Immunogenicity of Abdala COVID-19 vaccine in Vietnamese people after primary and booster vaccinations: a prospective observational study in Vietnam.

OBJECTIVES: We studied the immunogenicity after primary and booster vaccinations of Abdala COVID-19 vaccine, a receptor binding domain protein subunit vaccine, in Vietnamese people by determining the level of neutralization and cross-neutralization activities against the ancestral SARS-CoV-2 and its variants, and SARS-CoV-1. METHODS: We performed a prospective observational study, enrolling adults aged 19-59 years in Dong Thap province, southern Vietnam, and collected blood samples from baseline until 4 weeks post booster dose. We measured anti-nucleocapsid, anti-spike and neutralizing antibodies against SARS-CoV-2, and assessed the cross-neutralization against 14 SARS-CoV-2 variants, and SARS-CoV-1. Complementary antibody data came from Vietnamese healthcare workers fully vaccinated with ChAdOx1-S. RESULTS: After primary vaccination, anti-spike antibody and neutralizing antibodies were detectable in 98.4% and 87% of 251 study participants, respectively, with neutralizing antibody titers similar to that induced by ChAdOx1-S vaccine. Antibody responses after a homologous (Abdala COVID-19) or heterologous (mRNA BNT162b2) booster could neutralize 14 SARS-CoV-2 variants (including Omicron), and SARS-CoV-1. CONCLUSIONS: Abdala COVID-19 vaccine is immunogenic in Vietnamese people. Enhanced antibody response after a booster dose could cross-neutralize 14 SARS-CoV-2 variants and SARS-CoV-1. Our results have added to the growing body of knowledge about the contribution of protein subunit vaccine platforms to pandemic control.

Analysis of Co-expression of HSP 70 and BCL 2 in Oral Precancer and Cancer Patients Using Immunohistochemistry.

Introduction: Understanding of molecular model of oral carcinogenesis has carried cancer chemotherapy far forward from conventional drug therapies. Small molecule inhibitors have gained acceptance as it has fewer adverse effects and also provide targeted drug therapy. The association of HSP 70 (Heat Shock Protein 70) and BCL 2 (B-cell lymphoma 2) proteins with oral precancer and cancer is already established. However, the complex interaction between these two proteins and how they affect each other's expression is still not understood completely. In our study, we aimed to correlate the expression of HSP 70 and BCL 2 with different histopathological grades of oral precancer and cancer tissue samples using tissue immunohistochemistry. Materials and Methods: Tissue samples were taken from a total of 250 patients (100 OPMDs and 150 OSCCs) and subjected to immunohistochemistry using anti-human mouse monoclonal antibodies to HSP70 and BCL2. Immunostaining was done, and the immunostaining intensity distribution (IID) index was calculated. Results and Discussion: Immunoreactivity scores for both HSP 70 and BCL 2 correlated with different grades of dysplasia. However, only HSP 70 had a statistically significant association (p = 0.066). We also found that HSP 70 showed an inverse correlation, with higher expression majorly seen in well-differentiated OSCCs. Conclusion: Our study unveiled the HSP 70-BCL 2 interaction and provides insights about how this might affect drug designing and help overcome therapeutic lags. However, further studies are needed to provide a comprehensive review of such interactions among various small molecules.

An Overview of the Pharmacological Activities and Synthesis of Benzothiophene Derivatives.

One important class of organic compounds having many uses, especially in medical chemistry, is benzothiophene and its derivatives. This review examines the biological activity of benzothiophene derivatives and summarizes the synthetic methods used in their production. The effectiveness of several synthetic pathways, such as cyclization techniques, functional group modifications, and reactions catalyzed by transition metals, in gaining access to benzothiophene scaffolds has been examined. Additionally, a broad spectrum of therapeutic domains, such as antiinflammatory, antibacterial, antidiabetic, anticancer, antimicrobial, anti-leishmanial, antifungal, antimalarial, and antitubercular activities, are covered by the pharmacological activities that are being explored. The synthesis and pharmacological potential of benzothiophene derivatives are well-explained in this thorough review, which opens up new options for medicinal chemistry and drug discovery study. Overall, this study is a useful resource for scientists working on drug development and discovery as it sheds light on the pharmacological potential of benzothiophene derivatives. This review includes the synthesis and bioactivities of the years 2002-2024. The goal of this review is to compile the existing information on benzothiophene derivatives and provide guidance for future research and development as well as insights into their possible medicinal uses.

