L'Internet des objets (IoT) devrait interconnecter plus de 50 milliards d’objet d'ici à 2020. Avec l'IoT, une variété d’objets de différentes industries seront interconnectés à travers Internet. Avec un accent sur la gestion et le stockage des ressources énergétique et l'eau. L'IoT permet d’enrichir les services fournis par les distributeurs d’énergie à travers les smart-grid au-delà de la distribution, de l'automatisation et du contrôle. Les systèmes de gestion pour la domotique et les bâtiments intelligents aideront les consommateurs à surveiller et à ajuster leur consommation. Les compteurs intelligents fournissent ainsi un ensemble d’information permettant aux fournisseurs d’énergie de mettre en place des services plus intelligents pour l'ensemble de la chaîne de production d'énergie. L'objectif principal de ce projet de recherche doctorale est de développer des modules de communication très basse consommation. La consommation énergétique étant la plus grande contrainte pour les applications de compteurs intelligents. Les objets connectés alimentés par batterie tels que les capteurs et compteurs de gaz et d'eau sont concernés directement par la consommation en énergie de leur module de communication. Aujourd'hui, la plupart des solutions sans fil embarquées conçues pour capteurs alimentés ne sont pas compatible avec la pile protocolaire IPv6 afin d’économiser la consommation énergétique. Élaborer des technologies sans fil de l'IoT pour atteindre les objectifs de consommation d'énergie va démocratiser l’utilisation de ces technologies et aider les solutions de l’IoT à trouver leur place sur le marché. Ce doctorat débutera par: 1) Un état de l'art permettant d'examiner les solutions actuelles développées pour les réseaux de capteurs et des protocoles conçus pour les appareils alimentés par batterie. 2) Dans un deuxième temps en examinant les solutions Itron pour IPv6 réseau maillé. 3) La troisième phase sera la proposition et la conception d'une solution à faible consommation pour les modules sans fil et l'internet des objets. 4) Et enfin l’expérimentation et la validation des solutions proposées sur des plateformes d’expérimentations / The Internet of Things (IoT) is expected to grow to 50 billion connected devices by 2020. Within the IoT, devices across a variety of industries will be interconnected through the Internet and peer-to-peer connections as well as closed networks like those used in the smart grid infrastructure. With the global focus on energy and water management and conservation, the IoT will extend the connected benefits of the smart grid beyond the distribution, automation and monitoring being done by utility providers. Management systems for in-home and in-building use will help consumers monitor their own usage and adjust behaviors. These systems will eventually regulate automatically by operating during off-peak energy hours and connect to sensors to monitor occupancy, lighting conditions, and more. But it all starts with a smarter and more connected grid. Smart metering provides a base around which utilities can build up smarter advanced services for the whole chain of energy generation, transmission and distribution. The main objective of this doctoral research project is to come up with the IoT communication modules with very low consumption characteristics. The energy consumption is the most challenging issue for smart home and smart metering applications. The battery powered devices such as sensors and gas and water meters are concerned directly with the consumption of their communication module. Today most of the embedded wireless solutions designed for sensors and battery powered devices do not embed IPv6 stack in the communication module to have a basic hardware with low consumption. Elaborating IoT wireless technologies to achieve the tough energy consumption objectives imposed to them will boost up the spread of these technologies and help IoT to find its place in the market fast. This PhD program will start with: First) a state of the art and reviewing the current solutions developed for sensor networks and protocols designed for battery powered devices. Second) it continues by reviewing Itron solutions for IPv6 meshed network. Third) Design of a low consumption solution for IoT wireless modules and) finally test and experimentation on platform

No description available.

