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Early mobilization of critically ill ICU patients: A survey of knowledge, perceptions, and practices of Malaysian physiotherapists

Mirza FT, Saaudi N, Noor N

Med J Malaysia, 2024 Mar;79(Suppl 1):40-46.
PMID: 38555884

INTRODUCTION: Early mobilization and rehabilitation of critically ill patients in the Intensive care unit (ICU) is a topic of growing interest. Current evidence suggests that early mobilization is safe, feasible, and effective at reducing the incidence of ICU-acquired weakness. However, early mobilization is still not the standard of care in most ICUs worldwide. The aim of the study was to determine the level of knowledge, perceptions, and practice among ICU physiotherapists of early mobilization in critically ill ICU patients in Malaysia.
MATERIALS AND METHODS: A cross-sectional study was undertaken in 45 public, teaching, and private hospitals in Malaysia that provide ≥ 10 beds in their ICUs. Knowledge, perceived barriers, facilitators, and practice of early mobilization were assessed using a previously validated mobility survey questionnaire.
RESULTS: Only 35% of ICU physiotherapists reported receiving training/courses on early mobilization in the ICU. 100 (86%) physiotherapists underestimated the incidence of ICU-acquired weakness, and 88 (75%) were unfamiliar with the current literature on early mobilization in the ICU. The need for physician orders before mobilization, medical instability, excessive sedation, and risk of dislodgement of devices or lines were the most common barriers to early mobilization. Nearly half (49 [42%]) of the respondents reported physiotherapist as early mobilization clinical champion in their setting, but the most common physiotherapy treatment techniques in the ICU reported by the respondents' were still chest physiotherapy, range of motion exercises, and bed mobility.
CONCLUSION: We observed strong enthusiasm for early mobilization among Malaysian physiotherapists. Most respondents believed that early mobilization is important and beneficial to ICU patients. However, there is still a big gap in knowledge and training of early mobilization in ICU patients among Malaysian physiotherapists.
Fulltext Seed morphology variation of rice landraces from Tuaran and Kota Belud districts of Sabah, Malaysia

CHEE, F. T., SIAMBUN, M. M., MARIAM A. L.

Buletin Persatuan Genetik Malaysia, 2011;18(1):10-16.
MyJurnal

There is a need to set up a germplasm resource centre or gene bank in Sabah to keep the collections of varieties of locally cultivated crops, especially rice. This is necessary to prevent genetic loss caused by the infrastructure development in the state of Sabah especially when Sabah is known for her rich genetic resources for food and agriculture. This gene bank will play an important role in the conservation of genetic resources especially for future rice crop improvement and development. These collections are known to carry useful gene(s) for crop improvement such as aroma, taste, resistance to insect pests and diseases, and tolerance to abiotic stress. Decades ago, a set of local landrace rice collection were made and conserved at International Rice Research Institute (IRRI) and Malaysia Agriculture Research and Development Institute (MARDI). Besides IRRI and MARDI, local farmers also play an important role as conservationist. Therefore, this study has been carried out to re ne the status of the current genetic diversity in local rice farming. From January 2009 to February 2010, 108 samples were collected from Tuaran and Kota Belud districts. Preliminary observation of 19 samples found that
there is a high genetic diversity based on seed morphology alone. Variations in the characteristics were detected in awn, apiculus, lemma and palea, sterile lemma and seed coat. Length and width of seeds were measured and calculated for ratio to estimate the shapes of the seeds. The weight of 100 grains ranged from 1.42 to 3.19 g. However, further studies on morphology evaluation, disease screening, and molecular evaluation are needed to be compared with the existing data. In addition, genetic erosion, migration, and drift also need to be studied due to high seed exchanges among the local farmers.
Effect of kidney ischemia/reperfusion injury on proliferation, apoptosis, and cellular senescence in acute kidney injury in mice

