Professional Guidelines Research Articles

Departments of Chamber Ensemble and Concertmastering in Terms of Historical and Cultural Processes, Professional Intersections and Repertoire Policy

The purpose of the article. Based on a retrospective review of the formation of the art of collaborative performance and the creation of chamber ensemble and concertmaster departments, systematisation of the thesaurus of definitions used in defining the profession of musicians in these areas, and study and analysis of the curricula of chamber ensemble and concertmaster departments of music institutions of higher education in Ukraine, an attempt is made to clearly outline the professional guidelines of repertoire policy of each department. The research methodology consists in the use of the following methods: analytical – to analyse the historical roots of the formation of the art of collaborative performance, the emergence of such areas of specialisation as “chamber ensemble artist” and “pianist-concertmaster”, the introduction of differentiated training for these types of performance practice in music institutions of higher education, the characteristics of the synonymous vocabulary of these definitions; comparative – to compare certain parameters of training at these departments, outline common and distinctive features; axiological – to understand the importance of both professions and to define value guidelines in repertoire policy through the prism of the traditions of education and the purpose of musicians in these areas. Scientific novelty. For the first time in the history of Ukrainian musicology, an attempt is made to expand the understanding of the historical roots of the creation of the chamber ensemble and concertmaster departments based on the analysis of the formation of the art of collaborative performance; to clearly outline the direction of the repertory policy of each department by defining their professional guidelines. Conclusions. The analysis of the historical roots of the art of collaborative performance, the traditions of forming chamber ensemble and concertmaster departments, and the competent interpretation of the glossary of definitions used in defining the profession of musicians in these areas are important components of a clear understanding of the functioning of these units of pianists’ training, contributing to the logical differentiation of their performance repertoire. This makes it possible to actualise the issue of forming special competencies in pianists in the context of each typpe of their musical-pedagogical and performance training. Key words: chamber ensemble, concertmaster’s class, repertoire policy.

Barriers and Facilitators to the Outpatient Management of Low-risk Pulmonary Embolism From the Emergency Department.

Although recommended by professional society guidelines, outpatient management of low-risk pulmonary embolism (PE) from emergency departments (EDs) in the US remains uncommon. The objective of this study was to identify barriers and facilitators to the outpatient management of PE from the ED using implementation science methodology. We conducted semistructured interviews with a purposeful sample of emergency physicians using maximum variation sampling, aiming to recruit physicians with diverse practice patterns regarding the management of low-risk PE. We developed an interview guide using the implementation science frameworks-the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Interviews were recorded, transcribed, and analyzed in an iterative process. We interviewed 26 emergency physicians from 11 hospital systems, and the participants were diverse with regard to years in practice, practice setting, and engagement with outpatient management of PE. Although outer setting determinants, such as medicolegal climate, follow-up, and insurance status were universal, our participants revealed that the importance of these determinants were moderated by individual-level and inner setting determinants. Prominent themes included belief in consequences, belief in capabilities, and institutional support and culture. Inertia of clinical practice and complexity of the process were important subthemes. In this qualitative study, clinicians reported common barriers and facilitators that initially focused on outer setting and external barriers but centered on clinician beliefs, fear, and local culture. Efforts to increase outpatient treatment of select patients with acute PE should be informed by these barriers and facilitators, which are aligned with the deimplementation theory.

The Comparative Effectiveness andProvider-induced Demand Collaboration Project: A Pioneering Military-Civilian Academic Partnership to Build Health Services Research Capacity forthe Military Health System.

Like civilian health systems, the United States Military Health System (MHS) confronts challenges in achieving the aims of reducing cost, and improving quality, access, and safety, but historically has lacked coordinated health services research (HSR) capabilities that enabled knowledge translation and iterative learning from its wealth of data. A military-civilian academic partnership called the Comparative Effectiveness and Provider-Induced Demand Collaboration (EPIC), formed in 2011, demonstrated early proof-of-concept in using the MHS claims database for research focused on drivers of variation in health care. This existing partnership was reorganized in 2015 and its topics expanded to meet the need for HSR in support of emerging priorities and to develop current and HSR capacity within the MHS. A Donabedian framework of structure, process, and outcomes was applied to support the project, through a core of principal investigators, researchers, analysts, and administrators. Within this framework, new researchers and student trainees learn foundations of HSR while performing secondary analysis of claims data from the MHS Data Repository (MDR) focusing on Health and Readiness, Pediatrics, Policy, Surgery, Trauma, and Women's Health. Since 2015, the project has trained 25 faculty, staff, and providers; 51 students and residents; 21 research fellows across multiple disciplines; and as of 2022, produced 107 peer-reviewed publications and 130 conference presentations, across all five themes and six cores. Research results have been incorporated into Federal and professional policy guidelines. Major research areas include opioid usage and prescribing, value-based care, and racial disparities. EPIC researchers provide direct support to MHS leaders and enabling expertise to clinical providers. EPIC, through its Donabedian framework and utilization of the MHS Data Repository as a research tool, generates actionable findings and builds capacity for continued HSR across the MHS. Eight years after its reorganization in 2015, EPIC continues to provide a platform for capacity building and knowledge translation.

