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BackgroundBrain-computer interfaces can enable communication for people with paralysis by transforming cortical activity associated with attempted speech into text on a computer screen. Communication with brain-computer interfaces has been restricted by extensive training requirements and limited accuracy.MethodsA 45-year-old man with amyotrophic lateral sclerosis (ALS) with tetraparesis and severe dysarthria underwent surgical implantation of four microelectrode arrays into his left ventral precentral gyrus 5 years after the onset of the illness; these arrays recorded neural activity from 256 intracortical electrodes. We report the results of decoding his cortical neural activity as he attempted to speak in both prompted and unstructured conversational contexts. Decoded words were displayed on a screen and then vocalized with the use of text-to-speech software designed to sound like his pre-ALS voice.ResultsOn the first day of use (25 days after surgery), the neuroprosthesis achieved 99.6% accuracy with a 50-word vocabulary. Calibration of the neuroprosthesis required 30 minutes of cortical recordings while the participant attempted to speak, followed by subsequent processing. On the second day, after 1.4 additional hours of system training, the neuroprosthesis achieved 90.2% accuracy using a 125,000-word vocabulary. With further training data, the neuroprosthesis sustained 97.5% accuracy over a period of 8.4 months after surgical implantation, and the participant used it to communicate in self-paced conversations at a rate of approximately 32 words per minute for more than 248 cumulative hours.ConclusionsIn a person with ALS and severe dysarthria, an intracortical speech neuroprosthesis reached a level of performance suitable to restore conversational communication after brief training. (Funded by the Office of the Assistant Secretary of Defense for Health Affairs and others; BrainGate2 ClinicalTrials.gov number, NCT00912041.).

Care is a practice and form of labour making human survival and flourishing possible. This Symposium explores the place and work of care within housing movements, asking how care operates as a politics, an ethics, and a set of practices through which tenants survive—and ultimately seek to transform—the structural violence of capitalist housing systems. Situated in US cities with abiding associations with Blackness and indigeneity, papers in the Symposium examine housing movements that take care as the starting point. As we discuss in this introduction to the Symposium, in such movements, care operates as connective tissue across households and modes of difference; challenges relations of racial capitalism and settler colonialism that underlie dominant understandings of who deserves and can demand care; and drives calls for public care and experiments with non-propertised forms of ownership. Housing systems are care infrastructures, making housing movements a vital place for care work.

Objective.Artificial neural networks (ANNs) are state-of-the-art tools for modeling and decoding neural activity, but deploying them in closed-loop experiments with tight timing constraints is challenging due to their limited support in existing real-time frameworks. Researchers need a platform that fully supports high-level languages for running ANNs (e.g. Python and Julia) while maintaining support for languages that are critical for low-latency data acquisition and processing (e.g. C and C++).Approach.To address these needs, we introduce the Backend for Realtime Asynchronous Neural Decoding (BRAND). BRAND comprises Linux processes, termednodes, which communicate with each other in agraphvia streams of data. Its asynchronous design allows for acquisition, control, and analysis to be executed in parallel on streams of data that may operate at different timescales. BRAND uses Redis, an in-memory database, to send data between nodes, which enables fast inter-process communication and supports 54 different programming languages. Thus, developers can easily deploy existing ANN models in BRAND with minimal implementation changes.Main results.In our tests, BRAND achieved

This single-site case study will seek to answer the following question: how is the concept of privacy addressed in relation to a student success information system within a small, public institution of higher education? Three themes were found within the inductive coding process, which used interviews, documentation, and videos as data resources. Overall, the case study shows an institution in the early stages of implementing a commercial learning analytics system and provides suggestions for how it can be more proactive in implementing privacy considerations in developing policies and procedures.

