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ABSTRAK
Penelitian ini didasarkan pada pengalaman pribadi bahwa kondektur bis antar kota Jakarta Bandung kurang perilaku menolongnya. Pengaruh kehidupan di kota besar yang padat dapat menyebabkan timbulnya sikap acuh sehingga perilaku menolong akan berkurang. Kondektur bus yang singgah di kota besar tentu juga akan terpengaruh gejala tersebut.

Penelitian ini bertujuan untuk memperoleh gambaran kecenderungan tentang perilaku menolong kondektur bus antar kota yang melayani angkutan trayek Jakarta Bandung. Masalah penelitian ini adalah seberapa besar perilaku menolong kondektur bus antar kota jakarta Bandung. Penelitian ini menggunakan pendekatan penelitian kuantitatif non eksperimental. Pengukuan perilaku menolong dilakukan dengan kuesioner perilaku menolong yang dibuat sendiri oleh peneliti berdasarkan teori Decision model of helping dari Latane & Darley (1970). Subyek yang menjadi responden dalam penelitian ini adalah 68 orang kondektur bus antar kota Jakarta Bandung.

Dari penelitian yang dilakukan diperoleh hasil bahwa rata-rata kecenderungan perilaku menolong tergolong tinggi. Sehingga secara keseluruhan dapat diketahui bahwa kecenderungan perilaku menolong kondektur bus antar kota yang melayani angkutan trayek Jakarta Bandung berada pada tingkat yang tinggi. Saran untuk penelitian lebih lanjut adalah dilakukannya studi kualitatif pada subyeksubyek yang mempunyai karakteristik khusus seperti tipe kepribadian sehingga dapat diperoleh gambaran lebih mendalam mengenai kecenderungan periiaku menolong pada subyek-subyek tersebut.

