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Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study
Ushma D. Upadhyay ,
* E-mail: ushma.upadhyay@ucsf.edu
Affiliation Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, United States of America
Katrina Kimport,
Elise K. O. Belusa,
Nicole E. Johns,
Douglas W. Laube,
Affiliation Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
Sarah C. M. Roberts
Ushma D. Upadhyay,
Ushma D. Upadhyay Katrina Kimport ... Sarah C. M. Roberts
Since mid-2013, Wisconsin abortion providers have been legally required to display and describe pre-abortion ultrasound images. We aimed to understand the impact of this law.
We used a mixed-methods study design at an abortion facility in Wisconsin. We abstracted data from medical charts one year before the law to one year after and used multivariable models, mediation/moderation analysis, and interrupted time series to assess the impact of the law, viewing, and decision certainty on likelihood of continuing the pregnancy. We conducted in-depth interviews with women in the post-law period about their ultrasound experience and analyzed them using elaborative and modified grounded theory.
A total of 5342 charts were abstracted; 8.7% continued their pregnancies pre-law and 11.2% post-law (p = 0.002). A multivariable model confirmed the law was associated with higher odds of continuing pregnancy (aOR = 1.23, 95% CI: 1.01–1.50). Decision certainty (aOR = 6.39, 95% CI: 4.72–8.64) and having to pay fully out of pocket (aOR = 4.98, 95% CI: 3.86–6.41) were most strongly associated with continuing pregnancy. Ultrasound viewing fully mediated the relationship between the law and continuing pregnancy. Interrupted time series analyses found no significant effect of the law but may have been underpowered to detect such a small effect.
Nineteen of twenty-three women interviewed viewed their ultrasound image. Most reported no impact on their abortion decision; five reported a temporary emotional impact or increased certainty about choosing abortion. Two women reported that viewing helped them decide to continue the pregnancy; both also described preexisting decision uncertainty.
This law caused an increase in viewing rates and a statistically significant but small increase in continuing pregnancy rates. However, the majority of women were certain of their abortion decision and the law did not change their decision. Other factors were more significant in women's decision-making, suggesting evaluations of restrictive laws should take account of the broader social environment.
Citation: Upadhyay UD, Kimport K, Belusa EKO, Johns NE, Laube DW, Roberts SCM (2017) Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study. PLoS ONE 12(7): e0178871. https://doi.org/10.1371/journal.pone.0178871
Editor: Ganesh Dangal, National Academy of Medical Sciences, NEPAL
Received: January 3, 2017; Accepted: April 28, 2017; Published: July 26, 2017
Copyright: © 2017 Upadhyay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant quantitative data are available from UCSF Library Datashare (https://doi.org/10.7272/Q65H7D63). Data have been deidentified and all protected health information removed. All relevant qualitative data are within the paper. Original interviews cannot be provided because public availability would compromise patient confidentiality and participant privacy.
Funding: This study was funded by a private, anonymous foundation. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
In July 2013, a Wisconsin law took effect mandating that abortion providers display and describe the ultrasound image to patients prior to offering an abortion [1, 2]. While ten states have laws requiring abortion providers to offer women the opportunity to view their ultrasound images [3], Wisconsin's law goes a step further by requiring them to present the image in the patient's line of sight, whether or not the woman wishes to see it. If a woman does not want to view, she may physically turn her head away or close her eyes. The technician is required to give the woman a verbal description of the ultrasound image, including identification of fetal parts, the heartbeat and current development of the fetus. The law further requires abortion providers to offer patients a printed version of their ultrasound image and a state-produced booklet describing fetal development throughout pregnancy. Additionally, a woman must receive in-person state-directed information before starting a 24 hour waiting period and subsequently making a second trip to the clinic before she can have an abortion [1].
In recent decades, ultrasound use in abortion care has become routine, generally used to determine gestation of the pregnancy, multiple pregnancies, and other clinical indications [4–7]. Current medical guidelines note that while ultrasound is not required, it is recommended in abortion care [8]. Patient viewing of the pre-abortion ultrasound image, however, is not covered by medical guidelines. Viewing is an ancillary activity, not integral to the medical provision of abortion care. Laws mandating ultrasound viewing are not based on an identified medical need.
Drawing on experiences of patient ultrasound viewing in wanted pregnancies, scholars have speculated that ultrasound viewing prior to abortion would dissuade women from abortion [9–11]. However, recent literature on maternal-fetal bonding through ultrasound challenges the claim that viewing is central to bonding [12] and has posited ultrasound viewing as a social process rather than simple medical information [13, 14].
Research on the effects of offering voluntary ultrasound viewing on women's experience with abortion [15–18] provides evidence that ultrasound viewing does not dissuade women from abortion. A recent analysis of over 15,000 visits to outpatient abortion care facilities where women were offered the option to view their pre-abortion ultrasound image found that 43% of the women chose to view the image [15, 17] and that, for the majority of women who viewed their ultrasound image, viewing did not affect their likelihood of proceeding to abortion; among women who viewed their ultrasound, 98.4% proceeded to abortion [15]. For the very small subset of women who reported low decision certainty, viewing did slightly increase the odds of continuing a pregnancy [15]. However, it was not possible to distinguish whether it was viewing the image that swayed the more uncertain women, or whether they chose to view the image in order to be swayed. Additional research shows that, aside from impact on decision-making, pre-abortion ultrasound viewing can have other effects on women [17–19]. In a study of 20 women interviewed after receiving an ultrasound as part of abortion care, women's accounts illustrated that ultrasound viewing can cause emotional difficulty for women who plan to terminate their pregnancy [16], but other studies have found that the most common emotional response to ultrasound viewing is a neutral one, with many women reporting that viewing had no impact on them [19]. However, given findings that many women appreciate having the choice whether to view their ultrasound image [17, 20–22], it is unclear if we can generalize from findings on the effects (or lack thereof) of voluntary viewing to settings where viewing is mandatory, such as Wisconsin.
To date, three other state legislatures, Louisiana, Texas, and Kentucky have enacted similar laws mandating that abortion providers display and describe the ultrasound image prior to abortion. Two additional states, North Carolina and Oklahoma have passed similar laws, but they are enjoined by court order [3]. Other states may be considering similar mandatory viewing laws, making it important to examine the effects of such laws on women and their decisions to continue their pregnancies versus proceed to abortion.
We designed a mixed-methods study, integrating qualitative and quantitative methods, to investigate a mandatory ultrasound viewing law. We analyzed quantitative data abstracted from medical records from a high-volume abortion care facility in Wisconsin to examine whether this law impacted women's decision to view their ultrasound image and/or their decision to proceed to abortion or continue the pregnancy. In parallel, we conducted in-depth interviews with women who sought abortion care at the same facility and were subject to the law to qualitatively explore their decision-making about viewing and, for those who viewed, perceived effects of viewing.
We abstracted medical chart data and recruited participants for in-depth interviews at a high-volume abortion-providing facility in Milwaukee, Wisconsin. Over the course of data collection and analysis, the study team met frequently to discuss findings iteratively to inform ongoing analyses of both the qualitative and the quantitative data. The University of California, San Francisco Committee on Human Research granted ethical approval for all research protocols (Medical Chart Data: original approval date: 10 March 2015; study number: 15–15830; Interview Data: original approval date: 24 March 2015; study number: 15–15770).
Both before and after the law was implemented, all patients at the facility received a pre-abortion ultrasound on their first visit, along with blood testing, counseling, and other intake procedures. The main change after the law's implementation was related to the display of the ultrasound image: prior to the law's implementation, viewing the ultrasound image was voluntary; after the law went into effect, the ultrasound screen was placed in patients' direct line of sight. Wisconsin state law already required a 24-hour waiting period between a patient's initial information visit and the actual procedure. Therefore, both before and after implementation of the ultrasound viewing law, patients had to wait at least 24 hours after they received the ultrasound before they could have the abortion.
Medical chart data
Quantitative data came from patient medical charts, abstracted by two facility staff and one UCSF research assistant. Staff abstracted sociodemographic and clinical chart data for all abortion patients from one year prior to the law's implementation (July 7, 2012 –July 6, 2013) to one year after the law's implementation (July 7, 2013 –July 6, 2014). Typically, only one ultrasound is performed per abortion, however some women had additional ultrasound visits, which were also abstracted.
Outcome variables.
The main outcome of interest was continuing a pregnancy, defined as being eligible for an abortion but not obtaining one at the study clinic. Women who were eligible for an abortion but did not return were considered to have continued their pregnancy because it was not possible to assess whether they had an abortion at a nearby facility or elsewhere.
Main Independent variable.
For all analyses, the primary independent variable was time period pre- or post-law.
Potential mediator.
Per our conceptual model (Fig 1), we wanted to assess whether changes in viewing the ultrasound image either on the screen or receiving a printout of the image mediated the effects of the law on the decision to continue the pregnancy. In the pre-law period, all women seeking an abortion were offered the opportunity to view the image on the screen and in the post-law period women were able to look away if they did not want to see. In both the pre-law and post-law periods, all women were offered a printout of the ultrasound image. In both periods, whether the patient viewed the ultrasound image and whether she received a printout was recorded in her chart. For all analyses, we used a single dichotomous variable, combining both items for whether the woman viewed the image on screen or received the printout. As has been done in previous studies [15, 17], when women had more than one ultrasound, they were assigned to the 'viewed ultrasound' designation if they had viewed or received a printout of at least one ultrasound.
Fig 1. Conceptual model.
Potential moderator.
We also examined decision certainty as a moderator of the association between the law and viewing the ultrasound image. The interviews in this study and previous quantitative research [17] have found decision certainty to be a key factor in whether the woman views her ultrasound image. Thus, we hypothesized that decision certainty would moderate the effect between the law and viewing. Previous research has also found that decision certainty is also associated with decisions to have an abortion [15, 23, 24]. Thus, we hypothesized that it would also moderate the effect of viewing the ultrasound on the main outcome of continuing the pregnancy (Fig 1). Counselors assessed each woman's certainty about her decision to have an abortion at the clinic prior to the ultrasound and then documented whether she was firm or uncertain on an intake form. If the woman was uncertain, counselors would talk more with her and make notes on reasons for uncertainty. In some cases, women were referred out for further counseling and not scheduled for an abortion. Because there were so few women with low decision-certainty and with missing certainty data, we combined these groups in our analyses.
Control variables.
We controlled for several other potential variables that previous studies [15, 17] suggested could be related to women's viewing decisions or decisions to continue a pregnancy. These included sociodemographic characteristics (age, education, race/ethnicity, marital status, partner relationship, urbanicity), parity, time since last pregnancy, the primary decision-maker in the relationship (self, parent, husband, boyfriend, or other), support person presence at visit (yes, no), and noted concurrent or complicating medical issues.
Additionally, we included funding as a dichotomous variable, whether the woman qualified for partial financial assistance from an abortion fund or whether she was required to pay the full costs out of pocket. Women were interviewed about their ability to pay and qualification for funds at the ultrasound visit. After qualification was confirmed, women were referred to one or more abortion funds, which determined the amount the fund would provide. Some women received partial funding to cover laboratory costs from their ultrasound visit, even if they did not proceed to abortion. In post-hoc analyses, we assessed whether qualifying for such funding was significantly associated with both decision certainty and continuation of pregnancy. Thus we conducted additional analyses to better understand the effects of qualifying for funding on the outcome of interest.
We used the data directly as recorded in the chart, with the following few exceptions. We created an urban/rural designation based on zip code and Rural-Urban Commuting Area (RUCA) codes [25]. Entries in 'other' categories which fit a response group were recategorized (e.g. other for race/ethnicity). Data that were reported as continuous measures were grouped into categories for ease of analysis for age, highest level of education, and number of previous births. Dates which were written in error were recategorized as not in chart (e.g. if a woman entered her LMP as her date of last birth).
