-->PONE-D-26-08417-->-->Development and validation of search hedges for transgender and gender diverse (TGD) populations in Ovid MEDLINE and Ovid APA PsycInfo-->-->PLOS One

Dear Dr. Everhart,

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Academic Editor

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5. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Thank you for submitting your manuscript to PLOS One. The reviewers and I feel your work has merit; however, additional revisions are needed before your manuscript is acceptable for publication. The reviewers have several requests for clarification that I would like you to address if you choose to revise and resubmit your manuscript. I have elaborated on some of their suggestions below and would like you to consider these clarifications when addressing the reviewer's suggestions.

Reviewer 1's suggestion:

"The manuscript would benefit from more explicit discussion of how the search hedges translate across databases. Because indexing systems, controlled vocabularies, and field structures vary substantially between databases, readers would benefit from guidance on:

* which elements of the hedge are database-specific,

* how subject headings were mapped across databases, and

* what adaptations are required for implementation in other search platforms."

Editor's elaboration

You touch on this issue in your manuscript, but provide minimal details:

Line 115: "Although these hedges are designed and validated on the Ovid platform, they are constructed in such a way to facilitate translation to other platforms, including PubMed, EBSCOhost, ProQuest, and APA PsycNet."

You can expand on this statement in your manuscript if you want. However, I am concerned that a review of how to adapt search hedges for use in different databases is beyond the scope of this manuscript. You can consider providing a reference to an article discussing this topic as an alternative to the detailed discussion suggested by Reviewer 1.-->

Reviewer 1's suggestion:

"When utilizing a search hedge, information professionals and researchers should consider if the hedge has been validated, if it optimizes sensitivity or precision, when it was last updated, and whether it needs to be adapted to suit their specific research question."

This is a useful recommendation, but it would benefit from contextualization. The authors might discuss how often validated search hedges exist in practice, in which fields they are most common (e.g., clinical medicine vs. social sciences), and for approximately how many types of search queries such hedges have been developed.

Editor's elaboration:

I feel Reviewer 1's suggestion has merit and your paper would benefit from additional contextualization. However, I am concerned that a review of search hedges use is beyond the scope of this paper. Consider directing readers to papers addressing this general information about search hedge use, such as reference 4, as an alternative to a full discussion.

Reviewer 1's suggestions:

"Librarian co-authors [REDACTED] and [REDACTED] will maintain and periodically update the hedge to reflect language, indexing practices, and community usage developments."

It would be helpful to specify where these updates will be maintained. The authors might consider discussing whether a platform could be used to host and version search hedges. For example, research infrastructures or methodological repositories could serve as dissemination platforms. In the digital humanities and social sciences, infrastructures such as the *SSH Marketplace* operated by *DARIAH-EU* publish methodological resources; a similar approach could potentially be used for search hedges.

"Through active maintenance and user adaptation, these hedges should be refined and expanded to reflect changes in language, indexing preferences, and the needs of researchers working with TGD populations over time."

The authors should clarify whose responsibility such maintenance would be, how updates might be coordinated, and how frequently revisions should occur.

Editor's Elaboration:

I agree that it is important to update search hedges to "to reflect language, indexing practices, and community usage developments" and to ensure dissemination of these search hedges for use by others. However, I feel your paper should focus on the work being presented rather than describing work you may do in the future. Consider limiting your discussion to the need for this work to occur in the future. You could also direct readers to any currently available dissemination platforms for search hedges via a reference, in the manuscript itself, or via a supplemental appendix.

Reviewer 3's suggestion:

"In your previous published protocol, your team acknowledged a possible conflict of interest with two authors of the protocol overlapping with Knowsy. This might need to be acknowledged in this manuscript as well."

Editor's elaboration: Please include this in your discussion

Reviewer 3's suggestion:

"It looks like Table 3 is listed in the manuscript before Table 2. Not sure if this matters for the journal formatting, but pointing it out just in case. It does refer to the correct table so is probably okay.

Editor's elaboration: Please number your tables in the order they appear in the manuscript.

