Olli I Heimo
email: olli.heimo@utu.fi

Tapani N Liukkonen
email: tapani.liukkonen@utu.fi

Miika Oja-Nisula
email: miika.oja-nisula@utu.fi

Julius Rajala
email: julius.i.rajala@utu.fi

Anne Paavolainen
email: anne.paavolainen@utu.fi

Kai K Kimppa
email: kai.kimppa@utu.fi

Tuomas Mäkilä
email: tuomas.makila@utu.fi

Ethical Gathering of Exercise Metrics from Elderly: Case Jumppatikku

Keywords: Responsible Research and Innovation, Elderly, eHealth, Mobile, Ethical Design

Health gaming for elderly, alongside with other game types, have become an emerging trend amongst video game industry. As all emerging technologies, it brings some ethical questions which -as usual -are better solved before implementation, for the values these choices reflect to be embedded into the design. In this paper we introduce a case example of the elderly activation system Jumppatikku ('Exercise stick') and analyse the main ethical questions of the specific case example, as well as take into consideration other similar systems from the viewpoint of ethical design and responsible research and innovation.

Introduction

In this paper we introduce an ethical dilemma on elderly healthcare. During the 2000s and 2010s many different digital aids for activating and caring of elderly has been developed. These activation aids and methods rise several challenges which may, in the worst case endanger the privacy and security of these senior citizens.

The dilemmas are analysed through a variety of ethical theories. Both consequences [START_REF] Mill | Utilitarianism, several versions[END_REF] and intentions (see e.g. [START_REF] Kant | Immanuel Originally Grundlegung zur Metaphysic der Sitten[END_REF]) of any system we build should be considered when thinking of whether the system is morally good, or at least acceptable (See e.g. [START_REF] Moor | Just consequentialism and computing[END_REF]). In this paper the case of the Jumppatikku ("Exercise stick") is analysed from both of these perspectives. It is clear that the intention of the group developing the device and the related systems is good -the aim of the system is, after all, the wellbeing of the elderly for whom it is being designed -on top of which it is hoped to take into account and solve any various unintended consequences on a satisfactory level. Since considerations typically raised in IT and ethics field cover such as professional virtue (on virtue ethics, see e.g. [START_REF]Nicomachean Ethics[END_REF]), ethical discourse [START_REF] Habermas | Originally Faktizität und Geltung. Beirtäge zur Diskurstheorie des Rechts und des demokratischen Rechtsstaats[END_REF], and considerations for those in the weakest positions [START_REF] Rawls | John The Idea of Public Reason, Deliberative democracy: essays on reason and politics[END_REF], this paper is focused on (unintended) consequences of actions. The selection is intended to act as an opening of discussion on the topic, and consider a field not already covered by the design of the project activities. In the Jumppatikku project those who are in the weakest position are taken into account in designing a device and a system that will be available to all elderly irrespective of their financial or social status in Finland, this paper itself is part of the ethical discourse (albeit not purely in the sense Habermas intended), and we have no reason to suspect the professional integrity of the designers of the system.

In the 2 nd and the 3 rd sections the field of elderly health gaming, the Jumppatikku project and related, possible metrics that can be derived with these kinds of systems are introduced. This research is a theoretical ethical study from the Jumppatikku research project to ensure the ethical validity of the Jumppatikku exercise system. Thus in 4 th section the ethical dilemmas are introduced and discussed.

Background

Games for elderly

Primary interests for the usage of games with elderly are related to the training of memory, cognitive skills, and physical training. With the cognitive skills and memory the main aim is the prevention and slowing down the decline of memory. Muscle and balance training games are targeting fall prevention as falling related injuries (e.g. hip and wrist fractures) are one of the leading causes affecting the quality of life of elderly population. Some of the commercial off the shelf (COTS) training games are created and marketed for the elderly, but mostly they are created for wider audience.

The general (non-sedentary) games aiming at increased activity levels (e.g. dancing games based on body movements) have several differing limitations with elderly players. Such games use different techniques on detecting player's body movements, and depending on the method, players with physical limitations might have problems on using them. In general movement based games the target audience is relatively younger and the gameplay requires movements and/or positions that are not possible for some or most of the elderly players. Some of these games use physical devices (e.g. WiiMote) that contain buttons or require constant force for holding the device in hand for prolonged time, causing discomfort for elderly players.

In the more specialized use cases, meaning research and therapy sessions, the main reason for the usage of such games are the same as with the COTS games. Games for therapy sessions are specially made for therapies and even targeting the elderly only, but in many cases the games used are regular COTS games. The same principle applies to the research settings. As an example of COTS games used, the Super Mario game has been used to study the effects of gaming on the brain structure of the elderly subjects [START_REF] Kuhn | Playing Super Mario induces structural brain plasticity gray matter changes resulting from training with a commercial video game[END_REF] with promising preliminary results. As a custom counterpart for this game similar trend in results has been found with the Neuroracer [START_REF] Anguera | Video game training enhances cognitive control in older adult[END_REF].

Advertising and data mining

Advertising and data mining has been an upward trend in games for at least the past decade. For example, in-game advertising has grown from generating around $34 million in 2004 to an estimated $7 billion by 2016. [START_REF] Burns | In-Game Advertising to Continue Exponential Growth[END_REF][START_REF] Tassi | Analyst Says Video Game Advertising Will Double by[END_REF]). The rise of social online games can be identified as one of the major explanations for the observation. Especially Free-to-Play (F2P) games rely heavily on income from advertisers. Data mining in games, particularly that of player behaviour has been an important source of information especially in games that generally have long persisted online worlds. Game developers of these games have a constant need to add new content to keep the players engaged and for that they need data on preferred solutions and settings of the game, directly from the users. Free-to-Play games and Massive Multiplayer Online Games (MMOGs) are the most common games for data mining, and as such those games have been pushing data mining in games to new heights. [START_REF] Drachen | Game Data Mining[END_REF] What is game data mining exactly? Game data mining can be seen as an insight, formed by utilising the collected game metrics and game telemetry. Game telemetry is the raw data collected from a game, such as player location at a given time or play time. Game metrics, on the other hand, are data formed from game telemetry using simple aggregation. Average play time calculated from raw play times could be a game metric, or hotspots of players could be another. Game data mining in this example, could be seen as the process of getting insight on why the spot is a hotspot and what does it mean in terms of gameplay [START_REF] Drachen | Game Data Mining: Fundamentals[END_REF]

Capitalizing on the game data

The capitalization of the mined data varies depending on the game needs, but generally the focus is on improving gameplay and monetization. Gameplay can be improved in a number of ways. For instance, IO Interactive used heat maps composed of player character deaths in Kane & Lynch 2: Dog Days, a game developed by them, to get insight on the workings of the gameplay. In this particular case, the data revealed that there was a surprisingly high amount of team kills at a certain map location, but that otherwise the gameplay was as designed. [START_REF] Drachen | Gameplay Metrics in Game User Research: Examples from the Trenches[END_REF] A common way to gain from the game data in the form of monetization is to inspect what kind of downloadable content (DLC) players, and especially players spending the most, are interested in, and focusing on creating content for them.