Analysis.
We described socio-demographic and clinical characteristics of the samples before and after implementation of the law and assessed any differences from before to after the law using chi-square tests. We described and graphed the monthly rate of viewing the ultrasound image before and after the law. We also tested the hypothesized moderation of the effect of law on ultrasound viewing by decision certainty (Fig 1) by constructing an individual level model with an interaction between law and decision certainty.
We then described the proportion of women in the sample who did not have an abortion at the facility and the known reasons. Women who were not pregnant at the ultrasound visit, with no gestational sac seen, or who miscarried or probably miscarried were excluded from the subsequent analyses. Additionally, we excluded from subsequent analyses those who could not have an abortion at the facility because they were beyond the clinic's gestational limit at the time of first ultrasound, beyond the height and weight limit, had an ectopic pregnancy, had a chronic medical condition, were on specific medications, were referred for services elsewhere, or were otherwise ineligible for care at the facility.
We then constructed a series of models, using a block modeling approach which incrementally added variables to examine the changes in the odds of continuing the pregnancy; we started with a simple model of law as the sole predictor and then added viewing and decision certainty.
Then we constructed adjusted multivariable models examining the effects of the law on the decision to continue pregnancy. The second multivariable model omitted viewing as a potential mediator. We also tested potential interactions between decision certainty and law and gestational age and law based on a priori hypotheses and post-hoc potential associations based on statistical significance. We conducted a post-hoc analysis of qualifying for abortion funds and decision certainty. For all models, we used generalized estimating equations with logistic regression specifications and the patient as the panel variable to account for multiple pregnancies among the same woman.
Based on the literature, we expected to find mediation and moderation among the law, viewing the ultrasound image, decision certainty, and continuation of pregnancy (Fig 1). To understand the effect of the law on viewing and viewing on continuation of pregnancy, we conducted a mediation analysis using Preacher & Hayes bootstrapped test of mediation [26].
We then sought to examine moderation. Our initial plan was to conduct a moderated mediation analyses. However, there were too few women who were uncertain who did not view in the post-law period for this or even stratified models to be appropriate. We therefore examined rates of continuing pregnancy stratified by decision certainty and viewing status.
Finally, we wanted to consider alternative plausible hypotheses to rule out other factors that may have been occurring around the time of the law change. Specifically, we sought to examine whether there were any underlying time trends that may be occurring unrelated to the law change, but that might explain our findings. Thus we conducted an interrupted time series analysis using segmented regression for continuing the pregnancy [27, 28]. We conducted a second segmented regression model that adjusted for aggregated covariates. We assessed for autocorrelation using the Durbin-Watson statistic and examined the data for evidence of seasonality. We did not find evidence of autocorrelation or seasonality.
In-depth interviews
To explore women's experiences of mandatory ultrasound viewing, the second author conducted semi-structured, in-depth phone interviews. Women were recruited following their ultrasound visit. Patients were eligible if they were over 18, English-speaking, and had received an ultrasound as part of abortion care at the study facility. Recruitment took place between May and September of 2015. Most women were interviewed about one week after their ultrasound visit.
To recruit participants, following the ultrasound, the staff technician gave patients a study flyer, which described the study's objective to examine women's experience of the Wisconsin ultrasound law and included a toll-free phone number for UCSF research staff. Interested potential participants called the number and were screened for eligibility. Eligible callers were verbally consented and, if interested, scheduled for a phone interview. As we neared saturation, we noticed a disproportionate representation of white respondents compared to the facility's client population. We conducted a second round of recruitment purposively sampling women of color. After preliminary analyses, we found the experiences of women of color did not differ from white women. We thus determined that we had reached saturation soon after the second round of recruitment and ceased recruitment.
Phone interviews were conducted by the second author, a sociologist and expert in qualitative data collection and analysis. Respondents were asked about their experience at the facility on the day of their ultrasound, including ultrasound experience, what they thought and felt about viewing or not viewing the image and about hearing a description of the image, and any perceived impacts of viewing. Interviews were recorded and transcribed verbatim by a professional transcription company. In presenting the data below, we refer to respondents using pseudonyms.
Interviews averaged about 60 minutes. Respondents were compensated for their time with a $50 gift card.
Analysis of in-depth interviews.
Interviews were analyzed by the second author in Atlas.ti 7 using elaborative coding, with general codes developed based on the research question for respondents' emotional experience of viewing and their pregnancy decision-making and on findings from the quantitative data. Because the chart abstraction occurred simultaneously with the in-depth interviews, and thus the quantitative findings did not inform the interview guide itself, the ability of the in-depth interviews to shed light on some of the more unexpected quantitative findings was limited. Excerpts for these codes were detail-coded using modified grounded theory [29] to elucidate patterns within these broader experiences and decisions. Findings were discussed and contextualized by several authors, compelling an additional round of coding by the second author. Coding was considered complete when no new codes emerged.
Among all medical chart data requested from the 24 months of the study (N = 5595), 120 charts were missing (2.1%): 55 charts in the pre-law period and 65 charts in the post-law period. An additional 133 charts were outside referrals where the ultrasound was done at an alternate site and thus, the charts were not abstracted. Ultimately, 5342 charts were abstracted, with 2724 ultrasound visits in the pre-law period and 2618 in the post-law period.
There were slight differences between the pre- and post-law samples (Table 1). In the post-law period, women were less likely to report decision-making was shared with another person (3.7% pre-law vs 2.2% post-law, p = 0.001), and more likely to live in a rural zip code (6.1% pre-law vs 7.8% post-law, p = 0.02) than women in the pre-law period. Decision certainty was consistent between pre and post-law periods (Table 1).
Table 1. Characteristics of the pre- and post-law populations at a WI clinic, 7/7/2012-7/6/2014.
While the law required providers to display the ultrasound image, women were legally permitted to physically turn their heads away or close their eyes. Women in the post-law period were more likely to view the ultrasound image than women in the pre-law period, although more than half of patients did choose to view pre-law (61.3% pre-law vs 90.9% post-law, p<0.001) (Table 1). Compared to the pre-law period, significantly fewer women qualified for assistance from an abortion fund in the post-law period (46.6% pre-law vs 40.2% post-law, p<0.001). Among those eligible for an abortion at the study site, women in the post-law period were more likely to continue with their pregnancy than women in the pre-law period (8.7% pre-law vs 11.2% post-law, p = 0.002).
Viewing the ultrasound image.
Segmented regression analysis of the monthly aggregate data found a significant difference in viewing levels pre- vs post-law (p<0.001) (Fig 2). There was no significant time trend in percent of women viewing pre-law, but there was evidence of a statistically significant monthly increase in the post-law time period in the model (p = 0.02). In the individual-level model, we found no evidence of moderation of the effect of the law on viewing by decision certainty (interaction p = 0.10).
Fig 2. Monthly rate of viewing the ultrasound image or receiving printout.
Continuing the pregnancy.
Among the 5342 charts, 13% of women (695), did not proceed to abortion at the study site. Table 2 presents the women who did not have an abortion at the facility by reason. The most common reason women did not have an abortion at the facility was because they did not call or show for their abortion appointment or they called and cancelled or they never made an appointment in the first place (299, 43.0%) followed by reason not listed in chart (133, 19%).
Table 2. Primary reason for not having abortion (mutually exclusive) (total n = 693).
For the main analyses, we excluded the 181 women (3.4% of all women) who were not eligible for an abortion at the facility, as well as one woman whose birthdate and age were missing, two women who left during the first appointment and were missing extensive substantial chart data and one missing data on weeks gestation from the continuing pregnancy analyses. We retained 512 women (9.6% of all women) in the dataset who did not have an abortion. Thus the subsequently analyzed dataset included 5158 charts, 2625 pre-law and 2533 post-law. This sample size afforded us statistical power of 90% to detect an increase of 3 percentage points or greater in the proportion of women who continued their pregnancy in the pre- and post-law periods, based on a baseline continuation rate of 12%.
Among the 5,158 women who were eligible for an abortion, 512 continued the pregnancy, 228 (8.7% of all eligible women) before the law and 284 (11.2% of all eligible women) after the law. A univariate model showing the effect of the law on continuing pregnancy is shown in Table 3 with additional variables added to the model. Introduction of the law was significantly associated with higher odds of continuing the pregnancy (Model A: OR = 1.33, 95% CI = 1.10–1.59). Recalling that the law required the image be displayed, but the woman could turn her head away or close her eyes, the effect of the law was no longer significant when viewing the ultrasound image was added to the model suggesting mediation; viewing was associated with a higher odds of continuing the pregnancy (Model B: AOR = 1.86, 95% CI = 1.41–2.45). The effect of viewing was attenuated after adding decision certainty to the model. Being uncertain about the abortion decision was associated with an 8-fold increase in the odds of continuing pregnancy, making it the strongest factor associated with continuing pregnancy (Model C: AOR = 8.11, 95% CI = 6.13–10.74).
Table 3. Time period, viewing ultrasound, decision certainty and their associations with continuing pregnancy, n = 5,158.
A full model, adjusted for covariates, demonstrates that the effects of viewing and decision certainty on continuing the pregnancy remain (Table 4). A final full model that omits viewing (a potential mediator) shows that the law was associated with a higher odds of continuing pregnancy (aOR = 1.23, 95% CI: 1.01–1.50). Being uncertain about the abortion decision (aOR = 6.39, 95% CI: 4.72–8.64) was also associated with continuing pregnancy. An interaction term between decision certainty and the law on the outcome of continuing pregnancy was not significant, suggesting that the law had a statistically significant effect among both firm and uncertain women.
Table 4. Factors associated with continuing pregnancy, with and without the mediator, viewing (n = 5,158).
Additionally, women who were black and women who had at least one previous birth were more likely to continue their pregnancies than white women and nulliparous women. Women whose partners were the dominant decision-makers were also more likely to continue their pregnancies than those who identified themselves as the dominant decision-makers.
Women who were required to pay fully out of pocket were more likely to continue the pregnancy than those who qualified for partial assistance from an abortion fund (aOR = 4.98, 95% CI: 3.86–6.41). A further analysis of funding revealed that women who qualified for abortion funds were significantly more likely to be firm in their decision (98% of women who qualified for abortion funds were firm, compared to 94% of women who did not, p<0.001).
The results of the mediation analysis found that the relationship between the law and continuing the pregnancy was fully mediated by ultrasound viewing. The standardized regression coefficient between law and ultrasound viewing was statistically significant (0.30, p<0.001), as was the standardized regression coefficient between ultrasound viewing and continuing the pregnancy (0.09, p<0.001). We tested the significance of the indirect effect using bootstrapping procedures. The bootstrapped unstandardized indirect effect was 0.26, and the 95% confidence interval ranged from 0.019 to 0.033. Thus, the indirect effect was statistically significant. The direct effect was not significant (-0.005, p = 0.58), suggesting full mediation by viewing the ultrasound.
After the ultrasound viewing law went into effect, the percentage of women continuing their pregnancies increased slightly in almost all groups stratified by decision certainty and viewing status (Fig 3). We wished to explore whether decision certainty moderated the relationship between the law and continuing pregnancy, but due to small numbers of women who were uncertain, we were unable to formally do so. We were, however, able to examine continuing pregnancy rates stratified by decision certainty (Fig 3). While the vast majority of women reported "firm" decision certainty and more than 90% of these women proceeded to abortion, there was a statistically significant increase in continuing pregnancy rates among women who were firm before and after the law (7.1% pre-law, 9.6% post-law, p = 0.002). Among the small proportion of women expressing uncertainty about their decision to have an abortion or who had missing data on decision certainty (4.5% of women eligible for abortion, n = 232), 43% of those pre-law (n = 49) and 44% of those post-law (n = 52) continued their pregnancy, a difference that was not statistically significant (p = 0.959).
