Beyond compare

An Inclusional Understanding of Giftedness BEYOND COMPARE? THOUGHTS TOWARDS AN INCLUSIONAL, FLUID, AND
NON-NORMATIVE UNDERSTANDING OF GIFTEDNESS
Barry J. Hymer

[Published in The Routledge-Falmer International Companion to Gifted Education, edited by
Balchin, T., Hymer, B.J. and Matthews, D.; London: Routledge-Falmer (2008)]
This chapter is written from the stance of a practitioner researching his own practice as an
educator in the field of giftedness. I describe how a model of gift-creation has emerged
through critical responsiveness to my own practice, and I offer a parallel description of the
conditions under which gifts can be grown – rather than identified. These descriptions
underlie an argument for shifting professional focus from dominant twentieth-century
western rationalist approaches to the field of gifted and talented education, with their
deterministic, dualistic, individualistic, pragmatic, tool-for-result (cf. Vygotsky 1978), and
knowing-centred associations, towards a concept of giftedness which is co-constructed (not
identified) in a social, relationally respectful, activity-oriented, dialectical, tool-and-result
(Vygotsky 1978; Newman and Holzman 1993) manner and context.
At the heart of my own research journey has been a growing dissatisfaction with elements of
my practice as a consultant and trainer in gifted and talented education within the United
Kingdom, and profound concerns with the implications for learners of dominant „mystery‟
models of gifted education (Matthews and Foster 2006). My sense of being a „living
contradiction‟ (Whitehead 1989, 1993) has been nurtured by this dominant discourse at three
levels: a) at the level of content, a perceived emphasis on traditional test-and-place mantras
and an implied belief in the existence of the „naturally gifted‟ student, in the face of
overwhelming evidence of the fluidity of such abstract and socially-constructed concepts as
„intelligence‟ or „ability‟ (e.g., Dweck 1999, 2006; Hart et al. 2004; Sternberg and Davidson
1986; Sternberg 2004a, 2004b; Adey et al. 2007); b) at the level of process, my adoption of a
declarative, superficially authoritative „expert-speak‟ delivery style at conferences,
workshops, and training days, despite a personal commitment to the power and value of
dialogical, co-constructivist practices; and c) at the level of product, an implied faith in the
viability of transferred (i.e., efficiently transmitted) „objective‟ knowledge, understandings
and practices, despite a recognition of the salience of contextual factors in knowledge-
creation and a rejection of the „banking‟ concept of education (Freire 1993).
As a psychologist and educator trained within the standard social sciences tradition of the
neutral, disinterested outsider, I had been conditioned to believe that as a teacher I could
ensure „successful learning‟ principally through focusing my energies on the quality and
rigour of my arguments and evidence-base (an empirical foundation), and the technical
„efficiency‟ and persuasiveness of my presentations (the dark arts and tools of sophistry).
However, the evaluative feedback I have received in the course of recent research (Hymer
2007) has suggested, on the contrary, that beyond certain baseline presentational skills (e.g.,
of timekeeping, voice-projection, pace, use of audio-visual aids, content-audience match,
etc.) only a relatively small part of the significant meanings (deep learning) gained by
participants can be attributable to the course content („knowledge‟) and presentational
technique. What has struck me over the course of my research is how seldom people
comment on being convinced, impressed, or transformed by the „research evidence‟
underpinning an approach – even though „evidence-base‟ (and I mean by this empirical
evidence from within the hypothetico-deductive method) was, and to some extent remains,
one of my most frequently invoked claims to credibility and legitimacy. What they do (and
frequently) comment on is the personal knowledge, by which I include insights, principles, values, beliefs, practices, etc. that they have constructed through dialogue with me and with others. This is for me where learning becomes most real, meaningful, and „inclusional‟ as described by Rayner (2004, p.51): „… the idea that space, far from passively surrounding and isolating discrete, massy objects, is a vital, dynamic inclusion within, around and permeating natural form across all scales of organization, allowing diverse possibilities for movement and communication.‟ It is where knowledge transcends any single „knower,‟ and in the spirit of the African tribal concept of ubuntu, the dialectical unity of knowledge reflects the strength of its community of learners – being simultaneously distributed and personalised, dispersed but not attenuated, directed but also reciprocal: A culture in its very nature is a set of values, skills and ways of life that no one member of the society masters. Knowledge in this sense is like a rope, each strand of which extends no more than a few inches along its length, all being intertwined to give a solidity to the whole. The conduct of our educational system has been curiously blind to this interdependent nature of knowledge. We have „teachers‟ and „pupils,‟ „experts‟ and „laymen.