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Kualitas pelayanan rumah sakit merupakan indikator yang menentukan citra rumah sakit yang pada gilirannya akin menentukan kesinambungan rumah sakit baik sebagai lembaga pelayanan kesehatan maupun sebagai bisnis pelayanan kesehatan. Kualitas pelayanan rumah sakit akan meningkat apabila penggunaan obat di rumah sakit dilakukan secara rasional. Kepatuhan dokter menulis resep berdasarkan standar obat yang berlaku akan meningkatkan penggunaan obat yang rasional. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan keparuhan dokter menulis resep berdasarkan Formularium RSMH Palembang. faktor Internal yang diteliti meliputi umur, jenis kelamin, tingkat pendidikan, pengetalman, lama kerja, sikap, dan motivasi, sedangkan faktor eksternal yang diteliti meliputi kepemimpinan, imbalan, jabatan, peran Panitia Farmasi dan Terapi, peran Komite medik, dan peran Detailer. Dalam hal ini dilakukan juga penelitian untuk mengetahui faktor-faktor dominan yang mempengaruhi kepatuhan. Data diperoleh melalui survey menggunakan kuisioner yang validitas dan reliabilitas telah diuji coba terlebih dahulu. Besar sampel penelitian adalah 100 responden, dilakukan secara cross .yccfional dengan analisis kuantitatif. Metode analisis yang digunakan adalah analisis univariat, bivariat dengan "chi square", dan multivariate dengan "regresi logistik". Hasil penelitian menyimpulkan bahwa rata-rata kepatuhan dokter menulis resep berdasarkan Formularium adalah 52,28 %. Faktor internal yang bermakna berhubungan dengan kepatuhan adalah variabel tingkat pendidikan, pengetahuan, sikap dan motivasi, sedangkan faktor eksternal yang bermakna berhubungan dengan kepatuhan adalah variabel kepemimpinan, peran komite medik, dan peran detailer. Faktor-faktor dominan adalah variabel sikap, jenis kelamin, peran detailer, tingkat pendidikan, peran komite medik, dan motivasi. Dari penelitian ini diharapkan agar pimpinan RSMH beserta jajarannya memperbaiki citra kepemimpinan dengan introspeksi. Dengan citra kepemimpinan yang baik diharapkan pendekatan kepada dokter yang sebenarnya mempunyai sikap dan motivasi tinggi mendukung kebijakan penulisan resep berdasarkan Formularium tidak akan sulit. Perlu dilakukan peningkatan peran Kornite medik dan Panitia Farmasi dan terapi untuk mengeliminasi peran detailer, perlu dilakukan sosialisasi Formularium RSMH, dan meinanfaatkan dokter residen dan dokter umum, beserta dokter wanita untuk meningkatkan kepatuhan dokter. ...... The Factors that Relate to the Discipline of Doctor for Writing the Prescription Follow the Legal Standard of Medicine in Hospital of RSMH Palembang CityThe quality of service in hospital is an indicator to determine its image, so it can influence its activity not only as social service institution but also as business service institution. The quality of service in hospital will increase influenced by rational using of its medicine The discipline of doctor writes prescription based on the legal standard of medicine will increase the rationality of its medicine usage. The aim of this research is how to know the factors relate to the discipline of doctor for writing prescription based on formulation of RSMH Palembang. Internal factors that are investigated consist of age, sex, education, knowledge, experience, attitude, and motivation. External factors that are investigated consist of leadership, incentive, job, function of Medicine Committee and Therapy, function of Medical Committee, and function of Detailer. Besides that, in this case, the aim of this research is to know the dominant factors that influence the discipline. Data is collected by survey method, using valid and reliable questionnaire. The total of -samples in this research are 100 respondents, hold by cross sectional, using quantitative analysis. Method of analysis used variant, two variant combination of chi square, and multi variant combination of logistic regression. Conclusion, the discipline of doctor that writes the prescription following the medicine formulation shows 52,28 percent. The internal factors that determinate relate to the discipline are education, knowledge, attitude, and motivation. So, the external factors determinate it are leadership, function of Medical Committee, and function of Detailer. The dominant factors determinate the discipline are attitude, sex, function of l)etailer, education, function of Medical Committee, and motivation. Recommendation. The management of RSMH Hospital and their staffs must be improved their image, how to be introspection themselves. The good image of leadership is implied how to persuade the doctors, who have good motivation and good attitude, in order they realize and is not too difficult to write the prescription follow the formulation. So, it is important to increase the function of Medical Committee, and Medicine Committee and Therapy to eliminate the function of Detailer. It needs the socialization of formulation of RSMH join together with candidate physician and physician, and female physician, in order to improve the discipline of doctors.

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ABSTRAK Tesis ini akan membahas tentang hubungan antara tingkat pengawasan pekerjaan dengan besarnya nilai pekerjaan perbaikan (rework) pada struktur atas bangunan gedung beton bertulang. Terjadinya pekerjaan perbaikan bisa diakibatkan oleh perubahan dari pemilik, perubahan dan kesalahan disain, kesalahan pelaksanaan serta kesalahan dari supplier. Pembahasan penelitian ini akan menekankan pada pekerjaan perbaikan yang diakibatkan oleh kesalahan pelaksanaan (kontraktor). Hasil peninjauan lapangan memberikan gambaran bahwa penyebab utama terjadinya pekerjaan perbaikan selama pelaksanaan pekerjaan adalah rendahnya tingkat pengawasan. Hubungan yang diperoleh antara prosentase nilai pekerjaan perbaikan dengan prosentase biaya pelatihan tenaga pengawas memberikan kecenderungan bahwa dengan meningkatkan pelatihan-pelatihan kepada tenaga pengawas dapat menurunkan/memperkecil nilai pekerjaan perbaikan. Namun demikian nilai pekerjaan perbaikan tidak bisa dihilangkan sama sekali, hanya dapat diperkecil.

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ABSTRACT The relationship between work supervision stage with the amount of reworks value of the upper structure in the reinforced concrete building structure will be analyzed. It seem to be the cause of the changes by the owner, the change and misdesign, the error of implementation and the supplier's error. This research analysis will stress on the rework that caused by the error of implementation (contractor). The result of field study give the illustration that the main causes of rework's occurrence along the work implementation is the lack of supervision stage. The obtainable relationship between percentage of the rework value and the percentage of the supervisor training cost, gives the trend that by inclining the training to the supervisor will be able to decrease/ minimize the rework value. The rework value, however, will not be able to vanish at all, but it can be minimized only.

