ABSTRACT. Water stored as ice and snow at high elevations is a resource that plays an important role in the hydrologic cycle, particularly in the timing and volume of downstream discharge. Here we use geochemical and isotopic values of water samples to evaluate relative contributions of melting glacier ice and groundwater to discharge in Bhutan. River water samples were collected between 3100 and 4500 m in the Chamkar Chhu (river) watershed of central Bhutan's Himalaya. Glacier ice and snow were sampled in the ablation zone of Thanagang glacier. Groundwater was parameterized from spring water at elevations of 3100 and 3600 m. Synoptic sampling was carried out in separate expeditions in July, August and late September 2014, to characterize monsoon and post-monsoon conditions. Results from a two-component hydrologic mixing model using isotopic and geochemical (sulphate) values show that the glacier outflow contributions decrease from �76% at 4500 m to 31% at 3100 m. A fourcomponent hydrologic mixing model using end-member mixing analysis shows glacier ice melt increasing as a proportion of discharge over the 3 month sampling period, and consistently decreasing with distance downstream of Thanagang glacier terminus. These results indicate that isotopic and geochemical tracers can provide a quantitative evaluation of the source water contributions to streamflow in Bhutan.

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Background: Head and neck cancers are among the commonest cancers in the developing world. Personal habits, such as the use of tobacco, betel nut and alcohol are strongly associated with the development of head and neck cancers at certain sites. Therefore, they are among the preventable cancers. In Bhutan, there has not yet been a study conducted on head and neck cancers. Objective: To describe baseline epidemiological and histopathological characteristics of head and neck cancers in Bhutan. Methods: This is a 7-year descriptive study of all cases of head and neck cancers presented at the Jigme Dorji Wangchuk National Referral Hospital from 2011 to 2017. The data were collected from the hospital's medical records section, histopathology records, patient referral unit and some treatment centres in India. Prior approval was sought from the Research and Ethics Board for Health, the Ministry of Health and the hospital management. Results: There were a total of 515 cases of head and neck cancers from 2011 to 2017. The crude incidence rate was 10 per 100,000 and the overall age adjusted rate was 12.3 (95% CI 9.5-15.1) per 100,000 population. The prevalence during this 7-year period was 69.1 per 100,000 population. The commonest cancers are thyroid, oral cavity, hypopharyngeal, laryngeal and nasopharyngeal cancer in decreasing order. Head and neck cancers are more common in males than females in the majority of sites except thyroid, salivary gland and sinonasal malignancies. Thyroid cancers and nasopharyngeal cancers are found to affect younger age groups. Tashigang (48) followed by Paro (43) recorded the highest number of cases. Squamous cell carcinoma is the commonest histopathology type in almost all the cases, while papillary carcinoma is the commonest among thyroid cancers. Personal habits, such as smoking, chewing tobacco, betel nut and alcohol consumption, were found to be more common among patients suffering from oral cavity, laryngeal, hypopharyngeal and oropharyngeal cancers. Conclusion: Head and neck cancers are the third most common cancer in Bhutan after stomach cancer and cervical cancer. Thyroid, oral cavity and hypopharynx are the top three anatomical sites for head and neck cancers in Bhutan. The current epidemiological and histopathological profile of head and neck cancers will form a baseline of information and basis for further research on head and neck cancers in Bhutan.

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Objectives The unmet needs of contraception can lead to unintended pregnancy and transmission of sexually transmitted infections (STI). Therefore, this study aimed to evaluate the contraception use, knowledge, and attitude on STI among students under Royan University of Bhutan (RUB). Methods This was a cross-sectional study using an online questionnaire. The questionnaire was developed in Google forms and the link was shared through the college WeChat groups. The questionnaire consisted of four parts on socio-demographic, sexual behaviour and contraceptive use, knowledge, and attitude on STIs. All the students under RUB were invited to participate voluntarily in this study. The socio-demography was presented in frequency and proportion. Result A total of 1,283 students participated in this survey and 55.0% (701) were females. Of this, 29.4% (377) were sexually active and 94.4% reported using modern contraception. Commonly used contraceptives were: condoms (83.8%, 316) and emergency contraceptives (20.6%, 78), respectively. The mean knowledge and attitude scores on STI were 9.94 (range 2–20) and 12 (range 2–14), respectively. Good knowledge and attitude on STI were reported in 53.2% (683) and 70.1% (899) of participants. Conclusion Students reported average knowledge and a good attitude towards STI. Contraceptive use among university students was low. There is a need to strengthen health education on STIs in schools and universities. All forms of contraceptives especially condoms should be made easily available to sexually active people.

