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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2019
Sep. 30, 2018
OPERATING ACTIVITIES:    
Net loss $ 34,882 $ 35,663
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 81,584 83,053
Non-cash in-process research and development expense 59,889 0
Non-cash impairment charges 5,764 4,941
Deferred income tax (10,536) 789
Amortization of debt issuance costs 4,084 4,953
Loss on disposal of property and equipment 844 969
Change in fair value of contingent consideration and other 10 1,214
Share-based compensation 15,744 15,786
Changes in assets and liabilities, net of business acquisitions:    
Accounts receivable (17,519) 1,180
Inventories (30,553) (3,441)
Prepaid expenses and other current assets (8,162) 3,432
Other non-current assets 6,650 (1,397)
Accounts payable, accrued expenses and other current liabilities 366 9,418
Contract liabilities (1,395) (111)
Other non-current liabilities 597 546
Net cash provided by operating activities 142,249 156,995
INVESTING ACTIVITIES:    
Purchases of property and equipment (47,343) (52,056)
Proceeds from note receivable 752 679
Proceeds from sale of property and equipment 36 298
Cash (paid) provided for business acquisitions, net of cash acquired (30,509) 26,704
Acquired in-process research and development (64,995) 0
Net cash used in investing activities (142,059) (24,375)
FINANCING ACTIVITIES:    
Proceeds from borrowings of long-term indebtedness 215,800 50,000
Payments on debt (143,250) (460,000)
Payment of debt issuance costs 0 (4,388)
Proceeds from the issuance of common stock, net of issuance costs 0 349,590
Net cash paid for financing liabilities from business acquisitions 0 (33,843)
Proceeds from exercised stock options 6,948 9,239
Cash taxes paid in net equity settlement (6,272) (7,415)
Net cash (used in) / provided by financing activities 73,226 (96,817)
Effect of exchange rate changes on cash and cash equivalents (4,273) (4,747)
Net increase in cash and cash equivalents 69,143 31,056
Cash and cash equivalents at beginning of period 138,838 174,935
Cash and cash equivalents at end of period $ 207,981 $ 205,991