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Ketika Internet telah menjadi suatu media komunikasi dan teknologi yang merambah segala aspek sosial ekonomi termasuk perdagangan barang dan jasa, maka mulailah timbul berbagai persoalan-persoalan hukum yang berkaitan dengan dunia internet. Salah satunya adalah sengketa nama domain. Seringkali terdapat pihak-pihak yang mencoba mengambil keuntungan dengan merugikan orang lain terkait dengan pendaftaran nama domain. Pendaftaran nama domain menganut prinsip first come first serve, artinya siapa yang mengajukan terlebih dahulu dialah yang berhak atas nama domain tersebut. Namun demikian, terdapat kaidah¬kaidah hukum dalam pendaftaran nama domain yang menjadi pedoman hukum para pihak. Di Indonesia, terdapat kasus sengketa nama domain mustika-ratu.com. Dalam menyelesaikan sengketa nama domain, ada beberapa mekanisme yang tersedia, sementara itu pendekatan penyelesaian yang digunakan oleh PT Mustika Ratu Tbk adalah model pendekatan pidana karena terdapat unsur persaingan curang. Meskipun melalui Peninjauan Kembali kasus tersebut dinyatakan tidak terbukti, namun tidak berarti peluang menggunakan pendekatan pidana menjadi Lertutup terutama bagi kasus-kasus yang berkaitan dengan persaingan curang. Yang menjadi pokok permasalahan yang diangkat ada tiga yakni bagaimana mekanisme pendaftaran dan penyelesaian nama domain, serta putusan Peninjauan Kembali kasus sengketa nama domain mustika-ratu.com ini,apakah menutup peluang penggunaan pendekatan pidana dalam penyelesaian sengketa nama domain. Penelitian ini adalah penelitian hukum yuridis normatif dengan menggunakan tipologi penelitian preskriptif. Kasus sengketa nama domain mustika-ratu.com menjadi salah satu contoh sengketa nama domain yang diselesaikan melalui proses persidangan (in court settlement). Putusan Peninjauan Kembali majelis hakim yang memutus bebas tergugat Tjandra Sugiono atau Chandra Sugiono, bukan berarti menutup peluang untuk penyelesaian sengketa nama domain di Indonesia melalui jalur pengadilan. Pertimbangan hakim dalam memutus bebas atas Tjandra Sugiono, semata hanya karena lemahnya alat bukti ditemukan unsur persaingan curang. Dengan demikian penyelesaian sengketa nama domain tetap dapat menggunakan pendekatan pidana terutarna untuk kasus-kasus tertentu yang memenuhi unsur persaingan curang ataupun cybersquatting. Majelis hakim baik di PN, tingkat kasasi maupun PK, seharusnya bisa membuat penemuan hukum (rechvinding) dalam putusannya (tanpa mempersalahkan lemahnya alat bukti), dengan pertimbanganan tidak terpenuhinya kaidah trust, good faith dan legitimate interest, berdasarkan data-data registran yang tertuang dalam halaman whois networksolution.com.