Sari FT, Sari FT, Sari FT, Arfian N, Sari DCR

Med J Malaysia, 2020 05;75(Suppl 1):20-23.
PMID: 32471965

INTRODUCTION: Kidney ischemia/reperfusion injury (IRI) is the leading cause of acute kidney injury (AKI). Kidney IRI demonstrated apoptosis of epithelial cells in acute phase followed by proliferation of interstitial cells in chronic episode, and cellular senescence may contribute to development of AKI, however, its occurrence within acute or chronic episodes is still not completely understood.
METHODS: Kidney IRI was performed with bilateral pediculus clamping in Swiss Background mice (3 months, 30-40g). Mice were euthanised on day one (I/R1, n=6), day eight (I/R8, n=6), and day twelve (I/R12, n=6) to exam acute and chronic episodes. Sham operation procedure was performed in the control. Tubular injury was assessed based on periodic acid- Schift (PAS) staining. Reverse transcriptase PCR (RT-PCR) was done to quantify mRNA expression of Bax, Bcl-2, and p16. Immunohistostaining (IHC) was performed to examine localisation of apoptosis (p53) and proliferation (Bcl-2).
RESULTS: RT-PCR analysis showed upregulation of mRNA expression of Bcl-2, Bax, and p16 (p<0.05). The data showed that ischemia/reperfusion induces upregulation of Bax (p=0.20), Bcl-2 (p=0.45), p16 (p=0.18). Apoptosis and proliferation occurred in the epithelial cells in acute episodes, but occurred in interstitial areas in chronic episodes.
CONCLUSIONS: Ischemia/reperfusion injury induces upregulation proliferation, apoptosis, and cellular senescence in acute kidney injury. Apoptosis reached its peak on day 1, proliferation on day 8, and cellular senescence on day 12.
Pediococcus acidilactici LAB4 and Lactobacillus plantarum LAB12 assimilate cholesterol and modulate ABCA1, CD36, NPC1L1 and SCARB1 in vitro

Lim FT, Lim SM, Ramasamy K

Benef Microbes, 2017 Feb 07;8(1):97-109.
PMID: 27903090 DOI: 10.3920/BM2016.0048

There is growing interest in the use of probiotic lactic acid bacteria (LAB) for prevention of hypercholesterolaemia. This study assessed the cholesterol lowering ability of Pediococcus acidilactici LAB4 and Lactobacillus plantarum LAB12 in growth media. Both LAB yielded >98% (39.2 μg/ml) cholesterol lowering in growth media. Nile Red staining indicated direct assimilation of cholesterol by the LAB. The LAB were then explored for their prophylactic (pre-treatment of HT29 cells with LAB prior to cholesterol exposure) and biotherapeutic (treatment of HT29 cells with LAB after exposure to cholesterol) use against short and prolonged exposure of HT29 cells to cholesterol, respectively. For HT29 cells pre-treated with LAB, cholesterol lowering was accompanied by down-regulation of ATP-binding cassette family transporter-type A1 (ABCA1), cluster of differentiation 36 (CD36) and scavenger receptor class B member 1 (SCARB1). HT29 cells treated with LAB after prolonged exposure to cholesterol source, on the other hand, was associated with up-regulation of ABCA1, restoration of CD36 to basal level and down-regulation of Neimann-Pick C1-Like 1 (NPC1L1). The present findings implied the potential use of LAB4 and LAB12 as part of the strategies in prevention and management of hypercholesterolaemia.
Occurrence and level of emerging organic contaminant in fish and mollusk from Klang River estuary, Malaysia and assessment on human health risk

Omar TFT, Aris AZ, Yusoff FM, Mustafa S

Environ Pollut, 2019 May;248:763-773.
PMID: 30851586 DOI: 10.1016/j.envpol.2019.02.060

The occurrence, level, and distribution of multiclass emerging organic contaminants (EOCs) in fish and mollusks from the Klang River estuary were examined. The targeted EOCs for this assessment were phenolic endocrine disrupting compounds (bisphenol A, 4-OP, and 4-NP), organophosphorous pesticides (quinalphos, chlorpyrifos, and diazinon), estrogenic hormones (E2, E1, and EE2), and pharmaceutically active chemicals (primidone, sulfamethoxazole, dexamethasone, diclofenac, amoxicillin, progesterone, and testosterone). Results from this study showed that the prevalent contamination of the Klang River estuary by EOCs with diclofenac, bisphenol A, progesterone, and amoxicillin were predominantly detected in fish and mollusks. Among the EOCs, diclofenac and progesterone had the highest concentrations in fish and mollusk samples, respectively. The concentrations of diclofenac and progesterone in fish and mollusk samples range from 1.42 ng/g to 10.76 ng/g and from 0.73 ng/g to 9.57 ng/g, respectively. Bisphenol A should also be highlighted because of its significant presence in both fish and mollusks. The concentration of bisphenol A in both matrices range from 0.92 ng/g to 5.79 ng/g. The calculated hazard quotient (HQ) for diclofenac, bisphenol A, and progesterone without consideration to their degradation byproduct were less than one, thus suggesting that the consumption of fish and mollusks from the Klang River estuary will unlikely pose any health risk to consumers on the basis of the current assessment. Nonetheless, this preliminary result is an important finding for pollution studies in Malaysian tropical coastal ecosystems, particularly for organic micropollutant EOCs, and can serve as a baseline database for future reference.
An immune-inspired swarm aggregation algorithm for self-healing swarm robotic systems

