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Meeting recruitment targets in an expeditious manner is essential to the successful completion of any research project. However, despite the high prevalence and debilitating nature of Long COVID (LC), recruitment of participants into some LC studies has been challenging. We aimed to a) identify factors influencing participation in LC research among individuals who were infected by SARS-CoV-2 but had declined participation in a LC study and b) to compare these factors to those previously recognized. Using a semi-structured guide, we interviewed thirteen people about their thoughts, experiences, and attitudes concerning participation in LC research. We imported interview transcripts into Nvivo 14 and analyzed them using thematic analysis. For coding, we used Charmaz's coding scheme of open and focused coding within an application of the constant comparative method. Basic descriptive statistics were also deployed to supplement our qualitative analysis. Fifteen factors describe the facilitators and barriers mentioned by participants. The top three facilitators were Personal and social motivation, Incentives, and Familiarity and credibility of institutions involved with COVID-19; the top three barriers were Invasiveness, Social and political context, and Lack of time. Skepticism and infringement on participants' daily lives served as major obstacles to participation while trust, personal factors, and administrative factors encouraged participation. The facilitators and barriers identified are similar to those recognized previously except that in the politically charged atmosphere surrounding the COVID-19 pandemic, trust was especially vital. Many factors affect people's decisions to participate in LC research but only some are modifiable by researchers. Building trust, offering incentives participants value, and removing logistical barriers may improve recruitment rates.
Wahring et al. argue relationships matter more to men than women due to cultural and biological evolutionary pressures, though the latter may benefit from incorporating Error Management Theory. This predicts (i) men evolved to overperceive female sexual interest and (ii) women evolved to be skeptical of male commitment; potentially explaining why men likely form relationships and women likely terminate them.
Higher dose naloxone products (HDN) have recently been approved and marketed in the United States; however, evidence on the relative advantage of these products to standard 4 mg products has not been substantiated by prior research. People who use drugs are the primary beneficiaries and consumers of naloxone products. This study aimed to characterize their willingness to use HDN products and technical understanding of these products. We conducted in-depth interviews with syringe service program clients following an interview guide. Interviews were recorded and transcribed before being analyzed using a hybrid deductive-inductive qualitative approach. Interviews were conducted in partnership with community-based syringe service programs in three distinct regions of the state of Maryland, USA: a rural county, Baltimore city and a surrounding suburban community. Twenty-two interviews were completed. All participants had used opioids and responded to an overdose using naloxone in the past 3 months. The majority of participants were men (73%), non-Hispanic white (64%) and currently experiencing housing instability (59%). Participants demonstrated high willingness to use HDN, motivated by volatility in the local drug supply and perceived inefficiency of naloxone against potent synthetic opioids. Participants believed that the relative advantage of HDN was that it would reverse overdoses more quickly than existing products; however, many participants wanted increased control in overdose situations, including the ability to titrate and combine dosages to reduce the severity of precipitated withdrawal. Skepticism towards HDN products was rooted in general skepticism of pharmaceutical companies, as well as the belief that perceptions of lower dose naloxone being ineffective could be attributed to user error. Development of novel overdose reversal products should be informed by the experiences of primary consumers and beneficiaries of these products. A high level of transparency is needed in the marketing of these products to promote consumer trust and confidence in their safety and utility.
