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Purpose: A cancer diagnosis can result in a considerable financial burden to individuals and their households. This study aimed to investigate this problem in patients treated for melanoma brain metastases. Methods: An economic evaluation was conducted as a sub-study of a randomised controlled trial of whole brain radiotherapy (WBRT) versus observation following surgery and/or stereotactic radiosurgery (SRS) for 1-3 melanoma brain metastases. Employment status and pre-tax household income were measured at baseline and every 2 months for 12 months. Outcomes included changes in employment status or household income category at 12 months. Results: Of 125 patients, 64 were included in the analysis, 31 randomised to WBRT and 33 to observation, 61 patients were excluded because they were not in the workforce at baseline (42) or were unsure about their income (19). Mean age was 61 years (range 27-88), 37 (58%) completed employment questionnaires and 61 (96%) completed income questionnaires at baseline. Prior to treatment, 39% worked full-time, 8% part-time and 53% were unemployed. At 12 months, 23%, 12% and 65% individuals were employed full-time, part-time and unemployed, respectively. Job status change and household income at 12 months were not significantly different between the two treatment groups (p=0.18 and 0.87, respectively). Conclusions: A substantial proportion of patients experienced job loss after treatment of melanoma brain metastases, however this was similar for those undergoing WBRT or observation alone. Strategies to reduce the impact for both groups (e.g., financial counselling, employment rehabilitation) could be implemented by clinicians and allied health workers.

Purpose News reporting on mental illness can perpetuate stigma. An understanding of the current picture of such reporting is important to identify areas for improvement. This study investigated the quality of Australian news media coverage of complex mental illness in the context of crime and violence over a 2-year period, prior to the release of new media guidelines. Methods This research utilised a systematic search of Australian news articles that were published between July 2018 and July 2020 and reported on mental illness in relation to violent crime. Researchers developed a Mental Illness and Crime Reporting Quality Framework to determine quality scores for news articles according to 11 relevant factors in media guidelines. An additional 11 characteristics of articles were extracted for further descriptive analysis. Results One-hundred and twenty-eight Australian news articles met inclusion criteria. The average quality score was 50 (SD = 13.91) out of a possible maximum score of 100 (range 11 – 78). Strengths and weaknesses were identified as some criteria were consistently met, and other criteria were met rarely or not at all. There were emerging trends between quality scores and article characteristics, including publication source, though these analyses were not statistically significant. Conclusion The findings indicate that Australian news coverage of complex mental illness and violent crime met half of the criteria of reporting guidelines that minimises risk of perpetuating or reinforcing stigma. This demonstrates significant opportunity to improve the overall quality of media reporting on crime and mental illness. Future research should evaluate the impact of the guidelines on the quality of news reporting after their implementation by utilising a similar methodology, using these findings as a baseline measure.

Lentigo maligna (LM) is a common in situ melanoma subtype arising on chronically sun-damaged skin and mostly affects the head and neck region. Localisation in cosmetically sensitive areas, difficulty to obtain wide resection margins and advanced patient age/comorbidities have encouraged investigation of less invasive therapeutic strategies than surgery in managing complex cases of LM. Radiotherapy and imiquimod have emerged as alternative treatment options in this context. The treatment of LM with imiquimod cream can be challenging due to the nature of the disease including its often large size, variegated appearance, involvement of adnexal structures, poorly defined peripheral edge and frequent localisation close to sensitive structures such as the eyes and lips, and elderly patients with multiple comorbidities. Prolonged and unpredictable inflammatory reaction and side effects and compliance with a patient-delivered therapy can also be challenging. In the literature to date, studies evaluating the use of imiquimod to treat LM have utilised varying methodologies and provided short follow-up and these limitations have impaired the development of clear guidelines for dosage and management of side effects. Based on our multidisciplinary experience and review of the literature, we propose practical clinical strategies for the use of imiquimod for treating LM, detailing optimal administration procedures in various clinical scenarios and long-term management, with the aim of facilitating optimal patient outcomes.