Professional Guidelines for the Care of Extremely Premature Neonates: Clinical Reasoning versus Ethical Theory.

AbstractProfessional statements guide neonatal resuscitation thresholds at the border of viability. A 2015 systematic review of international guidelines by Guillen et al. found considerable variability between statements' clinical recommendations for infants at 23-24 weeks gestational age (GA). The authors concluded that differences in the type of data included were one potential source for differing resuscitation thresholds within this "ethical gray zone." How statements present ethical considerations that support their recommendations, and how this may account for variability, has not been as rigorously explored. We performed a mixed-methods exploratory analysis of 25 current international guidelines for neonatal resuscitation at 22+0-25+0 weeks GA. Qualitative analysis using a modified grounded theory yielded 34 distinct codes, eight categories, and four overarching themes. Three themes, consequentialism, principlism, and rights-based, consisted of concepts central to these ethical frameworks. The fourth theme, clinical reasoning, described counseling practices, medical management, outcomes data, and prognostic uncertainty, without any ethical context. The theme of clinical reasoning appeared in 22 of 25 guidelines. Ten guidelines lacked any ethical theme. Guidelines with an identified ethical theme were more likely to recommend comfort care than guidelines without an identified ethical theme, and recommended it at a higher average GA (22.7 weeks vs. 22.0 weeks, p = 0.03). Thus, how ethical concepts are incorporated into guidelines potentially impacts resuscitation thresholds. We argue that inclusion of explicit discussion of ethical considerations surrounding resuscitation in the "gray zone" would clarify values that inform recommendations and facilitate discussions about how neonatology ought to approach periviability as outcomes continue to evolve.

Kode Etik Pustakawan sebagai Aturan Profesional bagi Profesi Pustakawan

The librarian code of ethics as a professional rule for the librarian profession. The librarian code of ethics is a set of rules governing the ethical behavior expected of a librarian. The purpose of the code is to promote integrity, professionalism, and social responsibility in the practice of librarianship. The methodology used was a literature review of various sources of books, journal articles, and professional websites relevant to the librarian code of ethics. The results of the literature review show that a code of ethics generally consists of a set of ethical principles, values, and standards that form professional guidelines. They enable librarians to confront and solve ethical issues that arise in their practice. In this journal, we will discuss the librarian's code of ethics and how it shapes professional practice in the librarian profession.

COMMEMORATING THE 40TH ANNIVERSARY OF THE BIRTH OF HOWARD GARDNER’S THEORY OF MULTIPLE INTELLIGENCES VIA RESEARCH OF HIS APPROACH ON DIFFERENT LEVELS OF EDUCATION SYSTEMS IN THE CARPATHIAN BASIN

Individual and social well-being is a priority of the OECD 2030 Learning Compass aiming at contributing to generally more livable societies. One of the thought leaders of this international professional innitiative and guidelines is Howard Gardner, the father of the theory of multiple intelligences (MI). This approach implies that human intelligence should be differentiated into modalities, rather than be accepted as a general ability. The present publication aims at commemorating the 40th birth anniversary of MI theory, illustrating different ways of its possible educational implications in the Carpathian Basin, that have been carried out in the past fifteen years by a team of researchers lead by Dezső and attached to the doctoral school in education sciences at the Faculty of Hunmanities and Social Sciences of the University of Pecs, Hungary. The teams’ professional results contain edited compilations of lesson plans, and thematic projects using Gardner’s theory, testbook analysis from adequate aspects, and relevant research on coopretion between pre-service teacher education and schools with socially disadvantaged pupils. One of the most longitudinal researches of the field is Schmidt’s development focusing on pre-scool education. Her work is built on one of the US «Project Zero» Project Spectrum methods, and is called EIDW (Everybody is Intelligent in Different Ways). Schmidt adopted games and activities in different locations in the Carpathian Basin and observed different children’s intelligence profiles as well as those of their educators’. Abraham and Kolip’s researches are in their emerging stage. Whereas Abraham has investigated possible manifestations of inter-, and intrapersonal intelligences in a Vojvodinan kindergarten, as part of MI, aiming at illustrating how socialization in the education system affects these components of children’s personalities, Kolip has focused on even younger children and their educators concerning these areas in a South-Transdanubian village nursery. Although the participants of the research team have issued their findings several times, this is the first publication their work is presented as a common achievement. Keywords: the theory of multiple intelligences, individual and social well-being, educational development, professional cooperation.

