Melissa Knauert, MD, PhD
Research & Publications
Biography
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Research Summary
Dr. Knauert investigates sleep deprivation and circadian disruption in critically ill patients. In collaboration with the many members of the medical ICU care team, she has implemented an overnight sleep promotion protocol aimed at providing patients with an opportunity to sleep while admitted to the medical ICU. She is currently studying the influence of circadian light patterns on circadian alignment in medical ICU patients.
Extensive Research Description
Dr. Knauert investigates sleep deprivation and circadian disruption in critically ill patients. Sleep deprivation and circadian disruption are likely key factors in the development of ICU delirium. Furthermore, sleep and circadian abnormalities are implicated in broader perturbations of normal physiology including abnormalities of cardiovascular, immune, endocrine and metabolic systems. Over the long-term, this patient-oriented research will improve outcomes in the ICU by investigating questions and developing interventions at the intersection of sleep, circadian biology, and critical illness.
Past and current projects include:
- A feasibility study of ambulatory polysomnography in the medical ICU (MICU) examining sleep architecture. This work demonstrated the feasibility of portable polysomnography in a MICU setting, alterations in normal sleep architecture, and a high percentage of daytime sleep in MICU patients. (Funding R21 NR011066)
- A randomized controlled trial of a nocturnal clustered care intervention in the MICU (“Naptime”). Monitoring of sound levels during the Naptime Study revealed a large burden of low frequency sound which had not been previously reported. During Naptime (midnight to 4:00 AM), the intervention arm had 32% fewer room entries, and fewer minutes per hour of in-room activity. Naptime almost doubled the length of time between room entrances from 26 to 46 minutes. The intervention arm also had lower average and peak sound levels during the intervention period. (Funding P20 NR014126)
- An observational cohort study examining the overlap between delirium, electroencephalographic atypia and atypical sleep as defined by sleep montage electroencephalography. Patients without K-complexes or without sleep spindles had more severe encephalopathy and higher odds of death. The odds ratio (OR) for patients without K-complexes was 18.8 (p=0.046). The odds ratio for patients without sleep spindles was 6.3 (p=0.036). We concluded that loss of stage N2 features is common and associated with more severe encephalopathy and higher odds of death. The absence of either Stage N2 feature, K complexes or sleep spindles, may have important prognostic value. (Pepper Scholar, Funding P30 AG021342)
- An observational cohort study examining circadian rhythms in ICU using continuous heart rate monitoring. Analysis is in progress. (YCCI Scholar, Funding KL2 TR000140)
- An observational cohort study examining the influence of light on circadian rhythms in the ICU. This study will also examine the influence or circadian rhythm abnormalities on the duration of ICU delirium. (K23 HL138229)
- A randomized controlled trial of daytime bright light examining the impact of daytime bright light on circadian alignment and duration of delirium. (AASM Strategic Research Award)
Coauthors
Research Interests
Critical Care; Delirium; Noise; Respiration; Sleep; Sleep Deprivation; Sleep Wake Disorders; Pulmonary Medicine; Critical Illness
Selected Publications
- Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research StatementKnauert M, Ayas N, Bosma K, Drouot X, Heavner M, Owens R, Watson P, Wilcox M, Anderson B, Cordoza M, Devlin J, Elliott R, Gehlbach B, Girard T, Kamdar B, Korwin A, Lusczek E, Parthasarathy S, Spies C, Sunderram J, Telias I, Weinhouse G, Zee P. Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement American Journal Of Respiratory And Critical Care Medicine 2023, 207: e49-e68. PMID: 36999950, PMCID: PMC10111990, DOI: 10.1164/rccm.202301-0184st.
- Morning Chronotype Is Associated with Improved Adherence to Continuous Positive Airway Pressure among Individuals with Obstructive Sleep Apnea.Knauert M, Adekolu O, Xu Z, Deng A, Chu J, Baldassarri S, Kushida C, Yaggi H, Zinchuk A. Morning Chronotype Is Associated with Improved Adherence to Continuous Positive Airway Pressure among Individuals with Obstructive Sleep Apnea. Annals Of The American Thoracic Society 2023 PMID: 36917194, DOI: 10.1513/annalsats.202210-885oc.
