55 to date , the primary market for our products has been the united states , where we sell our products through a combination of direct sales representatives employed by us and distributor sales representatives employed by our exclusive independent distributors , who distribute our products on our behalf for a commission that is generally based on a percentage of sales . we believe there is significant opportunity to strengthen our position in the u.s. market by increasing the size of our u.s. sales force and we intend to add additional direct and distributor sales representatives in the future . during the year ended december 31 , 2017 , our international sales accounted for approximately 17 % of our total sales . the international sales total includes a full year of results following the september 1 , 2016 acquisition of the international operations and distribution channel of alphatec holdings , inc. ( “ alphatec international ” ) . we have sold our products in 54 countries outside the united states through a combination of direct sales representatives employed by us and international distributors . we believe there are significant opportunities for us to increase our presence in both existing and new international markets through the continued expansion of our direct and distributor sales forces and the commercialization of additional products . components of our results of operations we manage our business globally within one operating segment , which is consistent with how our management reviews our business , makes investment and resource allocation decisions and assesses operating performance . sales today , we sell primarily implants and related disposables , primarily to hospitals , for use by spine surgeons to treat spine disorders . we generally consign our surgical sets , which contain our implants , disposables , surgical instruments and cases to our sales representatives , and the sets are maintained with the sales representatives or at our hospital customers that purchase the implants and related disposables used in the surgeries . we recognize revenue when the consigned implants and related disposables have been implanted or used , or for sets that are sold directly and not consigned , when title to the goods and risk of loss are transferred to customers with no remaining performance obligations which affect the customer 's final acceptance of the sale . we completed our first sale of excelsiusgps in the fourth quarter of 2017 . we recognize revenue when the equipment is installed and accepted by the customer , which is consistent with when title to the good and risk of loss is transferred to the customer . we expect to expand our u.s. and international sales forces , which will provide us with significant opportunity to continue to increase our penetration in existing markets and to enter new international markets . we also expect to increase sales by commercializing new products , but expect the increase of sales from new products to be partially offset by decreased sales of earlier-generation products . 56 cost of goods sold while we have increased our in-house spinal implant product manufacturing capacity , we also have products manufactured by third-party suppliers . substantially all of our suppliers manufacture our products in the united states . our c ost of goods sold consists primarily of costs from our in-house manufacturing , costs of products purchased from third-party suppliers , excess and obsolete inventory charges , depreciation of surgical instruments and cases , royalties , shipping , inspection and related costs incurred in making our products available for sale or use . beginning in january 2013 , our cost of goods sold increased as a result of a medical device excise tax ( “ mdet ” ) of up to 2.3 % on the sale of certain medical devices in the united states . on december 18 , 2015 , the mdet was suspended for two years effective january 1 , 2016. in january 2018 , congress further extended the moratorium on the medical device excise tax through january 1 , 2020. research and development expenses our research and development expenses primarily consist of engineering , product development , clinical and regulatory expenses , consulting services , outside prototyping services , internal and external research activities , materials , depreciation , and other costs associated with development of our products . research and development expenses also include related personnel and consultants ' compensation and stock-based compensation expense . we expense research and development costs as they are incurred . we expect to incur additional research and development costs as we continue to develop new products . these costs will increase in absolute terms as we continue to expand our product pipeline and add personnel . selling , general and administrative expenses selling , general and administrative expenses primarily consist of salaries , benefits and other related costs , including stock-based compensation for personnel employed in sales , marketing , finance , legal , compliance , administrative , information technology , medical education and training , quality and human resource departments . our selling , general and administrative expenses also include commissions , generally based on a percentage of sales , to direct sales representatives and distributors . we expect our selling , general and administrative expenses will increase in absolute terms with the continued expansion of our sales force and commercialization of our current and pipeline products . we plan to hire more personnel to support the growth of our business . provision for litigation we record a provision for litigation settlements when a loss is known or considered probable and the amount can be reasonably estimated and in the case of a favorable settlement , income when realized . amortization of intangibles we amortize finite lived intangible assets over the period of estimated benefit using the straight-line method and estimated lives ranging from one to seventeen years . story_separator_special_tag for additional information regarding the alphatec international acquisition , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 2. acquisitions ” and for additional information regarding constant currency , please refer to “ non-gaap financial measures ” below . 