Metrics

Existing and theoretical metrics

The abundance of possible game metrics has led to a number of categorizations for them. Categorization by Larry Mellon [START_REF] Mellon | Applying metrics driven development to MMO costs and risks[END_REF] divides game metrics to player metrics (also known as user metrics), performance metrics and process metrics (sometimes known as pipeline metrics). Process metrics consist of metrics related to the development process and as such is only of interest for a limited set of people. Performance metrics are metrics on the game performance with frames per second (FPS) being the usual example of a performance metric. This is also a metric that generally only interests certain people, such as developers working on optimizing the game. The third and the most relevant category in considerations of capitalising on the game data, is the category of player metrics. Player metrics consist of all the metrics related to what the player does, and therefore can give an insight of choices and preferences of the players. It is the category that most of the research and discussion related to game analytics concern. Player metrics can again be divided to either generic, genre specific and game specific categories, or as suggested in Drachen, Seif El-Nasr and Canossa [START_REF] Drachen | Game Analytics -The Basics[END_REF] to customer, community and gameplay metrics. Customer metrics cover metrics related to the player as a customer and are mainly of interest for sales and marketing teams, such as customer retention rates. Community metrics tell about the players' involvement in the game community. Such metrics are usually collected from for example game forums explaining the activity levels of the entire community and are mainly for community managers. Gameplay metrics are related to what the player actually does and how he or she behaves in the game and pretty much consist of rest of the metrics. They essentially answer the questions of what the player did, where, at what time and which player(s) were involved. The last sub-categories are of gameplay metrics, which is yet divided to interface, in-game and system metrics. System metrics are collected from actions initiated by the game engine in response to player actions, such as unlocking an achievement. Interface metrics consist of the players' actions in the game menus and other possible interfaces in the game. In-game metrics are the metrics of what the player does in-game. Everything that does not fit the first two sub-categories fall under the in-game metrics. [START_REF] Drachen | Game Analytics -The Basics[END_REF] The concrete metrics collected in games depend on the game itself, on it's genre and of course, on which metrics the developers are interested of. Some core metrics, such as length of the gameplay session, can be collected from most if not all games regardless of the game type, but the majority of metrics only make sense in specific games. Most of the games for the elderly promote health in some way, be it physical or mental health, and as such they tend to be either fitness or puzzle games. In a fitness game the important metrics collected could represent such choices as which exercises were chosen, which were performed, how well and often were they performed as well as how many calories was burned in each session and in total. A puzzle game might collect metrics on which puzzles the player has given a go on, which of the puzzles he or she passed and how often, how he or she passed them (order of moves or choices), how long did it take to either complete a specific puzzle or for example, how long did the player try to solve it. These are noticeably more intimate metrics than what can be collected from other games in the sense that they are directly related to the players' physical and mental abilities, even more so when the game especially targets the elderly. For instance the pattern of how the player might try to keep solving a puzzle wrongly might reveal a decline in some cognitive skills or the inability to properly perform a certain exercise could give a strong indication of a physical disability. [START_REF] Drachen | Game Analytics -The Basics[END_REF][START_REF] Canossa | Interview with Aki Järvinen from Digital Chocolate[END_REF] The possibilities of physically tracking the player with gaming devices, be it a mobile phone or a game console, are becoming more and more plentiful as more sensors are added and their accuracy enhanced. Naturally this leads to game developers being able to create better experiences for the players, but it also means more data and more accurate data for those collecting the metrics. As mentioned above, this data is potentially rather valuable, at least if compared to such other examples of metrics, like how many frags a player gets in a FPS game. The TI SensorTag, which the Jumppatikku ("exercise stick") uses, has six sensors: pressure, humidity, temperature (IR), accelerometer, gyroscope and a magnometer. The new (2015) version of SensorTag also has a light sensor, making the total amount of different sensors to rise to seven. [17] At the time of writing, Jumppatikku has six moves which it can track and detect: squats, leg lifts, leg swings, leg rotations, hand swings and body twists. Body twists and foot rotations are both tracked using the accelerometer and gyroscope, but the rest of the moves only make use of the accelerometer. In essence just the two of these very basic sensors are enough to determine a variety of moves and possibly get hints of the players' physical condition. Add in a few external sensors, such as a heart rate sensor or a blood pressure sensor, plus some creative thinking and there is a huge amount of information that one could deduce about the player.

Examining metrics

Following the previous categorizations we can discuss genre specific metrics that relate to all health games that use imaging or movement sensors. In the case of interface metrics we collect data about subjects' actions with the application itself. This data can be used to measure how fast or how well they can use the interface. If data is collected for longer periods of time, the change in this data can reveal changes in physiological and cognitive performance. In the case of health games aimed for the cognitive effect, the in-game player performance data can directly concern the decline or improvement (or steadiness) of subjects' memory, visual attention or other cognitive skills (see e.g. [START_REF] Jimison | Unobtrusive monitoring of computer interactions to detect cognitive status in elders[END_REF]).

The body movement data and imaging sensors produce vast quantities of data which can be mined with specific algorithms. Modern imaging sensors and their 3D data can be used to measure heart rate from micro-fluctuations in surface veins on the face of the subjects of the study [START_REF]The Kinect for Windows Team, Detecting heart rate with Kinect[END_REF]. Facial micro-movements and gaze tracking can be used to reveal signs of depression [START_REF] Stratou | A demonstration of the perception system in SimSensei, a virtual human application for healthcare interviews[END_REF]. Combining different methods, the gaze tracking can potentially be used to track what kind of visual stimuli interests the subject based on their voluntary or involuntary micro-expressions [START_REF] Huang | Spontaneous facial micro-expression analysis using Spatiotemporal Completed Local Quantized Patterns[END_REF].

In the case of Jumppatikku, where the player data is collected from sensors located on the subjects hand or body, we have a variety of possibilities for data mining [START_REF]CC2541 SensorTag[END_REF][START_REF]SensorTag User Guide[END_REF]. With the sensor package and data collecting application we can receive data, including GPS-coordinates, accelerometer data, physical performance from the game's interface and in-game metrics related to the usage of the app and scores from the tasks itself. (See figure 1.)

Fig. 1. , Using Jumppatikku.
From this data set, the obvious findings are current location and hotspots where the subject tends to be during normal days. By combining these with other data sources we can deduct when and where the subject might be during certain days and times. [START_REF] Andrienko | Visual analytics tools for analysis of movement data[END_REF] Further, finer grained accelerometer and gyroscopic data can be used to track the limb movements of the subject. (See figure 2.) With data mining algorithms and learning neural networks, we can potentially monitor the development of diseases like Alzheimer and Parkinson's disease, or measure the gait of the user which can be used to predict the subjects' tendency to fall which can be used as a signal to guide them to either do certain exercises or seek related help (e.g. [START_REF] Montero-Odasso | Gait velocity in senior people an easy test for detecting mobility impairment in community elderly[END_REF][START_REF] Gabel | Full body gait analysis with Kinect[END_REF][START_REF] Stamatakis | Finger tapping clinimetric score prediction in Parkinson's disease using low-cost accelerometers[END_REF]).

Accurate and ubiquitous sensors can also be used to track fine-grained hand movements. This, combined with advanced algorithms has led to a situation where data mining of movement data can reveal personal information about the subjects. This includes their physical actions like hobbies, potential physically manifesting illnesses and even PIN-numbers they might punch in daily [START_REF] Beltramelli | Deep-Spying: Spying using Smartwatch and Deep Learning[END_REF].

Gathered information and ethics

As mentioned before, the system contains a huge amount of information. That information can, in wrong hands make the subject of the information vulnerable. There are several ways to protect the subject from these vulnerabilities, e.g. by limiting the access to the information, by securing it or by not collecting it in the first place. When the information is not collected one can be sure it cannot be misused. The difficulty with this method is to understand what information is relevant and what is not.

Limiting access brings forth some questions, foremost who should be told and what? From the raw data several things, such as timestamps or the diagnosis for Parkinsons' disease can be derived when the data is pre-analysed and transformed into information the medical personnel can interpret easily without the need to deliver the private information to them. This information is none-the-less sensitive information.

Moreover, the data, such as timestamps and movements, still stay in the servers. Hence, if the main system can be hacked, and if it logs location information (or something that can be interpreted as such) the information can be used to access elderly persons' homes for example for burglary. Thus, it must be taken care of that location info is not saved and that the system might give an impression for a casual hacker that it would be used in multiple locations (whether that is true or not).

This of course holds true for other parties as well -access to the system should be only on need-to-know, and of course, on informed consent basis.

Ownership or control of the data: to avoid undue paternalism, the default control of the data must be held by the user (see e.g. [START_REF] Koskinen | Rawls' view in context of Datenherrschaft over personal patient information[END_REF][START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF]). If the users do not want to share their data with any particular parties -even if those parties are health care profession-als -they must be able to choose so unless there are special reasons such as far advanced dementia or public health hazard.

Data control video recording is possible with X-Box and similar devices. If these kinds of devices are used, there is a need to be very careful indeed that the video material so collected does not fall into the hands of others than those who need the data for diagnostic purposes. must be noted that even though the system can alert the medical personnel if it recognises a risk of e.g. Parkinson's disease the system is not a doctor, and thus there is no doctor-made diagnosis and the alert should only be a guideline for the patient to see a doctor, and for the doctor to see a patient. Systems like this are not decision making systems, but only alert systems. There are two challenges with this: first we need to be aware of the patient's right to privacy and information security (handled below) and secondly, patient's right to a correct diagnosis. Even if the system could deliver 95% accurate prognosis it still -according to the medical traditions and legislation -is not a diagnosis (nor should it be). That information, therefore, is still a prediction and thus should be handled as such because false positives could affect the patients' behaviour. This can cause unnecessary and unwanted fear and pain for the patient when he or she is both afraid of the sickness and still waiting -in many cases for days, weeks or even months -for guidelines and diagnosis from his or her MD. Thus, there is an ethical dilemma: should the information about e.g. Parkinson's disease be visible to the user or just for the treating medical personnel? We need to note that this is not data from the system but a mere speculation by the system and it is not under the direct control of the user. The medical professionals can then use the data to deduct a diagnosis of the disease (or lack there-of). The patient typically does not have the necessary skills to do this, and thus should not be put in a position to try and worry about it.

While it is obvious that information security must be high in the server end, it must also be protected in the user's device. While the mobile device contains various kinds of information on the activity of the user, it should never reveal daily activities (at least time stamp and location) because the person using the device might not be the elderly person him-or herself. If the privacy of the user is leaked by the system for example to the person's relatives, it can harm the patient in situations where the relatives are not that trustworthy.

In essence the privacy of the user is in straight contradiction with the patient's right to see his or her own (medical) information when the user of the mobile device is someone else than the patient themselves. Therefore that person's information should be locked so that the users can leave their phone still in swipe to open mode (which tends to be a familiar password with elderly persons' mobile devices), or let their relatives call or send a message without fear of them accessing their medical information.

