564 Niagara St
Buffalo NY 14201
Medical School: State University Of New York At Buffalo School Of Medicine - 1989
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 186738
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Awards & Recognitions
Dr. James Lawrence is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:99204||Description:Office/outpatient visit new||Average Price:$214.94||Average Price Allowed
|HCPCS Code:20610||Description:Drain/inject joint/bursa||Average Price:$127.45||Average Price Allowed
|HCPCS Code:95934||Description:H-reflex test||Average Price:$136.24||Average Price Allowed
|HCPCS Code:20550||Description:Inj tendon sheath/ligament||Average Price:$99.23||Average Price Allowed
|HCPCS Code:95886||Description:Musc test done w/n test comp||Average Price:$109.00||Average Price Allowed
|HCPCS Code:99213||Description:Office/outpatient visit est||Average Price:$92.40||Average Price Allowed
|HCPCS Code:95900||Description:Motor nerve conduction test||Average Price:$84.88||Average Price Allowed
|HCPCS Code:95904||Description:Sense nerve conduction test||Average Price:$74.00||Average Price Allowed
|HCPCS Code:99212||Description:Office/outpatient visit est||Average Price:$53.63||Average Price Allowed
|HCPCS Code:J1030||Description:Methylprednisolone 40 MG inj||Average Price:$11.28||Average Price Allowed
|HCPCS Code:J1100||Description:Dexamethasone sodium phos||Average Price:$2.25||Average Price Allowed
HCPCS Code Definitions
- Injection, methylprednisolone acetate, 40 mg
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
- Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (List separately in addition to code for primary procedure)
- Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)
- Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
- Injection, dexamethasone sodium phosphate, 1mg
Medical Malpractice Cases
Medical Board Sanctions
Cardiovascular Disease (Cardiology)
Cardiovascular Disease (Cardiology)
*These referrals represent the top 10 that Dr. Lawrence has made to other doctors
ISSLS Prize Winner: Dynamic Loading-Induced Convective Transport Enhances Intervertebral Disc Nutrition. - Spine
Experimental animal study of convective transport in the intervertebral disc.To quantify the effects of mechanical loading rate on net transport into the healthy and degenerative intervertebral disc in vivo.Intervertebral disc degeneration is linked with a reduction in transport to the avascular disc. Enhancing disc nutrition is, therefore, a potential strategy to slow or reverse the degenerative cascade. Convection induced by mechanical loading is a potential mechanism to augment diffusion of small molecules into the disc.Skeletally mature New Zealand white rabbits with healthy discs and discs degenerated via needle puncture were subjected to low rate axial compression and distraction loading for 2.5, 5, 10, 15, or 20 minutes after a bolus administration of gadodiamide. Additional animals with healthy discs were subjected to high-rate loading for 10 minutes or no loading for 10 minutes. Transport into the disc for each loading regimen was quantified using post-contrast-enhanced magnetic resonance imaging.Low-rate loading resulted in the rapid uptake and clearance of gadodiamide in the disc. Low-rate loading increased net transport into the nucleus by a mean 16.8% and 12.6% in healthy and degenerative discs, respectively. The kinetics of small molecule uptake and clearance were accelerated in both healthy and degenerative discs with low-rate loading. In contrast, high-rate loading reduced transport into nucleus by a mean 16.8%.These results illustrate that trans-endplate diffusion can be enhanced by forced convection in both healthy and degenerative discs in vivo. Mechanical loading-induced convection could offer therapeutic benefit for degenerated discs by enhancing uptake of nutrients and clearance of by-products.4.
