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Previous research suggests a high prevalence of low energy availability (LEA) and stress fractures (SF) among competitive female endurance athletes. However, much less is known about these issues among recreational female runners. This study aimed to assess the prevalence and number of self-reported SF and risk of LEA among noncompetitive, recreationally active female runners, aged 18 - 25 years. Additionally, it compared characteristics between females with a history of multiple SF vs. one or no SF, and between those 'at risk' vs. 'not at risk' of LEA. Female recreational runners (n=485) completed an online survey that included the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Disordered Eating Screening Assessment (DESA-6). Thirty-three percent of participants reported ≥ 2 SF. Eighty-two percent of the ≥ 2 SF group were classified as 'at risk' of LEA (LEAF-Q score ≥ 8). In addition, ≥ 2 SF was associated with higher total LEAF-Q score, self-reported intentional food restriction for weight loss, and self-reported current eating disorder while weekly exercise duration was inversely associated with ≥ 2 SF. In conclusion, one-third of participants had multiple SF with a majority (82%) of this group classified as 'at risk' of LEA. Screening tools such as the LEAF-Q and DESA-6 are useful tools to identify characteristics associated with multiple SF in this demographic, especially questions regarding food restriction and the presence of a current or previous eating disorder.

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An electrochemical sensor based on an electroactive nanocomposite was designed for the first time consisting of electrochemically reduced graphene oxide (ERGO), polyaniline (PANI), and poly(alizarin red S) (PARS) for ciprofloxacin (CIPF) detection. The ERGO/PANI/PARS-modified screen-printed carbon electrode (SPCE) was constructed through a three-step electrochemical protocol and characterized using FTIR, UV-visible spectroscopy, FESEM, CV, LSV, and EIS. The new electrochemical CIPF sensor demonstrated a low detection limit of 0.0021 µM, a broad linear range of 0.01 to 69.8 µM, a high sensitivity of 5.09 µA/µM/cm2, and reasonable selectivity and reproducibility. Moreover, the ERGO/PANI/PARS/SPCE was successfully utilized to determine CIPF in milk with good recoveries and relative standard deviation (< 5%), which were close to those with HPLC analysis.

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In this study, the pressing issue of persistent organic pollutants in wastewater was addressed by designing and fabricating a magnetically separable MnFe2O4/rGO heterostructure catalyst for efficient mineralization of bisphenol A (BPA) and dyes such as alizarin red S (anionic) and malachite green (cationic), which are known for their resistance to biodegradation and carcinogenic properties. Comprehensive structural and surface analyses using XRD, XPS, SEM, and TEM/HRTEM coupled with magnetic and optical property measurements revealed the formation of the MnFe2O4/rGO heterostructures. Among all, the MnFe2O4/rGO-10 catalyst with 10% wt% of rGO exhibited 100% efficiency in the mineralization of BPA and both dyes under visible light illumination within 60 min. The stability and recyclability of the catalyst, assessed through XRD and VSM studies, demonstrated its consistent performance over multiple uses. The cost-effectiveness and stability of this catalyst underscore its potential for practical application in wastewater treatment, offering a viable solution to the persistent challenge of removing stubborn organic contaminants.

