ini, penulis menggunakan metode dokumentasi, yaitu melalui penelitian kepustakaan (liberary search) dengan cara mengumpulkan atau menginventarisasi buku-buku, surat kabar, catatan, majalah, agenda, legger, dan lain-lainnya yang berhubungan dengan masalah. Selanjutnya sebagai kesimpulan dalam penelitian ini bahwa antara konsep pendidikan menurut KH. Ahmad Dahlan dengan konsep pendidikan Islam sangat relevan sekali, dimana keduanya mempunyai dasar dan tujuan yang sama terbentuknya kepribadian muslim dan sama-sama menuju kepada penyatuan sistem pendidikan Islam.

In the Dominican Republic, green bell pepper (Capsicum annuum L.) and tomato (Solanum lycopersicum L.) are widely cultivated under protected greenhouse conditions as high value commercial crops for export. For the past 2 to 3 years, pepper and tomato have been observed in protected crop facilities in Jarabacoa and Constanza in the North Region with chlorotic and necrotic spots and rings on leaves, petioles, and stems, leaf bronzing, and tip necrosis. Fruits on symptomatic pepper and tomato plants showed concentric rings, irregular chlorotic blotches and deformation, and uneven maturation and development. Incidence on pepper and tomato was 20 to 100% and 5 to 20%, respectively. In initial tests, leaves and fruits from each of 20 symptomatic tomato and pepper plants from several greenhouse facilities were reactive in Tomato spotted wilt virus (TSWV; genus Tospovirus, family Bunyaviridae) immunostrip assays (Agdia, Inc., Elkhart, IN). Since these immunostrips are known to react with other tospoviruses, such as Tomato chlorotic spot virus (TCSV) and Groundnut ring spot virus, additional molecular diagnostic assays were conducted. Leaf and fruit samples from symptomatic plants were imprinted on nitrocellulose membrane (NCM) (2), air-dried, and sent to Washington State University for confirmatory tests. Viral nucleic acids were eluted from NCM discs (1) and subjected to reverse transcription (RT)-PCR using primers gL3637 (CCTTTAACAGTDGAAACAT) and gL4435 (CATDGCRCAAGARTGRTARACAGA) designed to amplify a portion of the L RNA segment of several tospoviruses (3). A single DNA product of ~800 bp was amplified from all samples. Amplicons from two tomato (leaf and fruit) and one pepper fruit samples were cloned separately into pCR2.1 (Invitrogen Corp., Carlsbad, CA). Two independent clones per amplicon were sequenced in both orientations. Sequence analyses of these clones (GenBank Accession Nos. KF 219673 to 75) showed 100% nucleotide sequence identity among themselves and 97% identity with corresponding L RNA sequences of pepper isolates of TSWV from Taiwan (HM180088) and South Korea (HM581940), 94 to 95% with tomato isolates of TSWV from South Korea (HM581934) and Hawaii (AY070218), and 89% with a tomato isolate from Indonesia (FJ177301). These results further confirm the presence of TSWV in symptomatic tomato and pepper plants. A comparison of TSWV sequences from the Dominican Republic with TSWV isolates from the United States and other countries in the Caribbean region could not be made due to the absence of corresponding sequences of the L-RNA of the virus from these countries in GenBank. TSWV-positive samples were negative for TCSV in RT-PCR, indicating the absence of this tospovirus that has been reported in the Caribbean region (data not shown). To our knowledge, this is the first confirmed report of TSWV in tomatoes and peppers in the Dominican Republic. The presence of vector thrips, Frankliniella occidentalis, on symptomatic plants was also confirmed, suggesting a role in the spread of TSWV under greenhouse conditions. Recent surveys identified some greenhouses with 100% symptomatic peppers. The presence of TSWV in tomato and pepper has important implications for the domestic and export vegetable industry in the Dominican Republic because of the broad host range of the virus (4). It is critical for commercial producers to monitor TSWV and deploy appropriate management strategies to limit virus spread. References: (1) O. J. Alabi et al. J. Virol. Methods 154:111, 2008. (2) P.-G. S. Chang et al. J. Virol. Methods 171:345, 2011. (3) F. H. Chu et al. Phytopathology 91:361, 2001. (4) G. Parrella et al. J. Plant Pathol. 85:227, 2003.