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Penggunaan Biodiesel kelapa sawit sebagai campuran bahan bakar minyak solar semakin meningkat seiring dengan penerapan peraturan pemerintah yang mewajibkan pencampuran biodiesel ke dalam minyak solar sebanyak 20% menjadi biosolar (B-20) pada tahun 2016 dan 30% (B-30) pada tahun 2020. Dilaporkan bahwa penggunaan B-20 menyebabkan penyumbatan pada saringan bahan bakar kendaraan. Penyumbatan disebabkan oleh adanya endapan yang terbentuk dari aglomerasi monogliserida terutama monopalmitin. Adanya endapan ini menurunkan sifat kemudahan alir (flow properties) B-20. Telah dilakukan penelitian untuk memperbaiki flow properties biodiesel dengan penambahan surfaktan Sorbitan Monooleate (SMO). Penambahan SMO pada biodiesel menyebabkan turunnya nilai cold filter plugging point (CFPP) yang dapat menghambat aglomerasi monogliserida. Pada pengujian pengaruh monogliserida terhadap terbentuknya endapan, kadar monopalmitin pada biodiesel divariasikan sebesar 0,4%, 0,5% dan 0,8% massa. Sampel ini dikondisikan pada suhu rendah (16⁰C) selama 24 jam, kemudian dibiarkan pada suhu kamar untuk selanjutnya disaring dan ditimbang endapannya. Semakin tinggi kandungan monogliserida dalam biodiesel, maka semakin banyak endapan yang terbentuk. Penelitian dengan SMO menggunakan biodiesel yang memiliki kandungan monogliserida yang berbeda-beda, yaitu sebesar 0,46% (B-100 A), 0,55% (B-100 B), dan 0,65% massa (B-100 C). Pada setiap biodiesel, penambahan SMO di variasikan 0,1%, 0,5%, dan 1% volume. Penyimpanan sampel biodiesel dikondisikan pada suhu rendah (16⁰C) dan pada suhu ruang (± 27⁰C). Pengaruh SMO terhadap suhu awal pembentukan kristal/wax pada biodiesel dianalisa dengan metode differential scanning calorimetry (DSC), sedangkan pengaruhnya terhadap flow properties dianalisis menggunakan 4 parameter yaitu : viskositas, densitas, titik kabut, dan cold filter plugging point (CFPP). Pengujian dilakukan setiap 1 minggu sekali untuk setiap sampel biodiesel. Penggunaan SMO 0,1% - 1% memperbaiki flow properties dengan menurunkan titik kabut sebesar ± 1,6⁰C dan CFPP sebesar 2⁰C, yang diakibatkan oleh penurunan suhu awal pembentukan kristal dari 10,47⁰C menjadi 6,99⁰C.

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The use of palm oil biodiesel as a mixture of diesel oil fuel is increasing along with the application of government regulations that require mixing biodiesel into diesel oil as much as 20% to biodiesel (B-20) in 2016 and 30% (B-30) in 2020. It was reported that the use of the B-20 caused a blockage in the vehicle's fuel filter. Blockage is caused by the presence of deposits formed from agglomeration of monoglycerides, especially monopalmitin. The presence of these deposits decreases the flow properties of B-20. Research has been carried out to improve the flow properties of biodiesel by adding Sorbitan Monooleate (SMO) surfactant. The addition of SMO to biodiesel causes a decrease in the value of cold filter plugging point (CFPP) which can inhibit agglomeration of monoglycerides. In testing the effect of monoglycerides on the formation of deposits, the level of monopalmitin in biodiesel was varied by 0,4%, 0,5% and 0,8% by mass. This sample is conditioned at a low temperature (16⁰C) for 24 hours, then left at room temperature to then filter and weigh the precipitate. The higher content of monoglycerides in biodiesel, the more deposits are formed. Research with SMO uses biodiesel which has different monoglyceride content, which is 0,46% (B-100 A), 0,55% (B-100 B), and 0,65% mass (B-100 C). In each biodiesel, the addition of SMO is varied by 0,1%, 0,5%, and 1% by volume. Storage of biodiesel samples is conditioned at low temperatures (16⁰C) and at room temperature (± 27⁰C). The effect of SMO on the initial temperature of crystal formation / wax on biodiesel was analyzed by the method of differential scanning calorimetry (DSC), while the effect on flow properties was analyzed using 4 parameters: viscosity, density, cloud point, and cold filter plugging point (CFPP). Tests are carried out every 1 week for each biodiesel sample. The use of SMO 0,1% - 1% improves flow properties by decreasing the cloud point by ± 1.6⁰C and CFPP by 2⁰C, which is caused by a decrease in the initial temperature of the crystal formation from 10,47⁰C to 6,99⁰C.

