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This article explores the views of frontline research staff in different Sub-Saharan African contexts on the notion of choice in biomedical research. It argues that the current emphasis on individual choice, in the conduct of biomedical research, ignores significant structural and contextual factors in resource-limited settings. These factors severely constrain individual options and often make biomedical research enrolment the most amenable route to healthcare for the world's poorest. From the position of frontline research staff, local contextual factors and structural issues narrowly frame the parameters within which many prospective participants are asked to choose, to such an extent that individuals are effectively presented with an 'empty choice'. The article draws on ethnographic and interview data and insights gained through graphic elucidation techniques. It demonstrates that for frontline research staff, macro-level structural factors and their bearing on everyday realities shape what choice in biomedical research participation means in practice.

Fakes have become a matter of concern across global health. Commissioning inquiry into presumed fake practices in global health requires both a pre-existing sense of what would constitute real provision and a suspicion that it is not being offered. In this Position Piece, we analyse the research methods being used to identify and reveal other—presumed—fakes in global health provision. We put forward the concept of the 'second-order fake'—the fake that is used to reveal a fake—to draw attention to the methodological politics at stake in the use of the fake. By reviewing historical cases of the creation of methods of deception, we analyse the assumptions they bring into global health from other disciplines. We foreground the promises of revelation that are embedded in probes that rely on fakes to uncover fakes. We suggest that despite the growing prevalence of methods which themselves deploy fakes to find fakes, these techniques bring us no closer to understanding the lived ambiguities of everyday practices of fakery.

Fakes have become a matter of concern across global health. Commissioning inquiry into presumed fake practices in global health requires both a pre-existing sense of what would constitute real provision and a suspicion that it is not being offered. In this Position Piece, we analyse the research methods being used to identify and reveal other—presumed—fakes in global health provision. We put forward the concept of the 'second-order fake'—the fake that is used to reveal a fake—to draw attention to the methodological politics at stake in the use of the fake. By reviewing historical cases of the creation of methods of deception, we analyse the assumptions they bring into global health from other disciplines. We foreground the promises of revelation that are embedded in probes that rely on fakes to uncover fakes. We suggest that despite the growing prevalence of methods which themselves deploy fakes to find fakes, these techniques bring us no closer to understanding the lived ambiguities of everyday practices of fakery.

Over the past decade, the phenomenon of "fake" peer reviews has caused growing consternation among scholarly publishers. Yet despite the significant behind-the-scenes impact that anxieties about fakery have had on peer review processes within scholarly journals, the phenomenon itself has been subject to little scholarly analysis. Rather than treating fake reviews as a straightforward descriptive category, in this article, we explore how the discourse on fake reviews emerged and why, and what it tells us about its seeming antithesis, "genuine" peer review. Our primary source of data are two influential adjudicators of scholarly publishing integrity that have been critical to the emergence of the concept of the fake review: Retraction Watch and the Committee on Publication Ethics. Via an analysis of their respective blog posts, Forum cases, presentations, and best practice guidance, we build a genealogy of the fake review discourse and highlight the variety of players involved in staking out the fake. We conclude that constant work is required to maintain clear lines of separation between genuine and fake reviews and highlight how the concept has served to reassert the boundaries between science and society in a context where they have increasingly been questioned.

The art of magic relies on deception and illusions to create human experiences that appear impossible. Misdirection lies at the heart of this deceptive art, and yet there is little consensus as to what this concept aims to describe. The concept of misdirection is not limited to magic, and its principles are applied to wide aspects of our lives (e.g., politics, public health, marketing). In recent years, scientists have started to examine the psychological mechanisms that underpin misdirection and new theoretical frameworks have been developed to help understand the concept itself. This paper provides two different perspectives on misdirection. In the first section we will discuss its use in magic and examine some of the key features involved in using misdirection to create magical illusions. This section will examine some common misconceptions of misdirection. The second section will provide a psychological perspective that discusses the key psychological mechanisms that are involved in misdirection (perception, memory, reasoning). The third section examines the uses of misdirection in other domains. This paper aims to provide a clearer understanding of how misdirection is used in magic which can serve as the basis for its use in other domains, such as public health.

The art of magic relies on deception and illusions to create human experiences that appear impossible. Misdirection lies at the heart of this deceptive art, and yet there is little consensus as to what this concept aims to describe. The concept of misdirection is not limited to magic, and its principles are applied to wide aspects of our lives (e.g., politics, public health, marketing). In recent years, scientists have started to examine the psychological mechanisms that underpin misdirection and new theoretical frameworks have been developed to help understand the concept itself. This paper will provide two different perspectives on misdirection. In the first section we will discuss its use in magic and examine some of the key features involved in using misdirection to create magical illusions. This section will examine some common misconceptions of misdirection. The second section will provide a psychological perspective that discusses the key psychological mechanisms that are involved in misdirection (perception, memory, reasoning). This paper aims to provide a clearer understanding of how misdirection is used in magic which can serve as the basis for its use in other domains, such as public health.