A study on expression of programmed death ligand-1 in small cell lung carcinoma and correlation with clinicopathological parameters.

Small cell lung carcinoma (SCLC) is characterized by rapid growth and an aggressive clinical course. Standard therapy regimes have limited effects on disease course; therefore the prognosis of SCLC is poor. In the current study, the frequency of programmed death ligand 1 (PD-L1) expression in SCLC and its correlation with clinico-pathological features were evaluated. The study included 100 cases of SCLC wherein testing for PD-L1 was done with the SP263 clone on the Ventana benchmark XT system. Cases with > 1% PD-L1 expression in tumour cells or immune cells were categorized as positive. PD-L1 expression was identified in 14% of cases using the cut-off of ≥ 1%. The tumour proportion score was 10% and the immune proportion score was 9.78% using a cut-off of ≥ 1%. PD-L1 positive expression was more frequent in the male population with age > 40 years. All the patients with positive PD-L1 expression were smokers. In the PD-L1 positive group, presence of necrosis was identified in 71.4% of cases and when compared with the PD-L1 negative subgroup this finding was statistically significant (p = 0.010). Personalized targeted therapy for cases of SCLC is still under evaluation. The use of immunotherapeutic targets, such as PD-L1, may help to define a new treatment strategy for SCLC. Development of new treatment strategies may improve prognosis and survival.

A proximal neurodynamic model for a system of non-linear inverse mixed variational inequalities.

In this article, we introduce a system of non-linear inverse mixed variational inequalities (SNIMVIs). We propose a proximal neurodynamic model (PNDM) for solving SNIMVIs, leveraging proximal mappings. The uniqueness of the continuous solution for the PNDM is proved by assuming Lipschitz continuity. Moreover, we establish the global asymptotic stability of equilibrium points of the PNDM, contingent upon Lipschitz continuity and strong monotonicity. Additionally, an iterative algorithm involving proximal mappings for solving the SNIMVIs is presented. Finally, we provide illustrative examples to support our main findings. Furthermore, we provide an example where the SNIMVIs violate the strong monotonicity condition and exhibit the divergence nature of the trajectories of the corresponding PNDM.

Achieving Well-Oriented FAPbI3 Perovskite Photovoltaics by Cyclohexane Modification.

It is essential and challenging to develop green and cost-effective solar cells to meet the energy demands. Solar cells with a perovskite light-harvesting layer are the most promising technology to propel the world toward next-generation solar energy. Formamidinium lead tri-iodide (FAPbI3)-based perovskite solar cells (F-PSCs), with their considerable performance, offer cost-effective solar cells. One of the major issues that the PSC community is now experiencing is the stability of α-FAPbI3 at relatively low temperatures. In this study, we fabricated FAPbI3-PSCs using cyclohexane (CHX) material via a two-step deposition method. For this purpose, CHX is added to the formamidinium iodide:methylammonium chloride (FAI:MACl) solution as an additive and used to form a better FAPbI3 layer by controlling the reaction between FAI and lead iodide (PbI2). The CHX additive induces the reaction of undercoordinated Pb2+ with FAI material and produces an α-FAPbI3 layer with low charge traps and large domains. In addition, the CHX-containing FAPbI3 layers show higher carrier lifetimes and facilitate carrier transfer in F-PSCs. The CHX-modified F-PSCs yield a high champion efficiency of 22.84% with improved ambient and thermal stability behavior. This breakthrough provides valuable findings regarding the formation of a desirable FAPbI3 layer for photovoltaic applications and holds promise for the industrialization of F-PSCs.

Maternal and child nutrition services associated with nutritional knowledge and practices, India.

Objective: To evaluate whether maternal and child nutrition activities provided through the Indian Integrated Child Development Services scheme in India were associated with improved nutritional knowledge and practices among beneficiary women. Methods: We used a multistage sampling design to randomly select 4400 pregnant women or mothers of children younger than 2 years for a cross-sectional telephone survey. The respondents were beneficiaries of the scheme from across 11 Indian states. We used multivariate regression models controlling for sociodemographic factors to estimate the association between: scheme activities and nutrition messages heard; and scheme activities and nutrition practices. We also estimated the proportion of the total association with nutrition practices which was mediated by nutrition messages. Results: Among 110 regression models testing unique pairs of seven activities and 18 nutrition messages, 103 showed a statistically significant positive relationship (median risk ratio, RR: 1.14). For activities and nine nutrition practices, 39 out of 54 tested pairs were significantly associated (median RR: 1.16). We observed statistically significant mediation through nutrition messages for 28 out of 42 tested pairs of activities and nutrition practices. Conclusion: Receipt of the scheme's activities was associated with improved nutrition knowledge and practices. Improvements in practices were statistically mediated by improvements in knowledge. These findings suggest that a large-scale nutrition scheme with a strong counselling component could successfully change beneficiary behaviours.