Introduction: Hair colour is determined by varying ratios of black-brown eumelanin and reddish-brown/reddish-yellow pheomelanin. Hair colour change has been reported with cancer therapies. Radiotherapy (RT) usually causes temporary epilation to permanent alopecia. A change in hair colour following radiation is rare and usually results in depigmentation. There has only been one other case reported of repigmentation after RT. Cases: We present five cases of changes to scalp hair pigmentation in the penumbral region in patients treated with volumetric modulated arc therapy (VMAT) for skin cancer. Five treated areas across four patients involved repigmentation from grey to black, and there was one case of depigmentation from brown to grey. The latter occurred during immunotherapy administration. For the two cases where recalculation of the dosimetry was possible for three areas, repigmentation changes happened at an average mean dose of 16 Gy (9.3 – 26 Gy) in an average of 26 (25 - 27) fractions; that is, 0.6 Gy per fraction at five fractions per week. Discussion: This series of six areas in five patients of hair colour change in the penumbral region of VMAT to the scalp for skin cancer is the first report of this phenomenon. Repigmentation of scalp hair with RT is rare. Even though rare, the potential for hair colour change may need to be part of the informed consent discussion in patients contemplating this treatment.

Introduction: Whole brain radiotherapy (WBRT) is a common palliative treatment for brain metastases from solid tumours. Traditionally, it is given with opposed lateral fields causing total alopecia as hair-bearing scalp skin receives the full dose. Volumetric modulated arc therapy (VMAT) can deliver WBRT with a simultaneous integrated boost (SIB) to larger metastases whilst minimising dose to critical structures such as the hippocampus. This feasibility study aimed to test the hypothesis that a reduced dose to the scalp using a VMAT hair-sparing WBRT protocol would spare scalp hair and reduce alopecia at four weeks post treatment without compromising disease control at three months. Methods: The Hair Spare study (01.07 WBRTMel sub-study SS01.13) was an investigator-initiated, prospective feasibility study. A VMAT hair-sparing WBRT protocol was developed to limit the dose to the scalp to 16 Gray (Gy) in 15 fractions. The primary objective was the rate of alopecia at 4 weeks post RT as measured by CTCAE v4 and clinician and patient perception. Quality of life (QoL) was assessed at baseline, one month and three months post treatment with validated instruments including European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ-C15-PAL+4) plus four additional questions specifically relating to hair, a visual analogue scale (VAS) to measure the perception of hair loss severity, and the total Chemotherapy-Induced Alopecia Distress Scale (CADS). Results: Nine patients with brain metastases from melanoma (6), breast (2) and lung (1) cancer were enrolled at the Mater Sydney Hospital, Crows Nest, Australia. At 4 weeks, 5 patients were evaluable: 4 reported moderate alopecia (CTCAE v4 Grade 2) and 1 reported mild alopecia (CTCAE v4 Grade 1). All 5 wore wigs or scarves to hide hair loss. Any amount of hair loss impacted QoL. Reduced hair loss compared to complete alopecia, as usually found with conventional WBRT, did not translate to a mean improvement in QoL. There was no symptomatic intracranial progression of disease while the patients remained on study. Two patients had MRI at 3 months, and both had evidence of intracranial progression of disease within the volume that had received prescription WBRT dose. From the data collected it seems that VMAT hair-sparing WBRT was well-tolerated. Conclusion: VMAT hair-sparing WBRT partially spared scalp hair at four weeks post WBRT and did not compromise symptomatic disease control during the study. The treating oncologists observed that the hair grew back quicker than with conventional WBRT, and that combined cytotoxic chemotherapy was additive to RT-induced alopecia. However, the study was not optimal in that data collection was hampered by patient availability. The patient population was too unwell to be followed up according to the protocol.

