THE CAPLA MODEL FOR MULTI-CULTURAL ADAPTATION

OF LEARNING RESOURCES FOR ALZHEIMER’S DISEASE

Nathalie Bricon-Souf and Jean-Marie Renard

CERIM, University of Lille 2, France

Keywords: e-Learning, Adaptation, Context, Pervasive computing, Ubiquitous computing, Alzheimer’s disease.

Abstract: To share medical courses about Alzheimer’s disease, used by French doctors, with Malian doctors, we have

to perform cultural adaptation of the learning resources. We present the CAPLA model for adaptation. We

introduce why cultural adaptation is indispensable to transform useful resources for France into useful

resources for Mali. We introduce the notion of variability and why we think that the explicit knowledge of

the variability is useful. We describe the typology of the variability for our medical and multi-countries e-

learning situations and how it can help to index the variability of the content of the medical courses. Then,

we use the notion of “documentarisation” and “re-documentation” issued from “socio-semantic web”

concepts to describe the collective activity of adapting a course. Using the context is still difficult and we

propose to detect the manifesting aspects of context, thanks to the variability knowledge. The Alois

Software is described, it implements the CAPLA model, it helps to annotate the variability of a course. We

show how we use the XML openDocument descriptions obtained from the presentation documents (Impress

or Powerpoint) to help people to adapt their courses: thanks to the knowledge we have on the context and

the variability, we can mark all the slides that need an adaptation and we can indicate the reason why this

adaptation is needed. Next step is to use this knowledge for pervasive and ubiquitous learning.

1 INTRODUCTION

The production of learning resources is difficult and

takes a lot of time, especially in the medical area

where the quality is mandatory and where the

knowledge evolves rapidly. Supplying everyone

around the world with high quality information is

essential. But it is also indispensable to provide

information well suited for each specific context of

use. This article presents a new approach for

redesigning and adapting medical resources to

different application domain. We focus on e-learning

for Alzheimer disease. Some neurologists from

Lille, a french city, were asked to share their courses

about Alzheimer disease, to help doctors from Mali

to dispose from numerous e-learning materials.

These courses can be shared through the French

Virtual Medical University (UMVF) which already

proposes a portal that gathers medical learning

resources from more than 30 universities (all the

universities from France and some universities from

French speaking countries). But without adaptations,

courses that are created in France would be useless.

For example as the care infrastructure is not the

same, a RMI (nuclear Magnetic Resonance Imaging)

should not be proposed in Mali as often as in France,

or as the prevalence of a disease is not the same,

clinical investigation could change. Even if the main

ideas of a course remain the same, some parts of the

course must be modified to correspond to actual

care.

The Internet provides technologies and

infrastructures for information sharing. The issue is

now to provide pertinent information which depends

on the context of use. Different axes of research deal

with the semantic of the courses. The Semantic Web

approaches as well as the use of domain ontologies

are some of the promising research areas

(Bouzeghoub, 2007). Meta descriptions of the

documents are helpful to retrieve learning resources.

The UMVF indexes the learning resources through

metadata such as author, title, and so on, as proposed

by the Dublin Core and through medical concepts

thanks to the medical thesaurus Mesh. The resource

manager workflow (Renard 2007) in the UMVF

helps authors and librarians to enter such

characteristics for each medical resources added to

the French Virtual University. It informs about the

462

Bricon-Souf N. and Renard J. (2009).

THE CAPLA MODEL FOR MULTI-CULTURAL ADAPTATION OF LEARNING RESOURCES FOR ALZHEIMER’S DISEASE.

In Proceedings of the International Conference on Health Informatics, pages 462-465

DOI: 10.5220/0001548004620465

 SciTePress

medical area of each course, but even if some

medical semantics is added, the granularity of the

description is still global. It is not appropriate to

adapt on the contents of the courses, taking into

account their semantic and their cultural aspects.

This issue is not faced when using other standards

for educational purpose as LOM, or SCORM. We

wanted to add some contextual indexes on the

courses, so that we can adapt the information. In

particular, cultural difference should be treated.

Moreover, if we are able firstly to provide such

indexes and secondly to capture the context of use

for the resources, we can think about ubiquitous and

pervasive learning resources, able to dynamically

adapt themselves according to the settings in which

they are used. This paper will present the CAPLA

(Contextual Adaptation and Pervasive Learning for

Alzheimer) model for adaptation. Our model is used

to index the variability of the content of medical

courses. This work is part of a French national

project called p-LearNet (pervasive Learning

Network) whose objectives are to explore the human

learning potential, in the framework of pervasive

communication and the use of Technology

Enhanced Learning (TEL). Then will briefly

describe the Alois Software which is proposed for

indexing and re-creating the courses.

