“And when systems get complex, then of course communication often suffers. This is because we've developed a highly bureaucratic system and the physicians and healthcare personnel have to deal with a very large amount of documentation and paperwork. And that's indeed where a lot of time gets lost … And naturally the patient, who is already suffering, ends up suffering even more because he or she can no longer understand what's going on.”
[Moderator Matthias Kirsch:] That's Ursula Wandl. She's a patient advocate at the TU Munich university hospital Klinikum rechts der Isar. She functions as a liaison between medical personnel and patients, no small job with a quarter of a million patients every year. Ursula Wandl and her colleague Christine Maurer are our Hidden Champions in this episode. Welcome to "We are TUM", the podcast by and for the Technical University of Munich. My name is Matthias Kirsch, and I'll be guiding you through this podcast. As always university President Thomas Hofmann will get things started by introducing the other topics of today's episode to you.
[Thomas F. Hofmann:] Welcome, dear listeners: The war in Ukraine unfortunately continues to hold our attention. In our segment on Cutting-Edge Research we'll be speaking with Christian Djeffal about how deeply this conflict is impacting our everyday routines. He's Assistant Professor for Law, Science and Technology at TUM and conducts research on Artificial Intelligence and the Internet of Things. He'll talk about whether or not our worst apprehensions of a cyber-war have already come to pass and how digitalization is affecting warfare.
Then we'll get to know the start-up TWAICE, which intends to play a major role in one of the most important challenges of our time, emission-free mobility. Its primary focus area is improving the development of batteries. Michael Baumann, one of the founders of TWAICE, will tell us how that will work. And we'll conclude by speaking with somnologist Dr. Alfred Wiater, a physician and long-time President of the German Sleep Society (DGSM) and shares with us his five tips on how you can make sleep work for you to make your days more productive. And now I wish you an enjoyable listening experience with the latest episode of "We are TUM"!
[Kirsch:] Paralyzed web sites, malicious software, blocked computer systems – the Russian war of aggression in Ukraine has also been digital for some time now. What does this cyber-war look like? Let's discuss the matter with Christian Djeffal, Assistant Professor for Law, Science and Technology at TUM and expert on the interface between law and technology, i.e. exactly the issue when we're talking about cyber-war. My colleague Clarissa Ruge met him and spoke with him about Russian antivirus programs and social media trolls and about how we can defend ourselves against cyber-attacks.
[Clarissa Ruge:] Mr. Djeffal, can you give us a quick look at the content of your research?
[Christian Djeffal:] Certainly. I look at the question of how to design digital technologies to be good and compliant with constitutional law: How we can influence and regulate new technologies in innovation, development and application and how these technologies change society and the way we behave.
[Ruge:] A couple of months ago, around mid-March, there was a warning about the virus protection program from Kaspersky. Does this fall under the heading of cybersecurity, and if so, why?
[Djeffal:] That event fits very well with the topic of cyber-security and with the future of cyber-security. That German Federal Office for Information Security (BSI) issued a warning about the Kaspersky virus scanner; the special thing here was that it was not only appropriate on technical grounds, but in particular because of the overall political climate. So here we have a case where we're dealing not only with technical security, but also with areas where legal, political and social components also play a role in evaluating the situation.
[Ruge:] That was a few months ago. Did anything happen, have you heard of any issues with the program?
[Djeffal:] In the meantime the Italian cybersecurity agency has warned against these products as well. Nothing concrete has come up yet. But in this case that's very hard to say, since virus scanners always need a very deep level of authorization in systems and otherwise the transmission of information has to be encrypted, in particular during updates. This means that as far as I know, nothing more exact than that has come to light. Of course Kaspersky has complained, just like several other observers have; the warning is now still in effect in Germany, however.
[Ruge:] I see. My next question can be introduced with a quote. Journalist Jessikka Aro is also author of the book "Putin's Trolls". She's determined that the information war has finally seeped into our everyday lives in the form of social media. Consequently she calls for a defense against fakes. What's your opinion?
