PANDIA: Personalized neuro-symbolic multimodal fusion for interpretable neonatal pain assessment.
The 31 matches
- [1] § 4. Experimentation and validation › 4.1 Datasets › 4.1.1 Dataset access and reproducibility. ↔ preprocessing/preprocess.py, lines 1–15 · score 0.96 · timestamp alignment, wavelet denoising, mel spectrogram, standardized preprocessing, face detection, linear interpolation
- [2] § 3. Methodology › 3.2 PANDIA architecture › 3.2.3 Concept bottleneck layer. ↔ pandia/models/concept_bottleneck.py, lines 1–28 · score 0.94 · eye squeeze, harmonic distortion, silence periods, mouth opening, cry intensity, brow lowering
- [3] § 3. Methodology › 3.2 PANDIA architecture › 3.2.3 Concept bottleneck layer. ↔ pandia/models/pandia.py, lines 149–186 · score 0.91 · eye squeeze, harmonic distortion, silence periods, mouth opening, cry intensity, brow lowering
- [4] § 3. Methodology › 3.2 PANDIA architecture › 3.2.7 Symbolic rule engine. ↔ pandia/models/symbolic_rules.py, lines 1–17 · score 0.88 · high confidence pain, conflicting indicator, NICU clinicians, pain baseline, moderate pain, escalation
- [5] § 3. Methodology › 3.2 PANDIA architecture › 3.2.7 Symbolic rule engine. ↔ pandia/models/symbolic_rules.py, lines 1–17 · score 0.88 · high confidence pain, NICU clinicians, pain baseline, moderate pain, gestational age, rule engine
- [6] § 3. Methodology › 3.2 PANDIA architecture › 3.2.4 Relational graph reasoner. ↔ pandia/models/graph_reasoner.py, lines 49–108 · score 0.85 · edges incident, absent modalities, concept nodes, missing modality, adjacency, zero
- [7] § 4. Experimentation and validation › 4.3 Evaluation metrics ↔ pandia/evaluation/metrics.py, lines 16–62 · score 0.84 · Brier Score, F1 macro, metrics, NPV, PPV, MCE
- [8] § 3. Methodology › 3.2 PANDIA architecture › 3.2.1 Module integration and data flow. ↔ pandia/models/symbolic_rules.py, lines 30–42 · score 0.81 · tier conflict resolution, human readable, Concept activations, rule engine, Algorithm, Symbolic
- [9] § 3. Methodology › 3.3 Training strategy › 3.3.3 Cybersecurity and deployment security. ↔ pandia/training/federated.py, lines 1–16 · score 0.80 · KL divergence, Anomaly detection, DP SGD, gradient, clipping, round
- [10] § 3. Methodology › 3.2 PANDIA architecture › 3.2.7 Symbolic rule engine. ↔ pandia/models/symbolic_rules.py, lines 30–42 · score 0.77 · tier conflict resolution, concept activations, rule engine, Algorithm, Symbolic, thresholds
- [11] § 3. Methodology › 3.2 PANDIA architecture › 3.2.5 Meta-learning personalization. ↔ pandia/models/meta_learner.py, lines 1–16 · score 0.77 · graph attention weights, concept bottleneck parameters, Meta learning, frozen, classifier, personalization
- [12] § 3. Methodology › 3.2 PANDIA architecture › 3.2.7 Symbolic rule engine. ↔ pandia/models/symbolic_rules.py, lines 101–147 · score 0.76 · High pain evidence, HR spike, intense crying, facial distress, Symbolic
- [13] § 4. Experimentation and validation › 4.2 Implementation details ↔ pandia/utils/data_utils.py, lines 17–103 · score 0.71 · random horizontal flipping, jittering, speed, Augmentation, noise, Temporal
- [14] § 3. Methodology › 3.2 PANDIA architecture › 3.2.5 Meta-learning personalization. ↔ pandia/utils/data_utils.py, lines 17–103 · score 0.70 · postnatal age, Contextual metadata, gestational age, 35 days, infant, weights
- [15] § 4. Experimentation and validation › 4.3 Evaluation metrics ↔ pandia/evaluation/metrics.py, lines 16–62 · score 0.68 · cohen kappa score, metrics, Quadratic, matrix, QWK, Weighted