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In contrast to the hyperactive platinum electrode, ARS modified platinum electrode presents a remarkable inertness toward adsorption and surface processes and lends it for further voltammetric applications. Measuring pyrogallol levels in samples is significant for assessing their antioxidant activity, which is crucial for understanding their potential health benefits and ability to combat oxidative stress. In addition, the excess consumption of pyrogallol can have significant negative effects on human health. A voltammetric sensor has been developed for the determination of pyrogallol using ARS modified platinum electrode. The electrode was prepared by electrodeposition of alizarin red S on a platinum electrode using cyclic voltammetry with a potential scan range of - 0.4 to 1.2 V against an Ag/AgCl quasi reference electrode for 60 cycles as optimum number of cycles. The modified electrode was characterized by CV and SEM techniques. This modified alizarin red S platinum electrode showed remarkable electrocatalytic performance and stability, resulting in a significant increase in pyrogallol oxidation current by 11.05% compared to the pyrogallol oxidative current at the unmodified platinum electrode. A well-defined oxidation peak was observed at ~ 0.40 V. The sensor exhibited a low limit of detection (LOD) of 0.28 µM and a linear standard curve covering the ranges of 1.0-40 µM and 0.01-10.0 mM pyrogallol. Extensive studies were performed to evaluate possible interferences from various organic and inorganic compounds and yielded satisfactory results that confirm the selectivity of the developed sensor for pyrogallol determination. In addition, the ARS-Pt electrode provided consistently reliable results for the accurate detection of pyrogallol in water and tomato samples.

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In the current work, a rapid, selective, and sensitive technique was developed for the detection of Alizarin Red S (ARS) by applying poly leucine modified carbon paste electrode (PLMCPE). Electrochemical impedance spectroscopy (EIS) and Scanning electron microscopy (SEM) were utilized to study the surface morphology of unmodified carbon paste electrode (UMCPE) and PLMCPE. The active surface area for UMCPE and PLMCPE was found to be 0.0012 cm2 and 0.0026 cm2 respectively. The electrochemical response of ARS at UMCPE and PLMCPE was analyzed using cyclic voltammetry (CV) in the potential window of 0.4 to 1.0 V. The cyclic voltammogram obtained for varying the pH of 0.2 M phosphate buffer (PB) solution showed maximum current for the oxidation of ARS at pH 6.5. The electrochemical reaction of ARS was found to be irreversible and adsorption controlled. The effect of variation of concentration of ARS on the oxidation peak current was evaluated using CV and linear scan voltammetry (LSV). A linear relationship between the concentration variation and current was obtained in the linear range of 1.5 µM-3.5 µM and 0.2 µM-5.0 µM for CV and LSV respectively. The limit of detection (LOD) of 0.68 µM for the CV method and 0.29 µM for the LSV method was exhibited by the developed sensor. The simultaneous study of ARS along with tartrazine (TZ) showed good selectivity for ARS. The interferents of foreign molecules showed no effect on the selectivity of the electrode. The applicability of PLMCPE on real samples gave good recovery ranging from 97.46-101.2%; hence, the sensor can be utilized on real samples. The developed sensor has good stability and sensitivity.

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Bone marrow stromal/stem cells (BMSCs) are primitive and heterogeneous cells that can be differentiated into osteoblasts, adipocytes and other subsets. Their bone-fat lineage commitment is responsible for the homeostasis of bone marrow microenvironment. However, there are little effective methods and evidence to simultaneously visualise the lineage commitment of BMSCs. Here we provide a bivalent differentiation medium that can enable BMSCs differentiation into osteoblasts and adipocytes in vitro, and establish a method to simultaneously distinguish osteoblasts or adipocytes from the heterogeneous BMSCs based on Alizarin red S and Oil red O staining, which have been used for detection of specific mineralized nodules and lipid droplets, respectively. This assay provides a specifically simple but effective and low-cost method to evaluate the efficiency of osteo-adipogenic (OA) allocation of BMSCs.►Researchers can utilize the bivalent differentiation medium to evaluate the efficiency of osteogenic and adipogenic differentiation of BMSCs in vitro.

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Cellulosic paper-based electrode materials have attracted increasing attention in the field of flexible supercapacitor. As a conductive polymer, polyaniline exhibits high theoretical pseudocapacitive capacitance and has been applied in paper-based electrode materials along with cellulose fibers. However, the stacking of polyaniline usually leads to poor performance of electrodes. In this study, metal-organic coordination polymers of zirconium-alizarin red S and zirconium-phytic acid are applied to modulate the polyaniline layer to obtain high-performance cellulosic paper-based electrode materials. Zirconium hydroxide is firstly loaded on cellulose fibers while alizarin red S and phytic acid are introduced to regulate the morphology of polyaniline through doping and coordination processes. The results show that the introduction of dual coordination polymers is effective to regulate the morphology of polyaniline on cellulose fibers. The performances of the paper-based electrode materials, including electrical conductivity and electrochemistry, are apparently improved. It provides a promising strategy for the potential development of economical and green electrode materials in the conventional paper-making process.