Contexte : La fibrillation auriculaire est commune chez les insuffisants cardiaques. L’efficacité des stratégies de contrôle de la fréquence et du rythme s’équivalent. Nous avons comparé l’impact économique des deux stratégies de traitement chez les patients avec fibrillation auriculaire et insuffisance cardiaque. Méthode : Dans cette sous-étude de l’essai Atrial Fibrillation and Congestive Heart Failure, la consommation de soins de santé des patients Québécois ainsi que leurs coûts ont été quantifiés grâce aux banques de données de la Régie de l’assurance-maladie du Québec et de l’Ontario Case Costing Initiative. Résultats : Trois cent quatre patients ont été inclus, âgés de 68±9 ans, fraction d’éjection de 26±6%. Les caractéristiques de base étaient bien réparties entre le contrôle du rythme (N=149) et de la fréquence (N=155). Les patients soumis au contrôle de la fréquence ont eu moins de procédures cardiovasculaires (146 versus 238, P<0.001) en raison du plus faible nombre de cardioversions et de moindres coûts reliés aux antiarythmiques (48 $±203 versus 1319 $±1058 par patient, P<0.001). Ces différences ont été compensées par un surplus de dépenses dues aux hospitalisations non-cardiovasculaires, aux dispositifs cardiaques implantables et aux médicaments non-cardiovasculaires dans le groupe du contrôle de la fréquence. Au total, les coûts par patient avec les stratégies du contrôle de la fréquence et du rythme s’élèvent à 78 767 $±79 568 et 72 764 $±72 800 (P=0.49). Interprétation : Chez les patients avec fibrillation auriculaire et insuffisance cardiaque, le contrôle de la fréquence est associé avec moins de procédures cardiovasculaires et une pharmacothérapie cardiovasculaire moins coûteuse. Toutefois, les coûts associés aux arythmies représentent moins de la moitié des dépenses de santé et le total des coûts s’équilibre entre les 2 stratégies. / Background: Atrial fibrillation is common in patients with heart failure. Rhythm and rate-control strategies are associated with similar efficacy outcomes. We compared the economic impact of the two treatment strategies in patients with atrial fibrillation and heart failure. Methods: In a pre-specified substudy of the Atrial Fibrillation and Congestive Heart Failure trial, healthcare expenditures of patients from Quebec were analyzed from a single-payer perspective using a cost-minimization approach. In-trial resource utilization including hospitalizations, procedures, emergency department visits, outpatient encounters, and medications were estimated from Quebec Health Insurance Board administrative databases supplemented by disease-specific costs from the Ontario Case Costing Initiative. Results: A total of 304 patients were included, age 68±9 years, 86% male, ejection fraction 26±6%. Baseline characteristics were similar in rhythm (N=149) and rate-control (N=155) groups. Arrhythmia-related costs accounted for 45% of total expenditures. Rate-control patients had fewer cardiovascular procedures (146 versus 238, P<0.001), driven by fewer cardioversions, and lower costs related to antiarrhythmic drugs ($48±203 versus $1319±1058 per patient, P<0.001). However, these differences were offset by trends towards higher expenditures due to hospitalizations for non-cardiovascular diagnoses, implantable cardiac arrhythmia devices, and non-cardiovascular drugs with rate-control. Overall, the total cost per patient was similar with rate and rhythm-control strategies ($78 767±79 568 versus $72 764±72 800, P=0.49). Interpretation: In patients with atrial fibrillation and heart failure, rate control is associated with fewer cardiovascular procedures, most notably cardioversions, and less expensive cardiovascular drugs. However, arrhythmia-related costs account for less than half of all healthcare expenditures and overall costs are similar with the two strategies.

Cette thèse concerne la conception de commandes échantillonnées pour les systèmes non-linéaires en temps continu. Les systèmes échantillonnés sont des éléments inhérents aux systèmes contrôlés par ordinateur, les systèmes hybrides ou les systèmes embarqués. La conception et le calcul des contrôleurs numériques appropriés sont des taches difficiles car ils contiennent des composants à la fois continu et en temps discret. Ce travail s'inscrit dans une activité de recherche menée par S. Monaco et D. Normand-Cyrot dans le domaine des systèmes échantillonnés non-linéaires. L'idée de base est de concevoir des contrôleurs digitaux qui permettent de récupérer certaines propriétés en temps continu qui sont généralement dégradées par l'échantillonnage. Tel est le cas de l'émulation lorsque les contrôleurs en temps continu sont mis en ouvre en utilisant des bloqueurs d'ordre zéro. Cette thèse apporte des contributions dans trois directions complémentaires. La première concerne les développements théoriques: une nouvelle conception de type ``backstepping digital" est proposée pour les systèmes en forme ``strict-feedback". Cette méthode est comparée à d'autres stratégies proposées dans la littérature. La deuxième contribution est le développement d'un logiciel pour la synthèse des contrôleurs et d'une ``boîte à outils" pour simuler (en Matlab) les systèmes échantillonnés non-linéaires et leurs contrôleurs. Cette boîte à outils inclut plusieurs algorithmes pour la synthèse de contrôleurs échantillonnés tels que: commande de type multi-échelle, reproduction entrée-sortie/Lyapunov, backstepping digital, etc. La troisième contribution concerne plusieurs études de cas menées pour mettre en évidence les performances des contrôleurs échantillonnés, calculés avec l'aide du logiciel. Des résultats expérimentaux et des simulations sont décrits pour divers exemples réels