Abstract Background Pre-existing comorbidities increase the likelihood of post-stroke dysphagia. This study investigates comorbidity prevalence in patients with dysphagia after ischemic stroke. Methods The data of patients with acute ischemic stroke from two large representative cohorts (STROKE-CARD trial 2014–2019 and STROKE-CARD registry 2020–2022 – both study center Innsbruck, Austria) were analyzed for the presence of dysphagia at hospital admission (clinical swallowing examination). Comorbidities were assessed using the Charlson Comorbidity Index (CCI). Results Of 2054 patients with ischemic stroke, 17.2% showed dysphagia at hospital admission. Patients with dysphagia were older (77.8 ± 11.9 vs. 73.6 ± 14.3 years, p

IntroductionSocial prescribing (SP) is a holistic and collaborative approach to help individuals access community-based supports and services for their nonmedical social needs. The aim of this study was to assess the needs and priorities of Canadian older adults (aged 55 years and older), with a focus on optimizing SP programs for those who are systemically disadvantaged and socially marginalized. MethodsSemistructured focus groups (N = 10 groups, 43 participants) were conducted online via Zoom with participants from across Canada. Data transcription and thematic analysis were completed in NVivo. Analyses were informed by self-determination theory. ResultsOur results suggest that older adults desire SP programs that respect their ability to maintain their autonomy and independence, aid and facilitate the development of connectedness and belonging, are built on a foundation of trust and relationship-building in interactions with providers and link workers, and prioritize the person and thus personalize SP to the unique needs of each individual. ConclusionSP programs should be informed by the values of older adults. As work is currently underway to formalize and scale SP in Canada, personalizing these programs to the unique circumstances, needs and priorities of participants should be a top priority.

IntroductionLa prescription sociale est une approche holistique et collaborative qui vise à aider les individus à avoir accès aux mesures de soutien et aux services communautaires nécessaires pour combler leurs besoins sociaux non médicaux. Cette étude visait à évaluer les besoins et les priorités des aînés canadiens (55 ans et plus), en portant une attention particulière à l’optimisation des programmes de prescription sociale à l’intention des personnes qui sont systémiquement défavorisées et socialement marginalisées. MéthodologieDes groupes de discussion semi-structurés (N = 10 groupes, 43 participants) ont été organisés en ligne sur Zoom avec des participants de l’ensemble du Canada. La transcription des données et l’analyse thématique ont été réalisées à l’aide du logiciel NVivo. Les analyses s’appuient sur la théorie de l’autodétermination. RésultatsD’après nos résultats, les aînés souhaitent avoir accès à des programmes de prescription sociale qui respectent leur capacité à maintenir leur autonomie et leur indépendance; qui favorisent le développement de liens et d’un sentiment d’appartenance; qui sont fondés sur la confiance et l’établissement de relations solides dans les interactions avec les fournisseurs et les agents de liaison communautaires et qui donnent la priorité à la personne, personnalisant ainsi la prescription sociale en fonction des besoins spécifiques de chacun. ConclusionLes programmes de prescription sociale doivent être fondés sur les valeurs des aînés. Alors que des travaux sont actuellement en cours pour formaliser et étendre la prescription sociale au Canada, la personnalisation de ces programmes en fonction de la situation, des besoins et des priorités spécifiques des participants devrait être une priorité majeure.

Abstract Background The United States has lost many lives to COVID-19. The role of social capital and collective action has been previously explored in the context of COVID-19. The current study specifically investigates the role of social trust at the county level and COVID-19 mortality in the US, hypothesizing that counties with higher social trust will have lower COVID-19 mortality rates. Methods We used cross-sectional data from the General Social Survey (GSS). We collected COVID-19 mortality data from the COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University until October 31, 2021. We obtained county characteristics from the 2019 American Community Survey and supplemented this data source with additional publicly available county-level data, such as measures of income inequality and political leanings. We measured social trust as a single item from the GSS and calculated mean social trust in a county by pooling responses from 2002 to 2018. We then modeled the relationship between mean social trust and COVID-19 mortality. Results Results indicate that counties with higher social trust have lower COVID-19 mortality rates. Higher values of mean social trust at the county level are associated with a decrease in COVID-19 mortality (b= -0.25, p-value

The Common Problems Project (CP2) is an interdisciplinary, problem-based pedagogy that was launched in 2015 by four partner colleges in the State University of New York (SUNY) system (Cortland, Oneonta, Oswego, and Plattsburgh). Since its inception, 100 faculty have participated in CP2 and integrated the pedagogy into 134 courses to implement 47 collaborative projects. CP2 is based on a simple but innovative approach in which instructors from different disciplines identify a real-world problem they have in common. They pair their relevant existing classes so that students can work in interdisciplinary teams to propose solutions to the problem. This paper describes CP2 and its theoretical underpinnings, provides the results of a three-pronged approach to assessment, and outlines recommendations for faculty and institutions who may be interested in replicating CP2 on their campuses. CP2 model holds promise for a future of collaborative problem solving as a pedagogical approach, and, as such, this article will be of interest to a wide range of scholars, practitioners, educators, and administrators.

