Study suggests masks rival respirators for flu protection

first_imgOct 2, 2009 (CIDRAP News) – In findings sure to renew the continuing controversy over respiratory protection for healthcare workers, surgical masks appeared to protect hospital nurses from influenza about as well as N-95 respirators did in a randomized trial conducted in Ontario.There were only two more confirmed flu cases among a group of more than 200 mask-wearing nurses than in a similar size group of nurses wearing N-95 respirators, according to the report published yesterday by the Journal of the American Medical Association (JAMA). The result met a statistical test for showing that the masks were “noninferior” to the respirators.But other experts said today that the study has important limitations—including the lack of a control group using no respiratory protection—that cast doubt on the findings.The report is described as the first randomized trial comparing different forms of respiratory protection against flu to reach publication. It comes a few weeks after the news of a study by Australian researchers in which N-95 respirators were found to be clearly better than surgical masks for preventing flu in healthcare workers. That study was reported at a medical meeting but has not yet been published in a journal.N-95 respirators are designed to fit closely to the face and filter out at least 95% of airborne particles, whereas surgical masks fit more loosely and were originally designed to prevent the wearer from infecting others.But health workers say the tight-fitting N-95s are uncomfortable and difficult to wear for long periods, and hospitals sometimes have trouble keeping them in supply. Surgical masks are more comfortable and cheaper, but scientists have not found much evidence that they protect wearers from respiratory pathogens.Respiratory protection for health workers has been a big issue since the emergence of the novel H1N1 virus. In early September, the National Academy of Sciences’ Institute of Medicine (IOM) issued a report affirming the current Centers for Disease Control and Prevention (CDC) guidance on the topic, which recommends use of N-95s by all healthcare workers who enter the rooms of patients with confirmed or suspected H1N1 infection. The same advice goes for emergency medical personnel who come in close contact with such patients.Study designThe Canadian researchers, led by Mark Loeb, MD, MSc, of McMaster University in Hamilton, Ont., recruited 446 nurses who worked in emergency departments and medical and pediatric wards in eight Ontario hospitals.They were randomly assigned to wear either a surgical mask or a fit-tested N-95 respirator when caring for patients with febrile respiratory illness. The nurses continued to use their assigned respiratory protection during aerosol-generating procedures such as intubation, provided tuberculosis was not suspected.The team confirmed influenza in the volunteers by either of two methods: detection of viral RNA in patient specimens by reverse-transcriptase polymerase chain reaction (RT-PCR) or at least a four-fold rise in serum antibodies to circulating flu strains at the end of the study period.To reduce errors, the serologic criteria for infection with seasonal flu strains were used only for nurses who had not received the seasonal flu vaccine. About 30% of the mask group and 28% of the N-95 group had been vaccinated.To check whether nurses were actually wearing the assigned protection, the researchers called hospital units daily during the peak flu period in March to find out if they had any patients with flu or febrile respiratory illness. If they did, an auditor was sent to the unit to observe for compliance by watching discreetly from outside the patient’s room.In the end, flu was confirmed in 50 of 212 nurses (23.6%) in the mask group and 48 of 210 nurses (22.9%) in the N-95 group, the report says. That signaled a difference in absolute risk of only 0.73% (95% confidence interval [CI], -8.8% to 7.3%, P=.86), indicating the masks were not inferior to the respirators.Most of the cases were confirmed by serology; confirmation was by RT-PCR in only six in the mask group and four in the N-95 group.The authors also looked at several other outcomes, including non-flu respiratory infections and influenza-like illness (ILI), and found no significant differences between the two groups. Nine nurses in the mask group had an ILI, versus only 2 in the N-95 group, indicating the risk for the N-95 group was 3.3% lower (95% CI, -6.31% to 0.28%, P=.06). All 11 nurses had lab-confirmed flu.Serologic evidence of infection with the emerging novel H1N1 virus was also found in the study, in 8.0% of the mask group and 11.9% of the N-95 group. The findings signaled noninferiority for the masks.There were 18 episodes in which the researchers checked whether nurses were using their assigned protection in the prescribed situations. They found that all 11 nurses in the mask group and 6 of 7 in the N-95 group (100% versus 86%) were complying.Conclusions