Purpose We aimed to compare Australian health system costs at 12 months for adjuvant whole-brain radiotherapy (WBRT) treatment after stereotactic radiosurgery (SRS) and/or surgery versus observation among adults with one to three melanoma brain metastases. We hypothesized that treatment with adjuvant WBRT and subsequent healthcare would be more expensive than SRS/surgery alone. Methods The analysis was conducted alongside a multicentre, randomized phase III trial. A bespoke cost questionnaire was used to measure healthcare use, including hospitalizations, specialist and primary care visits, imaging, and medicines over 12 months. Mean per-patient costs were calculated based on the quantity of resources used and unit costs, reported in Australian dollars ($AU), year 2018 values. Skewness of cost data was determined using normality tests and censor-adjusted costs reported using the Kaplan–Meier sample average method. The analysis of diference in mean costs at each 2-month time point and at 12 months was performed and checked using Kruskal–Wallis, generalized linear models with gamma distribution and log link, modifed Park test, ordinary least squares, and non-parametric bootstrapping. Results In total, 89 patients with similar characteristics at baseline were included in the cost analysis (n = 43 WBRT; n = 46 observation). Hospitalization cost was the main cost, ranging from 63 to 89% of total healthcare costs. The unadjusted 12-monthly cost for WBRT was $AU71,138 ± standard deviation 41,475 and for observation $AU69,848 ± 33,233; p = 0.7426. The censor-adjusted 12-monthly cost for WBRT was $AU90,277 ± 36,274 and $AU82,080 ± 34,411 for observation. There was no signifcant diference in 2-monthly costs between groups (p > 0.30 for all models). Conclusions Most costs were related to inpatient hospitalizations associated with disease recurrence. Adding WBRT after local SRS/surgery for patients with one to three melanoma brain metastases did not signifcantly increase health system costs during the frst 12 months. Trial Registration ACTRN12607000512426, prospectively registered 14 September 2007

BACKGROUND: The evidence-based management of melanoma patients with a positive sentinel lymph node biopsy (SLNB) has undergone a dramatic shift following publication of practice-changing surgical trials demonstrating no melanoma-specific survival advantage for completion lymph node dissection (CLND) in this scenario. We aimed to survey how surgeons' clinical practice had shifted in response to new evidence from these trials, and at a time when there was starting to become available systemic adjuvant treatments for AJCC Stage III melanoma patients. METHODS: A web-based survey consisting of practice-based questions and hypothetical clinical scenarios about current melanoma practice with regard to positive sentinel node biopsy was developed and sent to the surgical members of a Melanoma and Skin Cancer (MASC) Trials group in December 2018. Responses were analysed using descriptive statistics. RESULTS: There were 212 invitations sent and 65 respondents (31%). Respondents were from 17 countries, 94% of whom practice in specialist melanoma centres or at referral centres. Of these 97% were familiar with the MSLT2 and DeCOG-SLT clinical trials. At survey, 5% of respondents reported routinely recommending CLND and 55% recommend CLND in selected cases. Respondents were most likely to recommend CLND when multiple SLNs were positive. Important factors for surgical decision-making mentioned included size of SLN deposit, number of positive SLNs and likely compliance with the recommended surveillance regimen. CONCLUSION: In line with rapid adoption of published evidence, surgical management of Stage III melanoma has altered significantly, with few surgeons within the cohort now performing routine CLNDs after positive SLNB.

COVID-19 has brought with it an increase in predictions of mental ill-health and suicide impacts in Australia. For journalists, it has been a period not only of personal stress about their economic livelihoods and occupational safety, but also balancing providing up to date information about the pandemic with safe, sensitive and accurate reporting on associated suicide and mental health issues. Mindframe offers guidelines, resources and individualised support to help manage the complexities of reporting on suicide in this global pandemic, working with media to protect people in their audience who are vulnerable to suicide while also helping journalists protect their own mental health and well being.

