A Review of Contemporary Assessment Tools for Use with Transgender and Gender Nonconforming Adults

There is increasing recognition of the need for culturally sensitive services for individuals who identify as transgender and gender nonconforming (TGNC), and only recently have empirical studies appeared in the literature that inform best practices for TGNC people. Competent, culturally appropriate clinical services and research depend upon methodologically sound assessment of key constructs, but it is unclear whether appropriate self-report or clinician-rated assessment tools for adults exist. This article reviewed existing published measures to identify areas of strength as well as existing gaps in the available research. The search strategy for this systematic review identified any published article describing a self-report or clinician-rated scale for assessing transgender-related concerns. Each measure was reviewed for information on its scope, reliability, validity, strengths, limitations, and source. The majority of these questionnaires was developed with the TGNC communities and targeted important factors that affect quality of life for TGNC people. Limitations included limited evidence for validity, reliability, and sensitivity to change. Overall, the field is moving in the direction of TGNC-affirming assessment, and promising measures have been created to monitor important aspects of quality of life for TGNC people. Future research should continue to validate these measures for use in assessing clinical outcomes and the monitoring of treatment progress

Test–Retest Reliability and Sensitivity of a Brief Clinical Monitoring Measure for Transgender and Gender Diverse Adults: The Trans Collaborations Clinical Check-In (TC\u3csup\u3e3\u3c/sup\u3e)

The current study aimed to examine the test–retest reliability and sensitivity of the Trans Collaborations Clinical Check-In (TC3) in a 3-month period with four assessment points at baseline, 1, 2, and 3 months to examine its utility as a clinical progress monitoring measure. This study builds on the initial validation study conducted by Holt et al. (2019). The sample of 32 transgender and gender diverse (TGD) participants were chosen who met screening for at least modest depression and anxiety, and did not have other significant risk factors (e.g., mania, self-harm). Participants completed a battery of measures that assessed mood, well-being, and gender-related constructs at each of the time points in addition to demographic questionnaires. Overall, the TC3 exhibited excellent test–retest reliability. While there was no systematic change in scores, there was some random variation of scores around the mean; and large, within-person correlations between time points. The TC3 also demonstrated convergence with many of the gender-related constructs, and to a lesser degree demonstrated criterion validity with mental health constructs. Further longitudinal study with larger samples in addition to study within intervention frameworks are necessary next steps to understand the utility of the TC3 for assessing systematic change over time. Overall, the current study highlights the initial utility of the TC3 to measure aspects of gender-related well-being across time, such as during health or behavioral health services. Public Significance Statement -- The overall findings of the study suggest that the Trans Collaborations Clinical Check-In (TC3) is a valid and reliable tool for use with transgender and gender diverse (TGD) people in clinical settings, which addresses the dearth of validated, brief TGD-specific assessments that are routine essentials for providing evidence-based care

Keeping the Promise of Community-Based Participatory Research: Integrating Applied Critical Rhetorical Methods to Amplify the Community’s Voice for Trial Development

Community-based participatory research (CBPR) represents an important improvement in the integration of marginalized voices into research programs by including community members in the designs, conduct, and dissemination of studies. CBPR often features a social justice component, generating studies designed to reduce societal disparities and improve outcomes for disenfranchised groups. However, the practical implementation of CBPR usually fails to capitalize on this promise, using the same traditional research methodologies, leadership structures, trial designs, and research questions that inculcate researcher bias. In response to the problem, we propose a new solution: Applied critical rhetorical research (ACRR) integrated into the CBPR approach to clinical health research. ACRR research combines critical/cultural studies and rhetorical methods to amplify the figurative voice of marginalized populations. ACRR can expose how majority power (i.e., hegemony) manifests in social institutions like healthcare and government, where its meanings and subjectivities are absorbed. ACRR analyses enhance CBPR by shaping research in directions that reduce stigma, unintended disenfranchisement, and culturally bound bias, increasing the yield from CBPR for researchers and the community

The Rise of Transgender and Gender Diverse Representation in the Media: Impacts on the Population

In recent years, the transgender and gender diverse (TGD) population has gained a stronger voice in the media. Although these voices are being heard, there are limits on the types of TGD representation displayed in media. The current study interviewed 27 TGD individuals. These interviews exposed how participants view the rise of TGD media representation. The main themes that emerged were TGD awareness and TGD identity discovery and role modeling. Clearly, there is a disconnect between transnormativity in the media and transnormativity in reality

Trans Collaborations Clinical Check-In (TC3): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services