Parents of children with chronic diseases in rural Iran experience profound challenges, including limited access to pediatric specialists, social isolation, and severe financial strain. Concurrently, healthcare providers face workforce shortages, administrative burdens, and fragmented referral systems. This study aimed to explore unmet care needs and comparative perspectives of parents and providers regarding the integration of artificial intelligence to strengthen chronic disease management in resource-limited rural settings. Using a qualitative descriptive design, we conducted semi-structured interviews with 20 parents of children with chronic illnesses and 15 healthcare providers (physicians, nurses, and community health workers) from rural health centres in Iran. Participants were selected through purposive sampling based on direct experience with pediatric chronic disease management in villages (< 20,000 population). Data were analysed using conventional content analysis with iterative coding to derive emergent themes. Five key themes emerged: (1) Unmet daily care needs including geographic barriers to specialists, maternal emotional isolation, and catastrophic out-of-pocket expenses; (2) Systemic constraints faced by providers, notably administrative overload ("pajama time"), critical workforce shortages, and inefficient referral pathways; (3) AI as a potential bridge through symptom prediction models for early intervention, chatbots for emergency guidance, and AI-enabled teleconsultations to reduce unnecessary travel; (4) Divergent trust narratives parents expressed skepticism about autonomous AI decision-making while providers raised concerns about data privacy, workload implications, and erosion of clinical authority; and (5) Integration pathways emphasising AI embedded within the existing Behvarz (community health worker) network, mandatory digital literacy training, and co-designed platforms incorporating local cultural beliefs. AI technologies show promise for augmenting, though not replacing, human-centred care in rural pediatric chronic disease management. Successful implementation requires culturally resonant, transparent tools developed through participatory design with families and providers, robust data governance, and strategic alignment with Iran's primary healthcare infrastructure. This context-sensitive framework prioritises equity, trust-building, and caregiver empowerment while acknowledging the irreplaceable role of human empathy in chronic care delivery. Parents of children with chronic illnesses and healthcare providers were central to this research as knowledge partners rather than passive subjects. Twenty parents with lived experience of caring for a child with chronic disease in rural settings, alongside 15 frontline healthcare providers, actively shaped the study through in-depth sharing of their experiences during semi-structured interviews. Their narratives directly informed all emergent themes and the resulting conceptual framework. To ensure interpretive validity, we conducted member checking with a purposive subset of participants (n = 8 parents and n = 6 providers) who reviewed preliminary findings and provided feedback on whether the themes accurately reflected their realities and concerns. This iterative validation process strengthened the trustworthiness of our analysis and ensured that the final framework resonated with the everyday challenges and aspirations of rural families and providers. While participants were not involved in the initial study design or manuscript drafting due to the exploratory nature of this qualitative investigation, their experiential expertise fundamentally shaped the research outcomes and recommendations for culturally grounded AI integration. Their contributions transformed abstract technological possibilities into contextually meaningful pathways for supporting rural pediatric chronic disease management.
Ginkgo biloba products have been used for decades for cognitive symptoms, yet the clinical evidence in Alzheimer's disease (AD) remains modest and heterogeneous. This review revisits key symptomatic and prevention trials and summarizes how systematic reviews and meta-analyses have informed ongoing clinical skepticism, often citing small effect sizes, limited patient-centered meaningfulness, short follow-up, and repeated trial designs. We suggest that long-standing ambiguity reflects multiple, overlapping sources of heterogeneity, including mixed-pathology recruitment, variable dosing and exposure duration, inconsistent outcome frameworks, and limited integration of biological readouts; differences across preparations and characterization practices may further contribute to variability. In the biomarker era, AD is increasingly defined biologically, and amyloid PET-confirmed cohorts offer a clearer test by reducing diagnostic noise and enabling mechanism-adjacent interpretation. Recent studies in amyloid PET-positive MCI/AD report clinical preservation alongside directional changes in plasma oligomerization tendency (MDS-OAβ), with decreases in treated groups compared with increases in controls. While such findings cannot, by design, establish disease-modifying effects, they provide a biologically anchored context for interpreting modest clinical signals. We conclude with practical recommendations to align cohort biology, stage, exposure certainty, duration, endpoints, and biomarker panels in next-generation trials of Ginkgo preparations in early AD-spectrum disease.
This study examines the psychological mechanisms through which anthropomorphic artificial intelligence (AI) relates to consumer adoption intentions in fragile, low-trust economies. Integrating the Stimulus-Organism-Response framework with the Computers Are Social Actors paradigm, Institutional Trust Theory, and Privacy Calculus Theory, we investigate how human-like AI design shapes cognitive and affective responses within Sierra Leone's banking sector. Using survey data from 277 banking customers and partial least squares structural equation modeling, we find that AI anthropomorphism exhibits no direct association with adoption intention (β = -0.013, p = 0.760). Instead, its influence is entirely indirect-transmitted in parallel through perceived social presence (β = 0.144, 95% CI [0.062, 0.226]) and trust in the AI system (β = 0.139, 95% CI [0.068, 0.210]). Critically, customer skepticism-shaped by institutional fragility-functions as a boundary condition that substantially attenuates both pathways: among highly skeptical users (+1 SD), anthropomorphism's conditional effect on social presence becomes non-significant (β = 0.098, p = 0.124) compared to low-skepticism users (β = 0.412, p < 0.001), while its effect on trust is reduced by more than half (β = 0.118 vs. 0.284). These findings identify a critical boundary condition on human-like AI design: in low-trust environments, anthropomorphism operates not as a standalone adoption driver but as a relational amplifier whose efficacy depends on foundational trust and is substantially weakened when skepticism is high. The study challenges universalist assumptions in human-AI interaction research and underscores the need for institutionally sensitive design approaches in fragile economies.