- Keeping an eye on circadian time in clinical research and medicineKlerman E, Brager A, Carskadon M, Depner C, Foster R, Goel N, Harrington M, Holloway P, Knauert M, LeBourgeois M, Lipton J, Merrow M, Montagnese S, Ning M, Ray D, Scheer F, Shea S, Skene D, Spies C, Staels B, St‐Onge M, Tiedt S, Zee P, Burgess H. Keeping an eye on circadian time in clinical research and medicine Clinical And Translational Medicine 2022, 12: e1131. PMID: 36567263, PMCID: PMC9790849, DOI: 10.1002/ctm2.1131.
- 0726 Agreement Between an Electroencephalography-Measuring Headband and Polysomnography in Older Adults with Sleep DisturbancesMiner B, Pan Y, Burzynski C, Iannone L, Knauert M, Gill T, Yaggi H. 0726 Agreement Between an Electroencephalography-Measuring Headband and Polysomnography in Older Adults with Sleep Disturbances Sleep 2023, 46: a319-a320. DOI: 10.1093/sleep/zsad077.0726.
- 0733 The Association of Nocturia and Napping with Obstructive Sleep Apnea Among Older Adults with Insomnia and/or Daytime SleepinessPolisetty L, Pan Y, Iannone L, Knauert M, Yaggi K, Gill T, Miner B. 0733 The Association of Nocturia and Napping with Obstructive Sleep Apnea Among Older Adults with Insomnia and/or Daytime Sleepiness Sleep 2023, 46: a322-a323. DOI: 10.1093/sleep/zsad077.0733.
- 0841 Feasibility of Actigraphy during a Daytime Bright Pilot Study in the Medical ICULukas M, Doyle M, Intihar T, Wright K, Redeker N, Pisani M, Yaggi H, Knauert M. 0841 Feasibility of Actigraphy during a Daytime Bright Pilot Study in the Medical ICU Sleep 2023, 46: a370-a371. DOI: 10.1093/sleep/zsad077.0841.
- 0842 Feasibility of daytime bright light exposure and urinary 6-sulfatoxymelatonin profiling in the medical ICU: A pilot studyIntihar T, Doyle M, Lukas M, Wright K, Redeker N, Pisani M, Yaggi H, Knauert M. 0842 Feasibility of daytime bright light exposure and urinary 6-sulfatoxymelatonin profiling in the medical ICU: A pilot study Sleep 2023, 46: a371-a371. DOI: 10.1093/sleep/zsad077.0842.
- 0846 Prevalence of Obstructive Sleep Apnea Among Medical ICU PatientsEhrenberg M, Kongpakpaisarn K, Intihar T, Doyle M, Knauert M. 0846 Prevalence of Obstructive Sleep Apnea Among Medical ICU Patients Sleep 2023, 46: a373-a373. DOI: 10.1093/sleep/zsad077.0846.
- Insomnia with objective short sleep duration in community‐living older persons: A multifactorial geriatric health conditionMiner B, Doyle M, Knauert M, Yaggi H, Stone K, Ancoli‐Israel S, Cauley J, Redline S, Blackwell T, Gill T, Groups F. Insomnia with objective short sleep duration in community‐living older persons: A multifactorial geriatric health condition Journal Of The American Geriatrics Society 2022, 71: 1198-1208. PMID: 36524599, PMCID: PMC10089942, DOI: 10.1111/jgs.18195.
- Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study.Gohar A, Knauert M, Kalot M, Khan A, Sider D, Javed M, Wooldridge D, Eck L, Buckhold F, Colaco B, Bhat A, Castillo D, Newman R, Mustafa R. Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study. Postgraduate Medical Journal 2022, 98: 936-941. PMID: 37062998, DOI: 10.1136/postgradmedj-2021-140975.