- [16] § 3. Methodology › 3.2 PANDIA architecture ↔ pandia/training/losses.py, lines 113–150 · score 0.66 · graph sparsity, ordinal pain, concept supervision, Tensor, prediction, evidential
- [17] § 4. Experimentation and validation › 4.2 Implementation details ↔ pandia/training/trainer.py, lines 22–94 · score 0.65 · cosine annealing, AdamW, optimizer, batch, Training
- [18] § 3. Methodology › 3.2 PANDIA architecture › 3.2.1 Module integration and data flow. ↔ pandia/models/graph_reasoner.py, lines 49–108 · score 0.64 · GraphSAGE, learned adjacency, fused, nodes, layers, Module
- [19] § 3. Methodology › 3.2 PANDIA architecture › 3.2.1 Module integration and data flow. ↔ pandia/models/meta_learner.py, lines 1–16 · score 0.63 · graph attention weights, Meta learning, frozen, classifier, infant
- [20] § 3. Methodology › 3.2 PANDIA architecture ↔ pandia/training/trainer.py, lines 1–19 · score 0.61 · federated contrastive pretraining, multi task supervised, meta learning, PANDIA
- [21] § 3. Methodology › 3.2 PANDIA architecture › 3.2.1 Module integration and data flow. ↔ pandia/models/evidential_output.py, lines 1–12 · score 0.61 · epistemic uncertainty, system abstains, defers, Evidential, clinician, layer
- [22] § 3. Methodology › 3.3 Training strategy › 3.3.5 Multi-task supervised learning. ↔ pandia/training/losses.py, lines 113–150 · score 0.58 · ordinal loss, Concept supervision, prediction, weights, training, pain
- [23] § 3. Methodology › 3.3 Training strategy › 3.3.4 Federated infrastructure risk assessment (NIST CSF). ↔ pandia/training/federated.py, lines 78–197 · score 0.57 · global model, server, clients, aggregates, round, weighted
- [24] § 3. Methodology › 3.3 Training strategy › 3.3.4 Federated infrastructure risk assessment (NIST CSF). ↔ scripts/federated_train.py, lines 39–94 · score 0.57 · global model, server, clients, round, epochs, DP
- [25] § 3. Methodology › 3.2 PANDIA architecture › 3.2.2 Lightweight modality encoders. ↔ pandia/encoders/video_encoder.py, lines 48–69 · score 0.57 · Video Encoder, MobileNetV3, temporal, TCN
- [26] § 3. Methodology › 3.2 PANDIA architecture › 3.2.2 Lightweight modality encoders. ↔ pandia/encoders/audio_encoder.py, lines 1–9 · score 0.56 · mel spectrograms, Audio Encoder, TCN
- [27] § 3. Methodology › 3.2 PANDIA architecture › 3.2.3 Concept bottleneck layer. ↔ pandia/training/losses.py, lines 14–30 · score 0.56 · weak supervision, semi supervised, training
- [28] § 3. Methodology › 3.3 Training strategy › 3.3.4 Federated infrastructure risk assessment (NIST CSF). ↔ pandia/training/federated.py, lines 1–16 · score 0.54 · FedAvg, 1–3, IID, federated, training
- [29] § 3. Methodology › 3.3 Training strategy › 3.3.4 Federated infrastructure risk assessment (NIST CSF). ↔ scripts/federated_train.py, lines 39–94 · score 0.53 · global model, federated model, rounds, loss, device, PANDIA
- [30] § 4. Experimentation and validation › 4.2 Implementation details ↔ pandia/models/meta_learner.py, lines 37–79 · score 0.53 · inner loop, query, gradient, Meta, infant
- [31] § 4. Experimentation and validation › 4.2 Implementation details ↔ pandia/models/concept_bottleneck.py, lines 55–102 · score 0.51 · supervised concepts, concept bottleneck, dropout, hidden
Paper
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The authors' code
Python · 220 lines · 9.9 KB · MIT · 5 matches
- """
- Symbolic Rule Engine
- ────────────────────
- 18 hand-crafted rules (3 tiers) developed with NICU clinicians.