Inequities exist in reproductive care access for biological women of childbearing age from minoritized, racialized, and lower socioeconomic communities in the United States. While patient-reported barriers are well documented, less is known about healthcare providers' perceptions of these challenges in urban, under-resourced contexts. Providers' frontline insights are essential for understanding operational, institutional, and community-level obstacles and for designing more effective, contextually relevant interventions. This qualitative study explores providers' perspectives on the barriers clients face when accessing reproductive care in Washington, DC. We conducted in-depth interviews with 14 reproductive healthcare providers. The analysis yielded four themes: (1) limited health literacy: lack of or limited health and resources knowledge, (2) distrust and mistrust: skepticism toward health-related information and hesitancy to seek reproductive care, (3) challenges navigating care: challenges centered on engagement with available healthcare services, and (4) upstream structural barriers: policy-driven challenges that affect clinic operations and financial stability. Collectively, these findings underscore persistent barriers to reproductive care, even in contexts with broad insurance coverage, highlighting the disconnect between coverage and meaningful access. Despite high insurance coverage in DC, low-income, publicly-insured patients continue to encounter significant obstacles to reproductive care. Addressing these challenges requires policies that ensure healthcare systems provide accessible, patient-centered, and equitable care, as well as interventions that meaningfully integrate provider perspectives to enhance relevance, feasibility, promote provider engagement and buy-in, and support the long-term scalability and sustainability of efforts aimed at improving equitable access. PATIENT OR PUBLIC CONTRIBUTION: This study provides insight from reproductive healthcare providers serving patients in Wards 1, 4, 5, and 7 of the District of Columbia, Washington. All aspects of this qualitative study were informed by a community-advisory board (CAB) made up of members from these respective wards.
This article analyses the Tamil COVID-19 memes as artifacts of humor and social commentary during Tamil Nadu's first pandemic wave. Drawing on a corpus of WhatsApp memes, cross-verified on Facebook and Instagram, we trace how Tamil cinematic iconography and anthropomorphism articulated health anxieties and negotiated therapeutic authority between Siddha and biomedicine. Using visual ethnography, we identify two narrative logics, namely, dissonance (skepticism, satire) and congruence (pragmatic coexistence). Framed by encoding and decoding, carnivalesque inversion, and performative health communication, we argue that memes do not merely reflect sentiment, rather, they actively stage reasoning about care and pluralist health imaginaries.
This study presents a qualitative analysis of eight focus groups conducted in November 2024 to examine public perceptions, misconceptions, and informational needs related to low-dose radiation (LDR). Participants from diverse backgrounds discussed trust in science, perceived risk, personal experience, media influence, and expert communication. Initial uncertainty and skepticism were common, with many conflating LDR with high-dose exposure and nuclear accidents. Conflicting media portrayals, limited educational resources, and distrust of industry-funded research compounded this uncertainty. Trust in scientific authority was conditional: participants valued academic and government-backed research but were cautious of findings influenced by politics or corporations. Canadian studies were generally perceived as more credible than US research due to differences in regulatory and accountability frameworks. Risk perception was not static; expert presentations clarified the natural presence of radiation and its medical and environmental applications, leading to shifts in understanding in some groups, though skepticism persisted in others. Personal experiences, such as undergoing radiation therapy, and media representations shaped interpretations of risk. Across all groups, participants emphasized the need for transparent, emotionally resonant, and audience-specific communication. Recommendations included using trained science communicators, leveraging multimedia tools and social media platforms, and providing public health resources such as radon test kits and more precise risk-benefit explanations. Findings suggest that knowledge, experience, media, and institutional trust influence the public's understanding of LDR. Targeted, empathetic communication, combined with transparency in research, can foster a more informed public discourse. These insights have implications for public health communication, policymaking, and strategies to engage audiences on complex scientific topics (e.g., LDR) in a skeptical, media-saturated environment.