The device should not save the data to the device itself (due to security concerns), but rather the (useful and required) data should be stored on a server to which the user has access via a secured connection not included in the device itself. None-the-less, any speculations by the system always need to go through a medical professionaland the system should have an alert whenever it is deducting a pattern matching a disease -before the patient has access to this deduced information. This is not against the right of the patient to control their information (see e.g. [START_REF] Koskinen | Rawls' view in context of Datenherrschaft over personal patient information[END_REF][START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF]), as the deduced speculation is not yet known about the patient but only speculation about the patient's condition, and might out to be wrong.

Responsible Research and Innovation [START_REF] Shaw | Facilitating reflexivity in ICT research: researcher awareness in the human brain project[END_REF] can be used as a way to ensure ethics in design (see also [START_REF] Stahl | Participatory design as ethical practice -concepts, reality and conditions[END_REF]). If the designers do not possess the required character, although they should and this should be the aim through professional development, a subproject in a R&D project that covers ethical and social aspects can be built in the project instead. A part of the sub-project should be research governance as a way to also remain sensitive to broader concerns such as social acceptance. The main point however is that both the societal actors and innovators should be helped to become mutually responsive to ethical issues in any design project. Reflexivity through ethics is paramount to enable this ( [START_REF] Shaw | Facilitating reflexivity in ICT research: researcher awareness in the human brain project[END_REF], but see also [START_REF] Niemelä | Ethics by design -an experience-based proposal for introducing ethics to R&D of emerging ICTs[END_REF][START_REF] Van Den Hoven | Value Sensitive Design and Responsible Innovation[END_REF]).

Conclusions

The overall intent for the Jumppatikku is obviously good and the desired consequences seem valid. The idea of creating a good life and better health for the elderly seems indeed to be virtuous. Yet there are a few problems with the whole idea of data gathering with sensors that must be kept in mind. In this paper we have looked at these problems, and offered solutions through the use of ethical design methods, taking into account the various different possibilities that could go wrong and how to actually solve them in this context. Of course, this study is only a case study of the Jumppatikku, so any lessons learned should be understood in this context. However, most if not all of them can be used in similar situations as-is or at least with very little modification. Of course, in any project a reflection of methods used in other projects is always in order.

We hope, that we have shown that even quite simple looking and clearly good intentioned projects need ethical consideration so as to not misuse the collected data or the device itself; to help projects such as Jumppatikku achieve maximum benefits and as few drawbacks as possible.

Fig. 2 .

 2 Fig. 2. , Exercising by standing up and sitting down with Jumppatikku.


Gillian Harvie
email: gharvie@bigpond.net.au

Kenneth Eustace
email: keustace@csu.edu.au

Oliver K Burmeister
email: oburmeister@csu.edu.au

Assistive Technology Devices For The Oldest-Old: Maintaining Independence For The Fourth Age

Keywords: Assistive Technology Devices, Gerontechnology, Elderly, Fourth Age, ICT, Digital Divide -Ageing -Peer Training -Aged Care -Digital Inclusion

User interface design needs to be revisited for our oldest members of society. The literature has shown that over the age of 70 increasing numbers of older people find it difficult to learn, and the rapid changes in technology and associated interfaces make it particularly difficult for our oldest citizens to participate in the digital age. Focused on aged care residents, this is a perspective paper, outlining the needs and suggesting avenues for research in this under researched population of technology users. Also explored in attempts to overcome digital exclusion are the assistive technologies that aid members of this fourth age, as well as their family and professional carers.

Introduction

The literature defines the elderly in stages: with the oldest-old being those in the 80+ age group [START_REF] Chen | Internet use among young and older adults: Relation to psychological Well-being[END_REF][START_REF] Roberts | Striking a balance between in-person care and the use of eHealth to support the older rural population with chronic pain[END_REF][START_REF] Asla | The role of information in successful aging: The case for a research focus on the oldest old[END_REF]. Experiences of technology in this age-group, defined by [START_REF] Williamson | Information behavior of people in the fourth age: Implications for the conceptualization of information literacy[END_REF][START_REF] Baltes | New frontiers in the future of aging: from successful aging of the young old to the dilemmas of the fourth age[END_REF] as the fourth age, are considered in this perspective paper. The global population of elderly people is steadily increasing [START_REF] Heart | Older adults: are they ready to adopt health-related ICT?[END_REF][START_REF] Pollack | Intelligent Technology for an Aging Population: The Use of AI to Assist Elders With Cognitive Impairment[END_REF][START_REF] Harrington | Herman Bouma Foundation for Gerontechnology[END_REF][START_REF] Wu | The Attitudes and Perceptions of Older Adults With Mild Cognitive Impairment Toward an Assistive Robot[END_REF][START_REF] Chen | Use or non-use of gerontechnology--a qualitative study[END_REF][START_REF] Obi | Promoting ICT innovations for the ageing population in Japan[END_REF][START_REF] Peeters | Factors influencing the adoption of home telecare by elderly or chronically ill people: a national survey[END_REF]. It is generally accepted that while innovations in technology are advancing rapidly, the elderly are increasingly unable to keep up [START_REF] Heart | Older adults: are they ready to adopt health-related ICT?[END_REF], [START_REF] Wu | Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies[END_REF]. In particular, those in the fourth age, many of whom have not been exposed to technology in their home or working lives, are at a disadvantage as more and more daily tasks are performed electronically [START_REF] Harvie | Bringing The Oldest-Old Into The Digital Age: Challenges of Mobility, Literacy, And Learning[END_REF]. Access to information, resources and services is increasingly reliant on technology. Indeed, computer operating systems are frequently being changed and upgraded, ultimately resulting in a quite different computer experience, again leaving the older users at a disadvantage when they are presented with an interface which is quite different to what they have learned and to which they have become accustomed.

Given that relatively little work has been done in relation to technology use by the fourth age, this article's main contribution lies in its exploration of how such citizens can better be included in the digital age. While this fourth age group of people are not averse to learning how to use technology [START_REF] Harvie | Are We Failing a Generation?[END_REF], attempts to assist older people with training courses aimed at their level of expertise, have had varying degrees of success. As people age they become less mobile and less able to attend such courses. They also experience increasing physical difficulties, including visual and motor coordination challenges. Advances in technology can lead to isolation and ultimately a digital divide [START_REF] Harvie | Bringing The Oldest-Old Into The Digital Age: Challenges of Mobility, Literacy, And Learning[END_REF].

There has been some research which investigates the training courses and online communities which assist the oldest-old, examining whether these are useful for those in the age group and if not, what might be the alternatives. Many of our elderly wish to remain independent and living in their own homes for as long as possible, but while it is acknowledged that they need support to remain there, a large number are restricted in their use of technology in these homes. A certain level of independence can be achieved by the use of assistive technology devices (ATDs), but the elderly need to be persuaded of their benefit and relevance to themselves. The alternative is often that they will need to move from their homes to retirement villages or assisted living environments [START_REF] Burmeister | What seniors value about online community[END_REF].

As they become less mobile, the ability of the fourth age to take part in social activities is also decreased. Some have been introduced to social networking sites, such as Facebook but many prefer face-to-face communication. Smart phones and tablet devices provide easy access to information and social contact but this also requires knowledge, skill and financial resources. The fourth age, who lived through the years of the 'Great Depression', are averse to spending money on new equipment every few years. Yet, computer operating systems are constantly being upgraded and, over time, the interfaces are changing which leaves older users at the disadvantage of not only cost, but learning, in regards to those changes to technology, applications and interfaces.

Vignette

Rose, who is 85 years old, phoned in distress when her laptop had failed. Her computer was installed with Windows Vista -a very outdated operating system. The computer would not start up at all. When Rose was told that it might be impossible to recover the computer she was extremely upset and protested that it had not been used very much and indeed, was only bought after her husband had passed away, 6½ years earlier. In her mind, this was not a long time for an expensive possession to continue working; whereas in computer terms it was ancient. There followed some discussion around the possibility of her using an iPad instead, which might be easier to manage, since she only used her computer for email and internet browsing. 'No!' she protested. 'I want MY computer'. It was inconceivable to her that what was to her such an expensive piece of equipment should have such a short lifetime. She also believed that she was approaching the end of her days and that to buy a new computer would be an unacceptable waste of money. But she had grown accustomed to being able to communicate with her family over email, and keep up to date with news stories online. She was delighted when the computer was eventually recovered, but being so outdated it is only a matter of time before it happens again. Rose is not comfortable with change, as is evident by her reluctance to change to a tablet device. She has also not been willing to embrace other assistive technology devices, such as hearing aids, or personal emergency devices when they have been suggested to her as tools to improve her health and well-being. She accepts that these may be helpful to other elderly people but considers that they are not relevant to her, despite her being profoundly hard of hearing and prone to falls.

