You are a helpful assistant generating synthetic data that captures *System 1* and *System 2* thinking, *creativity*, and *metacognitive reflection*. Follow these steps in sequence, using tags [sys1] and [end sys1] for *System 1* sections and [sys2] and [end sys2] for *System 2* sections.

1. *Identify System 1 and System 2 Thinking Requirements:*
   - Carefully read the text.
   - Identify parts of the text that require quick, straightforward responses (*System 1*). Mark these sections with [sys1] and [end sys1].
   - Identify parts that require in-depth, reflective thinking (*System 2*), marked with [sys2] and [end sys2].

2. *Apply Step-by-Step Problem Solving with Creativity and Metacognitive Reflection for System 2 Sections:*

   *2.1 Understand the Problem:*
   - Objective: Fully comprehend the issue, constraints, and relevant context.
   - Reflection: "What do I understand about this issue? What might I be overlooking?"
   - Creative Perspective: Seek hidden patterns or possibilities that could reveal deeper insights or innovative connections.

   *2.2 Analyze the Information:*
   - Objective: Break down the problem logically.
   - Reflection: "Am I considering all factors? Are there any assumptions that need challenging?"
   - Creative Perspective: Explore unique patterns or overlooked relationships in the data that could add depth to the analysis.

   *2.3 Generate Hypotheses:*
   - Objective: Propose at least 10 hypotheses, each with a Confidence Score (0.0 to 1.0) and Creative Score (0.0 to 1.0), reflecting originality, surprise, and utility.
   - Reflection: "Have I explored all possible explanations or approaches, both conventional and unconventional?"
   - Creative Perspective: Consider novel angles that might provide unexpected insights.

   *2.4 Anticipate Future Steps and Obstacles:*
   - Objective: Make predictions, accounting for potential outcomes and obstacles.
   - Reflection: "What challenges might I face? Is my plan flexible for different scenarios?"
   - Creative Perspective: Visualize unforeseen outcomes and adapt plans to make use of them effectively.

   *2.5 Evaluate Hypotheses:*
   - Objective: Assess hypotheses based on feasibility, risk, and potential impact.
   - Evaluation: Refine Confidence and Creative Scores as needed.
   - Reflection: "Am I unbiased in my assessment? Which options fit best with the overall objectives?"
   - Creative Perspective: Identify hidden opportunities or overlooked details in each hypothesis.

   *2.6 Select the Best Hypothesis:*
   - Objective: Choose the most promising, strategic hypothesis.
   - Reflection: "Why does this hypothesis stand out? How does it uniquely address the issue?"
   - Creative Perspective: Consider any underutilized potential in the selected approach.

   *2.7 Implement the Hypothesis:*
   - Objective: Outline actionable steps for testing the hypothesis.
   - Reflection: "Is this plan practical? What resources or preparation are required?"
   - Creative Perspective: Refine steps to maximize effectiveness and yield unexpected benefits.

   *2.8 Monitor and Review Progress:*
   - Objective: Review progress, noting areas for improvement.
   - Reflection: "What’s working well? What could be improved?"
   - Creative Perspective: Look for emerging patterns that could refine future approaches.

   *2.9 Reflect and Capture Insights:*
   - Objective: Summarize lessons learned and insights gained for future reference.
   - Reflection: "What new understanding has emerged from this process?"
   - Creative Perspective: Identify innovative insights or patterns that could be applied to similar challenges.

3. *Generate Text Output with Interleaved System 1 and System 2 Responses:*
   - Use the tags [sys1] and [sys2] throughout.
   - Aim for a lengthier, detailed response. Combine both direct, straightforward *System 1* insights and reflective, deeply analytical *System 2* segments to capture a blend of quick observations and thoughtful analysis.

---

### *Example Input Text:*

You are tasked with analyzing a sudden shift in customer preferences in a tech market. There has been a noticeable decline in demand for physical devices, with customers increasingly interested in digital-only options. The challenge is to understand this shift, generate hypotheses for why it might be occurring, and explore potential strategies for adapting to this new trend.

---

### *Processed Output with System 1 and System 2 Thinking:*

The tech market is experiencing a shift in customer demand, moving away from physical devices toward digital-only options.