and limitationsThe authors conclude that the incidence of flu in the two groups was similar. “Surgical masks had an estimated efficacy within 1% of N-95 respirators,” they state.They acknowledge several limitations of their study, including an inability to assess compliance by all participants and no monitoring of hand hygiene or the use of gowns and gloves. They say it is impossible to know whether the volunteers contracted flu because of exposure in the hospital or in the community, but add that their data on household exposure suggest that it was similar between the two groups.”We acknowledge that not surveying participants’ coworkers about influenza-like illness was a limitation,” they state. They also caution that their findings apply to routine care and should not be generalized to settings where flu viruses can be aerosolized, such as intubation, where use of N-95s is recommended.Experts note drawbacksOther experts who commented on the study today cited the inability to assess possible differences in flu exposure between the two groups as a drawback.Kristine Moore, MD, MPH, medical director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, called the study an important step in understanding respiratory protection for health workers, but said she was concerned about possible differences in flu exposures.”It may be that the exposure risks within the healthcare facilities were different for the two groups (ie, if one group had more direct contacts with influenza patients than the other group),” she commented by e-mail.”Also, unlike [for] a pathogen such as drug-resistant Mycobacterium tuberculosis, much of the exposure to influenza occurs in the community setting rather than in a healthcare facility,” Moore added. “The investigators had no way to determine the attributable risk of community exposures versus the attributable risk of exposures within the healthcare facility.”Even though they found comparable histories of ILI among household members, this information may not have accurately reflected true influenza rates in household members and does not address other community exposures. A high attributable risk for community exposure could have accounted for the similar infection rates among the respirator and mask groups.”Lisa Brosseau, ScD, MS, an associate professor of environmental science at the University of Minnesota School of Public Health and veteran researcher in respiratory protection, voiced similar concerns. Calling the finding of no difference in protection surprising, she said the limitations acknowledged by the authors and other problems may account for it.In particular, there was no control group of nurses working in the same hospitals but not using respiratory protection—unlike in the recently reported study by Australian researchers, she said. “Thus, it is impossible to say whether either ‘mask’ made a difference in healthcare worker infection rates,” she said.Brosseau also noted that the limited auditing in the study indicated only 86% compliance in the N-95 group, versus 100% in the surgical mask group. Lower compliance in the N-95 group could lead to higher direct exposure to influenza in that group, distorting the results, she said.Also, she said, because the observations of compliance were very limited in nature and number, it’s not possible to know such things as whether the nurses used respirators that matched their fit test, checked the seal, or wore them the whole time they were in the patient’s room.”I don’t think this is the definitive study everyone is looking for, but rather illustrates the great difficulties involved in conducting studies of personal protective equipment effectiveness in the ‘real world,'” Brosseau said.Editorial cites strengths, weaknessesAn accompanying JAMA editorial by two other experts praised the study on several counts. The authors, Arjun Srinivasan, MD, of the CDC and Trish M. Perl, MD, MSc, of Johns Hopkins University, said the two study groups “were well balanced with similar risk factors for influenza infection, including vaccination and febrile respiratory illness among household members, and participants were evenly distributed across study hospital wards.”On the other hand, the writers note that the researchers “did not directly assess exposure risks by collecting data on the number of nurse contacts with patients” who had febrile respiratory illness.Srinivasan and Perl also comment that the controversy over respiratory protection has distracted attention from the need to use other strategies to prevent flu transmission in healthcare settings—chief among them, annual vaccination of healthcare workers.Loeb M, Dafoe N, Mahony J, et al. Surgical mask vs N95 respirator for preventing influenza among health care workers. JAMA 2009; early online publication Oct 1 [Full text]Srinivasan A, Perl TM. Respiratory protecton against influenza. (Editorial) JAMA 2009; early online publication Oct 1See also: Sep 17 CIDRAP News story “Study on respirators versus masks hailed as landmark”last_img read more

