Duodenal duplications are rare malformations with several anatomical varieties. The preferred treatment for duodenal duplications is complete removal when the location allows it without endangering nearby anatomical structures.

Through the trade of products and services, cities indirectly depend on distant water sources to function, prosper, and grow. To fully account for indirect (virtual) water dependencies, virtual water flows need to be known along complex supply chains. To this purpose, we build a new environmental multiregional input-output model for U.S. regions. The model is used to quantify the domestic, blue virtual water flows and analyze the water footprints of 69 major U.S. cities. Our results show a large inequality in the urban water consumed for economic production: just 7 out of the 69 cities included in this study account for 35% of the U.S. national water footprint of production. This is due to the production of water-intensive agricultural products in the metropolitan areas of western cities. The inequality reduces for the urban water footprint of consumption because, through the supply chains of industrialized food sectors, western virtual water is partially transferred to eastern cities as final demand. The water embodied in industrial products and services tends to be higher in western cities than in eastern cities; that is, the water embodied in food services could be several times higher in Los Angeles than in New York City. Trade hub cities attract large inflows of products which are mostly transformed for consumption elsewhere. Thus, the omission of product interdependencies within trade hub cities can increase by several times their water footprints of consumption. Overall, the proposed model is able to enhance subnational estimates of U.S. virtual water flows.

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Conventional indicators of water use for urban areas account primarily for direct water use. In contrast, our objective here is to employ the water footprint (WF) concept and methodology to include the virtual or indirect water use to assess the production‐side and consumption‐side WF of 65 United States (U.S.) cities. The 65 cities include the largest metropolitan areas and some of the major mid‐sized cities in the U.S. We use metropolitan areas to define our city boundaries as this is the native spatial resolution of the main datasets used. To estimate the urban WFs, we integrated large and disparate datasets, including commodity flow (agricultural, livestock, and industrial commodities), water use, and socioeconomic data. By analyzing the estimated WF values, we found indirect water use accounts on average for 66% of the WF of consumption. We found some cities are net virtual water exporters (11 of 65) because they rely heavily on direct water uses or are heavy producers of industrial commodities. Also, WF patterns vary widely across the U.S. but regional patterns seem to emerge. For example, the dense cities of the U.S. northeast megaregion have a significantly low per capita WF relative to the other cities, while cities in the Gulf Coast megaregion have a significantly higher industrial WF of production and consumption. Furthermore, there is inequality in the WF of consumption where a few cities account for a disproportionate share of the total U.S. urban water uses.

Supply chains enable the flow of goods and services within economic systems. When mapped for the entire economy and geographic locations of a country, supply chains form a spatial web of interactions among suppliers and buyers. One way to characterize supply chains is through multiregional input-output linkages. Using a multiregional input-output dataset, we build the multilayer network of supply chains in the United States. Together with a network cascade model, the multilayer network is used to explore the propagation of economic shocks along intranational supply chains. We find that the effect of economic shocks, measured using the avalanche size or total number of collapsed nodes, varies widely depending on the geographic location and economic sector of origin of a shock. The response of the supply chains to shocks reveals a threshold-like behavior. Below a certain failure or fragility level, the avalanche size increases relatively quickly for any node in the network. Based on this result, we find that the most fragile regions tend to be located in the central United States, which are regions that tend to specialize in food production and manufacturing. The most fragile layers are chemical and pharmaceutical products, services and food-related products, which are all sectors that have been disrupted by the Coronavirus Disease 2019 (COVID-19) pandemic in the United States. The fragility risk, measured by the intersection of the fragility level of a node and its exposure to shocks, varies across regions and sectors. This suggests that interventions aiming to make the supply-chain network more robust to shocks are likely needed at multiple levels of network aggregation.