FAKTOR-FAKTOR YANG MEMPENGARUHI MORTALITAS PADA PASIEN DENGAN FRAKTUR COSTA: Literature Review Anna Tri Wahyuni1), Masfuri2), Liya Arista3)1,2,3 Fakultas Ilmu Keperawatan Universitas Indonesia ABSTRAK Cedera paling umum yang terjadi pada trauma tumpul adalah fraktur costa (patah tulang iga/rusuk) dimana mekanisme cedera berpotensi mengancam jiwa. Pasien fraktur costa yang menunjukkan tingkat keparahan trauma lebih dari 90% melibatkan kepala, perut dan ekstremitas. Nyeri yang dirasakan akibat dari fraktur costa berkontribusi pada gangguan pernafasan, peningkatan resiko pneumonia dan gagal nafas yang meningkatkan angka morbiditas dan mortalitas. Pedoman penanganan fraktur costa sangat dibutuhkan untuk terjadinya komplikasi. Studi literature ini bertujuan menganalisis faktor-faktor yang mempengaruhi mortalitas pada pasien fraktur costa. Metode penulisan artikel ini menggunakan literature review yang didapat melalui 5 online database yaitu Sage Publishing, Science Direct, SpringerLink, Pub Med dan Google Scholar. Kriteria inklusi jurnal terkait meliputi: free fulltext, berbahasa Indonesia atau Bahasa asing lainnya, metode penelitian prospective, retrospective, case-control, cohort dan terbit antara tahun 2004-2021. Kata kunci yang yang digunakan dalam pencarian adalah “Respiratory depression OR Respiratory failure AND fraktur ribs AND Mortality”. Dari pencarian artikel diperoleh hasil akhir sebanyak 7 artikel yang relevan dan dilakukan proses review. Artikel tersebut menunjukkan hasil bahwa angka mortalitas dipengaruhi oleh faktor usia, skor keparahan cedera, jumlah patah tulang rusuk, dan implementasi penanganan infeksi. Faktor usia, tingkat keparahan cedera dan jumlah tulang rusuk yang patah menentukan tinggi rendahnya angka mortalitas pasien fraktur costa. Penanganan yang tepat dan manajemen nyeri yang sesuai dapat mempengaruhi penurunan angka morbiditas dan mortalitas pasien dengan fraktur costa. Pengembangan intervensi perawatan pasien fraktur costa terkait manajemen nyeri dan kontrol infeksi menjadi penelitian menarik selanjutnya.Kata kunci : Depresi pernafasan, gagal nafas, fraktur iga, angka kematian, angka kesakitanABSTRACT The most common injury in blunt trauma is a rib fracture, where the mechanism of injury is potentially life-threatening. Patients with rib fracture whose severity of the injury is greater than 90% are associated with damage to the head, abdomen, and extremities. Pain from rib fractures contributes to respiratory failure, increasing the risk of pneumonia and respiratory failure, which increases morbidity and mortality. Recommendations are needed for the treatment of complicated rib fractures. This literature study aims to analyze the factors that influence mortality in rib fracture patients. The method of writing this article uses a literature review sourced from 5 online databases, namely Sage Publishing, Science Direct, SpringerLink, Pub Med, and Google Scholar. The inclusion criteria for related journals included: free full text, in Bahasa or another foreign language, prospective, retrospective, case-control, cohort study method, and published between 2004 and 2021. Keywords used in the search were: "respiratory depression OR respiratory failure AND rib fractures AND death." From the article search results, we obtained 7 relevant articles which are the final results and a review process is carried out. The article showed that mortality was influenced by age, injury severity score, number of rib fractures, and infection control practices. The mortality rate of patient with rib fracture is determined by Factors such as age, severity of injury, and number of rib fractures. Appropriate care and adequate pain management can help reduce morbidity and mortality in patients with rib fractures. Another interesting research is the development of interventions in the treatment of rib fracture patients related to pain management and infection control.Key words: respiratory depression; respiratory failure; rib fracture; mortality; morbidity. Alamat korespondensi: RSUD Dr.Kanujoso Djatiwibowo Jalan MT.Haryono No 656 Ringroad BalikpapanEmail: annazahra30@gmail.com PENDAHULUAN Fraktur costa adalah cedera pada dada karena trauma tumpul, tajam atau kondisi patologis angka morbiditas dan mortilitas. Berdasarkan Western Trauma Association (WTA) sekitar 10% kematian pada orang dewasa muda disebabkan oleh cedera patah tulang rusuk yang melibatkan kepala, perut dan ekstremitas. Sebaliknya, pasien lanjut usia dengan patah tulang rusuk memiliki setidaknya 20% kematian yang secara langsung menyebabkan gagal napas progresif dan pneumonia (Brasel et al., 2017). Risiko pneumonia meningkat sebesar 27%, dan kematian meningkat sebesar 19% untuk setiap fraktur costa lebih dari 2 pada kelompok lanjut usia (Wanek & Mayberry, 2004). Pasien dengan trauma dada atau fraktur costa harusnya dilakukan pemantauan ketat sejak masuk rumah sakit, 24 jam pertama merupakan identifikasi awal adanya komplikasi yang menyebabkan depresi pernafasan. Menurut penelitian Coary, et.al (2020) fraktur costa adalah cedera paling serius pada 55% pasien berusia di atas 60 tahun yang menyebabkan kematian karena 90% dari patah tulang rusuk menunjukkan cedera tambahan pada pemeriksaan sistemik. Trauma langsung dan hipoventilasi yang diinduksi nyeri menyebabkan komplikasi pernafasan sehingga menjadi beban morbiditas dan mortalitas. Komplikasi