[Djeffal:] I basically agree with Ms. Aro and I find it remarkable how in-depth her research on this topic is, and I can say I agree with her conclusions. I'd also say we need a defense against fakes, but I think we need even more. Every intervention in the space of public discourse is like performing open-heart surgery on democracy. And I think we have to be very careful here and also need to develop a positive vision of how exactly we intend to communicate in social media in the future.
Let me say a few things about the term 'trolls': How is it possible to fight back against them at all? Some background information: In 2019 there was a report on the US election campaign revealing among other things that there were no fewer than 3,500 paid Facebook advertisements, more than 80,000 posts that reached about 126 million Americans. As with all questions relating to social media, we have to look at the problem on several different levels, that's very important.
This means social media platforms have to accept responsibility and implement clear rules about the conditions under which posts can be deleted and accounts blocked and about how the recommendation algorithms sort these messages. Trustworthy media providers have to be involved, as does the civil society at large and there has to be more transparency. On the whole and at various instances, the world is moving in this direction; we need more regulation in order to increase the chances for control here and to give social media providers the incentive of minimizing risks. But I also think once again that we need a positive vision, we have to know what we can handle from trolls, and members of the public need a certain level of media literacy in order to be able to deal properly with these things. After all, democratic discourse also thrives on the knowledge of how to ignore things and how to deal with controversial opinions.
[Ruge:] You've cited a couple of examples where positive evidence of interference has been found: Do you have some concrete recommendations for what can be done about the situation?
[Djeffal:] On the one hand we have to strengthen the media literacy of the general public, and that starts in adolescence and before. That's my specific recommendation. On the other hand we have to really work on, to understand, just how we want to actually shape social media and I think this is where the public has to be included, for example in risk management. Right now we're in the middle of a project in which we're attempting to analyze certain aspects of social media, to perform risk assessments, and we're involving members of the general public as well as experts. And this has a double effect: First of all, we understand better how this works, how the public also experiences the situation, and secondly we show the public what possibilities are available for shaping this media landscape and introduce them to it. And I think it's extremely important to do this together with civil-societal groups and with their support. This discussion can't be left to state and the commercial sector, here too we have to also include science and give this discussion a much broader basis.
Nevertheless, when a falsehood makes its way into the world, then we have to ask, how dangerous is it? Here I'm referring once again to March this year as Putin justified his war among other things with the following claim, and I quote: With the help of the USA, Ukraine is conducting experiments with African swine flu, cholera and coronavirus and is attempting to produce biological weapons. But these statements are completely absurd and of course are certainly intentional. Why? A very interesting question, since the claims really are bizarre. I think that has to do with a variety of effects, one of them is attention economy: an absurd statement is shared more often, attracts more attention. Second, and this is not so intuitive, sometimes absurd statements sound more credible because people think that a politician wouldn't stand up and say something like that if it wasn't true.
And then there's a third effect which goes somewhat deeper, referred to as framing. Here, anyone who manages to link certain players cognitively and emotionally with certain topics can really change the way people think. And we can see that here with terms like 'Ukraine', 'USA', 'experiment', 'swine flu', 'biological weapons'. If I succeed in creating a connection here, it's like the fertile soil in which not only antipathy, but also conspiracy theories, thrive. Framing has really very far-reaching, deep effects.
[Ruge:] And what unsettles you personally the most about this topic, about information war, the most?
[Djeffal:] I'm most worried about the impact on children and the vulnerable, on all those who have not developed, or not yet finished developing the capacity to act independently. Here we're dealing with things that we, even as adults, don't know exactly how to deal with or what effective governance should look like. And when I think of the fact that the next generation is actually growing up in this environment and makes such intensive use of it, that unsettles me. But there's also a productive side to this uneasiness. I think it drives me even more strongly to take action, to make specific suggestions about what can be done.
[Ruge:] You just correctly singled out the vulnerable and the young. As a mother, I can personally add that no matter how often I say to my kids and their TikTok, please delete that, don't watch that… There should be something in parallel taught in schools, some kind of education, since I think TikTok is the most widespread channels among children and youth…
[Djeffal:] That's right, children have to be taught to understand how these things work. But on the other hand, depending on the age – and I say this as a father – there have to be opportunities for parents to control media consumption to a certain extent. Just the same way I control when my kid watches television, today I should also be paying attention to which of the apps my child uses are acceptable and which are not, and also how the child uses them. That's not easy, and I think you're completely right, as adults we still don't have the right idiom, but these are the problems we actually have to address and where we need very specific instructions, not only as scientists, but also as parents, on how to control this media consumption and how to teach proper media use to children. My son is still too young, but the younger generation is in part better informed, can use these things more intuitively; that makes it difficult, but not impossible to help, to offer children a set of guidelines.