Dialogue between diverse publics and scientists is essential to ensuring that fast-moving research such as neuroscience delivers knowledge and technologies that meet society’s needs, and align with its values. In Australia, neuroscience engagement programs typically promote brain research to the publics, rather than seek their input. We argue for a shift to Responsible Research and Innovation (RRI)-type engagement, where scientists share their knowledge, and non-scientists share their attitudes, needs, insights and expectations, starting early in the technology-development pathway. This would allow the developmental pathway to be modified to meet society’s needs and mores. We have developed a prototype RRI engagement program for neuroscience, adapted to local Australian conditions, called The Brain Dialogue. Our preliminary results suggest it is possible to alter developmental pathways. Here, we describe its components: knowledge sharing; structured issues-driven activities that include diverse st...

Metastases of cutaneous squamous cell carcinoma (cSCC) in surgical sites distant from the primary lesion is anecdotally regarded as common but seldom reported. Patients with this condition usually have surgical treatment of the metastasis. The presented case is a 77-year-old immunocompetent male. He had surgery for a scalp primary cSCC that was closed with a split thickness skin graft (SSG). He developed a four centimetre (cm) solitary symptomatic metastatic cSCC in the SSG donor site on the right thigh 3 months after graft harvesting. There was a complete response of this metastasis following definitive curative radiotherapy until death from further metastatic disease six months later. Radiotherapy can be an alternative to surgery for large cSCC metastasis.

Objective: Treatment with immunotherapy has positively changed the long-term outlook of many patients with advanced melanoma; however, fatigue is a common and debilitating side effect. Evidence indicates exercise can improve treatment-related fatigue for patients receiving chemotherapy and radiotherapy. However, currently little is known about exercise behaviors and preferences of patients receiving immunotherapy. This project aimed to describe self-reported levels of fatigue related to immunotherapy; patient perspectives of exercise behaviors; and barriers and facilitators to engagement in exercise for patients receiving, or recently completed immunotherapy for unresectable stage III and stage IV melanoma. Method: A cross-sectional purpose-built survey was distributed to members of the Melanoma Patients Australia closed Facebook group via an online survey platform. The survey remained active for 1 month, with 3 posts during this time inviting members to participate. Results: A total of 55 responses were collected. Just over half the participants (n = 31; 56%) described exercising while receiving immunotherapy, with walking as the most common activity (n = 24; 77%). Participants described a range of physical and emotional benefits of exercise, the most predominant being fatigue reduction. Barriers to exercise also included fatigue and competing physical demands at home or work. Patient understanding of what constitutes exercise appeared to differ from clinical classifications. Conclusions: Results from this study indicate that patients are engaging in exercise while receiving immunotherapy, with the intent of mediating treatment-related fatigue. Identification of preferred exercise activities and barriers will assist in developing tailored exercise interventions for this cohort.

IntroductionThere is increasing evidence demonstrating the benefits of exercise in counteracting cancer treatment-related fatigue. Immunotherapy is an established treatment for advanced melanoma, and is associated with fatigue in a third of patients. The safety and efficacy of exercise in counteracting treatment-related fatigue in patients with advanced melanoma receiving immunotherapy are yet to be determined. This study aims to assess the safety, adherence to and acceptability of a mixed-methods parallel-group, pilot randomised controlled trial of a personalised, 12-week semi-supervised exercise programme prescribed by an exercise physiologist (iMove) in 30 patients with stage IV melanoma scheduled to commence immunotherapy: single agent ipilimumab, nivolumab or pembrolizumab, or combination ipilimumab and nivolumab. The trial will be used to provide preliminary evidence of the potential efficacy of exercise for managing fatigue.Methods and analysisThirty participants will be recruited from a specialist cancer centre between May and September, 2019. Participants will be randomised 1:1 to receive iMove, or usual care (an information booklet about exercise for people with cancer). Feasibility data comprise: eligibility; recruitment and retention rates; adherence to and acceptability of exercise consultations, personalised exercise programme and study measures; and exercise-related adverse events. Patient-reported outcome measures assess potential impact of the exercise intervention on: fatigue, role functioning, symptoms and quality of life. Follow-up will comprise five time points over 24 weeks. Physical assessments measure physical fitness and functioning.Ethics and disseminationThis study was reviewed and approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/48927/PMCC-2019). The findings from this trial will be disseminated via conference presentations and publications in peer-reviewed journals, and by engagement with clinicians, media, government and consumers. In particular, we will promote the outcomes of this work among the oncology community should this pilot indicate benefit for patients.Trial registration numberACTRN12619000952145; Pre-results.