Fig 3. Number of pregnancies by time period, decision certainty, and viewing/picture receipt status and percent of women in each category continuing their pregnancy, n = 5127A.
AExcludes 181 women who were not eligible for abortion at the facility and 31 women for whom data on ultrasound viewing or picture receipt was missing.
Results of the interrupted time series analysis found that overall, there was a slight but statistically significant increase in monthly continuing pregnancy rates over the entirety of the study time period (Table 5 Model A). Visually there appeared to be a significant increase at the time of the law and a significant difference in the monthly rate of women continuing pregnancies at the time the law was implemented supporting the individual-level results; however the difference did not reach statistical significance, perhaps due to lack of power [30]. Neither the slopes nor intercepts of pre- vs post-law linear fits of aggregate monthly data differed significantly (Table 5 Model B). We also tested the addition of monthly aggregate-level covariates for percent viewing and percent firm in decision; none were significant (Table 5 Model C, Fig 4).
Fig 4. Adjusted monthly rate of continuing pregnancy, predicted value of segmented regression with covariates.
Table 5. Monthly trend & segmented regression models of monthly continuing pregnancy rate.
In-depth interview findings
Characteristics of sample.
A total of 23 women completed a semi-structured interview. Respondents ranged in age from 18 to 44 years old, with most (n = 13) in their 20s. Of the 23 women, 15 identified as white, 6 as black, 1 as multiracial (black and white), and 1 as Latina. Most (n = 16) had at least some college, six had high school degrees, and one left school after 11th grade. At the time of their first appointment at the abortion clinic, most women were in the first trimester of their pregnancies: 14 were <7 weeks gestation, 6 were 7–13 weeks, and 3 were in the second trimester (13, 15, and 16 weeks, respectively). Broadly speaking, this sample was similar to the overall population that sought abortion care from the facility in the post-law period (Table 1). The exception to this similarity was in the relative over-participation of white women and under-participation of black and, particularly, Latina women.
The majority of respondents (n = 19) reported viewing their ultrasound image during their appointment at the abortion clinic. As the law mandates the visual display of the ultrasound image as well as a verbal description of the content of the image, the four women who declined to view did nonetheless hear a description of their ultrasound image. Most of the respondents (n = 18) were not aware of the law requiring that they be presented with their ultrasound image and listen to a description of the image. Three reported that they had a vague idea about the law prior to their appointment. One patient, for example, said she "might have read about it." Just two respondents said that they knew about the law in advance of their first appointment, and both women explained that they learned of it in the course of doing research to prepare themselves for their abortion appointments; both women viewed their ultrasound image. Because of respondents' general lack of knowledge about the law itself, and in light of the quantitative finding that viewing the ultrasound image mediated the association between the law and continuing a pregnancy, we focus our analysis below on how respondents described the effects of ultrasound viewing, with attention to how that experience fit into the broader context of their lives and decision-making.
Effects of ultrasound viewing.
All four of the respondents who declined to view their ultrasound image proceeded to abortion and, for the most part, those who did view their ultrasound image did not talk about viewing as having an impact on their decision to have an abortion. For example, one woman who viewed her ultrasound image because she thought it was "interesting" to see, reported that viewing had no impact on her decision to have an abortion: "Didn't change my mind at all or my feelings or anything like that." Another, who explained she chose to view in order to inform her decision-making process, was similarly unaffected by viewing, stating that it had, overall, no effect: "I could probably have gone away without seeing or not seeing it. I don't think it affected anything." Instead, respondents identified other factors as having a larger impact on their decision to have an abortion, such as the difficulty of securing funds to cover the cost of the abortion. Respondents who went to great lengths to overcome these factors—like, for example, the respondent who spent two days calling an abortion fund, seeking financial aid, before getting through and receiving support—were particularly unaffected by viewing. Across the respondents, as these examples demonstrate, the most common reported reaction to viewing was a neutral one; for most women, viewing had no emotional effect or impact on their decision to have an abortion.
Eight respondents, however, did report that viewing had an effect on them. Perhaps unexpectedly, for five of these eight, viewing solidified their decision to have an abortion. One explained:
I said, "Yeah, I want to see it." And then, I looked at it, and it's just a sac, that's it. And here it is right here. And then, yeah, that was it. That's how I knew I was ready [to have the abortion.] And I realized when I saw it, I wasn't emotionally connected to that as a child yet, so I was able to know from that point when I looked at the ultrasound I didn't feel bad. I was like, that's—you know—people—I was okay with it. So, I do think that was a positive experience that I was well enough to look at it and say, "Yeah, I want to see it, and yeah, I'm not having it."
Later in the interview, she summed up the effect of viewing, saying, "I just feel like looking helped me kind of accept, you know, be certain [about choosing abortion]."
For another woman, who reported choosing to view in order to confirm her decision to have an abortion, viewing did stir up some negative emotions: it reminded her of viewing the ultrasounds for her two existing children. Nonetheless, she said that experiencing those feelings did not make her waver on her decision to have an abortion. She explained, "Regardless of what I've seen, how I feel, even if I was to feel like I should keep it, at the end of the day, my mind's set that I shouldn't keep it, because I'm not ready."
Two of these respondents who described viewing their pre-abortion ultrasound image as having an emotional effect on them, however, said viewing contributed to their decision to continue the pregnancy. One respondent, for example, who was 10 weeks pregnant, showed up for her abortion appointment (which, per Wisconsin law, is at least 24 hours after her first appointment at the clinic) but left without obtaining the procedure, having decided to continue the pregnancy. She attributed some of her decision to continue the pregnancy to viewing her pre-abortion ultrasound scan at the abortion facility as well as viewing ultrasound images she received at a nearby hospital prior to her appointment at the abortion facility. She said, "maybe looking at all the ultrasounds made me change my mind." Deeper consideration of her experience, however, points to ongoing ambivalence about choosing abortion. She explained that, at the time of her first appointment (i.e. the ultrasound appointment), she was "not at all" sure abortion was the right decision for her. She elaborated:
Basically just listening to other people was—it kind of brought me there to even consider the abortion. It was never a thought of my own. So, and I finally listened to myself I felt like it [abortion] wasn't for me, and I knew that I wasn't going to be happy with the decision.
She continued, explaining that abortion was her boyfriend's preference:
He didn't want another child. Didn't want anything to do with raising another child. So, it [abortion] was just basically his idea—a lot of it. Kind of felt like I didn't really have a choice, and it was more of a thing that I would have been forced to do.
At the same time, her mother disapproved of her plan to have an abortion and offered to adopt the baby after it was born, allowing the respondent to have a role in the baby's life. She explained that viewing the ultrasounds made her ask herself, "why do I have to abort my child when I know I have the option to keep it?" These thoughts, however, were not brought on by viewing the ultrasound image; she said, "I was kind of already having those thoughts […] it [abortion] was just something that I was never comfortable with." She had not, however, articulated this hesitation to a member of the clinic staff. When they asked her if she wanted an abortion, she said she did and that it was her decision.
Another respondent, already a mother of five children between 8-years-old and 5-months-old, also attributed her decision to continue this pregnancy to viewing the ultrasound image. She described viewing her ultrasound image as a turning point in her pregnancy decision-making. This respondent had not considered abortion with any of her previous pregnancies, even for a second, but this time was different because her youngest was so young and her most recent pregnancy had been difficult, with several medical complications. She worried about her ability to have a safe pregnancy. Still, she was unsure about abortion: "It was probably a back and forth for a long time, which was probably why there was such a huge gap [of seven weeks] about when I found out about being pregnant and actually when I went to the clinic. It was a lot of back and forth." When asked how certain she was at the time of her first appointment that abortion was the right decision for her, she replied, "I don't think I was at all." She did not, however, share this uncertainty with any clinic staff members, instead conveying to them that she was firm in her decision to have an abortion.
Looking at the ultrasound image of her 16-week pregnancy clarified her decision and resolved her uncertainty:
It made me feel like I finally knew a little bit of how I felt about the whole situation. Before, I was unsure if it's the right thing to do. And, then when I—like, she was kicking her feet and the hand was going across the face, and all I could think was like, how do you do something like this? It's clearly alive, it's clearly moving around. Like, how? It's mine. That's my baby.
When she spoke to the father of her children soon after, he agreed and they jointly decided to continue the pregnancy and raise this child.
Finally, one respondent reported that she experienced happiness at viewing the ultrasound image: "looking at the screen didn't hurt me, actually. It made me happy, at least for a brief moment." Unlike any of the other women interviewed, this respondent was sure that she did not want to have an abortion. In fact, she wanted desperately to keep the pregnancy, but found herself in a complex legal situation wherein having the baby would likely result in her boyfriend going to jail. At the time of the interview, she had not scheduled her abortion appointment, saying, "I'm still holding out hope [that I can continue this pregnancy]." By her account, viewing did not affect her abortion decision. It did not add to or even impact her desire to continue the pregnancy. Like the women who were certain that abortion was the right decision for them, this respondent experienced viewing as unrelated to her abortion decision-making. Indeed, looking offered her a memory she could think back on in the future if she proceeds with the abortion. She said, "[by looking] I, you know, can still have that little part of me because for a few months' time, you know, that was my baby."
This is the first study to explore the effects of a mandated pre-abortion ultrasound viewing law on women, including whether it affects their decision to proceed with the abortion, using a mixed methods study design. In this study, chart data showed that Wisconsin's mandatory pre-abortion ultrasound viewing law was associated with a statistically significant and robust, but small, increased likelihood of continuing pregnancy, regardless of a woman's certainty about her abortion decision. However the in-depth interview findings demonstrate that the effect of viewing on a woman's decision to continue her pregnancy is best understood with attention to the broader context of her life circumstances. The multivariable analysis of the chart data was consistent with the qualitative finding that other factors were more important to her abortion decision. The innovative methods used in this paper integrating qualitative and quantitative research methods and analyses allow us a broad look at the question of how a mandatory ultrasound viewing law impacts women's abortion decisions.
The quantitative findings confirm the part of the conceptual model where pre-abortion ultrasound viewing mediates the relationship between the law and women's decisions to proceed to abortion or continue their pregnancies. In fact, viewing fully mediates the association so that the law has no independent impact on women's abortion decisions. We expected to also find that decision certainty moderates the impact of pre-ultrasound viewing on continuing pregnancy. While we were unable to formally test this association due to small numbers of uncertain women who did not view the image, stratified tabulations do not support this moderation effect. They suggest that the effect of mandated viewing impacts all women regardless of their decision certainty. This finding differs from a previous study in a voluntary context [15], where ultrasound viewing had a small impact only among women who were not certain that abortion was the right decision for them. Nevertheless, the current study showed that low decision certainty has strong associations with continuing pregnancy, and this is consistent with the previous study done in the context of voluntary ultrasound viewing [15].
