since our inception in 2008 , we have devoted substantially all our efforts to developing and commercializing otiprio , developing our current product candidates , and providing general and administrative support for these operations . as of december 31 , 2018 , we had cash , cash equivalents and short-term investments of $ 97.3 million . we have never been profitable , and as of december 31 , 2018 , we had an accumulated deficit of $ 415.2 million . our net losses were $ 50.4 million , $ 90.1 million and $ 110.6 million for the years ended december 31 , 2018 2017 and 2016 , respectively . substantially all our net losses have resulted from research and development expenses related to our clinical trials and product development activities , commercialization expenses to launch otiprio in the u.s. market , and other general and administrative expenses . we expect to continue to incur significant expenses and operating losses for the foreseeable future as we continue to develop , seek regulatory approval , and , if approved , commercialize our product candidates . in the near term , we anticipate our expenses will continue to be substantial as we : conduct clinical development of otividex ; conduct nonclinical and clinical development of oto-313 , oto-413 and oto-510 ; contract to manufacture our product candidates ; evaluate opportunities for development of additional product candidates ; maintain and expand our intellectual property portfolio ; hire additional staff as necessary to execute our product development plan ; and operate as a public company . we will require additional financing to complete the development of and , if approved , commercialize , otividex , oto-313 , oto-413 and any other product candidates . we believe we will continue to expend substantial resources for the foreseeable future for the development of otividex , oto-313 , oto-413 and any other product candidates we may choose to pursue . these expenditures will include costs associated with marketing and selling any products approved for sale , manufacturing , preparing regulatory submissions , and conducting nonclinical studies and clinical trials . the amount and timing of our future funding requirements will depend on many factors , including the pace and results of our clinical development efforts , the timing and nature of the regulatory approval process for our product candidates , and the revenue generated by otiprio and our other product candidates , if approved . when additional financing is required , we anticipate we will seek funding through public or private equity or debt financings or other sources , such as potential collaboration arrangements . we may not be able to raise capital on terms acceptable to us , or at all . our failure to raise capital as and when needed could have a negative impact on our financial condition and our ability to pursue our business strategies . we believe our existing cash and cash equivalents and short-term investments will be sufficient to fund our currently planned operations for a period of at least twelve months from the date of this report . in november 2008 , we entered into an exclusive license agreement with the regents of the university of california ( uc ) . under the license agreement , uc granted us an exclusive license under their rights to patents and applications that are co-developed and co-owned with us for the treatment of human otic diseases . our financial obligations under the license agreement include development and regulatory milestone payments of up to $ 2.7 million per licensed product , of which $ 1.9 million has been paid for otiprio , $ 0.8 million has been paid for otividex , and $ 0.1 million has been paid for oto-311 ( but such milestone payments are reduced by 75 % for any orphan indication product ) , and a low single-digit royalty on net sales by us or our affiliates of licensed products . in addition , for each sublicense we grant we are obligated to pay uc a fixed percentage of all royalties as well as a sliding-scale percentage of non-royalty sublicense fees received by us under such sublicense , with such percentage depending on the licensed product 's stage of development when sublicensed to such third party . we have the right to offset a certain amount of third-party royalties , milestone fees or sublicense fees against the foregoing financial obligations , provided such third-party royalties or fees are paid by us in consideration for intellectual property rights necessary to commercialize a licensed product . 64 in april 2013 , we entered into an exclusive license agreement with durect corporation ( durect ) , as part of an asset transfer agreement between us and incumed llc , an affiliate of the neurosystec corporation . under this license agreement , durect granted us an exclusive , worldwide , royalty-bearing license under durect 's rights to certain patents and applications covering our oto-313 product candidate , as well as certain related know-how . under this license agreement and the asset transfer agreement , we are obligated to make one-time milestone payments of up to $ 7.5 mil lion for the first licensed product . upon commercializing a licensed product , we are obligated to pay durect tiered , low single-digit royalties on annual net sales by us or our affiliates or sublicensees of the licensed products , and we