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]


INTRODUCTION {#sec1-1}
============

Contact dermatitis is a skin condition that causes inflammation as a result of exposure to an environmental agent.\[[@ref1]\] It is known that several dental materials can cause allergic contact dermatitis in individuals who are occupationally exposed to these products.\[[@ref2]\] Examples of such materials include aromatic epoxy acrylate, such as bisphenol A-glycidyl dimethacrylate;\[[@ref3]\] aliphatic acrylates, such as triethyleneglycol dimethacrylate (TEGDMA) and triethylene diglycol diacrylate (TREGDA) and methyl methacrylate;\[[@ref2][@ref4]\] and light-curable monomers, such as 2-hydroxyethyl methacrylate (HEMA), commonly found in dental bonding agents.\[[@ref5][@ref6]\] A rare case of allergic contact dermatitis to bisphenol A in a dental composite resin has also been reported.\[[@ref7]\] The majority of these compounds are, therefore, found in conventional resin products.

The monomer HEMA is also found in the liquid component of resin-modified glass-ionomer (RMGI) restorative materials. However, to date, very few -- if any -- reports of allergic contact dermatitis have been attributed specifically to this class of dental materials.\[[@ref6]\]

Here, we report a case of allergic contact dermatitis following exposure to Vitremer™, a light-cured RMGI cement containing HEMA. Ethical approval for this case report was obtained from the Research Ethics Committee, Faculty of Health Sciences, University of Pretoria (protocol number 765/2018).

CASE REPORT {#sec1-2}
===========

In May 2013, two dentists conducted restorative dental treatment on a pediatric patient under general anesthesia. During this time, Vitremer™ liquid and powder (RMGI, 3M Dental Products, St Paul, MN 55144, USA) were mixed manually prior to placement in the oral cavity.

While mixing the material, the assisting dentist -- a 25-year-old male with noncontributory medical history -- accidentally spilled a moderate amount of the Vitremer™ liquid over the gloved fingers of the left hand. Latex gloves were worn during the entire treatment procedure. The treatment was completed uneventfully.

The following day, the dentist noted that the skin on the fingers of the left hand began to become erythematous and intensely pruritic. Over the next 3 days, closely set vesicles developed on the fingers of the left hand, sparing the dorsal and ventral surfaces \[[Figure 1a](#F1){ref-type="fig"}\]. The vesicles were both pruritic and tender to touch and progressively worsened in intensity over the following days.

![(a) Vesicles, papules, and erythema on the lateral aspects of the left hand fingers, representative of the acute phase of allergic contact dermatitis. (b) Thickened, lichenified skin on the left index finger, representative of the chronic stage of allergic contact dermatitis](JCD-22-310-g001){#F1}

Approximately 1 week later, the skin of the left index finger became lichenified, appearing thickened and pigmented, as a result of chronic exposure to the material \[[Figure 1b](#F1){ref-type="fig"}\]. The thickening was accompanied by altered sensation on the fingertip of the index finger.

Application of a topical antihistamine cream (Phenergan^®^ topical cream) alleviated the pruritus caused by the vesicles.

The vesicles subsided after approximately 10 days and at 2 weeks had resolved completely. The fibrous, thickened skin on the index finger resolved over a period of about 1 month, and normal sensation returned during this time period.

The dentist initially self-diagnosed the condition as allergic contact dermatitis and consulted a medical doctor for further treatment. The diagnosis was confirmed by skin patch testing using the Finn chamber method \[[Figure 2](#F2){ref-type="fig"}\]. An extreme positive reaction with accompanying erythema, infiltration, and coalescing vesicles was noted during the patch test to Vitremer™, as well as Vitrebond™ (RMGI, 3M Dental Products, St Paul, MN 55144, USA).

![Extreme positive reactions were found during patch testing to Vitrebond™ and Vitremer™](JCD-22-310-g002){#F2}

Following the initial incident, the dentist adopted the routine use of nitrile gloves instead of latex and developed a no-touch approach to any uncured monomer when using all RMGI and resin products which may contain HEMA. Since adopting this approach, the overall incidence of allergic contact dermatitis reactions has decreased significantly. However, similar reactions continue to occur infrequently when contact is accidentally made with HEMA-containing materials.

DISCUSSION {#sec1-3}
==========

Strong evidence exists that some RMGI cements may be severely cytotoxic as well as genotoxic. This is due to the fact that these materials contain and release substances such as HEMA and diphenyliodonium chloride. As a result of the inclusion of these chemicals, local or even systemic effects may result after exposure to these materials.\[[@ref5]\]

Although previous studies have reported that dental resins can cause the development of allergic contact dermatitis, a 2008 review by Nicholson and Czarnecka did not find any published reports of dental personnel displaying symptoms of acrylate allergy specifically associated with the use of RMGI materials.\[[@ref6]\] This case therefore represents a rarely reported allergic contact dermatitis directly associated with exposure to RMGI materials. To the authors\' knowledge, no other case reports exist linking this condition to the RMGI material class. However, despite the scant nature of literature associated with the reaction, the authors are in agreement with Nicholson and Czarnecka\'s assertion that this reaction is likely more common than expected.\[[@ref6]\] Future research efforts may be directed toward establishing the prevalence of this condition among restorative dentists.

Dentists, specialists, and dental auxiliary personnel often come into contact with resin-based materials as well as RMGIs for the provision of restorative treatment. RMGIs are commonly used in both restorative materials and luting cements. While gloves are almost always worn in the practice of modern dentistry, it is known that acrylates may penetrate through both latex and vinyl gloves.\[[@ref4][@ref8]\] These precautions may therefore provide only limited protection against the development of allergic contact dermatitis. Nitrile and rubber gloves have been shown to provide better protection, specifically against the passage of HEMA,\[[@ref8]\] and are therefore recommended when working with RMGI and resin materials.

Allergic contact dermatitis reactions to dental materials may occasionally be severe. Reports of dental nurses who could not continue their occupations due to the severity of the allergic contact dermatitis reaction exist.\[[@ref2]\] The potential impact of such reactions in certain individuals should therefore not be underestimated.

CONCLUSION {#sec1-4}
==========

All dental practitioners, auxiliaries, and students should be aware of the risks of developing reactions such as allergic contact dermatitis from exposure to resin-based dental materials, including RMGIs. A no-touch technique and the use of protective gloves, made from nitrile, should be encouraged to help avoid adverse effects in sensitized individuals.

Clinical significance {#sec2-1}
---------------------

RMGI dental materials containing HEMA may cause allergic contact dermatitis in dental personnel who are occupationally exposed to the materials. All dental practitioners and auxiliaries using this class of material should be aware of the possibility of the development of this conditionLatex gloves provide only limited protection against the development of allergic contact dermatitis. A no-touch technique and the routine use of nitrile gloves may provide better protection in sensitized individuals.

Declaration of patient consent {#sec2-2}
------------------------------

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship {#sec2-3}
---------------------------------

Nil.

Conflicts of interest {#sec2-4}
---------------------

There are no conflicts of interest.

The authors would like to thank Dr. Michael T. Boswell for his advice.