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ABSTRAK
Pemerintah mengeluarkan peraturan baru terkait kualitas timah yang dapat diekspor minimum mengandung 99,9% Sn (Peraturan Menteri Perdagangan Nomor 32/M-DAG/PER/6/2013. Adanya aturan ini dianggap perusahaan menjadi peluang bisnis bagi perusahaan. Tujuan penelitian ini adalah untuk mengetahui jenis ? jenis strategi pembiayaan yang dapat ditempuh oleh perusahaan sehubungan dengan rencana perluasan fasilitas refining, untuk mengetahui strategi mana yang paling efisien bagi perusahaan ditinjau dari segi perpajakan, dan untuk mengetahui faktor ? faktor yang perlu dipertimbangkan dalam menentukan strategi pembiayaan sehubungan dengan rencana perluasan refining. Strategi pembiayaan yang dianalisis dalam penelitian ini adalah pembiayaan melalui bank financing, shareholder debt financing, equity financing dan leasing. Strategi terbaik adalah pembiayaan melalui bank financing dengan skema 60% bank financing dan 40% debt tanpa menerapkan fasilitas Peraturan Pemerintah nomor 1 tahun 2007. Selain itu faktor ? faktor yang juga perlu dipertimbangkan dalam menentukan strategi pembiayaan antara lain: besarnya pembiayaan eksternal, shareholder debt financing, penerapan metode saldo menurun, fasilitas penyusutan dipercepat sesuai PP No. 1 tahun 2007, opportunity cost shareholder, condition precedent, covenants, jaminan kreditur, dan event of default.

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ABSTRACT
The Government of Indonesia has issued a new regulation concerning minimum quality of Stannum can be exported of 99,9% Sn (Peraturan Menteri Perdagangan Nomor 32/M-DAG/PER/6/2013). This regulation is a bussiness chance for company. The purpose of this study is to study the type of strategies to finance the planned expansion of refining facilities, to find out which strategy is the most efficient one for company in term of taxation and to determine the factors to consider in determining the most appropriate financing strategy in connection with the planned expansion of refining. The analyzed financing strategy in this study was financing through bank financing, shareholder debt financing, equity financing and leasing. Bank financing is the best strategy with consist of 60% bank financing and 40% debt facilities without implementing The Government Regulation No.1 of 2007. In addition, factors that also needs to be considered in determining the best strategies, among others: the amount of external financing, shareholder debt financing, the application of the declining balance method, accelerated depreciation facilities provided by Government Regulation No. 1 of 2007, the opportunity cost of shareholders, condition precedent, covenants, collateral lender, and events of default. ;ABSTRAK
Pemerintah mengeluarkan peraturan baru terkait kualitas timah yang dapat diekspor minimum mengandung 99,9% Sn (Peraturan Menteri Perdagangan Nomor 32/M-DAG/PER/6/2013. Adanya aturan ini dianggap perusahaan menjadi peluang bisnis bagi perusahaan. Tujuan penelitian ini adalah untuk mengetahui jenis ? jenis strategi pembiayaan yang dapat ditempuh oleh perusahaan sehubungan dengan rencana perluasan fasilitas refining, untuk mengetahui strategi mana yang paling efisien bagi perusahaan ditinjau dari segi perpajakan, dan untuk mengetahui faktor ? faktor yang perlu dipertimbangkan dalam menentukan strategi pembiayaan sehubungan dengan rencana perluasan refining. Strategi pembiayaan yang dianalisis dalam penelitian ini adalah pembiayaan melalui bank financing, shareholder debt financing, equity financing dan leasing. Strategi terbaik adalah pembiayaan melalui bank financing dengan skema 60% bank financing dan 40% debt tanpa menerapkan fasilitas Peraturan Pemerintah nomor 1 tahun 2007. Selain itu faktor ? faktor yang juga perlu dipertimbangkan dalam menentukan strategi pembiayaan antara lain: besarnya pembiayaan eksternal, shareholder debt financing, penerapan metode saldo menurun, fasilitas penyusutan dipercepat sesuai PP No. 1 tahun 2007, opportunity cost shareholder, condition precedent, covenants, jaminan kreditur, dan event of default.