62 cost of goods sold replace_table_token_7_th the increase in cost of goods sold was primarily due to increases from higher volumes , product mix and inventory write offs . partially offsetting these increases was a cost benefit of $ 4.0 million from in-house manufacturing . research and development expenses replace_table_token_8_th the decrease in research and development expenses was due primarily to $ 4.0 million of one-time licensing cost incurred in 2016 , which was partially offset by increased investment into inr technology and orthopedic trauma for additional headcount to further research activities and development of new innovative products . selling , general and administrative expenses replace_table_token_9_th the increase in selling , general and administrative expenses was due primarily to increases of $ 15.8 million of costs to support alphatec international sales , $ 9.5 million of costs to build the inr technology and orthopedic trauma sales forces , and a $ 10.1 million increase in the u.s. sales force expenses . in addition , there were cost increases of $ 6.5 million related to general and administrative compensation costs . provision for litigation replace_table_token_10_th the current year provision for litigation , which is relatively consistent with the prior year provision , includes legal settlement and verdict costs . 63 for additional information regarding litigation , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 15. commitments and contingencies . ” amortization of intangibles replace_table_token_11_th the increase in the amortization of intangibles is primarily due to intangible assets acquired in connection with the alphatec international acquisition . acquisition related costs replace_table_token_12_th acquisition related costs remained consistent for the year ended december 31 , 2017 as compared to the year ended december 31 , 2016. the current year balance primarily consists of costs associated with the kb medical acquisition . other income , net replace_table_token_13_th the increase in other income , net is due primarily to increases in interest income from increased average investment balances and the note receivable with alphatec spine inc. , coupled with increases in foreign exchange transaction gains . for additional information regarding the note receivable with alphatec spine inc. , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 3. note receivable . ” 64 income tax provision replace_table_token_14_th our tax provision and effective tax rate for the year ended december 31 , 2017 was higher than the prior year due primarily to the impact of the u.s. tax cuts and jobs act ( “ tax reform act ” ) , as further described in “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 13. income taxes . ” year ended december 31 , 2016 compared to the year ended december 31 , 2015 sales the following table sets forth , for the periods indicated , our sales by product category and geography expressed as dollar amounts and the changes in sales between the specified periods expressed in dollar amounts and as percentages : replace_table_token_15_th product launches continue to be a driving force in our sales growth , particularly from products launched during the last three years . the growth in disruptive technology of $ 19.7 million was due primarily to sales of regenerative biologics , expandable interbody and minimally invasive products launched during the past three years , including sales from ttot since the acquisition in late 2014. innovative fusion sales decreased by $ 0.5 million due to sales declines of pedicle screw systems , which were partially offset by increases from alphatec international sales . replace_table_token_16_th in the united states , the increase in sales of $ 2.0 million was due primarily to expansion into new territories and increased penetration in existing territories . the region experienced strong sales in disruptive technology products , led by sales of expandable interbody products and regenerative biologics , which were partially offset by declines in innovative fusion products , primarily pedicle screw systems . 65 internationally , the increase in sales of $ 17.2 million was primarily due to incremental sales from the alphatec international acquisition . on a constant currency basis , our international sales grew $ 18.8 million , or by 40.4 % , due to expansion into new international territories . our worldwide sales increased 3.8 % on a constant currency basis . for additional information regarding the alphatec international acquisition , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 2. acquisitions ” and for additional information regarding constant currency , please refer to “ non-gaap financial measures ” below . cost of goods sold replace_table_token_17_th the increase in cost of goods sold was primarily due to increases from higher volumes , product mix , inventory write offs and increases in depreciation and other operational costs . included in these increases was a prior period adjustment of $ 1.8 million . partially offsetting these increases was $ 9.0 million in savings related to the two-year moratorium on the medical device excise tax ( “ mdet ” ) , which began january 1 , 2016. savings of $ 5.0 million were realized in 2016 from the impact of lower manufacturing costs from branch medical group ( “ bmg ” ) as well as a $ 3.4 million decrease in freight costs . for additional information regarding the prior period adjustment , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 1.

