on august 2 , 2019 , cms granted approval for a new technology add-on payment ( ntap ) for the t2bacteria panel for fiscal year 2020 and in september 2020 , cms extended the approval for 2021. in september 2019 , barda awarded us a milestone-based contract , with an initial value of $ 6 million , and a potential value of up to $ 69 million , for the development of new direct-from-blood diagnostic panels that will run on the t2dx . in september 2020 , we completed the initial phase and barda exercised the first contract option valued at $ 10.5 million . the existing reimbursement codes support our sepsis products and anticipate the same for our lyme disease product candidates . the economic savings associated with our sepsis products are realized directly by hospitals . in the united states , we have a commercial team that is primarily targeting hospitals with the highest concentration of patients at risk for sepsis-related infections . internationally , we have primarily partnered with distributors that target large hospitals in their respective international markets . we believe our sepsis products , which include t2candida , t2bacteria , t2resistance , and t2cauris , will redefine the standard of care in sepsis management while lowering healthcare costs by improving both the precision and the speed to detection of sepsis-causing pathogens . according to a study published in the journal of clinical microbiology in 2010 , targeted therapy for patients with bloodstream infections can be delayed up to 72 hours due to the wait time for blood culture results . in another study published in clinical infectious diseases in 2012 , the delayed administration of appropriate antifungal therapy was associated with higher mortality among patients with septic shock attributed to candida infection and , on that basis , the study concluded that more rapid and accurate diagnostic techniques are needed . due to the high mortality rate associated with candida infections , physicians often will place patients on antifungal drugs while they await blood culture diagnostic results which generally take at least five days to generate a negative test result . antifungal drugs are toxic and may result in side effects and can cost over $ 50 per day . the speed to result of t2candida and t2bacteria coupled with their higher sensitivity as compared to blood culture may help reduce the overuse of ineffective , or even unnecessary , antimicrobial therapy which may reduce side effects for patients , lower hospital costs and potentially counteract the growing resistance to antimicrobial therapy . the administration of inappropriate therapy is a driving force behind the spread of antimicrobial-resistant pathogens , which the united states centers for disease control and prevention , or the cdc , recently called “ one of our most serious health threats . ” the addition of the use of our products , t2bacteria , t2candida , and t2resistance , which all run on the t2dx instrument , with the standard of care for the management of patients suspected of sepsis , enables clinicians to potentially treat 90 % of patients with sepsis pathogen infections with the right targeted therapy within the first twelve hours of development of the symptoms of disease . currently , high risk patients are typically initially treated with broad spectrum antibiotic drugs that typically cover approximately 60 % of patients with infections . of the remaining 40 % of patients , approximately 30 % of the patients typically have a bacterial infection and 10 % typically have candida infections . t2candida and t2bacteria are designed to identify pathogens commonly not covered by broad spectrum antibiotic drugs . we compete with traditional blood culture-based diagnostic companies , including becton dickinson & co. and biomerieux , inc. , as well as companies offering post-culture species identification using both molecular and non-molecular methods , including biomerieux , inc. ( and its affiliate , biofire diagnostics , inc. ) , bruker corporation , accelerate diagnostics , luminex , genmark , cepheid and beckman coulter , a danaher company . in addition , there may be a number of new market entrants in the process of developing other post-blood culture diagnostic technologies that may be perceived as competitive with our technology . karius , inc. offers a lab developed culture independent diagnostic test for the identification of pathogens that has not been cleared by the fda but may be perceived as competitive with our technology . we have never been profitable and have incurred net losses in each year since inception . our accumulated deficit at december 31 , 2020 was $ 423.0 million and we have experienced cash outflows from operating activities over the past years . substantially all of our net losses resulted from costs incurred in connection with our research and development programs and from selling , general and administrative costs associated with our operations . we have incurred significant commercialization expenses related to product sales , marketing , manufacturing and distribution of our fda-cleared products , t2dx , t2candida and t2bacteria . in addition , we will continue to incur significant costs and expenses as we continue to develop other product candidates , improve existing products and maintain , expand and protect our intellectual property portfolio . we may seek to fund our operations through public equity or private equity or debt financings , as well as other sources . however , we may be unable to raise additional funds or enter into such other arrangements when needed on favorable terms or at all . our failure to raise capital or enter into such other arrangements if and when needed would have a negative impact on our business , results of operations and financial condition and our ability to develop , commercialize and drive adoption of the t2dx instrument , t2candida , t2bacteria , t2resistance , t2sars-cov-2 and future t2mr-based diagnostics . story_separator_special_tag the increase was driven by a $ 1.2 million increase in consulting expenses primarily related to the barda contract , an increase of $ 0.2 million in lab and facility expenses primarily for the barda contract and our t2sars-cov-2 panel and higher study related expenses of $ 0.1 million for assay development . these increases were partially offset by a $ 0.8 million decrease in payroll related and travel expenses due to a reduction in headcount and lower materials costs of $ 0.1 million . selling , general and administrative expenses selling , general and administrative expenses were $ 21.3 million for the year ended december 31 , 2020 , compared to $ 27.3 million for the year ended december 31 , 2019 , a decrease of $ 6.0 million . the decrease is driven by a decrease in payroll related expenses of $ 3.8 million and travel expenses of $ 1.0 million , all of which are attributable to a reduction in headcount and travel restrictions as a result of the covid-19 pandemic . stock compensation expense decreased by $ 1.0 million due to the