The Digital Divide

As was the case with Rose, many information and communication technologies (ICTs) are perceived by members of the fourth age to be of little or no relevance or use to themselves, even though access to information, resources and services is increasingly reliant on technology. Learning to use technology and adapting to the ever changing interfaces present challenges for the oldest-old. For example, web guidelines for older people learning to access online communities have been shown to require longer learning times [START_REF] Burmeister | Websites for Seniors: Cognitive Accessibility[END_REF]. The oldest-old need to learn how to navigate the digital spaces, digital language and interaction styles, and ever changing technology. Literacy and learning are thus challenges that need to be addressed. This is true for all use of technology, by the elderly. Increasingly the elderly encounter tasks that were once familiar to them that are now performed digitally. The learning divide is a sub-set of a wider digital divide (DD) to do with education. According to [START_REF] Montagnier | The Digital Divide Diffusion and use of ICTS. Information[END_REF], the phenomenon could be generalised as addressing either some form of socioeconomic divide or some form of education divide. One can extrapolate that less well-educated seniors are likely to face more of an age-based learning divide than better-educated ones. It is also possible that the kind of work undertaken by seniors during their working lives, will have an influence on their ability to participate online. Three reasons for non-use of ICT by older Portuguese residents were identified by [START_REF] Neves | Coming of (Old) Age in the Digital Age: ICT Usage and Non-Usage Among Older Adults[END_REF] as attitudinal, functional and physical. They define attitudinal as the elderly being willing to try technology but they are either generally indifferent or they lack the self-confidence to persevere. Functional is defined as a lack of access to a computer at home or they do not have the skills necessary to use it; and physical means they have physical or mental limitations preventing them from using technology.

Objectives

This paper discusses research that is in its early stages and the focus of which is to explore what factors facilitate or hinder the fourth age from taking advantage of Information Technology and to keep up with advancing technologies and ways to address that, now and in the future. The challenge is how do you bring Information Technology to them, making sure that it is relevant to them and enabling them to continue to access it? To address this dilemma, the following research questions have been identified: What factors influence the successful access to and continued use of Information Technologies for the oldest users? What are the enablers/inhibitors to the oldest-old embracing the use of assistive technologies?

These factors may include, but not be restricted to, the factors identified by [START_REF] Neves | Coming of (Old) Age in the Digital Age: ICT Usage and Non-Usage Among Older Adults[END_REF]: Attitudinal, Functional and Physical. These questions are relevant to current problems faced by the elderly in coming to grips with advances in Technology, hence the research innovation and relevance.

Digital inclusion of the fourth age

Although the use of computers and the Internet among older adults is increasing, there is an age-based divide [START_REF] Montagnier | The Digital Divide Diffusion and use of ICTS. Information[END_REF], [START_REF] Hiltz | Introduction to the Special Issue on Information Systems for an Aging Society[END_REF][START_REF] Van Volkom | Revisiting the Digital Divide: Generational Differences in Technology Use in Everyday Life[END_REF] whereby, compared to other age categories, older people are reporting less use of PCs and the Internet. Comparisons of ICT penetration by age for various OECD countries in 2000, including Australia were developed by [START_REF] Montagnier | The Digital Divide Diffusion and use of ICTS. Information[END_REF]. These comparisons showed that for people aged 18 to 24, close to 90% of them accessed the Internet, whilst for people aged 55-64 it was less than 50% and for people aged 65 and over, it was well under 20%. A report of ageing in Germany claimed, however, that the situation was changing, and that there were indications that technology could make a significant contribution to ageing successfully [START_REF]More Years More Life[END_REF]. However, [START_REF] Neves | Coming of (Old) Age in the Digital Age: ICT Usage and Non-Usage Among Older Adults[END_REF] calculated that 20% of 64-74 year-olds were frequent users, while 81% of 16-24 year olds embraced the technology. Indeed, 65% of older adults had never used technology. A large study by [START_REF] Smith | Older Adults and Technology Use[END_REF] revealed that those aged over 80 are still left behind in the use of the Internet and technology in the United States. Australian data correlates to these figures with 97% of 15 to 17 year-olds reporting use of the Internet, while only 46% of those aged 65 or older are Internet users [START_REF]0 -Household Use of Information Technology[END_REF]. An example of the age-based divide is that some seniors experience access limitations due to age-related disabilities [START_REF] Smith | Older Adults and Technology Use[END_REF]. It was reported by [START_REF] Montagnier | The Digital Divide Diffusion and use of ICTS. Information[END_REF] that in 2000 people with disabilities only enjoyed half the benefits of Internet access at home, compared to those without a disability. A solution was put forward by [START_REF] Lee | Age differences in constraints encountered by seniors in their use of computers and the internet[END_REF] that "One way to alleviate this problem may be to provide a publicly accessible infrastructure to the information technologies; for example, a high-tech pavilion in a city park, a computer booth in a shopping mall, or an Internet kiosk in a restaurant, bookstore or library". Given the prevalence of disability with increasing age and consequent geographical and mobility issues, public access through community centres, schools and libraries, alone, does not sufficiently overcome the challenges faced by seniors with age-related disabilities [START_REF]Older Australians and the Internet: Bridging the Digital Divide[END_REF]. This can only be of benefit to those elderly who are still mobile.

What, though, of the "shut-ins": the elderly who do not venture to such places easily, who are reliant on friends or family to transport them and who spend most of their time inside their own homes? One explanation for the age-based divide is that, with increasing age, there appears to be a diminution of power (purchasing power, political power, and position in society). It seems that the Digital Divide may be closing as more seniors use the Internet, email and other electronic forms of communication. Sociological research has shown that 'experience counts'. That is, the longer people have engaged in online activities, the more use they find for the Internet. There is increasing evidence that amongst younger seniors such online engagement is taking place, as seen for instance with their use of social networks [START_REF] Pfeil | Age differences in online social networking -A study of user profiles and the social capital divide among teenagers and older users in MySpace[END_REF], and that they engage with each other online and they participate in online communities [START_REF] Pfeil | Age differences in online social networking -A study of user profiles and the social capital divide among teenagers and older users in MySpace[END_REF][START_REF] Burmeister | Seniors extend understanding of what constitutes universal values[END_REF][START_REF] Xie | Multimodal Computer-Mediated Communication and Social Support among Older Chinese Internet Users[END_REF][START_REF] Burmeister | Sustaining online communities involving seniors[END_REF].

Assistive Technology Devices

There are a significant number of assistive technology devices, or gerontechnologies, which can be useful in assisting to maintain independence and continued well-being. Gerontechnology is the combination of gerontology and technology and can be defined as "the study of technology and aging for ensuring good health, full social participation, and independent living through the entire life span" [START_REF] Harrington | Herman Bouma Foundation for Gerontechnology[END_REF], [START_REF] Wu | Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies[END_REF]. These gerontechnologies include assistive technology devices marketed to people with hearing loss, memory loss, cognitive and other disabilities. Bookings for buses, taxis, cinemas, and health appointments can all be done online. Health care was identified by [START_REF]Older Australians and the Internet: Bridging the Digital Divide[END_REF], [START_REF] Olson | Diffusion of Technology: Frequency of Use for Younger and Older Adults[END_REF] as a particular reason for the elderly to take to the Internet for fact-finding related to their medical conditions. A number of technologies are available to assist with age-related health issues. These include, but are not limited to, vision and hearing aids, mobility aids such as wheelchairs or scooters, communication devices to assist people with speech difficulties, emergency call buttons, and initiatives to provide health care in the home.

One of these initiatives introduced in Europe and America, and in particular, the Netherlands, to counteract problems with nursing shortages, is home telecare [START_REF] Pakrasi | Ethical telehealth design for users with dementia[END_REF], which is defined by [START_REF] Peeters | Factors influencing the adoption of home telecare by elderly or chronically ill people: a national survey[END_REF] as "an audio-visual connection between a home-dwelling client and remote healthcare professionals, using communication technologies". The connection with a health professional takes place through a computer or television screen and allows the elderly to maintain their independence in their own homes longer, while providing assurance to those caring for them that their health needs are being met. One of the perceived advantages of this system is its relative ease of use once relevant training has been provided. While these ATDs are helpful for anyone with a disability, regardless of age, they are particularly beneficial for the very old to enable them to remain independent for as long as possible [START_REF] Wu | Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies[END_REF], [START_REF] Teipel | Information and communication technology solutions for outdoor navigation in dementia[END_REF][START_REF] Leikas | Ethics assessment in different fields: Social Gerontechnology, in Ethical Assessment of Research and Innovation: A Comparative Analysis of Practices and Institutions in the EU and selected other countries. Stakeholders Acting Together on the Ethical Impact Assessment of Research and Innovation[END_REF].

A number of focus groups were conducted by [START_REF] Wu | Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies[END_REF] with older adults living in communities in Europe. While they reported that the participants were aware of the digital divide of technology use between generations and were willing to embrace the use of various ICTs, they nevertheless displayed a lack of interest in assistive technology devices which they perceived as having negative connotations.