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ABSTRACT
The Government of Indonesia has issued a new regulation concerning minimum quality of Stannum can be exported of 99,9% Sn (Peraturan Menteri Perdagangan Nomor 32/M-DAG/PER/6/2013). This regulation is a bussiness chance for company. The purpose of this study is to study the type of strategies to finance the planned expansion of refining facilities, to find out which strategy is the most efficient one for company in term of taxation and to determine the factors to consider in determining the most appropriate financing strategy in connection with the planned expansion of refining. The analyzed financing strategy in this study was financing through bank financing, shareholder debt financing, equity financing and leasing. Bank financing is the best strategy with consist of 60% bank financing and 40% debt facilities without implementing The Government Regulation No.1 of 2007. In addition, factors that also needs to be considered in determining the best strategies, among others: the amount of external financing, shareholder debt financing, the application of the declining balance method, accelerated depreciation facilities provided by Government Regulation No. 1 of 2007, the opportunity cost of shareholders, condition precedent, covenants, collateral lender, and events of default.

Abstrak :
Penelitian ini terfokus pada usaha untuk menurunkan intensi turnover executive trainee di PT TRI. Turnover sebesar 61.9% diidentifikasi karena ketidakpuasan terhadap gaji, kondisi operasional, dan sifat pekerjaan. Penelitian dilakukan untuk melihat pengaruh kepuasan kerja terhadap intensi turnover menggunakan Job Satisfaction Survey (Spector, 1997) dan Withdrawal Cognition (Tang, Kim & Tang, 2000). Hasil dari 60 executive trainee menunjukkan pengaruh signifikan kepuasan kerja sebesar 53.9% terhadap intensi turnover. Hasil lanjutan menunjukkan sifat pekerjaan paling berkontribusi dan signifikan terhadap intensi turnover. Oleh karenanya, diberikan intervensi pelatihan mentoring pada atasan dari executive trainee dengan kepuasan pada sifat pekerjaan rendah dan sedang. Hasil uji perbedaan skor kepuasan kerja dan intensi turnover saat sebelum dan setelah intervensi menunjukkan terdapat peningkatan kepuasan kerja terutama pada faset sifat pekerjaan, serta penurunan intensi turnover secara signifikan. Dengan demikian, perusahaan perlu membekali atasan dengan pengetahuan dan keterampilan mentoring sebelum membimbing para executive trainee.

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This study focused on the efforts to reduce turnover intention of executive trainee at PT TRI. Turnover amounted to 61.9% was identified as dissatisfaction with salaries, operating conditions, and the nature of work. The study was conducted to see the effect of job satisfaction on turnover intention using Job Satisfaction Survey (Spector, 1997) and Withdrawal Cognition (Tang, Kim & Tang, 2000). The results of the 60 executive trainees showed that 53.9% of turnover intention was influenced by job satisfaction. Further result showed that the nature of work is the most contributing facet and has significant effect to turnover intention. Therefore, the researcher conducted an intervention in the form of mentoring training for superiors of executive trainee with low and medium satisfaction on nature of work. Result of a mean differences test on turnover intention and job satisfaction scores before and after the intervention showed that there was an increase of job satisfaction, especially on the nature of work, as well as reduce turnover intention significantly. Thus, company needs to equip superiors with the knowledge and skills of mentoring before guiding the executive trainee.

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Tesis ini mengkaji mengenai aturan terkait perlindungan hukum kegiatan penggalangan dana  yang dilakukan dengan menggunakan platform Donation based  Crowdfunding.  Kegiatan penggalangan dana pada dasarnya diatur pada Undang-Undang No. 9 Tahun 1961 dan PP No. 29 Tahun 1980 namun aturan ini belum mengenal penggalangan dana dengan menggunakan pihak ketiga seperti platform donation based crowdfunding. Permasalahan yang dikaji dalam tesis ini meliputi analisis bentuk badan usaha yang dapat digunakan oleh situs pengelola donation based crowdfunding sehingga mempunyai legal standing di Indonesia, bentuk perlindungan dan pengawasan terkait risiko dan juga perbandingan aturan dan perlindungan hukum donation based crowdfunding di Amerika, Uni Eropa dan India. Tesis ini disusun dengan menggunakan metode penulisan hukum normative yang bertujuan untuk meneliti kepastian hukum berdasarkan studi kepustakaan dan hukum positif yang ada. Penelitian ini menggunakan pendekatan undang-undang disertai dengan studi kepustakaan untuk mendapatkan pemahaman yang lebih komprehensif. Jenis data yang diperlukan dalam tesis ini adalah data sekunder yang diperoleh melalui studi kepustakaan, seperti peraturan perundang-undangan, dokumen-dokumen resmi, literature, dan buku-buku yang relevan dengan Donation Based Crowdfunding.