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Background: This study aimed to investigate the relationship between the prevalence of menstrual irregularities, energy intake, and sleep deprivation among female athletes. Methods: A total of 128 female athletes, with an average age of 19.2 ± 1.2 years, participated in the study and tracked their food intake over a three-day period. Menstrual status and sleep duration were assessed using a questionnaire, and psychological anxiety was evaluated using the State and Trait Anxiety Inventory (STAI). These were measured once during the investigation. The impact of sleep status on state anxiety and daily energy intake was examined using the T-test. A generalized linear model (GLM) with a log link function was employed to investigate the effects of sleep deprivation on the presence of menstrual irregularities. Results: As the results of the present study, sleep deprivation significant increased both state and trait anxiety (p < 0.05), as well as affecting energy intake (p < 0.05), particularly protein and carbohydrate intakes (p < 0.05). However, GLM analysis indicated that while sleep deprivation did not directly influence the prevalence of menstrual irregularities (p > 0.05), state anxiety emerged as a significant factor impacting the prevalence of menstrual irregularities (p < 0.05). Conclusions: The results of the present study suggest a potential pathway wherein sleep deprivation might elevate state anxiety levels, consequently indirectly contributing to an increase the probability of menstrual irregularities. In conclusion, the results of the presents study provide novels insights suggesting that sleep deprivation might directly increase state anxiety and indirectly affect the prevalence of menstrual irregularities. Hence, decreased sleep duration might be related to mental health issues and the prevalence of menstrual irregularities both significant concerns among female athletes. Future studies will play a crucial role in further elucidating how sleep patterns impact the health and well-being of female athletes.

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This study assessed the otolith (sagittae, lapilli, and asterisci) increment deposition rate in the range-shifting damselfish, A. vaigiensis, using different concentrations of Alizain Red S and evaluated the impact of staining on increment width. Daily increment deposition was verified in all otolith types and presented clearer fluorescent markings in the lapilli and sagittae than the asterisci, with high stain concentration showing the best clarity. Higher stain concentrations were found to decrease increment width, suggesting care is needed when using stained otoliths as a proxy for growth for this species.

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Light-gated chemical reactions allow spatial and temporal control of chemical processes. Here, we suggest a new system for controlling pH-sensitive processes with light using two photobases of Arrhenius and Brønsted types. Only after light excitation do Arrhenius photobases undergo hydroxide ion dissociation, while Brønsted photobases capture a proton. However, none can be used alone to reversibly control pH due to the limitations arising from excessively fast or overly slow photoreaction timescales. We show here that combining the two types of photobases allows light-triggered and reversible pH control. We show an application of this method in directing the pH-dependent reaction pathways of the organic dye Alizarin Red S simply by switching between different wavelengths of light, i. e., irradiating each photobase separately. The concept of a light-controlled system shown here of a sophisticated interplay between two photobases can be integrated into various smart functional and dynamic systems.