- INFLUENCE OF DEMOGRAPHIC FACTORS ON RESEARCH PARTICIPATIONSAMOJEDNY V, INTIHAR T, KNAUERT M. INFLUENCE OF DEMOGRAPHIC FACTORS ON RESEARCH PARTICIPATION CHEST Journal 2022, 162: a1479. DOI: 10.1016/j.chest.2022.08.1246.
- Best Practice for Improving Sleep in the ICU. Part I: Non-pharmacologicKorwin A, Knauert M. Best Practice for Improving Sleep in the ICU. Part I: Non-pharmacologic 2022, 231-248. DOI: 10.1007/978-3-031-06447-0_14.
- Sleep in Critical Illness: Future DirectionsKnauert M, Parthasarathy S. Sleep in Critical Illness: Future Directions 2022, 291-309. DOI: 10.1007/978-3-031-06447-0_17.
- Adding Insult to Injury Sleep Deficiency in Hospitalized PatientsMansour W, Knauert M. Adding Insult to Injury Sleep Deficiency in Hospitalized Patients Clinics In Chest Medicine 2022, 43: 287-303. PMID: 35659026, PMCID: PMC9177053, DOI: 10.1016/j.ccm.2022.02.009.
- Sleep Deficiency and HealthKnauert MP. Sleep Deficiency and Health Clinics In Chest Medicine 2022, 43: xiii-xiv. PMID: 35659032, DOI: 10.1016/j.ccm.2022.02.014.
- Sleep Deficiency and HealthKNAUERT M. Sleep Deficiency and Health Clinics In Chest Medicine 2022, 43: i. DOI: 10.1016/s0272-5231(22)00048-x.
- 0321 Poor Agreement Among Self-Reported and Objective Sleep Deficiency Assessments in Older PersonsMiner B, Yaggi H, Gill T, Doyle M, Stone K, Redline S, Ensrud K, Blackwell T, Knauert M. 0321 Poor Agreement Among Self-Reported and Objective Sleep Deficiency Assessments in Older Persons Sleep 2022, 45: a144-a145. DOI: 10.1093/sleep/zsac079.319.
- 0583 Tolerance and feasibility of daytime bright light in medical intensive care unit patientsIntihar T, Samojedny V, Korwin A, Knauert M. 0583 Tolerance and feasibility of daytime bright light in medical intensive care unit patients Sleep 2022, 45: a256-a257. DOI: 10.1093/sleep/zsac079.580.
- Enhancing Cosinor Analysis of Circadian Phase Markers Using the Gamma DistributionDoyle MM, Murphy TE, Miner B, Pisani MA, Lusczek ER, Knauert MP. Enhancing Cosinor Analysis of Circadian Phase Markers Using the Gamma Distribution Sleep Medicine 2022, 92: 1-3. PMID: 35306404, PMCID: PMC9356385, DOI: 10.1016/j.sleep.2022.01.015.
- Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational studyGohar AA, Knauert M, Kalot MA, Khan A, Sider D, Javed MA, Wooldridge D, Eck L, Buckhold F, Colaco B, Bhat A, Castillo DM, Newman R, Mustafa RA. Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study Postgraduate Medical Journal 2021, 98: 936-941. PMID: 34880081, PMCID: PMC10074556, DOI: 10.1136/postgradmedj-2021-140975.
- LIGHT SPECTRA: AN IMPORTANT CONSIDERATION FOR CIRCADIAN ALIGNMENT IN THE MEDICAL ICUWasden K, Intihar T, Knauert M. LIGHT SPECTRA: AN IMPORTANT CONSIDERATION FOR CIRCADIAN ALIGNMENT IN THE MEDICAL ICU CHEST Journal 2021, 160: a2425. DOI: 10.1016/j.chest.2021.07.2096.
- LIGHT PATTERNS OF THE MEDICAL ICU: ARE WE DISRUPTING CIRCADIAN RHYTHMS?Intihar T, Wasden K, Knauert M. LIGHT PATTERNS OF THE MEDICAL ICU: ARE WE DISRUPTING CIRCADIAN RHYTHMS? CHEST Journal 2021, 160: a2424. DOI: 10.1016/j.chest.2021.07.2095.