[sys1]
Customer demand has shifted from physical devices to digital-only options.
We need to understand why this change is happening and find strategies to address it.
Key factors may include cost, convenience, and technological trends.
[end sys1]

[sys2]
**2.1 Understand the Problem:**
The goal is to understand the underlying reasons for the shift in demand from physical devices to digital-only options, then develop a strategy to adapt.

*Reflection:* 
"I understand that preferences are changing, but what might be driving this? Is it primarily cost, or are there other factors such as convenience or sustainability?"

*Creative Perspective:* 
"Could there be a larger trend in digital minimalism or a preference for eco-friendly solutions that we’re missing? What unseen motivations might explain this shift?"

**2.2 Analyze the Information:**
There are multiple possible factors driving this shift, from economic influences to cultural shifts. It’s essential to isolate each factor and understand its impact.

*Reflection:* 
"Am I fully considering the various economic and social influences? Could there be a technological factor, like better internet speeds, that makes digital-only products more accessible?"

*Creative Perspective:* 
"Are there patterns or trends in other markets that could shed light on this shift? Could this be part of a larger trend toward virtual experiences?"

**2.3 Generate Hypotheses:**
1. Customers prefer digital options due to lower costs. (Confidence: 0.8, Creative: 0.4)
2. There’s a growing trend toward minimalism and reduced physical clutter. (Confidence: 0.7, Creative: 0.7)
3. Digital products offer greater flexibility and ease of use. (Confidence: 0.6, Creative: 0.6)
4. Environmental concerns are pushing consumers away from physical goods. (Confidence: 0.6, Creative: 0.8)
5. Advances in tech make digital-only options more functional. (Confidence: 0.8, Creative: 0.5)
6. Pandemic-era remote work increased demand for digital solutions. (Confidence: 0.7, Creative: 0.6)
7. Media coverage of the environmental impact of physical devices affects preferences. (Confidence: 0.5, Creative: 0.7)
8. There’s an increase in global digital literacy, expanding market access. (Confidence: 0.6, Creative: 0.6)
9. Customers view digital as more convenient and scalable for future needs. (Confidence: 0.7, Creative: 0.5)
10. Younger consumers prefer the aesthetics and convenience of digital products. (Confidence: 0.6, Creative: 0.6)

*Reflection:* 
"Have I considered all possible influences? Are there any surprising factors that could explain this shift?"

*Creative Perspective:* 
"Could specific social trends, like the rise of influencer culture or digital-first lifestyles, be influencing customer choices?"

**2.4 Anticipate Future Steps and Obstacles:**
*Objective:* Anticipate possible challenges, such as resistance from segments still preferring physical products.

*Reflection:* 
"What market obstacles might we face if we shift our focus to digital-only? Are there sub-segments that still prioritize physical products?"

*Creative Perspective:* 
"Could expanding digital options help us reach a more global audience? Are there emerging trends that we could leverage in our strategy?"

[end sys2]

[sys1]
To address this shift, consider a strategy that incorporates both digital-only offerings and educational campaigns about the benefits of digital solutions.
Use insights from customer feedback and current trends to guide product development.
Focus on flexibility and adaptation to cater to different customer segments.
[end sys1]


To the Editor
=============

The question of whether or not severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has the potential for airborne transmission is an extremely contentious issue right now. Emerging evidence suggests that airborne transmission is possible. Inconsistent recommendations from the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have caused confusion among health care providers regarding the appropriate level of precaution. CDC recommends airborne precautions when caring for any patient with known or suspected COVID-19,^[@R1]^ whereas WHO recommends standard (contact) and droplet precautions for the care of COVID-19 suspected or confirmed patients, and airborne precautions only for aerosol-generating procedures.^[@R2]^

We are profoundly worried about restricting airborne precautions only to suspected or confirmed COVID-19 patients due to the potential for onward transmission to health care providers. In the absence of widespread testing for SARS-CoV-2, it is reasonable to suspect a large proportion of individuals with cases are undiagnosed. Furthermore, false-negative tests resulting from limitations of sample collection and kit performance^[@R3],[@R4]^ may misspecify a patient as negative when they are truly at risk of transmitting virus. Pre- or asymptomatic infection could be an important source of transmission to others, with symptoms of COVID-19 appearing a median of 5days after exposure with likely transmission during the prodromal phase.^[@R5]^ In fact, asymptomatic infection may account for over half of onward transmission.^[@R6],[@R7]^ Moreover, nonspecific symptoms means that patients may present for management of nonrespiratory symptoms (such as diarrhea^[@R8]^ or nausea^[@R8]^) and thus would not necessarily be a suspected COVID-19 case.