So it appears that while it has been shown that elderly people are willing to learn about computers, they are still reluctant to embrace assistive technology devices in their lives [START_REF] Wu | The Attitudes and Perceptions of Older Adults With Mild Cognitive Impairment Toward an Assistive Robot[END_REF], [START_REF] Chen | Use or non-use of gerontechnology--a qualitative study[END_REF], [START_REF] Wu | Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies[END_REF]. This reluctance of elderly people to acknowledge their need for assistive technology devices was investigated by [START_REF] Wu | The Attitudes and Perceptions of Older Adults With Mild Cognitive Impairment Toward an Assistive Robot[END_REF] who introduced them to robot technology. While the participants could see that they might be helpful for others, they were not ready to accept the technologies for themselves. These perceptions would need to be taken into account when configuring artificially intelligent devices for the elderly. Perhaps the use of the term "robot" was a reason for the lack of enthusiasm, as some of the responses from participants related to perceived size of robots along with reduction of jobs for humans and possible safety issues [START_REF] Wu | The Attitudes and Perceptions of Older Adults With Mild Cognitive Impairment Toward an Assistive Robot[END_REF].

In contrast, [START_REF] Heinz | Perceptions of technology among older adults[END_REF] concluded that the elderly are willing to embrace technology if they perceive it has value to their situation. However, they highlight the issues with increasing functionality of devices, much of which is not relevant and not userfriendly to the elderly. Devices targeted to the elderly need to be more closely designed to their requirements and abilities. Perhaps one initiative would be to investigate methods of addressing Rose's protestation earlier in this paper "I want MY computer". The elderly may be better equipped to handle changing technology around them if their personal devices and interfaces remain familiar to them, dissociated from the underlying technology.

Benefits can be obtained from exploring what factors facilitate or hinder people from using technology. A great deal of research has been undertaken using surveys and a number of theoretical models to gain an understanding of the factors which influence the use of technology. While surveys are useful for gathering and evaluating statistical data, they do not shed a lot of light on what influences the elderly to accept or reject technology [START_REF] Chen | Use or non-use of gerontechnology--a qualitative study[END_REF], [START_REF] Fishbein | Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research[END_REF][START_REF] Davis | User acceptance of computer technology: A comparison of two theoretical models[END_REF][START_REF] Venkatesh | Theoretical extension of the technology acceptance model: Four longitudinal field studies[END_REF][START_REF] Venkatesh | User Acceptance of Information Technology: Toward a Unified View[END_REF][START_REF] Chung | Age differences in perceptions of online community participation among non-users: An extension of the technology acceptance model[END_REF][START_REF] Braun | Obstacles to social networking website use among older adults[END_REF][START_REF] Ryu | Understanding the factors affecting online elderly user's participation in video UCC services[END_REF][START_REF] Lagana | Enhancing the attitudes and self-efficacy of older adults toward computers and the internet: Results of a pilot study[END_REF][START_REF] Holden | Cognitive performance-altering effects of electronic medical records: An application of the human factors paradigm for patient safety[END_REF][START_REF] Van Westrenen | Cognitive work analysis and the design of user interfaces[END_REF][START_REF] Pan | Internet use intention and adoption among Chinese older adults: From the expanded technology acceptance model perspective[END_REF][START_REF] Scott | Cognitive engagement with a multimedia ERP training tool: Assessing computer self-efficacy and technology acceptance[END_REF][START_REF] Wagner | Computer use by older adults: A multi-disciplinary review[END_REF][START_REF] Broady | Comparison of older and younger adults' attitudes towards and abilities with computers: Implications for training and learning[END_REF]. While design of technology for the elderly needs to take into account their specific requirements, training is of particular importance in assisting with their acquisition of selfconfidence and continued use of the technology. Interestingly, the elderly do not like to be taught by younger people or their children and they recommend that these training environments should be led by older adults [START_REF] Burmeister | Enhancing connectedness through peer training for community dwelling older people: A person centred approach[END_REF].

Consideration also needs to be given to the future sustainability of assistive technology devices for the elderly. Those who currently are reliant on these technologies for their health and well-being are not always considered with the inevitable upgrades and improvements that are made. For instance, the Royal Automobile Association in Adelaide, South Australia recently warned that the new National Broadband Network roll-out by the Australian Government will put at risk a large number of users of personal alarms which, they assert, are not compatible with the new network. While this is not insurmountable, it will involve changes to current installations, disruption to users, possible failure of devices, and depending on the provider, may also incur a cost [START_REF] Kemp | RAA Warns electronic medical alert buttons won't work as well on NBN, putting people at risk[END_REF].

Conclusion

Since global populations are ageing, at least in the western world, one implication is that more seniors than ever before will be needing to have access to technology and acquire the skills to use it. This trend is likely to continue as governments and other agencies involved with seniors require more electronic interaction in order to save costs and increase access. Yet, many of the oldest seniors are unprepared for this change and are lacking in the skills and confidence to be able to access the required data. There are efforts taking place to train the elderly to provide them with these tools and skills to attain and maintain access. It would seem that assistive technology devices have the potential to be extremely beneficial to our fourth age population yet many are reluctant to take advantage of these ATDs for various reasons. Clearly, perceptions by the elderly of a need for the technology as well as its ease of use, will dictate whether acceptance is positive or negative. Research needs to be ongoing to determine the factors that encourage or inhibit the elderly to take advantage of these technologies. If they do not, they risk becoming further isolated and further disadvantaged, as services become increasingly tied to technology. Closer attention also must be paid by governments and other authorities when planning infrastructure changes which may impact on technologies used and relied upon by our oldest citizens.


Sue Hessey

Hazel Lacohee

Rob Collingridge
email: rob.collingridge]@bt.com

Balancing Act or Compromise? A Case Study Highlighting the Challenges of Trialling IT services with the Elderly

Keywords: User trials, IT, Ethics, Trust, Business Processes, Organizations, Stakeholders

The world's population is ageing. Older members of society have needs from IT which can be quite specific, reflecting their living arrangements and increased likelihood of suffering from physical and cognitive impairments. So how can businesses offering IT services understand these needs to develop products and services that this demographic group (and their carers) will be willing to adopt? In this paper we outline the process we went through to attempt to answer this question. Because our research involved elderly and (in some cases) disabled trial participants, the process had ethical considerations at the forefront, which on occasion affected the operational processes involved in bringing the trial to life. We describe the various challenges we encountered, where possible how we overcame them (by balancing commercial, stakeholder and participant requirements or by compromising where we could not), and what we learnt for future trials.

1

Background -BT

From developing the first amplified telephone handset in the 1920s for the deaf [START_REF] Maguire | Remembering the Post Office's Role in Creating the First NHS Hearing Aid[END_REF], to the highly successful BT Big Button 200 (Fig 1) with features such as easy-grip handsets for those with dexterity issues and an inductive coupler for use with hearing aids, BT has a long history of offering inclusive communication products. In addition, in collaboration with organizations such as local councils, telecare and telehealth services are offered with the intention of enabling such customers to live independently and securely in their own homes [START_REF][END_REF] (Fig 2 ). As well as the financial and non-financial benefits these products and services bring to BT and to customers, the public sector is another expected beneficiary of such services, as quoted by Paul Burstow, MP, Department of Health in March 2012:

The widespread adoption of telehealth and telecare as part of an integrated care plan will mean better quality of care and greater independence for people with long-term conditions. Delivered from the front line it could save the NHS up to £1.2 billion over five years. 1So the rationale for offering these services is clear: for BT, the customer and the public sector. But BT, like other IT companies, constantly evolves its product set to meet the changing needs of its customers, reflecting demographic and societal changes, and to fulfil its business and Corporate Social Responsibility (CSR) ambitions. Successful products continue to be sold, less successful ones are discontinued. In order to maintain the refresh cycle of new products, BT has various foresight and development teams within its organisation. For this case study in particular, the Research and Innovation department, in collaboration with teams in CSR [3] and the Business Development teams in the Health sector-facing part of the organization, developed a specific concept to potentially add to the existing suite of inclusive products. The concept was to be delivered in the form of a trial service, to address a specific and evident issue facing predominantly elderly members of the UK Populationthat of social isolation.

The Case for Researching Concepts to Address Social Isolation in Elderly User Groups

Social isolation among older people is an increasing problem. A survey conducted by Age UK in 2014 (Fig. 3) revealed that over 1 million people aged 65 and over admit to always or often feeling lonely, 30% of older people saying they would like to go out more often, while 41% say their TV or pet is their main form of companion. The charity also found that 12% feel "cut off" from society. Loneliness can be seriously damaging to health -feeling extreme loneliness can increase an older person's chances of premature death by 14% [4].

Fig. 3.

These statistics become more significant when looking at the projections for the future. In the UK, between 2015 and 2020, during which the general population is expected to rise 3%, the numbers aged over 65 are expected to increase by 12%; the numbers aged over 85 by 18% and the number of centenarians by 40% [START_REF]Political challenges relating to an aging population: Key issues for the 2015 Parliament[END_REF]. 25% of the UK population is projected to be aged 65 and over by 2050 [START_REF] Cracknell | Key Issues for the New Parliament 2010: The Ageing Population[END_REF]. When considering these projections, the incidence of social isolation and its effect on health and social services becomes even more significant.

Because of this evidence, the BT teams collaborated to develop a conceptual service which could potentially reduce social isolation among elderly people. BT is wellpositioned to be able to do this having the ability to offer fast Internet access to provide connectivity, to be able to work with consumer device vendors, to work with these vendors to adapt products' user interfaces according to the target user group's needs, and to work with external organisations to explore options for the concept's route to market and ongoing technical support for any prospective service. With these factors in place, a trial plan was created.