The in-depth interviews offer some insight into this apparent divergence from the conceptual model and prior studies. In the interview data, it was only the two women who were uncertain about choosing abortion who described viewing the ultrasound image as having an impact on them, consistent with previous research that low decision certainty plus viewing is associated with continuing the pregnancy. Their complex personal stories suggest, moreover, that they may have been seeking to justify choosing to continue the pregnancy. Citing ultrasound viewing as causing an attachment to the pregnancy, despite in at least one respondent's case having previously viewed a high quality image at a hospital, may have enabled these women to persuade themselves and those in their lives that continuing the pregnancy was the right decision for them. Neither of these women, however, communicated their uncertainty about abortion to clinic staff, suggesting that the facility's question on decision certainty may not have completely captured the variability and nuance in decision certainty among this population. Thus the quantitative measure of decision certainty was perhaps imprecise. As a dichotomous measure, it did not capture fine distinctions among levels of decision certainty. As one indicator, the proportion of women who were uncertain in this study appears lower than in some previous studies of women seeking abortion [15, 23]. This would explain why we found a significant effect of the law even among those who reported being firm in their decision.
Other factors identified in the quantitative analysis that were associated with proceeding to abortion bear discussion. That the proportion of women who qualified for assistance from an abortion fund dropped between pre-law and post-law periods, together with the finding that women who qualified for assistance from an abortion fund were more likely to proceed to abortion than those who would have to pay fully out of pocket, suggests that the drop in abortion funds available may have contributed to the increase in the percentage of women continuing pregnancy between pre- and post-law periods. Indeed reports from the clinic director confirm that due to funding constraints among abortion funds, fewer women were granted abortion funding in the post-law period. Abortion funds provide women with needed assistance to surmount financial barriers and make it possible to have a wanted abortion. Research has found that cost is a major barrier to obtaining a wanted abortion for women [31–33]. Future research should examine this relationship further.
Women reporting that their partners were the dominant decision-makers in their relationships were more likely to continue their pregnancies which demonstrates that men can have a strong influence on women's abortion decisions. While the literature finds that most men are supportive of women's abortion decisions [34, 35], it also finds that the small proportion of men who are controlling or violent are less likely to support women's reproductive decisions [34, 36, 37].
There are several strengths of our study. The qualitative sample includes a diverse group of women and the quantitative portion avails of a sufficiently large sample size. Our measure of viewing assessed viewing the printout as well as the image on screen to capture the consumption of any ultrasound image; no other study has examined the effects of the printout of the image. Further research is needed to understand whether and how women experience the printout differently from the image on screen.
There are a few limitations, however. First, in addition to viewing, the law also required providers to describe fetal development to all patients in the post-law period which may also have contributed to the effects seen among women in decisions to continue their pregnancies, but this study is unable to tease apart such effects. Second, women who were eligible for an abortion but did not return for an abortion were assumed to have continued the pregnancy, although it is possible that some obtained an abortion at another facility. There is no reason to believe that there was an increase in the percentage of women who went elsewhere for an abortion after the law, as there were no new abortion services over the study period. Third, the interview data were collected exclusively in the post-law period, so we cannot know whether their reports of any effects (or lack thereof) of viewing are specific to the mandatory viewing setting. Finally, because the chart abstraction and qualitative interviews took place concurrently, the interviews did not probe unexpected areas the quantitative analysis identified as of interest, such as the role of funding and whether women self-identified as the primary decision-maker. Future research should examine these points further.
Together, these qualitative and quantitative analyses find that Wisconsin's mandatory ultrasound viewing law caused an increase in viewing rates and, in turn, slightly increased the rate of continuing pregnancies. However, for the vast majority of women, the law does not change their minds about abortion; other factors have important roles in their decision-making.
Even with these robust data, we do not fully understand the precise mechanism behind "viewing" that is having the effect. Given that the image itself is different depending on the stage of fetal development, the image quality of the machine at this facility was not high, and all women—even those who averted their eyes—heard a verbal description of the image, we are unable to tease out how the law mandating viewing impacted decision-making for some, but not all, women. Indeed, in the in-depth interviews, the women who articulated an effect of viewing also described other factors that were personally significant to their decision-making, making it impossible to isolate anything specific about viewing the image. One possible mechanism we posit is that the effect of viewing is a culmination of existing social pressure to continue pregnancies, the existence of which is evidenced by the fact that a mandatory ultrasound viewing law has legislative support. It is important to consider the way a broader social environment that condones mandatory viewing may itself condition women's abortion decisions. With data from only a single state, our results may not be generalizable to other states with the same law, but we do expect that these findings would be consistent in other states with laws that are hostile to abortion rights. In such an environment the process of having the ultrasound image described and displayed may be the tipping point that leads a woman who was in the process of making her decision about whether to have an abortion decide to continue her pregnancy. The question of whether this cumulative social pressure to continue a pregnancy is coercive is important as evidence shows negative consequences for women who do not receive wanted abortions [38, 39].
In contexts where viewing the ultrasound image is decided by the patient, a significant minority of women seeking abortions already choose to view their ultrasound image. At the same time, in the absence of such a law the majority of women choose not to view for a variety of personal reasons [17]. Ultrasound viewing is not integral to the medical provision of abortion care. Thus, laws about whether to force women to view their ultrasounds are not a question of quality of care but instead are a question of values regarding whether the state should use legislation to attempt to influence women's abortion decisions. Together, these findings suggest that we should think about viewing not as a standalone experience, but as mediated by the broader social environment and the context of women's lives and circumstances.
S1 Data. Deidentified individual-level chart data.
https://doi.org/10.7272/Q65H7D63.
(XLS)
S2 Data. Monthly aggregate data.
S1 Text. Supplemental information on methods.
(DOCX)
We thank the staff at the collaborating facility for providing data, chart abstraction, and overall logistical administration, particularly Wendie Ashlock, Dabbie Phonekeo, and Shelly Santiago at Affiliated Medical Services. We also thank Hui Xie for chart abstraction. The authors also appreciate study support and data cleaning from Anna Bernstein, Sarah Combellick, MPH, and Alice Cartwright, MPH.
Conceptualization: UDU KK EKOB NEJ DWL SCMR.
Data curation: KK EKOB NEJ.
Formal analysis: UDU NEJ KK.
Funding acquisition: UDU.
Investigation: UDU KK EKOB NEJ DWL SCMR.
Methodology: UDU KK NEJ SCMR.
Project administration: EKOB.
Supervision: UDU.
Visualization: NEJ.
Writing – original draft: UDU KK EKOB NEJ.
Writing – review & editing: UDU KK EKOB NEJ DWL SCMR.
1. Wisconsin Senate Bill 206, Stat. Wis. Stat. § 253.10 (July 5, 2013, 2013).
2. Richmond T. Wis. gov signs abortion bill requiring ultrasound. AP2013.
3. Guttmacher Institute. State Policies in Brief: Requirements for Ultrasound. 2015 November 1, 2015. Report No.
4. Wiegerinck MM, Jones HE, O'Connell K, Lichtenberg ES, Paul M, Westhoff CL. Medical abortion practices: a survey of National Abortion Federation members in the United States. Contraception. 2008;78(6):486–91. pmid:19014795
5. O'Connell K, Jones HE, Simon M, Saporta V, Paul M, Lichtenberg ES. First-trimester surgical abortion practices: a survey of National Abortion Federation members. Contraception. 2009;79(5):385–92. pmid:19341852
6. O'Connell K, Jones HE, Lichtenberg ES, Paul M. Second-trimester surgical abortion practices: a survey of National Abortion Federation members. Contraception. 2008;78(6):492–9. Epub 2008/11/19. pmid:19014796.
7. American College of Obstetricians and Gynecologists (ACOG) and American College of Radiology (ACR). Practice parameter for the performance of obstetrical ultrasound. 2014 October 1, 2014. Report No.
8. National Abortion Federation. Clinical Policy Guidelines. 2013.
9. Thorpe K, Harker L, Pike A, Marlow N. Women's views of ultrasonography: a comparison of women's experiences of antenatal ultrasound screening with cerebral ultrasound of their newborn infant. Soc Sci Med. 1993;36(3):311–5. pmid:8426975
10. Fletcher JC, Evans MI. Maternal bonding in early fetal ultrasound examinations. 1983.
11. Boukydis CZ, Treadwell MC, Delaney-Black V, Boyes K, King M, Robinson T, et al. Women's responses to ultrasound examinations during routine screens in an obstetric clinic. Journal of Ultrasound in Medicine. 2006;25(6):721–8. pmid:16731888
12. Alhusen JL. A Literature Update on Maternal-Fetal Attachment. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2008;37(3):315–28.
13. Kimport K, Weitz TA. Constructing the meaning of ultrasound viewing in abortion care. Sociology of health & illness. 2015.
14. Mitchell LM. Baby's First Picture: Ultrasound and the Politics of Fetal Subjects: University of Toronto Press; 2001.
15. Gatter M, Kimport K, Foster DG, Weitz TA, Upadhyay UD. Relationship between ultrasound viewing and proceeding to abortion. Obstet Gynecol. 2014;123(1):81–7. Epub 2014/01/28. pmid:24463667.
16. Kimport K, Preskill F, Cockrill K, Weitz TA. Women's perspectives on ultrasound viewing in the abortion care context. Women's Health Issues. 2012;22(6):e513–e7. pmid:23040800
17. Kimport K, Upadhyay UD, Foster DG, Gatter M, Weitz TA. Patient viewing of the ultrasound image prior to abortion. Contraception. 2013;88(5):666–70. Epub 2013/09/14. pmid:24028750.
18. Beynon-Jones SM. Re-visioning Ultrasound through Women's Accounts of Pre-abortion Care in England. Gender & Society. 2015:0891243215590101.
19. Kimport K, Weitz TA, Foster DG. Beyond Political Claims: Women's Interest In and Emotional Response to Viewing Their Ultrasound Image in Abortion Care. Perspectives on Sexual and Reproductive Health. 2014;46(4):185–91. pmid:25209369
20. Graham O, Ankrett S, Killick SR. Viewing ultrasound scan images prior to termination of pregnancy: Choice for women or conflict for ultrasonographers? Journal of Obstetrics & Gynaecology. 2010;30(5):484–8.
21. Wiebe ER, Adams L. Women's perceptions about seeing the ultrasound picture before an abortion. European J of Contraception and Reproductive Healthcare. 2009;14(2):97–102.
22. Cappiello J, Merrell J, Rentschler D. A Qualitative Study of Women's Decision to View or Not View an Ultrasound Image Before Early Medication Abortion. Women's Health Issues. 2014;24(4):e413–e8. pmid:24981400
23. Roberts SCM, Turok DK, Belusa E, Combellick S, Upadhyay UD. Utah's 72-Hour Waiting Period for Abortion: Experiences Among a Clinic-Based Sample of Women. Perspectives in Sexual and Reproductive Health. 2016. Epub 2016/03/25. pmid:27010515.
24. Ralph LJ, Foster DG, Kimport K, Turok D, Roberts SC. Measuring decisional certainty among women seeking abortion. Contraception. 2016.
25. WWAMI Rural Health Research Center. Rural-urban commuting area codes 2012 [November 14, 2012]. http://depts.washington.edu/uwruca/.
26. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior research methods, instruments, & computers. 2004;36(4):717–31.
27. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299–309. pmid:12174032.
28. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. International Journal of Epidemiology. 2016:dyw098.
29. Charmaz K. Constructing grounded theory. 2nd edition ed. London; Thousand Oaks, Calif.: Sage; 2014. xxi, 388 pages p.
30. Zhang F, Wagner AK, Ross-Degnan D. Simulation-based power calculation for designing interrupted time series analyses of health policy interventions. Journal of Clinical Epidemiology. 2011;64(11):1252–61. http://dx.doi.org/10.1016/j.jclinepi.2011.02.007. pmid:21640554
31. Jones RK, Upadhyay UD, Weitz TA. At what cost? Payment for abortion care by U.S. women. Womens Health Issues. 2013;23(3):e173–8. pmid:23660430.
32. Haas-Wilson D. Women's reproductive choices: the impact of Medicaid funding restrictions. Fam Plann Perspect. 1997;29(5):228–33. Epub 1997/11/05. pmid:9323500.
33. Cook PJ, Parnell AM, Moore MJ, Pagnini D. The effects of short-term variation in abortion funding on pregnancy outcomes. J Health Econ. 1999;18(2):241–57. Epub 1999/05/27. pmid:10346355.
34. Jones RK, Moore AM, Frohwirth LF. Perceptions of male knowledge and support among U.S. women obtaining abortions. Womens Health Issues. 2011;21(2):117–23. Epub 2011/02/01. pmid:21276735.
35. Ralph L, Gould H, Baker A, Foster DG. The role of parents and partners in minors' decisions to have an abortion and anticipated coping after abortion. J Adolesc Health. 2014;54(4):428–34. Epub 2013/12/18. pmid:24332398.
36. Hathaway JE, Willis G, Zimmer B, Silverman JG. Impact of partner abuse on women's reproductive lives. J Am Med Womens Assoc. 2005;60(1):42–5. Epub 2006/07/19. pmid:16845768.
37. Moore AM, Frohwirth L, Miller E. Male reproductive control of women who have experienced intimate partner violence in the United States. Soc Sci Med. 2010;70(11):1737–44. pmid:20359808
38. Upadhyay UD, Biggs MA, Foster DG. The effect of abortion on having and achieving aspirational one-year plans. BMC women's health. 2015;15:102. Epub 2015/11/13. pmid:26559911;
39. Biggs MA, Upadhyay UD, McCulloch CE, Foster DG. Women's Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study. JAMA psychiatry. 2017;74(2):169–78. Epub 2016/12/16. pmid:27973641.
Is the Subject Area "Termination of pregnancy" applicable to this article?
Is the Subject Area "Ultrasound imaging" applicable to this article?
Is the Subject Area "Pregnancy" applicable to this article?
Is the Subject Area "Charts" applicable to this article?
Is the Subject Area "Health care facilities" applicable to this article?
Is the Subject Area "Decision making" applicable to this article?
Is the Subject Area "Emotions" applicable to this article?
Is the Subject Area "Schools" applicable to this article?