 

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This thesis examines the rules regarding law enforcement of fundraising activities carried out using the donation based crowdfunding platform. Fundraising activities are basically governed by Law No.9 of 1961 and PP No. 29 of 1980, however these rules does not recognize fundraising using third parties such as donation based crowdfunding platforms. The problem examined in this thesis include the analysis of business entity forms that can be used by donation based crowdfunding management sites so that they have legal standing in Indonesia, in terms of risk protection and supervision and also comparison of donation based crowdfunding legal protection and rules in United States, European Union and India. This thesis is compiled using normative legal writing method which aims to examine legal certainty based on existing literature studies and positive laws. This study uses a legal approach accompanied by literature studies to get a more comprehensive understanding. The types of data needed in this thesis are secondary data obtained through library studies, such as legislation, official documents, literature, and books that are relevant to Donation Based Crowdfunding.

 

Abstrak :
Diabetes mellitus (DM) is one of the public health problems worldwide, including in Indonesia. Cardiovascular disease was the main cause of death (75-80%) in DM, three-fourths of this death was caused by coronary heart disease (CHD). Approximately 34.2% of patients with acute coronary syndrome (ACS) receiving care at ICCU of Dr. Cipto Mangunkusumo General Hospital (RSCM) suffered from DM. Mortality rates of ACS in DM patients were still high and ACS prognosis in DM patients were still unfavorable. There are many factors playing a part in atherosclerosis and ACS incidence in DM patients, such as metabolic disorders due to hyperglycemia and the fomration of advanced glycation end product (AGE), oxidative stress, atherogenic dyslipidemia in DM in the form of high triglyceride level and low HDL cholesterol as well as an increase in small dense LDL, and insulin resistance. In addition, other risk factors of CHD frequently encountered with DM were hypertension, obesity, thrombocytc hyperaggregation and hypercoagulation. The management ofthis disease which was based on the control of risk factors was not yet satisfactory. Inflammatory response played an important role in pathogenesis of atherosclerosis, beginning with early lesion up to acute coronary syndrome. Increase in inflammatory responses (hsCRP) could predict cardiovascular event and predict post-ACS prognosis. Studies in DM population showed an increase in inflammation. ln-depth studies on inflammatory responses in ACS DM patients have not yet been reported. In normal condition, there was a balance of proinflammatory and antiinflammatory cytokines. The ratio of proinflammatory and antiinflammatory cytokines in ACS, particularly DM patients has not been studied. The relationship between metabolic factor (blood glucose, glyco Hb and lipid) and inflammatory response in ACS DM patients has not yet also been studied. Currently, the effort to decrease inflammatory response is made, among others, by aspirin, statin hypolipidemic medication and insulin sensitizer. Although aspirin and statin were used routinely in ACS patients and have proved to reduce inflammation, morbidity and mortality rates of ACS patients were still high. Thus, we would like to observe whether an addition of other medications in standard therapy could reduce inflammation better. Curcumin in experimental animals-and humans) showed -hypolipidemic effect (decrease 'in absorption and increase in catabolism) and hypoglycemia (effect on PPAR-7). Curcumin also demonstrated antiinflammatory effect. In this study we would like to observe the effects of curcumin on both metabolic factors and inflammatory responses in ACS patients. PROBLEM IDENTIFICATION The above elaboration showed a discrepancy associated with inflammatory response in DM ACS patients. Up to now, the relationship of metabolic factor and inflammatory response in DM ACS has not been clear yet. Likewise, the effects of curcumin on metabolic factor and inflammatory response in ACS have not yet been identified. OBJECTIVES To