dans les domaines électriques et mécaniques. / This thesis is concerned with the sampled-data control of non-linear continuous-time systems. Sampled-data systems are present in all computer controlled, hybrid or embedded systems. The design and computation of suitable digital controllers represent unavoidable tasks since both continuous and discrete-time components interact. The basic framework of this work takes part of a wide research activity performed by S. Monaco and D. Normand-Cyrot regarding non-linear sampled-data systems. The underlying idea is to design digital controllers that recover certain continuous-time properties that are usually degraded through sampling as it is the case when continuous-time controllers are implemented by means of zero-order holder devices (emulated control). This thesis brings contributions into three different directions. The first one regards theoretical developments: a new digital backstepping-like strategy design for strict-feedback systems is proposed. This method is compared with other strategies proposed in the literature. The second contribution is the development of a control designer and of a simulation toolbox (in Matlab) for non-linear sampled-data systems. This toolbox includes different digital design strategies such as: multi-rate control, input-output/Lyapunov matching, digital backstepping design, etc. The third contribution concerns several case studies conducted to highlight the performances of the sampled-data controller designs, computed by the means of the software toolbox. Experimental and simulation results are described for various real examples especially in the area of electrical and mechanical processes. / Teza de față se concentrează asupra studiului controlului eșantionat pentru sisteme neliniare în timp continuu. Sistemele eșantionate sunt componente indispensabile oricăror sisteme de control bazate pe dispozitive de calcul, sisteme hibride sau sisteme embedded. Sinteza și calculul comenzilor digitale, potrivite pentru astfel de sisteme, devine o sarcină dificilă o dată ce presupune existența de dinamici în timp discret respectiv în timp continuu.Cadrul de bază al acestei lucrări se regăsește în activitatea de cercetare realizată de Salvatore Monaco și Dorothée Normand-Cyrot în domeniul sistemelor eșantionate neliniare. Ideea care stă la bază este de a sintetiza comenzile digitale urmărind menținerea unor proprietăți impuse în timp continuu sub eșantionare. Aceste proprietăți sunt în general degradate sub eșantionare cum este cazul comenzilor emulate, când comenzile continue sunt implementate practic cu ajutorul extrapolatoarelor de ordin 0.Această teză își aduce aportul în 3 direcții complementare. Prima adresează dezvoltările teoretice unde o nouă sinteză de tip backstepping digital este propusă pentru sisteme în formă <strict-feedback>. Această metodă, dezvoltată în două versiuni, este comparată cu alte strategii similare propuse în literatură. A doua contribuție a tezei este legată de dezvoltarea unui toolbox software pentru sinteza de controllere digitale pentru sisteme nelinare sub eșantionare. Acest toolbox include strategii diferite pentru sinteza eșantionată precum: comandă de tip multi-rate, reproducere intrare-ieșire/Lyapunov, backstepping digital și alte soluții care sunt obiectul unor noi extensii. A treia contribuție este dată de studiile de caz dezvoltate pentru a scoate în evidență performanțele comenzilor eșantionate testate și calculate cu ajutorul aplicației software. Rezultatele experimentale și de simulare sunt obținute pentru diverse exemple reale din domeniul electric și mecanic.

A Cyber-physical System (CPS) can be described as a network of interlinked, concurrent computational components that interact with the physical world. Such a system is usually of reactive nature and must satisfy strict timing requirements to guarantee a correct behaviour. The components can be of mixed-criticality which implies different progress models and communication models, depending whether the focus of a component lies on predictability or resource efficiency. In this dissertation I present a novel approach that bridges the gap between stream processing models and Labelled Transition Systems (LTSs). The former offer powerful tools to describe concurrent systems of, usually simple, components while the latter allow to describe complex, reactive, components and their mutual interaction. In order to achieve the bridge between the two domains I introduce the novel LTS Synchronous Interface Automaton (SIA) that allows to model the interaction protocol of a process via its interface and to incrementally compose simple processes into more complex ones while preserving the system properties. Exploiting these properties I introduce an analysis to identify permanent blocking situations in a network of composed processes. SIAs are wrapped by the novel component-based coordination model Process Network with Synchronous Communication (PNSC) that allows to describe a network of concurrent processes where multiple communication models and the co-existence and interaction of heterogeneous processes is supported due to well defined interfaces. The work presented in this dissertation follows a holistic approach which spans from the theory of the underlying model to an instantiation of the model as a novel coordination language, called Streamix. The language uses network operators to compose networks of concurrent processes in a structured and hierarchical way. The work is validated by a prototype implementation of a compiler and a Run-time System (RTS) that allows to compile a Streamix program and execute it on a platform with support for ISO C, POSIX threads, and a Linux operating system.