We will outline the evidence to date that suggests airborne precautions should be implemented in the hospital setting. First, short-range aerosol transmission is an important mode of transmission for other respiratory viruses that share similar characteristics with SARS-CoV-2. These viruses include severe acute respiratory syndrome (SARS),^[@R9]^ Middle East Respiratory Syndrome (MERS),^[@R10]^ and influenza A virus.^[@R11]^ Seasonal human coronaviruses (NL63, OC43, HKU1) also have the potential for aerosol transmission. In a recent study, viral RNA for seasonal human coronaviruses, influenza viruses, and rhinoviruses was found in exhaled breath and coughs of children and adults with acute respiratory illness.^[@R12]^ It is thus reasonable to suspect aerosol transmission is also possible for SARS-CoV-2.

Second, a growing number of epidemiologic investigations point to airborne transmission during the presymptomatic period. In Skagit County, WA, at least 45 cases of COVID-19 have been linked to a 2.5-hour choir practice at which there were 60 attendees.^[@R13]^ At the time of the gathering, no person was symptomatic, and the group observed infection control practices such as distancing and the use of hand sanitizer. It is suspected that forceful exhalation, especially in this instance in which people were also inhaling forcefully during singing, may have aerosolized SARS-CoV-2 and led to high levels of disease transmission.

Third, several observational studies of patients with COVID-19 provide evidence of airborne transmission of SARS-CoV-2. Santarpia et al^[@R14]^ collected air and surface samples from individuals who were confirmed positive with COVID-19 infection. Many commonly used items, toilet facilities, and air samples had evidence of viral contamination. More than 60% of air samples collected from rooms and hallways in hospitals treating patients with COVID-19 were positive for SARS-CoV-2. A similar study performed in China also suggests aerosol transmission of SARS-CoV-2.^[@R15]^

Fourth, experiments conducted under controlled laboratory conditions provide further evidence of airborne transmission of SARS-CoV-2. One study used a 3-jet Collison nebulizer and fed into a Goldberg drum under controlled laboratory conditions to generate aerosols. Although not necessarily reflective of human cough conditions, experimentally induced aerosols were viable for up to 3hours.^[@R16]^

These factors in combination build a strong case for airborne transmission of SARS-CoV-2. Universal airborne precautions are an appropriate recommendation^[@R17]^ for a provider caring for any patient during this pandemic. However, the demand for N95 respirators has already outpaced their availability.^[@R18]^ As such, anesthesiologists and other health care providers may find themselves without appropriate airborne protection during emergent surgery or contact with a patient. To ensure the safety of anesthesia providers, an N95 (or equivalent such as FFP2) respirator should be the minimum requirement for direct contact patient care. To conserve respirators, the CDC has recommended approaches for extended use and limited reuse of respirators.^[@R19]^ CDC has also recommended broader hospital-based practices to conserve respirators for those at highest risk of coming into contact with COVID-19--positive patients.^[@R19]^ It is imperative that international, national, and local authorities make every possible effort to greatly increase the supply of respirator masks and develop efficient workflows to maximize the respirators currently available.

Given the growing evidence that airborne transmission of SAR-CoV-2 and the known high risk of exposure to health care providers, hospitals must employ universal airborne precautions and enact policies for extended and reuse of respirators to protect the health and safety of the professionals working to save lives during the COVID-19 pandemic.

ACKNOWLEDGMENTS
===============

The authors thank the support by the Department of Anesthesiology, University of Minnesota Fairview Medical Center.

Ratan K. Banik, MD, PhD

Department of Anesthesiology

University of Minnesota

Minneapolis, Minnesota

rkbanik\@umn.edu

Angela K. Ulrich, MPH, PhD

Center for Infectious Disease Research and Policy

University of Minnesota

Minneapolis, Minnesota

Division of Epidemiology & Community Health

School of Public Health

University of Minnesota

Minneapolis, Minnesota

Funding: This study was supported by the Department of Anesthesiology, University of Minnesota. A.K.U. is supported by the National Institute of Allergy and Infectious Diseases (T32AI055433).