Abstract Introduction Gout, a common comorbidity of chronic kidney disease (CKD), is associated with high morbidity and healthcare utilization. However, a large proportion of gout remains undermanaged or untreated which may lead to worse patient outcomes and greater healthcare costs. This study estimates the present and future health and economic burden of controlled and uncontrolled gout in a virtual United States (US) CKD population. Methods A validated microsimulation model was used to project the burden of gout in patients with CKD in the USA through 2035. Databases were utilized to build a virtual CKD population of “individuals” with controlled or uncontrolled gout. Modelling assumptions were made on the basis of the literature, which was sparse in some cases. Health and economic outcomes with the current care (baseline) scenario were evaluated, along with potential benefits of urate-lowering intervention scenarios. Results The prevalence of comorbid gout and CKD in the USA was projected to increase by 29%, from 7.9 million in 2023 to 9.6 million in 2035 in the baseline scenario. Gout flares, tophi, and comorbidity development were also projected to increase markedly through 2035, with the economic burden of gout in the CKD population subsequently increasing from $38.9 billion in 2023 to $47.3 billion in 2035. An increased use of oral urate-lowering therapies in undermanaged patients, and pegloticase use in patients refractory to oral urate-lowering therapies were also project to result in 744,000 and 353,000 fewer uncontrolled gout cases, respectively, by 2035. Marked reductions in complications and costs ensued. Conclusions This study projected a substantial increase in comorbid gout and CKD. However, improved use of urate-lowering interventions could mitigate this growth and reduce the health and economic burdens of gout.

RésuméLe rapport Lalonde, publié en 1974 par le ministre canadien de la Santé nationale et du Bien-être social, a fait oeuvre de pionnier en matière de santé publique au Canada en reconnaissant que les déterminants de la santé vont bien au-delà des services de soins de santé. Cinquante ans plus tard, ce numéro spécial de Promotion de la santé et prévention des maladies chroniques au Canada montre comment on peut agir sur les déterminants de la santé en amont au moyen d’une nouvelle intervention appelée « prescription sociale ». La prescription sociale oriente les patients vers des ressources communautaires qui correspondent à leurs priorités personnelles. Elle favorise ainsi un changement de paradigme par lequel l’approche de promotion de la santé n’est plus axée sur les déficits mais sur les forces. La première partie de ce numéro porte sur la croissance rapide de la prescription sociale et ses applications variées au Canada, que ce soit des initiatives ciblant diverses populations ou des interventions privilégiant le contact avec la nature, les arts, l’activité physique ou encore la connectivité sociale. Les contributions d’un large éventail de partenaires (chercheurs, professionnels de la santé et membres de la communauté, etc.) explorent l’adaptabilité de la prescription sociale à différents groupes, soulignent le rôle que jouent la communauté et les expériences vécues dans la recherche et signalent également la nécessité d’un plus grand nombre d’études sur l’efficacité et les résultats de la prescription sociale. Les études de cas présentées prouvent l’existence d’avantages tangibles sur les plans de l’équité en santé et de l’accès aux services sociaux. Ce numéro ne reflète pas seulement la portée et l’incidence actuelles de la prescription sociale au Canada : il jette aussi les bases de son évolution future et de son intégration dans les pratiques de santé en général.

Wellbeing is fundamental to an individual's ability to function and live well. Maori have some of the worst wellbeing statistics in New Zealand (Chalmers & Williams, 2018). From a te ao Maori perspective mana (power, authority) and kaitiakitanga (guardianship) encapsulate the critical relationships inherent in Maori understandings of wellbeing. These relationships highlight the interconnectedness and interdependence of humans with the people, places and things in their worlds, and the responsibilities associated with these people, places and things. This article discusses findings from a Teaching and Learning Research Initiative funded project, Te Whakapumautia te mana: Enhancing Mana Through Kaitiakitanga (2020-2021), and outlines implications for early childhood education (ECE) from the findings. The aim of the project was to investigate ways that ECE provides mokopuna (grand/child/ren) opportunities to recognise mana and understand ways to attain mana through being kaitiaki (guardians) of themselves, others and their environment, thereby contributing to a collective sense of wellbeing. The article focuses on kaiako (teacher/s) understandings of mana and kaitiakitanga and how they are currently reflected in contemporary ECE services.