INTRODUÇÃO: O treinamento físico provoca adaptações cardiovasculares, sendo que maiores adaptações estruturais cardíacas são observadas em atletas de elite, que realizam treinamento físico de alta intensidade com o objetivo de aumento no rendimento. Além disto, atletas apresentam diminuição da frequência cardíaca de repouso, embora os mecanismos que explicam a bradicardia em atletas ainda são controversos. O nível das adaptações pode variar e fatores como o tipo de modalidade esportiva, tempo e nível de treinamento físico podem contribuir para tal variação. Desta forma, o objetivo deste estudo foi investigar a influência de modalidades esportivas (ciclismo, corrida de longa distância e remo) e da periodização do treinamento físico nas adaptações estruturais e funcionais, autonômicas e não autonômicas cardíacas e vasculares em atletas de elite no repouso, na inclinação ortostática e nas 24 horas. MÉTODOS: Neste estudo experimental longitudinal prospectivo foram avaliados 13 ciclistas, 13 corredores e 11 remadores de elite, saudáveis (entre 20 e 36 anos; masculino), engajados em treinamento físico competitivo, em 2 períodos de treinamento: período básico-PB e período competitivo-PC. Avaliação da capacidade funcional máxima foi feita por teste cardiorrespiratório. Adaptações estruturais cardíacas foram avaliadas por meio do ecocardiograma bidimensional com doppler. Frequência cardíaca intrínseca foi estudada por meio do duplo bloqueio farmacológico (atropina 0,04 mg/kg e esmolol 500 g/kg, i.v.). Frequência cardíaca e pressão arterial foram registradas continuamente no repouso e no teste de inclinação ortostática por meio de ECG e monitor de pressão arterial, respectivamente (500Hz). A variabilidade da frequência cardíaca e pressão arterial foram analisadas pelo método auto-regressivo. Frequência cardíaca e pressão arterial de 24 horas foram aquisitadas pelo Holter e Mapa, respectivamente. Avaliação da sensibilidade barorreflexa espontânea foi calculada pelo método da sequência. Os dados foram apresentados como mediana e variação interquartil. RESULTADOS: Remadores apresentaram maior VO2max que os corredores no PC (p<0,04). Ciclistas e remadores apresentaram maior VO2max no PC comparado ao PB (p<0,05). Corredores apresentaram maiores diâmetros diastólicos do ventrículo esquerdo que ciclistas (p<0,06) e remadores (p<0,01) no PB. Corredores e ciclistas apresentaram maiores diâmetros diastólicos do ventrículo esquerdo que remadores (p<0,004) no PC. Corredores apresentaram maiores índices de massa do ventrículo esquerdo que ciclistas (p<0,04) no PB e ciclistas maiores que remadores (p<0,03) no PC. Ciclistas foram os únicos atletas que apresentaram a reversão do remodelamento cardíaco no PB (p<0,04). No repouso, corredores mostraram menor frequência cardíaca que ciclistas no PC ciclistas = 50(45/55), corredores = 44(43/47), remadores = 44(43/53)bpm, p<0,03]. Corredores e remadores mostraram maior efeito vagal [ciclistas = 41(36/46), corredores = 55(48/59), remadores = 50(42/66)bpm, p=0,03] e maior frequência cardíaca intrínseca ciclistas = 84(82/87), corredores = 92(87/94), remadores = 96(85/101)bpm, p=0,03] que ciclistas no PC. Remadores tinham maior frequência cardíaca intrínseca que ciclistas no PB ciclistas = 88(86/92), corredores = 91(82/99), remadores = 95(90/101)bpm, p=0,03]. PC comparado ao PB diminuiu o efeito vagal 41(36/46) vs. 48(43/51)bpm, p<0,05] e frequência cardíaca intrínseca 84(82/87) vs. 88(86/92), p<0,05] dos ciclistas. No teste de inclinação, corredores mostraram menor aumento da frequência cardíaca que ciclistas no PB ciclistas = 64(49/73), corredores = 46(43/55), remadores = 53(42/77)%, p<0,05]. Nem a modalidade ou período de treinamento físico influenciaram os índices de variabilidade da frequência cardíaca no repouso ou na inclinação ortostática. A modalidade esportiva e o período de treinamento físico influenciaram a pressão arterial e sua variabilidade, no repouso e na inclinação ortostática. Remadores apresentaram menor sensibilidade barorreflexa espontânea que corredores no PC (p=0,03). Tanto a modalidade quanto o período de treinamento físico influenciaram a resposta da frequência cardíaca de 24 horas, sua variabilidade