yang sering terjadi adalah pneumotoraks diikuti hemothoraks, kontusio paru dan flail chest.Nyeri adalah suatu pengalaman sensorik yang multidimensional dengan fenomena yang berbeda dalam intensitas (ringan,sedang, berat), kualitas (tumpul, seperti terbakar, tajam), durasi (transien, intermiten,persisten), dan penyebaran (superfisial atau dalam, terlokalisir atau difus) (Bahrudin, 2018). Induksi nyeri pada pasien dengan fraktur costa menyebabkan pasien kesulitan bernafas dimana keparahan memar paru yang mendasarinya signifikan dengan terjadinya hipoksemia atau gangguan pernafasan. Hal ini menyebabkan pasien cenderung membatasi pergerakan dan menjadi tirah baring lama. Kondisi tirah baring lama menyebabkan tubuh mengalami penurunan berbagai fungsi secara sistematis, yang disebut dengan sindroma dekondisi dan rentan terjadinya infeksi (Hashem, Nelliot, & Needham, 2016; Hunter, Johnson, & Coustasse, 2014; Phelan, Lin, Mitchell, & Chaboyer, 2018 dalam Ananta & Fitri, 2020).Fraktur costa atau patah tulang rusuk secara klinis penting disebabkan tiga hal yaitu: sebagai penanda penyakit serius cedera intrathoraks dan perut, sebagai sumber rasa sakit yang signifikan, dan sebagai prediktor untuk kerusakan paru, terutama pada pasien usia lanjut. Organ perut yang paling sering terluka adalah hati dan limpa. Pasien dengan patah tulang rusuk kanan, memiliki 19% hingga 56% kemungkinan cedera hati, sedangkan patah tulang sisi kiri memiliki 22% hingga 28% kemungkinan cedera limpa (Wanek & Mayberry, 2004). Kematian pada orang dewasa dan lansia cenderung terjadi kemudian (≥72 jam setelah masuk) dan biasanya sebagai akibat dari kegagalan multi-organ yang dipicu oleh insufisiensi pernapasan dan pneumonia sehingga tingkat kematian secara keseluruhan, tanpa memandang usia, diperkirakan antara 10 dan 12% (Wanek & Mayberry, 2004). Tingkat mortalitas untuk pasien trauma usia lanjut yang mengalami patah tulang rusuk lebih besar daripada mereka yang tidak mengalami cedera toraks (Coary, et.al, 2020). Penelitian yang dilakukan Marini, et.al, (2021) menyatakan indikator penyebab kematian pada pasien fraktur costa dengan atau tanpa trauma kepala dan cedera organ adalah usia, jenis kelamin, ISS (Injury Severe Score), dan GCS (Glasglow Coma Scale).Berdasarkan uraian diatas maka peneliti ingin menganalisis faktor-faktor yang mempengaruhi angka morbiditas dan mortalitas pada pasien dengan fraktur costa untuk meningkatkan pemahaman tentang penanganan fraktur costa serta mengidentifikasi dari beberapa artikel terkini dalam mengurangi mortalitas. METODE PENELITIAN Metode penulisan artikel ini menggunakan literature review yaitu studi yang berfokus pada hasil penulisan yang berkaitan dengan topik, tema atau variabel penulisan.dan dipakai untuk menghimpun data atau sebuah sintesa sumber-sumber yang berhubungan dengan topik penelitian (Nursalam, 2017). Didapatkan 5 database yang dilakukan melalui pencarian elektronik dari yaitu Sage Publishing, Science Direct, SpringerLink, Pub Med dan Google Scholar. Kriteria inklusi telaah jurnal ini adalah free fulltext, berbahasa Indonesia atau bahasa asing lainnya, dengan metode penelitian prospective, retrospective, case-control, cohort dan terbit tahun 2004-2021. Kata kunci yang yang digunakan dalam pencarian adalah “Respiratory depression OR Respiratory failure AND fraktur ribs AND Mortality”. HASIL DAN PEMBAHASAN Berdasarkan hasil studi literature terdapat banyak faktor yang mempengaruhi terjadinya depresi pernafasan pada pasien fraktur costa yang dapat menyebabkan kematian. Terdapat 17.500 artikel yang muncul setelah dilakukan telusur berdasarkan kata kunci dalam google scholar, 10.000 artikel tidak masuk kriteria inklusi, 350 artikel duplikat dengan database yang lain. Kemudian sisanya disaring kembali berdasarkan hasil abstrak, metode dan hasil temuan sesuai topik peneliti yang diinginkan dan diperoleh 7 artikel yang relevan dan tersedia dalam bentuk fulltext. Beberapa penelitian terkait pencegahan depresi pernafasan pada fraktur costa berfokus pada manajemen nyeri baik secara farmakologis maupun non farmakologis. Penanganan dan pemantauan yang ketat dapat mengurangi komplikasi yang menyebabkan terjadinya depresi pernafasan. Berikut faktor-faktor yang mempengaruhi angka morbiditas dan mortalitas pada fraktur costa menurut Coary, et.al (2020) yaitu: (1) Usia, pasien berusia > 65 tahun memiliki kematian 2-5 kali lebih tinggi dibandingkan usia dibawahnya pada kondisi fraktur costa lebih dari dua. Pasien dengan komorbid sering menjadi faktor penyulit ditambah dengan kondisi paru-paru yang buruk (misal: perokok). Faktor pemulihan menjadi terhambat disebabkan osteoporosis, sistem pernafasan yang buruk, gangguan pertukaran gas dan tergambar dari lama rawat inap. (2) Jumlah patah tulang, dari beberapa penelitian meta-analisis diperoleh hasil jumlah absolut fraktur tulang rusuk yang berjumlah >2 maka dua kali lebih mungkin meninggal dunia dibandingkan pasien dengan 1-2 patah tulang rusuk. (3) Posisi anatomi patah tulang, Fraktur costa bilateral memiliki resiko kematian lebih tinggi dimana segmen flail chest menghasilkan gerak paradox yang menyebabkan pergerakan dinding dada mengarah kedalam saat inspirasi sedangkan tulang rusuk yang sehat bergerak keluar sehingga ventilasi tidak adekuat dan terjadi depresi pernafasan dan kematian. Berbeda dengan penelitian yang dilakukan Brasel et al., (2006) faktor