Christina Roberts

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: N/A

Reviewer #2: Yes

Reviewer #3: Yes

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-->3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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-->4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: This manuscript addresses an important methodological gap in evidence synthesis by developing and validating search hedges intended to improve retrieval of literature related to transgender and gender diverse (TGD) populations. The work is timely given the rapid evolution of terminology related to gender diversity and the well-documented challenges of constructing comprehensive search strategies in this area. The manuscript demonstrates a thoughtful attempt to balance methodological rigor with responsiveness to evolving language. However, several areas would benefit from clarification, expansion, and methodological justification.

The manuscript would benefit from greater clarity and consistency in terminology. The text alternates between several related but distinct terms such as “transgender and gender diverse”, “transgender”, “diverse and expansive gender identities”, and “2SLGBTQIA+”. These terms refer to overlapping but not identical populations and conceptual frameworks. The authors should define these terms clearly and justify their choice of terminology in relation to the scope of the search hedges.

Additionally, it should be acknowledged that some less advantaged communities do not prefer the term “minority”.

The manuscript refers to validation using sensitivity and precision, but it would be clearer to use the more established information-retrieval terminology of *recall* and *precision*. The authors note that:

"search hedges are validated by testing their sensitivity, also referred to as recall, against a 'gold standard' set of known relevant records."

A reference should be provided for this methodological approach, or the authors should verify whether a canonical reference (e.g., from information science or systematic review methodology literature) exists. The statement that hedges are evaluated by:

"their precision, which is the ratio of relevant to irrelevant records retrieved [6]. A challenge of search hedge development is balancing sensitivity and precision, as they are inversely related"

is correct but would benefit from clearer explanation of how this trade-off was operationalized in this study.

The manuscript also states that:

"The hedges were validated for sensitivity using a gold standard set of 144 articles from the Knowsy portal of evidence syntheses tagged as Two-Spirit, transgender, or gender non-binary."

However, further methodological detail is required. For example:

- How were the 144 articles selected and curated in the Knowsy portal?

- Why was this particular dataset chosen as the gold standard rather than other potential sources?

More detail is also needed regarding the screening process described in the manuscript:

"an international research team of subject experts independently screened a randomized sample of search results in a two-stage screening process with an additional screener resolving disputes."

The manuscript should specify how many reviewers were involved, how disagreements were resolved, and whether inter-rater agreement or another measure of consistency was assessed.

The authors should consider whether Homosaurus, a controlled vocabulary widely used for LGBTQ+ information organization, could have been used to identify relevant search terms. If it was considered but not used, the manuscript could explain why. Given that the study addresses evolving terminology, engagement with existing domain-specific vocabularies would strengthen the methodological justification.

The manuscript would benefit from more explicit discussion of how the search hedges translate across databases. Because indexing systems, controlled vocabularies, and field structures vary substantially between databases, readers would benefit from guidance on:

* which elements of the hedge are database-specific,

* how subject headings were mapped across databases, and

* what adaptations are required for implementation in other search platforms.

Some sentences require clarification or expansion. For example, the manuscript states:

"Social science journals have been slower to adopt structured abstracts which can be a barrier to efficient search development [7,8]."

In its current form, this sentence appears disconnected from the surrounding paragraph. The authors should either expand on how the absence of structured abstracts affects search hedge development or remove the sentence.

Similarly, the statement:

"Reviews on topics with developing or dynamic terminology, especially require a more sensitive strategy."

is unclear and should be elaborated. The authors could specify why dynamic terminology—such as evolving gender identity terms—creates challenges for search strategy construction and why higher recall may be necessary in such contexts.

The manuscript advises that:

"When utilizing a search hedge, information professionals and researchers should consider if the hedge has been validated, if it optimizes sensitivity or precision, when it was last updated, and whether it needs to be adapted to suit their specific research question."

This is a useful recommendation, but it would benefit from contextualization. The authors might discuss how often validated search hedges exist in practice, in which fields they are most common (e.g., clinical medicine vs. social sciences), and for approximately how many types of search queries such hedges have been developed.

The authors should also acknowledge limitations of relying on validation against a gold standard dataset. For example:

* new articles published after the creation of the gold standard may not be represented,

* the gold standard itself may omit relevant studies,

* validation results may therefore underestimate or overestimate actual recall.

The manuscript notes that:

"Existing search strategies often fail to capture the full range of gender diversity — particularly when it comes to culturally specific gender identities, Indigenous systems of sex and gender, and evolving gender terminology."

