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]


A five-year-old boy presented (Day 0) with gingival bleeding and pancytopenia (white blood cells: 1.7 × 10^9^/L; hemoglobin: 7.3 g/dL; platelets: 16 × 10^9^/L). A coagulation panel was unremarkable. Peripheral blood smear revealed dysmorphic promyelocytes with red-blue granules, folded reniform nuclei and no Auer rods. Bone marrow examination showed immature myeloid cells (\>60% promyelocytes) that were positive for myeloperoxidase (MPO), CD117, CD13 and CD33, and negative for CD34 and HLA-DR. Cytogenetic analysis showed a male karyotype with 46,XY, *t*(15;17)(q24;q21). Quantitative real-time polymerase chain reaction was positive for PML-RARα. A diagnosis of acute promyelocytic leukemia (APL) was established. Induction chemotherapy with daunorubicin (50 mg/m^2^ Days 1, 3 and 5), cytarabine (100 mg/m^2^ every 12 h, Days 1--10) and thioguanine (100 mg/m^2^ every 12 h, Days 1--10) along with all-*trans* retinoic acid (ATRA; 45 mg/m^2^ per day in two divided doses starting on Day 1) was initiated on admission Day 2. Prophylactic dexamethasone (0.1 mg/kg twice daily) was administered along with ATRA. On Day 9, the patient developed a hypertensive crisis, bilateral lower extremity edema, proteinuria (24-h urine protein 1000 mg) and hyperlipidemia (triglycerides: 525 mg/dL, total cholesterol: 275 mg/dL). His serum albumin at this time was 3.2 g/dL. Given the above presentation and the definition of nephrotic-range proteinuria in children (\>40 mg/m^2^/h), a diagnosis of nephrotic syndrome (NS) (most likely minimal change disease) was established and steroids (prednisone 2 mg/kg/day) were initiated. Proteinuria and other manifestations of NS resolved on admission Day 26, after which steroids were quickly tapered and eventually discontinued. The patient has now completed the second course of DAT without signs or symptoms of NS. During the second course, he only received prophylactic doses of steroids.

The association of NS with acute myeloid leukemia (AML) is rare, with only 10 cases reported previously (Table [1](#SFU062TB1){ref-type="table"}). There was a remarkable male predominance (80%), and the median age at diagnosis was 33 (range: 3--81) years. Surprisingly, 45% of all cases and all three pediatric cases were APL. NS was present before treatment in 45% of cases, suggesting a direct pathogenic role of leukemia. In other cases, anthracycline therapy was the main culprit. Histopathological findings on renal biopsy did not reveal a unique pattern and varied from minimal change disease (MCD) to focal segmental glomerulosclerosis (FSGS), immune complex deposition, macrophage infiltration, membranous glomerulonephritis, proliferative glomerulonephritis and detachment of epithelial cells from the glomerular basement membrane. From the nine patients who received some form of treatment for NS, steroids were the chosen treatment in seven patients, with a response rate of 86%; the other two patients were treated only with chemotherapy and NS responded to treatment in both. Table 1.Summary of previous reports on the association between AML and NSReference, yearAge, sex, FABInduction regimenProteinuria before AML treatmentPossible etiologyRenal histologyTx of NS, responseOutcome\[[@SFU062C10]\], 197220, M, n/aNone+AMLMembranous GNNoneDeath at 6 days (renal failure)\[[@SFU062C9]\], 198357, M, M4Vincristine and prednisone, followed by cytarabine, daunorubicin, thioguanine, and prednisone+AMLFSGS, immune complex depositsSteroids\
+CR, relapse at 2 m and death\[[@SFU062C11]\], 198681, F, M3None+n/aProliferative GNSteroids\
--Early death\[[@SFU062C12]\], 198933, M, M2Cytarabine, daunorubicin--AnthracyclineMCD, IgM depositsSteroids\
+Death at 26 days (sepsis)\[[@SFU062C13]\], 199533, F, M3Cytarabine, daunorubicin, 6-MP, prednisone--AnthracyclineEpithelial-GBM detachmentNoneDeath at 16 days (DAH)\[[@SFU062C14]\], 199659, M, M2Enocitabine, daunorubicin, 6-MP, cytarabine, vincristine, prednisolone, M-CSF+M-CSFMacrophage infiltrationSteroids\
+Death at 14 months (sepsis)\[[@SFU062C2]\], 200244, F, M5Etoposide, cytarabine, daunorubicin+AMLn/a, possible MCDChemoTx\
+Death at 6 months\
(DAH)\[[@SFU062C15]\], 200453, M, n/aCytarabine, daunorubicin+AMLMembranous GNSteroids\
+n/a\[[@SFU062C16]\], 20109, M, M3Cytarabine, idarubicin, etoposide, ATRA--AnthracyclineFSGSSteroids\
+CR at 2 years\[[@SFU062C1]\], 20123, M, M3Cytarabine, daunorubicin, ATRA--ATRA syndromen/aChemoTx\
+CROur case5, M, M3Cytarabine, daunorubicin, thioguanine, ATRA, and dexamethasone--Anthracyclinen/aSteroids\
+CR[^1]

A number of mechanisms may explain the rare association between NS and AML. Disruption of podocyte integrity and function due to cytokine release has been proposed as a mechanism of nephrotic syndrome during ATRA-induced differentiation syndrome in APL \[[@SFU062C1]\]. A causal relationship between NS and AML is further supported by the response of proteinuria to chemotherapy for AML and the association between higher leukemia burden and more proteinuria \[[@SFU062C1], [@SFU062C2]\]. Anthracyclines have been proposed as a culprit in the development of NS following treatment of AML since they can cause acute renal tubulointerstitial toxicity \[[@SFU062C3], [@SFU062C4]\]. Also, adriamycin rapidly increases the expression of the ligands on podocytes for advanced glycation end products, leading to podocyte stress and glomerulosclerosis in mouse models \[[@SFU062C5]\]. Adriamycin is now often used to induce experimental FSGS \[[@SFU062C6], [@SFU062C7]\]. Finally, NS in AML may reflect a local immune complex-mediated process \[[@SFU062C8], [@SFU062C9]\]. Given the absence of proteinuria before AML treatment in our patient, we believe daunorubicin was the most likely cause of NS in the present case. However, a direct effect of ATRA (e.g. terminal differentiation of promyelocytes and toxic effects of the released granules) cannot be ruled out. He had no signs of recurrent NS after re-exposure to chemotherapy, suggesting re-challenge may be safe in drug-induced NS.

Conflict of interest statement {#s2}
==============================

None declared.

[^1]: 6MP, 6-mercaptopurine; AML, acute myeloid leukemia; ATRA, all-*trans* retinoic acid; ChemoTx, chemotherapy; CR, complete remission; DAH, diffuse alveolar hemorrhage; FSGS, focal segmental glomerulosclerosis; GBM, glomerular basement membrane; GN, glomerulonephritis; M-CSF, macrophage colony-stimulating factor; MCD, minimal change disease; n/a, not available; NS, nephrotic syndrome; Tx, treatment.