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Evaluation of effective and low-cost materials as catalysts to combat the threat of pollution is a significant and growing trend. With this aim, we have synthesized calcium ferrite brownmillerite by wet preparation approach as a catalyst for pollution. The structural analysis is established by the X-ray diffraction of Ca2 Fe2 O5 , whereas the tetrahedral and octahedral sites band stretching for ferrite specimen has been deduced using FTIR. The bandgap energy has been estimated by the Tauc relation (2.17 eV). Ca2 Fe2 O5 brownmillerite exhibits a BET surface area of 10 m2 /g and a BJH pore volume of 0.121 cm3 /g with the average particle size of 70 nm. Importantly, the alizarin Red S dye degradation has been studied using the prepared ferrite catalyst, under dark ambient conditions and without the presence of any acidic or basic additives. Degradation is also supported by both FTIR and TOC analysis. Surface properties of brownmillerite Ca2 Fe2 O5 have been characterized using electronic spectroscopy and CO2 temperature programmed desorption (TPD) analysis and revealed that the basic surface of brownmillerite Ca2 Fe2 O5 offers active sites that are suitable for degradation processes. All results show that the preparation of brownmillerite Ca2 Fe2 O5 via the Pechini method is suitable to produce fine surfaces and pores with nanosized particles.

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PURPOSE: Oral contraceptives (OCs) are commonly used by female athletes raising concerns regarding the possible adverse effects of OCs on physical performance, musculoskeletal injuries, and bone density. We aimed to review all current studies on the physiological effects of OCs in physically active women. MATERIALS AND METHODS: A review of literature in electronic search in PubMed and Google Scholar databases from December 2002 to December 2022 using relevant keywords. The reference lists of the articles found eligible were also reviewed. RESULTS: Out of 344 articles in the initial database, 54 clinical studies were eligible for inclusion in our literature review. OCs are used by about two-thirds of female athletes. Current research suggests that OCs' effects on endurance performance and muscle strength are mostly reassuring. OCs do not seem to have a major negative impact on bone health or sports injuries. In fact, new data suggests that they may even significantly reduce the risk of anterior cruciate ligament (ACL) injury. CONCLUSIONS: OCs can be safely used by young female athletes, who may also benefit from better menstrual cycle control. OCs offer newly realised protection from ACL injuries. The use of OCs must be carefully individualised according to their preferences, expectations, and experience.

Hormonal contraception can be safely prescribed to active women. The International Olympic Committee advocates a new and wider definition for the 'athlete triad', where low energy availability presents a special challenge for these athletes. New data suggests that the use of oral contraceptives may protect against ACL injury.

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PURPOSE: Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine. METHODS: This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame. RESULTS: Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2 = 69.7, p = 0.002), treatments (X2: 23.6-43.8, p: <  0.001-0.003), and referrals (X2 = 132, p <  0.001) were for shin injuries. Larger proportions of nutrition assessments (X2 = 40.7, p <  0.001), interventions (X2 = 26.8, p = 0.003), and referrals (X2 = 27.5, p = 0.002) were performed in or after the year 2015. CONCLUSION: Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.

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The purpose of this narrative review is to identify health and performance consequences associated with LCA in female endurance athletes. The intake of carbohydrates (CHO) before, during, and after exercise has been demonstrated to support sport performance, especially endurance activities which rely extensively on CHO as a fuel source. However, low energy availability (LEA) and low carbohydrate availability (LCA) are common in female athletes. LEA occurs when energy intake is insufficient compared to exercise energy expenditure, and LEA-related conditions (e.g., Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S)) are associated with a myriad of health and performance consequences. The RED-S model highlights 10 health consequences and 10 performance consequences related to LEA. The independent effect of LCA on health and performance has been under-researched, despite current CHO intake being commonly insufficient in athletes. It is proposed that LCA may not only contribute to LEA but also have independent health and performance consequences in athletes. Furthermore, this review highlights current recommendations for CHO intake, as well as recent data on LCA prevalence and menstrual cycle considerations. A literature review was conducted on PubMed, Science Direct, and ResearchGate using relevant search terms (i.e., "low carbohydrate/energy availability", "female distance runners"). Twenty-one articles were identified and twelve met the inclusion criteria. The total number of articles included in this review is 12, with 7 studies illustrating that LCA was associated with direct negative health and/or performance implications for endurance-based athletes. Several studies included assessed male athletes only, and no studies included a female-only study design. Overall, the cumulative data show that female athletes remain underrepresented in sports science research and that current CHO intake recommendations and strategies may fail to consider female-specific adaptations and hormone responses, such as monthly fluctuations in estrogen and progesterone throughout the menstrual cycle. Current CHO guidelines for female athletes and exercising women need to be audited and explored further in the literature to support female athlete health and performance.