cash provided by operating activities the decrease in net cash provided by operating activities for the year ended december 31 , 2017 was due primarily to the timing of collection and billing of trade accounts receivable , which was partially offset by an increase in depreciation and amortization expense . the increase in net cash provided by operating activities for the year ended december 31 , 2016 was due primarily to the recovery of the restricted cash related to the depuy synthes settlement , coupled with lower working capital and lower year-over-year income tax payments . 72 cash used in investing activities the increase in net cash used in investing activities for the year ended december 31 , 2017 was due primarily to higher investment in marketable securities and increased purchases of property and equipment , which was partially offset by the decrease in cash used for the acquisition of businesses . the decrease in net cash used in investing activities for the year ended december 31 , 2016 was due primarily to lower investment in marketable securities and decreased purchases of property and equipment , which was partially offset by the issuance of a note receivable , and an increase in cash used for the acquisition of businesses . cash provided by financing activities the increase in cash provided by financing activities for the year ended december 31 , 2017 was due primarily to higher proceeds from exercises of stock options , which was partially offset by payments for business acquisition liabilities . the decrease in cash provided by financing activities for the year ended december 31 , 2016 was due primarily to higher payments of business acquisition liabilities . liquidity and capital resources the following table highlights certain information related to our liquidity and capital resources : replace_table_token_32_th during the year ended december 31 , 2017 , our total cash , cash equivalents and marketable securities increased $ 79.1 million , primarily as a result of our cash provided by operating activities and increased investment in marketable securities .


 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.
     ```cash provided by operating activities the decrease in net cash provided by operating activities for the year ended december 31 , 2017 was due primarily to the timing of collection and billing of trade accounts receivable , which was partially offset by an increase in depreciation and amortization expense . the increase in net cash provided by operating activities for the year ended december 31 , 2016 was due primarily to the recovery of the restricted cash related to the depuy synthes settlement , coupled with lower working capital and lower year-over-year income tax payments . 72 cash used in investing activities the increase in net cash used in investing activities for the year ended december 31 , 2017 was due primarily to higher investment in marketable securities and increased purchases of property and equipment , which was partially offset by the decrease in cash used for the acquisition of businesses . the decrease in net cash used in investing activities for the year ended december 31 , 2016 was due primarily to lower investment in marketable securities and decreased purchases of property and equipment , which was partially offset by the issuance of a note receivable , and an increase in cash used for the acquisition of businesses . cash provided by financing activities the increase in cash provided by financing activities for the year ended december 31 , 2017 was due primarily to higher proceeds from exercises of stock options , which was partially offset by payments for business acquisition liabilities . the decrease in cash provided by financing activities for the year ended december 31 , 2016 was due primarily to higher payments of business acquisition liabilities . liquidity and capital resources the following table highlights certain information related to our liquidity and capital resources : replace_table_token_32_th during the year ended december 31 , 2017 , our total cash , cash equivalents and marketable securities increased $ 79.1 million , primarily as a result of our cash provided by operating activities and increased investment in marketable securities .