This is an important point but requires additional references and engagement with existing research on the discoverability of LGBTQ+ scholarship and culturally specific gender identities in bibliographic databases.

The authors also state that:

"while other terms that do not currently retrieve many records have been deliberately included for future growth as scholarly research adapts to emerging terminology"

The manuscript should clarify what “future growth” refers to and whose needs this anticipates (e.g., future researchers, evolving academic terminology, indexing updates). Providing concrete examples of such terms would improve clarity.

There are several stylistic issues that could be improved. For example, the sentence beginning in row 98 is unusually long and would benefit from being split or rewritten for clarity.

The manuscript states that:

"Librarian co-authors [REDACTED] and [REDACTED] will maintain and periodically update the hedge to reflect language, indexing practices, and community usage developments."

It would be helpful to specify where these updates will be maintained. The authors might consider discussing whether a platform could be used to host and version search hedges. For example, research infrastructures or methodological repositories could serve as dissemination platforms. In the digital humanities and social sciences, infrastructures such as the *SSH Marketplace* operated by *DARIAH-EU* publish methodological resources; a similar approach could potentially be used for search hedges.

Relatedly, the manuscript states:

"Through active maintenance and user adaptation, these hedges should be refined and expanded to reflect changes in language, indexing preferences, and the needs of researchers working with TGD populations over time."

The authors should clarify whose responsibility such maintenance would be, how updates might be coordinated, and how frequently revisions should occur.

Further methodological clarification is required regarding the screening process. In particular:

* Who conducted the full-text reviews?

* How many reviewers were involved?

* How was subjectivity addressed during relevance assessment?

For example, the manuscript notes that:

"the majority of the articles in this category were coded as TGD-relevant upon examination of the full-text"

The criteria used to determine relevance should be clearly defined, and the procedures for resolving disagreements should be described.

Overall, the manuscript addresses an important methodological challenge and has the potential to make a valuable contribution to evidence synthesis and information retrieval in gender diversity research. Strengthening the methodological transparency, clarifying terminology, and expanding discussion of validation and sustainability would substantially improve the manuscript.

Reviewer #2: I thoroughly enjoyed reading this paper and thought it was well researched and a much needed addition to publications on this topic. I have a few suggested edits, which are:

-Lines 77-78: I found the sentence structure difficult here. Consider changing to "Reviews on topics with developing or dynamic terminology require a more sensitive strategy."

-Lines 79-80: Suggest adding consideration of which database platform the hedge is for

-Line 93: remove the "s" from the end of 'retrieves' as it is referring to 'search hedges'

-Line 145: Consider defining the term "cisgender" when it first appears

-Line 449: Remove "At the same time" from beginning of sentence as it is the beginning of a new section and reads as a continuation of a paragraph instead.

Reviewer #3: Overall, this is a very well written, organized, and clear manuscript on a very relevant topic that fills a gap in research. I believe the methods and conclusions are sound. My suggestions focus on ways to improve clarity.

Lines 74-76: The terms precision and sensitivity can be further defined to provide clarity. I recommend incorporating a brief summary of your definitions of these terms in your previously published protocol.

Lines 96-98: The term “excessive noise” should be defined in terms of what it actually means. In this context, you are using “excessive noise” as a metaphor and not everyone reading this will understand what you mean. You use similar terms (e.g., noisy) throughout the manuscript. Either define it the first time you use it so that it is clear what you mean, or use more precise non-metaphorical descriptions.

Line 115: This is the first time you mention Medline and PsycInfo in the main text (other than the title and abstract). Include Ovid here like you do in the title and abstract just to make it clear that this is the platform you used.

Line 118: Methods section should have a subheading for the Gold Standard Set. The gold standard set--what it includes, how it was developed, why it was selected, and why it is appropriate--are all very important to the validation methods and resulting outcomes. This should be described in detail. Would also be good to briefly discuss external validation vs internal as you did in the protocol.

Line 135: In the “search term selection” section, you state that “we consulted the initial searches used to populate Knowsy,” but I don’t see that this list is publicly available on the Knowsy website, but I may have missed it. Please specify if you got the list from the public website or if you got the list from one of the co-authors in this manuscript who helped to develop or continue to maintain Knowsy. In your previous published protocol, your team acknowledged a possible conflict of interest with two authors of the protocol overlapping with Knowsy. This might need to be acknowledged in this manuscript as well.

