The 2017 RGS-IBG chair’s theme: decolonising geographical knowledges, or reproducing coloniality?

The theme for the chair’s plenaries at the 2017 Royal Geographical Society (RGS) with the Institute of British Geographers (IBG) Annual Conference is ‘Decolonising geographical knowledges: opening geography out to the world’. This commentary explains why this pursuit of critical consciousness via decolonial thinking could do more harm than good. We show how the emphasis on decolonising geographical knowledges rather than structures, institutions and praxis reproduces coloniality, because it recenteres non-Indigenous, white and otherwise privileged groups in the global architecture of knowledge production. It is argued that an effective decolonial movement within geography must recognise the intersectionality of indigeneity and race, and necessitates that the terms on which the discipline starts debates about decolonisation and decoloniality are determined by those racialized as Indigenous and non-white by coloniality

The impact of long-term systemic glucocorticoid use in severe asthma: A UK retrospective cohort analysis

<p><i>Objective</i>: Systemic glucocorticoids (SGCs) are a treatment option for severe asthma but are associated with the development of adverse events (AEs). Evidence on the extent of SGC use and the relationship between SGC dose and AE risk in severe asthma is limited. <i>Methods</i>: Patients with severe asthma (Global Initiative for Asthma step 4/5), with no SGC use during the <6–12 months before severe asthma determination (index date) were identified in the UK-based Clinical Practice Research Datalink database (2004–2012). Patients were assessed for SGC exposure and an incident diagnosis of an SGC-related AE (cataracts, diabetes, myocardial infarction [MI], osteoporosis, peptic ulcer or stroke) during the 8-year observation phase. The dose-related risk of an SGC-related AE was determined using AE-specific Cox proportional hazards models. <i>Results</i>: Overall, 75% of 60,418 patients identified with severe asthma received SGC during the 8-year follow-up, with the majority receiving an average of >0–≤2.5 mg/day. The risk of diabetes (hazard ratio [HR]:1.20 [95% confidence interval (CI): 1.11, 1.30]), MI (HR: 1.25 [95% CI: 1.09, 1.43]) and osteoporosis (HR: 1.64 [95% CI: 1.51, 1.78]) was increased at low SGC doses (0–2.5 mg/day), with further risk increases at doses >2.5 mg/day versus no SGC use. Compared with no SGC use, SGC increased the risk of peptic ulcer in a non-dose-dependent manner, but the risk of stroke was unchanged. <i>Conclusions</i>: Most patients with severe asthma are exposed to SGC, which increases SGC-related AE risk. This suggests that SGC exposure should be minimized as recommended by asthma treatment guidelines.</p