Communication Services Research Articles

Reconfigurable data intensive service for low latency cyber-physical systems and IoT communication

<span>The fourth industrial revolution is realized through the many developments in cyber-physical systems (CPS) made possible by the widespread use of the internet of things (IoT). CPS sensor networks must enable mobile and wireless CPSs with their specific flexibility and heterogeneity needs without compromising quality of service (QoS). The research article focuses on reconfigurable data communication hardware for numerous IoT-supporting infrastructures and performance estimation using delay, power, throughput, and packet delivery ratio (PDR) for different IoT node configurations. Tree topology-based network configuration from cloud data to sensor fog organizers, sensor network directors, and IoT-embedded sensors is supported. Functional simulation is performed in iFoGSim, Xilinx ISE, and Modelsim 10.0 with a maximum of 64 variable nodes programmed for data communication and interplay verification with a minimum delay of 9.1 ns, maximum frequency of 319 MHz, power of 7.5 mW, throughput of 0.280, and maximum PDR=1. The simulation is applicable for fog computing and CPS processed from different alters in specific topologies.</span>

Large scale public health system transformation: Germany

Abstract The COVID-19 pandemic was a stress test for public health services in Germany. Decision making was complex (party lengthy and inconsistent) due to the divided responsibilities within the federal system. Some improvements on the public health system were already enacted during the pandemic. A “pandemic radar” was established to bundle up relevant infectious disease indicators with indicators of health services use. The national electronic notification and information system for infectious diseases was extended. Digital improvements were made in the public health offices. Laboratory capacity was strengthened, so was inter-science modelling to forecast pathogen spread. A nation-wide collaborative mechanism, the cloverleaf system, was introduced between regions to avoid the overburdening of hospitals. It is now established for times of excess need for inpatient services. In 2020, a 4 billion euros investment program, the “Pact of Public Health Services”, was adopted to strengthen and modernize the German public health service institutions. The pact is implemented until 2026. The human resources component is the largest. Further priorities include digitalization, improvement of the infrastructure (of designated ports and airports) for the implementation of the International Health Regulations, research and the creation of agile and resilient public health structures. Outputs so far include the establishment of more than 4800 new public health positions, the appointment of new professorships for public health services, the initiation of several research projects, and the roll-out of more than 300 digitalization projects. A new federal institute for prevention is planned. It aims to foster networking between public health services, strengthen health communication, data use, and evidence for public health services. In this process, WHO advised the federal ministry e.g. on behavioral insights; heat health action; prevention on noncommunicable diseases and others. Many public health actors have provided opinions. However, consensus building on how Germany can overcome fragmentation in public health is ongoing.

Lithuanian Intelligence Services’ Strategic Communication: 2012–2022 National Threat Assessments, Activity Reports and Recruitment Videos

This study examines the communication of the State Security Department of the Republic of Lithuania and the Second Investigation Department under the Ministry of National Defence in 2012–2022. It identifies the aspects relevant to the strategic communication of the intelligence services, analyses specifics of the texts and tendencies in national threat assessments and activity reports, and examines how these institutions present themselves. The study applies the theory of securitisation and critical discourse analysis. It includes other research related to the topic, practices of foreign intelligence services in publishing annual reports and using the YouTube social media platform, media publications and other sources. The study concludes that strategic communication for intelligence agencies is essential for the long-term success of their operations. By focusing on strategic objectives, they inform and educate the public about themselves and national security and develop a cooperative relationship, contributing to deterrence. Both institutions examined in this study are becoming not only formally more open to the public, but also aim to build and maintain a high institutional reputation, connect with their audience and create an image of professionalism, modern accountability and openness to the public.