BackgroundSocial prescribing (SP) takes a holistic approach to health by linking clients from clinical settings to community programs to address their nonmedical needs. The emerging evidence base for SP demonstrates variability in the design and implementation of different SP initiatives. To effectively address these needs, coproduction among clients, communities, stakeholders, and policy makers is important for tailoring SP initiatives for optimal uptake. ObjectiveThis study aims to explore the role of coproduction in SP initiatives. The research question is as follows: How and for what purpose has coproduction been incorporated across a range of SP initiatives for different clients? MethodsA review of international literature will be conducted following the JBI guidelines for scoping reviews. We will search multiple databases including Scopus, MEDLINE, and the PAIS Index, as well as gray literature, from 2000 to 2023. The primary studies included will describe a nonmedical need for clients, a nonmedical SP program or initiative, coproduction of the SP program, and any follow-up. Review articles and commentaries will be excluded. Titles, abstracts, and full-text articles will be screened, and data will be extracted by at least 2 research team members using Covidence and a pilot-tested extraction template. Clients with lived experience will also participate in the research process. Findings will be descriptively summarized and thematically synthesized to answer the research question. ResultsThe project was funded in 2023, and the results are expected to be submitted for publication in early 2025. ConclusionsDescriptions of what coproduction is meant to accomplish may differ from theoretical aspirations. Continued understanding of how coproduction has been designed and executed across varied international SP models is important for framing engagement in practice for future SP arrangements and their evaluation. We anticipate this review will guide clients, communities, stakeholders, and policy makers in further developing SP practice within health care systems. Trial RegistrationOpen Science Framework Registries B8U4Z; https://osf.io/b8u4z International Registered Report Identifier (IRRID)DERR1-10.2196/57062

Effective treatment and immunoprophylaxis of viral respiratory infections with neutralizing monoclonal antibodies (mAbs) require maintaining inhibitory concentrations of mAbs at the airway surface. While engineered mAbs with increased affinity to the neonatal Fc receptor (FcRn) are increasingly employed, little is known how increased affinity of Fc to FcRn influences basal-to-apical transepithelial transport (transcytosis) of mAbs across the airway epithelium. To investigate this, we utilized a model of well-differentiated human airway epithelium (WD-HAE) that exhibited robust FcRn expression, and measured the transepithelial transport of a mAb against SARS-CoV-2 Spike protein (CR3022) with either wildtype IgG1-Fc or Fc modified with YTE or LS mutations known to increase affinity for FcRn. Despite the marked differences in the affinity of these CR3022 variants for FcRn, we did not find substantial differences in basal-to-apical transport reflective of systemic dosing, or apical-to-basal transport reflective of inhaled dosing, compared to the transport of wildtype IgG1-Fc. These results suggest increasing FcRn affinity may only have limited influence over transcytosis rates of systemically dosed mAbs across the human airway epithelium over short time scales. Over longer time scales, the elevated circulating levels of mAbs with greater FcRn affinity, due to more effective FcRn-mediated recycling, may better resupply mAb into the respiratory tract, leading to more effective extended immunoprophylaxis.

Abstract Habitat fragmentation and host community composition are implicated as key drivers of changing tick populations and tick‐borne pathogen dynamics, altering infection risk through coupled socioecological pathways that mediate interactions between tick vectors, vertebrate hosts, and humans. Patterns of host diversity may be particularly idiosyncratic across urbanized landscapes, due to trade‐offs between extreme fragmentation that reduces habitat suitability and access, and human activities that artificially increase resource availability for wildlife. We used camera and hair trap surveys and tick sampling to identify links between landscape composition and configuration, the mammalian host community, and the presence of three tick vector species at a human–wildlife interface in New York City, an emerging area within an endemic region for several tick‐borne diseases. We found that human infrastructures, such as the presence of fences in yards, could affect mammal host community composition by changing the “hardness” of edges between urban greenspaces and residential areas. We identified yard‐ and broader landscape‐level features associated with the presence of urban mammal species, and identified cascading effects of host community composition on tick distribution in yards, suggesting management implications for the mitigation of human exposure to tick‐borne pathogens. In particular, we identified a possible role of ubiquitous mesomammals, such as raccoons (Procyon lotor), in transporting Amblyomma americanum ticks between parks and neighboring residential yards, and confirmed the key role of white‐tailed deer (Odocoileus virginianus) for introducing Ixodes scapularis ticks into yards. Our results challenge assumptions that biodiversity loss in human‐modified areas always increases the risk for tick‐borne diseases. Instead, we found many residential sites had higher mammal species richness and higher detection of low reservoir competent (“dilution”) hosts for Borrelia burgdorferi, such as opossums (Didelphis virginiana), than paired forested greenspaces. Our study highlights the importance of disentangling the mechanisms mediating tick‐borne disease hazard as a critical first step toward reducing urban tick‐borne disease risk.