- Tier 1 (6 rules): High-confidence pain — all 3 primary indicators fire
- Tier 2 (5 rules): Moderate pain — any 2 indicators agree
- Tier 3 (7 rules): Conflicting indicators → uncertainty escalation / no-pain baseline
- Thresholds are gestational-age-adjusted:
- τ_b ∈ [0.60 (<28w) … 0.75 (≥37w)]
- Algorithm 1 & 2 from the paper.
- """
- from dataclasses import dataclass, field
- from typing import Optional
- import torch
- from pandia.models.concept_bottleneck import get_ga_stratum, GA_THRESHOLDS, CONCEPT_NAMES
- @dataclass
- class RuleOutput:
- pain_level: int # 0=none, 1=mild, 2=moderate, 3=severe
- confidence_tier: int # 1, 2, or 3
- abstain: bool
- explanation: str
- recommendation: str
- active_concepts: list = field(default_factory=list)
- class SymbolicRuleEngine:
- """
- Translates 12 concept activations → human-readable pain assessment.
- Implements the three-tier conflict-resolution mechanism (Algorithm 2).
- """
- # Default thresholds (term infant, ≥37w)
- TAU_DEFAULT = dict(
- brow_lower=0.70, cry_intensity=0.60, hr_accel=0.50,
- eye_squeeze=0.70, nasolabial=0.65, mouth_open=0.65,
- f0_elev=0.60, harmonic=0.55, silence=0.55,
- o2_desat=0.55, resp_irreg=0.55, bp_elev=0.55,
- )
- def __init__(self, abstain_u_threshold=0.50):
- self.abstain_u_threshold = abstain_u_threshold
- def _get_thresholds(self, gestational_age_weeks: float) -> dict:
- """Scale default thresholds by GA stratum (±0.15 range)."""
- s = get_ga_stratum(gestational_age_weeks)
- ga_row = GA_THRESHOLDS[s] # tensor (12,)
- base = GA_THRESHOLDS[3] # term baseline
- delta = ga_row - base # negative for preterm
- tau = dict(self.TAU_DEFAULT)
- for i, name in enumerate(CONCEPT_NAMES):
- key = name.replace("_acceleration", "_accel") \
- .replace("_desaturation", "_desat") \
- .replace("_irregularity", "_irreg") \
- .replace("_elevation", "_elev")
- if key in tau:
- tau[key] = float(tau[key] + delta[i].item())
- return tau
- def evaluate(self, concepts: torch.Tensor, uncertainty: float,
- gestational_age_weeks: float = 37.0,
- ventilated: bool = False) -> RuleOutput:
- """
- Args:
- concepts: (12,) tensor of concept activations ∈ [0,1]
- uncertainty: scalar epistemic uncertainty u
- gestational_age_weeks: float
- ventilated: suppress audio concepts C5-C8 if True
- Returns:
- RuleOutput
- """
- c = concepts.detach().cpu().float()
- tau = self._get_thresholds(gestational_age_weeks)
- # Named activations
- C = {name: float(c[i]) for i, name in enumerate(CONCEPT_NAMES)}
- # Ventilated infant protocol — suppress audio concepts
- if ventilated:
- for k in ["cry_intensity", "f0_elevation", "harmonic_distortion", "silence_periods"]:
- C[k] = 0.0
- # ── Tier 1: Physiological Override ───────────────────────────────
- tier1_fire = self._tier1_rules(C, tau, uncertainty)
- if tier1_fire:
- return tier1_fire
- # ── Tier 2: Symbolic Consensus ───────────────────────────────────
- tier2_fire = self._tier2_rules(C, tau, uncertainty)
- if tier2_fire:
- return tier2_fire
- # ── Tier 3: Uncertainty Escalation ───────────────────────────────
- return self._tier3_rules(C, tau, uncertainty)
- # ── Tier 1 Rules (6) ─────────────────────────────────────────────────
- def _tier1_rules(self, C, tau, u) -> Optional[RuleOutput]:
- """All 3 primary indicators exceed threshold → immediate high pain alert."""