Enhancement of efficiency in CsSnI3 based perovskite solar cell by numerical modeling of graphene oxide as HTL and ZnMgO as ETL.

Perovskite photovoltaics have an immense contribution toward the all-round development of the solar cell. Apart from the flexibility, stability, and high efficiency, more stress has been given to using lead-free as well as eco-friendly, inexpensive materials in the fabrication of PSC devices. The utilization of non-volatile material, such as cesium tin iodide (CsSnI3), can be proposed for designing the PSC device, which not only makes it eco-friendly but also offers better optoelectronic characteristics due to its smaller bandgap of 1.27 eV. The inclusion of Sn in the perovskite material also functions as an increment in the stability of the perovskite. In the present simulation, CsSnI3 is used as an active absorber layer while the ZnMgO is used as an ETL for a cost-effective nature. Similarly, graphene oxide (GO) is used as HTL for a superior collection of holes. The comprehensive numerical modeling of the ZnMgO can be utilized in solar cell designing with appropriate CsSnI3 thickness, working temperature, total defectivity, and resistance impact, respectively. The presently simulated device offers an excellent efficiency of 17.37 % with CsSnI3-based PSC. These results of the study also show an effective route to develop highly efficient lead-free PSC devices.

Experimental and Theoretical Investigations of MAPbX3 -Based Perovskites (X=Cl, Br, I) for Photovoltaic Applications.

This work mainly focuses on synthesizing and evaluating the efficiency of methylammonium lead halide-based perovskite (MAPbX3 ; X=Cl, Br, I) solar cells. We used the colloidal Hot-injection method (HIM) to synthesize MAPbX3 (X=Cl, Br, I) perovskites using the specific precursors and organic solvents under ambient conditions. We studied the structural, morphological and optical properties of MAPbX3 perovskites using XRD, FESEM, TEM, UV-Vis, PL and TRPL (time-resolved photoluminescence) characterization techniques. The particle size and morphology of these perovskites vary with respect to the halide variation. The MAPbI3 perovskite possesses a low band gap and low carrier lifetime but delivers the highest PCE among other halide perovskite samples, making it a promising candidate for solar cell technology. To further enrich the investigations, the conversion efficiency of the MAPbX3 perovskites has been evaluated through extensive device simulations. Here, the optical constants, band gap energy and carrier lifetime of MAPbX3 were used for simulating three different perovskite solar cells, namely I, Cl or Br halide-based perovskite solar cells. MAPbI3 , MAPbBr3 and MAPbCl3 absorber layer-based devices showed ~13.7 %, 6.9 % and 5.0 % conversion efficiency. The correlation between the experimental and SCAPS simulation data for HIM-synthesized MAPBX3 -based perovskites has been reported for the first time.

Programmed Death Ligand-1 Testing in Adenocarcinoma Lung: A Comparative Study of Cell Block versus Biopsy.

Background: Immunotherapy currently stands as a novel treatment option, specifically in cases of advanced non-small cell lung carcinoma (NSCLC). Expression of programmed death ligand-1 (PD-L1) in tumor cells forms the mainstay for the use of anti-PD-L1 monoclonal antibodies in the treatment of NSCLC. Aims: The objectives of the study were to assess utility of cell blocks for testing of PD-L1 in adenocarcinoma lung and to compare the expression of PD-L1 in cell blocks and the corresponding biopsy specimens. Materials and Methods: The current study was a prospective case series that included 20 cases of NSCLC-adenocarcinoma lung. Cases included in the study had biopsies performed from lung masses, along with which cell blocks were prepared from fine needle aspiration cytology (FNAC) samples. Testing for PD-L1 was done using the monoclonal PD-L1 antibody, SP-263 clone on the Ventana Benchmark XT system. PD-L1 expression was assessed only in the tumor cells, and cases with >1% expression, cytoplasmic or membranous, in tumor cells were categorized as positive. Results: PD-L1 expression was identified in the biopsy samples of tumor cells of 20% of cases (n = 4/20). In the corresponding cell blocks, PD-L1 expression was identified in the tumor cells of 15% of cases (n = 3/20). Sensitivity and specificity of cell blocks were 75% and 100%, respectively. Positive and negative predictive values were 100% and 94.12%, respectively. Conclusion: PD-L1 testing has both predictive and prognostic implications. PD-L1 testing in cell block samples is a potential alternative, specifically in cases where biopsy tissue is minimal or unavailable.