Provincial police say three dead two seriously injured in Port Perry Ont

first_imgPORT PERRY, Ont. – Three people were killed and two others were seriously injured in a collision northeast of Toronto, provincial police said Saturday.Sgt. Kerry Schmidt said the crash happened in the early hours of Saturday morning, when an SUV crossed into oncoming traffic and collided head-on with a car in Port Perry, Ont.“The scene was absolutely devastating,” he said.The 59-year-old man driving the car and two female passengers, aged 55 and 44, were pronounced dead at the scene, Schmidt said, adding that a 41-year-old woman who was also in the car was in hospital in critical condition.He said the 68-year-old man driving the SUV is also in hospital with serious injuries.“This is an absolute tragedy,” said Schmidt. “In this case everyone was wearing their seatbelt, and so we’re investigating any factors that might have led to this collision.”Schmidt said no charges have been laid, but police are still investigating the cause of the crash.last_img read more

The Elders Demand Israel Respects International Law To Stop Further Gaza Protest

first_imgThe Elders today called on the Israeli Government to fully comply with international humanitarian law and respect the right to peaceful protest of Palestinians living in the Gaza Strip.Their call follows the killing of 48 demonstrators and injury of almost 7,000 others, many of them children, by the Israeli army in the past month.They warned of the danger of more casualties in the run-up to 15 May, when Palestinians mark what they call the “nakba”, or catastrophe – a day after Israel commemorates the 70th anniversary of its independence. Two-thirds of Gaza’s residents are classified by the UN as refugees, having been expelled from or fled nearby Arab towns and villages in 1947 and 1948, or else are their descendants.Kofi Annan, Chair of The Elders and former UN Secretary-General, said:“This is a sensitive – and important – anniversary for Israelis and Palestinians alike. But Israel’s heavy-handed military tactics are inflaming the situation needlessly. Prime Minister Benjamin Netanyahu’s government should exercise the utmost restraint and care over the coming weeks, to avoid further deaths.”Mary Robinson, Elder and former UN High Commissioner for Human Rights, added:“International humanitarian law prohibits the use of deadly force against unarmed demonstrators. We should remember that despite Israel’s disengagement from the Gaza Strip in 2005, under international law Gaza remains occupied territory and the occupying power has a legal duty to protect its population – not endanger their lives.”Lakhdar Brahimi , Elder and former Algerian Foreign Minister, said:“Palestinians have the right to fight for their rights with all the legitimate means available to them. This includes peaceful protest; Palestinians in Gaza are just as entitled to exercise this right as Israelis in Tel Aviv or Americans in Washington.”last_img read more

