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]


Sir,

Management of recalcitrant corneal ulcer of any etiology is always challenging to ophthalmologists. The mainstream of current medical practice of resistant corneal ulcer includes intensive topical fortified antibiotics with supportive therapy. When these medical therapies fail, one may consider autologous serum, conjunctival flap, tarsorrhaphy, or penetrating keratoplasty. In the recent past, amniotic membrane transplantation (AMT) has been successfully used to treat persistent corneal epithelial defects and ulcers of diverse etiologies.

AMT for the treatment of corneal ulcers was first introduced by Lee and Tseng\[[@ref1]\] in 1997. The unique property of amniotic membranes (AMs) in the reconstruction of ocular surfaces is that it contains amazing mixture of growth factors and cytokines, facilitating proliferation and differentiation of epithelial cells, reducing the inflammatory response by inhibiting protease activity, and reducing inflammatory cell activity.\[[@ref2][@ref3]\] Clinical results showed that the success rate of treatment for corneal ulcers with AMT is over 80%.\[[@ref4][@ref5]\]

In our prospective study, we evaluated the benefit of use of commercially available dried and processed AM in the management of resistant corneal ulcers. Sutureless AMT is valuable in the office setting to promote healing of recalcitrant corneal ulcers that are not responding well to conservative treatment. Topical medications can be used simultaneously as medication penetration has not been found to be an issue. All the patients tolerated AM very well.

Between July 2016 and May 2018, eight eyes (5 men and 3 women with a mean age of 67 years), who suffered from recalcitrant corneal ulcers after failure of conventional ulcer treatment for \>7 days were treated with commercially available dried and processed amniotic membrane. Inclusion criterion for our modified treatment was the size of ulcer \>5 mm in diameter with or without hypopyon. Cases with viral keratitis were not included in the study. Out of eight cases, four cases were of bacterial etiology \[[Figure 1](#F1){ref-type="fig"}\] while other four did not show any conclusive growth on culture.

![Patient with large corneal ulcer before amniotic membrane transplantation](OJO-12-68-g001){#F1}

How to Apply Amniotic Membrane in the Office {#sec1-1}
============================================

Under topical anesthesia, the base of the ulcer was debrided with 23-gauge needle. AM grafts were overlaid in small pieces over the debrided area. The whole corneal ulcer surface was covered by the AM pieces, followed by bandage contact lens as cover. The membrane was placed with stromal side down (Orient the graft with the "IOP" watermark facing the physician to ensure that the stromal side is in contact with the eye) \[[Figure 2](#F2){ref-type="fig"}\]. Documentary photographs were taken.

![Identifying the stromal side of amniotic membrane (IOP mark should face up)](OJO-12-68-g002){#F2}

After AM transplantation, seven eyes achieved rapid epithelialization within 2--3 weeks (range 14--28 days) \[[Figure 3](#F3){ref-type="fig"}\] except one case who had postcataract surgery epithelial defect and took 6 weeks to epithelize.

![Two weeks after amniotic membrane transplantation](OJO-12-68-g003){#F3}

Conclusion {#sec1-2}
==========

In-office sutureless AMT is easy to use and safe procedure and could become a part of treatment algorithms in the disease course to improve patient outcomes. It is conclusively evident that AMT has certainly gained an acceptable position in the armamentarium of the ophthalmologists in the management of recalcitrant corneal ulcers.

Financial support and sponsorship {#sec2-1}
---------------------------------

Nil.

Conflicts of interest {#sec2-2}
---------------------

There are no conflicts of interest.