This paper presents "Neither/Nor," a philosophical synthesis which defines conceptual and experiential modes of knowing as complementary skills which can be deliberately trained and oscillated. The paper argues that neither theory (concepts) nor practice (experience) alone can suffice for desirable outcomes in personal flourishing or scientific inquiry. Drawing from Western and Eastern philosophical traditions-from ancient skepticism and Buddhism to modern pragmatism and cognitive science-Neither/Nor proposes that "latent Platonism," the unconscious preference for abstract concepts over direct experience, contributes to both personal suffering and intellectual impasses. The paper begins with a concrete example of Type I diabetes management, demonstrating the constant negotiation between abstract formulas and embodied experience required by the disease, before providing five practical principles: (1) regard concepts and experience as trainable skills; (2) commit to oscillation between skills; (3) prioritize relations and processes over objects and states; (4) embrace trial-and-error learning; and (5) employ conditional historicism over linear causal thinking. The Neither/Nor framework demonstrates how these principles can reduce personal suffering, enhance scientific inquiry, and provide a methodology for evaluating diverse philosophical positions pragmatically. Neither/Nor points towards a way of living rather than merely an abstract theory, contributing to both individual flourishing and more flexible approaches to complex societal challenges.
Public acceptance of the first COVID-19 vaccine administration was not uniform, yet the nature and county-level characteristics of heterogeneous emotional responses remain poorly characterized. To examine changes in social media emotional expression across US counties before and after the first COVID-19 vaccine administration, and whether changes varied by county-level partisanship and COVID-19 death rates. Cross-sectional study of geotagged COVID-19-related posts on the socia media platform Twitter from 3065 US counties from over 1.9 million unique users who created more than 18 million posts during the study period (September 1, 2020, to March 31, 2021), covering 100 days before and after first vaccine administration. Data were analyzed from January 2023 to April 2026. Geotagged COVID-19-related social media posts during the 100-day periods before and after December 14, 2020. Levels of joy, sadness, anger, and fear expressed in posts, measured using the National Research Council of Canada Word-Emotion Association Lexicon. After vaccine administration, fear decreased (β = -0.424; 95% CI, -0.510 to -0.338; P < .001; Cohen d = -0.20), joy increased (β = 0.683; 95% CI, 0.601 to 0.766; P < .001; Cohen d = 0.33), and anger increased (β = 0.445; 95% CI, 0.384 to 0.506; P < .001; Cohen d = 0.28). Sadness did not change significantly (β = -0.004; 95% CI, -0.075 to 0.067; P = .91). Democratic-leaning counties showed greater joy increases (β = 0.162; 95% CI, 0.115 to 0.209; P < .001), larger fear decreases (β = -0.066; 95% CI, -0.115 to -0.017; P = .007), and smaller anger increases (β = -0.042; 95% CI, -0.075 to -0.009; P = .009) than Republican-leaning counties. Higher county COVID-19 death rates were associated with greater fear decreases (β = -3.69 × 10-6; 95% CI, -6.03 × 10-6 to -1.35 × 10-6; P = .002); death rate did not significantly moderate joy or anger. In this cross-sectional study of 18 million geotagged social media posts, the first COVID-19 vaccine administration was associated with increased joy and anger and decreased fear, with fear showing the greatest evidence of a vaccine-specific shift. These findings suggest that monitoring social media discourse can provide early signals of optimism, skepticism, and division, thereby informing targeted communication strategies.
Although music therapy can have positive impacts on motivation, treatment readiness, and craving for people with substance use disorders (SUD), most of the literature is from the objectivist paradigm and lacks the voices and lived experiences of people with addictions. A nuanced and situated understanding of music therapy that centers the experiences and voices of service users may help improve treatment. Therefore, the purpose of this study was to understand the lived experience of adults with SUD on a detoxification unit who participated in a single recovery-oriented group blues songwriting session. A board-certified music therapist facilitated 12 group single-session songwriting experiences over 6 months. Participants composed lyrics for a two-verse song identifying agency for and pathways to recovery based upon Snyder's Hope Theory. A research assistant individually interviewed 20 participants about their experiences. We used reflexive thematic analysis to analyze data, and a separate music therapy scholar provided trustworthiness to ensure the results were credible. We identified eight themes and grouped them into three categories to portray the songwriting sequence: Anticipating songwriting (Initial skepticism and doubt); Songwriting processes (An open and connected community, Composing lyrics was therapeutic, The engaging and genuine music therapist); and Songwriting products (Pride in the product, Mood changes and hope, A distinct approach, and Gratitude and recommendation). The findings offer a service user-centric understanding of the lived experience of songwriting germane to adults with SUD on a detoxification unit. Implications for clinical practice, limitations, and suggestions for future research are provided.