Boosting efficiency above 28% using effective charge transport layer with Sr3SbI3 based novel inorganic perovskite.

Strontium antimony iodide (Sr3SbI3) is one of the emerging absorbers materials owing to its intriguing structural, electronic, and optical properties for efficient and cost-effective solar cell applications. A comprehensive investigation on the structural, optical, and electronic characterization of Sr3SbI3 and its subsequent applications in heterostructure solar cells have been studied theoretically. Initially, the optoelectronic parameters of the novel Sr3SbI3 absorber, and the possible electron transport layer (ETL) of tin sulfide (SnS2), zinc sulfide (ZnS), and indium sulfide (In2S3) including various interface layers were obtained by DFT study. Afterward, the photovoltaic (PV) performance of Sr3SbI3 absorber-based cell structures with SnS2, ZnS, and In2S3 as ETLs were systematically investigated at varying layer thickness, defect density bulk, doping density, interface density of active materials including working temperature, and thereby, optimized PV parameters were achieved using SCAPS-1D simulator. Additionally, the quantum efficiency (QE), current density-voltage (J-V), and generation and recombination rates of photocarriers were determined. The maximum power conversion efficiency (PCE) of 28.05% with JSC of 34.67 mA cm-2, FF of 87.31%, VOC of 0.93 V for SnS2 ETL was obtained with Al/FTO/SnS2/Sr3SbI3/Ni structure, while the PCE of 24.33%, and 18.40% in ZnS and In2S3 ETLs heterostructures, respectively. The findings of this study contribute to in-depth understanding of the physical, electronic, and optical properties of Sr3SbI3 absorber perovskite and SnS2, ZnS, and In2S3 ETLs. Additionally, it provides valuable insights into the potential of Sr3SbI3 in heterostructure perovskite solar cells (PSCs), paving the pathway for further experimental design of an efficient and stable PSC devices.

Designing an efficient lead-free perovskite solar cell with green-synthesized CuCrO2 and CeO2 as carrier transport materials.

With increased efficiency, simplicity in manufacturing, adaptability, and flexibility, solar cells constructed from organic metal halide perovskite (PVK) have recently attained great eminence. Lead, a poisonous substance, present in a conventional PVK impacts the environment and prevents commercialization. To deal with this issue, a number of toxicity-free PVK-constructed solar cells have been suggested. Nevertheless, inherent losses mean the efficiency conversion accomplished from these devices is inadequate. Therefore, a thorough theoretical investigation is indispensable for comprehending the losses to improve efficiency. The findings of a unique modelling method for organic lead-free solar cells, namely methylammonium tin iodide (MASnI3), are investigated to reach the maximum practical efficiencies. The layer pertinent to MASnI3 was constructed as a sandwich between a bio-synthesized electron transport layer (ETL) of CeO2 and a hole transport layer (HTL) of CuCrO2 in the designed perovskite solar cells (PSCs). In this study, the use of algae-synthesized Au in the back contacts has been proposed. To obtain the maximum performance, the devices are further analyzed and optimized for active layer thickness, working temperature, total and interface defect density analysis, impedance analysis (Z'-Z), and capacitance-voltage (C-V), respectively. An optimal conversion efficiency of 26.60% has been attained for an MASnI3-constructed PSC. The study findings may open the door to a lead-free PSC through improved conversion efficiencies.

SOCS-JAK-STAT inhibitors and SOCS mimetics as treatment options for autoimmune uveitis, psoriasis, lupus, and autoimmune encephalitis.

