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Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
Cash flows from operating activities: |  |  |
Net (loss) income | $ (77,329) | $ 7,028 | $ (33,226)
Adjustments to reconcile net (loss) income to net cash used in operating activities: |  |  |
Depreciation and amortization | 815 | 1,690 | 2,486
Remeasurement of acquisition-related contingent consideration | 0 | 3,327 | 845
Remeasurement of financing-related contingent consideration | 0 | 435 | 378
Amortization of debt discount and debt issuance costs | 1,248 | 6,524 | 5,995
Changes in deferred tax | (15,666) | (7,431) | (6,334)
Share-based compensation expense | 8,872 | 2,999 | 519
Gain on sale of Hospital Products | 0 | (45,760) | 0
Loss on deconsolidation of subsidiary | 0 | 0 | 1,750
Gain from release of certain liabilities | (217) | (3,364) | 0
Other adjustments | 1,272 | 142 | (254)
Net changes in assets and liabilities |  |  |
Accounts receivable | 0 | 8,281 | 2,471
Inventories, net | 0 | (1,352) | 1,155
Prepaid expenses and other current assets | (439) | 1,863 | (1,187)
Research and development tax credit receivable | 2,796 | 2,213 | (1,014)
Accounts payable & other current liabilities | 4,232 | (2,788) | 4,641
Deferred revenue | 0 | 0 | (114)
Accrued expenses | 895 | (13,226) | 357
Earn-out payments for contingent consideration in excess of acquisition-date fair value | 0 | (5,323) | (10,988)
Royalty payments for contingent consideration payable in excess of original fair value | 0 | (866) | (1,748)
Other assets and liabilities | (3,789) | (3,126) | (4,057)
Net cash used in operating activities | (77,310) | (48,734) | (38,325)
Cash flows from investing activities: |  |  |
Purchases of property and equipment | (26) | (98) | (29)
Proceeds from disposal of property and equipment | 0 | 0 | 154
Proceeds from the disposition of the Hospital Products | 16,500 | 25,500 | 0
Proceeds from sales of marketable securities | 102,224 | 36,284 | 63,246
Purchases of marketable securities | (61,769) | (131,407) | (24,648)
Net cash provided by (used in) investing activities | 56,929 | (69,721) | 38,723
Cash flows from financing activities: |  |  |
Proceeds from the February 2020 private placement | 0 | 60,570 | 0
Proceeds from the May 2020 public offering | 0 | 116,924 | 0
Proceeds from issuance of ordinary shares | 263 | 2,189 | 118
Other financing activities, net | 0 | 0 | (145)
Net cash provided by (used in) financing activities | 263 | 179,683 | (27)
Effect of foreign currency exchange rate changes on cash and cash equivalents | (896) | 720 | 78
Net change in cash and cash equivalents | (21,014) | 61,948 | 449
Cash and cash equivalents at January 1 | 71,722 | 9,774 | 9,325
Cash and cash equivalents at December 31 | 50,708 | 71,722 | 9,774
Supplemental disclosures of cash flow information: |  |  |
Income taxes paid (refund), net | 76 | (1,701) | 140
Interest paid | $ 6,469 | $ 6,469 | $ 6,469

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