Faculty-student authorship practices in nursing: Cross-sectional study

BackgroundAcademic institutions often encourage nursing students to submit scholarly work for publication. Oftentimes, faculty and students collaborate on scholarship during a student's enrollment in a nursing program. Although there are benefits to the faculty and students, there are also areas of conflict due to the lack of professional and institutional guidelines to ensure equitable gains. PurposeThe study explored authorship practices among nursing institutions in order to identify criteria for faculty-student authorship guidelines and policies. MethodsA descriptive and cross-sectional study was utilized to describe nursing faculty's perception of best practices for faculty-student authorship and their level of comfort with specific components of the authorship process. ResultsThere were several criteria that the faculty identified as warranting authorship credit, such as completing the review of the literature or making substantial contributions to analysis and interpretation of data. On the other hand, there were several criteria the faculty felt neutral or did not warrant authorship credit, such as providing general administration support or writing assistance. ConclusionMost faculty felt comfortable discussing authorship criteria with students. However, their responses highlighted complexities inherent in faculty-student relationships when collaborating on scholarship. This accentuated the need for the nursing profession and institutions to develop and implement faculty-student authorship guidelines.

FTP7.6 Management of Colorectal Cancer with Synchronous Liver Metastases: A systematic review of national and international clinical guidelines (CoSMIC-G)

Abstract Introduction The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. Variation in interpretation of the limited body of evidence may introduce inequality in practice. This study appraises the recommendations made by national/international guidelines on the management of patients with synchronous liver metastases from colorectal cancer. Methods A systematic review of national and international professional body guidelines published between 2012-2022 was carried out using PubMed and Guidelines International Network and evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidance in was assessed for strength of recommendation and levels of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The protocol was registered with PROSPERO (CRD42021243744). Results Searches returned 385 articles with 11 guidelines eligible for inclusion. One (9%) guideline defined ‘synchronous disease’ at outset, 2 (18%) recommended neo-adjuvant chemotherapy. Two guidelines provided “moderate” support for synchronous liver and bowel resection, 5 recommended against synchronous hepatic and colorectal resection and four made no comment. No guidelines described either hepatic or colorectal criteria for synchronous surgery. Discussion This study demonstrates important variations between clinical guidelines on management of synchronous liver metastases in colorectal cancer.

Space Efficiency in Finnish Mid-Rise Timber Apartment Buildings

As in many other building types, space efficiency in mid-rise timber apartment buildings is one of the critical design parameters to make a project feasible. Space efficiency depends on varying selection criteria related to construction materials, construction methods, and proper planning. To date, no study provides a comprehensive understanding of space efficiency in mid-rise timber apartment buildings. This paper examined data from 55 Finnish mid-rise timber apartment buildings built between 2018 and 2022 under the Finnish Land Use and Building Act to increase the understanding of which factors and design parameters influence the space efficiency of mid-rise timber apartment buildings. The main findings of this study indicated that: (1) among the case studies, the space efficiency ranged from 77.8% to 87.9%, and the average was 83%; (2) the mean values of the ratios of structural wall area to gross floor area, vertical circulation area to gross floor area, and technical spaces (including shafts) to gross floor area were found to be 12.9%, 2.6%, and 1.5%, respectively; (3) construction methods or shear wall materials make no significant difference in terms of space efficiency, and there is no scientific correlation between the number of stories and space efficiency; (4) the best average space efficiency was achieved with central core type, followed by peripheral core arrangement. This research will contribute to design guidelines for clients, developers, architects, and other construction professionals of mid-rise timber apartment building projects.