Background There is a lack of consensus regarding optimal surgical excision margins for primary cutaneous melanoma > 1 mm in Breslow thickness (BT). A narrower surgical margin is expected to be associated with lower morbidity, improved quality of life (QoL), and reduced cost. We report the results of a pilot international study (MelMarT) comparing a 1 versus 2-cm surgical margin for patients with primary melanoma > 1 mm in BT. Methods This phase III, multicentre trial [NCT02385214] administered by the Australia & New Zealand Medical Trials Group (ANZMTG 03.12) randomised patients with a primary cutaneous melanoma > 1 mm in BT to a 1 versus 2-cm wide excision margin to be performed with sentinel lymph node biopsy. Surgical closure technique was at the discretion of the treating surgeon. Patients’ QoL was measured (FACT-M questionnaire) at baseline, 3, 6, and 12 months after randomisation. Results Between January 2015 and June 2016, 400 patients were randomised from 17 centres in 5 countries. A total of 377 patients were available for analysis. Primary melanomas were located on the trunk (56.9%), extremities (35.6%), and head and neck (7.4%). More patients in the 2-cm margin group required reconstruction (34.9 vs. 13.6%; p p = 0.036). After 12 months’ follow-up, no differences were noted in QoL between groups. Discussion This pilot study demonstrates the feasibility of a large international RCT to provide a definitive answer to the optimal excision margin for patients with intermediate- to high-risk primary cutaneous melanoma.

This chapter concentrates on the evolution of a psychology of creativity. In doing so, we track thinking from early attempts at understanding creativity from Sir Francis Galton and Cesare Lombroso through to Freud and the psychoanalytic view of creativity. We then turn our attention to the rationalist responses from psychology, addressing Guildford’s early contributions, psychometric testing for creativity and the rise of the behaviourists. Personality approaches are examined before we move on to creative thinking, computational models and simulations of the creative mind. We then explore possible biological and biochemical foundations of creativity before moving outward to motivation and social psychological approaches. We finish this section by looking at processes of group creativity and the effect the environment has on creative people’s work.

This chapter explores ideas on creativity that are pivotal for the argument we are presenting in this book. They are at the heart of our curriculum and pedagogical approach which we present later in this book. It is here, in this chapter, that we look at various confluence approaches, including a reiteration of Bourdieu’s sociological approach, and focus in detail on the systems model of creativity initially put forward by psychologist Mihaly Csikszentmihalyi. The idea that creativity needs to be examined and understood as a complete system is increasingly being argued for and evidenced in the literature on creativity. Beth Hennessey and Teresa Amabile, in their 2010 Annual Review of Psychology article reviewing research work into creativity, asserted that ‘deeper understanding of creative behavior will require more interdisciplinary research based on a systems view of creativity that recognises a variety of interrelated forces operating at multiple levels’ (Hennessey and Amabile, Annual Review of Psychology 61:569–598, 2010, p. 591). Later, in 2017, Hennessey wrote in the special issue celebrating fifty years of The Journal of Creative Behavior that ‘seven years have passed since the publication of that paper, and an examination of the most current research suggests that a growing number of publications are now reflecting a systems approach as well as a multidisciplinary perspective’ (Hennessey, The Journal of Creative Behavior 51(4): 341–344, 2017, p. 341).

In this chapter, in drawing our conclusions, we argue that if there is a future for this model, and we sincerely believe there is, much more testing needs to be done in a wider set of institutions across a diverse array of cultures. Only then will we be able to confirm what we have experienced in Newcastle and these other settings. But since the systems model has been applied to research in Asian, North American and European conditions already, we are confident applying it in the educational setting also across these cultures, and others, will certainly not be disadvantageous. Our experience tells us you can educate for creativity using a systems centred approach.