yang paling mempengaruhi kematian adalah faktor usia ditandai dengan Injury Severity Score (ISS) jika dikaitkan dengan peningkatan terjadinya pneumonia. Analisis yang menyatakan komorbiditas mempengaruhi kematian hal ini disertai dengan faktor usia bukan karena faktor komorbiditas murni. Komorbiditas yang biasanya menyertai fraktur costa menurut penelitian adalah komorbiditas yang spesifik seperti gagal jantung kongestif, aritmia, gagal ginjal, penyakit hati, kanker metastatik dan penyakit neurologis.Pada penelitian Bulger et al dalam Wanek & Mayberry, (2004), membandingkan pasien yang berusia minimal 65 tahun keatas dengan usia 18-64 tahun dengan metode cohort pada kasus fraktur costa pada kelompok >65 tahun memiliki dua kali mortalitas dan morbiditas yang tinggi. Risiko pneumonia meningkat sebesar 27%, dan kematian meningkat sebesar 19% untuk setiap fraktur tulang rusuk tambahan pada kelompok lanjut usia.Nyeri adalah keluhan yang paling dirasakan oleh pasien dengan fraktur costa. Oleh sebab itu penanganan manajemen nyeri untuk mengontrol nyeri terus-menerus dan mencegah depresi pernafasan harus diberikan terapi yang agresif dengan pendekatan multimodalitas. Penelitian yang dilakukan oleh Peek, et.al, (2019) dengan membandingkan pemberian analgesik dengan 4 metode yaitu analgesia epidural, analgesia intravena, blok paravertebral dan blok intercostal, diperoleh hasil berdasarkan systematic review dan meta-analysis analgesia epidural signifikan mengurangi rasa sakit dibandingkan intervensi yang lain. Intervensi keperawatan sendiri menekankan pada terapi non farmakologis untuk kontrol nyeri pada pasien fraktur. Terapi nonfarmakologis dengan guided imagery dapat mengurangi intensitas dan skala nyeri pada pasien fraktur. Guided imagery mempengaruhi hampir semua fisiologis sistem kontrol tubuh yaitu pernapasan, denyut jantung, tekanan darah, tingkat metabolisme dalam sel, mobilitas dan sekresi gastrointestinal, fungsi seksual, dan bahkan respon imun (Rossman, 2000). Intervensi ini juga dapat mempercepat penyembuhan pasien dan mengurangi hari rawat inap (Forward et.al, 2015) Gambar 1. Algorithma fraktur costa (Brasel K.J, et.al, 2016).Western Trauma Association (WTA) menyatakan algorithma penanganan fraktur costa sebagai suatu observasi atau pemantauan ketat pada fraktur costa lebih dari 2 patah tulang (Brasel et.al, 2017). Berdasarkan algoritma diatas maka pasien dengan patah tulang rusuk >2 dengan usia lebih dari 65 tahun jika pada observasi kurang dari 24 jam menunjukkan peningkatan pada depresi pernafasan maka segera pindahkan ke ICU dan pertimbangkan penggunaan ventilator dan operasi rib fixaxion. Penggunaan terapi analgesia epidural digunakan untuk kontrol nyeri dilanjutkan batuk efektif, tehnik relaksasi nafas dalam dan mobilisasi dini (Brasel et.al, 2017). Analisis terkait studi literatur untuk memperkuat hasil analisis terdapat pada masing-masing artikel dibawah ini. Tabel 1. Artikel terkait faktor-faktor yang mempengaruhi terjadinya depresi pernafasan pada pasien dengan fraktur costa.Study citationMetode penelitian Desain PenelitianSampel dan Jumlah sampelHasil temuanA multidisciplinary clinical pathway decreases rib fracture–associated infectious morbidity and mortality in high-risk trauma patientsTodd,et.al,(2006)prospective cohort study Non eksperimental150 pasien dari Februari 2002-Oktober 2004 dengan > 45 tahun dan>4 patah tulang rusuk.Diperoleh hasil usia, skor keparahan cedera, dan jumlah patah tulang rusuk, jalur klinis menurunkan mekanisme hari tergantung ventilator, lama rawat inap, morbiditas infeksi, dan mortalitas dengan (interval kepercayaan 95% [CI] P<0.01).Predicting outcome of patients with chest wall injuryPressley, et.al, (2012)retrospectively reviewedNon eksperimental649 pasien (Juni 2008 hingga Februari 2010) termasuk usia, jumlah patah tulang, cedera bilateral, adanya kontusio paru, klasifikasi memar, LOS, masuk ICU, ventilasi mekanikSebuah sistem penilaian sederhana memprediksi kemungkinan bahwa pasien akan memerlukan ventilasi mekanik dan perawatan yang berkepanjangan. Skor 7 atau 8 memprediksi peningkatan risiko kematian, penerimaanke ICU, dan intubasi. Skor 5 memprediksi lama tinggal yang lebih lama dan periode ventilasi yang lebih lama. Factors Affecting Pneumonia Occurring to Patients with Multiple Rib FracturesByun & Kim., (2013).retrospectively reviewedNon eksperimentalData rekam medis 327 pasien laki-laki rata-rata usia 53 tahun dengan fraktur costa akibat kecelakaan dari Januari 2002- Desember 2008.Faktor yang mempengaruhi pneumonia pada pasien dengan fraktur tulang rusuk multipel dalam analisis multivariat termasuk usia (p=0,004), ISS (p＜0,001), dan skor tulang rusuk(p=0,038). Penggunaan antibiotik tidak berhubungan dengan kejadian pneumonia (p=0,28).Determinants of Mortality in Chest Trauma PatientsEkpe & Eyo, (2014)Retrospective and prospective Non eksperimental149 pasien dengan trauma thoraks 121 laki-laki, 28 perempuan dari Januari 2007-Desember 2011Variabel bebas, umur, jenis kelamin dan jenis cedera dada tidak terbukti berkorelasi dengan mortalitas dengan nilai P >0,05. Namun adanya cedera organ ekstra toraks terkait, skor MEWS saat masuk tinggi> 9, cedera pada interval presentasi lebih dari 24 jam, dan cedera dada yang parah ditandai dengan keterlibatan dada bilateral yang berkorelasi positif dengan mortalitas dengan nilai P <0,05.The number of displaced rib