e a resposta da pressão arterial de 24 horas. CONCLUSÃO: Tanto a modalidade esportiva quanto o período de treinamento físico influenciaram nas adaptações estruturais cardíacas, intrínsecas e autonômicas cardíacas e vasculares. Entretanto a modalidade esportiva parece influenciar mais expressivamente essas adaptações / INTRODUCTION: Physical exercise training provokes cardiovascular adaptations and the highest structural cardiac adaptations are observed in elite athletes who perform high intensity training with the objective of increasing their physical performance. Besides, athlete shows decrease on resting heart rate. However, the mechanisms that explain the bradycardia in athletes are still controversial. The level of these adaptations may vary and some factors as the type of sport modality, time and level of physical training can contribute to such different responses. Thus, the aim of this study was to investigate the influence of sport modalities (cycling, long distane runner and rower) and physical training periodization on cardiac structural and functional, cardiac autonomic and non-autonomic and vascular adaptations in elite athletes at rest, tilt table test and within 24 hours. METHODS: In this prospective longitudinal experimental study, 13 cyclists, 13 runners and 11 rowers, healthy (20 to 36 years old; male), engaged in competitive training were evaluated in 2 periods of training: basic period BP and competitive period -CP. Maximal functional capacity was evaluated by cardiopulmonary test. Cardiac structural adaptations were evaluated by two-dimensional echocardiography with doppler. Intrinsic heart rate was studied by means of double pharmacological blockade (atropine 0.04 mg/kg and esmolol 500 g/kg, iv.). Heart rate and blood pressure were recorded continuously at rest and tilt table test by means of ECG and arterial blood pressure monitor, respectively (500Hz). The heart rate and blood pressure variabilities were analyzed by autoregressive method. Heart rate and blood pressure within 24 hours were recorded using Holter and blood pressure ambulatory monitor, respectivamente. Spontaneous baroreflex sensitivity was calculated using the sequence method. The data were presented as median and interquartile range. RESULTS: Rowers showed higher VO2max than runners at CP (p<0.04). Cyclists and rowers showed higher VO2max at CP compared to BP (p<0.05). Runners presented higher left ventricular diastolic diameters than cyclists (p<0.06) and rowers (p<0.01) at BP. Runners and cyclists presented higher left ventricular diastolic diameters than rowers (p<0.004) at CP. Runners showed higher left ventricular mass index than cyclistas (p<0.04) at BP and cyclists higher than rowers (p<0.03) at CP. Cyclists were the only athletes who had a reversal of cardiac remodeling at BP (p<0.04). At rest, runners showed lower heart rate than cyclists at CP cyclists = 50(45/55), runners = 44(43/47), rowers = 44(43/53)bpm, p<0.03]. Runners and rowers showed higher vagal effect [cyclists = 41(36/46), runners = 55(48/59), rowers = 50(42/66)bpm, p=0.03] and higher intrinsic heart rate cyclists = 84(82/87), runners = 92(87/94), rowers = 96(85/101)bpm, p=0,03] than cyclists at CP. Rowers had higher intrinsic herat rate than cyclists at BP cyclists = 88(86/92), runners = 91(82/99), rowers = 95(90/101)bpm, p=0.03]. CP compared with BP decreased the vagal effect 41(36/46) vs. 48(43/51)bpm, p<0.05] and intrinsic heart rate 84(82/87) vs. 88(86/92), p<0.05] of cyclists. At tilt table test, runners showed smaller increase in heart rate than cyclists at BP cyclists = 64(49/73), runners = 46(43/55), rowers = 53(42/77)%, p<0.05]. Neither the sport modality or the training period influenced the indices of heart rate variability at rest and tilt test. The sport modality and the training period influenced the blood pressure and its variability at rest and tilt test. Rowers showed lower spontaneous baroreflex sensitivity than runners at CP (p=0.03). Both the sport modality and the training period influenced the heart rate response in 24 hours, its variability and blood pressure response in 24 hours. CONCLUSION: Both Sport modality and physical training period influenced the cardiac structural, intrinsic and autonomic adaptations as well the vascular adaptations. However, the sport modality seems to influence more significantly these adaptations