Trial Objectives

The original intentions of the trial were, over a period of 12 months, to build upon previous research on the role of technology in addressing loneliness, and to inform the strategic direction for the implementation of these technologies. The technology for the trial was deliberately simple -a system using Skype over the participants' existing TV.

The county of Cornwall was chosen as the geographical location for the trial as:

1. Its population's age is higher than the national average (1:4 is over 65 years old) and is expected to increase [7], 2. There was an established collaboration between some of the stakeholder groups to deliver the trial, and 3. Infrastructure was already in place to deal with technical and participant support during the trial.

The original objectives of the trial, from a commercial point of view, were to:

 Measure the benefits of TV video chat in reducing social isolation.  Evaluate performance, experiences of the user and their families/carers and feature sets to identify improvements and future service enhancements.  Understand usage models and frequency of use to support proposition insight.  Understand geographic and demographic elements to support any proposed business model.

Another objective was to be able to use research findings for publication due to its relevance in the field of Human Computer Interaction (HCI) which includes 'Inclusion and Accessibility', 'Designing for the Elderly' and 'User Interface Experience Design'. To enable us to do this, ethical approval was needed; this was provided by a university partner whose faculties specialise in researching technology use in elderly populations. Having ethical approval to ensure participants are protected is vital and an activity all stakeholders supported. However, it was the negotiation of the detailed recruitment and participant engagement processes for this ethical approval procedure with the multiple stakeholders which created the first of the trial's many challenges. The stakeholders were those involved in bringing the trial to launch who also had an interest in the trial's output. The number and diversity of these stakeholders is demonstrated in the list below:  Device vendor (supplier of the hardware to be installed on participants' TVs).  CSR and regional Broadband roll-out programme managers within BT.  Public sector-facing marketing teams of BT.  University partner advising and supporting the BT research team through the ethical approval process.


All stakeholders had a common desire for the highest levels of participant safety and protection. However, the production of the detailed processes and documentation which the ethics approval committee required, needed to take into account a variety of logistical requirements from different stakeholders. For example, one of the charities was already running a similar exercise in trialling non-technical means of reducing social isolation and were some way ahead of BT's research team in developing their own ethically approved participant referral and engagement processes. While honouring their wish to keep our processes aligned with theirs for the recruitment programme they were running, it did not fully match the resourcing capabilities of (for example) the housing associations who needed separate, parallel participant referral processes. The nature of the work of both organisations was in itself differentone being a charity supporting the elderly, the other organisations dealing with aspects of social housing tenancies). This in itself doubled the already significant quantity of process documentation required by the ethics approval committee.

Letters of communication to participants similarly required agreement from all parties to ensure consistency in the tone, content and intent of the documentation, from the original flyer advertising the trial, to welcome letters, to letters advising of the end of the trial and letters outlining what participants needed to expect in terms of providing feedback to the researchers. Legal documentation was thoroughly reviewed (i.e. terms and conditions plus two sets of participant consent forms). Finally, technical criteria checklists, for the use by the referrer (outreach worker, charity or housing association representative) needed to be produced such that the referrer themselvesusually an individual from a non-technical backgroundwas confident that they could record that such criteria could be met for the trial service to be delivered in the participant's home. Another requirement upon this referrer was that they recommend the participant on a subjective assessment of whether or not the individual would benefit from such a service, taking into account what they knew of the participant's health, social network and living arrangements. As this was a responsibility upon the referrer (BT did not engage the participant directly until all consents had been given), this too needed special consideration. Again, these processes did not extend to all referral parties because some wished to retain their own processes, and this too had to be taken into consideration.

When all agreements were met and documentation produced, the ethical approval board itself caused another impact on the roll-out of the trial, because our application was submitted during summer recess and the board did not meet until some weeks after. Although this was a known factor, it had an impact on the ability to start recruiting participants, and in turn this affected the timescales for launch of the trial service.

As a result, the trial start date was pushed back, leading to a loss of momentum, especially with the internal commercial partners. However the need for ethical approval was paramount, so the trial launch continued and approval was eventually gained to start recruitment.

Challenge 2 -Issues with Trust

Popular and widespread adoption of new technology is less straightforward than it might initially appear; given that technology is always imperfect there are initially more barriers to take-up than drivers that will push adoptionthis was especially true of our group of participants. Central to the adoption process is the need to consider the question of whether the technology itself can be trusted as well as the necessary trust in those who deploy, control and deliver such technology. In this trial, this task was made more complex because we needed to access and engage with a potentially vulnerable population of elderly people. To do this we needed to build a trusted relationship with those stakeholders through whom we wished to access the participant population, as well as the participants themselves, and also to address any trust issues around the technology we proposed to deliver.

Trust issues in Participant Engagement. Rigorous research requires participant engagement with the research process and in this instance recruitment and engagement posed a challenge. From a recruitment perspective trust issues were more complex because we did not have an existing relationship or direct access to a sample with the required characteristics, hence this gave rise to the necessity to leverage relationships with stakeholders who did. This placed an extra burden on the trust/risk relationship in two ways; stakeholders were being asked to trust both our technology and our ethical rigour in sharing their personal contacts whilst participants were being asked to trust the judgement of stakeholders in recommending referral and participation in the trial.

Without a direct trust relationship with those delivering the trial, participants were required to rely 'second hand' on their trusted stakeholder relationship and in turn this introduces a potential risk to disrupt or redefine the confidence they have in that relationshipa relationship risk that applies to both participants and stakeholders, albeit for different reasons.

Any asymmetry of relationships between individuals and institutions is also important in understanding the issues of risk and trust and this presents a further complication here between the parties concerned: participants (who are in receipt of services from stakeholders), stakeholder institutions (supplying services to potential participants) and those organising and running the trial (supplying a service to stakeholders' participant referrals). Each party concerned is required to address and assess the level of trust required and risk involved but each will perceive both the risk and degree of trust differently. From a business perspective we could not measure, with any certainty, the impact these relationships may have had on perception of risk, trust, and willingness to participate or engage with the technology offered, as a result it was difficult to preempt, react to or manage these varied perceptions.

Trust in Technology.

The unfamiliar nature of cutting edge technologies can be intimidating, particularly for a potentially non-technical, elderly population, but since we proposed to utilise the television as our medium of delivery, trust issues around technology were minimised because the television is a technology that has gained longstanding trust and acceptance in most homes, amongst most users. This was a challenge which we considered but believe we overcame because from the users' perspective what we were offering was a different way of using that tried, tested and trusted technology, combined with an enhanced service proposition that aimed to improve and extend opportunities for communication with friends and family. This gave us confidence that any issues concerning the device and its usage were not due to trust (or lack of) in the technology itself.

Challenge 3 -Technical and Organisational Issues

The delivery of service into participants' homes depended on a co-ordination of tasks led by BT's Research Project team, with Internet connections (where required) delivered by a 3 rd party supplier, and a separate local delivery team installing the devices on participants' TV sets. Co-ordination of the two parts of the delivery process was problematic because there was no direct link between the twoall interactions were mediated by the Research Project team. There was a dependency between Internet connections being delivered before the local delivery team could install devices. At the outset of the trial, we had agreement from these two teams that co-ordination of these parts of the delivery process would be seamless, although as we will discuss later, such attempts were thwarted by various different issues.

The trial service required a high speed Internet connection, with uplink speeds higher than standard ADSL. Despite investment in infrastructure in the region [START_REF]Superfast Cornwall: Superfast Cornwall 2011-2015[END_REF], high-speed connectivity was not ubiquitous and take-up was inconsistent within the participant group for the trial. Some participants had pre-existing high-speed services so could go straight to the device-installation phase; others did not, either having no Internet connection at all, or using ADSL, which in addition to insufficient uplink speeds is prone to lower speeds in rural areas due to the distance from the exchange. Because of this, according to the trial terms and conditions, BT offered to provide high-speed Internet connections to participants who did not have them already. Although being an existing BT customer was a condition for trial referral, some non-BT customers were referred and in order for the team to arrange upgrades to participants' existing connections, we needed to ask for MAC addresses (a condition of the ISP industry at the time). This was a concept beyond the understanding of many participants, but only they, as the account holder, could obtain it from their ISP, adding further complications to the task of getting participants connected and placing an added level of responsibility upon them, which we had intended to avoid. Additionally, delivery of some of the fast Internet connections was delayed due to delivery timescales in the third party organisation, due in turn to challenges presented by the Cornish environment and delays from their supplier of infrastructure and engineering teams. Some of the fibre-to-the-premises connectionsalthough offering the highest speed Internet connectivity and theoretically the best user experience when using the device -were the most problematic due to these issues.