‟ But the community of learning is somehow overlooked. (Bruner 1966, p.126) I sent this passage to my friend and colleague Marie Huxtable, inviting her thoughts, and received this response (e-mail dated 30 July 2006): I like the analogy …. When I first started struggling with high ability ideas I did a talk where I used the image of a plait - with means, motives and opportunities as the strands. I think a „challah‟ is better - that is a plaited bread - each strand is still distinct but impossible to separate from the other - each is the whole so to speak - and bread with its link with life I quite like as well. Marie‟s image resonated with me. Perhaps significant in her development of the analogy from rope to challah is the possible further progression of the metaphor: the implication that the indivisibility of the breaded strands is most apparent when these are baked. Is the presentational or workshop content nothing but the raw materials, the doughy mix? Its planning and „delivery‟ the plaiting? But does dialogue do the baking? Certainly the dialogical methods of Socrates, Wittgenstein, Bakhtin, Lipman, Vygotsky, and others see little merit in the instrumental constructions rejected by Bruner (above), preferring the dialectical unity of reciprocal meanings, co-constructed. Where once I believed I had a choice to make between a) a rationalist, deductive route to the teaching and learning dialectic, and b) a romantic, purely inductive alternative – or maybe c) a hybrid of the two – I now acknowledge the generative-transformational power of the relational, social element. It is an avenue well-advanced by Friedman: The true teacher is not the one who pours information into the student‟s head as through a funnel – the old-fashioned „disciplined‟ approach – or the one who regards all potentialities as already existing within the student and needing only to be pumped up – the newer „progressive‟ approach. It is the one who fosters genuine mutual contact and mutual trust, who experiences the other side of the relationship, and who helps his pupils realise, through the selection of the effective world, what it can mean to be a man. I have over time and in response to feedback become emboldened by the realisation that on occasion to replace the propositional, declarative, expert-speak mode of presentational style with one more dialogical, fallible, and open to correction and provocation has carried fewer dangers than I‟d feared, and provided more space for the living of such values as individual intellectual respect and the conditions conducive to generative-transformational giftedness. I use the term „generative-transformational giftedness‟ tentatively because I see it as embodying not so much a reified „thing,‟ as we have objectified „intelligence‟ or „giftedness‟ in the 20th century, but rather a limpid process-state, fluid and changeable, and simultaneously both a value in and of itself, and a relational outcome. What I describe as generative-transformational giftedness, and the conditions under which I suggest it arises, is proposed as a theoretical scientific model – not a literal picture of „reality‟ – but a personally meaningful, partial, and provisional way of imagining the unobservable. The model is influenced by the Deweyan (and proto-Vygotskyan) emphasis on the significance of the future in the present: „Everything we see in children is transitional, promises and signs of the future … not to be treated as achievements, cut off and fixed; they are prophetic, signs of an accumulating power and interest.‟ (Dewey 1902, p.14) This in turn anticipates the malleable or incremental self-theory of intelligence described by Dweck: „For (people holding an incremental view of intelligence) intelligence is not a fixed trait that they simply possess, but something they can cultivate through learning.‟ (1999, p.3) There is also a clear connection to the Marxian-Vygotskyan concept of development as continuously emergent, relational human activity – with the search for method as being necessarily „tool-and-result‟ (Vygotsky 1978) rather than „tool-for-result‟. Neither the tool (e.g., my presentation of „good knowledge‟) nor the result (e.g., the insights and learning demonstrated by the audience-responders) is, except in a shallow transmission-of-knowledge sense, independently meaningful – they exist synergistically, reciprocally, germinating together, „… influencing each other in complex and changing ways as the totality tool-and-result develops‟ (Holzman 1997, p.58). This is for me most in evidence not in the full flow of presentation-mode, but in the gaps, the hiatuses, the moments of reflection, challenge, and dialogue with the community, where I can jettison the declarative „expert-speak‟ power-over position in favour of something much more social, relational, activity-oriented, and dialectical in its nature. In the words of one participant at a whole-school training event (23 September 2005): „I have learned a lot in this session – but I don‟t think he “taught” me anything. How has this happened?