Timmis J, Ismail AR, Bjerknes JD, Winfield AF

Biosystems, 2016 Aug;146:60-76.
PMID: 27178784 DOI: 10.1016/j.biosystems.2016.04.001

Swarm robotics is concerned with the decentralised coordination of multiple robots having only limited communication and interaction abilities. Although fault tolerance and robustness to individual robot failures have often been used to justify the use of swarm robotic systems, recent studies have shown that swarm robotic systems are susceptible to certain types of failure. In this paper we propose an approach to self-healing swarm robotic systems and take inspiration from the process of granuloma formation, a process of containment and repair found in the immune system. We use a case study of a swarm performing team work where previous works have demonstrated that partially failed robots have the most detrimental effect on overall swarm behaviour. We have developed an immune inspired approach that permits the recovery from certain failure modes during operation of the swarm, overcoming issues that effect swarm behaviour associated with partially failed robots.
Fulltext Piper sarmentosum Leaves Aqueous Extract Attenuates Vascular Endothelial Dysfunction in Spontaneously Hypertensive Rats

Hashim Fauzy F, Mohd Zainudin M, Ismawi HR, Elshami TFT

Evid Based Complement Alternat Med, 2019;2019:7198592.
PMID: 31485247 DOI: 10.1155/2019/7198592

Piper sarmentosum is a tropical plant in Southeast Asia known for its traditional use in curing various ailments including hypertension. Previous research works have provided evidence for the herb's antihypertensive property. However, the exact mechanisms involved are still in question. The present study investigated the effects of Piper sarmentosum leaves aqueous extract (PSAE) treatment on vascular endothelin system in spontaneously hypertensive rats (SHRs). Four groups of SHRs were treated for 28 consecutive days, with negative and positive control groups receiving distilled water and 3 mg/kg perindopril, respectively. Another two groups are the treatment groups, which received PSAE and combination of 1.5 mg/kg perindopril and PSAE. Weekly measurements of blood pressure showed that PSAE significantly reduced the systolic, diastolic, and mean arterial pressures (P < 0.05) of the rats. PSAE also increased mesenteric artery nitric oxide (NO) level (P < 0.05) and reduced endothelin-1 (ET-1) level (P < 0.05) in the treatment groups. Our results demonstrate that oral administration of PSAE reduced blood pressure in SHRs by reducing the ET-1 level while increasing NO production.
Fulltext Evolution of mycoheterotrophy in Polygalaceae: The case of Epirixanthes

Mennes CB, Moerland MS, Rath M, Smets EF, Merckx VS

Am J Bot, 2015 Apr;102(4):598-608.
PMID: 25878092 DOI: 10.3732/ajb.1400549

The mycoheterotrophic lifestyle has enabled some plant lineages to obtain carbon from their mycorrhizal symbionts. The mycoheterotrophic genus Epirixanthes (Polygalaceae) consists of six species from tropical Asia. Although it is probably closely related to the chlorophyllous genus Salomonia and linked to arbuscular mycorrhizal fungi, lack of DNA sequence data has thus far prevented these hypotheses from being tested. Therefore, the evolutionary history of Epirixanthes remains largely unknown.
Seasonal variation in respiratory syncytial virus chest infection in the tropics