- A SAS macro for modelling periodic data using cosinor analysisDoyle MM, Murphy TE, Pisani MA, Yaggi HK, Jeon S, Redeker NS, Knauert MP. A SAS macro for modelling periodic data using cosinor analysis Computer Methods And Programs In Biomedicine 2021, 209: 106292. PMID: 34380075, PMCID: PMC8435001, DOI: 10.1016/j.cmpb.2021.106292.
- A Pilot Protocol for Intermittent Feeding in Mechanically Ventilated Medical Intensive Care Unit PatientsKorwin A, Honiden S, Intihar T, Wasden K, Heard A, Powierza C, Knauert M. A Pilot Protocol for Intermittent Feeding in Mechanically Ventilated Medical Intensive Care Unit Patients 2021, a2879-a2879. DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2879.
- Intermittent Feeding in Mechanically Ventilated Medical Intensive Care Unit Patients: Preliminary OutcomesKorwin A, Honiden S, Intihar T, Wasden K, Powierza C, Knauert M. Intermittent Feeding in Mechanically Ventilated Medical Intensive Care Unit Patients: Preliminary Outcomes 2021, a2889-a2889. DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2889.
- 441 Influence Of Chronotype On CPAP AdherenceAdekolu O, Xu Z, Chu J, Kushida C, Yaggi H, Knauert M, Zinchuk A. 441 Influence Of Chronotype On CPAP Adherence Sleep 2021, 44: a174-a175. DOI: 10.1093/sleep/zsab072.440.
- 681 Sleep Apnea Severity and COVID-19 Hospitalization Outcomes: Interim AnalysisMansour W, Knauert M. 681 Sleep Apnea Severity and COVID-19 Hospitalization Outcomes: Interim Analysis Sleep 2021, 44: a266-a266. PMCID: PMC8135644, DOI: 10.1093/sleep/zsab072.679.
- Light Levels in ICU Patient Rooms: Dimming of Daytime Light in Occupied RoomsLusczek ER, Knauert MP. Light Levels in ICU Patient Rooms: Dimming of Daytime Light in Occupied Rooms Journal Of Patient Experience 2021, 8: 23743735211033104. PMID: 34368424, PMCID: PMC8312159, DOI: 10.1177/23743735211033104.
- A SAS Macro for Cosinor Analysis of Automated Heart Rate Data in the ICUDoyle M, Murphy T, Knauert M. A SAS Macro for Cosinor Analysis of Automated Heart Rate Data in the ICU Innovation In Aging 2020, 4: 210-210. PMCID: PMC7740472, DOI: 10.1093/geroni/igaa057.679.
- A Clinic Blueprint for Post-Coronavirus Disease 2019 RECOVERY Learning From the Past, Looking to the FutureLutchmansingh DD, Knauert MP, Antin-Ozerkis DE, Chupp G, Cohn L, Dela Cruz CS, Ferrante LE, Herzog EL, Koff J, Rochester CL, Ryu C, Singh I, Tickoo M, Winks V, Gulati M, Possick JD. A Clinic Blueprint for Post-Coronavirus Disease 2019 RECOVERY Learning From the Past, Looking to the Future CHEST Journal 2020, 159: 949-958. PMID: 33159907, PMCID: PMC7641526, DOI: 10.1016/j.chest.2020.10.067.
- Pilot Observational Study to Detect Diurnal Variation and Misalignment in Heart Rate Among Critically Ill PatientsKnauert MP, Murphy TE, Doyle MM, Pisani MA, Redeker NS, Yaggi HK. Pilot Observational Study to Detect Diurnal Variation and Misalignment in Heart Rate Among Critically Ill Patients Frontiers In Neurology 2020, 11: 637. PMID: 32760341, PMCID: PMC7373742, DOI: 10.3389/fneur.2020.00637.
- Circadian Biology and Its Importance to Intensive Care Unit Care and OutcomesGao C, Knauert M. Circadian Biology and Its Importance to Intensive Care Unit Care and Outcomes Seminars In Respiratory And Critical Care Medicine 2019, 40: 629-637. PMID: 31826263, DOI: 10.1055/s-0039-1698394.