An Item Analysis of the Conditional Reasoning Test of Aggression. - The Journal of applied psychology
This manuscript uses item response theory (IRT) to estimate item characteristics of the Conditional Reasoning Test of Aggression (CRT-A). Using a sample size of 5,511 respondents, the present analysis provides an accurate assessment of the capability of the CRT-A to measure latent aggression. The one-parameter logistic (1PL) model, two-parameter logistic (2PL) model, and three-parameter logistic (3PL) model are compared before the item analysis. Results suggest that the 2PL model is the most appropriate dichotomous IRT model for describing the item characteristics of the CRT-A. Potential multdimensionality in the CRT-A is also examined. Results suggest that CRT-A items work as theoretically intended, with the probability of selecting an aggressive response increasing with latent trait levels. Information curves indicate that the CRT-A is best suited for use with individuals who are high on latent aggression. Exploratory analyses include an examination of polytomous IRT models and DIF comparing student and employee respondents. The results have implications for future research using the CRT-A as well as the identification of populations appropriate for measurement using this assessment tool. (PsycINFO Database Record(c) 2015 APA, all rights reserved).
Low rate loading-induced convection enhances net transport into the intervertebral disc in vivo. - The spine journal : official journal of the North American Spine Society
The intervertebral disc primarily relies on trans-endplate diffusion for the uptake of nutrients and the clearance of byproducts. In degenerative discs, diffusion is often diminished by endplate sclerosis and reduced proteoglycan content. Mechanical loading-induced convection has the potential to augment diffusion and enhance net transport into the disc. The ability of convection to augment disc transport is controversial and has not been demonstrated inÂ vivo.To determine if loading-induced convection can enhance small molecule transport into the intervertebral disc inÂ vivo.Net transport was quantified via postcontrast enhanced magnetic resonance imaging (MRI) into the discs of the New Zealand white rabbit lumbar spine subjected to inÂ vivo cyclic low rate loading.Animals were administered the MRI contrast agent gadodiamide intravenously and subjected to inÂ vivo low rate loading (0.5 Hz, 200 N) via a custom external loading apparatus for either 2.5, 5, 10, 15, or 20 minutes. Animals were then euthanized and the lumbar spines imaged using postcontrast enhanced MRI. The T1 constants in the nucleus, annulus, and cartilage endplates were quantified as a measure of gadodiamide transport into the loaded discs compared with the adjacent unloaded discs. Microcomputed tomography was used to quantify subchondral bone density.Low rate loading caused the rapid uptake and clearance of gadodiamide in the nucleus compared with unloaded discs, which exhibited a slower rate of uptake. Relative to unloaded discs, low rate loading caused a maximum increase in transport into the nucleus of 16.8% after 5 minutes of loading. Low rate loading increased the concentration of gadodiamide in the cartilage endplates at each time point compared with unloaded levels.Results from this study indicate that forced convection accelerated small molecule uptake and clearance in the disc induced by low rate mechanical loading. Low rate loading may, therefore, be therapeutic to the disc as it may enhance the nutrient uptake and waste product clearance.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Regulation of presynaptic Ca2+, synaptic plasticity and contextual fear conditioning by a N-terminal Î²-amyloid fragment. - The Journal of neuroscience : the official journal of the Society for Neuroscience
Soluble Î²-amyloid has been shown to regulate presynaptic Ca(2+) and synaptic plasticity. In particular, picomolar Î²-amyloid was found to have an agonist-like action on presynaptic nicotinic receptors and to augment long-term potentiation (LTP) in a manner dependent upon nicotinic receptors. Here, we report that a functional N-terminal domain exists within Î²-amyloid for its agonist-like activity. This sequence corresponds to a N-terminal fragment generated by the combined action of Î±- and Î²-secretases, and resident carboxypeptidase. The N-terminal Î²-amyloid fragment is present in the brains and CSF of healthy adults as well as in Alzheimer's patients. Unlike full-length Î²-amyloid, the N-terminal Î²-amyloid fragment is monomeric and nontoxic. In Ca(2+) imaging studies using a model reconstituted rodent neuroblastoma cell line and isolated mouse nerve terminals, the N-terminal Î²-amyloid fragment proved to be highly potent and more effective than full-length Î²-amyloid in its agonist-like action on nicotinic receptors. In addition, the N-terminal Î²-amyloid fragment augmented theta burst-induced post-tetanic potentiation and LTP in mouse hippocampal slices. The N-terminal fragment also rescued LTP inhibited by elevated levels of full-length Î²-amyloid. Contextual fear conditioning was also strongly augmented following bilateral injection of N-terminal Î²-amyloid fragment into the dorsal hippocampi of intact mice. The fragment-induced augmentation of fear conditioning was attenuated by coadministration of nicotinic antagonist. The activity of the N-terminal Î²-amyloid fragment appears to reside largely in a sequence surrounding a putative metal binding site, YEVHHQ. These findings suggest that the N-terminal Î²-amyloid fragment may serve as a potent and effective endogenous neuromodulator.Copyright Â© 2014 the authors 0270-6474/14/3414210-09$15.00/0.