text:
Microsoft Unveils the Lumia 540 Dual SIM Smartphone for INR 10,199 in India
Blending exceptional design and great imaging quality, the Lumia 540 is a stylish, mid-range smartphone that delivers high-end performance in a compact package. The device can also be upgraded to Windows 10 when the service becomes available later this year.
Starting May 14, consumers can pre book their Lumia 540 and avail exciting offers. Consumers can walk into key retail partner stores in different cities across the country for consumers to avail the pre booking offer.
Building on Microsoft's ambition of offering a true Windows Phone experience and premium features across price points, the device sets a new benchmark in the mid-range segment. The Lumia 540 Dual SIM features the latest Windows Phone 8.1 innovations and boasts a 5-inch HD display and crafted design details. It helps people stay productive on-the-go with Microsoft services like Skype and Office available out-of-the-box.
The device also enables better mobile experiences, such as taking wide-angle selfies that fit in more of the action, thanks to the front-facing 5 megapixel camera. The Lumia 540 Dual SIM is the perfect device for today's youngsters as it offers multiple options for enhancing fun and productivity as part of a strong package.
Designed for young, ambitious people looking for their first serious smartphone, Lumia 540 comes with the best hardware and software experience to help people achieve more every day-
•Lumia 540 Dual SIM features crafted details and better mobile experiences-
•Instantly upgrade your phone calls with the ability to turn an incoming call into a video call with the touch of a button where you can fit more into the frame, thanks to the wide-angle, 5-megapixel front-facing camera, using the pre-loaded Skype service
•Capture even more detail with the rear-facing 8-megapixel camera with 2x zoom and LED Flash, and enjoy the resulting images on the big HD display
•Save and sync photos, videos and Office documents securely with up to 30GB of free cloud storage with built-in OneDrive
•Access, edit and share Word, Excel and PowerPoint documents and OneNote notebooks wherever you are, with the pre-installed Office suite
•Connect with work and personal e-mail while on the go with built-in Microsoft Outlook
•Enjoy favourite apps like Facebook, Twitter, WhatsApp, PayTm, Ola, Gaana and Instagram, with thousands more available from Windows Phone Store.
•Smart Dual SIM lets you assign distinct profiles to SIM cards and ensures you never miss a call by forwarding calls to the active SIM card.
•Running the latest Denim software update and with 1GB of RAM and 8GB of on board memory.
The India offer for Lumia 540 Dual SIM
The Lumia 540 is being introduced to Indian consumers with some exciting offers. On every purchase of the new Lumia 540, Airtel subscribers can double the data on their current package free for a period of 2 months.
Paytm, the online wallet will offer a cashback worth INR 1000 on recharges made via the Paytm app (Rs. 200 off every month for 5 months). Ola offers consumers cashback of INR 800 on Ola money recharges (for Rs.200 cashback per recharge for the first four recharges of Rs.500 or higher). Lumia 540 Dual SIM users will also get a 2 months free subscription on Gaana.com with unlimited music downloads.