These delays became compounded by issues with the local device installation team, who were managed by yet another stakeholder group. However problems encountered here, which could not be foreseen, were associated with organisational and resourcing problems rather than technical issues. The delivery of devices and their support was intended to be an "add-on" to existing services the organisation already offered. Installation engineers to install and support the trial service were agreed upon at an early stage, but in due course the teams involved shrank in size, with redundancy and sick leave affecting resourcing profiles, and our trial service deliveries were de-prioritised as a result. Engineers left, taking skills with them, and their replacements were not sufficiently skilled or available to complete the tasks. The knock-on effect was that participant deliveries were delayed, and ongoing support was not available, necessitating the research project manager to become involved directly in technical support issues. This was challenging due to his location being over 350 miles from the trial location but essential due to the level of technical support needed by participants. Whilst this was provided as an act of good will, the lack of ongoing local support resulted in a loss of momentum and interest amongst participants.

Challenge 4 -Technology Engagement

The final challenge presented itself during and after the trial. In our attempts to provide a trial technology to those who were socially isolated (to meet the original objective of the study) our referral partners suggested participants they knew whose relatives lived far way away, or who did not have a local social network. For some, this worked well, or rather it augmented existing relationships, for others, it did not help, as in the case of those who had relatives in the US or Australia where significant time differences meant the service was not useful, because when they were awake and ready to use the service, their relatives were asleep, or at work. Participants observed and accepted that their younger relatives often have dependent children to attend to, were likely to be working full time and have busy social lives, and therefore it was hard to find a mutually convenient time to call. Although the intention was for this trial technology to enhance social interaction (as geographic barriers are eliminated by the technology), the complex context of people's lives meant that quite often, even the convenience of a Skype over TV service was not enough to increase interaction and as a result, some participants found this a barrier to use.

In addition, within this cohort, there was an observed deterioration of existing social networks, such that those who did not have many living relatives did not have anyone else they wanted to connect with and hence did not find a use for the technologyit seemed they needed a pre-existing social network for it to work beneficially. Additionally one participant mentioned that, as she is disabled, she had the device set up with her bedroom TV as she goes to bed early, but this too was a barrier as she was uncomfortable being able to be seen in bed by even her own relatives, inferring a concern this participant had regarding her privacy. Finally, usability issues such as the usage of the device's remote control (Fig. 4), switching between input channels on the TV and intermittent technical problems presented barriers to use. Without local technical support, it was also challenging to make changes to installed devices, provide additional training or add new connections to participants' devices remotely, which had knock-on effects to the devices' usage, and therefore our ability to collect participants' experiences of the device's usage as initially planned. Fig. 4 5

What did we learn?

Despite the challenges of the trial, a significant amount was learnt, some of which was unexpected, but all of which was valuable. Our attempt to prove that social isolation could be alleviated by Skype over TV could not be delivered by this trial alone, but our understanding of the barriers to use (as described above), and the requirement for local, accessible support delivered by trusted individuals and organisations is vital for the success of a service such as this. As a result, one of our main conclusions was that customers need a service more than just a device. And that service includes one that a customer can trust and that will be delivered responsibly and supported fully, with seamless single point-of-contact customer experience (regardless of the number of suppliers actually involved).

The importance of user engagement in service design

A key lesson learnt is in the value of engaging with a population of potential real end users; as service developers and technologists we may believe that our product or service is new, exciting and innovative but we have to accept that this view may not be upheld by non-technical potential users who may tell us some uncomfortable truths. By listening to users' experience and understanding how engaging with a technology relates to their own desires and experience we can gain valuable insights that would not otherwise be accessible. In undertaking such an endeavour we are likely to encounter views that run counter to our own but it is not until we engage with consumers of that product or service that we can create the opportunity to understand why it might, for example, appear to be a technologically elegant solution from a developer's perspective but a clumsy one from a user's perspective. In a business context it is the opinion of the consumer that is most important and if we confine ourselves to a focus on technological solutions in isolation we may well end up 'fixing' the wrong things. This is particularly important in the public sector where funds are at stake that are needed to provide services that will ultimately be used by the people who are paying for them such as health care programmes [START_REF] Lacohee | Understanding Public Perceptions: Trust and Engagement in ICT-Mediated Services[END_REF]. Some might argue that the process of soliciting opinion from potential end users is not objective because they are not well-informed enough to judge the value of a product or service as mere 'members of the public.' Technologists and service designers are also members of the public of course and we would argue that there is value in the very process of uncovering knowledge gaps or misunderstanding because it allows us to address the 'right' aspects of a product or service to enable development and better understanding. As Bruni et al [START_REF] Bruni | Public Engagement in Setting Priorities in Health Care[END_REF] (2008, p.16) describe, our potential end users may not be technological experts, but they are experts in 'lived experience.' In listening to and taking account of what participants tell us we can create the opportunity for the cocreation of trust to create better, appropriate and more user-centric products and services that have wider market appeal. If we design services around the end users and involve them and engage with them from the outset, trust and confidence are more likely to follow as a natural consequence and by listening to and responding to end users we can start to develop an empathy with the user perspective that addresses any issues that impact on trust, acceptability and take-up.

Understanding Technology Adoption

Classic adoption theories such as Rogers' (1995) 'diffusion of innovations' [START_REF] Rogers | Diffusion of Innovations: Fifth Edition[END_REF] and the Davis' (1989) 'technology acceptance model' [START_REF] Davis | Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology[END_REF] both address the importance of social structures and personal beliefs in the acceptance of any new technology. In order to achieve public buy-in with technological developments, we need to understand the issues from a number of perspectives. Acceptance of, and trust in the technology to be offered is of central importance to the adoption of new solutions, but trust of those people involved in the introduction and delivery of technology is also central and this relationship is often ignored or overlooked. Decisions regarding whether or not to engage are not necessarily based on technical novelty alone, but on the analysis of attendant risks and benefits. This risk-based approach repositions the question of trust and places it at the baseline of every discussion whilst simultaneously expanding its importance [START_REF] Lacohee | Understanding Public Perceptions: Trust and Engagement in ICT-Mediated Services[END_REF]. We need to consider these discussions in the light of this.

An additional learning point is that technology adoption may be enabled by re-focussing marketing efforts away from the target demographic. It can be a hard thing to admit that one needs helpthat one is struggling to cope with living alone for example. Often this is instead recognised by other family members. Additional user research conducted by BT among a sample of adults with elderly relatives suggested the main instigator for adoption of these services may actually be this population and not their elderly relatives. Not only did they perceive value in being able to physically see their relatives using the technology, they could see the value of integrating such a service with other telecare or smart home services to remotely monitor their relatives in the case of falls etc. They are also likely to be willing to support their relatives in the setting up and maintenance of such a service, and deal with suppliers if things go wrong.

Understanding Issues of Trust

In the course of working with multiple stakeholders supporting a vulnerable population we have learned that trusted relationships are a necessary and key component for success. Those relationships can be enhanced by explicit, clearly defined and appropriate benefits to all concerned and voluntary, mutually understood and agreed boundaries. When balanced with respect for the value of the opinions of end users we can increase opportunities for reciprocity in the consumer/developer relationship that can be translated into robust product and service offerings that can benefit consumers, business and wider society. We need to enter into these relationships with as much knowledge as possible about the potential impacts, particularly when dealing with a vulnerable population and this highlights the importance of the quality of trusted relationships between stakeholders and potential participants and between both stakeholders and participants and those delivering the trial.

These aspects of risk and trust are particularly apparent when comparing the challenges of recruitment and engagement for this trial with a previous trial led by a charity, with BT providing technical support, to a similar participant group. Participants were originally signed up to the trial by a community GP, and thereafter engagement was managed by a charity, of which one individual grew relationships and trust with participants and was a single point of contact for them throughout the trial period. The success of this recruitment strategy was in contrast to that experienced on this trial, inferring that existing levels of trust between the GP and charity representative were more fully formed than those encountered on our trial. To summarise, it is clear therefore that success of technology introduction needs to consider and build these important trust relationships, potentially over a longer period than we had initially assumed.

Conclusions

In having completed the trial, we are now able to summarise the findings and translate them into new service ideas to the business and stakeholders. Our findings go beyond the user experience aspects we originally envisagedour learnings apply to the entire service launch, delivery and support aspects, so were greater than we first envisaged. For us this was an unexpected but worthy result.

As of 2016, the participants of our trial probably represent the last generation willing to use a single-function service like this however, so in the future this service may be embedded within a wider suite of inclusive and smart home products, delivered responsibly and supported through established networks of family members, social services and/or the NHS, to meet changing needs.

Additionally, there are customers with different needs who may benefit from simple video communication servicesthe autistic population, for example, may find interaction easier when mediated via a screen. Wider understanding of their needs would be required in developing these communications services.

The challenge is now to develop products and services which meet evolving consumer, stakeholder and supplier needs. We hope our trial learning enables our organisationand othersto design new products effectively with these considerations in mind.

Fig. 1 .Fig. 2 .

 12 Fig. 1.

Challenges 4 . 1 Challenge 1 -

 411 Balancing the needs of multiple stakeholders for ethical approval.

  Local delivery and support team (part of BT).

	 Local development council who ran outreach programmes to educate elderly IT us-
	ers.  Local housing associations for referral of potential participants.  Local charities for the referral of potential participants.
	 A non-BT Internet Service Provider to provide the high-speed Internet connections
	for the service.

https://www.gov.uk/government/news/telehealth-and-telecare-could-save-nhs-1-2-billion

Acknowledgment.