have the right to o ffset a certain amount of third-party license fees or royalties against such royalty payments to durect . in addition , each sublicense we grant to a third party is subject to payment to durect of a low double-digit percentage of all non-royalty payments we receive under such sublicense . story_separator_special_tag 69 results of operations comparison of the years ended december 31 , 2018 and 2017 the following table sets forth the significant components of our results of operations for the years ended december 31 , 2018 and 2017 ( in thousands ) : replace_table_token_2_th product sales , net . otiprio is sold in the united states upon delivery to our network of specialty distributors who fill orders received from hospitals , ambulatory surgery centers and physician offices , who are the primary end user customers of otiprio . net product sales represent revenues for otiprio sold to our distributors during this period . product sales are recorded net of estimated chargebacks , government rebates and distributor fees . cost of product sales . cost of product sales in 2018 is less than cost of product sales in 2017 primarily due to a 2017 write-down of excess inventory of $ 1.5 million , and an impairment of otiprio manufacturing equipment of $ 0.4 million . research and development expenses . the decrease of $ 10.9 in research and development expenses resulted from decreased spending for a number of activities including : ( i ) a net $ 10.5 million decrease in otividex clinical trial and development costs due to the completion and early termination of our otividex clinical trials in 2017 , which was partially offset by an increase in clinical trial costs from the otividex phase 3 trial initiated in the third quarter of 2018 ; ( ii ) a $ 2.2 million decrease in otiprio related expenses mainly due to costs incurred in 2017 related to filing our otiprio supplemental new drug application for aoe ; ( iii ) a decrease of $ 2.6 million in other research and development costs , including professional services ; and ( iv ) a $ 1.7 million decrease in personnel costs , including stock-based compensation expense , due to a reduction in headcount . these decreases were partially offset by : ( i ) an increase of $ 4.3 million in research costs for our oto-413 hearing loss program ; and ( ii ) a $ 1.8 million increase in research costs for our oto-313 tinnitus program . selling , general and administrative expenses . the decrease of $ 26.8 million in selling , general and administrative expenses was primarily related to reduced personnel costs , including stock-based compensation expense , of approximately $ 18.1 million , resulting primarily from reductions in commercial headcount during 2017 and 2018 , and a $ 8.7 million decrease in outside services and other operating expenses for otiprio promotional support . interest income . interest income consists primarily of interest earned on our available-for-sale securities . the increase of $ 0.4 million in interest income was primarily the result of increased returns on our available-for-sale securities during 2018 compared to 2017. comparison of the years ended december 31 , 2017 and 2016 the following table sets forth the significant components of our results of operations for the years ended december 31 , 2017 and 2016 ( in thousands ) : replace_table_token_3_th 70 product sales , net . in march 2016 , we began sales of otiprio in the united states to our network of specialty distributors who fill orders received from hospitals and ambulatory surgery centers , who are the primary end user customers of otiprio for use during ttp surgery . n et product sales represent revenues for otiprio sold to our distributors during this period . product sales are recorded net of estimated chargebacks , government rebates and distributor fees . cost of product sales . cost of product sales in 2017 and 2016 is greater than net product sales primarily due to fixed costs associated with manufacturing the initial commercial lots , write-downs of excess inventory and an impairment of otiprio manufacturing equipment of $ 0.4 million in 2017. research and development expenses . the decrease of $ 18.0 million in research and development expenses was primarily due to : ( i ) a net $ 12.8 million decrease in otiprio clinical trial and development costs due to completion of our otiprio label expansion trials in aoe and aomt , the completion of our phase 3b clinical trial in pediatric patients with a history of otitis media requiring tympanostomy tubes in 2016 , and a decrease in otiprio expenses related to manufacturing , which are recorded as cost of product sales since our commercial launch of otiprio . these decreases were partially offset by an increase related to the cost of filing our otiprio supplemental new drug application for aoe ; ( ii ) a $ 7.3 million decrease in otividex clinical trial and development costs due to the completion and early termination of our otividex clinical trials in 2017 and the completion of nonclinical studies and reduced expenses related to manufacturing ; and ( iii ) a $ 1.1 million decrease in oto-311 clinical trial and development costs due to the completion of the phase 1 clinical trial in 2017 and the completion of nonclinical studies . these decreases were partially offset by : ( i ) a $ 0.3 million increase in