Tourist loyalty in the metaverse: the role of immersive tourism experience and cognitive perceptions

Purpose Metaverse technology is of interest to researchers and practitioners in tourism and hospitality. The metaverse offers tourists the capacity to enjoy unprecedented tourism experiences. These opportunities may radically change the tourism and hospitality landscape. This study aims to examine how metaverse experiences affect tourists' cognitive processing, satisfaction and loyalty toward metaverse tourism using the stimulus-organism-response paradigm and cognitive experiential self-theory. Design/methodology/approach An online survey was undertaken to gather information from 329 respondents who were frequent users of different metaverse applications to meet the study's objectives. Data were evaluated through partial least squares structural equation modelling. Findings The findings revealed that metaverse experiences, such as immersion, escapism and enjoyment, had a significant positive impact on metaverse organismic experience. Additionally, metaverse cognitive processing positively influenced metaverse tourist responses, including satisfaction and loyalty, with tourist involvement acting as a moderator. Originality/value This study provides guidelines for metaverse developers and travel industry professionals to encourage visitor satisfaction and loyalty to metaverse tourism.

Comparison of Insulin Analogs and Human Insulins: A Narrative Review

Abstract Introduction Since insulin analogs have pharmacological properties that are similar to the normal physiological action of insulin, it has been suggested that they provide better glucose control and less rates of hypoglycemia compared to human insulins. Methods We performed a narrative, nonsystematic review of the literature including clinical trials, systematic reviews, meta-analyses, and professional guidelines related to the comparison of human insulins and insulin analogs in terms of glucose control, safety profile, and cost. Results Long-acting basal insulins result in mild improvement in glucose control and less rates of nocturnal hypoglycemic compared to neutral protamine Hagedorn insulin, mainly among patients with type 1 diabetes. Rapid-acting insulin analogs provide better glucose control and lower rates of hypoglycemia compared to regular insulin among patients with type 1 diabetes, whereas no advantage has been shown for insulin analogs among patients with type 2 diabetes for glucose control or hypoglycemia. Premixed insulin analogs provided no advantage in glucose control and inconsistent benefit in lowering the rates of hypoglycemia compared to human premixed insulins among patients with type 2 diabetes. The cost of insulin analogs is significantly higher than human insulins, and favorable cost-effectiveness has only been demonstrated for rapid-acting insulin analogs in type 1 diabetes. Conclusion Currently available evidence supports the use of rapid-acting insulin analogs and possibly long-acting basal insulin over human insulins for patients with type 1 diabetes. For patients with type 2 diabetes, the use of long-acting insulin analogs may be recommended for selected patients who are at an increased risk of significant hypoglycemia, while no clear benefits of meal insulin analogs over human insulins have been observed.

The impact of implicit and explicit bias about disabilities on parent experiences and information provided during prenatal screening and testing

BackgroundPrenatal screening technology has consistently raised concerns regarding the conversations and information provided about disabilities, particularly given that research shows trauma related to negative prenatal screening and diagnosis experiences among parents of children with Down syndrome.1 ObjectiveTo determine what information obstetric medical providers (OB/MFMs) are most and least likely to provide when delivering prenatal screening/testing results about Down syndrome (DS), the subsequent impact of bias on prenatal screening experiences, and how these issues can be addressed through training, resources, and professional guidelines. MethodsOnline surveys were distributed to parents of children with DS born between 2016 and 2021 via local DS organizations and the national DS Diagnosis Network (April 2020–December 2021). ResultsOf the 242 parents who completed the survey, a majority indicated that OB/MFMs were most likely to discuss medical issues and reproductive options while less than 40% reported that OB/MFMs discussed psychosocial outcomes, supports, and services. Respondents reported that the 61.3% of OB/MFMs who delivered the diagnosis as bad news or said “I'm sorry” were significantly less likely than their counterparts to provide information about life outcomes, supports and services, condition-specific resources, or more comprehensive prenatal care. Qualitative responses about screening/diagnosis experiences provided further context about the impact of implicit and explicit bias on the provision of accurate, up-to-date information. ConclusionTo meet information needs during prenatal screening, OB/MFMs need access to accurate, balanced, and up-to-date information about disabilities and more training on disability cultural competency and how to deliver prenatal screening/testing results without implicit or explicit bias.