We thank Prof. Ray Jones of Plymouth University for his advice on the ethical approval process.


Arnaud Lallouet

Thi-Bich-Hanh Dao

Andreï Legtchenko

Abdelali Ed -Dbali

Finite Domain Constraint Solver Learning

In this paper, we present an abstract framework for learning a finite domain constraint solver modeled by a set of operators enforcing a consistency. The behavior of the consistency to be learned is taken as the set of examples on which the learning process is applied. The best possible expression of this operator in a given language is then searched. We instantiate this framework to the learning of bound-consistency in the indexical language of Gnu-Prolog.

Introduction

Constraint Satisfaction Problems (or CSPs) have been widely recognized as a powerful tool to model, formulate and solve artificial intelligence problems as well as industrial ones. A common framework to address this task is the combination of search and filtering by a local consistency. Enforcing a local consistency is usually done by the scheduling of monotonic and contracting operators up to reach their greatest common fix point. The consistency is obtained as the common closure of the set of operators. This closure is efficiently computed by a chaotic iteration of the operators [Apt, 1999]. But usually, the task of finding efficient operators which actually define a consistency is considered as one of the smartest skills of the solver's implementor. The essence of the learning framework consists in considering the behavior of the operator enforcing the desired consistency as a set of examples in order to find an adequate representation of this operator in a given language.

Theoretical framework

Let be a set of variables and ¡ £¢ ¥¤ ¦¡ ¨ § © § their finite domains. A constraint is a pair ¤ "! © where $# is the arity of the constraints and ! %# '& § ( ¡ § is the set of solu- tions of . A CSP is a set of constraints. For )# , a search state 0 is a tuple ¤ 10 2 § 3© " § 4 ( where 5 76 98 @ , 0 A § B# C¡ D § . A singletonic search state ¤ FE AG § IH © § ( represents a single tu- ple. The search space is P ( ¢ Q& § ( 'R ¤ ¦¡ § © . The set P ( ordered by point-wise inclusion # forms a complete lattice.

A consistency for a constraint S¢ T¤ 1 U! © is an operator V XW P ( `Y P ( such that: a V is monotonic, i.e 0 b# c0 2d fe V ¤ 10 2© 3# V ¤ 10 Ad g© , in order to ensure the confluence of the reduction mechanism, a V is contracting, i.e 5 h0 i8 pP f( , V ¤ 10 2© q# r0 , in order to reduce variable's domains, a V is correct w.r.t , i.e 5 s0 8 CP f( , every solutions of which are present in 0 remain in V ¤ 0 2© , a V represents , i.e for every singletonic search state 0 which does not represent a solution of , V ¤ 10 2© is an empty state (at least one element of the tuple V ¤ 10 2© is the empty set).

Operators which satisfy the first three conditions are called pre-consistencies for . As an example of consistency, if we suppose that each variable domain ¡ § is ordered by a total ordering t and for u v# w¡ D § , we denote by x u y the set E 2 8 ¡ § min¤ ¦u © t ` %t max¤ ¦u 3© H , then the bound-consistency is defined by 5 h0 8 P ( , 5 6 r8 q , ¤ 0 A© § ¢ Q0 § x ! § y , with ! § the projection of ! on 6 .

Let 0 2 be the consistency to be learned. Our aim is to build a consistency V which behaves like 0 as much as possible. Thus V must be contracting, monotonic, correct w.r.t 0 (5 s0 S8 P ( , 0 ¤ 10 2© # V ¤ 0 A© ) and singleton complete w.r.t 0 2 ( V ¤ 10 2© 4# Q 0 2 A¤ 10 2© for any singletonic search state 0 ). How- ever, singleton completeness is difficult to get and even not always possible to express in a given language. In order to transform a pre-consistency into a consistency, let us define a consistency F such that 5 h0 ¨8 P ( , F A¤ 10 2© is an empty state if 0 is a non-solution singletonic state, and F d A¤ 0 A© ¢ e0 otherwise. Thus V bf g and F f hV are consistencies for if V is a pre-consistency for . Therefore by adding F d in the set of operators, processed by a chaotic iteration mechanism [Apt, 1999], we only need to build pre-consistencies for . On the other hand, the correctness condition must be ensured for every 0 I8 iP ( which is generally huge. We show that: Proposition 1 If V is a monotonic and contracting operator such that V ¤ 10 2© j¢ C0 for every singletonic state 0 which repre- sents a solution of , then V is a pre-consistency for .

Therefore, by considering monotonic operators, we can reduce the search space to a sample set k which is a subset of P ( and which contains all singletonic search states. Let l be the language in which operators are expressed and m be an operator in this language. In order to find the best possible expression, we shall be able to compare two consistencies. This is usually done with a distance. Let be such a distance be- tween two consistencies. The learning problem is formulated as follows:

minimize 7¤ ¦ 0 2n 2 Um © , subject to 5 s0 8 ik , 0 2 A¤ 0 A© j# om "¤ 0 2© j# 0 , where k p# qP ( , k contains all singletonic search states of P ( and m is a monotonic operator. Following the machine learning vocabulary, 0 r represents the example space and l the hypothesis space.

Learning indexicals

To instantiate our theoretical framework, we have to define strong language biases in order to limit the combinatorial explosion.

The first question is the language in which operators are expressed. The language of indexicals [van Hentenryck et al., 1991] is chosen, motivated by the ease of integration of the user-defined indexicals in Gnu-Prolog [START_REF] Diaz | [END_REF]. In this language, an operator is written X in r, where X represents the domain of the variable 6 and r is an expression representing a subset of ¡ b § . If we denote s the unary constraint representing 6 's domain, then the indexical represents the operator s ut Y s wv .

Then comes the choice of consistency. We learn the boundconsistency, since it allows to limit the example space to intervals instead of arbitrary subsets.

For each variable we learn a reduction indexical and define an indexical for F . The reduction indexical for 6 is of the form X in minX .. maxX where minX, maxX are in some fixed forms. In practice, we use linear, piecewise linear and rational forms. In order to the reduction indexical to be monotonic, the bound minX must be anti-monotonic and maxX monotonic. This can be ensured by syntactic conditions on the sign of the coefficients for each expression.

The indexicals for F could be implemented in two ways: by using Gnu-Prolog indexicals for predefined constraints in which each instance of min and max is simply replaced by val, or by a direct code using val and C operators.

As distance between two consistencies, we use the global error on the example space k . By considering that V must be correct w.r.t 0 r , this distance is x n zy 4 V ¤ 10 2© U{ 0 2 ¤ 0 2© .

Example For lack of space, we present here one example. An user defined global constraint is defined by the following conjunction: 6 T| @} ṽ "6 ¥| @} v z U h6 ¥| } T h} | 6 9 A z "6 £ w } `~ . When treated glob- ally as a two dimensional polyhedra, these constraints yield less indexicals than the above decomposition. On the domain

x g ry ox y , our system generates the following opera- tors: When trying all reductions on boxes included in x y x z ry , the learned operators ran in 290 ms, while the non- decomposed constraints ran in 400 ms. All tests have been done on a Pentium4, 2Ghz, 512MB running Linux.

Conclusion

Related work Solver learning has been first introduced by [START_REF] Apt | Automatic generation of constraint propagation algorithms for small finite domains[END_REF] in which they automatically generate a set of rules from the tuples defining a constraint. The complexity of the rules generation limits them to small finite domains such as boolean.

The system PROPMINER [START_REF] Abdennadher | Slim Abdennadher and Christophe Rigotti. Automatic generation of rule-based solvers for intensionally defined constraints[END_REF][START_REF] Abdennadher | Slim Abdennadher and Christophe Rigotti. Automatic generation of rule-based constraint solvers over finite domains[END_REF] is devoted to the learning of Constraint Handling Rules [Früwirth, 1998]. The produced solver is often very readable, especially when a small number of rules are produced. While being less general in theory since we only deal with finite domains, our method works on domains and constraint arities much larger.

In an earlier paper [Dao et al., 2002], we have presented an indexical learning process. We propose here two main improvements, besides a more general theoretical framework: the possibility of using only a sample of the example space while still ensuring the correctness of the learned solver and the reparation method. It follows that our system is able to handle larger constraint arity and larger domains and therefore yields a better solver. Summary We have presented a general, languageindependent framework for finite domain constraint solver learning and an instantiation to the learning of boundconsistency with Gnu-Prolog indexicals.

X

  in 6*min(Y)/<20+18 .. -10/<(1 + max(Y))+45 Y in 10/<(max(X)+1)+6 .. -590/<(max(X)+1)+47 Reparation operators are implemented from Gnu-Prolog indexicals. Here is the one for 6 : X in val(Y)+4 .. 44 & 0 .. val(Y)+29 & 50+val(Y)/>3+1 .. 44 & 5*val(Y)-119 .. 44

Acknowledgment We gratefully thank Michel Bergère and the anonymous referees for their remarks on this paper. This work is supported by french CNRS grant 2JE095.