redpajama_set_name: RedPajamaCommonCrawl


In the center of the square "Piazza del Popolo" – Metro Line A – Flaminio. The meeting point is the fountain with the lions and obelisk.
Discover Pompeii and the still-active volcano that brought the bustling Roman city to its terrible end on this exclusive day trip from Rome.
In a 90-minute tour with an expert guide, you'll see the most fascinating sights of the city, from plaster death casts to Pompeii's fast food joints, stairs, beds and streets cut out by carriage wheels 2,000 years ago.
Another high point of the tour comes when you climb to the crater of Mt. Vesuvius, the destructive force that buried Pompeii in 79 AD. Lava flows have scarred the sides of the volcano and are visible on the winding road to the top – a spot which also offers the most beautiful view of the Bay of Naples below.
During winter and on days when Mt. Vesuvius is closed due to weather conditions, you'll visit the Naples National Archaeological Museum instead. Here you'll see a fantastic array of artefacts, mosaics, statues and artwork excavated from Pompeii and Herculaneum – the ideal way to complement a visit to the ruins.
To join the Pompeii & Vesuvius Full Day Trip from Rome you should meet the group in the center of the square "Piazza del Popolo" – Metro Line A – Flaminio. The meeting point is the fountain with the lions and obelisk. Please make sure to be at the meeting point 15 minutes before departure.
You will travel in a comfortable air-conditioned coach with an expert English-speaking chaperone to accompany you. The journey to Pompeii takes about 2 hours and 30 minutes.
On arrival at Pompeii you will be taken on a 90-minute tour of one of the world's most fascinating historic sites – a city literally frozen in time.
Pompeii was once a prosperous commercial town and the center of an important wine-producing district. But on 24 August AD 79 Mount Vesuvius erupted burying the entire town under a thick carpet of volcanic ash.
When the site was rediscovered in the 18th century, it was found that underneath all the dust and debris the city was more or less intact. The buildings, artifacts and skeletons left behind have revealed fascinating details about daily life 2000 years ago.
During your time in Pompeii group sizes will be limited to 25 people or less with headsets for every visitor, so your guide will be easy to hear and interact with.
You will also have the chance to climb to the edge of the crater of Mt. Vesuvius. You can peer into the crater, which still fumes slightly. Vesuvius is considered one of the most dangerous volcanoes in the world because of the 3,000,000 people who live around its base.
From the crater rim you will enjoy stunning views of the bay of Naples, Naples, Capri, Ischia, the edge of the Amalfi coast and more.
During the winter season and on days when Mt. Vesuvius is closed due to weather conditions, your tour of the past will take you to the Naples National Archaeological Museum instead.
Lunch (pizza and a drink) in a Naples pizzeria is included in your tour.
Please make sure to be at the meeting point 15 minutes before departure. Guests arriving after departure cannot be accommodated, and missed tours or tickets cannot be refunded.
We are unable to accommodate guests with wheelchairs or mobility impairments on our tours. We are also unable to accommodate pushchairs or strollers on our tours.
On rare occasions, the summit of Vesuvius may close due to inclement weather. In this case, an extended tour of Pompeii will be provided or a visit to an alternate location (Archaeological Museum in Naples).
The hike up to the crater of Vesuvius is optional and requires a good level of general fitness to complete. The hike is uphill at a 14 degree angle and 20 minutes long (about 1 mile). The hike is prevalently on soft ground, adequate footwear is recommended. Those who choose may remain at the parking area and enjoy the views.
Infants under 3 years travel for free but needs to be specified in the booking. Please book child ticket for the infant.
Please specify any food allergies or intolerance while booking, under please note section of the booking form.
Maximum group size for guided tour in Pompeii is 25.
The official tour guides at Pompeii are carefully chosen by the local activity operator. Our local partner constantly evaluates Pompeii guides and asks for feedback from every customer to ensure that they only use the most talented and knowledgeable of this pool.
they charge 10% more than others.


Or do you have to have atleast one model on the field turn one?
You lsoe the game if you have no models on the board at the end of your turn. So if you did this you would auto lose - unless you include a scalpel squadron who automatically arrive your first turn.
You CAN start the game with nothing on the boarsd, but if at the end of any game turn you have no models on the board, you automatically lose the game.
So a full Deep Strike army IS possible, IF you have units which will arrive in the first turn.
Nothing on the board at the end of turn one, and you lose the game.
SO your army of Venoms would work, so long as the only thing is them is Scalpel Squadrons.
It's actually only if you don't have any models on the board at the end of the GAME turn. If it was YOUR turn, you could start with a single minimum sized unit of infantry on the board and not worry about whether they die or not in the enemy turn. As it stands, you DO have to be concerned about what happens in the enemy turn if they go 2nd.
If you take a scalpel squadron, you can deep strike them automatically on turn 1, then on turn 2 deep strike everything else. This is great if you can somehow guarantee yourself going 2nd, as you can simply have nothing on the table in your opponent's turn 1, then put the scalpel squad on the table, then even if your opponent kills the scalpel squad in turn 2, the rest of your reserves can come on in your turn on turn 2, and have at least FnP 6+.
Its actually a shame we don't have better ways to more quickly push the game towards later stages, as that would slightly improve DE performance overall.
Subject: Re: Full deep strike army.


text:
class AlterVisitorSetDefaultsForBannedAndNotOnList < ActiveRecord::Migration[4.2]
  def change
    change_column_default :visitors, :banned, false
    change_column_default :visitors, :not_on_list, false

    execute "UPDATE visitors SET banned = FALSE WHERE banned IS NULL"
    execute "UPDATE visitors SET not_on_list = FALSE WHERE not_on_list IS NULL"
  end
end

redpajama_set_name: RedPajamaGithub


Plutocracy is not Democracy! Enough!
"Plutocracy is the rule by the wealthy, power provided by wealth". I would argue that our current system more resembles a plutarchy; a combination of plutocracy and oligarchy. When it comes to corporations, there is no difference between Republicans or Democrats. Criticizing Republicans as a democrat, or Democrats as a republican, is an exercise in futility. The real culprits are those corporations that have hijacked this government and governments around the world. Corporations, wake up! If you don't have anyone left to buy your goods and services, you can not make a profit. If the majority is in perpetual debt, earning low wages, not being able to afford a home, health insurance, college or everyday goods, then you no longer have a stable market. What you have is an angry majority. You can postpone it for so long using the media pundits and politicians that you have paid for. And those that blame the victims are out of touch; they do not understand that opportunity is rapidly vanishing in The Land of Opportunity.
Both the Tea Party and Occupy Wall Street movements recognize the dire situation on main street. Where the Tea Party protestors primarily hold the government responsible for this decline, Occupy Wall Street protestors emphasize the influence of corporations on the government. I do not know whether Occupy will have enough steam to bring forth change. But, what I do think is that plutarchy, as it currently stands, can not be sustained for too long in the United States.
First they ignore you, then they ridicule you, then they fight you, then you win!


I am a nefarious financial spirit that has taken possession of the Hundred Years Gallery.
This Hostile Takeover is all-encompassing, entailing every physical, spiritual and other intangible aspect that constitutes the very existence of the Hundred Years Gallery.
I am now in possession of the gallery's financial assets, define its legal structures and as of today have taken complete control of corporate communications, including all Social Media Channels.
Resistance is futile, yet rewards for engagement are plentiful.
Via this electronic transmission you are cordially invited to witness the material manifestation of this Hostile Takeover, which will come to completion on the 22nd of September, at precisely 19:17:28 hrs (GMT+1), coordinates N 51° 31′ 59.038" W 0° 4′ 34.374".