fractures is more predictive for complications in chest trauma patientsChien et.al, (2017)retrospectively reviewedNon eksperimentalJanuari 2013 -Mei 2015 diperoleh data di rumah sakit dengan total pasien 3151. Pasien yang dirawat dengan trauma dada dan patah tulang rusuk, termasuk cedera otak, limpa, panggul atau hatiJumlah patah tulang rusuk yang bergeser bisa menjadi prediktor kuat untuk berkembangnya penyakit paru-paru komplikasi. Untuk pasien dengan kurang dari tiga patah tulang rusuk tanpa perpindahan tulang rusuk dan paru-paru awal atau cedera organ lainnya, manajemen rawat jalan bisa aman dan efisien.Is the number of rib fractures a risk factor for delayed complications? Flores-Funes, et.al, (2020)Retrospective case–control studyNon eksperimentalPasien yang dirawat dengan diagnosis patah tulang rusuk antara 2010 dan 2014, diperoleh 141 pasien.Tidak ada perbedaan dalam karakteristik dasar pasien (usia, jenis kelamin dan Indeks Komorbiditas Charlson) antara kedua kelompok. Perbedaan ditemukan pada jumlah fraktur pada kelompok tanpa komplikasi p>0,05 (tidak signifikan) pada kelompok dengan komplikasi, (p=0,05) dan pada penurunan kadar hemoglobin (p=0,01). Hari rawat inap bervariasi pada setiap kelompok tetapi tanpa signifikansi statistik (p=0,11). Kesimpulan: Jumlah fraktur iga yang paling baik memprediksi munculnya komplikasi (delayed pleuro-pulmonary) dan perdarahan yang lebih besar) adalah patah tulang rusuk 3 atau lebihPredictors of mortality in patients with rib fracturesMarini, et.al, (2021) Retrospective review Non eksperimental1188 pasien patah tulang rusuk dan cedera tambahan yang dirawat selama Januari 2013-Desember 2014; 800 laki-laki dan 388 perempuan Usia, GCS, jenis kelamin laki-laki, dan Injury Severity Score (ISS) tetapi tidak jumlah patah tulang rusuk dan/atau Pulmonary contusion merupakan prediksi kematian. Peningkatan mortalitas pada pasien patah tulang rusuk dimulai pada usia 65-80 tahun tanpa peningkatan lebih lanjut. Jumlah patah tulang rusuk bukan faktor independen peningkatan mortalitas terlepas dari usia. Severe traumatic brain injury adalah penyebab kematian paling umum pada pasien usia 16-65 tahun, dibandingkan dengan komplikasi pernapasan pada pasien berusia 80 tahun atau lebih. Banyak penelitian yang telah dilakukan untuk menentukan faktor prediktor kematian pada pasien fraktur costa. Dari 7 artikel di atas terdapat berbagai bukti yang mempengaruhi kematian akibat fraktur costa dengan metode penelitian yang berbeda.Penelitian Chien, et.al, (2017) dan Flores-Funes, et.al, (2020) menunjukkan hasil yang hampir sama dimana jumlah fraktur costa yang >2 akan meningkatkan angka morbiditas dan mortalitas dikarenakan faktor komplikasi pada paru. Berbeda dengan penelitian yang dilakukan Marini, et.al, (2021) yang menyatakan jumlah dari fraktur costa tidak memprediksi peningkatan mortalitas terlepas dari usia. Menurut peneliti faktor usia menjadi prediktor utama dalam menentukan angka mortalitas pada pasien dengan fraktur costa, dimana peningkatan mortalitas pada pasien patah tulang rusuk dimulai pada usia 65-80 tahun ke atas.Penelitian yang dilakukan Todd et.al,(2006) menghasilkan hipotesa bahwa usia, skor keparahan cedera, dan jumlah patah tulang rusuk, dan implementasi jalur klinis signifikan dengan penurunan lama perawatan di unit perawatan intensif, lama rawat inap di rumah sakit, infeksi pneumonia, dan mortalitas. Maka semakin lanjut usia, tingkat keparahan yang tinggi dan jumlah patah tulang rusuk bilateral atau >2 dapat meningkatkan angka morbiditas dan mortalitas pasien dengan fraktur costa.Penelitian Pressley et.al, (2012) dilakukan dengan melakukan analisis dengan menggunakan trauma dada scoring system dimana skor >7 memprediksi peningkatan risiko kematian, penerimaan ke ICU, dan intubasi. Penilaian scoring system ini dapat digunakan untuk memprediksi kemungkinan pasien akan memerlukan ventilasi mekanik dan perawatan yang berkepanjangan sehingga dapat memperparah penyakit, menimbulkan infeksi oportunistik dan menyebabkan resiko mortalitas.Penelitian Ekpe & Eyo, (2014) menggunakan system MEWS (modified early warning signs) untuk menganalis faktor prognosis pada pasien dengan trauma dada. Sebagai variabel bebas, umur, jenis kelamin dan jenis cedera dada tidak terbukti berkorelasi dengan mortalitas dengan nilai P >0,05. Namun adanya cedera organ ekstra toraks terkait, skor MEWS saat masuk tinggi> 9, dimana interval presentasi lebih dari 24 jam dengan cedera dada yang parah ditandai dengan keterlibatan dada bilateral, berkorelasi positif pada mortalitas. Berbeda dengan penelitian sebelumnya Byun & Kim., (2013) dimana faktor umur berpengaruh pada terjadinya infeksi pneumonia dan meningkatkan angka mortilitas dengan atau tanpa diikuti tingkat keparahan pada trauma dada.Berdasarkan analisis diatas terdapat persamaan hasil penelitian dimana rata-rata metode penelitian yang dilakukan dengan menggunakan retrospective review non eksperimental. Peneliti mengamati data rekam medis dari beberapa rentang waktu dengan kriteria inklusi menderita patah tulang rusuk lebih dari dua. Namun, terdapat kriteria yang berbeda-beda pula dimana peneliti memasukkan trauma tambahan seperti brain injury dan cedera pada organ yang lain. Jumlah sampel antara penelitian satu dengan yang lain juga berbeda dari ratusan hingga ribuan data yang dianalisis. Hal ini menyebabkan hasil penelitian yang diperoleh