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Alizarin red S is a sulfonated, water-soluble derivative of alizarin. This work presents femtosecond studies of alizarin red S (ARS) nanoparticles in comparison to ARS in aqueous solution and to alizarin in DMSO. The femtosecond studies cover a probing spectral range of 350-750 nm using different excitation wavelengths, taking into account the variation of the absorption spectra with the pH values of the solvent. Stationary absorption spectra show slight differences between solution and nanoparticles. Excitation at 530 nm results in low and noisy responses, therefore, we additionally recorded transient spectra of the nanoparticles at λex = 267 nm. While the results in DMSO are comparable to previous studies in non-aqueous solvents, we report a relatively fast relaxation of 14 ps in [La(OH)2][ARS] nanoparticles in aqueous solution after excitation at 530 nm, which is similar to Na(ARS) solution (19 ps). The dynamics changed with lower pH, but still without significant differences between nanoparticles and solution. We propose [La(OH)2][ARS] nanoparticles as a suitable alternative to dissolved molecules with similar spectroscopic properties, for example, with regard to biomarker applications.

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OBJECTIVES: To investigate associations between self-reported exercise training habits and amenorrhea/oligomenorrhea among physically active women. DESIGN: A cross-sectional survey was completed by 3705 women (median age = 40 years [quartile 1, quartile 3: 30, 45], body mass index = 22.1 kg/m2 [20.5, 24.2]) representing multiple nationalities and sports via the STRAVA™ exercise application. Respondents selected the amount of time they participated in low intensity, moderate intensity, and high intensity exercise training per week. Amenorrhea/oligomenorrhea was defined as self-reporting ≤10 menses in the last year. METHODS: Associations between weekly exercise volume for low intensity training, moderate intensity training, and high intensity training and amenorrhea/oligomenorrhea were modeled with univariate logistic regression models, followed by adjustment for age and body mass index. RESULTS: Amenorrhea/oligomenorrhea prevalence was 16 % (n = 576/3705), with no difference by country of origin or most sport modes. In adjusted models, participating in low intensity training ≥7 h/week or moderate intensity training ≥6 h/week was associated with 1.43 (95 % confidence interval: 1.04-1.96) and 1.46 (1.10-1.95) greater odds of amenorrhea/oligomenorrhea compared to 2 to 3 h/week, respectively. Similarly, high intensity training ≥5 h/week was associated with 1.41 (1.03-1.92) greater odds of amenorrhea/oligomenorrhea compared to 1 to 2 h/week. Participating in low intensity training for ≤30 min/week compared to 2 to 3 h/week was associated with reduced amenorrhea/oligomenorrhea odds (0.65 [0.44-0.94]). CONCLUSIONS: Taken together, these associations suggest greater weekly exercise volume, irrespective of intensity, may increase amenorrhea/oligomenorrhea risk among physically active women.

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Relative Energy Deficiency in Sport (RED-S) defines insufficient calorie intake for the physiological and athletic functions of the athlete, and accordingly deterioration in the musculoskeletal, hormonal, cardiovascular and immune systems. Herein, we present a 42-year-old female long-distance runner with multiple pelvic stress fractures who didn't complete her prescribed treatment program and wanted to keep running despite being aware of the associated pain and risks. The Goldman dilemma refers to the unsettling reality that a significant number of professional athletes may contemplate sacrificing their lives in order to achieve Olympic glory. This disregard for the numerous challenges stemming from an obsession with success is equally applicable to the amateur athlete depicted in this case. Our patient's fractures were examined in relation to RED-S and managed through conservative treatment methods. The RED-S and Goldman dilemma should be kept in mind not only in professional but also in semi-professional, and amateur athletes.