Drug-induced changes to the vertebral endplate vasculature affect transport into the intervertebral disc in vivo. - Journal of orthopaedic research : official publication of the Orthopaedic Research Society
Intervertebral disc health is mediated in part by nutrient diffusion from the microvasculature in the adjacent subchondral bone. Evidence suggests that a reduction in nutrient diffusion contributes to disc degeneration, but the role of the microvasculature is unclear. The purpose of this study was to induce changes in the endplate microvasculature in vivo via pharmaceutical intervention and then correlate microvasculature characteristics to diffusion and disc health. New Zealand white rabbits were administered either nimodipine (to enhance microvessel density) or nicotine (to diminish microvessel density) daily for 8 weeks compared to controls. Trans-endplate diffusion and disc health were quantified using post-contrast enhanced magnetic resonance imaging (MRI). Histology was utilized to assess changes to the subchondral vasculature. Results indicate that nimodipine increased vessel area and vessel-endplate contact length, causing a significant increase in disc diffusion. Surprisingly, nicotine caused increases in vessel number and area but did not alter diffusion into the disc. The drug treatments did affect the microvasculature and diffusion, but the relationship between the two is complex and dependent on multiple factors which include vessel-endplate distance, and vessel-endplate contact length in addition to vessel density. Our data suggest that drugs can modulate these factors to augment or diminish small molecule transport.Â© 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
Spontaneous septic arthritis of the lumbar facet caused by methicillin-resistant Staphylococcus aureus in an otherwise healthy adolescent. - American journal of orthopedics (Belle Mead, N.J.)
We report the case of a 16-year-old boy with isolated septic arthritis of a lumbar facet. This rare presentation of an infection in a lumbar facet joint occurred after minor trauma sustained in a football game. Septic arthritis of the spinal facet joint is an uncommon phenomenon. Only 5 cases have been reported in immunocompromised pediatric patients. To our knowledge, no case of septic arthritis in an immunocompetent pediatric patient has been reported. An otherwise healthy 16-year-old boy presented with 4 weeks of escalating back pain after a minor athletics-related trauma. Evaluation showed incapacitating pain, lumbar musculature spasms, and the absence of fever, hemodynamic, or neurologic changes. Laboratory values were within normal limits. Magnetic resonance images showed a fluid collection within the L3-L4 facet and a localized abscess. Computed tomographic-guided aspiration showed methicillin-resistant Staphylococcus aureus infection, for which the patient received 6 weeks of vancomycin with complete resolution of symptoms. Refractory lumbago in an adolescent requires careful evaluation.
Guidelines: is bigger better? A review of SIGN guidelines. - BMJ open
To quantify and analyse the quality of evidence that is presented in national guidelines.Levels of evidence used in all the current valid recommendations in the Scottish Intercollegiate Guideline Network (SIGN) guidelines were reviewed and statistically analysed.The proportion of level D evidence used in each guideline and a statistical analysis.Data were collected from published guidelines available online to the public. SIGN methodology entails a professional group selected by a national organisation to develop each of these guidelines. Statistical analysis of the relationship between the number of guideline recommendations and the quality of evidence used in its recommendations was performed.The proportion of level D evidence increases with the number of recommendations made. This correlation is significant with Kendall's Ï„=0.22 (approximate 95% CI 0.008 to 0.45), pâ€‰=â€‰0.04; and Spearman Ï=0.22 (approximate 95% CI 0.02 to 0.57), p=0.04.Practice guidelines should be brief and based on scientific evidence. Paradoxically the longest guidelines have the highest proportion of recommendations based on the lowest level of evidence. Guideline developers should be more aware of the need for brevity and a stricter application of evidence-based principles could achieve this. The findings support calls for a review of how evidence is used and presented in guidelines.
