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Empirical work has been limited in its ability to directly study whether skill requirements in the workplace have been rising and whether these changes have been related to technological change. This article answers these questions using a unique data set from West Germany that enabled me to look at how skill requirements have changed within occupations. I show that occupations require more complex skills today than in 1979 and that the changes in skill requirements have been most pronounced in rapidly computerizing occupations. Changes in occupational content account for about 36% of the recent educational upgrading in employment.

In this study, we explore a new approach for analyzing changes in the gender pay gap that uses direct measures of job tasks and gives a comprehensive characterization of how work for men and women has changed in recent decades. Using data from West Germany, we find that women have witnessed relative increases in nonroutine analytic and interactive tasks. The most notable difference between the genders is, however, the pronounced relative decline in routine task inputs among women, driven, at least in part, by technological change. These changes explain a substantial fraction of the closing of the gender wage gap.

Background No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course. Methods After retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 h after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS). Results One hundred ten patients were matched (OFA: n  = 55; OA: n = 55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6–34) vs 5 mg (2–18), p  = 0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66–115) vs 77 mmol/l (IQR: 69–95), p  = 0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p  = 0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1–5) vs 5 (3–6) hours, p = 0.001 and 2 (1–3) vs 3 (2–5) days, p  = 0.037). Conclusion The use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results. Trial registration This study was retrospectively registered to ct2 (identifier: NCT03816592 ) on January 25, 2019.

After the fall of the Berlin Wall on November 9, 1989, and the collapse of the German Democratic Republic, a sudden, unexpected, and massive influx of East German migrants hit the entire West German labor market. The context is well suited for investigating whether immigration influences natives’ wages and how the effects depend on product and labor market conditions. We propose direct measures of potential migration with exogenous variation, compare migrants to natives with similar capabilities, and segment the labor market along predetermined margins. We find that immigration can have negative effects on the wages of natives. These effects surface when product and labor markets are competitive but not under regulations that restrict the entry of firms and provide workers with a strong influence on firms’ decision making.

In the late 1990s and into the early 2000s, Germany was often called “the sick man of Europe.” Indeed, Germany's economic growth averaged only about 1.2 percent per year from 1998 to 2005, including a recession in 2003, and unemployment rates rose from 9.2 percent in 1998 to 11.1 percent in 2005. Today, after the Great Recession, Germany is described as an “economic superstar.” In contrast to most of its European neighbors and the United States, Germany experienced almost no increase in unemployment during the Great Recession, despite a sharp decline in GDP in 2008 and 2009. Germany's exports reached an all-time record of $1.738 trillion in 2011, which is roughly equal to half of Germany's GDP, or 7.7 percent of world exports. Even the euro crisis seems not to have been able to stop Germany's strengthening economy and employment. How did Germany, with the fourth-largest GDP in the world transform itself from “the sick man of Europe” to an “economic superstar” in less than a decade? We present evidence that the specific governance structure of the German labor market institutions allowed them to react flexibly in a time of extraordinary economic circumstances, and that this distinctive characteristic of its labor market institutions has been the main reason for Germany's economic success over the last decade.

À l’aide de nouvelles données reliant les informations administratives sur la situation professionnelle des travailleurs en République démocratique allemande (RDA) avant et après la réunification, j’étudie la mobilité professionnelle pendant la « Wende » (1989-1992). Je compare les schémas des travailleurs de la RDA avec ceux des travailleurs de la République fédérale d’Allemagne (RFA) issus de la même cohorte de naissance. Les résultats révèlent diverses facettes de la mobilité professionnelle, y compris le reclassement et la rétrogradation. Les travailleurs de la RDA affichent notamment une mobilité professionnelle beaucoup plus élevée que les cohortes correspondantes en RFA. En ce qui concerne les sorties de l’emploi, la cohorte la plus âgée (58-60 ans en 1989) est en tête des chiffres globaux dans les deux parties de l’Allemagne, ce qui reflète l’application généralisée des régimes de retraite anticipée à l’époque. Classification JEL : J62, P23. Using novel data linking administrative labor market information of German Democratic Republic (GDR) workers before and after reunification, I investigate occupational mobility during the “Wende” (1989-1992). I compare GDR workers’ patterns with Federal Republic of Germany (FRG) workers from the same birth cohort. The results indicate diverse occupational mobility facets, including upgrading and downgrading. Notably, GDR workers exhibited much higher occupational mobility dynamics than the corresponding FRG cohorts. Regarding transitions to non-employment, the oldest cohort (aged 58-60 in 1989) drives the aggregate figures in both parts of Germany, reflecting the widespread application of early retirement schemes at the time.

BackgroundHyperlactatemia is a biological marker of tissue hypoperfusion with well-known diagnostic, prognostic, and therapeutic implications in shock states. In daily clinical practice, it is difficult to find out the exact mechanism underlying hyperlactatemia. Central venous to arterial CO2 difference (pCO2 gap) is a better parameter of tissue hypoperfusion than the usual ones (clinical examination and mixed venous saturation). Furthermore, the ratio between the pCO2 gap and p(v–a)CO2/C(a–v)O2 may be a promising indicator of anaerobic metabolism, allowing for the identification of different causes of tissue hypoxia and hyperlactatemia. The main aim of the study is to demonstrate that initial hemodynamic resuscitation based on an algorithm integrating the pCO2 gap and p(v–a)CO2/C(a–v)O2 ratio vs. usual clinical practice in acute circulatory failure improves lactate clearance.MethodsLACTEL is a randomized, prospective, multicentric, controlled study. It compares the treatment of hyperlactatemia using an algorithm based on the pCO2 gap and P(v–a)CO2/C(a–v)O2 ratio vs. usual clinical practice in acute circulatory failure. A total of 90 patients were enrolled in each treatment group. The primary endpoint is the number of patients with a lactate clearance of more than 10% 2 h after inclusion. Lactate levels were monitored during the first 48 h of treatment as hemodynamic parameters, biological markers of organ failure, and 28-day mortality.DiscussionpCO2 derivate indices may be of better interest than routine clinical indices to differentiate causes of hyperlactatemia and diagnose anaerobiosis. LACTEL results will provide clinical insights into the role of these indices in the early hemodynamic management of acute circulatory failure in the ICU.Clinical Trial Registrationwww.clinicaltrials.gov; identifier: NCT05032521.

Many researchers believe that the observed positive association between computer use and wages simply reflects unobserved heterogeneity: like pencils and other \"white-collar\" tools, computers are assigned to employees who possess productive attributes that would attract higher wages in any event. This study evaluates that claim by identifying the mechanisms through which computers changed the wage structure in West Germany in the late 1990s. The author finds that the spread of computers-but not of pencils-shifted the task composition of occupations toward analytical and interactive tasks that are complementary to computers' capabilities, and away from routine cognitive and manual tasks for which computers tend to substitute. Employees possessing computer-complementary skills enjoyed wage increases because computers both raised the demand for their skills and increased their marginal product.