This chapter outlines the undergraduate experience of students in the Bachelor of Communication at the University of Newcastle in Australia where the theories about creative practice are coupled with the teaching, in this case, of media practice and production. While our higher education students, studying media production, are led toward very specific creative projects, ones they develop and work on themselves, this approach to their creative education would not work if they were not, firstly, given some grounding in the ideas that led up to these actions and practices. Our approach of heavily interlinking theory about creativity with creative media practice has produced an iterative set of learning cycles that enable students to frame and inform their practice as they develop as practitioners. In doing so, they acquire a set of tools and a research grounded language they can increasingly apply to their own creative practice. They begin to analyse what they do while they are also learning how to do it. This process is staged across three years, from introduction of the ideas through to consolidation, and by the time they reach the capstone creative production course they are well prepared. They enter this course with a highly relevant set of pragmatically useful skills to engage in and use to think deeply about their own creative practice. This is not just the development of technical skills but a solid and well integrated melding of theory with practice.

This chapter looks at this research literature on creativity as it is drawn on in the field of education. While there have been quite a number of authors engaged in the pursuit of the relationship between creativity and education, not the least of which is Vygotsky, we have concentrated on a few here to get some sense of what this field has been doing in this regard. Some, such as Feldman and Benjamin in the US, argue that the research into creativity has impacted education only slightly, while others insist there is a strong, dynamic and fluid conversation occurring across these two bodies of research. For example, Pamela Burnard from Cambridge University in the UK suggests there has been a revival of interest in research into the scholarship around creativity in education. She cites eminent creativity researchers like Csikszentmihalyi, Runco and Sternberg as having an interest in education. She also includes the educational work of Anna Craft in this list as one who has both stimulated and taken part in debates on creativity and education. Many in the educational field, including Anne Harris, appreciate the work done by Anna Craft, and others, in pursuing educational scholarship on creativity.

This chapter discusses post-graduate research employing these ideas around creativity. Some of those that go on to further study undertake traditional research, often in the form of an ethnography, while many of them at postgraduate level pursue further creative practice as a form of practitioner based enquiry (PBE). They investigate screenwriting, radio journalism, commercial and documentary video productions, sound production and many other creative topics and use the theories about creativity as their intellectual frame. The PBE methodological approach allows them to revisit, refine and develop further what occurred for them in their capstone course and across the life of their postgraduate research as they transition from practitioner to researcher and participant observer and back again. For them, this all-inclusive research approach is the culmination of years of being embedded in the system of creative practice education and research.

This chapter outlines the deep contextual background to research into creativity arguing that across the globe there have been different ways of conceiving of creativity. Not all cultures see the bringing of novelty into being in the same way that the West does and not all cultures value it the same way. In this chapter, we look closely at the South Asian experience before concentrating on Taoist and Confucian understandings in East Asia. Then we zero in on early thinking in the West around the notions of the muse and inspiration before looking at the development of the ideas on genius and the problems these entail. We argue that, despite the differing cultural discourses about creativity, there are some commonalities in these differences suggesting to us the possibility of finding a view of creativity that could be universal in its application.