The Transmission Control Protocol (TCP) is the dominant transport protocol in today?s Internet. The original design of TCP left congestion control open to future designers. Short of implementing changes to the TCP stack on the end-nodes themselves, Internet Service Providers have employed several techniques to be able to operate their network equipment efficiently. These techniques amount to shaping traffic to reduce cost and improve overall customer satisfaction. <br /><br /> The method that gives maximum control when performing traffic shaping is using an inline traffic shaper. An inline traffic shaper sits in the middle of any flow, allowing packets to pass through it and, with policy-limited freedom, inspects and modifies all packets as it pleases. However, a number of practical issues such as hardware reliability or ISP policy, may prevent such a solution from being employed. For example, an ISP that does not fully trust the quality of the traffic shaper would not want such a product to be placed in-line with its equipment, as it places a significant threat to its business. What is required in such cases is third-party rate control. <br /><br /> Formally defined, a third-party rate controller is one that can see all traffic and inject new traffic into the network, but cannot remove or modify existing network packets. Given these restrictions, we present and study a technique to control TCP flows, namely triple-ACK duplication. The triple-ACK algorithm allows significant capabilities to a third-party traffic shaper. We provide an analytical justification for why this technique works under ideal conditions and demonstrate via simulation the bandwidth reduction achieved. When judiciously applied, the triple-ACK duplication technique produces minimal badput, while producing significant reductions in bandwidth consumption under ideal conditions. Based on a brief study, we show that our algorithm is able to selectively throttle one flow while allowing another to gain in bandwidth.

The Transmission Control Protocol (TCP) is the dominant transport protocol in today?s Internet. The original design of TCP left congestion control open to future designers. Short of implementing changes to the TCP stack on the end-nodes themselves, Internet Service Providers have employed several techniques to be able to operate their network equipment efficiently. These techniques amount to shaping traffic to reduce cost and improve overall customer satisfaction. <br /><br /> The method that gives maximum control when performing traffic shaping is using an inline traffic shaper. An inline traffic shaper sits in the middle of any flow, allowing packets to pass through it and, with policy-limited freedom, inspects and modifies all packets as it pleases. However, a number of practical issues such as hardware reliability or ISP policy, may prevent such a solution from being employed. For example, an ISP that does not fully trust the quality of the traffic shaper would not want such a product to be placed in-line with its equipment, as it places a significant threat to its business. What is required in such cases is third-party rate control. <br /><br /> Formally defined, a third-party rate controller is one that can see all traffic and inject new traffic into the network, but cannot remove or modify existing network packets. Given these restrictions, we present and study a technique to control TCP flows, namely triple-ACK duplication. The triple-ACK algorithm allows significant capabilities to a third-party traffic shaper. We provide an analytical justification for why this technique works under ideal conditions and demonstrate via simulation the bandwidth reduction achieved. When judiciously applied, the triple-ACK duplication technique produces minimal badput, while producing significant reductions in bandwidth consumption under ideal conditions. Based on a brief study, we show that our algorithm is able to selectively throttle one flow while allowing another to gain in bandwidth.