Survey on Current Status, Challenges and Opportunities towards Integration of Traditional Smallholder Crop-livestock Systems in Kenya

The current study reports the results of a baseline survey conducted to establish current status of optimizing productivity of crop-livestock systems in Kenya. Results from the study showed that 74% and 18% of the household head and respondents were male and female respectively, indicating a male dominance of household headship. The household head (69%) and respondents (16%) reported to have completed classes for formal school. On average, farmers were walking 1.83 Km, 5.18 Km, 4.65 Km, and 12.79 Km to the nearest village market, town market, extension office and farmers’ training centers respectively. This shows that extension and communication services are still far apart from the farming communities, with a negative implication on technology adoption and household food and nutrition security. Majority of the farmers did not utilize organic nutrients for crop production (96%). Open heaping/piling, composting with other materials, use of solid and liquid manures was reported to be utilized on average 67 kg, 30 kg, 11 kg and 2 kg respectively. This implies a poor manure management, low adoption and utilization levels of organic manures, with subsequent impact on climate change, crop productivity and household food and nutrition security. The main constraint limiting the use of organic fertilizers were ranked as follows; ignorance of the technical aspects linked to the use of manure as an organic fertilizer (17.8%), low awareness of manure usefulness to improve soil fertility (16.4%), high affordability and timely accessibility of chemical fertilizers (16.3%). Results further show that majority of the respondent did not utilize Nitrogen fixing plants (66%), nutrient cycling (84%) and legume crops (75%). The main Nitrogen-fixing plants were faba bean (10%), Sesbania (9%), cowpea (5%), alfalfa (2%) and sunflower (1%) respectively. The survey recommends promotion of climate smart interventions and organic soil fertility management approaches, farmers capacity building and promotion of agribusiness.

Exploring the mechanism of sustained consumer trust in AI chatbots after service failures: a perspective based on attribution and CASA theories

In recent years, artificial intelligence (AI) technology has been widely employed in brand customer service. However, the inherent limitations of computer-generated natural language content occasionally lead to failures in human-computer interactions, potentially damaging a company’s brand image. Therefore, it is crucial to explore how to maintain consumer trust after AI chatbots fail to provide successful service. This study constructs a model to examine the impact of social interaction cues and anthropomorphic factors on users’ sustained trust by integrating the Computers As Social Actors (CASA) theory with attribution theory. An empirical analysis of 462 survey responses reveals that CASA factors (perceived anthropomorphic characteristics, perceived empathic abilities, and perceived interaction quality) can effectively enhance user trust in AI customer service following interaction failures. This process of sustaining trust is mediated through different attributions of failure. Furthermore, AI anxiety, as a cognitive characteristic of users, not only negatively impacts sustained trust but also significantly moderates the effect of internal attributions on sustained trust. These findings expand the research domain of human-computer interaction and provide insights for the practical development of AI chatbots in communication and customer service fields.

Utility optimization for computation offloading and splitting in time-varying HAP and LEO satellite integrated MEC networks

To provide ubiquitous and low-latency communication and computation services for remote and disaster areas, high altitude platform (HAP) and low earth orbit (LEO) satellite integrated multi-access edge computing (HLS-MEC) networks have emerged as a promising solution. However, most current studies directly assume that the number of connected satellites is fixed and neglect the modeling of the time-varying multi-satellite computing process. Motivated by this, we establish an M/G/K(t) queuing model to illustrate task computation on satellites. To evaluate the efficiency and quality of computation offloading and splitting, we develop a utility model. This model is defined as a difference between a value function that assesses the trade-offs of task offloading, considering latency reductions and energy savings, and a cost function that quantifies expenses related to latency and energy consumption. After formulating the utility maximization problem, we propose the deep reinforcement learning-based offloading and splitting (DBOS) scheme that can overcome the time-varying uncertainties and high dynamics in the HLS-MEC network. Specifically, the DBOS scheme can learn the best computation offloading and splitting policy to maximize the utility by sensing the number of connected satellites, the distance between the HAP and satellites, the available computing resources, and the task arrival rate. Finally, we evaluate and validate the computational complexity and convergence property of the DBOS scheme. Numerical results show that the DBOS scheme outperforms the other three benchmarks and maximizes the utility under time-varying dynamics.

