in addition , plus has an early preclinical investigational drug which is a proprietary combination of rhenium nanpoliposomes and liposomal doxorubicin . theoretically , this combination could provide a synergistic combination of both chemotherapy and radiation in a single treatment . current business activities related to both doceplus and doxoplus are focused on identification of potential partners for these two drugs . plus ' rnl technology was a key part of the licensed radiotherapeutic portfolio that we acquired from nanotx , corp. ( “ nanotx ” ) on may 7 , 2020. the licensed radiolabeled nanoliposome platform can be applied toward several cancer targets and was developed by a multi-institutional consortium based in texas at the mays cancer center / ut health san antonio md anderson cancer center now led by dr. andrew brenner , md , phd , who is the kolitz chair in neuro-oncology research and co-leader of the experimental and developmental therapeutics program . the licensed technology was previously funded by both the national institutes of health/national cancer institute ( nih/nci ) and the cancer prevention and research institute of texas ( cprit ) . dr. 42 brenner 's rnl research program has an active $ 3m award from nih/nci which will financially support the continued clinical development of rnl for recurrent glioblastoma through the completion of a phase 2 clinical trial and enrollment of up to 55 patients . plus therapeutics ' lead investigational drug , rnl , is a novel injectable radiotherapy designed to deliver targeted high dose radiation directly into a brain tumor in a safe , effective , and convenient manner to optimize patient outcomes . rnl , which is composed of radionuclide rhenium-186 ( 186 re ) and a nanoliposomal carrier , is infused directly into the brain tumor via precision brain mapping and convection enhanced delivery . the rnl radiation dose delivered to patients may be up to 15-20x greater than what is possible with external beam radiation therapy ( ebrt ) . some additional potential benefits of rnl compared to ebrt include : - rnl can be visualized in real-time during administration , possibly giving doctors better control of radiation dosing and distribution . - potentially more effectively treats the bulk tumor and microscopic disease in surrounding healthy tissue . - using a small catheter , rnl is infused directly into the targeted tumor , which may reduce radiation exposure to healthy cells . by contrast , ebrt is less targeted and selective . - rnl is given during a single 3- to 4-day in-patient hospital visit , while ebrt requires out-patient visits 5 days a week for approximately 6 weeks . recurrent glioblastoma ( gbm ) affects approximately 12,000 patients annually in the u.s. and is the most common and lethal form of brain cancer . the average life expectancy with glioblastoma is less than 24 months , with a one-year survival rate of 40.8 % and a five-year survival rate of only 6.8 % . gbm can cause headaches , seizures , vision changes and other neurological complications . despite the best available medical treatments to eliminate the initial brain tumor , some microscopic disease frequently remains , with tumor regrowth within months . in fact , approximately 90 % of patients experience tumor recurrence . this tumor type is incredibly difficult to remove completely , and often is resistant or quickly develops resistance to most available therapies . the treatment of gbm remains a significant challenge and it has been nearly a decade since the fda approved a new therapy for this disease . there is no clear standard of care for recurrent gbm and even the few currently approved treatments , in aggregate , provide only marginal survival benefit . current approved therapies are associated with significant side effects , which limit dosing and prolonged use . by infusing the rnl drug directly into the tumor , bypassing the blood-brain barrier , normal brain and external tissues may be spared from radiation damage . we believe that radiation in the form of high energy electrons may be effective against glioblastoma if an adequate dose can be effectively delivered . for comparison , current ebrt protocols for recurrent glioblastoma typically recommend a total maximum dose of about 35 gy . in contrast , the most recently dosed patient with rnl in our clinical trial received over 500 gy without significant adverse effects to-date . rnl is currently being evaluated for the treatment of recurrent glioblastoma in the phase 1 multi-center respect dose-finding clinical trial . respect is evaluating the safety , tolerability , and distribution of rnl for the treatment of recurrent glioblastoma . thus far , rnl has demonstrated early potential efficacy signals in patients with adequate dosing and tumor coverage with two patients surviving more than 30 months , compared to a median survival of approximately 9 months with the current standard of care . the sixth dose escalation cohort of this trial has been completed , which increased the rnl drug volume to 8.8 milliliters and radiation dose to 22.3 millicuries . the increased treatment volume in the sixth cohort will allow treatment of tumors up to approximately 4.5 cm in size , which may include