Autoimmune diseases arise from atypical immune responses that attack self-tissue epitopes, and their development is intricately connected to the disruption of the JAK-STAT signaling pathway, where SOCS proteins play crucial roles. Conditions such as autoimmune uveitis, psoriasis, lupus, and autoimmune encephalitis exhibit immune system dysfunctions associated with JAK-STAT signaling dysregulation. Emerging therapeutic strategies utilize JAK-STAT inhibitors and SOCS mimetics to modulate immune responses and alleviate autoimmune manifestations. Although more research and clinical studies are required to assess their effectiveness, safety profiles, and potential for personalized therapeutic approaches in autoimmune conditions, JAK-STAT inhibitors and SOCS mimetics show promise as potential treatment options. This review explores the action, effectiveness, safety profiles, and future prospects of JAK inhibitors and SOCS mimetics as therapeutic agents for psoriasis, autoimmune uveitis, systemic lupus erythematosus, and autoimmune encephalitis. The findings underscore the importance of investigating these targeted therapies to advance treatment options for individuals suffering from autoimmune diseases.

Targeting high performance of perovskite solar cells by combining electronic, manufacturing and environmental features in machine learning techniques.

This study employs Machine Learning (ML) techniques to optimize the performance of Perovskite Solar Cells (PSCs) by identifying the ideal materials and properties for high Power Conversion Efficiency (PCE). Utilizing a dataset of 3000 PSC samples from previous experiments, the Random Forest (RF) technique classifies and predicts PCE as the target variable. The dataset includes various features encompassing cell architecture, substrate materials, electron transport layer (ETL) attributes, perovskite characteristics, hole transport layer (HTL) properties, back contact specifics, and encapsulation materials. ML-driven analysis reveals novel, highly efficient PSC configurations, such as Fe2O3/CsPbBrI2/NiO-mp/Carbon, CdS/FAMAPbI3/NiO-C/Au, and PCBM-60/Phen-NaDPO/MAPbI3/asy-PBTBDT/Ag. Additionally, the study investigates the impact of crucial parameters like perovskite bandgap, ETL thickness, thermal annealing temperature, and back contact thickness on device performance. The predictive model exhibits high accuracy (86.4 % R2) and low mean square error (1.3 MSE). Notably, the ML-recommended structure, SnO2/CsFAMAPbBrI/Spiro-OmeTAD/Au, achieves an impressive efficiency of around 23 %. Beyond performance improvements, the research explores the integration of ML into the manufacturing and quality control processes of PSCs. These findings hold promise for enhancing conversion yields, reducing defects, and ensuring consistent PSC performance, contributing to the advancement of this renewable energy technology.

Comparative study of distinct halide composites for highly efficient perovskite solar cells using a SCAPS-1D simulator.

This research investigates the influence of halide-based methylammonium-based perovskites as the active absorber layer (PAL) in perovskite solar cells (PSCs). Using SCAPS-1D simulation software, the study optimizes PSC performance by analyzing PAL thickness, temperature, and defect density impact on output parameters. PAL thickness analysis reveals that increasing thickness enhances JSC for MAPbI3 and MAPbI2Br, while that of MAPbBr3 remains steady. VOC remains constant, and FF and PCE vary with thickness. MAPbI2Br exhibits the highest efficiency of 22.05% at 1.2 µm thickness. Temperature impact analysis shows JSC, VOC, FF, and PCE decrease with rising temperature. MAPbI2Br-based PSC achieves the highest efficiency of 22.05% at 300 K. Contour plots demonstrate that optimal PAL thickness for the MAPbI2Br-based PSC is 1.2 µm with a defect density of 1 × 1013 cm-3, resulting in a PCE of approximately 22.05%. Impedance analysis shows the MAPbBr3-based PSC has the highest impedance, followed by Cl2Br-based and I-based perovskite materials. A comparison of QE and J-V characteristics indicates MAPbI2Br offers the best combination of VOC and JSC, resulting in superior efficiency. Overall, this study enhances PSC performance with MAPbI2Br-based devices, achieving an improved power conversion efficiency of 22.05%. These findings contribute to developing more efficient perovskite solar cells using distinct halide-based perovskite materials.

Achieving above 24% efficiency with non-toxic CsSnI3 perovskite solar cells by harnessing the potential of the absorber and charge transport layers.

