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A 6 months old female presented with fever, irritability, and poor feeding for two days. Parents also report poor sleep and high- pitch crying. She was born in the hospital, and her mother had a spontaneous vaginal delivery. Parents refused immunization with repeated family doctor counseling. On examination, the pulse is 116 beats per minute, blood pressure is 80/50 mm hg, and the temperature is 102 F. She looks toxic and drowsy. The neck is stiff on examination. Meningitis is suspected, and lumbar puncture is planned. CSF gram-stain analysis shows gram-negative coccobacilli. Which of the following could have prevented the condition?

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"Excepting only Yosemite , Hetch Hetchy is the most attractive and wonderful valley within the bounds of the great Yosemite National Park and the best of all campgrounds. People are now flocking to it in ever-increasing numbers for health and recreation of body and mind. Though the walls are less sublime in height than those of Yosemite, its groves, gardens, and broad, spacious meadows are more beautiful and picturesque ... Last year in Oct. I visited the valley with Mr. William Keith, the artist. He wandered about from view o view, enchanted, made 38 sketches, and enthusiastically declared that in varied picturesque beauty Hetch Hetchy greatly surpassed Yosemite. It is one of God's best gifts, and ought to be faithfully guarded.Which of the following aspects of Muir's description expresses a major change in Americans' view's of the national environmentA)Wilderness areas are worthy subjects for artistic warsB) Wilderness areas serve as evidence of divine creationC) The Government should preserve wilderness areas in a natural stateD) mountainous scenery is more beautiful than mountain terrainMuir's ideas are most directly a reaction to the A) Increasing usage of Western landscapesB) increase in Urban populationsC) Western migration of groups seeking religious refugeD) opening a new frontier in recently annexed territoryMuir's position regarding wilderness was most strongly supported by which of the followingA) Members of Populist movementB) Urban political bossesC) American Indians living on reservesD) Preservationists concerned about overuse of natural resources

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