Chan PW, Chew FT, Tan TN, Chua KB, Hooi PS

Pediatr Pulmonol, 2002 Jul;34(1):47-51.
PMID: 12112797 DOI: 10.1002/ppul.10095

Respiratory syncytial virus (RSV) is the most important cause of lower respiratory tract infection (LRTI) in young children. We determined if there was a seasonal variation in Malaysia in the incidence of RSV infection in young children admitted with LRTI, and possible associations of RSV infection with local meteorological parameters. A total of 5,691 children, aged less than 24 months and hospitalized with LRTI (i.e., bronchiolitis and pneumonia) between 1982-1997, were included in this study. Nasopharyngeal samples were collected and examined for RSV by immunofluorescence, viral culture, or both. Seasonal variations were determined by analyzing the monthly RSV-positive isolation rate via time series analysis. Possible correlations with local meteorological parameters were also evaluated.RSV was isolated in 1,047 (18.4%) children. Seasonal variations in RSV infection rate were evident and peaked during the months of November, December, and January (test statistics [T] = 53.7, P < 0.001). This seasonal variation was evident for both bronchiolitis and pneumonia categories (T = 42.8 and 56.9, respectively, P < 0.001). The rate of RSV infection appeared to correlate with the monthly number of rain days (r = 0.26, P < 0.01), and inversely with the monthly mean temperature (r = -0.38, P < 0.001). In the tropics, seasonal variations in the incidence of RSV infection are evident, with an annual peak in November, December, and January. This information provides a guide for healthcare provisions and implementation of RSV prevention.
Asthma and TNF variants in Chinese and Malays

Tan EC, Lee BW, Tay AW, Chew FT, Tay AH

Allergy, 1999 Apr;54(4):402-3.
PMID: 10371104
Dietary lecithin improves dressing percentage and decreases chewiness in the longissimus muscle in finisher gilts

Akit H, Collins CL, Fahri FT, Hung AT, D'Souza DN, Leury BJ, et al.

Meat Sci, 2014 Mar;96(3):1147-51.
PMID: 24334033 DOI: 10.1016/j.meatsci.2013.10.028

The influence of dietary lecithin at doses of 0, 4, 20 or 80 g/kg fed to finisher gilts for six weeks prior to slaughter on growth performance, carcass quality and pork quality was investigated. M. longissimus lumborum (loin) was removed from 36 pig carcasses at 24h post-mortem for Warner-Bratzler shear force, compression, collagen content and colour analyses. Dietary lecithin increased dressing percentage (P=0.009). Pork chewiness and collagen content were decreased by dietary lecithin (P<0.05, respectively), suggesting that improved chewiness may be due to decreased collagen content. However, dietary lecithin had no effect on shear force, cohesiveness or hardness (P>0.05, respectively). Dietary lecithin reduced loin muscle L* values and increased a* values (P<0.05, respectively) but no changes on b* values (P=0.56). The data showed that dietary lecithin improved dressing percentage and resulted in less chewy and less pale pork.
Fulltext Potential application of biomass derived graphene for COVID-19 pandemic

Arifin NFT, Yusof N, Nordin NAHM, Jaafar J, Ismail AF, Aziz F, et al.

Mater Today Proc, 2021;46:1959-1962.
PMID: 33680866 DOI: 10.1016/j.matpr.2021.02.379

Since the emergence of the novel coronavirus disease (COVID-19) pandemic, intense research has been carried out to find the effective vaccine. However, this issue remains as a global challenge. Graphene has captured various attention due to promising antimicrobial and antiviral applications, hydrophobic characteristic and superior electrical conductivity. Recently, biomass derived graphene also promises great opportunity to combat the spread COVID-19. In this paper, we demonstrated the ability and role of biomass derived graphene as superhydrophobic coating, biosensors and disinfectant in the fight against COVID-19.
Fulltext Global stability and cost-effectiveness analysis of COVID-19 considering the impact of the environment: using data from Ghana

Asamoah JKK, Owusu MA, Jin Z, Oduro FT, Abidemi A, Gyasi EO

Chaos Solitons Fractals, 2020 Nov;140:110103.
PMID: 32834629 DOI: 10.1016/j.chaos.2020.110103