Microfluidic multi-input reactor for biocatalytic synthesis using transketolase. - Journal of molecular catalysis. B, Enzymatic
Biocatalytic synthesis in continuous-flow microreactors is of increasing interest for the production of specialty chemicals. However, the yield of production achievable in these reactors can be limited by the adverse effects of high substrate concentration on the biocatalyst, including inhibition and denaturation. Fed-batch reactors have been developed in order to overcome this problem, but no continuous-flow solution exists. We present the design of a novel multi-input microfluidic reactor, capable of substrate feeding at multiple points, as a first step towards overcoming these problems in a continuous-flow setting. Using the transketolase-(TK) catalysed reaction of lithium hydroxypyruvate (HPA) and glycolaldehyde (GA) to l-erythrulose (ERY), we demonstrate the transposition of a fed-batch substrate feeding strategy to our microfluidic reactor. We obtained a 4.5-fold increase in output concentration and a 5-fold increase in throughput compared with a single input reactor.
StayFuse for proximal interphalangeal joint fusion. - Foot & ankle international
Proximal interphalangeal (PIP) joint fusion is a commonly performed procedure for lesser-toe deformities. There are various techniques described to accomplish it. We report the results of PIP joint fusion carried out with an intramedullary fusion device in 150 consecutive toes. The aim of our study was to evaluate the outcomes of PIP joint fusion with this technique.A total of 150 toes in 140 consecutive patients who underwent PIP joint fusions of the lesser toes with a StayFuse implant were included in our study. The mean age of the patients was 69.5 years, and the mean follow-up was 18 months. Clinical, radiologic, and subjective evaluations as well as preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were carried out.Of the PIP joints, 95.3% were clinically asymptomatic, but the radiologic fusion was 73%. The mean preoperative AOFAS score improved from 22.9 to 81.6 at follow-up. There were implant-related complications in 8 toes. Ninety-five percent of the patients were satisfied with the procedure, and 3.3% of the patients needed revision surgery.This technique maintained PIP joint alignment and provided rotational and angular stability with high patient satisfaction and low complication and reoperation rates. We conclude that this is a reproducible technique and an alternative for PIP joint fusions.Level IV, retrospective case series.
Tetanus and the evolution of intensive care in Australia. - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine
A review of two series of patients with tetanus from the Royal Adelaide Hospital provides a historical perspective on the evolution of intensive care in Australia. Nine consecutive severe cases presenting in 1957 constituted one of the first series published. Four patients died. The second series of 38 severe cases, among a total of 56 cases presenting between 1967 and 1985, included two deaths, comparing favourably with survival in other contemporary series. The specialty of intensive care evolved considerably during this time. Neuromuscular blockade introduced in the first series produced radical changes in management. Supportive measures that were not then widely practised, involving intermittent positive pressure ventilation, were used in the second series for up to 46 days and evolved into standard ICU practice. The option of using a tank respirator was rejected. Older patients were susceptible to complications commonly related to respiratory, cardiovascular and diabetic comorbidities, but most returned to their previous lifestyle. Severe tetanus often resulted from mild injuries in patients who were incompletely immunised. Four patients developed tetanus following surgical procedures. The use of nitrous oxide in the first series was abandoned owing to adverse effects on bone marrow function. Complications reported in early literature, such as fractures and myositis ossificans, presumably related to unrelieved spasm, are no longer seen. Clinicians are now likely to see the condition only if working with counter-disaster teams overseas.
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564 Niagara St Buffalo, NY 14201
300 Niagara St Niagara Family Health Center
430 Niagara St Ubmd At Lakeshore