Experience of elderly women about the interpersonal violence suffered

This study aimed to understand the experiences of elderly women seen in a reference outpatient clinic, regarding to the interpersonal violence suffered in their daily lives. A cross-sectional, qualitative, and exploratory cohort study was chosen, with elderly women seen in a outpatient clinic of a hospital of reference in Recife, from February to March 2022. Data were obtained through semi-structured interviews, audio-recorded, and later transcribed in a literal way. Data analysis was carried out using Minayo's thematic content analysis technique. The sample included 13 elderly women, with a mean age of 68.8 years. The categories revealed, from the perspective of the elderly, an increase in the occurrence of violence and its relationship with substance use and financial dependence. Furthermore, it was observed that healthcare professionals and support services are ill-prepared to identify violence and provide protection and care measures. It is understood that there is a long way to go in terms of legislation and professional practice guidelines in elder protection commissions.

Need for continued improvements to our communities and buildings for health

Abstract Globally, non-communicable diseases (NCDs) are leading causes of mortality, morbidity, and healthcare costs. Growing evidence demonstrates that key protective factors for NCDS (e.g., physical activity, healthy eating, and social connections) can be influenced through better design of and amenities in our community and building environments. Guidelines for multi-sector professionals that provide strategies for bettering these environments have proven successful in improving NCD outcomes in jurisdictions that have implemented them into policies and practices across settings. In 2023, the Healthy Community Guidelines informed by the latest evidence and multi-sector practitioner inputs are being released. There is great need to implement its strategies broadly across our cities and towns so we may create environments for better NCD prevention and management. In doing so, we have the opportunity to achieve our goals of improved NCD outcomes, life expectancies and more sustainable healthcare systems in the next decade.

Ankyloglossia in Australia: Practices of health professionals.

To investigate the opinions and practices of health professionals involved in ankyloglossia diagnosis and management in Australia. Two hundred and thirty-seven health professionals across Australia responded to an online survey including their diagnostic and management practice of ankyloglossia. Descriptive statistics, content analysis and thematic analysis were used to analyse quantitative data and open-ended responses, respectively. Most (91.6%) respondents reported they are responsible for the assessment and diagnosis of ankyloglossia in their clinical practice. A majority (56.7%) reported using more than one assessment tool in clinical practice. Less than half (46.4%) reported providing treatment to manage ankyloglossia. Surgical management was used by 44.5%, and 56.4% used non-surgical management as their primary treatment of ankyloglossia. Of the total sample, 26.6% had completed no further training or professional development in the field. 46% of respondents stated they always educate parents about ankyloglossia diagnoses, whereas 29.5% reported they always educate parents about management of ankyloglossia. Of respondents, a high level of confidence was reported by 62.6% of health professionals in the assessment of infants with ankyloglossia. Of those who perform surgical management, 53.7% reported feeling extremely confident in their skills. Fifty-two percent of respondents reported they were dissatisfied with the current service delivery for infants with ankyloglossia. The diagnosis, management and education practices varied greatly amongst health professionals in Australia. Clinical guidelines for all relevant health professionals are needed to ensure standardised diagnosis and management processes. In future, this will help guide evidence-based diagnosis and intervention for infants with ankyloglossia.

Beyond a literacy model for psychiatry in the mass media.

Professional statements suggest that psychiatrists engage in media work to supply a general audience with medical knowledge informed by relevant professional expertise. However, media work may be motivated by interests other than disinterested service to the well-being of the public, such as fame, money and a platform for one's wider views. The role of media psychiatrist is also crucially shaped by the unpredictable needs of a complex media ecology and marketplace. Furthermore, the properties of the media, and different forms within them, bring implicit meanings such as the wider authorisation of therapeutic self-reflection or the promotion of para-social intimacy. Finally, the media psychiatrist may function as an entrepreneur, converting the currency of celebrity into new forms of cultural, social and political capital. Professional guidelines for media work should be updated in light of such observations.

Between objects of science and lived lives. The legal liminality of old human remains in museums and research

ABSTRACT Collections of old human remains in museums are currently under increased scrutiny and pressure. On the one hand they are problematised from a post-colonial and human rights point of view as the material remains of historic and ongoing structural violence connected to scientific knowledge production. On the other, new methods in archaeological science have led to increasing demand for destructive sampling. Without guidance and support by laws and formal standardised professional guidelines, museums may find themselves squeezed from two opposing sides. Based on an analysis of laws and professional guidelines, and a large-scale survey of the practical handling of old human remains in Swedish museums, this article argues that the lack of a shared professional process that recognises the complexity of old human remains as both objects of science and lived lives, risks undermining the role of museums in their relationship to both the public and the research community.

