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A 27-year-old man (who is also the lead author) presented with dull pain deep to the suprasternal notch, following a period of intense exercise (rowing). He was initially sent home with no diagnosis, but 24 hours later returned to a different Accident & Emergency (A&E), due to continued discomfort and an increasingly altered mental state, and was diagnosed with an extensive type A aortic dissection extending from the aortic root to the iliac bifurcation of the aorta, with an ~8 cm aneurysm on the ascending aorta and a diseased aortic valve. Following emergency surgery to replace the aortic valve and the aorta from the aortic root to the middle of the aortic arch (hemiarch), the patient recovered well.

A woman in her 30s presented with sudden onset right-sided weakness, speech difficulties and transient loss of consciousness. She had a medical history of migraine, hypothyroidism and cervical lymphadenopathy. On examination, her National Institutes of Health Stroke Scale (NIHSS) score was 8 due to dense right-sided hemiparesis. CT brain imaging showed no intracranial haemorrhage but revealed incidental findings of left supraclavicular and cervical lymphadenopathy. CT intracranial angiogram did not show large vessel occlusion. She received thrombolytic treatment for ischaemic stroke. NIHSS improved to 3 with no immediate complications. Following admission, she developed swinging fever, seizures and fluctuating right-sided weakness. Repeat MRI of the head showed leptomeningeal enhancement. Biopsy of the cervical lymph nodes showed histiocytic granulomatous lymphadenitis, which was suggestive of tuberculous meningitis (TBM). She was treated with quadruple antimicrobial therapy and steroids for TBM, as well as aspirin for ischaemic stroke, which resulted in good clinical improvement.

ObjectivesTo describe the incidence of new onset paediatric diabetes mellitus, clinical characteristics and patterns of presentation to emergency departments (ED) during the COVID-19 pandemic, and to assess whether this increase was associated with SARS-CoV-2 infection.DesignRetrospective medical record review.SettingForty nine paediatric EDs across the UK and Ireland.PatientsAll children aged 6 months to 16 years presenting to EDs with (1) new onset diabetes or (2) pre-existing diabetes with diabetic ketoacidosis (DKA), during the COVID-19 pandemic (1 March 2020–28 February 2021) and the preceding year (1 March 2019–28 February 2020).ResultsThere were increases in new onset diabetes (1015 to 1183, 17%), compared with background incidence of 3%–5% in the UK over the past 5 years. There were increases in children presenting with new onset diabetes in DKA (395 to 566, 43%), severe DKA (141 to 252, 79%) and admissions to intensive care (38 to 72, 89%). Increased severity was reflected in biochemical and physiological parameters and administration of fluid boluses. Time to presentation from symptom onset for children presenting with new onset diabetes and DKA were similar across both years; healthcare seeking delay did not appear to be the sole contributing factor to DKA during the pandemic. Patterns of presentation changed in the pandemic year and seasonal variation was lost. Children with pre-existing diabetes presented with fewer episodes of decompensation.ConclusionsThere were increases in new onset diabetes in children and a higher risk of DKA in the first COVID pandemic year.

Transient ischaemic attack can be difficult to diagnose clinically. This article guides you through the radiological options available and highlights the role of diffusion weighted magnetic resonance imaging in detecting acute ischaemia

When establishing a business gaining experience and getting sound advice are prerequisites. That's exactly what American born Ian Morrison did before setting up Knighton Mill Pottery in Wiltshire, UK. In 2014 Morrison spent 12 months of long days making tableware for the Leach Pottery, founded in 1920 by Bernard Leach and Shoji Hamada in St Ives, Cornwall. Despite this grueling schedule, he made his own work out of hours and devised a business plan aided by the company director. Knighton Mill Pottery makes about 3,000 pots a year. The kiln holds between 300 and 500 pots depending on scale and is fired once a month. Owning a pottery has long been a dream for Morrison, who began making from a young age. For many years Morrison had a small workshop in the US. I fire my work unglazed on the exterior so that the making process, any tool mark, any fingerprint, any inconsistencies, are revealed.

Making tiles is relatively quick,\" reveals tile maker Bronwyn Williams-Ellis, who works from her studio in Bath, UK offering a refreshing alternative to mass produced tiles. Far more time is absorbed with the client's end of the project, decision making and also waiting for the areas that are to be tiled to be completed and then measured. It can be disastrous designing and making a tile panel of a fixed size for a wall that may change size and shape before it is complete. Although she makes individual ceramic sculptures, commissioned tiles are the financial backbone of the business for Williams-Ellis, who has 30 years' experience as a ceramicist. Clay tiles can take up to four weeks to dry naturally in the British climate and so when there are time pressures, or the need for hygienic and more waterproof surfaces Bronwyn uses standard bisque tiles. Bronwyn works at earthenware temperatures because of the richness and warmth of the colour and texture available

Social injustice, war and racism are the drivers behind the work of Hawaii based ceramic sculptor Amber Aguirre, which is collected and exhibited internationally. Often using whimsy to get her message across, Amber hopes her art will help people consider different viewpoints. Her mother was a Holocaust survivor and her father a forced labour camp survivor from Hungary. They had Aguirre late in life. Hearing screaming at night from her mother's nightmares was the norm for Aguirre growing up in the suburbs of San Francisco. Fear was a regular part of her life. Aguirre grew up with the overwhelming need to speak out against social injustice. Many years later Aguirre received her Bachelor of Fine Arts degree at the University of Southern California and then continued her education with a Masters Degree in Art Education at San Francisco State University. At that time she also received her California teaching credential and went on to teach ceramics in the public school system. Aguirre's artwork is often her therapy and making sculpture helped her come to terms with her disability.

Clay allows Liz Watts to create pieces that can be appreciated through 360 degrees. It is only pieces that will withstand firing that are put in the kiln; Liz casts weaker ones in bronze. I love the experimentation with ceramics and the technical understanding of the clay work, says Liz. In 2018 she had two pieces accepted for the Society of Women Artists open at The Mall Galleries, London which was a fantastic acknowledgement of my work she says. Liz has been known to make pieces that incorporate porcelain, bronze, silver wire, glass and slate. Well versed in each medium, time is spent switching between the different methods, which in part are dictated by individual projects, available exhibition opportunities and the image she desires. Working on between 30 and 40 pieces a year of varying sizes they are primarily ceramic because bronze is expensive to produce. All her work is individual, hand built and decorated.

High specification manufactured kilns are not the only way to fire pottery. Cornwall based potter Mary Kaun-English specialises in pit-firing; an ancient method of firing ceramic work. Mary's firing practice occurs predominately in the sand on Cornish beaches. This process involves digging a large hole, placing her bisque fired ceramics in the pit and creating a huge fire on top where pots are fired for several hours with temperatures reaching 800 degrees farenheit in the hottest part of the pit. Ever conscious of keeping her work sustainable, Mary uses locally dug, heavily grogged clay which helps to avoid excessive breakages. No glazes are used in this process as the required temperature is not reached.