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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 6 Months Ended
--- | ---
Jun. 30, 2022 | Jun. 30, 2021
Cash flows from operating activities: |  |
Net loss | $ (89,868) | $ (33,026)
Adjustments to reconcile net loss to net cash used in operating activities: |  |
Depreciation and amortization | 506 | 417
Amortization of debt discount and debt issuance costs | 2,229 | 625
Change in deferred taxes | 25,870 | (6,228)
Stock-based compensation expense | 3,163 | 3,729
Gain from release of certain liabilities | (33) | (166)
Other adjustments | 1,239 | 757
Net changes in assets and liabilities |  |
Prepaid expenses and other current assets | 13,305 | (3,106)
Research and development tax credit receivable | 30 | 3,078
Accounts payable & other current liabilities | (4,457) | 176
Accrued expenses | 2,559 | 1,199
Other assets and liabilities | (2,678) | (1,021)
Net cash used in operating activities | (48,135) | (33,566)
Cash flows from investing activities: |  |
Purchases of property and equipment | 0 | (26)
Proceeds from the disposition of the hospital products | 0 | 16,500
Proceeds from sales of marketable securities | 56,501 | 66,213
Purchases of marketable securities | (2,202) | (53,372)
Net cash provided by investing activities | 54,299 | 29,315
Cash flows from financing activities: |  |
Payments for debt issuance costs | (4,803) | 0
Proceeds from stock option exercises and employee share purchase plan | 2,009 | 149
Net cash (used in) provided by financing activities | (2,794) | 149
Effect of foreign currency exchange rate changes on cash and cash equivalents | 50 | (478)
Net change in cash and cash equivalents | 3,420 | (4,580)
Cash and cash equivalents at January 1, | 50,708 | 71,722
Cash and cash equivalents at June 30, | 54,128 | 67,142
Supplemental disclosures of cash flow information: |  |
Interest paid | 6,455 | 3,234
Income taxes (refund) paid | $ (14,096) | $ 7

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