[Ruge:] How and why was the information war able to escalate in Germany as well?
[Djeffal:] There is a clear interest in influencing the situation in Germany, and that hasn't only been the case since the war between Ukraine and Russia started, it's been that way for a long time. Germany is an important country and there are certain basic conflicts which break out more and more severely. That means there is a great interest in exerting a targeted effect on public opinion here in Germany. And now that the world situation has become so much tenser, this interest will certainly not become smaller, it will continue to grow.
[Ruge:] And let me close with a personal question: What do you hope to be able to achieve with your research?
[Djeffal:] One thing for certain is that I'm hoping to simply understand the situation and to understand from the point of view of a legal scholar what the regulation strategies actually are. In my case, however, I can say that it's important to formulate concrete solutions and to try to look for alternative formats, for example for social media. At our School our dean Urs Gasser is currently founding a Re-Boot Social Media Lab, where this kind of approach can be fostered and I think it's the job of my generation of scientists to accompany this digital transformation critically, but also constructively, to encourage and contribute new ideas on how we can do things differently. And if I succeed with this kind of idea, well, that would be a great success for me personally.
[Ruge:] Thank you for speaking with us.
[Djeffal:] It's been my pleasure.
[Kirsch:] The TU Munich hospital is large. It's even very large. 33 different clinics and departments, over 1,100 beds, almost a quarter of a million patients every year. And when these patients have difficulties or worries, there are exactly two women among the over 6,500 employees who take care of nothing else: Christine Maurer and Ursula Wandl. They are the two patient advocates at the university hospital TUM Klinikum rechts der Isar. My colleague Fabian Dilger speaks with them about their role as liaisons between patients, personnel and physicians, translating medical jargon into intelligible language and explaining how things work at the hospital.
[Fabian Dilger:] Ms. Maurer, what does a typical day look like for a patient advocate?
[Christine Maurer:] We play a very, very important role, for the patients and their family members, when we receive an e-mail or telephone message that someone needs support. First we initiate a conversation with the person who contacts us, the patient or family member. We listen, we try to analyze the situation in question and then we try to find a way to resolve things – whom can we discuss the problem with, is it a certain station, certain colleagues? And it's highly positive for us to see that, after only about a year, colleagues also approach us very openly and talk to us about things and we sometimes also accompany patients in physician's consultations. One of our great functions there is to interpret, to translate…
We don't get involved in treatments in any way, that's none of our business. But we're allowed to explain what's going on. And you can say a lot about medicine in German and then also ask the patient whether or not they've understood. If I have an illness, I have to understand the illness in order to be able to cooperate. I also have to be able to understand the treatment, that means a less threatening atmosphere. So, once we've listened and understood what the issue is ourselves, our role is to mediate and resolve, not to judge or find a medical treatment, just a completely natural role.
[Dilger:] Now the university hospital TUM Klinikum rechts der Isar has recognized the necessity of maintaining this position. Somebody has to be there. Why does such a large clinic need a patient advocate?
[Ursula Wandl:] Over the last few years there have been many developments in hospital systems, in the health care system. And a hospital is a very large institution with many different groups of people and professional groups and many, many interfaces. And when systems get complex, then of course communication often suffers. This is because we've developed a highly bureaucratic system and the physicians and healthcare personnel have to deal with a very large amount of documentation and paperwork. And that's indeed where a lot of time gets lost.
In my early days as practicing physician and specialist in a major hospital there was more time available than there is today. And naturally the patient, who is already suffering, ends up suffering even more because he or she can no longer understand what's going on. In addition, medicine as such has already become so complex that physicians themselves in the various areas of specialization are overwhelmed, since they are no longer capable of simply knowing everything in every specialty area.