This Language Access Plan (LAP) outlines our commitment to providing universal access for all Individuals.
This plan sets the framework for any actions to be taken to ensure a good faith effort is made to provide meaningful access of services, programs, and activities to Limited English Proficient persons or Individuals. The LAP is an integral part of the Agency's effort to ensure that services offered to enhance the lives of the Individuals we serve and their families are of the highest quality. The LAP also helps ensure that DDS is viewed as an Employer of Choice for Agency employees whose first language is not English.


"Imagery Suite" is a Wombat Records release of the long awaited Frank Gambale (acoustic/electric guitar) and Maurizio Colonna (classical guitar) collaboration. This CD is a wonderful blend of two great guitarists fromcompletely different worlds meeting in the middle to create beautiful, passionate music. Rich melodies with fiery and melodic solos is a must for allGambale fans and a must for those who may never have heard Colonna's wonderful touch. Classical meets fusion - the result on "Imagery Suite" is virtuosity and melodyall rolled into one.
Recorded live at Spav Studio, Rome.
Mixed at Bunker Studio, Cagliari.


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A Global Overview of Research Funding in 2016/17- What has changed?
Featured Article: A Global Overview of Research Funding in 2016/17- What has changed?
Laserglow in Research: Understanding Sensory Neurons and Pathways that Control Mating Choices
News: LIBS-based Device Scans Ocean Floor for Metal-Rich Minerals
It has been a documented trend within the scientific community that countries in which the government funds research by means of federal or mandatory reserves are better able to foster innovation and set global standards of quality, compared to governments who fail to prioritize research funding and then suffer scientific 'brain-drain'. As the outgoing US President's latest budget for research and development is released, we take a look at the situation of government-backed research funding around the world, and what the near future may hold.
A quick overview of Obama's R&D Budget for FY 2017 indicates the plan adheres to the $1.07 trillion cap for discretionary spending that was enacted into law in late 2015, but also requests a significant amount of mandatory spending, mostly aimed at programs that have historically not been funded this way. This provides a mechanism to bypass funding caps on non-defense related research, most notably clean energy, neuroscience, cancer research, climate-science and water research. The overall budget proposal includes a massive 62.9% of mandatory spending. What's important to note is that most R&D is typically contained in the discretionary budget. Unless the proposal is accepted and passed, agencies like National Institutes of Health (NIH), NASA and US Department of Agriculture will face a significant drop in budget.
This has a direct impact on these agencies' ability to support academic-level research. NIH got a boost in federal funding in FY 2016, yet NIH's capacity to fund research is still lower than it was before sequestration (mandatory budget cuts) prior to FY 2013. While biomedical research still continues to benefit from Federal R&D spending, there are concerns among advocates about the steep fall in basic and applied research public funding in US, which impacts fields like cybersecurity, quantum information technology and battery technology.
In Canada, while the newly elected Liberal government has pledged to increase funding to academic institutes by $2bn this fiscal as well as increase tuition grants for low income families by up to 50%, little is specified about direct federal funding for R&D. Federal spending has seen a steady decline, and experts in higher education are wary about being optimistic too soon. As recent as August 2015, massive spending cuts were announced to MD/PhD program of Canadian Institutes of Health Research, signaling that the end is near for the 30-year program that encouraged specialists to combine medicine with innovative biological research.
The UK, as recently as Nov 2015 was spending 1.7% of its GDP on science and research, which is still behind Germany (2.8%) and USA (2.9%). There are concerns however, that the 5-year budget freeze on spending (in cash terms) will have negative impact on the already low funding facing many research institutes in the UK. Biotechnology and microbiology sectors however, will continue to receive funding as expected in 2017, with centers like the Crick's Institute in London set to make it easier for researchers to focus on long term goals.
Further south, the Australian government has faced criticism for failing to support the Commonwealth Scientific and Industrial Research Organization (CSIRO) that announced over 275 staff job cuts in February due to lack of funding. A further proposed 20% cut from federal funding for universities has alarmed the academic and scientific community alike.
India fares better despite the stagnation in federal spending and massive inflation, with the 2016-17 Indian budget proposal pledging up to 12% increase in R&D budget on Biotechnology alone. Collaboration with global academic institutes has allowed innovation to thrive in India despite a disproportionately small percentage of GDP being spent on research. Chinese federal funding for research is focused on quantum computing, cybersecurity, gene sciences and brain research, as indicated by China's new spending plan, released in March.
The situation in EU however is vastly different from that of other countries. As member states rely mainly on the collective EU for non-defense R&D funding, recent statistics offer little hope for the immediate future. Between 2008 and 2014, central and eastern European countries and Greece saw anywhere between 5 to 40 percent reduction in research funding, with Greece, Hungary and Latvia facing the worst cuts. These cuts were attributed to both reduction in national, as well as EU-level funding. The latter will only get more competitive as EU struggles to stay ahead in research.
While a changing political climate, increased competition and alarmingly high dependency on private research funding can affect innovation fostered at research centers, we cannot underestimate the importance of national-level funding for R&D. It may be the single factor that determines a nation's competitiveness and economic stability in the future. The research community on the other hand, must continue to advocate for more opportunities, while acknowledging that some innovations must pay off in order to pave the way for others.
Laserglow understands that researchers' needs are changing; and we are committed to offer the best value to our customers. We are continually expanding our product offering to provide more options, and to ensure that the solutions we develop meet your high standards. Call us today to talk about how we may assist you in your project.
Understanding Sensory Neurons and Pathways that Control Mating Choices
Researchers at UC Berkeley have published a multidisciplinary study that aims to identify the different classes of chemosensory neurons that detect sex-specific pheromones and are responsible for courtship decisions. The study was performed in Drosophila (a genus of Fruit Flies) and combined aspects of anatomy, calcium imaging, optogenetics and behavioral studies. Laserglow's 635nm LabSpec Laser was used as an excitation source.
Courtship displays are seen throughout the animal kingdom. Male fruit flies, belonging to the species Drosophila melanogaster, also perform courtship rituals toward female flies however, this behavior isn't observed towards male flies. Male flies detect pheromones by means of two sets of sensory neurons: one set that detects female pheromones and promotes courtship, while the other detects male pheromones and inhibits courtship. This study aims to understand how these sensory neurons controlled courtship behavior. The experiment identified several neuronal pathways that send signals to either excite or inhibit a central target, called P1 neurons. In the presence of female pheromones, the male's P1 neurons are activated, while the same P1 neurons are inhibited in presence of a male. The researchers suggest that this balance of excitatory and inhibitory signals controls a fly's decision to court. The researchers used a combination of cell-labeling, thermal ablation and imaging techniques that included stimulating neurons with red laser light to observe physiological response. The results indicate that it will soon be possible to identify circuits that act downstream of the P1 neurons and how P1 neurons integrate signals from different senses.
This study is among one of many that aims to map neural pathways involved in the mating decisions of complex animals. The researchers believe that what we learn from studying animal neurology may one day have a significant impact on studying progression and treatment of neurological disorders in humans. This study was first published on eLife in Nov 2015. To find out more about the experimental setup, go to: eLife Full Paper
LIBS-based Device Scans Ocean Floor for Metal-Rich Minerals
Laser Development and Material and Processes departments at Germany's Laser Zentrum Hannover (LZH), together with eight European partners are developing a laser-based, autonomous inspection system to locate natural resources on or under the seabed. The project aims to detect soil samples, like manganese nodules and analyze material composition in situ. The researchers claim that such systems will enable mapping of mineral compositions of sea beds easily at low cost, and have a minimal impact on the environment.
In the setup, an autonomous underwater vehicle (AUV) is equipped with a Laser Induced Breakdown Spectroscopy (LIBS)-based analyzer. The AUV is also equipped to create 3D maps of the seabed, and is built to withstand tremendous amounts of pressure underwater. The developers used knowledge gained from LZH's previous mission exoMARS, wherein a LIBS-based system was sent to Mars to analyze surface samples.
This project involves technical experts from many disciplines- like oceanography, 3D cartography, biogeochemistry, various engineering disciplines and laser sciences. The device will be scanning ocean floors till 2020. Read more at: LZH full press release