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 Suspicious Activity Report : 55 to date , the primary market for our products has been the united states , where we sell our products through a combination of direct sales representatives employed by us and distributor sales representatives employed by our exclusive independent distributors , who distribute our products on our behalf for a commission that is generally based on a percentage of sales . we believe there is significant opportunity to strengthen our position in the u.s. market by increasing the size of our u.s. sales force and we intend to add additional direct and distributor sales representatives in the future . during the year ended december 31 , 2017 , our international sales accounted for approximately 17 % of our total sales . the international sales total includes a full year of results following the september 1 , 2016 acquisition of the international operations and distribution channel of alphatec holdings , inc. ( “ alphatec international ” ) . we have sold our products in 54 countries outside the united states through a combination of direct sales representatives employed by us and international distributors . we believe there are significant opportunities for us to increase our presence in both existing and new international markets through the continued expansion of our direct and distributor sales forces and the commercialization of additional products . components of our results of operations we manage our business globally within one operating segment , which is consistent with how our management reviews our business , makes investment and resource allocation decisions and assesses operating performance . sales today , we sell primarily implants and related disposables , primarily to hospitals , for use by spine surgeons to treat spine disorders . we generally consign our surgical sets , which contain our implants , disposables , surgical instruments and cases to our sales representatives , and the sets are maintained with the sales representatives or at our hospital customers that purchase the implants and related disposables used in the surgeries . we recognize revenue when the consigned implants and related disposables have been implanted or used , or for sets that are sold directly and not consigned , when title to the goods and risk of loss are transferred to customers with no remaining performance obligations which affect the customer 's final acceptance of the sale . we completed our first sale of excelsiusgps in the fourth quarter of 2017 . we recognize revenue when the equipment is installed and accepted by the customer , which is consistent with when title to the good and risk of loss is transferred to the customer . we expect to expand our u.s. and international sales forces , which will provide us with significant opportunity to continue to increase our penetration in existing markets and to enter new international markets . we also expect to increase sales by commercializing new products , but expect the increase of sales from new products to be partially offset by decreased sales of earlier-generation products . 56 cost of goods sold while we have increased our in-house spinal implant product manufacturing capacity , we also have products manufactured by third-party suppliers . substantially all of our suppliers manufacture our products in the united states . our c ost of goods sold consists primarily of costs from our in-house manufacturing , costs of products purchased from third-party suppliers , excess and obsolete inventory charges , depreciation of surgical instruments and cases , royalties , shipping , inspection and related costs incurred in making our products available for sale or use . beginning in january 2013 , our cost of goods sold increased as a result of a medical device excise tax ( “ mdet ” ) of up to 2.3 % on the sale of certain medical devices in the united states . on december 18 , 2015 , the mdet was suspended for two years effective january 1 , 2016. in january 2018 , congress further extended the moratorium on the medical device excise tax through january 1 , 2020. research and development expenses our research and development expenses primarily consist of engineering , product development , clinical and regulatory expenses , consulting services , outside prototyping services , internal and external research activities , materials , depreciation , and other costs associated with development of our products . research and development expenses also include related personnel and consultants ' compensation and stock-based compensation expense . we expense research and development costs as they are incurred . we expect to incur additional research and development costs as we continue to develop new products . these costs will increase in absolute terms as we continue to expand our product pipeline and add personnel . selling , general and administrative expenses selling , general and administrative expenses primarily consist of salaries , benefits and other related costs , including stock-based compensation for personnel employed in sales , marketing , finance , legal , compliance , administrative , information technology , medical education and training , quality and human resource departments . our selling , general and administrative expenses also include commissions , generally based on a percentage of sales , to direct sales representatives and distributors . we expect our selling , general and administrative expenses will increase in absolute terms with the continued expansion of our sales force and commercialization of our current and pipeline products . we plan to hire more personnel to support the growth of our business . provision for litigation we record a provision for litigation settlements when a loss is known or considered probable and the amount can be reasonably estimated and in the case of a favorable settlement , income when realized . amortization of intangibles we amortize finite lived intangible assets over the period of estimated benefit using the straight-line method and estimated lives ranging from one to seventeen years . story_separator_special_tag for additional information regarding the alphatec international acquisition , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 2. acquisitions ” and for additional information regarding constant currency , please refer to “ non-gaap financial measures ” below . 