2 THE CAPLA MODEL FOR

ADAPTATION

2.1 The CAPLA Needs for Adaptation

We notice there is room for a specific description of

the variability of the resources. When we move from

a context (e.g. Country=France) to another context

(e.g. Country=Mali), pertinent adaptation of the

content are often necessary. In this paper, we will

illustrate it by the “vaccum-cleaner example”: to

detect Alzheimer, during cognitive tests it is not

pertinent to propose to an individual living in the

bush in Mali to recognize a vacuum-cleaner even if a

French resource proposes to do so. The concept of

“recognize a vacuum cleaner” as “an easy task to

do” depends on culture. Introducing such a resource

in a course induces cultural variability. In fact the

need for adaptation is very frequent.

Two different notions must be distinguished.

 Variability: it describes criteria which induce

change. For example, each time the notion of the

prevalence of a disease appears in a course, it

induces variability as the prevalence is not the same

everywhere; the related information can depend on a

geographic and/or epidemiological context.

 Context: it describes the environment

: when,

who, where an individual is producing/using a

course are some of the obvious context knowledge.

(Example of context description: a course, written

for France, for a general practitioner, the teacher will

use it in an amphitheatre equipped with a data

projector and a PC with high speed broadband

network).

We have made the following hypothesis to

propose our model: (i)Indexing the resources with

variability could help to explicit some knowledge on

these resources (e.g. it’s interesting to notice that

"vacuum-cleaner" is not always easy to understand

according to the culture); (ii) Once a resource is

indexed with variability, it should ease the

adaptation to another context (for example, someone

from Senegal could benefit from the indexation

made for Mali); (iii) The explicit knowledge of

variability AND of context can help to propose a

smart adaptation of the courses (“vacuum cleaner”

as “culturally variable” will be changed for Mali but

not for Belgium);. (iv) pervasive learning can use

such models and be proposed as soon as we are able

to detect the context.

2.2 Variability and Courses

Re-Documentation

With the emergence of the Web2.0 applications,

documents are more and more used in collective

practice. Zacklad focuses on situations where

documents serve to coordination (Zacklad, 2006),

we use his work for our model.

Documentarisation

can be made on this course,

in our case through the annotation of the variability.

“Documentarisation consists of endowing the

substrates with specific attributes making it possible:

(i) to manage them along with other substrates, (ii)

to handle them physically, which is a prerequisite to

be able to browse semantically among the semiotic

content, and lastly, (iii) to guide not only the

recipients, but also the producers themselves to an

increasing extent, around the substrate by providing

one or several maps of the semiotic contents”

(Zacklad, 2006). It doesn’t affect the document. We

use some annotation of the variability to enrich the

knowledge we have on the semiotic content of a

document. In this paper, we focus on the specific

area of our multi-countries e-learning application but

other criteria can come from more general

knowledge. We propose a first typology for the

variability of the Alzheimer’s disease domain,

THE CAPLA MODEL FOR MULTI-CULTURAL ADAPTATION OF LEARNING RESOURCES FOR ALZHEIMER’S

DISEASE

463

thanks to different meetings with French doctors and

Malian doctors.

Invariant

: seems to be acceptable for everyone

(Everyone accepts that a great number of people

suffer from Alzheimer’s disease in the world)

Non adaptable

(Elderly people stay at home in

Mali, specific French legislation for elderly medical

houses is completely useless)

Adaptable

: in that case we found the main

following criteria justifying variability:

Environment: Epidemiology-Geography

Culture: Family or Patient-Health

Professionals - Legislation

Care: Technical environment-Availability of

medication - Infrastructure

Public: Skills -Objectives

The annotation with variability (e.g. “to use a

vacuum-cleaner depends on culture") is then seen as

a documentarisation of the document.

Redocumentarisation

allows making a new

documentarisation, the user can rearticulate the

semiotics contents according to his own

interpretation. One of the possible actions for the re

documentarisation of a course is to display it with an

easy-to-interpret representation of the variability: the

proto document.

Redocumentation

aims to rearrange the initial

document, allowing to add or to delete some parts, to

reformulate or to reorganise the document. The

objective is then to rewrite the variable parts of the

resources according to their future use.

2.3 The CAPLA Model of Context

Modelling and using context remains complex, even

in the medical domain which is said to be a good

area for context (Bricon-Souf , 2007). Lot of works

have been done around context (Dey, 2001;

Winograd, 2001). In particular, representing context

with multiple points of view has been proposed

(Kirsh-Pinheiro, 2004). Our model is able to detect

that “something is context because of the way it is

used in interpretation” as Winograd said.