As our global climate warms, people, and economies utilizing water resources sourced by snow and ice melt in mountain areas are disproportionately affected relative to locations that rely on rainfall. Worldwide, the vast majority of those impacted by snowfall changing to rainfall and earlier melt from a warming climate live in Asia. The Brahmaputra River originates in the declining glaciers and snowfields of the Chinese and Bhutanese Himalaya before flowing to the mega population centers of the Bangladesh delta. Bhutan's economy relies on water resource-dependent hydropower and agriculture imposing important questions about the impact of climate change on the long-term viability of water supplies in these important economic sectors. To clarify potential effects on water supplies in a warming world, and specifically to quantify the role of meltwater to river discharge in the headwaters of the Brahmaputra basin, we utilize a combined field observation-remote sensing approach to quantify river discharge source waters in a representative headwater basin, the Chamkhar Chhu. Using 4 years of water isotope and chemistry data together with a Bayesian Monte Carlo mixing model run seasonally in 2016, we find that the Chamkhar Chhu is mostly a rain-dominated basin at the lower elevation of our study domain (2591 m a.s.l.), with peak contributions from snowmelt in the early-monsoon and ice melt in the post-monsoon seasons. The radioactive tritium isotope shows glacier ice at the terminus was formed before the 1960s bomb spike while groundwater and river water samples taken in August (late monsoon) are sourced from mostly newer water inputs that show little tritium. The influence of the highly reacted Tsampa tributary, sourced by a debris covered glacier, and additional groundwater inputs generally increase major ion concentrations with distance from the glacier snout. An overall decreasing trend in the minimum snow and ice cover extent maps produced using MODIS Terra data from 2000 to 2017

Understanding human–canid conflict and coexistence must focus on documenting human–canid interactions and identifying the underlying drivers of reciprocal human attitude which enables appropriate strategies to minimize conflict and forge coexistence. The dhole (Cuon alpinus), Asia's most widely distributed wild canid, is highly threatened by human persecution and anthropogenic activities. Despite its “endangered” status, its ecological role as an apex predator, negative interactions with humans, and dhole-specific attitude studies are limited, thus hindering the development of a comprehensive dhole-conservation strategy. Here, we investigate the influence of socioeconomic factors of age, gender, income, residency inside/outside a protected area (PA), and other variables (cultural beliefs, livestock loss, and quantity of livestock loss) on the attitudes of local people and support for dhole conservation in the Himalayan Kingdom of Bhutan. We conducted a semi-structured questionnaire survey of 1,444 households located within the PA and non-PA from four representative regions in the country. Using R programming, we ran Pearson's chi-square test of independence to test the overall difference in the attitude and support for dhole conservation, followed by recursive partitioning through a conditional inference regression tree to identify its significant covariates with the highest explanatory power. Majority (79.1%) of respondents (χ2 = 488.6; df = 1; p < 0.001) disliked the dhole over those who liked it. More than half (57.7%) (χ2 = 412.7; df = 2; p < 0.001) opposed dhole conservation over those who either supported or remained neutral. Experience of livestock loss to dholes was the primary ( p < 0.001) factor influencing the negative attitude and opposition to dhole conservation, despite an acknowledgment of the ecological role of the dhole in controlling agricultural crop predators. Our study, which is the first-ever survey in Bhutan, solely focused on investigating human attitudes and perceptions toward the dhole, indicating that livestock loss to dholes transcends all positive attitudes to the species and drives a predominant dislike and opposition to its conservation. To improve the attitude and support toward the dhole and to foster dhole–human coexistence, livestock predation by dholes needs alleviation by improving the existing animal husbandry, in conjunction with promoting conservation awareness on this species.