COVID-19 potentially threatens the lives and livelihood of people all over the world. The disease is presently a major health concern in Ghana and the rest of the world. Although, human to human transmission dynamics has been established, not much research is done on the dynamics of the virus in the environment and the role human play by releasing the virus into the environment. Therefore, investigating the human-environment-human by use of mathematical analysis and optimal control theory is relatively necessary. The dynamics of COVID-19 for this study is segregated into compartments as: Susceptible (S), Exposed (E), Asymptomatic (A), Symptomatic (I), Recovered (R) and the Virus in the environment/surfaces (V). The basic reproduction number R 0 without controls is computed. The application of Lyapunov's function is used to analyse the global stability of the proposed model. We fit the model to real data from Ghana in the time window 12th March 2020 to 7th May 2020, with the aid of python programming language using the least-squares method. The average basic reproduction number without controls, R 0 a , is approximately 2.68. An optimal control is formulated based on the sensitivity analysis. Numerical simulation of the model is also done to verify the analytic results. The admissible control set such as: effective testing and quarantine when boarders are opened, the usage of masks and face shields through media education, cleaning of surfaces with home-based detergents, practising proper cough etiquette and fumigating commercial areas; health centers is simulated in MATLAB. We used forward-backward sweep Runge-Kutta scheme which gave interesting results in the main text, for example, the cost-effectiveness analysis shows that, Strategy 4 (safety measures adopted by the asymptomatic and symptomatic individuals such as practicing proper coughing etiquette by maintaining a distance, covering coughs and sneezes with disposable tissues or clothing and washing of hands after coughing or sneezing) is the most cost-effective strategy among all the six control intervention strategies under consideration.
Immunochemical characterization of edible bird's nest allergens

Goh DL, Chua KY, Chew FT, Liang RC, Seow TK, Ou KL, et al.

J Allergy Clin Immunol, 2001 Jun;107(6):1082-7.
PMID: 11398089

BACKGROUND: We have previously described anaphylaxis induced by edible bird's nest (BN) and demonstrated that this condition is IgE mediated.
OBJECTIVES: This study aimed at describing the immunochemical properties of the BN allergens. Comparative studies between 3 commercially available sources (according to the country of origin) of BN were also made.
METHODS: Crude extracts of commercially available processed BN from Sarawak (Malaysia), Thailand, and Indonesia and fresh unprocessed BN from the caves of Sarawak were obtained by means of aqueous extraction. Specific IgE toward these sources were determined by using fluorescence allergosorbent tests (FASTs). Cross-reactivity studies between the 3 sources of commercially available processed BN were carried out by means of FAST inhibition. Immunochemical characterization by means of IgE immunoblot, periodate treatment, and heat stability studies were carried out on fresh unprocessed BN from Sarawak.
RESULTS: Serum from allergic patients showed differences in IgE binding to the 3 sources of commercially available BN, with the highest levels of specific IgE recorded with the Sarawak source (P
Age- and sex-related changes in lymphocyte subpopulations of healthy Asian subjects: from birth to adulthood

Lee BW, Yap HK, Chew FT, Quah TC, Prabhakaran K, Chan GS, et al.

Cytometry, 1996 Mar 15;26(1):8-15.
PMID: 8809475

Flow cytometric analysis of lymphocyte subsets were evaluated in 391 healthy Asian subjects ranging in age from birth to 40 years. Lymphocyte subsets were analysed using specific monoclonal antibodies: CD20 (B cells), CD3 and CD2 (T cells), CD16 and CD56+ (NK cells), CD4/CD3+ (helper-inducer T cells), CD8/ CD3+ (suppressor/cytotoxic T cells), HLA-DR expression on CD3 and CD25 (Tac) on CD3. The total white cell count, absolute lymphocyte counts, and B cell percentages peaked in infancy and declined steadily with age. Absolute counts of each subset, which were derived from absolute lymphocyte counts, also followed this trend. Increases with age were seen in the NK, T cell (CD2, CD3), and CD8 percentages. Males tended to have higher NK and CD8 percentages than females, and, conversely, females had higher CD3 and CD4 percentages than males. Comparison of our results with studies involving Caucasian subjects indicated higher NK percentages in our Asian population and lower CD4 absolute counts in the males of our population. These results indicate the presence of age, sex, and probable racial differences in lymphocyte subset expression. Our results may serve as reference standards for the Asian population.
Phenotypic and mutational spectrum of 21 Chinese patients with Alström syndrome

Rethanavelu K, Fung JLF, Chau JFT, Pei SLC, Chung CCY, Mak CCY, et al.