- bl = C["brow_lowering"] > tau.get("brow_lower", 0.70)
- ci = C["cry_intensity"] > tau.get("cry_intensity", 0.60)
- hr = C["hr_acceleration"] > tau.get("hr_accel", 0.50)
- o2 = C["o2_desaturation"] > tau.get("o2_desat", 0.55)
- es = C["eye_squeeze"] > tau.get("eye_squeeze", 0.70)
- mo = C["mouth_opening"] > tau.get("mouth_open", 0.65)
- active = [n for n, v in [("brow_lowering", bl), ("cry_intensity", ci),
- ("hr_acceleration", hr), ("o2_desaturation", o2),
- ("eye_squeeze", es), ("mouth_opening", mo)] if v]
- # Rule T1-1: All three primary indicators
- if bl and ci and hr:
- return RuleOutput(3, 1, False,
- "High pain evidence: facial distress, intense crying, HR spike.",
- "Immediate clinical assessment required.", active)
- # Rule T1-2: Facial + O2
- if bl and es and o2:
- return RuleOutput(3, 1, False,
- "High pain evidence: facial grimacing, O2 desaturation.",
- "Immediate clinical assessment required.", active)
- # Rule T1-3: Cry + HR + O2
- if ci and hr and o2:
- return RuleOutput(3, 1, False,
- "High pain evidence: cry, HR spike, O2 drop.",
- "Immediate clinical assessment required.", active)
- # Rule T1-4: All facial
- if bl and es and mo:
- return RuleOutput(2, 1, False,
- "Moderate-high pain: complete facial pain expression.",
- "Prompt pain assessment recommended.", active)
- # Rule T1-5: HR + resp
- ri = C["resp_irregularity"] > tau.get("resp_irreg", 0.55)
- if hr and ri and o2:
- return RuleOutput(3, 1, False,
- "High pain: physiological triad (HR, RR, SpO2).",
- "Immediate clinical assessment required.", active)
- # Rule T1-6: F0 + harmonic + cry
- f0 = C["f0_elevation"] > tau.get("f0_elev", 0.60)
- hd = C["harmonic_distortion"] > tau.get("harmonic", 0.55)
- if ci and f0 and hd:
- return RuleOutput(2, 1, False,
- "High pain cry acoustics: intensity, F0, harmonic distortion.",
- "Prompt pain assessment recommended.", active)
- return None
- # ── Tier 2 Rules (5) ─────────────────────────────────────────────────
- def _tier2_rules(self, C, tau, u) -> Optional[RuleOutput]:
- bl = C["brow_lowering"] > tau.get("brow_lower", 0.70)
- ci = C["cry_intensity"] > tau.get("cry_intensity", 0.60)
- hr = C["hr_acceleration"]> tau.get("hr_accel", 0.50)
- mo = C["mouth_opening"] > tau.get("mouth_open", 0.65)
- ri = C["resp_irregularity"] > tau.get("resp_irreg", 0.55)
- active = [n for n, v in [("brow_lowering", bl), ("cry_intensity", ci),
- ("hr_acceleration", hr), ("mouth_opening", mo),
- ("resp_irregularity", ri)] if v]
- # Rule T2-1
- if bl and ci:
- return RuleOutput(2, 2, False,
- "Moderate pain: facial distress with crying.",
- "Pain assessment recommended within 5 minutes.", active)
- # Rule T2-2
- if bl and hr:
- return RuleOutput(2, 2, False,
- "Moderate pain: facial distress with HR elevation.",
- "Pain assessment recommended within 5 minutes.", active)
- # Rule T2-3
- if ci and hr:
- return RuleOutput(1, 2, False,
- "Mild-moderate pain: crying with HR response.",
- "Monitor closely; reassess in 10 minutes.", active)
- # Rule T2-4
- if mo and ci:
- return RuleOutput(1, 2, False,
- "Mild pain: mouth opening with vocalization.",
- "Monitor; non-pharmacological comfort measures.", active)
- # Rule T2-5
- if hr and ri:
- return RuleOutput(1, 2, False,
- "Mild pain: physiological indicators (HR, RR).",
- "Monitor; reassess in 15 minutes.", active)
- return None
- # ── Tier 3 Rules (7) ─────────────────────────────────────────────────
- def _tier3_rules(self, C, tau, u) -> RuleOutput:
- # Always increment uncertainty
- u_adjusted = min(u + 0.10, 1.0)
- if u_adjusted > self.abstain_u_threshold:
- return RuleOutput(0, 3, True,
- "Conflicting or insufficient signals.",
- "Clinician review required.", [])
- # Sub-rules T3-1…T3-4: single-indicator mild signals
- bl = C["brow_lowering"] > tau.get("brow_lower", 0.70) * 0.8
- ci = C["cry_intensity"] > tau.get("cry_intensity", 0.60) * 0.8
- hr = C["hr_acceleration"] > tau.get("hr_accel", 0.50) * 0.8