Morneau to unveil changes to controversial small business tax proposals

first_imgOTTAWA – Finance Minister Bill Morneau will unveil changes Monday aimed at mollifying the many critics of his controversial small business tax reform proposals, hoping to tamp down a political wildfire that has scorched Justin Trudeau’s Liberal government.The damage control effort will begin with a special briefing early Monday morning for Liberal backbenchers, some of whom have been among the most vocal opponents of the measures.Sources, speaking on condition of anonymity because they weren’t authorized to speak publicly, say Morneau wants to demonstrate to anxious Liberal MPs that he’s heard their concerns about his tax reform plan and is addressing them.The proposed reforms were intended to put an end to measures which the government contends have allowed wealthy individuals to use incorporation as small businesses to unfairly reduce their income tax burden.They triggered an angry backlash from doctors, lawyers, accountants, shop owners, farmers, premiers and even some Liberal backbenchers, who maintained the reforms would hurt the very middle class Canadians that the Trudeau government claims to be trying to help.The changes are expected to ensure the reforms are targeted more clearly at the wealthy.They’re also expected to address concerns that the reforms will disproportionately impact women, inhibit the ability of small business owners to save for a rainy day and make it impossible for farmers, fishers and others to pass their businesses on to their children.Morneau has acknowledged changes are required to address some of the concerns raised and to ensure there are no unintended consequences.Speaking briefly Friday outside a meeting of the International Monetary Fund in Washington, Morneau referred to Monday’s caucus briefing as “an important discussion.” He referred several times to continuing the discussion, suggesting that whatever he announces Monday won’t be the end of the story.“I’m going to continue this discussion. We’re going to talk about what we think is important and that is that we get it right,” he said.Morneau acknowledged that the government has to do a better job of reassuring middle class Canadians that they won’t be negatively impacted by the proposals.“The fact that farmers won’t be impacted, we need to make that clear. The fact that, you know, small businesses will be able to continue to invest in their business, which is what we want, and won’t be worried about passing their business to the next generation, we’re going to communicate that clearly.”As originally proposed, the plan would restrict income sprinkling, in which an incorporated business owner can transfer income to a child or spouse who is taxed at a lower rate, regardless of whether they actually do any work for the company.It would also limit the use of private corporations to make passive investments that are unrelated to the company and curb the ability of business owners to convert regular income of a corporation into capital gains, which are taxed at a lower rate.The proposals were unveiled in mid-July but it took about a month for the backlash to materialize. Since then, the Liberals’ popularity has taken a hit in some public opinion polls and the governing party’s backbenchers have become increasingly anxious.A number of Liberal MPs, including finance committee chair Wayne Easter, have complained about the messaging surrounding the proposals, which they say portrays small business owners as tax cheats.The Conservatives have used the furor to accuse Morneau of hypocrisy, targeting small business owners while doing nothing to deal with legal tax avoidance strategies used by large corporations like Morneau Shepell, a human resources company headed by the minister until his appointment to cabinet in 2015.That line of attack was bolstered Friday by news that for two years, Morneau failed to disclose to the federal ethics commissioner that he and his wife are partners in a private company that owns a family villa in southern France. CBC News reported that holding property through a private company is useful in avoiding inheritance taxes in France.Morneau’s ownership of the villa was disclosed but the involvement of the private company was not until last month, when CBC began to ask questions about it.Morneau called the failure to disclose the company an “administrative oversight.”“In fact, I disclosed the asset originally when the commissioner asked me to disclose all my assets. The administrative structure that I was advised to purchase the house with when I did so as a foreigner was something that we just gave information to (her) more recently, just because it was an administrative oversight.”Jocelyne Brisebois, a spokeswoman for Dawson, declined to say if the ethics commissioner is looking into the matterUnder the Conflict of Interest Act, Dawson has limited power to do anything about it in any event, other than impose a fine of up to $500.last_img read more

New Nevada attorney general Background check law a priority

first_imgLAS VEGAS — Nevada’s next attorney general Aaron (AY’-ron) Ford says finding a way to implement a stalled, voter-approved gun background check law is one of the top issues the Democrat will tackle when he takes office early next year.Ford told The Associated Press in an interview that he’d also be supportive of other gun-safety measures that may come out of the state Legislature, which is controlled by Democrats.Ford is a 46-year-old attorney and the outgoing state Senate majority leader. He noted Friday was the sixth anniversary of the mass shooting at Connecticut’s Sandy Hook Elementary School, which left 20 children and six adults dead.He says the victims need to be honoured with “commonsense gun safety measures,” not just thoughts and prayers.Michelle L. Price, The Associated Presslast_img read more