Mapping cellular coverage suitability: a GIS-Based approach to identifying poor service areas

Cellular coverage is a critical component of modern telecommunications, providing essential services for communication, commerce, and emergency response. Despite its importance, many regions, particularly those with challenging terrain or low population density, experience inadequate cellular service. This study focuses on the commune of Laghouat, Algeria, employing a GIS-based Multi-Criteria Analysis (MCA) to assess cellular coverage suitability. Using ArcGIS Pro, four key factors were integrated: cell tower locations, terrain elevation, population distribution, and restricted areas. The methodology includes performing a Viewshed analysis to identify dead zones, converting population data into raster format to map demand, and digitizing restricted areas where telecommunication infrastructure development is prohibited. All factors were standardized to a common scale to ensure comparability and a weighted overlay analysis was conducted to generate a comprehensive suitability map. The map highlights areas of poor cellular coverage, guiding the placement of new infrastructure. Additionally, the research considers regulatory restrictions on land use, ensuring compliance with governmental policies. The resulting suitability map provides valuable insights for telecommunications providers and policymakers, enabling them to target underserved regions for infrastructure improvements while adhering to legal constraints. This study offers a robust, scalable framework for identifying and addressing cellular coverage gaps, applicable to other regions with similar geographic and demographic challenges.

Innovative Management Strategies and Competitive Advantage of Global System for Mobile Communication (GSM) Service Providers in Taraba State, Nigeria

This study investigates the effects of product, service, process, and technological innovations on the competitive advantage of GSM service providers in Jalingo, Taraba State, Nigeria. It aims to determine how these different types of innovations influence market positioning and operational efficiency within the regional telecommunications sector. The research is framed using Dynamic Capabilities Theory, which emphasizes the role of strategic adaptability and resource reconfiguration in achieving and sustaining competitive advantage in rapidly changing markets. Employing a mixed-methods approach, the study integrates quantitative data from structured questionnaires distributed to 115 staff across major telecom providers and qualitative insights from industry reports. A total of 102 responses were analyzed using regression analysis in SPSS to evaluate the effect of innovation types on competitive advantage. The findings reveal that all types of innovation—product, service, process, and technological—significantly enhance the competitive advantage of GSM providers in Jalingo. Service innovation showed the strongest effect, followed by technological, product, and process innovations. The study underscores the critical importance of a holistic innovation strategy that includes diverse forms of innovation to improve competitive advantage. GSM providers in Jalingo who embrace comprehensive innovation strategies are more likely to secure greater market share and achieve long-term profitability. The study recommends that GSM service providers should prioritize developing new service offerings and enhancing existing services. This could include investing in customer relationship management systems to personalize services, implementing loyalty programs, or introducing flexible pricing models that cater to different customer segments.

High Capacity and Reversible Fragile Watermarking Method for Medical Image Authentication and Patient Data Hiding.

The exchange of medical images and patient data over the internet has attracted considerable attention in the past decade, driven by advancements in communication and health services. However, transferring confidential data through insecure channels, such as the internet, exposes it to potential manipulations and attacks. To ensure the authenticity of medical images while concealing patient data within them, this paper introduces a high-capacity and reversible fragile watermarking model in which an authentication watermark is initially generated from the cover image and merged with the patient's information, photo, and medical report to form the global watermark. This watermark is subsequently encrypted using the chaotic Chen system technique, enhancing the model's security and ensuring patient data confidentiality. The cover image then undergoes a Discrete Fourier Transform (DFT) and the encrypted watermark is inserted into the frequency coefficients using a new embedding technique. The experimental results demonstrate that the proposed method achieves great watermarked image quality, with a PSNR exceeding 113dB and an SSIM close to 1, while maintaining a high embedding capacity of 3 BPP (Bits Per Pixel) and offering perfect reversibility. Furthermore, the proposed model demonstrates high sensitivity to attacks, successfully detecting tampering in all 18 tested attacks, and achieves nearly perfect watermark extraction accuracy, with a Bit Error Rate (BER) of 0.0004%. This high watermark extraction accuracy is crucial in our situation where patient data need to be retrieved from the watermarked images with almost no alteration.