Lead toxicity is a barrier to the widespread commercial manufacture of lead halide perovskites and their use in solar photovoltaic (PV) devices. Eco-friendly lead-free perovskite solar cells (PSCs) have been developed using certain unique non- or low-toxic perovskite materials. In this context, Sn-based perovskites have been identified as promising substitutes for Pb-based perovskites due to their similar characteristics. However, Sn-based perovskites suffer from chemical instability, which affects their performance in PSCs. This study employs theoretical simulations to identify ways to improve the efficiency of Sn-based PSCs. The simulations were conducted using the SCAPS-1D software, and a lead-free, non-toxic, and inorganic perovskite absorber layer (PAL), i.e. CsSnI3 was used in the PSC design. The properties of the hole transport layer (HTL) and electron transport layer (ETL) were tuned to optimize the performance of the device. Apart from this, seven different combinations of HTLs were studied, and the best-performing combination was found to be ITO/PCBM/CsSnI3/CFTS/Se, which achieved a power conversion efficiency (PCE) of 24.73%, an open-circuit voltage (VOC) of 0.872 V, a short-circuit current density (JSC) of 33.99 mA cm-2 and a fill factor (FF) of 83.46%. The second highest PCE of 18.41% was achieved by the ITO/PCBM/CsSnI3/CuSCN/Se structure. In addition to optimizing the structure of the PSC, this study also analyzes the current density-voltage (J-V) along with quantum efficiency (QE), as well as the impact of series resistance, shunt resistance, and working temperature, on PV performance. The results demonstrate the potential of the optimized structure identified in this study to enhance the standard PCE of PSCs. Overall, this study provides important insights into the development of lead-free absorber materials and highlights the potential of using CsSnI3 as the PAL in PSCs. The optimized structure identified in this study can be used as a base for further research to improve the efficiency of Sn-based PSCs.

A Rare Case of Cytomegalovirus Colitis with Subsequent Non-tubercular Mycobacteria Immune Reconstitution Inflammatory Syndrome.

Cytomegalovirus (CMV) colitis occurs commonly in immunocompromised patients with high mortality. CMV infection has also been reported in immunocompetent individuals and it has a varied clinical presentation. When HIV-infected patients are started on antiretroviral therapy (ART) there is a reconstitution of the immune system which results in the paradoxical worsening of existing conditions or development of new disease conditions known as immune reconstitution inflammatory syndrome (IRIS). In the setting of IRIS one of the most common infections to occur is non-tubercular mycobacteria (NTM). The infection generally develops when the CD4 count is < 50 cells/µL. Here we present a rare case of CMV colitis followed by NTM infection in the setting of IRIS, its management, and treatment outcomes.

Adverse birth outcomes among women with 'low-risk' pregnancies in India: findings from the Fifth National Family Health Survey, 2019-21.

Background: Despite substantial progress in improving maternal and newborn health, India continues to experience high rates of newborn mortality and stillbirths. One reason may be that many births happen in health facilities that lack advanced services-such as Caesarean section, blood transfusion, or newborn intensive care. Stratification based on pregnancy risk factors is used to guide 'high-risk' women to advanced facilities. To assess the utility of risk stratification for guiding the choice of facility, we estimated the frequency of adverse newborn outcomes among women classified as 'low risk' in India. Methods: We used the 2019-21 Fifth National Family Health Survey (NFHS-5)-India's Demographic and Health Survey-which includes modules administered to women aged 15-49 years. In addition to pregnancy history and outcomes, the survey collected a range of risk factors, including biomarkers. We used national obstetric risk guidelines to classify women as 'high risk' versus 'low risk' and assessed the frequency of stillbirths, newborn deaths, and unplanned Caesarean sections for the respondent's last pregnancy lasting 7 or more months in the past five years. We calculated the proportion of deliveries occurring at non-hospital facilities in all the Indian states. Findings: Using data from nearly 176,699 recent pregnancies, we found that 46.6% of India's newborn deaths and 56.3% of stillbirths were among women who were 'low risk' according to national guidelines. Women classified as 'low risk' had a Caesarean section rate of 8.4% (95% CI 8.1-8.7%), marginally lower than the national average of 10.0% (95% CI 9.8-10.3%). In India as a whole, 32.0% (95% CI 31.5-32.5%) of deliveries occurred in facilities that were likely to lack advanced services. There was substantial variation across the country, with less than 5% non-hospital public facility deliveries in Punjab, Kerala, and Delhi compared to more than 40% in Odisha, Madhya Pradesh, and Rajasthan. Newborn mortality tended to be lower in states with highest hospital delivery rates. Interpretation: Individual risk stratification based on factors identified in pregnancy fails to accurately predict which women will have delivery complications and experience stillbirth and newborn death in India. Thus a determination of 'low risk' should not be used to guide women to health facilities lacking key life saving services, including Caesarean section, blood transfusion, and advanced newborn resuscitation and care. Funding: Bill and Melinda Gates Foundation and the World Bank. The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the Gates Foundation or of the World Bank, its Executive Directors, or the countries they represent.