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]


Case report
===========

We report the case of a 17-year-old primigravida with a normal medical history who first presented to the obstetrical outpatient clinic at 16 weeks of gestation. As a consequence, no nuchal translucency could be measured on ultrasound at the appropriate 12-week term. The second trimester biochemical triple screen test showed a low risk for trisomy 18 and 21. A routine 23 weeks ultrasound examination demonstrated a female foetus with a growth curve at the 25th percentile. The profile was dysmorphic with a marked retrognatism and a long upper lip with a smooth philtrum ([Fig. 1](#g001){ref-type="fig"}). The nasal bone was normal and the corpus callosum hypoplasic ([Fig. 2](#g002){ref-type="fig"}). The heart was «bulging» with a thickened myocardium ([Fig. 3](#g002){ref-type="fig"}). We observed a single umbilical artery together with a pathological left uterine artery doppler. The volume of amniotic fluid was normal.

![--- Dysmorphic profile with long upperlip](FVVinObGyn-8-101-g001){#g001}

![--- Hypoplasia of corpus callosum](FVVinObGyn-8-101-g002){#g002}

![--- Abnormal thickened myocardium](FVVinObGyn-8-101-g003){#g003}

An amniocentesis was performed and showed a female karyotype with a terminal deletion of the long arm of chromosome 1 (15.58 Mb deletion in region 1q42.13-q44) ([Fig. 4](#g004){ref-type="fig"}). Parental karyotypes were verified to exclude an inherited translocation but the karyotypes of both parents turned out to be normal. The couple was referred for genetic counselling but, despite the very poor foetal prognosis, the couple decided not to allow an interruption of the pregnancy.

![--- Terminal deletion of the long arm of chromosome 1](FVVinObGyn-8-101-g004){#g004}

Future ultrasound findings at 32.4 weeks of gestation demonstrated a polyhydramnios. The cardiac function was normal and the growth curve remained on the 25th percentile. No microcephaly was noted with a cranial perimeter measured at 288.5 mm (48th percentile using the CFEF curves).

At 34 weeks, a premature rupture of membranes complicated by a chorioamniotitis led to a caesarean section. A baby girl was delivered with a birth weight of 1990 g (Percentile 40). The foetus was born in a state of apparent death, subsequently resuscitated and intubated. Facial dysmorphy was present with micrognathia, low set ears, a short neck, hypertelorism and a smooth and long philtrum. The corpus callosum was hypoplastic and the cardiac echography confirmed the abnormally thickened myocardium without structural abnormalities. The baby died 7 days after birth due to cardiorespiratory failure. The parents refused an autopsy.

Review of the literature
========================

To date, 30 children with microscopically visible terminal deletion of chromosome 1q have been reported in the literature ([@B2]). The clinical syndrome associated with this karyotypic condition includes moderate to severe growth and psychomotor retardation, epilepsy, microcephaly and central nervous system anomalies (hypoplasia or agenesis of the corpus callosum, ventriculomegaly, Arnold-Chiari type 1 malformation) ([@B11]). Patients show typical facial features (micrognathia, short neck, low set ears, long upper lip). Other malformations include urogenital (hypospadia) and cardiac anomalies (tetralogy of Fallot, atrial and ventricular septal defect) ([@B7]).

Very few cases of prenatal diagnosis have been reported and the antenal echographic findings that should suggest a terminal deletion of chromosome 1 have not been standardized yet. A summary of the reported antenatal features is shown in Table I. Most diagnoses are made in the second and third trimester of gestation. Only [@B11] described a case diagnosed at the occasion of the first trimester ultrasound.

Antenatal growth retardation and microcephaly seem to be present in all cases described in the literature but are not specific for a 1 q deletion; however craniofacial features (microgenia, nasal bone hypoplasia or absence of the nasal bone), brain malformations (ventriculomegaly, hypoplasia or agenesis of corpus callosum) and cardiac anomalies (septal defect, pulmonary atresia with intact septum) can suggest this genetic abnormality, especially if they are associated. The hypospadia and the cleft palate were not reported prenatally. Hydramnios and a single umbilical artery was described before in one single case. In this case report, growth retardation and microcephaly were not present and have not led to the prenatal suspicion of 1q deletion. Although microcephaly has been described to be progressive ([@B3]), it was not present at 32 weeks.

Based on the analysis of 15 cases with 1 q terminal deletion, [@B5] reported the characteristic facial appearance and pattern of associated malformations in children with 1 q 42-43 deletion ([@B5]). Growth retardation is found at birth only in 4 cases but all children developed growth retardation after birth. In all cases at birth microcephaly was present.

In our patient, the analysis of the foetal profile has allowed us to highlight a long upper lip with a smooth philtrum and retrognathia. Only [@B2] and [@B11] describe an abnormal profile associated with this condition.

The cardiac anomaly seems to be consistent with a non-compaction of the left ventricular myocardium (LVNC). [@B6] reported a newborn infant with LVNC associated with interstitial 1q43-q43 deletion. The deleted region included the locus for the RyR2 gene (cardiac ryanodine receptor type 2 gene). It was the first case reporting an association between LVNC and terminal 1q deletion.

Postanatal echocardiography confirmed prominent trabeculations with deep intertrabecular recesses in the left ventricle without septal defect.

In conclusion, only a few cases of terminal 1q deletion syndrome have been diagnosed antenatally and the malformations detected do not appear to define a specific 1q deletion foetal phenotype.

Growth retardation and microcephaly may not develop during foetal life and are not always present in the context of terminal 1q deletion. The facial dysmorphism is, oppositely, systematically described in affected children.

We therefore recommend to perform a detailed analysis of the foetal profile at routine ultrasound to search anomalies such as microgenia, retrognathia, philtrum anomaly, hypoplasia or absent nasal bone. We consider that non-compaction of the left ventricular myocardium can be associated with terminal chromosome 1q deletion.