This chapter takes these ideas and introduces a model we believe helps in educating higher education students for creativity. This model, given the emphasis that we have placed on it in this narrative, is based, of course, on the systems model of creativity but adapted for the educational setting by Michael Meany. His paper, ‘Creativity and Curriculum Design: An Integrated Model’ (Creativity and curriculum design: An integrated model. In F. Martin (Ed.), Refereed Proceedings of the Australian and New Zealand Communication Association Conference 2017 – Communication worlds: Access, Voice, Diversity, Engagement. ISSN 1448–4331. http://www.anzca.net/conferences/past-conferences/, 2017), which we have drawn on here, sets it out in full. We have used this model as a framework to educate our students for creativity and it has begun to be adapted successfully in a few cross-cultural settings that we believe indicates its more general applicability across other institutional and sociocultural settings around the world. Just as Anna Craft’s work was strongly centred on the UK context and ‘her work always approached the problem with an eye to the global context’ (Harris, Creativity and education. Basingstoke: Palgrave Macmillan, 2016, p. 12), we also feel our work is ‘applicable to diverse contexts’ (ibid.). For us, designing a curriculum based on the systems view of creativity takes account not only of a broad range of pedagogies, but more importantly, focuses on the intersections between creative agents, in this case our students, and the broader social and cultural contexts they intersect with as we ‘create and maintain the conditions in which creativity can thrive’ (Lucas, Creative teaching, teaching creativity and creative learning. In A. Craft, B. Jeffrey, & M. Leibling (Eds.), Creativity in education. London: Continuum, 2001, p. 35) using a Systems Centred Learning (SCL) approach devised from within a particular higher educational setting.

This chapter applies these ideas of creativity and education in an international setting. If this educational process works, which we believe it demonstrably does, then it must be applicable in other settings for it to be of any worth internationally. Fortunately, it has begun to be adapted to other educational settings and these include a course run at Monash University in Melbourne and another in the Singaporean setting. It is worth noting here that there was a commonality in the cohorts for each of these cases; they were both predominantly East or South Asian, principally Singaporean, Chinese, Indian and Malaysian. The Singaporean setting where the curriculum was delivered in the undergraduate program, in an almost identical manner to what had occurred in Newcastle, was the subject of study by Susan Kerrigan, Pia Aquilia and Cathie Payne (Refereed Proceedings of the Australian and New Zealand Communication Association conference: Communicating Change and Changing Communication in the 21st Century, http://www.anzca.net/past-conferences/past-conf-index.html, 2012, J Int Commun, 19, 147–166, 2013) and its results will be discussed in more detail as we build the case for the efficacy of this approach. The Monash case was implemented and adapted differently but the essentials of the embedded systems approach remained intact.

This chapter is an appraisal of the work sociology has undertaken as a discipline in terms of their investigations of creativity. Unlike psychology, which sees creativity as an attribute of all areas of human activity, from the arts to the sciences, sociology appears to focus its efforts on the arts and cultural production. We start our appraisal of the social environment by starting at the macro level with Sorokin’s work on civilisations and Kavolis’ concern with periods of artistic efflorescence. We then examine the idea that art is a social product drawing on Marx and a number of others who also claim that art is fundamentally a social construction rather than being produced solely by a single individual. We look at Janet Wolff’s detailed arguments about the social production of art, the relationship between agency and structure, as well as the work coming from the ‘production of culture’ school of thought led by Richard Peterson and his concerns with various constraints on the creative process. Howard Becker’s notion of ‘art worlds’ is a concept that has become, and continues to be, important. There are some similarities between Becker’s idea and Pierre Bourdieu’s notion of the field although Becker and Bourdieu debated this. French sociologist and anthropologist Bourdieu was deeply concerned with a social agent’s ability to act within systemically structured contexts particularly as this relates to many forms of creativity and cultural production. We then briefly explore what effect poststructuralist thinkers like Roland Barthes and his ideas on the ‘death of the author’ had on thinking about creativity.

The writers interviewed for this research on creativity in Australian fiction writing all tell different stories: literary fiction, young adult, romance, science fiction, crime, fantasy, children’s books. The ways in which these writers tell their stories is also varied: unusual narrators, integrating multimedia, a pared-back writing style, revelling in the complexity of language. These differences can also be seen in their audiences and formats, ranging from picture books for those who are learning to read to large print books for those who have been reading for more years than they can remember. Some works are published as stand-alone novels; others have been published as a series of interconnected works.