sedikit berbeda antara satu dengan yang lain.Manajemen fraktur costa berfokus pada manajemen nyeri yang adekuat, batuk efektif, relaksasi nafas dalam dan mobilisasi dini (Brasel et al., 2017). Berdasarkan beberapa penelitian manajemen nyeri pada pasien orthopedic terutama pasca operasi adalah dengan guided imagery. The American Holistic Nurses Association menyatakan guided imagery adalah modalitas holistik yang membantu klien dalam menghubungkan pengetahuan batin mereka pada pemikiran, perasaan, dan tingkat penginderaan, mempromosikan penyembuhan bawaan mereka dengan kemampuan bersama-sama memandu klien mengatasi stres; resolusi konflik; masalah pemberdayaan diri; dan persiapan medis-bedah (Integrative & Review, 2016). Oleh sebab itu, guided imagery tepat jika digunakan pada managemen nyeri non farmakologis yang diterapkan dalam intervensi keperawatan.Dalam teori keperawatan Jean Watson tentang Transpersonal Caring mendefinisikan hubungan manusia yang bersifat caring, bersatu dengan orang lain dengan menghargai klien seutuhnya termasuk keberadaannya di dunia (Alligood, 2014). Watson menyatakan kepedulian transpersonal caring adalah dasar dari teori kepedulian manusia dimana fokus dari kepedulian transpersonal adalah pada peduli, penyembuhan, dan keutuhan, bukan pada penyakit, sakit dan patologi yang mencakup 10 faktor karatif dalam konsep utamanya (Integrative & Review, 2016). Sesuai dengan teori Watson, Guided Imagery (GI) menggabungkan kedua sains (melalui praktik berbasis bukti) dan seni (melalui aplikasi untuk berlatih) untuk mengobati rasa sakit pasien menggunakan imaginasi terbimbing dan teknik relaksasi nafas dalam. Kombinasi dengan terapi obat, GI menyediakan rezim pengobatan holistik untuk manajemen nyeri untuk menenangkan pikiran dan merilekskan tubuh mereka, memberikan kesempatan bagi klien untuk menciptakan lingkungan penyembuhan internalnya sendiri (Integrative & Review, 2016).Intervensi keperawatan untuk batuk efektif dan mobilisasi dini termasuk poin penting dalam manajemen perawatan pasien fraktur costa. Batuk efektif adalah suatu metode batuk dengan benar dan pasien dapat mengeluarkan dahak secara maksimal untuk mengeluarkan sekret dari saluran pernapasan bawah (Potter dan Perry, 2006). Mobilisasi sendiri dapat menghasilkan outcome yang baik bagi pasien seperti meningkatkan pertukaran gas, mengurangi angka Ventilator Associated Pneumoia (VAP), mengurangi durasi penggunaan ventilator, dan meningkatkan kemampuan fungsional jangka panjang (Green, Marzano, Leditschke, Mitchell, & Bissett, 2016 dalam Ananta & Fitri, 2020). Oleh sebab itu, kedua intervensi ini perlu diteliti lebih lanjut guna mengembangkan riset terkait manajemen pasien fraktur costa. SIMPULAN Pasien dengan usia lanjut dengan patah tulang rusuk atau fraktur costa biasanya menunjukkan tingkat kelemahan, multi-morbiditas, dan kompleksitas medis yang tinggi (Coary, et.al, 2020). Hal ini tentu menjadi penghambat dalam faktor penyembuhan tulang dan dapat meningkatkan angka mortalitas. Pemaparan hasil analisis menggambarkan faktor usia, cedera tulang rusuk atau costa bilateral lebih dari 2, terjadinya komplikasi dan cedera pada organ lain menyebabkan pasien harus dirawat di ruang ICU lebih lama karena resiko infeksi dan komplikasi yang dapat meningkatkan angka morbiditas dan mortalitas.Terlepas dari faktor usia, tingkat keparahan cedera dan jumlah tulang rusuk yang patah menentukan haluaran pasien yang lebih baik. Penanganan fraktur costa yang tepat yang berfokus pada kontrol kerusakan, manajemen nyeri, fiksasi seleksi, dan kualitas hidup mempengaruhi penurunan angka morbiditas dan mortalitas pasien dengan fraktur costa. Kedudukan dan peran perawat spesialis dalam tugas mengatur asuhan klien dengan kompleksitas tinggi menjadi sangat penting (Masfuri, et.all, 2019) SARAN Penelitian klinis terkait implementasi keperawatan berbasis kasus masih jarang dilakukan. Implementasi keperawatan pada pasien dengan fraktur costa terkait manajemen nyeri dan kontrol infeksi menjadi penelitian yang menarik untuk dilakukan karena hal ini menjadi indikator faktor yang mempengaruhi angka mortalitas pasien dengan fraktur costa. DAFTAR PUSTAKA Alligood Raile Martha,2014, Nursing Theorits and their Work, 8th edition, by Mosby, an imprint of Elsevier IncAnanta Tanujiarso, B., & Fitri Ayu Lestari, D. (2020). Mobilisasi Dini Pada Pasien Kritis Di Intensive Care Unit (Icu): Case Study. 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Studying extra regional trade networks in Antiquity can be considered a relatively popular field of research, but the intensity and patterns of such complex system still leave lot of questions, particularly in the case of Rome’s Far Eastern trade. There is still a trend to visualize a kind of globalized commercial activity between the Imperium and communities on the eastern edge of the Silk Road(s). However, the facts provide us a more comprehensive picture. Due to the meticulous work of international joint research projects working in East and Southeast Asia followed by a raised interest in collecting ancient objects among local people, an increasing number of Roman objects have been discovered in the region. These finds prove the significance of mediator cultures in transferring Roman artifacts beyond India – with their own imprints on forming evaluation/acceptance of these non-local goods by the receiving culture.