the majority of glioblastoma tumors that appear in the recurrent setting . no treatment-related saes have been observed thus far . respect is supported by an award from the national cancer institute ( nci ) , part of the u.s. national institutes of health ( nih ) . in september 2020 , the fda granted both orphan drug designation and fast track designation to rnl for the treatment of patients with glioblastoma . based on substantial preclinical work completed and published , rnl is thought to have potential clinical benefits in other difficult to treat cancers such as leptomeningeal carcinomatosis , peritoneal carcinomatosis , recurrent head and neck cancer , and pediatric brain cancer . story_separator_special_tag on august 19 , 2019 , we received written notice from nasdaq indicating that , based on our stockholders ' deficit of $ 6.3 million as of june 30 , 2019 , as reported in our quarterly report on form 10-q for the quarter ended june 30 , 2019 , we were no longer in compliance with the minimum stockholders ' equity requirement for continued listing on the nasdaq capital market under nasdaq listing rule 5550 ( b ) ( 1 ) , which requires listed companies to maintain stockholders ' equity of at least $ 2.5 million . we continue to seek additional capital through strategic transactions and other financing alternatives . without additional capital , current working capital and cash generated from sales will not provide adequate funding for research and product development activities at their current levels . if sufficient capital is not raised , we will at a minimum need to significantly reduce or curtail our research and development and other operations , and this would negatively affect our ability to achieve corporate growth goals . although the stock markets and our stock price have recovered to some extent in recent weeks , there may likely be continued market volatility due to the pandemic or other events , which could cause our stock price to decline . this in turn will likely negatively impact our ability to raise funds through equity-related financings . further , a continued global economic downturn may impair our ability to obtain additional financing through other means , such as strategic transactions or debt financing . the overall deterioration 48 of the credit and financial markets due to the covid-19 pandemic will likely generally reduce our ability to obtain additional financing to fund our operations . should we be unable to raise additional cash from outside sources or if we are unable to do so in a timely manner or on commercially reasonable terms , it would have a material adverse impact on our operations . cash ( used in ) provided by operating , investing and financing activities for the years ended december 31 , 2020 and 2019 is summarized as follows ( in thousands ) : replace_table_token_6_th operating activities net cash used in operating activities for the year ended december 31 , 2020 was $ 8.4 million compared to $ 5.9 million in the same period of 2019. overall , our operational cash use increased during the year ended december 31 , 2020 as compared to the same period in 2019 , due primarily to timing of cash payments made for operating assets and liabilities . investing activities net cash used in investing activities for year ended december 31 , 2020 was primarily related to cash payments of $ 0.4 million made for in process research and development assets from nanotx , and $ 0.1 million for purchases of fixed assets . net cash provided by investing activities for the year ended december 31 , 2019 were related to the sale of the cell therapy business for gross proceeds of $ 5.6 million . financing activities net cash used for financing activities for the year ended december 31 , 2020 was related to repayment of $ 5.0 million of the term loan in april 2020 , and cash payments of $ 0.1 million for our finance leases , offset by cash proceeds received from issuance of common stock of $ 4.0 million and warrant exercises of $ 1.1 million . net cash provided by financing activities for the year ended december 31 , 2019 was primarily related to net proceeds of $ 16 million received from the september 2019 offering , and the sale of common stock under the purchase agreement dated september 21 , 2018 with lincoln park , proceeds from the exercise of warrants of $ 0.5 million , partially offset by the principal payment of long-term obligations of $ 3.7 million . off-balance sheet arrangements we do not have any off-balance sheet arrangements ( as defined by applicable regulations of the sec ) that are reasonably likely to have a current or future material effect on our financial condition , results of operations , liquidity , capital expenditures or capital resources . critical accounting policies and significant estimates the preparation of financial statements in conformity with accounting principles generally accepted in the united states requires us to make estimates and assumptions that affect the reported amounts of our assets , liabilities , revenue , and expenses , and that affect our recognition and disclosure of contingent assets and liabilities . while our estimates are based on assumptions we consider reasonable at the time they were made , our actual results may differ from our estimates , perhaps significantly . if results differ materially from our estimates , we will make adjustments to our financial statements prospectively as we become aware of the necessity for an adjustment . we believe it is important for you to understand our most critical accounting policies . these are our policies that require us to make our most significant judgments and , as a result , could have the greatest impact on our future financial results . impairment 49 we assess certain of our long-lived assets , such as property and equipment and intangible assets other than goodwill , for potential impairment when there is a change in circumstances that indicates carrying values of assets may not be recoverable . such long-lived assets are deemed to be impaired when the undiscounted cash flows expected to be generated by the asset ( or asset group ) are less than the asset 's carrying amount . any required impairment loss would be measured as the amount by which the asset 's carryi ng value exceeds its fair value and would be recorded as a reduction in the carrying value of the related asset and a charge to operating expense . there was no impairment in 20 20 or 201 9 . g oodwill goodwill

liquidity and capital resources short-term and long-term liquidity the following is a summary of our key liquidity measures ( for continuing operations ) at december 31 , 2020 and 2019 ( in thousands ) : replace_table_token_5_th to date , these operating losses have been funded primarily from outside sources of invested capital in our common stock , proceeds raised from the loan and security agreement , and gross profits . we have had , and we will continue to have , an ongoing need to raise additional cash from outside sources to fund our future clinical development programs and other operations . our inability to raise additional cash would have a material and adverse impact on operations and would cause us to default on our loan . on october 23 , 2020 , we entered into the distribution agreement with canaccord , pursuant to which we may issue and sell , from time to time , atm shares , depending on market demand , with canaccord acting as an agent for sales . sales of the atm shares may be made by any method permitted by law deemed to be an “ at the market offering ” as defined in rule 415 ( a ) ( 4 ) of the securities act of 1933 , as amended ( the “ securities act ” ) , including , without limitation , sales made directly on or through the nasdaq capital market . canaccord will use its commercially reasonable efforts to sell the atm shares we request to be sold on our behalf , consistent with canaccord 's normal trading and sales practices , under the terms and subject to the conditions set forth in the distribution agreement . we have no obligation to sell any of the atm shares . we may instruct canaccord not to sell the atm shares if the sales can not be effected at or above the price we designate from time to time and we may at any time suspend sales pursuant to the distribution agreement . during the year ended december 31 , 2020 , we issued 1,616,331 shares under the distribution agreement for net proceeds of approximately $ 3.2 million .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```liquidity and capital resources short-term and long-term liquidity the following is a summary of our key liquidity measures ( for continuing operations ) at december 31 , 2020 and 2019 ( in thousands ) : replace_table_token_5_th to date , these operating losses have been funded primarily from outside sources of invested capital in our common stock , proceeds raised from the loan and security agreement , and gross profits . we have had , and we will continue to have , an ongoing need to raise additional cash from outside sources to fund our future clinical development programs and other operations . our inability to raise additional cash would have a material and adverse impact on operations and would cause us to default on our loan . on october 23 , 2020 , we entered into the distribution agreement with canaccord , pursuant to which we may issue and sell , from time to time , atm shares , depending on market demand , with canaccord acting as an agent for sales . sales of the atm shares may be made by any method permitted by law deemed to be an “ at the market offering ” as defined in rule 415 ( a ) ( 4 ) of the securities act of 1933 , as amended ( the “ securities act ” ) , including , without limitation , sales made directly on or through the nasdaq capital market . canaccord will use its commercially reasonable efforts to sell the atm shares we request to be sold on our behalf , consistent with canaccord 's normal trading and sales practices , under the terms and subject to the conditions set forth in the distribution agreement . we have no obligation to sell any of the atm shares . we may instruct canaccord not to sell the atm shares if the sales can not be effected at or above the price we designate from time to time and we may at any time suspend sales pursuant to the distribution agreement . during the year ended december 31 , 2020 , we issued 1,616,331 shares under the distribution agreement for net proceeds of approximately $ 3.2 million .