Chronic kidney disease heavily burdens patients and health systems. Digital health interventions offer significant potential but face implementation challenges driven by stakeholders' emotional and practical experiences. This review synthesizes these affective dimensions to inform clinical practice. A qualitative systematic review was conducted across six databases for studies published through April 2025. Methodological quality was rigorously appraised. We integrated Python-based computational sentiment analysis to quantify stakeholder emotional polarity (positive, negative, neutral) with thematic analysis. Identified barriers were mapped to established implementation frameworks to select expert-validated implementation strategies. Twenty-three qualitative studies were included, revealing five domains: accessibility, communication, workflow, empowerment, and clinical effectiveness. Patients praised digital empowerment but highlighted socioeconomic access barriers. Nurses valued workflow efficiencies but reported role ambiguity. Clinicians expressed deep skepticism toward remote clinical effectiveness due to diagnostic limitations. To resolve these tensions, prioritized implementation strategies include identifying clinical champions, promoting intervention adaptability, and systematically assessing organizational readiness before deployment. Stakeholder emotions critically dictate digital health adoption. For clinical practice, these findings emphasize moving beyond generic deployments. Healthcare systems must address clinician diagnostic concerns via hybrid care models, resolve nurse workflow ambiguities through targeted training, and provide low-cost devices to bridge patient equity gaps. Tailoring solutions to these psychosocial needs is essential for successful integration into routine kidney care.
Ribosome specialization, whereby ribosomes of distinct composition translate different sets of mRNAs, is a concept that has garnered both wide-spread excitement and skepticism from the translation field. The controversy is rooted in experimental challenges, which make rigorous controls difficult and not obvious to the nonexpert. In addition, considerations of translation mechanisms and ribosome homeostasis also suggest heterogeneity to be limited, fueling doubt. Lastly, the mechanisms by which heterogeneity can lead to specialization are often challenging to imagine and not spelled out. In this perspective, we define ribosome heterogeneity and specialization, use examples to examine both the technical challenges and potential solutions. We then consider the mechanism-based challenges with the goal of proposing biologically relevant circumstances where ribosome specialization might exist and how it might affect translation in an mRNA-specific manner. It is hoped that this article will help resolve the controversy around the subject, in addition to providing a guide for scientists entering the field, so they can concentrate their efforts fruitfully and rigorously.
Our climate is changing, with heatwaves, wildfires and hurricanes posing increased risks for individuals with a disability such as spinal cord injury (SCI). Despite growing recognition of disability-related climate risk, the specific challenges for individuals with SCI have not been well-documented. This narrative review aimed to broadly explore the literature describing the impacts of a changing climate (e.g., rising temperatures, adverse weather, etc.) on individuals with SCI. A structured search was conducted across five databases (PubMed, EMBASE, Scopus, Web of Science, CINAHL) and was supplemented by citation tracking to identify additional relevant studies. Twelve articles were analyzed thematically. Three themes were identified. In terms of adverse weather events, individuals with SCI are physiologically (e.g., due to autonomic dysregulation) and physically (e.g., unable to evacuate or seek healthcare due to mobility issues) at risk, experiencing psychological impacts (e.g., anxiety). There was a mismatch between their perceived and actual preparedness for these events, placing themselves further at risk, due in part to climate skepticism and fatalism. The third theme was inequity and disability discrimination. As the research originates largely from the Global North, those living with SCI globally are generally underrepresented or excluded from climate adaptation policy development. SCI is also often considered with other 'disabilities' such as blindness and impaired mental capacity, masking climate impacts. Individuals with SCI experience several physiological, physical and psychological challenges in the face of increasing climate-related events. Addressing these challenges will require targeted, SCI-specific and inclusive strategies in clinical practice, education, and policy development.
Traditional insurance claims dataset analyses have exposed disparities in treatment delays for kidney stones along lines of socio-economic status, particularly among patients who are underinsured and/or racial/ethnic minorities. Analyzing patient experiences through qualitative semi-structured interviews allows for elucidation of common root causes leading to care delays in patients with kidney stones. 20 participants were recruited from a group of adult patients at a safety net hospital and academic medical center who had been referred for urological care after presenting to the Emergency Department for kidney stones. Patients were selected for semi-structured interviews if they failed to present to the urology clinic after 60 days of referral placement. Interviews were conducted in Spanish or English. Transcripts were coded and analyzed using thematic analysis. Of the 20 participants, the median age in years was 46 (range 22-72), 50% identified as female, 40% were White, 40% were Hispanic, 20% were Black, and 20% were Spanish-dominant. The median delay was 105 days. Thematic analysis identified patient-extrinsic obstacles in obtaining timely care in the form of care costs and skepticism from health care providers, such as perceptions of being drug-seeking or feigning pain. We further identified patient-intrinsic obstacles, such as gaps in understanding of the dangers of stone disease and difficulty navigating care coordination. This study provides insights into multi-level factors that impact care delays for patients with kidney stone disease. Findings from this work deepen understanding of why patient experiences in care delays manifest along lines of socio-economic status and can inform future interventions to reduce disparities.