Over time, traditional batik art continue to be explored and developed by a community ofsupporters. Various techniques and styles continue to emerge and inspire each other. Recognized theexistence of the world community. Likewise with modern Indonesian painting, to date the work andthe artist is able to leave a deep imprint for generations thereafter until today.Starting from the traditional batik and painting modern Indonesia, known to this day -through the creation of research - development possibilities of adapting the technique of batik andmodern painting techniques, so as to give birth to a new style that can contribute to the survival ofYogyakarta batik. From the analysis of the traditional batik of Yogyakarta and painting modernIndonesia, found a wide variety of painting techniques and artistic elements that can be combinedand used in batik techniques, in this case a blend of traditional and artistic batik art modern paintingbatik can be categorized as postmodernism, lifting the spirit of the old with a new style.Keywords: motif, batik, postmodernism, painting, Yogyakarta Seiring berjalannya waktu, seni batik tradisional terus digali dan dikembangkan olehmasyarakat pendukungnya. Berbagai teknik dan gaya terus bermunculan dan saling menginspirasi.Eksistensinya diakui masyarakat dunia. Begitu juga dengan seni lukis modern Indonesia, hingga saatini karya dan senimannya mampu meninggalkan jejak yang mendalam bagi generasi setelahnyahingga saat ini.Berawal dari batik tradisional dan lukisan modern Indonesia yang dikenal hingga saat ini -melalui penelitian penciptaan - dikembangkan kemungkinan-kemungkinan pengadaptasian teknikbatik dan teknik lukis modern, sehingga mampu melahirkan gaya baru yang dapat disumbangkanbagi kelangsungan batik di Yogyakarta. Dari hasil analisa batik tradisional Yogyakarta dan seni lukismodern Indonesia, didapati berbagai macam teknik lukis dan elemen artistik yang dapat dipadukandan digunakan dalam teknik membatik, dalam hal ini perpaduan seni batik tradisional dan artistikseni lukis modern dapat dikategorikan sebagai batik postmodernisme, mengangkat spirit lamadengan gaya yang baru.Kata kunci: motif, batik, postmodernisme, lukis, Yogyakarta

Philosophy is high ranked art which left imprint in its revolutionary stages from ancient to modern on the different regions of the world depending upon their mind and environment. After the last Prophetic age, Many Muslim interpreter Philosophers for the thinkings of Great Ancient Philosophers like [Pythagoras, Socrates, Aristotle, and Plato and like them Hindi philosophers such Apanshsad, Sidhārtā, Kaplā etc. (Who didn’t get fame as a philosophers)]; were born who are called the latter Philosophers (Al-Mut'akhirīn) like Ibn Sīnā, Al-Farābī, Al-Shaikh Al-Maqtūl, Ibn Rushd etc. These Philosophers started teaching people the different arts of Philosophy such as Theology, Logic, Mathematics, Ethics, and Politics in the interpretation of Ancient Philosophers. These arts had been adopted by different regional people basis on their zone such the Hindi Philosophy demonstrates the arts of Theology, Body Sciences, Mathematics, Medical etc and the Indonesian Philosophy deals with the social sciences like Ethics, Politics, Sociology. Moreover, these regional Philosophies impacted each other. In another dimension, Muslims scholars who believed in the quotations of Qur'ān and Sunnah without paraphrasing them; neglected these arts outright or partially. So, this study aims to illuminate the Hindi and Indonesian Philosophy with their revolutionary stages and also highlights the views of Muslims Scholars in the light of Manuscript Al-Tamīz written by ʿAbd Al-ʿAzīz Al-Firhārwī (1206AH-1239AH), great Muslim thinker of the Indo-Pak.

National Education in Indonesia is still covered with a variety of issues. One of them is the moral degradation among students. Although since 2010 has imposed an integrated character education in schools, but these conditions indicate the character education has not been done properly. This was especially the case in elementary school. Because at this level attitude formation is a major concern compared to the cognitive and psychomotor. The learning process is integrated with learning characters of various subjects in primary schools should be done not just in a state of conscious mind (conscious mind), but it is more empowered is to condition the subconscious mind when active. To that end, the character of the learning process must be carried out under conditions that do with relaxation hypnosis, mind focus and the alpha state, the subconscious communication, reps, make braided rapport with learners, the information conveyed in the imprint, the message is delivered in a condition of intense emotions, affirmation and visualization. With such a mechanism learners belief system can be programmed or reprogrammed as expected character. Through this belief system changes can be found changes in the character of learners effectively and relatively fixed.