- Pilot study: an intensive care unit sleep promotion protocolKnauert MP, Pisani M, Redeker N, Murphy T, Araujo K, Jeon S, Yaggi H. Pilot study: an intensive care unit sleep promotion protocol BMJ Open Respiratory Research 2019, 6: e000411. PMID: 31258916, PMCID: PMC6561389, DOI: 10.1136/bmjresp-2019-000411.
- Chapter 19 Sleep in Hospitalized PatientsKnauert M, Pisani M. Chapter 19 Sleep in Hospitalized Patients 2019, 411-437. DOI: 10.1016/b978-0-12-813014-8.00019-6.
- Association between death and loss of stage N2 sleep features among critically Ill patients with deliriumKnauert MP, Gilmore EJ, Murphy TE, Yaggi HK, Van Ness PH, Han L, Hirsch LJ, Pisani MA. Association between death and loss of stage N2 sleep features among critically Ill patients with delirium Journal Of Critical Care 2018, 48: 124-129. PMID: 30179762, PMCID: PMC6226351, DOI: 10.1016/j.jcrc.2018.08.028.
- Non-circadian signals in the intensive care unit: Point prevalence morning, noon and nightAltman MT, Pulaski C, Mburu F, Pisani MA, Knauert MP. Non-circadian signals in the intensive care unit: Point prevalence morning, noon and night Heart & Lung 2018, 47: 610-615. PMID: 30143362, PMCID: PMC6234066, DOI: 10.1016/j.hrtlng.2018.07.011.
- Survey of clinical pharmacist perceptions and practices in promoting sleep in intensive care unit patientsHeavner M, Nguyen N, Knauert M, Verceles A, Pisani M, Seung H, Gonzales J. Survey of clinical pharmacist perceptions and practices in promoting sleep in intensive care unit patients JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018, 2: 46-52. DOI: 10.1002/jac5.1027.
- Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness: an observational cohort studyAltman MT, Knauert MP, Murphy TE, Ahasic AM, Chauhan Z, Pisani MA. Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness: an observational cohort study Annals Of Intensive Care 2018, 8: 63. PMID: 29740704, PMCID: PMC5940933, DOI: 10.1186/s13613-018-0408-4.
- Creating NaptimeKnauert MP, Redeker NS, Yaggi HK, Bennick M, Pisani MA. Creating Naptime Journal Of Patient Experience 2018, 5: 180-187. PMID: 30214923, PMCID: PMC6134539, DOI: 10.1177/2374373517747242.
- 940Nguyen N, Heavner M, Gonzales J, Verceles A, Pisani M, Knauert M. 940 Critical Care Medicine 2018, 46: 453. DOI: 10.1097/01.ccm.0000528947.29749.ed.
- Delirium is Associated With Sleep Disturbance After Critical IllnessAltman M, Knauert M, Ahasic A, Chauhan Z, Pisani M. Delirium is Associated With Sleep Disturbance After Critical Illness CHEST Journal 2017, 152: a1066. DOI: 10.1016/j.chest.2017.08.1100.
- Rothman Index Predicts ICU Mortality at 24 HoursPerkins M, Knauert M, Honiden S, Siner J, Ma J, Lee D, Pinker E, Pisani M. Rothman Index Predicts ICU Mortality at 24 Hours CHEST Journal 2017, 152: a332. DOI: 10.1016/j.chest.2017.08.358.
- Factors Influencing Patients' Sleep in the Intensive Care Unit: Perceptions of Patients and Clinical Staff.Ding Q, Redeker NS, Pisani MA, Yaggi HK, Knauert MP. Factors Influencing Patients' Sleep in the Intensive Care Unit: Perceptions of Patients and Clinical Staff. American Journal Of Critical Care 2017, 26: 278-286. PMID: 28668912, PMCID: PMC5559223, DOI: 10.4037/ajcc2017333.