62 cost of goods sold replace_table_token_7_th the increase in cost of goods sold was primarily due to increases from higher volumes , product mix and inventory write offs . partially offsetting these increases was a cost benefit of $ 4.0 million from in-house manufacturing . research and development expenses replace_table_token_8_th the decrease in research and development expenses was due primarily to $ 4.0 million of one-time licensing cost incurred in 2016 , which was partially offset by increased investment into inr technology and orthopedic trauma for additional headcount to further research activities and development of new innovative products . selling , general and administrative expenses replace_table_token_9_th the increase in selling , general and administrative expenses was due primarily to increases of $ 15.8 million of costs to support alphatec international sales , $ 9.5 million of costs to build the inr technology and orthopedic trauma sales forces , and a $ 10.1 million increase in the u.s. sales force expenses . in addition , there were cost increases of $ 6.5 million related to general and administrative compensation costs . provision for litigation replace_table_token_10_th the current year provision for litigation , which is relatively consistent with the prior year provision , includes legal settlement and verdict costs . 63 for additional information regarding litigation , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 15. commitments and contingencies . ” amortization of intangibles replace_table_token_11_th the increase in the amortization of intangibles is primarily due to intangible assets acquired in connection with the alphatec international acquisition . acquisition related costs replace_table_token_12_th acquisition related costs remained consistent for the year ended december 31 , 2017 as compared to the year ended december 31 , 2016. the current year balance primarily consists of costs associated with the kb medical acquisition . other income , net replace_table_token_13_th the increase in other income , net is due primarily to increases in interest income from increased average investment balances and the note receivable with alphatec spine inc. , coupled with increases in foreign exchange transaction gains . for additional information regarding the note receivable with alphatec spine inc. , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 3. note receivable . ” 64 income tax provision replace_table_token_14_th our tax provision and effective tax rate for the year ended december 31 , 2017 was higher than the prior year due primarily to the impact of the u.s. tax cuts and jobs act ( “ tax reform act ” ) , as further described in “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 13. income taxes . ” year ended december 31 , 2016 compared to the year ended december 31 , 2015 sales the following table sets forth , for the periods indicated , our sales by product category and geography expressed as dollar amounts and the changes in sales between the specified periods expressed in dollar amounts and as percentages : replace_table_token_15_th product launches continue to be a driving force in our sales growth , particularly from products launched during the last three years . the growth in disruptive technology of $ 19.7 million was due primarily to sales of regenerative biologics , expandable interbody and minimally invasive products launched during the past three years , including sales from ttot since the acquisition in late 2014. innovative fusion sales decreased by $ 0.5 million due to sales declines of pedicle screw systems , which were partially offset by increases from alphatec international sales . replace_table_token_16_th in the united states , the increase in sales of $ 2.0 million was due primarily to expansion into new territories and increased penetration in existing territories . the region experienced strong sales in disruptive technology products , led by sales of expandable interbody products and regenerative biologics , which were partially offset by declines in innovative fusion products , primarily pedicle screw systems . 65 internationally , the increase in sales of $ 17.2 million was primarily due to incremental sales from the alphatec international acquisition . on a constant currency basis , our international sales grew $ 18.8 million , or by 40.4 % , due to expansion into new international territories . our worldwide sales increased 3.8 % on a constant currency basis . for additional information regarding the alphatec international acquisition , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 2. acquisitions ” and for additional information regarding constant currency , please refer to “ non-gaap financial measures ” below . cost of goods sold replace_table_token_17_th the increase in cost of goods sold was primarily due to increases from higher volumes , product mix , inventory write offs and increases in depreciation and other operational costs . included in these increases was a prior period adjustment of $ 1.8 million . partially offsetting these increases was $ 9.0 million in savings related to the two-year moratorium on the medical device excise tax ( “ mdet ” ) , which began january 1 , 2016. savings of $ 5.0 million were realized in 2016 from the impact of lower manufacturing costs from branch medical group ( “ bmg ” ) as well as a $ 3.4 million decrease in freight costs . for additional information regarding the prior period adjustment , please refer to “ part ii ; item 8. financial statements and supplementary data ; notes to consolidated financial statements ; note 1.

