In this study, we (a) describe patterns of challenging student behaviors (classwide and for a target student with attention deficit hyperactivity disorder [ADHD]) and teacher behaviors (i.e., praise, commands, and responses to challenging behavior) in kindergarten through Grade 5 classrooms, (b) examine the relations between these behaviors, and (c) describe a threshold of teacher behaviors most associated with low levels of challenging student behavior. Participants were 55 teachers observed using a modified version of the Student Behavior Teacher Response (SBTR) system. Across grades, there was variability in rates of classwide challenging behavior per hour (M = 35.81 to 102.62) and rates of praise per hour (M = 10.90 to 37.70). The percentage of challenging behaviors to which teachers responded appropriately was generally low (M = 27% to 47%) and stable across grades. For classwide challenging behavior, higher percentages of appropriate teacher response were significantly associated with lower rates of challenging behavior (b = −.43; p < .01), but effective commands and labeled praise were not. Classwide challenging behaviors dropped to 30 per hour once teachers reach a threshold of 51% appropriate response, with little incremental benefit at higher levels. Implications for professional development and future study of behavior management practices are discussed.

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IntroductionChoosing Wisely, an international effort to reduce low value care worldwide, considers communication between clinicians and patients during routine clinical encounters a key mechanism for change. In Australia, Choosing Wisely has developed a 5 Questions resource to facilitate better conversations. The primary aim of this study is to evaluate the impact of the Choosing Wisely Australia 5 Questions resource and a video designed to prepare patients for question-asking and participation in shared decision-making on (a) self-efficacy to ask questions and participate in shared decision-making, (b) intention to participate in shared decision-making and (c) a range of secondary outcomes. The secondary aim of this study is to determine whether participants’ health literacy modifies the effects of the interventions.Methods and analysisWe will use 2×2×2 between-subjects factorial design (preparation video: yes, no × Choosing Wisely 5 Questions resource: yes, no × health literacy: adequate, inadequate). Participants will be recruited by an online market research company, presented with a hypothetical non-specific low back pain scenario, and randomised to study groups stratified by health literacy. Quantitative primary and secondary outcome data will be analysed as intention-to-treat using appropriate regression models (ie, linear regression for continuous outcomes, logistic regression for dichotomous categorical outcomes).Ethics and disseminationEthical approval for this study was obtained from the University of Sydney Human Research Ethics Committee (protocol number: 2018/965). The results from this work will be disseminated through peer-reviewed international journals, conferences and updates with collaborating public health bodies. Resources developed for this study will be made available to patients and clinicians following trial completion.Trial registration numberThis trial has been registered with the Australia New Zealand Clinical Trials Registry (trial number: 376477) and the stage is Pre-results.

with an MS in Industrial Engineering and PhD in Engineering Education. Dina is a 2016 recipient of the National Science Foundation's Graduate Research Fellowship and an Honorable Mention for the Ford Foundation Fellowship Program. Her research interest focuses on changing the deficit base perspective of first-generation college students by providing asset-based approaches to understanding this population. Dina is interested in understanding how first-generation college students author their identities as engineers and negotiate their multiple identities in the current culture of engineering. Dina has won several awards including the

Objective The use of the Internet for health‐related questions is increasing, but it is not clear whether individuals can understand the information available online. Most health organizations recommend that health educational materials (HEMs) be written below the sixth grade reading level. This study was designed to evaluate the readability level of available online HEMs pertaining to traumatic brain injury (TBI), epilepsy, and posttraumatic epilepsy (PTE). Methods This cross‐sectional readability assessment included HEMs from TBI and epilepsy stakeholder organizations and those obtained from four Internet searches. The search strategy was designed to replicate a nonmedical individual's keyword searches. Each HEM was assessed with an online automated readability tool using three indices (Flesch Reading Ease Score, Flesch–Kincaid Grade Level, and Simple Measure of Gobbledygook). Findings were compared as a function of organization type (journalistic news or health organization), targeted medical condition (TBI, epilepsy, or PTE), or content topic (patient health education, clinical research education, or both). Results Readability analysis of 405 identified HEMs revealed scores above the sixth grade reading level recommendation. Only 6.2% of individual HEMs met the sixth grade recommendation. Journalistic news organizations’ HEMs had similar readability levels to health organizations’ HEMs. PTE‐related HEMs required the highest readability level, >11th grade (P < .001). There were significant differences in the readability scores (P < .01 for all indices) among HEMs with information on health education, research education, or both topics. The highest required readability level (>12 grade level) was for HEMs that included both health and research education. Significance The majority of TBI‐, epilepsy‐, and PTE‐related online HEMs do not meet the sixth grade reading recommendation. Improving the readability of HEMs may advance health literacy around TBI, epilepsy, and PTE, leading to more effective participant recruitment/retention strategies for future antiepileptogenesis trials in persons with TBI and perhaps better patient‐centered outcomes.