One key aspect of evidence-based psychological services is monitoring progress to inform treatment decision making, often using a brief self-report measure. However, no such measure exists to support measurement based care given the distinct needs of transgender and gender diverse people (TGD), a group facing large documented health disparities and marginalization in healthcare. The purpose of the present study was to develop and provide initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC3). TGD communities, providers identified as TGD-affirmative, and relevant academic experts contributed to item and scale development. The final 18 item version was administered to 215 TGD adults (75 transfeminine, 76 transmasculine, 46 nonbinary, 18 unknown; mean age of 30 with a range of 19 to 73), who were recruited for an online study, with other questionnaires assessing negative affect, well-being, gender dysphoria, gender minority stressors, and resilience. Higher scores on the TC3 (indicating better adjustment and comfort with gender) were generally associated with lower depression, anxiety, minority stress, and gender dysphoria and greater life satisfaction, body congruence, and positive aspects of being TGD such as pride in identity and community belongingness. These results support the validity of the TC3 as a brief measure to be used as a clinical tool for TGD people receiving mental health services. Additional research is needed on the reliability and validity of the TC3 across multiple time points to determine utility as a progress monitoring measure. The TC3 should also be further validated with more culturally diverse samples

Transgender and Gender Diverse Clients’ Experiences in Therapy: Responses to Sociopolitical Events and Helpful and Unhelpful Experiences

We examined transgender and gender-diverse (TGD) people’s reports of their therapy experiences over the course of a year. We explored how participants’ therapists integrated discussions about current events, as well as their more general perspectives on helpful and unhelpful experiences. A total of 107 participants provided data on these questions at least once over 12 months of surveys (M age = 33.79; 70.1% White), reflecting on their current therapy experiences. Through thematic analysis of qualitative data, the following themes were constructed regarding discussing sociopolitical events: (a) facilitating coping via bearing witness to clients’ internal experiences and implementing other therapeutic interventions; (b) moving beyond the individual by integrating identity, systems, or contexts; (c) feeling disconnected and misunderstood. We grouped participants’ helpful experiences into the following themes: (1) availability, connection, and therapeutic approaches facilitate positive experiences; (2) the necessity of knowledge, education, and affirmation of TGD identities; (3) helpful therapy means seeing the world in which clients live. We grouped participants’ unhelpful experiences into the following themes: (1) logistical issues can interfere with therapy; (2) lack of depth and disconnection results in subpar therapy; (3) insufficient understandings of TGD identities results in potentially harmful practices. These findings deepen understandings of how to integrate discussions about current events into therapy and provide competent and affirming care to TGD clients

Impact of sequence variation in the ul128 locus on production of human cytomegalovirus in fibroblast and epithelial cells

The human cytomegalovirus (HCMV) virion envelope contains a complex consisting of glycoproteins gH and gL plus proteins encoded by the UL128 locus (UL128L): pUL128, pUL130, and pUL131A. UL128L is necessary for efficient infection of myeloid, epithelial, and endothelial cells but limits replication in fibroblasts. Consequently, disrupting mutations in UL128L are rapidly selected when clinical isolates are cultured in fibroblasts. In contrast, bacterial artificial chromosome (BAC)-cloned strains TB40-BAC4, FIX, and TR do not contain overt disruptions in UL128L, yet no virus reconstituted from them has been reported to acquire mutations in UL128L in vitro. We performed BAC mutagenesis and reconstitution experiments to test the hypothesis that these strains contain subtle mutations in UL128L that were acquired during passage prior to BAC cloning. Compared to strain Merlin containing wild-type UL128L, all three strains produced higher yields of cell-free virus. Moreover, TB40-BAC4 and FIX spread cell to cell more rapidly than wild-type Merlin in fibroblasts but more slowly in epithelial cells. The differential growth properties of TB40-BAC4 and FIX (but not TR) were mapped to single-nucleotide substitutions in UL128L. The substitution in TB40-BAC4 reduced the splicing efficiency of UL128, and that in FIX resulted in an amino acid substitution in UL130. Introduction of these substitutions into Merlin dramatically increased yields of cell-free virus and increased cell-to-cell spread in fibroblasts but reduced the abundance of pUL128 in the virion and the efficiency of epithelial cell infection. These substitutions appear to represent mutations in UL128L that permit virus to be propagated in fibroblasts while retaining epithelial cell tropism

Caspase-8 scaffolding function and MLKL regulate NLRP3 inflammasome activation downstream of TLR3

TLR2 promotes NLRP3 inflammasome activation via an early MyD88-IRAK1-dependent pathway that provides a priming signal (signal 1) necessary for activation of the inflammasome by a second potassium-depleting signal (signal 2). Here we show that TLR3 binding to dsRNA promotes post-translational inflammasome activation through intermediate and late TRIF/RIPK1/FADD-dependent pathways. Both pathways require the scaffolding but not the catalytic function of caspase-8 or RIPK1. Only the late pathway requires kinase competent RIPK3 and MLKL function. Mechanistically, FADD/caspase-8 scaffolding function provides a post-translational signal 1 in the intermediate pathway, whereas in the late pathway it helps the oligomerization of RIPK3, which together with MLKL provides both signal 1 and 2 for inflammasome assembly. Cytoplasmic dsRNA activates NLRP3 independent of TRIF, RIPK1, RIPK3 or mitochondrial DRP1, but requires FADD/caspase-8 in wildtype macrophages to remove RIPK3 inhibition. Our study provides a comprehensive analysis of pathways that lead to NLRP3 inflammasome activation in response to dsRNA