Project Summary Parent award. The parent award for this supplement is associated with the Arkansas Children's Research Institute (ACRI) Center for Translational Pediatric Research (CTPR: P20GM121293-05S1). The CTPR aims to build an innovative, multi-disciplinary pediatric research center that utilizes cutting-edge systems biology technologies and state-of-the-art translational research to study pediatric diseases. The COBRE Administrative Supplement NOSI supports the development of team science projects that bring together… investigators from IDeA states with different perspectives and expertise to address complex, clinical and/or translational research questions with complementary approaches. These goals are in lockstep, and this proposal utilizes team science approaches from investigators with a history of successful collaborations from two IDeA states. The current proposal is directly in line with the goals of the CTPR and is headed by one current and two former COBRE-funded investigators from two IDeA states. The overall objective of the Pediatric Acute Respiratory Infection Study (PARIS) is to conduct a comprehensive genomic assessment of current circulating respiratory viruses and compare those to viruses collected since 2015 to elucidate the clinical impact of viral genetic diversity and the geographic and temporal distribution of respiratory virus strains and how respiratory viruses change throughout the seasons and over multiple years. Research question. Respiratory infections cause approximately 2 million global deaths each year. As was seen during the COVID-19 pandemic, different genetic strains of the same virus may have varying levels of virulence and clinical manifestations. Differentiating and determining these factors during clinical presentations is crucial for all respiratory viruses. This supplement aims to differentiate and determine the clinical impact of viral genetic diversity, distribution, and seasonal variations of respiratory viruses, expanding our knowledge beyond SARS- CoV-2. By sequencing and comparing historical and current viral samples, we will provide actionable information on transmission patterns, genomics, phylogenetics, and epidemiology of respiratory viruses to clinicians. Further, we will compare Electronic Health Records data from Arkansas and New Mexico to classify the severity of clinical outcomes using the World Health Organization's Ordinal Scale for Clinical Improvement and based on the isolated viral variant. Team science approach. We represent a collaboration between clinicians, genomic scientists, and epidemiologists. Dr. Kennedy is an Allergy and Immunology clinician at Arkansas Children's Hospital and ACRI, who has extensively studied the role of respiratory infections causing asthma exacerbations. Dr. Dinwiddie is an expert in respiratory viruses and human genomics and has over fifteen years of experience designing, developing, and implementing next-generation sequencing protocols, including in ...