‟ It is at these moments that I can inform and develop my own grasp of the subject matter, refining, cultivating, pruning – growing it, and an „audience‟ can do the same. In short, I have come to see myself as performing when delivering a well-rehearsed „script‟ (past learning), but as performing above myself when in true dialogue with others (new, two-way learning). In the Vygotskyan sense, this performatory function is associated with learning, not ego, and betrays no sense of inauthenticity or deception. We wear a mask without inhibition or guilt – to „act up,‟ to play the „role‟ of learner, and through this play to habituate to and advance within the learning role. In the words of Keleman (2001, p.95), „In the facades we put on for others we demonstrate our potential.‟ The gaps are significant. It may be no accident that teachers who hold as inviolable their pupils‟ capacities to think for themselves and to remember that „a body of knowledge is given life and direction by the conjectures and dilemmas that brought it into being and sustained its growth‟ (Bruner 1966, p.159) often eschew the hegemonic concept of teaching to ability (and for which mixed-ability classes are by definition no antidote) in favour of inclusivity of opportunity, open-ended learning outcomes, creativity, challenge, and personalised enquiry (Hannaford 2005; Hart et al. 2004; Jeffrey and Woods 2003; Mant et al. 2007; Wilson et al. 2005). A vivid example from Hart et al.‟s seminal study is Anne, a Year 1 teacher who talks about children‟s „spontaneous, unpredictable acts of meaning-making‟ (p.63) happening in the gaps: There has to be a structure, with gaps in .…‟ Is this an adequate or a satisfactory definition of a learning without limits school or classroom? Only if there is an accompanying account of what might fill those gaps. She is abundantly clear: with the children‟s acts of meaning-making, problem-solving, invention, imagination and discovery. Anne and her colleagues, the constraints of [official requirements] and so on, may set the structures, but in the gaps, the children take the lead (pp. 64-65). It is in these social, relational, activity-oriented, generative-transformational, dialectical moments that I personally have sensed a vitality and engagement amongst the communities with which I work, moments where they and I can discard our received roles as teacher/student, expert/novice, actor/spectator, full jug/empty glass, and take on a different stance, showing the value of individual intellectual respect for our uniquely constructed meanings, and permitting the creation of generative-transformational giftedness – embracing those fluid, inclusional conditions which nurture thinking with clarity, insight, and creativity, to produce new meanings and create new products and achievements. As part of my research into my own practice as an educator in the field of giftedness, I have invited participants to comment directly on their experiences of me, and the „degree of fit‟ they perceive between my message and my practice. I have also invited them to reflect more introspectively on their own values, practices, and educational intentions and ambitions. In reviewing post-event evaluation returns, I am encouraged if individuals feel they have had the opportunity to be part of the experience, not just the recipient of it, to have been challenged to think critically for themselves – even (especially?) to the point of rejecting aspects of my own „truth,‟ to ask their own questions not just to respond to mine, and to sense a congruence between my implicit values and my explicit practice: „Our values need to be seen in lived relation with others. For them to make sense, the values themselves need to be understood as real-life practices, not as abstract concepts.‟ (Whitehead and McNiff 2006, p.58) I am encouraged, because it is at these times that I see generative-transformational giftedness in gestation and emergence, evidence of my living my core personal and educational values and realising the relationally dynamic epistemological standards of judgment which are both consisting in and attendant on these values. I have come to use the notion of generative-transformational giftedness in pursuit of conceptual clarity, yet recognising its complexity and its association with established meanings. This brings with it both possibilities and hazards. As intimated earlier, what I mean by invoking the term „giftedness‟ is giftedness in a non-psychometric sense of „gifted disposition‟ – a tendency to think with clarity, creativity, originality, and insight in a certain way under certain conditions. This draws on but also extends the term as used by Perkins et al. (1993), who define a disposition as a „tendency to think or behave in certain ways under certain conditions.‟ What are the „ways‟ and the „conditions‟ specifically in relation to generative-transformational giftedness? I suggest that these are categorisable under the following five emergent criteria for gift-creation, captured
in the acronym, G-T CReATe1:
Generative-Transformational