[Dilger:] Patient advocate means that you speak out on behalf of the patient, you take their side in an argument. Do you see yourself more as an attorney for the patient or as a mediator between medical personnel and the patient?
[Maurer:] I personally see myself as more of a liaison, sometimes also as a kind of guide. Being an attorney is already risky because of the lack of neutrality. Actually it's about saying, hey, colleagues, someone has some needs here and is being overlooked. It has to be said quite clearly, since the personnel shortage has gotten much worse during Corona period. This also means you go to a station and you first have to listen to the nurses and hear about what their situation is. Or you find out how the nurses see the patients and their family members. You have to actively draw out the news on both sides, then you're the liaison, I wouldn't say mediator, more of a liaison. And attorney is really a bit too much, I think.
[Dilger:] You've both been working together as patient advocates for about a year; you're actually a good, cohesive team, since you've known each other for quite some time already.
[Wandl:] Right, we've known each other since 1996. I was, I am a general practitioner, hematologist and oncologist and nevertheless I took a big jump, I made a big turnaround when I decided to go to work for a reinsurance company. And at this insurance company I had a lot of freedom to develop projects; one day I was at a surgeon's conference across from Dr. Maurer, from Christine, and I asked her what she does, what kind of a career she has. And she said she works in rehabilitative medicine. So I decided to invite her to dinner in Munich, which was at the same time actually a kind interview over dinner, which she didn't know at the time, and I knew immediately that she was the right person to take over as lead physician of the rehab service.
[Dilger:] Your role is as an intermediary between personnel and patients. How does the personnel react to your presence when you get involved?
[Wandl:] Well, to be honest, I'm very positively surprised. I actually expected some fairly defensive postures, especially on the part of the colleagues, I thought they'd feel intruded on by an outsider. And exactly the opposite is the case, the doors are all open, everyone wants to talk. The same is true with the nurses. On the whole I'm very positively surprised. This also shows us how necessary this role is. It's a very large hospital, a lot of routine has developed there, and perhaps it's a welcome thing for a little bit of fresh liaison.
[Dilger:] Dr. Maurer, you have a double volunteer role at the university hospital TUM Klinikum rechts der Isar: In addition to being patient advocate you're also a spiritual councilor. What's the difference between speaking with a patient as a spiritual councilor or as a patient advocate?
[Maurer:] In the meantime I've been a spiritual councilor for about nine years. The patients don't know that I'm a physician, and they shouldn't. As a volunteer, I have a position which means I visit all the patients once a week. The patient advocate is called in by patients or family members when they have a direct problem specifically with the hospital situation, and they tell me they don't understand a particular process or say they don't understand how the treatment is being explained or what will happen next. That's a completely different subject. And as a spiritual councilor the patient can also tell me: I know what happens next, but I'm worried about it. As a patient advocate I have to find a way. As a spiritual councilor I listen, I share my understanding, I simply listen and convey the feeling I'm there for someone for a certain time.
[Dilger:] Ms. Wandl, Ms. Maurer, thank you for sharing with us.
[Maurer:] We're glad to have had the chance to speak with you.
[Wandl:] And thank you for taking the time to speak with us, we wish you all the best.
The Young Perspective
[Kirsch:] How often have we heard in the last years: Electro-mobility is the future. But critics of e-cars raise one specific point again and again: The batteries just aren't good enough, making them and disposing of them is harmful to the environment. And that's exactly where Michael Baumann and Stephan Rohr want to step in with their start-up TWAICE and improve the development of batteries. My colleague Clarissa Ruge speaks with founder Michael Baumann about exactly how that's supposed to work.
[Ruge:] I'm looking forward to speaking with Michael Baumann, the founder of the start-up TWAICE. The first thing I'd like to know is: There are plenty of companies conducting research in the field of battery development, Tesla, BMW, VW – So why does the world also need TWAICE?
[Michael Baumann:] To be honest, batteries are still a very young technology. Right now a lot of research is being done in areas like production, manufacturing and areas like that. We're concentrating purely on battery analytics and are thus helping to make development activities more efficient and make the entire lifecycle of batteries more transparent.
[Ruge:] How large is the increase in efficiency your software achieves on average?