A Generic Transformation Approach for Complex Laboratory Data Using the Fast Healthcare Interoperability Resources Mapping Language: Method Development and Implementation.

Reaching meaningful interoperability between proprietary health care systems is a ubiquitous task in medical informatics, where communication servers are traditionally used for referring and transforming data from the source to target systems. The Mirth Connect Server, an open-source communication server, offers, in addition to the exchange functionality, functions for simultaneous manipulation of data. The standard Fast Healthcare Interoperability Resources (FHIR) has recently become increasingly prevalent in national health care systems. FHIR specifies its own standardized mechanisms for transforming data structures using StructureMaps and the FHIR mapping language (FML). In this study, a generic approach is developed, which allows for the application of declarative mapping rules defined using FML in an exchangeable manner. A transformation engine is required to execute the mapping rules. FHIR natively defines resources to support the conversion of instance data, such as an FHIR StructureMap. This resource encodes all information required to transform data from a source system to a target system. In our approach, this information is defined in an implementation-independent manner using FML. Once the mapping has been defined, executable Mirth channels are automatically generated from the resources containing the mapping in JavaScript format. These channels can then be deployed to the Mirth Connect Server. The resulting tool is called FML2Mirth, a Java-based transformer that derives Mirth channels from detailed declarative mapping rules based on the underlying StructureMaps. Implementation of the translate functionality is provided by the integration of a terminology server, and to achieve conformity with existing profiles, validation via the FHIR validator is built in. The system was evaluated for its practical use by transforming Labordatenträger version 2 (LDTv.2) laboratory results into Medical Information Object (Medizinisches Informationsobjekt) laboratory reports in accordance with the National Association of Statutory Health Insurance Physicians' specifications and into the HL7 (Health Level Seven) Europe Laboratory Report. The system could generate complex structures, but LDTv.2 lacks some information to fully comply with the specification. The tool for the auto-generation of Mirth channels was successfully presented. Our tests reveal the feasibility of using the complex structures of the mapping language in combination with a terminology server to transform instance data. Although the Mirth Server and the FHIR are well established in medical informatics, the combination offers space for more research, especially with regard to FML. Simultaneously, it can be stated that the mapping language still has implementation-related shortcomings that can be compensated by Mirth Connect as a base technology.

Communication, Socialization, and Literacy for Adults With Developmental Disabilities: An Interview Study of Parents' Perspectives and Experiences.

The study highlights the significance of continuous support and services in communication, socialization, and literacy skills for adults with developmental disabilities (DDs). The aim of the study was to gather in-depth information on the individualized needs, lived experiences, and expectations of adults with DD by interviewing their parents. A total of 14 parents of adults with DD participated in one-on-one semistructured interviews. During the interviews, parents were asked to describe (a) their children's current communication, socialization, reading and writing skills; (b) the types of communication, socialization, and literacy support their children were receiving; and (c) the types of support that their children needed. Interviews were video- and audio-recorded, transcribed, and analyzed qualitatively using thematic analysis. Thematic analysis revealed three main themes and eight subthemes: (1) insufficient support and services for adults with DD (i.e., lack of competent professionals and lack of literacy support), (2) approaches that the parents attempted for their children with DD (i.e., parents' responsibilities, technologies, and pseudoscience), and (3) recommendations for ongoing support and services (i.e., novel technologies, social media, and motivation). The study highlights crucial gaps between the participating parents' desire for individualized, consistent, and innovative support and services for their adult children with DD and scarcity of resources in communication, socialization, and literacy. The dearth of evidence-based support and resources leads to easy access to pseudoscience. Future research is warranted to develop innovative, customized, and highly motivating programs in communication, socialization, and literacy for adults with DD. https://doi.org/10.23641/asha.27214407.