„Poor is the pupil who does not surpass his master‟
This super-ordinate term is borrowed from McNiff et al., who note, „This idea of generative
power acts as the basic unit of energy whereby each thing may transform itself endlessly in
the process of its own realisation of potential‟ (McNiff, Whitehead and Laidlaw 1992, p.35).
It draws also on the notion of praxis as used by Freire (1993), as the generative combination
of reflection and action which exist „… in such radical interaction that if one is sacrificed –
even in part – the other immediately suffers. There is no true word that is not at the same time
a praxis. Thus, to speak a true word is to transform the world‟ (p.68).
Within the field of giftedness, the generative-transformational element is realised when the
conditions are created for the learner‟s transcendence from the particular known to the
indeterminate unknown, and the resultant creation of a new insight, meaning, service or
product which fell outside the predicted range of expectations for that learning episode. There
is a clear implication here, that the generative transformational (G-T) criterion is unlikely to
be met in the traditional objectivist classroom, with its linear progression from assumed
ignorance to received enlightenment, and in which all educational tools are bent to the will of
(existing) knowledge transmission. Rather, the generative transformational criterion is more
easily met in the co-constructivist classroom of active, collaborative, learner-driven, and
metacognitive learning (Watkins et al. 2007), where existing meanings can be worked on,
challenged and transformed, generating new connections and new meanings.
Contradictory/Dialectical