Abstract.The decision of the Supreme Court Number 46 P/HUM/2018 has triggered the division of the legal paradigm in Indonesia. The philosophical discourse between justice, certainty, and the legal use in the reality of Indonesian law reflects the strong grip of legal positivism that resides in the Supreme Court's decision and causes a waning sense of justice and public hope to obtain a track record of candidates who are proper and with integrity. This study aims to explain the philosophical dialectic between justice, certainty, and legal use in PMA No. 46 of 2018 while expressing a representation of justice, construction of legal certainty and legal use that is incarnated according to the judge's consideration in the decision. The approach through justice theory John Stuart Mill and John Rawls will be used to slice the conception of justice, certainty, and legal use that resides in the decision of the Supreme Court Number 46 P/HUM /2018. This research is a normative-philosophical legal research. The results showed that the construction of justice imprinted in the verdict tended to project the concept of justice as equality (justice as fairness) from John Rawls, this can be seen from the consideration of judges contained in decisions emphasizing individual freedom (political rights, elected and elected) as a form of efforts to strengthen libertarian rights or natural rights that cannot be negated by the freedom of others. The aspects of legal benefit and certainty reflect the grip of the positivistic paradigm in law. This is reflected in two lines of consideration, firstly there is no consideration of the common interest (the greatest benefit) in the decision which is a test stone to see the implications of the prohibition norm for former convicted corruption for the future of parliament and the regeneration of people's representatives. Whereas the aspect of legal certainty in the decision only touches the legal realm as lex and negates the ontological basis of the law as an ius which is full of consideration of morality and justice ideas without trying to reveal what is behind the text (meta-teleological aspects) PKPU No. 20 of 2018. Thus, three legal values (certainty, legal use, and justice) should have an equally important position within the framework of the state legal system. When all three are in conflict, the central role of the judge's duty to equally apply the three legal objectives.Keywords: Justice, certainty, legal use, Law, Supreme Court Decision.

Abstract: Hijab being very sentimental and crucial because as muslim, hijab is considered an obligation like what Allah mention in the Qur’an with the aim of getting peace when practicing a religion. However, forcing the use of the hijab is no longer part of practicing religious teachings but rather using religion to vent their ego so that it is ingrained as a cultural practice especially in Indonesia today. This paper was made using a falsification test with the aim of examining whether the concept of the hijab that has been imprinted so far is still relevant to the current conditions and social context of society. On this journal we would like to inform how big the impact that generated by the construction of the majority thought the rule of one form and fit will come with a culture rooted in society. Then the conclusion is drawn that hijab should adapt to the context of modernity in this era of globalization. Keywords: Hijab, Intolerance, Deconstruction Abstrak: Hijab menjadi suatu hal yang sangat sentimental dan krusial karena sebagai umat muslim hijab dianggap sebagai suatu kewajiban seperti apa yang sudah disebutkan Allah dalam Al-Qur’an dengan tujuan mendapatkan kedamaian ketika mengamalkan suatu agama. Namun pemaksaan penggunaan hijab bukan lagi bagian dari pengamalan ajaran agama melainkan menggunakan agama untuk melampiaskan ego mereka sehingga sudah mendarah daging sebagai suatu praktik budaya terutama di Indonesia saat ini. Tulisan ini dibuat menggunakan uji falsifikasi dengan tujuan mengkaji apakah konsep hijab yang sudah terpatri selama ini masih relevan dengan kondisi dan konteks sosial masyarakat saat ini. Pada jurnal ini kami memperlihatkan seberapa besar dampak yang dihasilkan oleh kelompok mayoritas terhadap konstruksi pemikiran masyarakat salah satunya bentuk supremasi akan hijab yang kemudian membaur bersama budaya yang mengakar di masyarakat. pada kemudian ditarik kesimpulan bahwa hijab seharusnya beradaptasi dengan konteks modernitas di era globalisasi ini.Kata kunci: Hijab, Intoleransi, Dekonstruksi.

Despite significant research on the effects of stress on the hypothalamic–pituitary–adrenal (HPA) axis, questions remain regarding long-term impacts of large-scale stressors. Leveraging data on exposure to an unanticipated major natural disaster, the 2004 Indian Ocean tsunami, we provide causal evidence of its imprint on hair cortisol levels fourteen years later. Data are drawn from the Study of the Tsunami Aftermath and Recovery, a population-representative longitudinal study of tsunami survivors who were living along the coast of Aceh, Indonesia, when the tsunami hit. Annual rounds of data, collected before, the year after and 2 y after the disaster provide detailed information about tsunami exposures and self-reported symptoms of post-traumatic stress. Hair samples collected 14 y after the tsunami from a sample of adult participants provide measures of cortisol levels, integrated over several months. Hair cortisol concentrations are substantially and significantly lower among females who were living, at the time of the tsunami, in communities directly damaged by the tsunami, in comparison with similar females living in other, nearby communities. Differences among males are small and not significant. Cortisol concentrations are lowest among those females living in damaged communities who reported elevated post-traumatic stress symptoms persistently for two years after the tsunami, indicating that the negative effects of exposure were largest for them. Low cortisol is also associated with contemporaneous reports of poor self-rated general and psychosocial health. Taken together, the evidence points to dysregulation in the HPA axis and “burnout” among these females fourteen years after exposure to the disaster.

Indonesian EFL students faced online teaching and learning in such a rapid process. Therefore, this research was carried out to search for EFL students in Indonesia about their responses on teaching and learning online. This research applied the action research method with the paradigm of quantitative descriptive approach. Data for this research was collected via an online questionnaire, distributed to one class size sample consisting of 32 students in the even semester of the 2019/2020 academic year at one of the private colleges in the West Sumatra province of Indonesia. The data were analysed by descriptive statistics, especially the percentage of each item available in the questionnaire. Findings of this research show that the respondents, or the students, had their evaluation toward the online teaching and learning. 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