ABSTRACT Introduction Social prescribing offers a formal pathway of connecting patients in the health system with sources of support within the community to help improve their health and well‐being. Since its launch in March 2022, the Canadian Institute for Social Prescribing has acted as a collective impact network to identify, connect and build upon established social prescribing initiatives using a co‐design methodology. The institute received input from a participant advisory council, co‐design partners and several communities of interest groups. This study aimed to describe the perceptions of the Canadian Institute for Social Prescribing's role in advancing social prescribing using a co‐design approach and the barriers and facilitators to implementing social prescribing in Canada. Methods We used a qualitative descriptive study design, document analysis, participant observation and semi‐structured individual interviews (n = 7) with members of the Canadian Institute for Social Prescribing co‐design group and the institute's leadership. We also analysed documents, field notes and transcripts using codebook thematic analysis. Results Four themes were developed representing the facilitators of implementing the Canadian Institute for Social Prescribing to support social prescribing: Creating relational mechanisms (i.e., partnerships and connections), Bringing awareness to social prescribing and contributing to the evidence (i.e., values and beliefs), Addressing systemic conditions (i.e., having a common language for social prescribing and organizing the community health sector) and Enabling funding and policy to drive social prescribing initiatives (i.e., shifting evidence into policy and securing sustainable funding). Conclusion Participants' reflections on the co‐design process demonstrated that the Canadian Institute for Social Prescribing development provided networking opportunities and shared resources relevant to social prescribing. Co‐design efforts also fostered relational and informational support, which laid the necessary groundwork in Canada to overcome the complex interplay between the macro‐ and micro‐level settings in which social prescribing is practiced. Patient or Public Contribution The interviews and observations involved participants with lived experience of delivering, receiving or advocating for social prescribing.

AbstractThe Lalonde report, published in 1974 by the Canadian Minister of National Health and Welfare, broke ground for public health in Canada by acknowledging that the determinants of health are much broader than health care services. Fifty years later, this special issue of Health Promotion and Chronic Disease Prevention in Canada charts a clear path towards addressing upstream determinants of health through an emerging intervention called “social prescribing.” Social prescribing connects patients with community resources tailored to their individual priorities, fostering a paradigm shift from a deficitbased to a strengths-based approach in health promotion. Part 1 of this issue covers the rapid growth and diverse applications of social prescribing across Canada, with targeted initiatives for various populations and interventions ranging from nature and arts to physical activity and social connectivity. Contributions from a wide range of partners, including researchers, health professionals and community members, explore the adaptability of social prescribing for different groups, underscore the role of community and lived experiences in research, and call for more studies on social prescribing’s effectiveness and outcomes. Highlighted case studies demonstrate tangible benefits in health equity and access to social services. This issue not only reflects the current scope and impact of social prescribing in Canada but also sets the stage for its future development and integration into broader health practices.