‟Without contraries, there is no progression‟ We learn most from the moments that jar, not from the moments that gel. In the words of a teacher at a recent (18th October 2007) school training day, „I learn best when I‟m intellectually uncomfortable – that‟s what really stretches me.‟ The contradictory-dialectical (C) criterion for gift-creation comprises the catalytic reaction which comes about in response to the juxtaposition of ideas, thoughts, beliefs, and experiences which have an analytical tension at the surfaces, but synthetic power in the depths. In this instance, I argue that the meanings generated by the speakers consist of a dialectical unity, not a relationship of cause or tool (e.g., the teacher‟s presentation of content to her class) and effect or result (e.g., a consequent „comprehension‟ transmitted to the listeners), but rather a Platonic understanding that permits multiple, contradictory ways of thinking, and a simultaneous holding of the one and the many. „(T)he dialectical unity rather than metaphysical duality was central [to the totality of Vygotsky‟s enterprise]‟ (Holzman 1997, p.59). Whilst this might ultimately resolve itself as a preference for one thought or solution over another, this is not required, and it may 1 This model, and its theoretical underpinnings, are described in more detail than can be accommodated in this chapter in a forthcoming book, Gifted and Talented: A Living Theory Approach by B.J. Hymer, J. Whitehead & M. Huxtable (London: John Wiley, in press) not even be desirable: „The beginning of wisdom is the discovery that there exist
contradictions of permanent tension with which it is necessary to live and that it is above all
not necessary to seek to resolve.‟ (Gorz, quoted in Ball 1998, p.81)
Relational
‟In all things we learn only from those we love‟ (Johann Wolfgang von Goethe - 1749–1832.) The relational (R) criterion is characterised by a power-with or power-through rather than power-over relationship between teacher and student – a relationship which is respectful of the different-ness of the other, yet also secure in one‟s own integrity and open to the creation of something new – „All real living is meeting‟ (Buber 2002, p.xiv). The relational element is germane to the field of gifted education, as it is to all true education, and it is this element that prevents the field from being reduced to arguments over the merits or otherwise of such „technical fixes‟ as acceleration, or to a reliance on the direct instruction of the keyboard age. We respond best to those who convey the unmeasurable virtues of empathy, trust, congruence, and recognition, and this has implications for us as educators: we see the power of the relational especially when this is harnessed with the (intellectually) activity-oriented dimension (below), as in this mother‟s reflections on the re-creation of her son‟s „giftedness‟: This academic year our very bright six-year-old son is absolutely loving school. Why, after two years of absolute trauma, boredom and deliberate misbehaviour, has our son become a motivated, excited, learning-driven child? I put it down to one thing: the teacher. She likes him, she knows how to challenge him mentally, and to make work fun. She pitches work at the right level for him, and is firm when she needs to be. So here‟s three very heartfelt cheers to all those teachers out there, who are challenged by these kids, rather than see them as a problem. (Mother on a high-ability weblist, posting, December 2004) The response to this posting, from a Dutch educator, captures beautifully the respectful, relational „we‟ in this gift-creating dynamic: The enrichment tasks teachers write can be very challenging and inspiring, but if they fail to motivate, give just and fair feedback, approach the kids as seriously as they do their friends and colleagues, then the whole project very often fails. (Heleen Wientjes, Utrecht University, high-ability weblist posting December 2004)
Wientjes‟ comment echoes Hargreaves‟ study of interpersonal relations in education (1975),
as much as it does Freire‟s belief that „[The teacher‟s] efforts must be imbued with a
profound trust in people and their creative power. To achieve this, they must be partners of
the students in their relations with them.‟ (Freire 1993, p.56)
Activity-oriented
„I‟m a playing boy, not a working boy‟ The activity-oriented (A) criterion is evident in the context of active participation in a
learning experience: that intellectual activity generated in a learning episode that leads to the
creation of meaning in the minds of the community. It arises from dialogical activity that is
generated between the various members of the learning community, and is a function of the
quality of that external and internal (reflective and metacognitive) dialogue. Bruner (1966,
p.117) speaks of „the energising lure of uncertainty made personal by one‟s effort to control
it‟, and proceeds to argue that, „To channel curiosity into more powerful intellectual pursuits
requires precisely that there be (a) transition from the passive, receptive, episodic form of
curiosity to the sustained and active form.‟ (p. 117)
Watkins et al. (2007) regard active learning as being one of five core classroom processes for
promoting effective learning, and understand the term to go way beyond „learning by doing‟,
to involve elements which are variously behavioural (the use and creation of materials),
cognitive (the construction of new meaning), and social (the engagement with others as
collaborators and resources). It is this integrated sense of „active‟ that is embraced in the G-T
CReATe model, a Vygotskyan method which „…is activity-based rather than
knowledge/epistemology-based … Knowledge is not separate from the activity of practising
method; it is not “out there” waiting to be discovered through the use of an already-made
tool.‟ (Holzman 1997, p. 52)
Temporal/Social