COVID-19 Vaccination Hesitancy in Autoimmune Disease Patients: Policy Action and Ethical Considerations.

As COVID-19 vaccination guidelines were issued by Advisory Committee on Immunization Practices (ACIP) and the Centers for Diseases Control and Prevention (CDC) across the US, each state and clinical provider instituted vaccine implementation and education policies and protocols for high-risk populations. However, current research has shown that while people with autoimmune diseases were listed by ACIP and CDC as a COVID-19 high-risk population, the rate of adherence to implementation and education protocols, as well as the prioritization of this sub-population as a high-risk group, varied among the clinicians and vaccinators thus impacting the hesitancy towards the COVID-19 vaccine and a correlation to low vaccination rates. The purpose of this review was to explore factors of COVID-19 vaccination hesitancy in people living with autoimmune diseases in relation to current implementation and education policies and protocols, as well as ethical and contextual factors, while providing possible implications. COVID-19 vaccine hesitancy in people living with autoimmune disease was greater than in the general population, as demonstrated by increased levels of overall mistrust and fear of potential risk and harmful side effects. Evidence has shown that COVID-19 vaccination is safe and effective for patients with autoimmune diseases. Additionally, the benefits of COVID-19 vaccination outweigh its potential risks and adverse effects in this population. However, the non-adherence to policy and protocols, especially community education protocols, by those providing the vaccination have a negative impact on the overall perception of the vaccine and needs to be addressed at local and state levels in order to protect this population. Future research should provide strategies to guide collaborative efforts between government and local agencies in providing tailored vaccination campaigns to this population. In parallel with policy, COVID-19 vaccination intervention implementation and educational protocols should be developed with evidence-based guidelines for public health and clinical professionals that are targeted at this vulnerable high-risk population.

Fertility preservation in female cancer patients.

In Hungary, an average of 2066 women under the age of 40 are diagnosed with cancer each year according to data from the National Cancer Registry. Approximately two-thirds of these patients require gonadotoxic treatment for their disease, which could potentially reduce their chances of future conception and childbirth. Currently, there are no professional guidelines on fertility preservation in Hungary, however, it is important to inform patients about their options. In our previous paper, we presented the gonadotoxic effects of oncotherapies and the currently available fertility preservation techniques. This second paper provides current treatment methods and recommends fertility preservation techniques in different cancer types. The success of an oncofertility program relies heavily on the effective communication and collaboration between oncologists and reproductive specialists involved in fertility preservation. This paper may be the first step in elaborating a guideline towards improving access to oncofertility services and ultimately improving the quality of life for young cancer survivors in Hungary. Orv Hetil. 2023; 164(29): 1134-1145.

Prevalence of Heart Failure Stages in a Universal Health Care System: The Military Health System Experience

BackgroundMorbidity and mortality related to heart failure are increasing and disparities are widening. These alarming trends, often confounded by access to care, are poorly understood. This study evaluates the prevalence of all stages of heart failure by race and socioeconomic status in an environment with no access barrier to care. MethodsWe conducted a cross-sectional observational study of adult beneficiaries aged 18 to 64 years of the Military Health System (MHS), a model for universal health care for fiscal years 2018-2019. We calculated prevalence of preclinical (stages A/B) or clinical (stages C/D) heart failure stages as defined by professional guidelines. Results were analyzed by age, race, and socioeconomic status (using military rank as a proxy). ResultsAmong 5,440,761 MHS beneficiaries aged 18 to 64 years, prevalence of preclinical and clinical heart failure was 18.1% and 2.5%, respectively. Persons with preclinical heart failure were middle aged, with similar proportions of men and women, while those with heart failure were older, mainly men. After multivariable adjustment, male sex (1.35 odds ratio [OR] [preclinical]; 1.95 OR [clinical]), Black race (1.64 OR [preclinical]; 1.88 OR [clinical]) and lower socioeconomic status were significantly associated with large increases in the prevalence of all stages of heart failure. ConclusionAll stages of heart failure are highly prevalent among MHS beneficiaries of working age and, in an environment with no access barrier to care, there are striking disparities by race and socioeconomic status. The high prevalence of preclinical heart failure, particularly notable among Black beneficiaries, delineates a critical time window for prevention.