- if bl:
- return RuleOutput(1, 3, False,
- "Possible mild pain: isolated brow lowering.",
- "Observe; reassess in 15 minutes.", ["brow_lowering"])
- if ci:
- return RuleOutput(1, 3, False,
- "Possible mild pain: isolated cry signal.",
- "Observe; reassess in 15 minutes.", ["cry_intensity"])
- if hr:
- return RuleOutput(1, 3, False,
- "Possible mild pain: isolated HR response.",
- "Observe; reassess in 15 minutes.", ["hr_acceleration"])
- # No pain baseline
- return RuleOutput(0, 3, False,
- "No significant pain indicators detected.",
- "Continue routine monitoring.", [])
symbolic_rules.py at commit 60bfd15, under MIT · at the source
Overview
- Computer Science Department, Military Academy of Fondouk Jedid, Nabeul, Tunisia
- Military Research Center, Aouina, Tunisia
- Information Systems Department, College of Computer Science and Information Technology, King Faisal University, Al Ahsa, Saudi Arabia
Abstract
Effective pain assessment in infants aged 0–3 months is a critical challenge in neonatal intensive care units (NICUs) and family medicine clinics, where self-reporting is impossible and current observational tools remain subjective and inconsistent. This paper presents PANDIA (Personalized Adaptive Neuro-symbolic Data-fusion for Infant Assessment), a novel multimodal AI system that combines hierarchical representation learning, graph-based inter-modal reasoning, meta-learning personalization, and symbolic concept-bottleneck explanations for robust infant pain assessment. Unlike transformer-centric approaches, PANDIA employs lightweight CNN/
Reproduced under the paper's license (CC BY), from the paper cited above.
Repository
Its files are read in the Code ↔ Paper reader above, with 31 matches between paragraphs and lines of code.
oussama123-ai/pandia
60bfd153f3c7389f907072ebdf32a88d6322b86d, 16 March 2026Availability: 1 check, the latest on 28 September 2026: the link answers
- 28 September 2026: the link answers
35 files
- pandia/
__init__.py , Python, 9 lines - pandia/
deployment/ , Python, 1 line__init__.py - pandia/
deployment/ , Python, 119 linesedge_inference.py - pandia/
deployment/ , Python, 116 linesehr_interface.py - pandia/
encoders/ , Python, 4 lines__init__.py - pandia/
encoders/ , Python, 27 lines, 1 matchaudio_encoder.py - pandia/
encoders/ , Python, 27 linesphysio_encoder.py - pandia/
encoders/ , Python, 69 lines, 1 matchvideo_encoder.py - pandia/
evaluation/ , Python, 1 line__init__.py - pandia/
evaluation/ , Python, 92 lines, 2 matchesmetrics.py - pandia/
models/ , Python, 10 lines__init__.py - pandia/
models/ , Python, 102 lines, 2 matchesconcept_bottleneck.py - pandia/
models/ , Python, 37 lines, 1 matchevidential_output.py - pandia/
models/ , Python, 108 lines, 2 matchesgraph_reasoner.py - pandia/
models/ , Python, 79 lines, 3 matchesmeta_learner.py - pandia/
models/ , Python, 198 lines, 1 matchpandia.py - pandia/
models/ , Python, 220 lines, 5 matchessymbolic_rules.py - pandia/
training/ , Python, 1 line__init__.py - pandia/
training/ , Python, 197 lines, 3 matchesfederated.py - pandia/
training/ , Python, 150 lines, 3 matcheslosses.py - pandia/
training/ , Python, 94 lines, 2 matchestrainer.py - pandia/
utils/ , Python, 1 line__init__.py - pandia/
utils/ , Python, 124 lines, 2 matchesdata_utils.py - preprocessing/
__init__.py , Python, 1 line - preprocessing/
preprocess.py , Python, 140 lines, 1 match - scripts/
__init__.py , Python, 1 line - scripts/
evaluate.py , Python, 97 lines - scripts/
export_edge_model.py , Python, 87 lines - scripts/
federated_train.py , Python, 98 lines, 2 matches - scripts/
train.py , Python, 84 lines - setup.py, Python, 16 lines
- tests/
__init__.py , Python, 1 line - tests/
test_pandia.py , Python, 222 lines - LICENSE, License, 21 lines
- README.md, Text, 170 lines
The paper's code and data availability statement is in the Data section.