‟Whilst a child can think for herself, she can‟t think by herself‟ Traditional western conceptualisations of giftedness have tended to emphasise the majesty of the individual mind over the humility of the social mind – what might be termed the „exo-mind‟. The wisdom of this emphasis can be questioned in the light of what we know about how, in reality, knowledge tends to be generated – rarely through some lonely spasm of intellectual brilliance, but more frequently through a hard and social passage in which knowledge is shared, challenged, modified, and built upon. John Waller (2004) concludes his careful exploration of scientific breakthroughs with the reflection that no achievement in science is exclusively the product of one brain. And the eminent twenty-first century scientist, Gill Samuels (inventor of Viagra, amongst other pharmaceutical breakthroughs) observed in an interview that she „… was one of a team of a thousand, it took us thirteen years, and we didn‟t set out to invent Viagra‟ (The Independent, 9 June 2005) – at a stroke capturing the essence of the Temporal-Social (Te) element in the G-T CReATe model: the creative harnessing of the exo-brain, dogged persistence over time, and the flexibility to connect unexpected findings with alternative objectives. Within this model, the social element is social in the Vygotskyan sense that „what I can do with your help today, I can do alone tomorrow,‟ in Rayner‟s (2004) sense of inclusionality, or in the African cultural notion introduced earlier, of ubuntu – „I am who I am because of who we all are.‟ The Temporal-Social element of this model leads one to expect divergences from linear-sequential expectations in gifted performance (e.g., David Jesson‟s research at York University, which found that only 28% of pupils identified as gifted or talented in primary school went on to achieve their expected three A-grades at A-level, whilst many teenagers not previously highlighted as very able did achieve top grades), whereas traditional models are puzzled by such divergences, or seek to „fix‟ these through ever more rigorous tracking and monitoring procedures, and ever-younger identification – within the United Kingdom, as early as four. Having discussed the components of the G-T CReATe model, it is now possible to offer a compare-and-contrast representation of the values underpinning the traditional conceptualisation of giftedness, and those of the proposed model, as well as a brief summary of their contrasting emphases within the school and classroom: It remains to be seen whether, in the twenty-first century, educational policy will remain committed to the identification of the individually gifted child, and consequent provision for her needs, or instead will embrace the practical implications of „mastery‟models (Matthews and Foster 2006) such as G-T CReATe, which eschew gifted identification for a clearer focus on gift-creation. While the latter ambition is the more demanding, it is my belief that it is educationally more authentic. References
Adey, P.,Csapo, B., Demetriou, A., Hautmaki. J. & Shayer, M. (2007) „Can we be intelligent about intelligence? Why education needs the concept of plastic general ability.‟ Educational Research Review, 2:2, 75-97 Ball, S.J. (1998); Educational studies, policy entrepreneurship and social theory; in R. Slee, G. Weiner & S. Tomlinson (eds), School Effectiveness for Whom? Challenges to the School Effectiveness and School Improvement Movements; London: Falmer Press Bruner, J.S. (1966); Toward a Theory of Instruction; Cambridge, MA: Harvard University Buber, M. (2002); Between Man and Man; London: Routledge Classics Dewey, J. (1902); The Child and the Curriculum; Chicago: University of Chicago Press Dweck, C.S. (1999); Self-Theories – Their Role in Motivation, Personality and Development; Dweck, C.S. (2006); Mindset – The New Psychology of Success; New York: Random House Freire, P. (1993); Pedagogy of the Oppressed; London: Penguin Books Hannaford, C. (2005); Fairer Schools: Fairer Society; Utbildung & Demokrati; Sweden: Hargreaves, D.H. (1975); Interpersonal Relations and Education; London: Routledge & Hart, S., Dixon, A., Drummond, M.J. & McIntyre, D. (2004); Learning Without Limits; Holzman, L. (1997); Schools for Growth – Radical alternatives to current educational models; New Jersey: Lawrence Erlbaum Associates Hymer, B.J. (2007); How do I understand and communicate my values and beliefs in my work as an educator in the field of giftedness? Doctoral dissertation, University of Newcastle Upon Tyne Jeffrey, B. & Woods, P. (2003); The Creative School – A framework for success, quality and 00/52, Department of Economics, University of York Kelemen, L. (2001); To Kindle a Soul; Southfield, Michigan: Targum Press Mant, J., Wilson, H. & Coates, D. (2007) „The Effect of Increasing Conceptual Challenge in Primary Science Lessons on Pupils' Achievement and Engagement‟ in The International Journal of Science Education, 29(14), 5 November, 2007, pp. 1707-1719 Matthews, D.J. & Foster, J.F. (2006) „Mystery to mastery: Shifting paradigms in gifted education‟, Roeper Review, vol. 28, no. 2, pp. 64-69. McNiff, J., Whitehead, J. & Laidlaw, M. (1992); Creating a Good Social Order Through Newman, F. & Holzman, L. (1993); Lev Vygotsky: Revolutionary Scientist; London: Rayner, A.D.M. (2004); Inclusionality and the Role of Place, Space and Dynamic Boundaries in Evolutionary Processes, Philosophica, 73, 51-70 Sternberg, R.J. (2004a); Introduction to Definitions and Conceptions of Giftedness; in Essential Readings in Gifted Education, Volume 1: Definitions and Conceptions of Giftedness; London: Sage Sternberg, R.J. (2004b); Lies We Live By: Misapplication of Tests in Identifying the Gifted; in Essential Readings in Gifted Education, Volume 2: Identification of Students for Gifted and Talented Programs; London: Sage Sternberg, R.J. & Davidson, J.E. (1986); Conceptions of Giftedness; Cambridge: Cambridge Vygotsky, L.S. (1978); Mind in Society; Cambridge MA: Harvard University Press Waller, J. (2004); Leaps in the Dark: The Making of Scientific Reputations; Oxford: OUP Watkins, C., Carnell, E. & Lodge, C. (2007); Effective Learning in Classrooms; London: Whitehead, J. (1989); Creating a Living Educational Theory from Questions of the Kind, „How Do I Improve my Practice?‟; Cambridge Journal of Education, 19, 1, pp.41-52 Whitehead, J. (1993); The Growth of Educational Knowledge – Creating your own living Whitehead, J. & McNiff, J. (2006); Action Research Living Theory; London: Sage Wilson, H., Mant, J. & Coates, D. (2005); Creative Science and Conceptual Challenge: Lessons from the AstraZeneca Science Teaching Trust Project; G&T Update, Issue 22, March 2005, pp.5-7 Two models of giftedness, reflecting contrasting ontological and epistemological stances Traditional
G-T CReATe
Conceptualisation
Conceptualisation
creation; happens at moments of coincidence between opportunity and need methodologies for dissemination and championing performance over time? progression in performance intelligence and learning- or mastery-led orientation

Source: http://www.ncl.ac.uk/cflat/news/documents/HymerFINALroutledgencl.pdf

Microsoft word - discography.doc

Patient Education Handout LUMBAR DISCOGRAPHY (Disc Stimulation) The discs of the spine may develop tears in the outside lining that holds the spongy, shock absorber part of the disc inside. The disc may then become painful causing pain due to nerves that grow into the disc where there should be none. Movement then causes severe back pain due to these new nerves being compressed.

New hope available for fibromyalgia and chronic fatigue sufferers - carrollwood, fl patch

New Hope Available for Fibromyalgia and Chronic Fatigue Sufferers - Ca. http://carrollwood.patch.com/articles/new-hope-available-for-fibromyalg. Hi, Deborah! Log Out Change Towns Follow this Patch Editor Camille C. Spencer : Covering Carrol wood and Northdale Marketplace Volunteer Opinion , The Neighborhood Files New Hope Available for Fibromyalgia and Chroni

Copyright © 2010-2019 Pdf Physician Treatment