Los Alamos is the birthplace of grapes grown for Kendall-Jackson, Sutter Home, Byron, Beringer, Mondavi, Meridian and many boutique wineries. It is also the ideal hub for exploring over 100 world-class wineries and tasting rooms. Walk down the street and enjoy a tasting at Casa Dumetz, Frequency, Bedford, or Municipal Wines, or jump in your car and travel the wine tours the movie Sideways made famous. Los Alamos is right in the middle of three famous wine trails and minutes from the Los Olivos tasting rooms. We would be happy to arrange a wine tour for you. See "little extras".
Los Alamos is an antique-lover's dream, with unique treasures from all over the world as well as right here in town! Within blocks of the Victorian Mansion are four antique galleries: Gussied Up, The Gentleman Farmer, The Depot Mall, and Golden Oaks Antiques.
Los Alamos is home to the Union Hotel, which was a stagecoach stop during the Wild West. Be sure to stop by this historic and authentically decorated spot for a drink in the saloon. Don't forget to check out the old-time gas station right next door, which harkens back to the days when Bell Street was the major route through California. This gas station has been featured in numerous movies and photo shoots through the years and is currently an event space.
Stroll down the street to the C Gallery, which features contemporary art, with a "contemplative" edge. Or visit the Terramonary in nearby Orcutt which has been making fine, hand crafted pottery and ceramics since 1990.
Los Alamos offers some of the most delectable dining in the area. Across the street from the Victorian Mansion, you can taste by firelight what Variety dubbed "probably the best pizza on the West Coast" at Full of Life Flatbread. The menu changes daily with unique concoctions featuring freshly picked herbs and paired with local wines from an extensive wine list. Bell Street Farms offers fresh bistro cuisine in a distinct environment for both residents and visitors alike. Hang out in the market and dining room or eat and drink outside on the big patio. For lunch, try the famously-large burgers or carne asada at Charlie's, or walk a few blocks down Bell Street to Plenty on Bell, where you can enjoy a gourmet salad or the special bowl of the week. And don't forget to stop by Bob's Well Bread and enjoy some hand-made artisan breads and pastries while enjoying an espresso or coffee.
This adorable Danish town is only a short drive from Los Alamos. You can stroll through the European-style streets and visit art galleries, tasting rooms, museums, and clothing boutiques. You can even visit a full-sized holiday gingerbread house (Nov. – Dec.), enjoy the street performers during Danish Days (Sept.) or catch a play at PCPA Theaterfest. Don't forget the Hans Christian Andersen Museum! You can see the calendar of events at http://www.solvangusa.com/events/.
The Santa Ynez Valley is recognized throughout the equestrian world for its horse ranches. Enjoy a wonderful ride through the beautiful backcountry on horseback. Add some wine tasting to the adventure with VinoVaqueros and ride through the Fess Parker family ranch and vineyards. See spectacular 360 degree views of the Santa Ynez Valley and after your ride, make your way to the tasting room to taste select wines from the vineyard. Or visit one of the many outstanding horse ranches, including the Quicksilver Ranch which raises miniature horses.
Nearby Figueroa Mountain offers numerous hiking trails to explore the local flora and fauna. Or take a short twenty minute hike up to Nojoqui Falls where you will experience a 100-foot waterfall with fresh water from the high cliffs above cascading into a natural pool.
Vegas-like action in the Valley! This Casino Resort offers gaming at its exhilarating best, including slot machines, Blackjack and Poker.
Play a round of 18 holes at one of the near-by golf courses, including La Purisma, Rancho San Marcos, River Course at The Alisal, Zaca Creek, or Sunset Ridge.
One of the best ways to explore the backcountry is on two wheels. Enjoy a self-guided tour or let a resident expert show you the way.
Soar silently above the Santa Ynez Valley Mountains in this adventure of a lifetime while experiencing breathtaking views of the surrounding vineyards, ranches, forests, and lakes.
Glide through the quaint town of Solvang on a Segway. Experience history, sightseeing and adventure and see all the hot spots in 1 hour on this emission free tour.
Taste a sampling of gourmet, locally grown olive oil from the most current harvest at Global Gardens or Olive Hill Farm in Los Olivos.
Tour this unique facility and see the world's largest bird up close.
Clairmont Farm is a family owned lavender farm located just down the street from the Mansion. There are five acres of the Grosso variety of lavender, known for its healing quality. They offer a complete line of lavender based products, including essential oils, homemade soaps, distinctive lavender honey, and tea.
Enjoy a fun scenic flight or an acrobatic adventure in a 1943 Super Stearman Biplane out of nearby Oceano Beach.
The Melodrama is a central coast fixture. Located in the nearby community of Oceano Beach, on historic Highway One, the Melodrama has been entertaining natives and tourists alike since 1975.
Guadalupe-Nipomo Dunes Preserve is part of the 18-mile stretch of coastal dunes on California's Central Coast. From 1923 to the 1950s, six films were set in the dunes, including Cecil B. Demille's classic version of the Ten Commandments. At the end of production, the massive sets reproducing ancient Egypt were dismantled and buried on the site to prevent reuse. They are still buried there today and may be seen from time to time as the dunes shift.
There are hundreds of species to view, including waterfowl, osprey, hawks, bald eagles, woodpeckers, owls, and yellow-billed magpies.


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The Torrance Police Department is the police department serving Torrance, California.

The department employs 227 sworn officers and 124 civilians. The department is the largest law enforcement agency in South Bay, and is one of the largest police departments in Los Angeles County.

Since June 2021, the Chief of Police has been Jay Hart.

Overview

The Torrance Police Department has jurisdiction in the city limits of Torrance. Other sections with a "Torrance, CA" address are served by either the Los Angeles Police Department (the Harbor Gateway area east of Western Avenue) or the Los Angeles County Sheriff's Department in an unincorporated area adjacent to the Harbor Freeway with the ZIP code of 90502.  Both areas are easily identified by their Los Angeles County-styled street signage.  The department patrols an approximate one mile (1.6 km) area of Torrance Beach.

Officers carry the Glock 21 .45 Auto as the primary sidearm and the holster of choice is made and produced by Safariland.

Bureaus/Units
 Administrative Bureau; consisting of the Personnel, Research & Training and Records Divisions
 Support Services Bureau; consisting of the Communications and Services Divisions
 Patrol Bureau; consisting of the Patrol and Community Affairs Divisions
 Special Operations Bureau; consisting of the Special Investigations and Detective Divisions
 Special Units include; Robbery/Homicide, Cold Case Homicide, SWAT, Crisis Negotiation Team (CNT), K-9, Motors, School Resource Officer (SRO), Community Lead Officer (CLO), etc...

Controversy
During the massive multi-agency manhunt for Christopher Jordan Dorner, the prime suspect in the 2013 Southern California shootings, in two separate incidents in the early morning hours of February 7, 2013, police shot at people unrelated to Dorner.  Dorner was not present at either incident.
Officers of the Torrance Police Department initiated the shooting in the second of these two cases.

Torrance police officers first rammed the truck with their car, then opened fire. The vehicle was being driven by David Perdue who was on his way to the beach for some early morning surfing before work.  Police claim that Perdue's pickup truck "matched the description" of the one belonging to Dorner.
However, the Los Angeles Times reports that "the pickups were different makes and colors ... Perdue looks nothing like Dorner: He's several inches shorter and about a hundred pounds lighter ... Perdue is white; Dorner is black."

Six months after the assault, the police paid Perdue $20,000 for the damage to his truck. The city has offered Perdue a half million dollars to settle the case, but he insists on almost four million dollars. , the city has not allowed outside investigators to see the truck.

In contrast, the Los Angeles Police Department paid two women who were attacked a sum of $4.2 million in damages without going to court.

In popular culture
In the 2015 film Straight Outta Compton, members of the Torrance Police Department harass members of N.W.A.

See also

 Law enforcement in Los Angeles County
 List of law enforcement agencies in California

References

External links
 Torrance Police Department
 "A Journey to Service"
 Torrance Police Recruiting Commercials

Municipal police departments of California
Organizations based in Torrance, California

redpajama_set_name: RedPajamaWikipedia


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Leslie Richard French (23 April 1904 – 21 January 1999) was a British actor of stage and screen.

French was primarily a theatre actor, as well as a director, singer and dancer, with a varied career that included the classics, musical revue, pantomime and ballet. He became most associated with the role of Ariel in William Shakespeare's The Tempest, and over the years he essayed many of Shakespeare's spirits and clowns, such as Puck, Feste and Touchstone.

Early life
French was born in Bromley, Kent, in 1904 and was educated at the London School of Choristers. He made his first appearance as a child actor in a 1914 Christmas show at the Little Theatre and left school the same year to join the touring Ben Greet Company as a stagehand and prompter. Hired as an understudy in the West End to Bobby Howes in the musical Mr. Cinders, French played the title role when the play went on regional tour.

Theatre
In 1930, he joined the Old Vic company, where he played Poins in Henry IV, Part I, Eros in Antony and Cleopatra, the Fool in King Lear and the role with which he became most associated with, Ariel in The Tempest. This latter role saw him share the stage with contemporaries John Gielgud (as Prospero) and Ralph Richardson (as Caliban), the first time these two actors appeared on stage together. French was the first male actor to essay the role of Ariel for many years and did so in nothing more than a small loincloth, helping to make this version something of a talking point at the time. French and Gielgud were also the inspiration for Eric Gill's carving of Prospero and Ariel above the entrance to the then new Broadcasting House in Portland Place.

French continued his stage career at the Old Vic and later the Open Air Theatre in Regent's Park, specialising in Shakespeare's spirits and clowns, such as Puck, Feste, Touchstone and of course Ariel, roles greatly enhanced by his singing and dancing ability. He also directed several plays including successful stagings of The Taming of the Shrew and As You Like It.
As well as the classics, French also appeared in musical revue, pantomime and ballet.

Maynardville open-air theatre

In 1955 he helped to establish the new Shakespearean seasons at the Maynardville Open-Air Theatre in Cape Town, South Africa. This theatre, which had opened a short while before, on 1 December 1950, had multi-racial casts performing to multi-racial audiences. In 1963 he was awarded the key to the city for his work with the theatre.

Film and television
French made the occasional foray into film and television, appearing in two Luchino Visconti films, The Leopard (1963) and Death in Venice (1971), as well as many British television programmes. These included Dixon of Dock Green, Armchair Theatre, Z-Cars, The Avengers (the episode You Have Just Been Murdered), Jason King and The Singing Detective. His role as Mr. Woodhouse in a BBC serial of Jane Austen's Emma (1960) is considered one of his most memorable screen performances. French was also considered for the role of the First Doctor in the science fiction series Doctor Who; William Hartnell was cast. He finally appeared in the programme in its 1988 serial, Silver Nemesis, playing the Mathematician.

Selected filmography
 Radio Pirates (1935) – Leslie
 Peg of Old Drury (1935) – Alexander Pope
 This England (1941) – Johnny
 The Wallet (1952)
 Orders to Kill (1958) – Marcel Lafitte
 The Scapegoat (1959) – Lacoste
 The Singer Not the Song (1961) – Father Gomez
 The Leopard (1963) – Cavalier Chevally
 The Rescue Squad (1963) – Mr. Manse
 More Than a Miracle (1967) – Brother Giuseppe de Coopertino
 Death in Venice (1971) – Travel Agent
 Invitation to the Wedding (1983) – Hobbs
 The Living Daylights (1987) – Lavatory Attendant
 Young Toscanini (1987) – Comparsa (uncredited)

References

External links

1904 births
1999 deaths
People from Bromley
English male stage actors
English male film actors
English male television actors
Male actors from Kent
20th-century English male actors