Contexte : La fibrillation auriculaire est commune chez les insuffisants cardiaques. L’efficacité des stratégies de contrôle de la fréquence et du rythme s’équivalent. Nous avons comparé l’impact économique des deux stratégies de traitement chez les patients avec fibrillation auriculaire et insuffisance cardiaque. Méthode : Dans cette sous-étude de l’essai Atrial Fibrillation and Congestive Heart Failure, la consommation de soins de santé des patients Québécois ainsi que leurs coûts ont été quantifiés grâce aux banques de données de la Régie de l’assurance-maladie du Québec et de l’Ontario Case Costing Initiative. Résultats : Trois cent quatre patients ont été inclus, âgés de 68±9 ans, fraction d’éjection de 26±6%. Les caractéristiques de base étaient bien réparties entre le contrôle du rythme (N=149) et de la fréquence (N=155). Les patients soumis au contrôle de la fréquence ont eu moins de procédures cardiovasculaires (146 versus 238, P<0.001) en raison du plus faible nombre de cardioversions et de moindres coûts reliés aux antiarythmiques (48 $±203 versus 1319 $±1058 par patient, P<0.001). Ces différences ont été compensées par un surplus de dépenses dues aux hospitalisations non-cardiovasculaires, aux dispositifs cardiaques implantables et aux médicaments non-cardiovasculaires dans le groupe du contrôle de la fréquence. Au total, les coûts par patient avec les stratégies du contrôle de la fréquence et du rythme s’élèvent à 78 767 $±79 568 et 72 764 $±72 800 (P=0.49). Interprétation : Chez les patients avec fibrillation auriculaire et insuffisance cardiaque, le contrôle de la fréquence est associé avec moins de procédures cardiovasculaires et une pharmacothérapie cardiovasculaire moins coûteuse. Toutefois, les coûts associés aux arythmies représentent moins de la moitié des dépenses de santé et le total des coûts s’équilibre entre les 2 stratégies. / Background: Atrial fibrillation is common in patients with heart failure. Rhythm and rate-control strategies are associated with similar efficacy outcomes. We compared the economic impact of the two treatment strategies in patients with atrial fibrillation and heart failure. Methods: In a pre-specified substudy of the Atrial Fibrillation and Congestive Heart Failure trial, healthcare expenditures of patients from Quebec were analyzed from a single-payer perspective using a cost-minimization approach. In-trial resource utilization including hospitalizations, procedures, emergency department visits, outpatient encounters, and medications were estimated from Quebec Health Insurance Board administrative databases supplemented by disease-specific costs from the Ontario Case Costing Initiative. Results: A total of 304 patients were included, age 68±9 years, 86% male, ejection fraction 26±6%. Baseline characteristics were similar in rhythm (N=149) and rate-control (N=155) groups. Arrhythmia-related costs accounted for 45% of total expenditures. Rate-control patients had fewer cardiovascular procedures (146 versus 238, P<0.001), driven by fewer cardioversions, and lower costs related to antiarrhythmic drugs ($48±203 versus $1319±1058 per patient, P<0.001). However, these differences were offset by trends towards higher expenditures due to hospitalizations for non-cardiovascular diagnoses, implantable cardiac arrhythmia devices, and non-cardiovascular drugs with rate-control. Overall, the total cost per patient was similar with rate and rhythm-control strategies ($78 767±79 568 versus $72 764±72 800, P=0.49). Interpretation: In patients with atrial fibrillation and heart failure, rate control is associated with fewer cardiovascular procedures, most notably cardioversions, and less expensive cardiovascular drugs. However, arrhythmia-related costs account for less than half of all healthcare expenditures and overall costs are similar with the two strategies.

Optogenetics is a set of technologies that enable optically triggered gain or loss of function in genetically specified populations of cells. Optogenetic methods have revolutionized experimental neuroscience by allowing precise excitation or inhibition of firing in specified neuronal populations embedded within complex, heterogeneous tissue. Although optogenetic tools have greatly improved our ability manipulate neural activity, they do not offer control of neural firing in the face of ongoing changes in network activity, plasticity, or sensory input. In this thesis, I develop a feedback control technology that automatically adjusts optical stimulation in real-time to precisely control network activity levels. I describe hardware and software tools, modes of optogenetic stimulation, and control algorithms required to achieve robust neural control over timescales ranging from seconds to days. I then demonstrate the scientific utility of these technologies in several experimental contexts. First, I investigate the role of connectivity in shaping the network encoding process using continuously-varying optical stimulation. I show that synaptic connectivity linearizes the neuronal response, verifying previous theoretical predictions. Next, I use long-term optogenetic feedback control to show that reductions in excitatory neurotransmission directly trigger homeostatic increases in synaptic strength. This result opposes a large body of literature on the subject and has significant implications for memory formation and maintenance. The technology presented in this thesis greatly enhances the precision with which optical stimulation can control neural activity, and allows causally related variables within neural circuits to be studied independently.