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Its JSON (tracing-map.json) is deposited on Zenodo with its DOI once the map is validated.
Data
Datasets cited
- data.mendeley.com/
datasets/ , at Mendeley Data; found in the referencesmdnpl-dataset - zenodo:19727881, at Zenodo; found in “Data Availability”
Data Availability
All code, trained models, preprocessing pipelines, and evaluation scripts required to reproduce the findings of this study are fully publicly available without restriction at: https://
Reproduced under the paper's license (CC BY), from the paper cited above.
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Version 2, 28 September 2026
- Funding: added Nvidia; King Faisal University; Medical Research Council
Version 1, 28 September 2026: the first record
Recorded: type, language, journal, volume, issue, pages, dates, 2 authors, 23 references.
Cite
This paper
El Othmani, O., & Naouali, S. (2026). PANDIA: Personalized neuro-symbolic multimodal fusion for interpretable neonatal pain assessment. PLOS digital health, 5(5), e0001442. https://
BibTeX
@article{elothmani2026pa
author = {El Othmani, Oussama and Naouali, Sami},
title = {{PANDIA: Personalized neuro-symbolic multimodal fusion for interpretable neonatal pain assessment}},
journal = {PLOS digital health},
year = {2026},
month = may,
volume = {5},
number = {5},
pages = {e0001442},
publisher = {PLOS},
issn = {2767-3170},
doi = {10.1371/
url = {https://
pmid = {42189831},
pmcid = {PMC13210372}
}
RIS
TY - JOUR
AU - El Othmani, Oussama
AU - Naouali, Sami
TI - PANDIA: Personalized neuro-symbolic multimodal fusion for interpretable neonatal pain assessment
T2 - PLOS digital health
J2 - PLOS Digit Health
PY - 2026
DA - 2026/
VL - 5
IS - 5
SP - e0001442
SN - 2767-3170
PB - PLOS
DO - 10.1371/
UR - https://
LA - en
ER -
CSL-JSON
{
"id": "10.1371/
"type": "article-journal",
"title": "PANDIA: Personalized neuro-symbolic multimodal fusion for interpretable neonatal pain assessment",
"container-title": "PLOS digital health",
"author": [
{
"family": "El Othmani",
"given": "Oussama"
},
{
"family": "Naouali",
"given": "Sami"
}
],
"container-title-short":
"volume": "5",
"issue": "5",
"page": "e0001442",
"DOI": "10.1371/
"PMID": "42189831",
"PMCID": "PMC13210372",
"ISSN": "2767-3170",
"publisher": "PLOS",
"URL": "https://
"language": "en",
"issued": {
"date-parts": [
[
2026,
5,
26
]
]
}
}
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You validate the map as this page shows it: 1 repository of the authors' code, each at its verified commit and with its license, 33 scripts, and 31 matches between paragraphs and code (see the Code and Map sections). It then receives a DOI on Zenodo, with you (your ORCID iD) and OSCR as its creators; the code itself is not deposited.
The map's fingerprint: sha256:3cd8279e68d4e365…
Add the badge to its README
The badge links the code to this page. Copy one of these into the README of the paper's code: only you decide where it goes, and nothing is changed for you.
Markdown
[, paste the snippet at the top, then “Commit changes…” and, to review it first, “Create a new branch and start a pull request”. You open the pull request; OSCR asks for no permission.
Request its removal
To ask OSCR to remove this record, the copies of its authors' scripts or its tracing map, use the removal request page: signed in, you say who you are, what to remove and why, then review and confirm the request. Published rules decide every request (how).
Discussion, reproductions, activity
Discussion: questions and error reports about this paper and its code, from signed-in readers and its authors. It opens with sign-in.
Reproductions: reports from readers who ran the authors' code: what they reproduced, with which environment, commit and data. It opens with sign-in.
Activity: what happens around this paper: new versions of its record, its map's validation, discussions and reproductions. It opens with sign-in.