The previous chapter demonstrates the importance of a systems approach to understanding creativity and gives a brief overview of the literature. This chapter describes and analyses the systems model of creativity developed by Mihaly Csikszentmihalyi (1988, 1990, 1994, 1997, 2003) and provides context for the analyses of creative systems in Part II. What is clear from the previous chapter is a gradual movement in thinking away from a focus on the individual towards confluence or systems approaches to creativity. With one or two notable exceptions, pre-twentieth-century ideas concentrate on creativity as divinely inspired, as the product of an extraordinary individual or genius or as a symptom of mental illness. These ideas were criticized in the twentieth century within the discipline of psychology, and others, as attempts were made to make creativity the subject of scientific study. Working under many of the same assumptions as those they criticized, this intensive period of research did little to alter the fundamental belief that creativity is located in the individual.

Many ideas reach a tipping point and then they escape the person who first came up with them. When people talk about the ‘theory of evolution’, Darwin’s authoritative voice is still resonant in the concept but researchers who have followed him have taken the initial ideas he proposed and developed them, elaborated on them, changed some basic concepts and carried those ideas forward until the propositions he originally put forward have taken on a life of their own. A similar process has occurred with the idea of ‘the culture industry’, a concept originally designed to shock. It was introduced by Adorno and Horkheimer ([1944] 2002) to express their concerns about the problems of developing a commercial imperative by putting art and industry together — two seemingly incompatible things. Others such as Bernard Miege (2004) and David Hesmondhalgh (2013) picked up the idea of a culture industry and presented empirical and well-reasoned evidence to support it, at the same time modifying and critiquing the central idea in the process. In undertaking the research necessary to confirm or reject what were initially theoretical propositions, these researchers lent their work to a steady evolution of them. We make a similar but more limited claim here. The systems approach to creativity, as described more fully by Fulton and Paton in Chapter 3, owes a lot to Mihaly Csikszentmihalyi (1988, 1997, 1999, 2014) but, as this book demonstrates, the idea is beginning to break free of its moorings.

In the original article John F. Thompson was inadvertently omitted as an author. The author list is updated as shown in this correction.

Background Brain metastases (BMs) are common in melanoma patients. Adjuvant whole brain radiotherapy (WBRT) following local treatment of intracranial melanoma metastases with neurosurgery and/or stereotactic radiosurgery is controversial. A randomised trial is needed. However, accrual to WBRT trials has been problematic. A pilot study by Australia and New Zealand Melanoma Trials Group (ANZMTG) was conducted to see if accrual was feasible. Methods Sites canvassed for interest included those who treat melanoma patients, had a proven accrual in previous melanoma trials and who had the relevant infrastructure support. Feasibility forecasts from interested sites were sought. These were compared to the patient numbers documented in the research contracts. A target accrual of 60 patients in 2 years was set. Funding was sought for the pilot study. Basic demographics of the pilot study cohort were collected. Results The first centre opened December 2008; the first patient was randomised in April 2009. The pilot accruing period concluded in September, 2011. In 30 months, 54 patients from 10 of a total of 17 activated sites in Australia (39, 72%) and in Norway (15, 28%) had been accrued. Feasibility forecasts predicted 133 trial eligible patients per year (including 108 Australian + 25 International patients). Site estimates generally overestimated accrual with 4 of 17 active sites estimating within 50% of target numbers. Sites with patient estimates calculated from records were more accurate than those estimated from memory. The overall recruitment target was lower in the research contracts when compared to the feasibility evaluation. Basic demographics of the pilot study revealed 62% of patients were males; 58% had a single metastasis, 28% had two and 14% had three metastases. 12-month overall survival was 50%. Conclusions Despite only 54 patients and not the full 60 patient target being accrued in two years the Trial Management Committee and Data Safely Monitoring Committee approved the continuation of the pilot study to the main trial. On the basis of this successful pilot study, funding was achieved for the full study. 143 patients of a target of 200 have been randomised by June 2014.

The letter 'Mind your backs: NVQs march on', raises the question of the role of the trained nurse in conjunction with the development of level three NVQs.