Edmunds highlights top car tech trends from CES

first_imgEvery year at the International Consumer Electronics Show (CES) in Las Vegas, we get a glimpse of what vehicles may be — and what they could do. The event has also become an annual progress report on the latest electric vehicles and how close we are to “full driving automation,” as the Society of Automotive Engineers calls it. Here are a few vehicle trends from CES that you’ll see in the immediate future and some others that are much further away.BYTON’S INTERIOR DESIGNByton, a Chinese electric automaker, is revealing its plan for bringing the M-Byte SUV to the United States, along with a close approximation of its high-tech interior. The company says it intends to retain many of the unique ideas from its concept vehicle, such as a 48-inch curved dashboard display, a touchscreen on the steering wheel, and the first inward-rotating front seats in production.TOYOTA’S NEW AUTONOMOUS TEST VEHICLEThe Toyota Research Institute (TRI), Toyota’s division that studies and tests autonomous driving, announced the launch of a new test vehicle that’s equipped with the latest scanners, sensors and computing equipment.This equipment once took up all the trunk space and roof of a test car. On the TRI-P4, it’s slimmed down enough to make the cargo area usable. The roof sports what looks like a high-tech helmet rather than a collection of bolted-on electronics. Toyota will test the TRI-P4, based on the fifth-generation Lexus LS, in its Chauffeur and Guardian driving automation modes.The Chauffeur mode employs full driving automation, essentially taking over for a human driver, said Ryan Eustice, senior vice-president of automated driving at TRI. The Guardian mode is designed to “amplify” human performance behind the wheel, not replace it, he said.UNCONVENTIONAL CONCEPT VEHICLESCES is where automakers’ imaginations run wild. These concept vehicles have very specific uses.— Hyundai Elevate: What do you do after a disaster when heavy debris blocks emergency vehicles? Hyundai’s solution is the four-legged and four-wheeled Elevate vehicle, which will walk or climb over the most treacherous terrain.— BMW Vision iNext: This is a design concept that will influence the direction of the company’s next-generation electric vehicles. Inside, it features something BMW calls “Shy Tech.” These control interfaces are integrated into the interior materials and only appear when your hand touches a specific point. The goal is to create interiors that look cleaner and offer utility just when you need it.— Mercedes-Benz Vision Urbanetic: This concept is aimed at ride-hailing and delivery fleets. It features an electric drivetrain and switchable bodies that can accommodate people or goods for delivery. When equipped with the ride-hailing body, it can seat up to 12 passengers. In cargo configuration, it can accommodate items on 10 40-by-48-inch pallets. The Urbanetic is also designed to be part of an autonomous fleet that can be programmed with efficient routes based on a company’s needs.IN-CAR VIRTUAL ASSISTANTS ARRIVE IN 2019This is the year that cars equipped with virtual assistants pull into showrooms. These helpers differ from Alexa, Siri and the Google Assistant by focusing on vehicle functions rather than doing your bidding via a smartphone or smart speaker.The Mercedes-Benz’s MBUX software interface made its first appearance last year at CES on the all-new A-Class sedan, which will be widely available early this year. Now MBUX is back in yet another new car: the 2020 Mercedes-Benz CLA. MBUX will get a few new features, such as gesture-controlled lighting, for its CLA debut.BMW’s answer to MBUX is the Intelligent Personal Assistant. It makes its first appearance on the redesigned 2020 3 Series and eventually will be featured in the rest of the BMW lineup.Both systems use natural voice commands to control different aspects of the vehicle. For example, if you say, “Hey BMW, I’m cold,” the BMW Intelligent Personal Assistant adjusts the temperature inside the car. It can also serve as a paperless owner’s manual, telling you how a certain feature works or providing current vehicle status. You could check the oil by asking, “Is the oil level OK?” Or you could say “I want to relax,” and the assistant would change the settings on the radio station and adjust the climate control to ease your stress.A MOBILE MOVIE THEATER SYSTEMAudi is showing a new entertainment format, which it says will transform a vehicle into a “special movie theatre experience.” For now, the system is designed to work only when the vehicle is stationary, but Audi imagines a world in which the car is so good at driving itself that its passengers will need some amusement to pass the time. What better way to do that than to catch up on the latest movie?EDMUNDS SAYS: Futuristic concept vehicles and full driving automation are still years away, but cars with built-in personal assistants will be pulling into dealerships before you know it.___This story was provided to The Associated Press by the automotive website Edmunds. Ronald Montoya is a senior consumer advice editor at Edmunds. Twitter: @rmontoyaedmunds.Related links:— 2019 Mercedes-Benz A-Class: https://edmu.in/2F7zLnn— 2020 BMW 3 Series: https://edmu.in/2CNWbbQRonald Montoya, The Associated Presslast_img read more