We resolve a $1,000 Erdős prize problem, complete with formal verification generated by a large language model. In over a dozen papers, beginning in 1976 and spanning two decades, Paul Erdős repeatedly posed one of his "favorite" conjectures: every finite Sidon set can be extended to a finite perfect difference set. We establish that {1, 2, 4, 8, 13} is a counterexample to this conjecture. During the preparation of this paper, we found that although this problem was presumed to be open for half a century, Marshall Hall, Jr. published a different counterexample three decades before Erdős first posed the problem. With a healthy skepticism of this apparent oversight, and out of an abundance of caution, we used ChatGPT to vibe prove both Hall's and our counterexamples in Lean.
Despite decades of methodological sophistication, research on sustainable food behavior remains critically limited in predicting actual purchases. This study aims to examine how methodological fragmentation across psychometric, econometric, and behavioral approaches affects the predictive validity of sustainable food choice and purchasing behavior. This integrative systematic review of 62 empirical studies across psychometric validation, discrete choice experiments (DCEs), trust and cognitive biases, and objective behavioral measurement diagnoses the structural disarticulation between these traditions as the primary cause of limited predictive validity. Findings reveal a pronounced inversion of the evidence hierarchy: while self-report studies report moderate attitude-behavior correlations (β ≈ 0.40-0.50, self-report), the only long-term study using objective scanner data demonstrates that this relationship collapses to a virtually null effect (β = 0.022), representing a 95.6% decay in predictive capacity. Psychometric instruments demonstrate strong structural validity but lack ecological validation against actual purchases. DCEs have evolved econometrically (from MNL to GMNL models), yet remain isolated from psychological theory and real-world validation. Critically, no reviewed study integrated validated scales, a DCE, and objective behavioral data within a single design. Key moderators-skepticism, halo effects, and affective heuristics-are systematically underoperationalized. To overcome this impasse, we propose Hybrid Choice Models (HCM) as the central tool to formally articulate latent attitudes, stated preferences, and observed behavior, enabling cumulative evidence to inform policy and market strategies with greater predictive accuracy. These findings indicate that predictive advances depend on integrating measurement paradigms to achieve ecologically valid and policy-relevant models of sustainable consumer behavior.
Thousands of scholars across Europe faced discrimination for their heritage, especially Jewish heritage, throughout the 1930s. Hundreds of these persecuted academics worked in science and healthcare, often as primary researchers within a medical sub-specialty. In response, in 1933 British professors founded the Society for the Protection of Science and Learning (SPSL) with two objectives: raising funds to provide maintenance grants for displaced scholars and connecting scholars to academic placements worldwide. In this article, I analyze the stories of nineteen physicians fleeing fascist persecution in Europe through their 712 leaves of correspondence within the archive of the SPSL. I selected two medical subspecialties, to compare whether the well-funded field of oncology would have greater success placing refugees compared to the less academically-elevated field of orthopedic surgery. Through the first analysis of two complete medical subspecialty records from the SPSL archives, I examine how the SPSL faced difficulties deciding which colleagues to help financially and triaged levels of support. I also situate the experiences of the analyzed applicants within the context of British interwar medicine and academia, including British skepticism of foreign research and overlaps between SPSL leadership and the British eugenics movement. When funding ran low, the SPSL still assisted scholars through different channels, whether referring to other aid organizations, sending support letters to potential employers, or simply staying in contact. The surge in applications in 1938, five years after the organization's foundation, hindered scholars' chances as persecution increased and funding tapered. Importantly, the British medical establishment distrusted the overall research quality of many fleeing scholars and felt even less confident admitting medical practitioners who were not also researchers. Ultimately, medical scholars from fascist Germany and Austria who applied to the SPSL had a similar experience to other aspiring refugees seeking British assistance before 1939: they could not rely on Britain to support their immigration and predominantly settled elsewhere.