Background While community engagement is increasingly promoted in global health research to improve ethical research practice, it can sometimes coerce participation and thereby compromise ethical research. This paper seeks to discuss some of the ethical issues arising from community engagement in a low resource setting. Methods A qualitative study design focusing on the engagement activities of three biomedical research projects as ethnographic case studies was used to gain in-depth understanding of community engagement as experienced by multiple stakeholders in Malawi. Data was collected through participant observation, 43 In-depth interviews and 17 focus group discussions with community leaders, research staff, community members and research participants. Thematic analysis was used to analyse and interpret the findings. Results The results showed that structural coercion arose due to an interplay of factors pertaining to social-economic context, study design and power relations among research stakeholders. The involvement of community leaders, government stakeholders, and power inequalities among research stakeholders affected some participants' ability to make autonomous decisions about research participation. These results have been presented under the themes of perception of research as development, research participants' motivation to access individual benefits, the power of vernacular translations to influence research participation, and coercive power of leaders. Conclusion The study identified ethical issues in community engagement practices pertaining to structural coercion. We conclude that community engagement alone did not address underlying structural inequalities to ensure adequate protection of communities. These results raise important questions on how to balance between engaging communities to improve research participation and ensure that informed consent is voluntarily given. ; Peer reviewed

Background: While community engagement is increasingly promoted in global health research to improve ethical research practice, it can sometimes coerce participation and thereby compromise ethical research. This paper seeks to discuss some of the ethical issues arising from community engagement in a low resource setting. Methods: A qualitative study design focusing on the engagement activities of three biomedical research projects as ethnographic case studies was used to gain in-depth understanding of community engagement as experienced by multiple stakeholders in Malawi. Data was collected through participant observation, 43 In-depth interviews and 17 focus group discussions with community leaders, research staff, community members and research participants. Thematic analysis was used to analyse and interpret the findings. Results: The results showed that structural coercion arose due to an interplay of factors pertaining to socialeconomic context, study design and power relations among research stakeholders. The involvement of community leaders, government stakeholders, and power inequalities among research stakeholders affected some participants' ability to make autonomous decisions about research participation. These results have been presented under the themes of perception of research as development, research participants' motivation to access individual benefits, the power of vernacular translations to influence research participation, and coercive power of leaders. Conclusion: The study identified ethical issues in community engagement practices pertaining to structural coercion. We conclude that community engagement alone did not address underlying structural inequalities to ensure adequate protection of communities. These results raise important questions on how to balance between engaging communities to improve research participation and ensure that informed consent is voluntarily given.

BACKGROUND: While community engagement is increasingly promoted in global health research to improve ethical research practice, it can sometimes coerce participation and thereby compromise ethical research. This paper seeks to discuss some of the ethical issues arising from community engagement in a low resource setting. METHODS: A qualitative study design focusing on the engagement activities of three biomedical research projects as ethnographic case studies was used to gain in-depth understanding of community engagement as experienced by multiple stakeholders in Malawi. Data was collected through participant observation, 43 In-depth interviews and 17 focus group discussions with community leaders, research staff, community members and research participants. Thematic analysis was used to analyse and interpret the findings. RESULTS: The results showed that structural coercion arose due to an interplay of factors pertaining to social-economic context, study design and power relations among research stakeholders. The involvement of community leaders, government stakeholders, and power inequalities among research stakeholders affected some participants' ability to make autonomous decisions about research participation. These results have been presented under the themes of perception of research as development, research participants' motivation to access individual benefits, the power of vernacular translations to influence research participation, and coercive power of leaders. CONCLUSION: The study identified ethical issues in community engagement practices pertaining to structural coercion. We conclude that community engagement alone did not address underlying structural inequalities to ensure adequate protection of communities. These results raise important questions on how to balance between engaging communities to improve research participation and ensure that informed consent is voluntarily given.

Abstract
Background
A patient charter is an explicit declaration of the rights of patients within a particular health care setting. In early 2020 the Save the Children Emergency Health Unit deployed to Cox's Bazar Bangladesh to support the establishment of a severe acute respiratory infection isolation and treatment centre as part of the COVID-19 response. We developed a charter of patient rights and had it translated into Bangla and Burmese; however, the charter remained inaccessible to Rohingya and members of the host community with low literacy.

Methods
To both visualise and contextualise the patient charter we undertook a graphic elicitation method involving both the Rohingya and host communities. We carried out two focus group discussions during which we discussed the charter and agreed how best to illustrate the individual rights contained therein.

Results
Logistical constraints and infection prevention and control procedures limited our ability to follow up with the original focus group participants and to engage in back-translation as we had planned; however, we were able to elicit rich descriptions of each right. Reflecting on our method we were able to identify several key learnings relating to: 1) our technique for eliciting feedback on the charter verbatim versus a broader discussion of concepts referenced within each right, 2) our decision to include both men and women in the same focus group, 3) our decision to ask focus group participants to describe specific features of each illustration and how this benefited the inclusivity of our illustrations, and 4) the potential of the focus groups to act as a means to introduce the charter to communities.

Conclusions
Though executing our method was operationally challenging we were able to create culturally appropriate illustrations to accompany our patient charter. In contexts of limited literacy it is possible to enable access to critical clinical governance and accountability tools.