research costs for our hearing loss programs ; ( ii ) a $ 1.9 million increase in laboratory costs and facilities expense primarily due to the lease of our new headquarters facility , which began in december 2016 ; and ( iii ) a $ 1.0 million increase in personnel costs , including stock-based compensation expense , due to additional headcount . selling , general and administrative expenses . the decrease of $ 2.9 million in selling , general and administrative expenses was primarily related to reduced personnel costs , including stock-based compensation expense , of approximately $ 4.3 million , resulting from reductions in headcount during 2017. these reduced personnel costs are net of one-time termination benefits expense . this overall decrease was partially offset by a $ 1.4 million increase in outside services and facilities expense primarily

liquidity and capital resources we have incurred significant losses and negative cash flows from operations since our inception . as of december 31 , 2018 , we had an accumulated deficit of $ 415.2 million and we expect to continue to incur significant losses for the foreseeable future . we expect our research and development and selling , general and administrative expenses to continue to be substantial and , as a result , we may need additional capital to fund our operations , which we may obtain through one or more public or private equity or debt financings , or other sources such as potential collaboration arrangements . as of december 31 , 2018 , we had cash , cash equivalents and short-term investments of $ 97.3 million . we have principally financed our operations through sales and issuances of our equity securities , debt financing as well as private placements of redeemable convertible preferred stock and convertible notes . 71 the following table sets forth a summary of the primary sources and uses of cash for the years ended december 31 , 2018 , 201 7 and 201 6 ( in thousands ) : replace_table_token_4_th operating activities . the primary uses of cash were to fund increased levels of development activities for our product candidates and to support the commercialization of otiprio . we expect to continue the use of cash for development of our product candidates for the foreseeable future . net cash used in operating activities was $ 38.4 million in 2018 compared to $ 75.3 million in 2017. the $ 36.9 million decrease in the utilization of cash was primarily due to a decrease in operating losses compared to the prior year . net cash used in operating activities was $ 75.3 million in 2017 million compared to $ 94.3 million in 2016. the $ 19.0


 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 we have incurred significant losses and negative cash flows from operations since our inception . as of december 31 , 2018 , we had an accumulated deficit of $ 415.2 million and we expect to continue to incur significant losses for the foreseeable future . we expect our research and development and selling , general and administrative expenses to continue to be substantial and , as a result , we may need additional capital to fund our operations , which we may obtain through one or more public or private equity or debt financings , or other sources such as potential collaboration arrangements . as of december 31 , 2018 , we had cash , cash equivalents and short-term investments of $ 97.3 million . we have principally financed our operations through sales and issuances of our equity securities , debt financing as well as private placements of redeemable convertible preferred stock and convertible notes . 71 the following table sets forth a summary of the primary sources and uses of cash for the years ended december 31 , 2018 , 201 7 and 201 6 ( in thousands ) : replace_table_token_4_th operating activities . the primary uses of cash were to fund increased levels of development activities for our product candidates and to support the commercialization of otiprio . we expect to continue the use of cash for development of our product candidates for the foreseeable future . net cash used in operating activities was $ 38.4 million in 2018 compared to $ 75.3 million in 2017. the $ 36.9 million decrease in the utilization of cash was primarily due to a decrease in operating losses compared to the prior year . net cash used in operating activities was $ 75.3 million in 2017 million compared to $ 94.3 million in 2016. the $ 19.0
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 Suspicious Activity Report : since our inception in 2008 , we have devoted substantially all our efforts to developing and commercializing otiprio , developing our current product candidates , and providing general and administrative support for these operations . as of december 31 , 2018 , we had cash , cash equivalents and short-term investments of $ 97.3 million . we have never been profitable , and as of december 31 , 2018 , we had an accumulated deficit of $ 415.2 million . our net losses were $ 50.4 million , $ 90.1 million and $ 110.6 million for the years ended december 31 , 2018 2017 and 2016 , respectively . substantially all our net losses have resulted from research and development expenses related to our clinical trials and product development activities , commercialization expenses to launch otiprio in the u.s. market , and other general and administrative expenses . we expect to continue to incur significant expenses and operating losses for the foreseeable future as we continue to develop , seek regulatory approval , and , if approved , commercialize our product candidates . in the near term , we anticipate our expenses will continue to be substantial as we : conduct clinical development of otividex ; conduct nonclinical and clinical development of oto-313 , oto-413 and oto-510 ; contract to manufacture our product candidates ; evaluate opportunities for development of additional product candidates ; maintain and expand our intellectual property portfolio ; hire additional staff as necessary to execute our product development plan ; and operate as a public company . we will require additional financing to complete the development of and , if approved , commercialize , otividex , oto-313 , oto-413 and any other product candidates . we believe we will continue to expend substantial resources for the foreseeable future for the development of otividex , oto-313 , oto-413 and any other product candidates we may choose to pursue . these expenditures will include costs associated with marketing and selling any products approved for sale , manufacturing , preparing regulatory submissions , and conducting nonclinical studies and clinical trials . the amount and timing of our future funding requirements will depend on many factors , including the pace and results of our clinical development efforts , the timing and nature of the regulatory approval process for our product candidates , and the revenue generated by otiprio and our other product candidates , if approved . when additional financing is required , we anticipate we will seek funding through public or private equity or debt financings or other sources , such as potential collaboration arrangements . we may not be able to raise capital on terms acceptable to us , or at all . our failure to raise capital as and when needed could have a negative impact on our financial condition and our ability to pursue our business strategies . we believe our existing cash and cash equivalents and short-term investments will be sufficient to fund our currently planned operations for a period of at least twelve months from the date of this report . in november 2008 , we entered into an exclusive license agreement with the regents of the university of california ( uc ) . under the license agreement , uc granted us an exclusive license under their rights to patents and applications that are co-developed and co-owned with us for the treatment of human otic diseases . our financial obligations under the license agreement include development and regulatory milestone payments of up to $ 2.7 million per licensed product , of which $ 1.9 million has been paid for otiprio , $ 0.8 million has been paid for otividex , and $ 0.1 million has been paid for oto-311 ( but such milestone payments are reduced by 75 % for any orphan indication product ) , and a low single-digit royalty on net sales by us or our affiliates of licensed products . in addition , for each sublicense we grant we are obligated to pay uc a fixed percentage of all royalties as well as a sliding-scale percentage of non-royalty sublicense fees received by us under such sublicense , with such percentage depending on the licensed product 's stage of development when sublicensed to such third party . we have the right to offset a certain amount of third-party royalties , milestone fees or sublicense fees against the foregoing financial obligations , provided such third-party royalties or fees are paid by us in consideration for intellectual property rights necessary to commercialize a licensed product . 64 in april 2013 , we entered into an exclusive license agreement with durect corporation ( durect ) , as part of an asset transfer agreement between us and incumed llc , an affiliate of the neurosystec corporation . under this license agreement , durect granted us an exclusive , worldwide , royalty-bearing license under durect 's rights to certain patents and applications covering our oto-313 product candidate , as well as certain related know-how . under this license agreement and the asset transfer agreement , we are obligated to make one-time milestone payments of up to $ 7.5 mil lion for the first licensed product . upon commercializing a licensed product , we are obligated to pay durect tiered , low single-digit royalties on annual net sales by us or our affiliates or sublicensees of the licensed products , and we have the right to o ffset a certain amount of third-party license fees or royalties against such royalty payments to durect . in addition , each sublicense we grant to a third party is subject to payment to durect of a low double-digit percentage of all non-royalty payments we receive under such sublicense . story_separator_special_tag 69 results of operations comparison of the years ended december 31 , 2018 and 2017 the following table sets forth the significant components of our results of operations for the years ended december 31 , 2018 and 2017 ( in thousands ) : replace_table_token_2_th product sales , net . otiprio is sold in the united states upon delivery to our network of specialty distributors who fill orders received from hospitals , ambulatory surgery centers and physician offices , who are the primary end user customers of otiprio . net product sales represent revenues for otiprio sold to our distributors during this period . product sales are recorded net of estimated chargebacks , government rebates and distributor fees . cost of product sales . cost of product sales in 2018 is less than cost of product sales in 2017 primarily due to a 2017 write-down of excess inventory of $ 1.5 million , and an impairment of otiprio manufacturing equipment of $ 0.4 million . research and development expenses . the decrease of $ 10.9 in research and development expenses resulted from decreased spending for a number of activities including : ( i ) a net $ 10.5 million decrease in otividex clinical trial and development costs due to the completion and early termination of our otividex clinical trials in 2017 , which was partially offset by an increase in clinical trial costs from the otividex phase 3 trial initiated in the third quarter of 2018 ; ( ii ) a $ 2.2 million decrease in otiprio related expenses mainly due to costs incurred in 2017 related to filing our otiprio supplemental new drug application for aoe ; ( iii ) a decrease of $ 2.6 million in other research and development costs , including professional services ; and ( iv ) a $ 1.7 million decrease in personnel costs , including stock-based compensation expense , due to a reduction in headcount . these decreases were partially offset by : ( i ) an increase of $ 4.3 million in research costs for our oto-413 hearing loss program ; and ( ii ) a $ 1.8 million increase in research costs for our oto-313 tinnitus program . selling , general and administrative expenses . the decrease of $ 26.8 million in selling , general and administrative expenses was primarily related to reduced personnel costs , including stock-based compensation expense , of approximately $ 18.1 million , resulting primarily from reductions in commercial headcount during 2017 and 2018 , and a $ 8.7 million decrease in outside services and other operating expenses for otiprio promotional support . interest income . interest income consists primarily of interest earned on our available-for-sale securities . the increase of $ 0.4 million in interest income was primarily the result of increased returns on our available-for-sale securities during 2018 compared to 2017. comparison of the years ended december 31 , 2017 and 2016 the following table sets forth the significant components of our results of operations for the years ended december 31 , 2017 and 2016 ( in thousands ) : replace_table_token_3_th 70 product sales , net . in march 2016 , we began sales of otiprio in the united states to our network of specialty distributors who fill orders received from hospitals and ambulatory surgery centers , who are the primary end user customers of otiprio for use during ttp surgery . n et product sales represent revenues for otiprio sold to our distributors during this period . product sales are recorded net of estimated chargebacks , government rebates and distributor fees . cost of product sales . cost of product sales in 2017 and 2016 is greater than net product sales primarily due to fixed costs associated with manufacturing the initial commercial lots , write-downs of excess inventory and an impairment of otiprio manufacturing equipment of $ 0.4 million in 2017. research and development expenses . the decrease of $ 18.0 million in research and development expenses was primarily due to : ( i ) a net $ 12.8 million decrease in otiprio clinical trial and development costs due to completion of our otiprio label expansion trials in aoe and aomt , the completion of our phase 3b clinical trial in pediatric patients with a history of otitis media requiring tympanostomy tubes in 2016 , and a decrease in otiprio expenses related to manufacturing , which are recorded as cost of product sales since our commercial launch of otiprio . these decreases were partially offset by an increase related to the cost of filing our otiprio supplemental new drug application for aoe ; ( ii ) a $ 7.3 million decrease in otividex clinical trial and development costs due to the completion and early termination of our otividex clinical trials in 2017 and the completion of nonclinical studies and reduced expenses related to manufacturing ; and ( iii ) a $ 1.1 million decrease in oto-311 clinical trial and development costs due to the completion of the phase 1 clinical trial in 2017 and the completion of nonclinical studies . these decreases were partially offset by : ( i ) a $ 0.3 million increase in research costs for our hearing loss programs ; ( ii ) a $ 1.9 million increase in laboratory costs and facilities expense primarily due to the lease of our new headquarters facility , which began in december 2016 ; and ( iii ) a $ 1.0 million increase in personnel costs , including stock-based compensation expense , due to additional headcount . selling , general and administrative expenses . the decrease of $ 2.9 million in selling , general and administrative expenses was primarily related to reduced personnel costs , including stock-based compensation expense , of approximately $ 4.3 million , resulting from reductions in headcount during 2017. these reduced personnel costs are net of one-time termination benefits expense . this overall decrease was partially offset by a $ 1.4 million increase in outside services and facilities expense primarily