Abstract Background Familial hypercholesterolemia (FH) is a heritable disorder affecting 1.3 million individuals in the USA. Eighty percent of people with FH are undiagnosed, particularly minoritized populations including Black or African American people, Asian or Asian American people, and women across racial groups. Family cascade screening is an evidence-based practice that can increase diagnosis and improve health outcomes but is rarely implemented in routine practice, representing an important care gap. In pilot work, we leveraged best practices from behavioral economics and implementation science—including mixed-methods contextual inquiry with clinicians, patients, and health system constituents—to co-design two patient-facing implementation strategies to address this care gap: (a) an automated health system-mediated strategy and (b) a nonprofit foundation-mediated strategy with contact from a foundation-employed care navigator. This trial will test the comparative effectiveness of these strategies on completion of cascade screening for relatives of individuals with FH, centering equitable reach. Methods We will conduct a hybrid effectiveness-implementation type III randomized controlled trial testing the comparative effectiveness of two strategies for implementing cascade screening with 220 individuals with FH (i.e., probands) per arm identified from a large northeastern health system. The primary implementation outcome is reach, or the proportion of probands with at least one first-degree biological relative (parent, sibling, child) in the USA who is screened for FH through the study. Our secondary implementation outcomes include the number of relatives screened and the number of relatives meeting the American Heart Association criteria for FH. Our secondary clinical effectiveness outcome is post-trial proband cholesterol level. We will also use mixed methods to identify implementation strategy mechanisms for implementation strategy effectiveness while centering equity. Discussion We will test two patient-facing implementation strategies harnessing insights from behavioral economics that were developed collaboratively with constituents. This trial will improve our understanding of how to implement evidence-based cascade screening for FH, which implementation strategies work, for whom, and why. Learnings from this trial can be used to equitably scale cascade screening programs for FH nationally and inform cascade screening implementation efforts for other genetic disorders. Trial registration ClinicalTrials.gov, NCT05750667. Registered 15 February 2023—retrospectively registered, https://clinicaltrials.gov/study/NCT05750667 .

Abstract Background Rising housing prices are becoming a top public health priority and are an emerging concern for policy makers and community leaders. This report reviews and synthesizes evidence examining the association between changes in housing price and health outcomes. Methods We conducted a systematic literature review by searching the SCOPUS and PubMed databases for keywords related to housing price and health. Articles were screened by two reviewers for eligibility, which restricted inclusion to original research articles measuring changes in housing prices and health outcomes, published prior to June 31st, 2022. Results Among 23 eligible studies, we found that changes in housing prices were heterogeneously associated with physical and mental health outcomes, with multiple mechanisms contributing to both positive and negative health outcomes. Income-level and home-ownership status were identified as key moderators, with lower-income individuals and renters experience negative health consequences from rising housing prices. This may have resulted from increased stress and financial strain among these groups. Meanwhile, the economic benefits of rising housing prices were seen to support health for higher-income individuals and homeowners – potentially due to increased wealth or perception of wealth. Conclusions Based on the associations identified in this review, it appears that potential gains to health associated with rising housing prices are inequitably distributed. Housing policies should consider the health inequities born by renters and low-income individuals. Further research should explore mechanisms and interventions to reduce uneven economic impacts on health.

Abstract Background Vaccine homophily describes non-heterogeneous vaccine uptake within contact networks. This study was performed to determine observable patterns of vaccine homophily, as well as the impact of vaccine homophily on disease transmission within and between vaccination groups under conditions of high and low vaccine efficacy. Methods Residents of British Columbia, Canada, aged ≥ 16 years, were recruited via online advertisements between February and March 2022, and provided information about vaccination status, perceived vaccination status of household and non-household contacts, compliance with COVID-19 prevention guidelines, and history of COVID-19. A deterministic mathematical model was used to assess transmission dynamics between vaccine status groups under conditions of high and low vaccine efficacy. Results Vaccine homophily was observed among those with 0, 2, or 3 doses of the vaccine. Greater homophily was observed among those who had more doses of the vaccine (p

To survive, animals must convert sensory information into appropriate behaviours1,2. Vision is a common sense for locating ethologically relevant stimuli and guiding motor responses3-5. How circuitry converts object location in retinal coordinates to movement direction in body coordinates remains largely unknown. Here we show through behaviour, physiology, anatomy and connectomics in Drosophila that visuomotor transformation occurs by conversion of topographic maps formed by the dendrites of feature-detecting visual projection neurons (VPNs)6,7 into synaptic weight gradients of VPN outputs onto central brain neurons. We demonstrate how this gradient motif transforms the anteroposterior location of a visual looming stimulus into the fly's directional escape. Specifically, we discover that two neurons postsynaptic to a looming-responsive VPN type promote opposite takeoff directions. Opposite synaptic weight gradients onto these neurons from looming VPNs in different visual field regions convert localized looming threats into correctly oriented escapes. For a second looming-responsive VPN type, we demonstrate graded responses along the dorsoventral axis. We show that this synaptic gradient motif generalizes across all 20 primary VPN cell types and most often arises without VPN axon topography. Synaptic gradients may thus be a general mechanism for conveying spatial features of sensory information into directed motor outputs.