evaluate inflammatory responses in DM ACS and its relationship with metabolic factors (glucose, blood; glyco Hb, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride); to evaluate the ratio of proinflammatory and antiinflammatory cytokines (IL-6/IL-10) in ACS DM patients, and to identify the effects of curcumin on metabolic factors and inflammatory responses in ACS patients. SETTING The study was conducted at ICCU of RSCM, ICCU of Persahabatan, ICCU of RS MMC and ICCU of Medistra Hospital, Cardiology Polyclinic, Department of Internal Medicine, Faculty of Medicine University of Indonesia! RSCM and Integrated Cardiac Service Poiyclinic of RSCM. STUDY SUBJECTS ACS patients (DM and non-DM) and CHD (DM and non-DM). DESIGN There were two studies: l. Observational design to observe inflammatory responses (hscRP, IL-6, IL-IO, VCAM and ICAM) in DM ACS, non-DM ACS, DM CI-ID, and non-DM CHD; to evaluate the relationship between metabolic factors (fasting blood glucose, blood glucose 2 hours PP, glyco Hb, total cholesterol, LDL cholesterol, HDI.. cholesterol and triglyceride) and inflammatory responses (hsCRP, IL-6, IL-10, VCAM and ICAM) in ACS DM. 2. Interventional study which was a double-blind randomized trial to evaluate the effects of curcumin at escalating doses (low dose 3:-:IS mglday, moderate dose 3x30 mg/day and high dose 3x60 mg/day on metabolic factors (fasting blood glucose. blood glucose 2 hours PP and glyco Hb) and the effects of curcumin at escalating doses on inflammatory responses (hsCRP, ll.-6, VCAM and ICAM) in ACS patients. RESULTS In observational study, |46 subjects were analyzed, consisting of 84 ACS patients, (30 DM ACS patients and 54 non-DM ACS), and 62 CHD (25 DM CHD patients and 37 non-DM CHD patients). The results of the study in the four groups of patients showed: 1. Inflammatory response in DM ACS was higher than in DM CHD (hsCRP, p=0.00; II..-6, p=0.00; IL-10, p=0.00) and non-DM ACS (ICAM, P=0.03). 2. The ratio of proinflammatory and antiinflammatory cytokines (IL-6/II..-10) in DM ACS did not differ from that of DM CHD (p=0.2l) and non-DM ACS (p=0.5 l). 3. There was a relationship between metabolic factors and inflammatory responses in DM ACS: triglyceride and ll.-6 (r=O.39, p=0.03) and II..-I0 (r=0.37, p=o.o4). In interventional study we performed randomization in 75 ACS patients divided into four groups, consisting of low-dose curcumin group of 15 patients, moderate-dose curcumin group of 15 patients, high-dose curcumin group of IS patients, and placebo group of 30 patients. The results of the study in these four groups showed: l. Low-dose curcumin showed a decrease in hsCRP in one week ofthe first month after intervention, there was a significant difference liom that of placebo (p=0.04). Low-dose, moderate-dose, high-dose curcumin groups showed a decrease in IL-6, but was not significantly different from placebo. Low-dose, moderate-dose, high-dose curcumin did not show a decrease in VCAM and ICAM after intervention of 2 months. 2. Low-dose curcumin group tended to experience a decrease in glyco Hb level after intervention of 2 months (p=0.06); however, it was not significantly different from that of placebo. 3. There was a tendency that low-dose curcumin reduced total cholesterol and LDI. cholesterol; however, it was not significantly different from that of placebo. There was a tendency that low-dose curcumin increased HDL cholesterol; however, it was not significantly different from that of placebo. 4. There was a tendency that the pattern of escalating doses had some effects in inflammatory responses and metabolic factors, in which low-dose curcumin showed the best effects, followed by moderate-dose and finally high- dose curcumin. CONCLUSIONS In this study, inflammatory responses in DM ACS patients were higher than those in DM CHD and non-DM ACS patients. There was no difference in the ratio of proinflammatory and antiinflammatory cytokines (IL-6fIL-IO) in DM ACS compared with DM CHD and non-DM ACS. ln addition, the present study identified some of the relationships between metabolic factors and inflammatory responses. Low-dose curcumin reduced hsCRP in one week of the first month after the intervention in ACS patients. There was a tendency that low-dose curcumin reduced glyco Hb level in ACS.