[Baumann:] You really have to look at the entire lifecycle of a battery. That's also what we're doing and right now we say: the development process in a vehicle takes five, six years. And using the simulations possible with our software, you can significantly reduce that and then cut development time by twenty to fifty percent. And if we look at the extended lifecycle: A battery like this can go dead after as little as two years, but it could also last over ten years in the vehicle. And that's where we're really helping, making it easier to understand the aging process and then to move the bar in the direction of a lifetime of ten years or more instead of two years.
[Ruge:] I read in research reports that Asia is actually in the lead when it comes to battery development. And you want to compete?
[Baumann:] You have to break down a general statement like that. Where Asia is certainly in the lead is in terms of developing cell chemistry and producing cells, that means the development and manufacture of the cells. The majority of cells in the world market currently comes from Asia. But when it comes to understanding the lifecycle performance of batteries, we can see that our team is already a good bit ahead with some unique progress. We can certainly hold our own with a lot of teams from Asia.
[Ruge:] What do you think, what year will it be when we see nothing but electric cars driving on Germany's streets?
[Baumann:] We're currently seeing this trend towards electro-mobility accelerate very quickly, on the one hand because of political developments, emission targets, but in Germany in particular because manufacturers have finally really grasped the fact that nothing will work without electric vehicles. Of course it will take some time until we reach the point where we only have electric vehicles. But I think that's something we'll certainly be seeing in the next ten to twenty years.
[Ruge:] One big worry is that all these batteries will end up as junk and will then be a big burden on the ecology. You're developing what you call "Second Life" applications for batteries. How can you get a battery to take on a second life?
[Baumann:] You have to say that batteries, as long as you handle them correctly, sometimes last much longer than they're expected to. But the key question is how to really render this aging process transparent and then how to remove the uncertainties regarding the lifecycle. And that's what our software does, we continuously capture battery data and then we can track very precisely how the battery behaves and can then derive a corresponding recommended action so that a "second life" is possible.
[Ruge:] How difficult was it for you in the initial phase to raise funds from third parties?
[Baumann:] I think it wasn't all that extremely difficult for us, since we had chosen a topic area which is simply very interesting and relevant, where a corresponding amount of support was available too. To be honest, it's a relatively comfortable situation to be in, coming right out of the university or from your doctorate and then founding a company in this environment.
[Ruge:] I know it's always hard to generalize, but is there a tip, a piece of advice you have to encourage other founders who aren't lucky enough to be enjoying that much venture capital right now?
[Baumann:] Sure. In recent years there has luckily been a very strong trend towards entrepreneurship. The influx of money into the venture capital market and the financial market for start-ups are continuously growing. I think, the important thing is that you have to get out and around at an early phase. On the one hand that means talking about the idea with people, receiving feedback, but also coming into contact with the right possible investors as early as possible.
[Ruge:] The start-up sector also inspires a few clichés. What would you say, where are the general outside impressions too romanticized or just wrong?
[Baumann:] Where is the topic of founding a start-up romanticized? I think the point is that an idea is one thing, but really building a company around an idea is another. And there's just an awful lot of hard work involved, you have to be able to withstand a lot of setbacks, it's a rocky road, even if you have a really good idea. And I think everyone has to be aware of the fact, you really have to commit to taking this path. And the most important factor there is that you have a real, true passion for the idea. It really has to be a part of your very existence…
[Ruge:] Where do you see TWAICE in five years, where do you see yourself, your colleagues, friends?
[Baumann:] Ultimately the issue that we're looking at is really a very fundamental and global problem. We see that electrification and renewable energy sources are important topics that we need on a global basis in order to stop or at least slow down things like climate change. And accordingly we want to approach this task on a global basis, we're doing a lot in Europe right now, the next step is the USA and then in a second step of course Asia, in particular China. And ultimately we want to make our mark in the entrepreneurship scene in Germany, but naturally also in the international scene.
[Ruge:] Thanks for speaking with us!
[Baumann:] Thank you.
[Kirsch:] Concluding this episode, as always we'll leave the direct surroundings of TU Munich and move on to our feature "Five Tips". Our guest today is the pediatrician and specialist for youth Dr. Alfred Wiater. He specializes in somnology and was for six years the chairman of the German Sleep Society (DGSM). I'll speak with Dr. Alfred Wiater about the potential hidden in a good night's sleep. Welcome, Dr. Wiater.