Agricultural raw materials, information and communications technology and service exports on economic growth in twenty Sub-Saharan countries: A panel vector error correction model approach

Agricultural raw materials, information and communications technology and service exports on economic growth in twenty Sub-Saharan countries: A panel vector error correction model approach

Key Predictors of Patient Satisfaction and Loyalty in Saudi Healthcare Facilities: A Cross-Sectional Analysis.

Patient satisfaction and loyalty are essential indicators of healthcare quality, directly impacting patient outcomes and the long-term success of healthcare facilities. Despite the growing importance of patient-centered care in Saudi Arabia, there is limited research exploring the factors that influence patient satisfaction and loyalty, particularly in the Riyadh region. This study aims to identify the key factors influencing patient satisfaction and loyalty among Saudi patients attending public and private healthcare facilities in the Riyadh region. The study focuses on how healthcare service quality, communication, and demographic factors contribute to patient satisfaction and loyalty. A cross-sectional study was conducted with a sample of 350 Saudi patients from 10 healthcare facilities in Riyadh. Data were collected using the Patient Satisfaction Questionnaire (PSQ-18) and the Patient Loyalty Questionnaire (PLQ). Descriptive statistics, Pearson correlation, and multiple linear regression were employed to identify predictors of patient satisfaction and loyalty. Significant predictors of patient satisfaction included general satisfaction (β = 0.48, p < 0.001), communication (β = 0.35, p < 0.001), and the frequency of healthcare visits (β = 0.13, p = 0.011). Private healthcare facilities had higher satisfaction (p < 0.001) and loyalty scores (p < 0.001) compared to public facilities. Patient loyalty was strongly predicted by general satisfaction (β = 0.55, p < 0.001) and communication (β = 0.42, p < 0.001). Communication quality and patient satisfaction are key drivers of patient loyalty in Saudi healthcare facilities. Private facilities outperform public ones in patient satisfaction and loyalty. These findings emphasize the need for healthcare providers to enhance communication and service quality to foster patient loyalty. Tailored approaches to meet the diverse needs of patients, particularly in terms of education and visit frequency, are crucial for improving healthcare outcomes in Saudi Arabia.

A review of research on the development of low-orbit Internet constellations

In recent years, with the surge in Internet users, innovative companies such as SpaceX and OneWeb have planned to build low-orbit Internet constellations, triggering a global boom in the development of low-orbit satellite Internet constellations. Therefore, it is of great significance to study the development of low-orbit Internet constellations at home and abroad and the technical difficulties currently faced by low-orbit Internet constellations in their development. This paper first introduces three representative low-orbit Internet constellation plans abroad (Starlink, OneWeb, Lightspeed) and the latest development of domestic constellations. Then, based on the characteristics of low-orbit Internet constellations, the five major technical challenges faced by low-orbit Internet constellations are analyzed in detail: constellation relative motion evolution prediction, constellation autonomous navigation and orbit determination, constellation variable path planning, constellation self-organization collaborative control, constellation communication and network services. Finally, based on the current development trend of low-orbit Internet constellations, suggestions are given for the development of low-orbit Internet constellations in my country based on my country's national conditions.