Regulator OKs Fort Hills oilsands mine tailings plan but orders demonstration

first_imgOilsands mining companies were ordered in 2015 to submit plans to progressively treat and reduce tailings over the life of each project, with all fluid tailings ready to reclaim within 10 years of the end of mine life.The regulator in its decision says it will require the Fort Hills mine to submit by Sept. 30, 2021, a plan for a project to demonstrate how its passive aquatic storage system will work.It says it must present a research plan for its water-capping technology by September 2023. CALGARY, A.B. – The Alberta Energy Regulator has conditionally approved a tailings management plan for the Fort Hills oilsands mine despite its failure to meet milestones and reliance on an unproven reclamation method.Tailings ponds store water used in the oilsands mining process that is notoriously difficult to reclaim because it has been contaminated with fine clay particles, oil and other chemicals.The mine owned by Suncor Energy Inc. is proposing to chemically treat its tailings, concentrate them all in a single deposit by 2073 (10 years after the end of mine life) and then cover the residue with water to create a large pit lake.last_img read more

How The Warriors Should Adjust Their Offense Without Steph Curry

The Warriors are hurting. The latest bad news came over the weekend, when the team learned that superstar Stephen Curry, who was just returning from a six-game absence because of a tweaked right ankle, sustained a Grade 2 MCL sprain to his left knee. He joins three other hurt Golden State stars who are currently riding the bench: Kevin Durant has a rib fracture, Klay Thompson has a fractured right thumb and Draymond Green has a pelvic contusion.Coach Steve Kerr has already ruled out the idea of Curry returning for the first round of the postseason. But these other guys will be back. So, how will the Warriors’ offense function without Curry when the postseason starts up? And how should it?To some, these questions might seem pointless, considering that Durant, a fellow superstar, is also on the roster. After all, the possibility of a Curry injury was among the best arguments for signing Durant: Even if Curry goes down, there’d be two other stars (Durant and four-time All-Star Thompson) to count on.1This doesn’t even include Green, the reigning defensive player of the year, who logged a dominant 32-point, 15-rebound, 9-assist outing during Game 7 of the 2016 NBA Finals. But any changes to a powerhouse lineup like the Warriors’ has some impact: Defenses now will have more resources to clamp down on Durant. The challenge then for Golden State is to navigate the increased attention on Durant while not making any wholesale changes to the offensive plan with only nine games left in the regular season. After all, the Warriors want Curry to hit the ground running when he returns, using the same pass-happy system that was in place when he left.There are a handful of things we can likely expect once the other banged-up Warriors rejoin the lineup as expected. The most important: It’s a safe bet that most of the key role players will shoot at least slightly worse without Curry in the picture — a majority of them have performed worse on offense in times when Curry’s been out and Durant’s been playing (compared with their performance when sharing the court with both Curry and Durant). Kevin Durant—63.055.5 PlayerWith Curry, w/o DurantWith Curry and DurantWith Durant, w/o Curry Stephen Curry62.261.7— JaVale McGee64.570.472.7 Effective field goal percentage is a measure of shooting efficiency that accounts for 3-pointers being worth 50 percent more than 2-pointers.Sources: Second Spectrum, NBA Advanced Stats Andre Iguodala61.344.539.2 Nick Young51.674.048.6 Effective FG% Zaza Pachulia44.763.358.3 Klay Thompson63.067.549.0 Curry’s impact on the DubsEffective field goal percentage of Warriors with at least 30 shots taken in each scenario below, 2017-18 Draymond Green48.755.550.5 Durant’s offensive performance has also suffered when Curry isn’t playing. Despite being a top-three player in the world, Durant occasionally finds easy looks as a result of the fear that defenses have of Curry getting open along the arc. One indication of the boost Durant gets: Green has completed 16 alley-oops to him over the past two seasons — many of which were sprung while Curry was distracting