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BACKGROUND: Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). OBJECTIVE: The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes' and sport professionals' perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. METHODS: An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. RESULTS: Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. "Health" and "sports performance" were the highest scoring motivators, while the highest scoring barriers were "cost of food," "easy access to unhealthy food," and "time to cook or prepare food." Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. CONCLUSIONS: The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance.

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Fungi were used as one of the most common bioremediation methods. From this perspective, our study highlights the optimization of Alizarin Red S (ARS) dye adsorption performance for the sodium alginate (SA) by using the fungus Aspergillus terreus (A. terreus) to form a composite bead and the possibility of its reusability. This was accomplished by mixing SA with different ratios of biomass powder of A. terreus, including 0%, 10%, 20%, 30%, and 40%, to form composite beads of A. terreus/SA-0%, A. terreus/SA-10%, A. terreus/SA-20%, A. terreus/SA-30%, and A. terreus/SA-40%, respectively. The ARS adsorption characteristics of these composite mixtures were analyzed at various mass ratios, temperatures, pH values, and initial concentrations. Moreover, sophisticated techniques, such as scanning electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR), were employed to detect the morphological and chemical properties of this composite, respectively. The experimental results revealed that A. terreus/SA-20% composite beads have the highest adsorption capacity of 188 mg/g. Its optimum adsorption conditions were achieved at 45 ∘C and pH 3. Moreover, the ARS adsorption was well explained by the Langmuir isotherm (qm = 192.30 mg/g) and pseudo-second-order and intra-particle diffusion kinetics. The SEM and FTIR findings corroborated the superior uptake of A. terreus/SA-20% composite beads. Lastly, the A. terreus/SA-20% composite beads can be employed as an eco-friendly and sustainable alternative to other common adsorbents for ARS.

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BACKGROUND: Short and long-term health consequences surrounding Low Energy Availability can be mitigated by recognizing the risk factors and making early diagnosis of the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). While awareness of the Triad among physicians and allied health professionals has been studied, there are very few studies that assess physician awareness of both the Triad and RED-S. METHODS: Our study assesses Low Energy Availability, the Triad, and RED-S knowledge with an electronic survey, educational handout, and follow up survey among physicians across multiple specialties at a single academic institution. RESULTS: Among 161 respondents, respective Triad and RED-S awareness among surveyed specialties was highest in Orthopedic surgeons (100%, 100%), followed by Physical Medicine & Rehabilitation (70%, 53%), Family Medicine (67%, 48%), Internal Medicine (54%, 36%), Obstetrics and Gynecology (46%, 32%), Pediatrics (45%, 29%), Endocrinology (33%, 33%), and Other (33%, 33%). Comparing the initial survey results to the follow-up survey results, there was an increase from 37 to 72% of physicians who correctly identified that the presence of low BMI or recent weight loss is not a required component of the Triad or RED-S. Both the initial and follow-up survey revealed a continued misperception surrounding the use of hormonal contraception to resume menstrual cycles, with 33% of physicians on initial survey and 44% of physicians on follow-up survey incorrectly answering that question. CONCLUSIONS: Multidisciplinary physicians have various levels of knowledge surrounding the Triad and RED-S, and there is a need for improved physician awareness, diagnosis, and treatment of the Triad and RED-S. Misperceptions exist surrounding the role of hormonal contraception in female athletes with the Triad and RED-S to regain and regulate menses.

When there is insufficient energy intake compared to energy output, leading to low energy availability, this lack of energy can strain the body's metabolic needs. The Female Athlete Triad (Triad) and/or Relative Energy Deficiency in Sport (RED-S) refer to this strain that affects organ systems. While these syndromes exist, it is unclear if there is a differential in awareness among physicians from different specialties. Our study confirms that physician awareness varied among different specialties, and misperceptions continue to exist surrounding hormonal contraception and regulating menses.