Empirical Mode Decomposition Based Amplify and Forward Technique for Cooperative Cognitive Radio System

The rapid growth in the mobile industry due to increase in number of users accessing diverse services causes a high demand for radio spectrum. Nonetheless, the radio spectrum allocated for different wireless communication services is restricted. Cooperative Cognitive Radio (CCR) technique with Amplify and Forward (AF) relaying protocol used to address the problem suffers from noise amplification resulting in poor reception at the destination. Hence, in this paper, Empirical Mode Decomposition (EMD) based AF technique for CCR system was carried out to improve the performance of the existing CCR with AF relaying protocol. The transmitted signal from Primary User (PU) was received at the Secondary User (SU) where SU superimposed its own signal using Exclusive OR (XOR) rule. The combined signal from XOR was made to pass through EMD and amplified using AF by multiplying with the relay gain. The amplified signal was radiated to PU and SU receivers during the second hop transmission. The multiple copies of the receive signal at the SU receiver at different number of path (L = 2, 4) were combined at destination using Maximal Ratio Combiner (MRC). Mathematical expression for Bit Error Rate (BER) and Throughput (TP) were derived using the Probability Density Function (PDF) of the Nakagami-m fading distribution. Extensive simulations using MATLAB R2021a were employed to assess the effectiveness of the proposed technique and evaluated using BER and TP by comparing with the existing AF CCR. The EMD based AF technique proposed gave better performance with 75.2% reduction in BER and 21.86% increase in TP over the existing AF technique for CCR. The proposed technique can be deployed to improve the performance of cooperative cognitive radio system.

Ethnic disparities in perceived racism, patient-provider communication and healthcare utilization: Asian Americans

ABSTRACT Background Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities by influencing patient-provider communication and utilization of healthcare services. Objective This study aimed to investigate how Asian American subgroups differ in their perception of everyday racism, internalized racism, and perceived racism in healthcare settings and whether these perceptions predict their interactions with their health care providers and their utilization of healthcare services. Methods An online survey study was conducted. ANOVA tests were employed to compare the differences in perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system among Filipino (N = 310), Japanese (N = 242), Chinese (N = 287), Asian Indian (N = 304), Korean (N = 199) and Vietnamese (N = 151) participants. Multiple regression analyses assessed whether perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system predicted healthcare service utilization and patient-provider communication among the Asian subgroups sampled. Results There were significant group differences in perceived everyday racism (F = 8.56, p < .001), internalized racism (F = 3.46, p < .01), perceived racism in healthcare (F = 4.57, p < .001). Perceptions of racism and socioeconomic variables were found to predict patient-provider communication and utilization of healthcare services disparately across various Asian subgroups. For instance, the perception of everyday racism was a significant predictor of patient-provider communication for each of the subgroups, excluding the Vietnamese participants. Internalized racism was a significant predictor only for Filipino and Chinese participants. Surprisingly, perceived racism in healthcare was not a predictor for any of the subgroups. Conclusion Findings highlight the complex interplay of sociodemographic factors and perceived racism in shaping patient-provider communication and healthcare service utilization within the Asian American community. Implications are suggested for addressing the unique challenges faced by different Asian American subgroups and for promoting equitable healthcare access and fostering positive patient-provider relationships among the Asian American subgroups.

Exploring the role of national weather services in climate change knowledge and communication: an international survey

This study investigates the roles, perspectives, and communication strategies of National Meteorological Services (NMS) concerning climate monitoring, climate change projections, and the attribution of meteorological phenomena to climate variations. Using a survey distributed to 131 of the 193 National Meteorological Services affiliated with the World Meteorological Organization, we explore how these entities contribute to and communicate about the science of climate change. The survey targeted their involvement in observing and recording climate data, making climate projections, attributing specific weather events to climate change, and their methods of communicating these issues to the public and government officials. Responses were received from 44 countries, reflecting diverse levels of economic development and capabilities in handling, and disseminating complex climate information. The results show a strong engagement in traditional meteorological tasks, with a varied approach to the scientific study of climate change effects and public communication strategies. This study highlights the critical role of NMS in climate change research and underscores the challenges they face in effectively communicating complex climate information, which is crucial for public understanding and policymaking.