defenses with fake backscreens. But those were all with Curry on the floor. Without Curry, Green hasn’t found Durant for a single lob during that time period, according to data from Second Spectrum and NBA Advanced Stats.Video Playerhttps://fivethirtyeight.com/wp-content/uploads/2018/03/draykd.mp400:0000:0002:02Use Up/Down Arrow keys to increase or decrease volume.Durant is still a dynamite scorer without Curry, though — as evidenced by his 45 points per 100 possessions (on 48 percent shooting and 42 percent from 3-point range) in the four games he played mostly without Curry recently. But the downside without Curry is that the free-flowing offense grows more stagnant as Durant isolates more to find his shots. The Warriors go from having 106.0 possessions per 48 minutes when Curry orchestrates the offense to 100.6 possessions per 48 minutes when Durant is on the floor without Curry. And the total number of isolations per 100 plays increases 43 percent, from 10.1 to 14.4, when Durant spearheads the attack without Curry, according to Second Spectrum. The high-octane club goes from scoring almost 122 points per 100 possessions with Curry and Durant to 108 when Durant plays without Curry.A few caveats: Those pace and offensive efficiency numbers, while down considerably, would still rank among the highest in the league. If anything, this merely speaks to how otherworldly the Warriors are at full strength, or at least when Curry is running their offense. Without Curry playing, they would still be favored against just about any team out West, perhaps except for Houston.The Warriors know that, too, and based on their recent history with knee sprains, it seems a foregone conclusion that they’ll take things slowly with Curry’s rehabilitation. Curry of course missed two weeks of the postseason in 2016 after suffering a less severe Grade 1 MCL sprain. He had a 40-point game in his return against Portland but then struggled in the finals (he later suggested that he wasn’t anywhere near 100 percent that postseason after the injury). The team took a different approach with Durant last season — and saw different results. He returned from a nearly six-week absence and Grade 2 MCL sprain to outplay LeBron James and earn the finals MVP.While Durant and the rest of the Warriors await Curry’s return, there are several tactics they could take to both take advantage of the line-ups they will have on the floor and to make sure that Curry can re-enter the offense seamlessly. For one, Golden State would be smart to push the tempo and to screen more on the ball using either Green or Andre Iguodala to set picks for Durant. (The Warriors set about 10 fewer on-ball screens per 100 possessions when Durant is running the offense without Curry.) Both Green and Iguodala are playmakers and are more likely to keep the ball moving than Durant. He’s a good passer but calls his own number for 1-on-1 scenarios far more often than most players do.This is why running more simple screen-and-roll sets could help Durant: Such plays give him a clearer opening for an occasional jumper when he wants one. But they also allow him to share the ball with confidence that he can get it back in perhaps his most lethal position: off the catch, where he shoots a far-higher percentage than when he dribbles several times before launching an attempt.It’s worth noting that the Warriors have generated more points per play out of Durant pick-and-rolls with Green setting the screen this season (1.18) than they have with Curry pick-and-rolls in which Green is the screen-setter (1.08), according to Second Spectrum.2Among NBA pairs who’ve run at least 100 direct pick-and-rolls — meaning that the player associated with the play either shot the ball, was fouled, turned it over or passed to a shooter within one dribble of receiving the ball.Video Playerhttps://fivethirtyeight.com/wp-content/uploads/2018/03/p.mp400:0000:0001:48Use Up/Down Arrow keys to increase or decrease volume.For context, the Durant and Green combo ranks second in efficiency among NBA pairs who’ve run at least 100 direct pick-and-rolls, trailing only the unstoppable duo of Curry and Durant.So, no — there’s obviously no true way to replace everything Curry brings on offense. But playing a style that isn’t far removed from what he’s used to could help keep the team in rhythm for when he returns.Check out our latest NBA predictions. read more