We refer to Sato’s work (Sato, 2004) who proposes

the following definitions: Manifesting aspects of

context take significant roles in forming situations

for the current action; latent aspects of context

become irrelevant to the current action. Situation is a

collective condition at the scene of the interaction

that is composed of relations among variables of

conditions such as environmental states, contexts,

systems and users’ states. The analysis of the

multicultural e-learning situation allows us to

determine some main attributes for context such as

user, pedagogic activities, device and localization. In

order to detect which aspects of context are

manifest, we use the variability mentioned on the

documentarisation of the course. So, when part of

the course is tagged as “variable due to

environment”, the aspects of context which are

semantically linked with the notion of environment

become manifest. For example, if a course item

mentions a “vacuum cleaner” and is marked as

depending on the culture (cultural variability), it is

important to know if the course is used in a country

with the same culture as the one in which it has been

written : the Country aspect of context becomes

manifest. Some rules are written to express the

relations between variability and context. In the

current state of work, we use simple rules which

verify if the context of the initial course is the same

as for the future adapted course. (e.g, as the context

of “country” is manifest for the “vacuum cleaner”

we will verify if the countries are the same).

3 IMPLEMENTATION

The Alois Software is written in java, it helps people

(i) to annotate the variability of the courses; (ii) to

generate the proto-course to make the actual

adaptation of the course. The medical staffs provide

us courses in Powerpoint or openOffice presentation

format and we choose to use them through the XML

provided by the openDocument description. When

parsing such documents, we can extract enough

information about the slides to feed the Alois tool. A

MySQL database is used to index each slide of the

courses, and to manage the information about the

variability of each slide. Thanks to this database, the

variability annotation part of the tool (Figure 1)

proposes a representation of the existing slides, the

current variability annotation already provided and

proposes a user interface for the variability

annotation (java, swing).

The proto-course generation tool (Figure 2) uses

the variability information in order to generate an

openDocument with: (i) an hyperlink to the original

slide; (ii) a tag informing about the necessity of

careful examination of the slide.

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464

Figure 1: The Alois Tool.

Figure 2 : This slide comes from the proto-document. The

star shaped tag indicates why the author must look at this

slide (in that case: care infrastructure should differ).

4 RESULTS AND CONCLUSIONS

Based on actual need for sharing learning materials

on Alzheimer diseases, we propose a new approach

for redesigning and adapting medical resources. We

propose a model to take into account some semantic

aspects of the learning contents that are often

neglected. Using such explicit knowledge should

help the adaptation. We mainly used PowerPoint

presentations as courses and slides as items of

courses, obviously courses are not limited to this and

we will have to introduce in our model some more

complex representation of learning resources as

proposed in the literature. A Software has been

proposed, it is currently in test for some adaptation

of Alzheimer courses for Mali and for Chili.

ACKNOWLEDGEMENTS

Thanks to Pr Florence Pasquier from Lille hospital

(Neurology), as well as to Dr Cheik Guinto, GP in

Mali for their helpful discussions, comments, as well

as for their e-learning materials. The work has been

supported by the GIP UMVF and the national

research project p-LearNet .

REFERENCES

Bouzeghoub A., Do K.N. and Lecocq C., 2007.

Contextual Adaptation of Learning Resources, IADIS

International conference Mobile Learning 2007,

ISBN: 978-972-8924-36-2, p.p.41-48, Lisbonne, 5-7

Bricon-Souf N., Newman C. , 2007. Context awareness in

health care : A review Int J Med Inform. Jan;76(1):2-

12.

Dey A., Abowd G., Salber D. , 2001. A conceptual

framework and toolkit for supporting the rapid

prototyping of context-aware applications in special

issue on context_aware computing, Human computer

Interaction Journal Vol 16 (2-4), pp97-166

Kirsch-Pinheiro M., Gensel J., Martin H., 2004.

Representing Context for an Adaptative Awareness

Mechanism . CRIWG: 339-348

MESH : http://www.nlm.nih.gov/mesh/

Renard JM., Bourde A., Cuggia M., Garcelon N., Souf N.,

Darmoni S. et al. 2007. An Internet supported

workflow for the publication process in UMVF

(French Virtual Medical University) . Int J Med

Inform; 76(5-6): 363-368.

Sato, K., 2003. Context Sensitive Interactive Systems

Design : A Framework for representations of contexts,

in proceedings of the 10

International Conf. on Hum-

Comput Inter.. Vol3 : Human-Centered computing. 3

1323-1327

UMVF : www.umvf.org

Winograd, T., 2001. Architecture for context, Human

Computer Interaction Vol 16(2-4).

Zacklad M. 2006. Documentarisation Processes in

Documents for Action (DofA): The Status of

Annotations and Associated Cooperation

Technologies in Computer Supported Cooperative

Work (CSCW), Volume 15, Numbers 2-3, pp. 205-

228(24)

This tag indicates

the variability

reason so that it

should be remake:

“To redo : care”

Hyperlink to

ori

inal slide

A representation

of the original

item of course

The choice of the

criteria for the

variabilit

annotation

Visualization of

the encoding

already done.

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