Investigating the Relationship Between Patient-Centered Communication and Quality of E-Consult in China: A Cross-Sectional Standardized Patient Study

ABSTRACT Patient-centered communication is widely acknowledged as an essential element of high-quality healthcare. Our study attempted to explore the weaknesses in the actual doctor-patient communication process and the most critical elements in patient-centered communication to improve the service quality of e-consult. We recruited ten standardized patients presenting fixed cases (urticaria and childhood diarrhea) for 321 valid interactions to measure patient-centered communication and e-consult service quality. The scores of patient-centered communication included exploring the patient’s disease experience, understanding the patient’s social situation, and reaching a consensus between doctors and patients. We measured the quality of e-consult services by the total words of doctor’s responses, accurate diagnosis, appropriate prescription, lifestyle modification advice, patient satisfaction, continuance intention, and cost. Ordinary least-squares and logistic regression were performed to investigate the association between patient-centered communication and e-consult service quality. The total mean score of patient-centered communication was 17.67. The mean words of responses and cost were 178.55 words and 39.46 yuan, respectively. 82.87% of doctors diagnosed accurately, with 21.81% prescribing appropriate prescriptions and 81.93% providing lifestyle modification advice. 254 interactions obtained high satisfaction, and 218 had continuance intention after the interactions. Doctors with higher patient-centered communication levels would provide more words of responses. They were more likely to provide accurate diagnoses, appropriate prescriptions, and lifestyle modification advice, resulting in better patient satisfaction, continuance intention, and higher costs. Therefore, it is necessary to standardize and improve the doctor-patient communication process of e-consult and develop training for different doctors.

Service Quality Affects BPJS Patient Satisfaction at the Pematang Health Center, Serang Regency, Banten in 2024

Health service providers must strive to improve the quality of services for the realization of the highest degree of public health. The purpose of this study is to find out and analyze the quality of service affecting BPJS patient satisfaction at the Pematang Health Center, Serang Regency, Banten in 2024. The research design uses an analytical survey with a cross sectional design. The population in this study is all patients who are treated using BPJS as many as 4,210 people with an accidental sampling technique with a sample of 98 people. The data analysis used used was univariate analysis, bivariate using chi-square and multivariate using logistic regression. The results of the logistic regression analysis that affected were the variables of immediate service p = 0.003, politeness p = 0.005 and effective communication p = 0.000 and the most influential variable was effective communication with an Exp B value of 13.922. The conclusion of the variables that do not affect is the use of information technology, physical facilities, quick response, skills and attitudes and the variables that affect are prompt service, politeness and effective communication and the most influential is effective communication. It is recommended to the Puskesmas to make a budget for Communication Skills training for all health workers, mentoring, and implementation by making the motto of the Pematang Health Center to be (smile, greeting, polite fast and precise). Providing services in a timely, polite, friendly manner and can maintain patient privacy in order to increase patient satisfaction and provide physical facilities such as (chairs, air conditioners, loudspeakers and machines to take no queue) as well as provide information on the use of mobile JKN.

Quality of Service and Congestion Control in Software-Defined Networking Using Policy-Based Routing

Managing queuing delays is crucial for maintaining Quality of Service (QoS) in real-time media communications. Customizing traditional routing protocols to meet specific QoS requirements—particularly in terms of minimizing delay and jitter for real-time media—can be both complex and time-intensive. Furthermore, these protocols often encounter challenges when adapted for vendor-specific hardware implementations. To address these issues, this paper leverages the programmable features of Software-Defined Networking (SDN) to simplify the process of achieving user-defined QoS, bypassing the limitations of traditional routing protocols. In this work, we propose a policy-based routing module that integrates with traditional routing protocols to ensure QoS for real-time media flows. QoS is achieved by rerouting the flow along a new low-latency path calculated by the proposed module when the queuing delay exceeds a certain threshold. The experimental results demonstrate that the proposed solution significantly enhances the performance of traditional routing protocols within an SDN framework, effectively reducing the average end-to-end delay by 80% and total packet loss by 73%, while also improving jitter and alleviating network congestion.