Lines 140-143: This last sentence (starting with “cultural specific terms” is a little confusing and could be revised into more simple or straightforward terms for clarity.

Lines 177-179: It would be helpful to clarify why you determined these two databases were the predominant databases in the health sciences and social sciences, and, for example, why you chose to use Medline via Ovid instead of PubMed. I’m not passing judgment on your decision - only asking for clarification.

Lines 187-189: It would be helpful to state why you intentionally aligned with the [tiab] field. This is common for systematic review search methodology but it is good to explain why.

Lines 256-257: Consider numbering the list for clarity. ... five categories: 1) Exclude, 2) No_Abstract, …

Lines 280-284: Consider moving the last two sentences in this paragraph describing how the articles were independently screened by two reviewers to the very beginning of the paragraph. Also, you state that screening was done by at least two “trained reviewers.” Are these trained reviewers the co-authors or other people?

Line 291: It looks like Table 3 is listed in the manuscript before Table 2. Not sure if this matters for the journal formatting, but pointing it out just in case. It does refer to the correct table so is probably okay.

Figures 1 & 2: You explain in your methods that the total number of articles included includes the included articles from the title and abstract screening combined with the included articles from the full-text screening. So, for figure 1, the total included articles is 1,324+339=1,663. This should be visualized in both figure 1 and 2.

Lines 313-315: It may be helpful to include a table with the precision calculations.

Tables 2 & 3: Would be easier to read if abbreviations for INC, EXC, TA, and FT were spelled out on the table. Also, specifying OVID would be more accurate for both databases.

Line 377: Again, specify OVID when naming the databases.

Lines 396-397: May be helpful to specify the “other terms” that retrieve relevant articles for “transperson.”

Lines 464-469: These two sentences about NLM thesaurus changes and the new nonbinary tag in PsycInfo can be further clarified to make it more explicit whether or not you were able to incorporate these changes into your search hedge. I don’t think you did because you completed the search hedge in 2024. This is okay, but the phrasing of the sentences could be more clear and explicit.

Lines 476-478: In final draft, include where (what platform or website) these continuously updated hedges will be made publicly available.

Additional Limitations: Your previously published protocol provides more information about the Knowsy gold standard set of articles, which were collected in 2019. This should be acknowledged as a limitation because it means that your gold standard set does not include recent articles published between 2019-2026, and that your search hedge reflects this. This can be connected back to your discussion regarding the need to consistently update due to evolving language and database functionality and goal of continuing to update and maintain this hedge.

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Reviewer #1: No

Reviewer #2: Yes: Brooke Ballantyne Scott

Reviewer #3: Yes: Hannah M. Schilperoort

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Development and validation of search hedges for transgender and gender diverse (TGD) populations in Ovid MEDLINE and Ovid APA PsycInfo

PONE-D-26-08417R1

Dear Dr. Everhart,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Christina M. Roberts, M.D., M.P.H.

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

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-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->3. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: Thank you for your detailed responses to my comments and for your revisions. I believe this is a strong and relevant article that will add to the knowledge on TGD and LGBTQ+ health research.

I have two additional, connected suggestions.

Comment #1

I understand your hesitance in including a Gold Standard section in your Methods section given the reasons that you provided in your comments to both reviewers. However, both reviewers brought up similar concerns, which means that other readers may also have similar thoughts, which is why I think it would be beneficial to incorporate this into your article. This will give you more control of how readers interpret your work/article.

I continue to advocate that you include a Gold Standard section in your Methods, either as its own subheading or incorporated in the part of the broader Methods section that you think is the most appropriate. You do not need to go over the creation of the gold standard set in detail. Rather, provide a brief explanation of why you chose to use the Knowsy set as your gold standard instead of another set and why it was appropriate to do so. I am not passing judgment on your decision at all, but encourage you to briefly explain your choice in 1-3 sentences.

Comment #2

Thank you for adding the potential conflict of interest to the Limitations section. At the end of the new paragraph you state: “However, this is true for any gold standard data set.” This is true but good to acknowledge, especially for readers who are not as familiar with search hedge validation. My suggestion is to add one or two citations to support this last sentence.

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-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: Yes: Brooke Ballantyne Scott

Reviewer #3: No

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