- Sleep Disturbance after Hospitalization and Critical Illness: A Systematic ReviewAltman MT, Knauert MP, Pisani MA. Sleep Disturbance after Hospitalization and Critical Illness: A Systematic Review Annals Of The American Thoracic Society 2017, 14: 1457-1468. PMID: 28644698, PMCID: PMC5711402, DOI: 10.1513/annalsats.201702-148sr.
- Reply: Sleep in the Intensive Care Unit Is a PriorityKnauert MP, Kamdar BB. Reply: Sleep in the Intensive Care Unit Is a Priority Annals Of The American Thoracic Society 2016, 13: 1868-1869. PMID: 27726437, PMCID: PMC5122496, DOI: 10.1513/annalsats.201607-578le.
- Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care ProvidersKamdar BB, Knauert MP, Jones SF, Parsons EC, Parthasarathy S, Pisani MA. Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers Annals Of The American Thoracic Society 2016, 13: 1370-7. PMID: 27104770, PMCID: PMC5021080, DOI: 10.1513/annalsats.201601-087oc.
- Comparing average levels and peak occurrence of overnight sound in the medical intensive care unit on A-weighted and C-weighted decibel scalesKnauert M, Jeon S, Murphy TE, Yaggi HK, Pisani MA, Redeker NS. Comparing average levels and peak occurrence of overnight sound in the medical intensive care unit on A-weighted and C-weighted decibel scales Journal Of Critical Care 2016, 36: 1-7. PMID: 27546739, PMCID: PMC5097003, DOI: 10.1016/j.jcrc.2016.06.005.
- Sleep Loss and Circadian Rhythm Disruption in the Intensive Care UnitKnauert MP, Haspel JA, Pisani MA. Sleep Loss and Circadian Rhythm Disruption in the Intensive Care Unit Clinics In Chest Medicine 2015, 36: 419-429. PMID: 26304279, DOI: 10.1016/j.ccm.2015.05.008.
- Sleep and Sleep Disordered Breathing in Hospitalized PatientsKnauert MP, Malik V, Kamdar BB. Sleep and Sleep Disordered Breathing in Hospitalized Patients Seminars In Respiratory And Critical Care Medicine 2014, 35: 582-592. PMID: 25353103, DOI: 10.1055/s-0034-1390080.
- Feasibility study of unattended polysomnography in medical intensive care unit patientsKnauert MP, Yaggi HK, Redeker NS, Murphy TE, Araujo KL, Pisani MA. Feasibility study of unattended polysomnography in medical intensive care unit patients Heart & Lung 2014, 43: 445-452. PMID: 25023504, PMCID: PMC4150840, DOI: 10.1016/j.hrtlng.2014.06.049.
- Sources of Overnight Patient Sleep Disruption in the Medical Intensive Care UnitKnauert M, Yaggi H, Redeker N, Murphy T, Araujo K, Pisani M. Sources of Overnight Patient Sleep Disruption in the Medical Intensive Care Unit CHEST Journal 2012, 142: 547a-547b. DOI: 10.1378/chest.1383037.
- 708. Gene Targeting with Triplex-Forming Oligonucletides in the Pyrimidine MotifKalish J, Knauert M, Hegan D, Glazer P. 708. Gene Targeting with Triplex-Forming Oligonucletides in the Pyrimidine Motif Molecular Therapy 2006, 13: s273-s274. DOI: 10.1016/j.ymthe.2006.08.787.
- Triplex forming oligonucleotides: sequence-specific tools for gene targetingKnauert M, Glazer P. Triplex forming oligonucleotides: sequence-specific tools for gene targeting Human Molecular Genetics 2001, 10: 2243-2251. PMID: 11673407, DOI: 10.1093/hmg/10.20.2243.
- A more powerful method to evaluate p‐values in GENEHUNTERZhao H, Sheffield L, Pakstis A, Knauert M, Kidd K. A more powerful method to evaluate p‐values in GENEHUNTER Genetic Epidemiology 1999, 17: s415-s420. PMID: 10597472, DOI: 10.1002/gepi.1370170770.
Clinical Trials
Conditions | Study Title |
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Immune System; Men's Health; Women's Health | Effects of circadian regulation and sleep on immune responses |