[Alfred Wiater:] Hello, Mr. Kirsch.
[Kirsch:] Before we get to the actual sleep tips you've brought us today, a personal question, Mr. Wiater: When you know you have an important appointment the following day, is there something you pay special attention to before you go to sleep?
[Wiater:] Well, it's important that you're well prepared and that you've thought through all the possible surprises which could occur at an appointment like that. Then you'll probably still be able to get a good night's sleep. But every now and then I too wake up at three o'clock in the morning or so and then I have to think everything over again.
Well, I think the first tip would be if you think things through with a little distance and perspective, sometimes you'll find new solutions; we're creative when we sleep, especially during REM sleep. And of course you can use this creativity for the next day as well, even when the sleep rhythm is briefly interrupted.
[Kirsch:] That's fascinating. That means we might not have to feel that bad if we have trouble falling asleep right away on the night before an important appointment. What specific tips do you have for us that have to do with sleep?
[Wiater:] Well, we always have to consider sleep and being awake at the same time; that's why preparation for a good night's sleep starts early in the morning. That means we should use the daylight, the colors of the early morning and get outside for half an hour to enjoy the sunlight, even if the sky is covered with clouds, since sunlight has a large portion of blue light in the morning. This blue light blocks what we call our sleep hormone, melatonin, and stimulates our serotonin, which makes us feel happy. Serotonin makes us feel awake, and the fascinating thing about it all is that serotonin is the basis for the formation of melatonin in the evening. That means when we don't get enough sunlight during the day and haven't produced enough serotonin, in the evening we don't have a sufficient basis to generate our sleep hormone melatonin. So, in the morning ride your bike to campus, or take a stroll for a half an hour and take advantage of the sunlight.
The same applies during the course of the rest of the day. Let's look at the mid-day nap. That can have its good sides and bad sides. Of course, you can try to make up for not having gotten a good night's sleep with an afternoon nap. But that really won't help. The mid-day nap, the Power Nap, is not a replacement, but it's been proven that an additional sleep phase of fifteen or twenty minutes regenerates what we need, and that makes us more awake and better prepared for the rest of the day.
And that brings me to the next tip. The afternoon. The third tip: Do a workout. It has been proven that more significant physical activity in the afternoon means we fall asleep faster in the evening and that we sleep deeper as well. Deep sleep is very important for our energetic regeneration. So get as much sun as you can in the afternoon, but in the afternoon, not the evening, since in the evening our energy balance would be unnecessarily put under pressure and our bodies would not have a chance to settle back down.
The workout in the afternoon and timeout in the evening. Really reduce stress, turn off, find peace. And turning off means turning off your smartphone, PC, tablet and all that. And it's very important to put in a pause during the last half an hour before going to bed, so that our minds have a chance to calm down as well. It's much better to use the time to read a book. Reading as little as six minutes in the evening results in stress reduction of almost seventy percent.
And it shouldn't get too warm in the bedroom, 18 degrees Celsius room temperature is perfect. And the room should be dimmed as well, since our sleep hormone melatonin is excreted when it's dark. And it should be as quiet as possible and there shouldn't be anything in the bedroom which could cause stress when we wake up. One example is the digital alarm clock which shows us to the second how much time we've spent lying around. That just generates stress with the result that once we've woken up again for a second, we can't fall asleep that easily any more.
[Kirsch:] Thank you for sharing your expert knowledge with us, Dr. Wiater.
[Wiater:] It's been my pleasure, and I hope all our listeners may now be able to get a better night's refreshing sleep.
[Kirsch:] And that's it for this episode of "We are TUM". In the next episode we'll once again be showcasing TUM's cutting-edge research, student life and we'll be speaking with all those who make TU Munich the unique place that it is. This has been "We are TUM". This episode was produced by Fabian Dilger, Clarissa Ruge, ProLehre Media and Didactics and by me, Matthias Kirsch. Sound design and post-production by Marco Meister at Edition Meister in Berlin. That's all until the next episode. Make sure to join us and discover the big and little secrets of the Technical University of Munich!
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