Am J Med Genet A, 2020 02;182(2):279-288.
PMID: 31755649 DOI: 10.1002/ajmg.a.61412

Alström syndrome (AS) is a monogenic syndromic ciliopathy caused by mutations in the ALMS1 (Alström Syndrome 1) gene. A total of 21 subjects with AS from 20 unrelated Chinese families were recruited. Our cohort consists of 9 females and 12 males, between 5 months and 20 years old. The first symptom(s) appeared between 3 and 24 months. They were recorded to be either visual impairments (83%) or dilated cardiomyopathy (17%). Median time from symptom onset to seeking medical attention was 6 months (3-36 months) and the median time needed to reach the final molecular diagnosis is 54 months (6-240 months). System involvement at the time of the survey was as follows: visual symptoms (100%), hearing Impairment (67%), endocrine symptoms (43%), neurological symptoms (19%), hepatic symptoms (14%), and renal Involvement (14%). These findings are comparable to data reported in the literature. However, the proportion of subjects with cognitive impairment (33%) and behavioral problems (19%) were higher. Thirty-three unique mutations were identified in the ALMS1 gene, of which 18 are novel mutations classified as pathogenic/likely pathogenic according to the American College of Medical Genetics (ACMG) guideline. Four recurrent mutations were identified in the cohort, in particular; c.2084C>A, p. (Ser695Ter), is suggestive to be a founder mutation in people of Chinese ancestry. The participation of AS subjects of differing ethnicities is essential to improve the algorithm in facial recognition/phenotyping, as well as to understand the mutation spectrum beyond than just those of European ancestry.
Fulltext Chloroplast capture and range extension after hybridization in taro (Colocasia esculenta)

Matthews PJ, Hossain MA, Sookchaloem D, Nguyen VD, Wong SY, Joling J, et al.

Ecol Evol, 2024 Aug;14(8):e70082.
PMID: 39206463 DOI: 10.1002/ece3.70082

Complete chloroplast genomes of 17 samples from six species of Colocasia (Araceae) were sequenced, assembled, and aligned together with two previously reported complete genome sequences from taro (Colocasia esculenta). Analysis provides a well-supported phylogenetic tree for taro and closely-related wild Colocasia species in Southeast Asia. Two chloroplast lineages (CI and CII) form a well-defined haplotype group and are found in cultivated taros known as var. esculenta (dasheen, CI), var. antiquorum (eddoe, CII), and in a widespread, commensal wild form known as var. aquatilis (CI). A third lineage (CIII) is also found in wild taros known as var. aquatilis and in the wild species C. lihengiae, C. formosana, and C. spongifolia. We suggest three different scenarios to explain the grouping of CIII wild taros (C. esculenta) with other wild Colocasia species. Chloroplast lineages CI and CIII in C. esculenta and an unknown parent species may be involved in an as yet undated history of hybridization, chloroplast capture, and range extension. Substantial taxonomic revision may be needed for C. esculenta after further studies of morphological and genetic diversity within the crop, in wild populations, and in closely related wild species. The results also point to the Bengal delta as a region of key interest for future research on the origins of tropical wetland taros.
A 5-year-old boy with left flank mass and pain: Questions

Ag NJ, S NA, Md MA, Cj NA, F T, I MI

Pediatr Nephrol, 2021 Nov 18.
PMID: 34796397 DOI: 10.1007/s00467-021-05322-2
A 5-year-old boy with left flank mass and pain: Answers

Ag NJ, S NA, Md MA, Cj NA, F T, I MI

Pediatr Nephrol, 2021 Nov 18.
PMID: 34796396 DOI: 10.1007/s00467-021-05323-1
Evolution of endemism on a young tropical mountain

Merckx VS, Hendriks KP, Beentjes KK, Mennes CB, Becking LE, Peijnenburg KT, et al.

Nature, 2015 Aug 20;524(7565):347-50.
PMID: 26266979 DOI: 10.1038/nature14949

Tropical mountains are hot spots of biodiversity and endemism, but the evolutionary origins of their unique biotas are poorly understood. In varying degrees, local and regional extinction, long-distance colonization, and local recruitment may all contribute to the exceptional character of these communities. Also, it is debated whether mountain endemics mostly originate from local lowland taxa, or from lineages that reach the mountain by long-range dispersal from cool localities elsewhere. Here we investigate the evolutionary routes to endemism by sampling an entire tropical mountain biota on the 4,095-metre-high Mount Kinabalu in Sabah, East Malaysia. We discover that most of its unique biodiversity is younger than the mountain itself (6 million years), and comprises a mix of immigrant pre-adapted lineages and descendants from local lowland ancestors, although substantial shifts from lower to higher vegetation zones in this latter group were rare. These insights could improve forecasts of the likelihood of extinction and 'evolutionary rescue' in montane biodiversity hot spots under climate change scenarios.

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