```    
 Suspicious Activity Report : in addition , plus has an early preclinical investigational drug which is a proprietary combination of rhenium nanpoliposomes and liposomal doxorubicin . theoretically , this combination could provide a synergistic combination of both chemotherapy and radiation in a single treatment . current business activities related to both doceplus and doxoplus are focused on identification of potential partners for these two drugs . plus ' rnl technology was a key part of the licensed radiotherapeutic portfolio that we acquired from nanotx , corp. ( “ nanotx ” ) on may 7 , 2020. the licensed radiolabeled nanoliposome platform can be applied toward several cancer targets and was developed by a multi-institutional consortium based in texas at the mays cancer center / ut health san antonio md anderson cancer center now led by dr. andrew brenner , md , phd , who is the kolitz chair in neuro-oncology research and co-leader of the experimental and developmental therapeutics program . the licensed technology was previously funded by both the national institutes of health/national cancer institute ( nih/nci ) and the cancer prevention and research institute of texas ( cprit ) . dr. 42 brenner 's rnl research program has an active $ 3m award from nih/nci which will financially support the continued clinical development of rnl for recurrent glioblastoma through the completion of a phase 2 clinical trial and enrollment of up to 55 patients . plus therapeutics ' lead investigational drug , rnl , is a novel injectable radiotherapy designed to deliver targeted high dose radiation directly into a brain tumor in a safe , effective , and convenient manner to optimize patient outcomes . rnl , which is composed of radionuclide rhenium-186 ( 186 re ) and a nanoliposomal carrier , is infused directly into the brain tumor via precision brain mapping and convection enhanced delivery . the rnl radiation dose delivered to patients may be up to 15-20x greater than what is possible with external beam radiation therapy ( ebrt ) . some additional potential benefits of rnl compared to ebrt include : - rnl can be visualized in real-time during administration , possibly giving doctors better control of radiation dosing and distribution . - potentially more effectively treats the bulk tumor and microscopic disease in surrounding healthy tissue . - using a small catheter , rnl is infused directly into the targeted tumor , which may reduce radiation exposure to healthy cells . by contrast , ebrt is less targeted and selective . - rnl is given during a single 3- to 4-day in-patient hospital visit , while ebrt requires out-patient visits 5 days a week for approximately 6 weeks . recurrent glioblastoma ( gbm ) affects approximately 12,000 patients annually in the u.s. and is the most common and lethal form of brain cancer . the average life expectancy with glioblastoma is less than 24 months , with a one-year survival rate of 40.8 % and a five-year survival rate of only 6.8 % . gbm can cause headaches , seizures , vision changes and other neurological complications . despite the best available medical treatments to eliminate the initial brain tumor , some microscopic disease frequently remains , with tumor regrowth within months . in fact , approximately 90 % of patients experience tumor recurrence . this tumor type is incredibly difficult to remove completely , and often is resistant or quickly develops resistance to most available therapies . the treatment of gbm remains a significant challenge and it has been nearly a decade since the fda approved a new therapy for this disease . there is no clear standard of care for recurrent gbm and even the few currently approved treatments , in aggregate , provide only marginal survival benefit . current approved therapies are associated with significant side effects , which limit dosing and prolonged use . by infusing the rnl drug directly into the tumor , bypassing the blood-brain barrier , normal brain and external tissues may be spared from radiation damage . we believe that radiation in the form of high energy electrons may be effective against glioblastoma if an adequate dose can be effectively delivered . for comparison , current ebrt protocols for recurrent glioblastoma typically recommend a total maximum dose of about 35 gy . in contrast , the most recently dosed patient with rnl in our clinical trial received over 500 gy without significant adverse effects to-date . rnl is currently being evaluated for the treatment of recurrent glioblastoma in the phase 1 multi-center respect dose-finding clinical trial . respect is evaluating the safety , tolerability , and distribution of rnl for the treatment of recurrent glioblastoma . thus far , rnl has demonstrated early potential efficacy signals in patients with adequate dosing and tumor coverage with two patients surviving more than 30 months , compared to a median survival of approximately 9 months with the current standard of care . the sixth dose escalation cohort of this trial has been completed , which increased the rnl drug volume to 8.8 milliliters and radiation dose to 22.3 millicuries . the increased treatment volume in the sixth cohort will allow treatment of tumors up to approximately 4.5 cm in size , which may include the majority of glioblastoma tumors that appear in the recurrent setting . no treatment-related saes have been observed thus far . respect is supported by an award from the national cancer institute ( nci ) , part of the u.s. national institutes of health ( nih ) . in september 2020 , the fda granted both orphan drug designation and fast track designation to rnl for the treatment of patients with glioblastoma . based on substantial preclinical work completed and published , rnl is thought to have potential clinical benefits in other difficult to treat cancers such as leptomeningeal carcinomatosis , peritoneal carcinomatosis , recurrent head and neck cancer , and pediatric brain cancer . story_separator_special_tag on august 19 , 2019 , we received written notice from nasdaq indicating that , based on our stockholders ' deficit of $ 6.3 million as of june 30 , 2019 , as reported in our quarterly report on form 10-q for the quarter ended june 30 , 2019 , we were no longer in compliance with the minimum stockholders ' equity requirement for continued listing on the nasdaq capital market under nasdaq listing rule 5550 ( b ) ( 1 ) , which requires listed companies to maintain stockholders ' equity of at least $ 2.5 million . we continue to seek additional capital through strategic transactions and other financing alternatives . without additional capital , current working capital and cash generated from sales will not provide adequate funding for research and product development activities at their current levels . if sufficient capital is not raised , we will at a minimum need to significantly reduce or curtail our research and development and other operations , and this would negatively affect our ability to achieve corporate growth goals . although the stock markets and our stock price have recovered to some extent in recent weeks , there may likely be continued market volatility due to the pandemic or other events , which could cause our stock price to decline . this in turn will likely negatively impact our ability to raise funds through equity-related financings . further , a continued global economic downturn may impair our ability to obtain additional financing through other means , such as strategic transactions or debt financing . the overall deterioration 48 of the credit and financial markets due to the covid-19 pandemic will likely generally reduce our ability to obtain additional financing to fund our operations . should we be unable to raise additional cash from outside sources or if we are unable to do so in a timely manner or on commercially reasonable terms , it would have a material adverse impact on our operations . cash ( used in ) provided by operating , investing and financing activities for the years ended december 31 , 2020 and 2019 is summarized as follows ( in thousands ) : replace_table_token_6_th operating activities net cash used in operating activities for the year ended december 31 , 2020 was $ 8.4 million compared to $ 5.9 million in the same period of 2019. overall , our operational cash use increased during the year ended december 31 , 2020 as compared to the same period in 2019 , due primarily to timing of cash payments made for operating assets and liabilities . investing activities net cash used in investing activities for year ended december 31 , 2020 was primarily related to cash payments of $ 0.4 million made for in process research and development assets from nanotx , and $ 0.1 million for purchases of fixed assets . net cash provided by investing activities for the year ended december 31 , 2019 were related to the sale of the cell therapy business for gross proceeds of $ 5.6 million . financing activities net cash used for financing activities for the year ended december 31 , 2020 was related to repayment of $ 5.0 million of the term loan in april 2020 , and cash payments of $ 0.1 million for our finance leases , offset by cash proceeds received from issuance of common stock of $ 4.0 million and warrant exercises of $ 1.1 million . net cash provided by financing activities for the year ended december 31 , 2019 was primarily related to net proceeds of $ 16 million received from the september 2019 offering , and the sale of common stock under the purchase agreement dated september 21 , 2018 with lincoln park , proceeds from the exercise of warrants of $ 0.5 million , partially offset by the principal payment of long-term obligations of $ 3.7 million . off-balance sheet arrangements we do not have any off-balance sheet arrangements ( as defined by applicable regulations of the sec ) that are reasonably likely to have a current or future material effect on our financial condition , results of operations , liquidity , capital expenditures or capital resources . critical accounting policies and significant estimates the preparation of financial statements in conformity with accounting principles generally accepted in the united states requires us to make estimates and assumptions that affect the reported amounts of our assets , liabilities , revenue , and expenses , and that affect our recognition and disclosure of contingent assets and liabilities . while our estimates are based on assumptions we consider reasonable at the time they were made , our actual results may differ from our estimates , perhaps significantly . if results differ materially from our estimates , we will make adjustments to our financial statements prospectively as we become aware of the necessity for an adjustment . we believe it is important for you to understand our most critical accounting policies . these are our policies that require us to make our most significant judgments and , as a result , could have the greatest impact on our future financial results . impairment 49 we assess certain of our long-lived assets , such as property and equipment and intangible assets other than goodwill , for potential impairment when there is a change in circumstances that indicates carrying values of assets may not be recoverable . such long-lived assets are deemed to be impaired when the undiscounted cash flows expected to be generated by the asset ( or asset group ) are less than the asset 's carrying amount . any required impairment loss would be measured as the amount by which the asset 's carryi ng value exceeds its fair value and would be recorded as a reduction in the carrying value of the related asset and a charge to operating expense . there was no impairment in 20 20 or 201 9 . g oodwill goodwill