market based restricted stock units reaching the end of the derived service periods and a reduction in headcount . tradeshow and other marketing expenses decreased by $ 0.9 million , primarily due to the impact of the covid-19 pandemic cancellations . expenses related to systems restoration from the 2019 cyber-attack decreased by $ 0.7 million . there was $ 0.2 million less of conferences , primarily due to the covid-19 pandemic cancellations , and $ 0.1 million less dues and subscriptions . the decreases are partially offset by an increase of $ 0.6 million in it support and consulting primarily due to remediating the material weakness , an increase of $ 0.5 million in d & o insurance premiums , and a $ 0.5 million impairment charge from a vacated operating lease , and an increase of $ 0.1 million in consulting fees primarily related to temporary help related to final cyber-recovery efforts in early 2020 , compliance with section 404 of the sarbanes-oxley act and a board members search . interest income interest income was immaterial for the years ended december 31 , 2020 and 2019. interest expense interest expense was $ 5.5 million for the year ended december 31 , 2020 , compared to $ 7.3 million for the year ended december 31 , 2019. interest expense decreased by $ 1.8 million primarily due to the change in fair value of the derivative associated with the crg term loan agreement . 65 other income , net other income , net , was $ 0.1 million for the year ended december 31 , 2020 , compared to $ 0.4 million for the year ended december 31 , 2019. other income , net , decreased $ 0.3 million primarily due to decreased dividend and other investment income . liquidity and capital resources we have incurred losses and cumulative negative cash flows from operations since our inception , and as of december 31 , 2020 and 2019 we had an accumulated deficit of $ 423.0 million and $ 376.2 million respectively . having obtained clearance from the fda and a ce mark in europe to market the t2dx , t2candida , and t2bacteria , we have incurred significant commercialization expenses related to product sales , marketing , manufacturing and distribution . we may seek to continue to fund our operations through public equity or private equity or debt financings , as well as other sources . however , we may be unable to raise additional funds or enter into such other arrangements when needed on favorable terms or at all . our failure to raise capital or enter into such other arrangements if and when needed would have a negative impact on our business , results of operations and financial condition and our ability to develop and commercialize t2dx , t2candida , t2bacteria , t2sars-cov-2 and other product candidates . historically , we have funded our operations primarily through our august 2014 initial public offering , our december 2015 public offering , our september 2016 private investment in public equity ( “ pipe ” ) financing , our september 2017 public offering , our june 2018 public offering , our july 2019 establishment of an equity distribution agreement and equity purchase agreement ( note 7 ) , private placements of redeemable convertible preferred stock and debt financing arrangements . equity distribution agreement on july 30 , 2019 , we entered into an equity distribution agreement ( the “ sales agreement ” ) with canaccord genuity llc , as agent ( “ canaccord ” ) , pursuant to which we may offer and sell shares of common stock in an “ at the market offering ” as defined in rule 415 ( a ) ( 4 ) of the securities act , for aggregate gross sale proceeds of up to $ 30.0 million from time to time through canaccord . on march 9 , 2020 , we entered into an amendment to the sales agreement to increase the aggregate gross sales amount from $ 30.0 million to $ 65.0 million . on april 8 , 2020 , we entered into an amendment to the sales agreement to increase the aggregate gross sales amount from $ 65.0 million to $ 95.0 million . as of december 31 , 2020 , we had sold 101,606,667 shares of common stock with an aggregate gross sales amount of $ 95.0 million . we had agreed to pay canaccord for its services of acting as agent 3 % of the gross proceeds from the sale of the shares pursuant to the sales agreement . legal and accounting fees were reclassified to share capital upon issuance of shares under the sales agreement . purchase agreement on july 29 , 2019 , we entered into a $ 30.0 million purchase agreement ( the “ purchase agreement ” ) with lincoln park capital fund

net cash used in operating activities net cash used in operating activities was $ 43.2 million for the year ended december 31 , 2020 , and consisted primarily of a net loss of $ 46.8 million , an adjustment for non-cash items including stock-based compensation expense of $ 3.9 million , non-cash interest expense of $ 3.2 million , depreciation and amortization expense of $ 1.7 million , non-cash lease expense of $ 1.5 million , a change in fair value of derivative of $ 1.4 million , covid-19 related impairment charge of $ 0.6 million of our t2-owned instruments and components , an impairment of one of our operating lease assets of $ 0.5 million , amortization of bond premium of $ 0.1 million , and a net change in operating assets and liabilities of $ 6.5 million . the net change in operating assets and liabilities was primarily driven by a decrease in operating lease liabilities of $ 2.7 million , an increase in accounts receivable of $ 2.2 million due to higher consumable and instrument sales shipped near quarter end , a decrease in accounts payable of $ 1.6 million due to timing of payments , and an increase in prepaid expenses and other assets of $ 1.1 million primarily related to order deposits with our contract manufacturer and increased software subscriptions , partially offset by an increase in accrued expenses of $ 0.4 million primarily from bonus , $ 0.4 million of a decrease in inventory primarily due to increased sales and an increase in deferred revenue of $ 0.3 million primarily due to warranty and service performance obligations associated with the recent instrument sales . net cash used in operating activities was $ 45.4 million for the year ended december 31 , 2019 , and consisted primarily of a net loss of $ 59.0 million , an adjustment for non-cash items including stock-based compensation expense of $ 5.5 million , non-cash interest expense of $ 2.4 million , depreciation and amortization expense of $ 2.2 million , amortization of operating lease assets of $ 1.4 million , and a change in fair value of derivative of $ 0.3


 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.
     ```net cash used in operating activities net cash used in operating activities was $ 43.2 million for the year ended december 31 , 2020 , and consisted primarily of a net loss of $ 46.8 million , an adjustment for non-cash items including stock-based compensation expense of $ 3.9 million , non-cash interest expense of $ 3.2 million , depreciation and amortization expense of $ 1.7 million , non-cash lease expense of $ 1.5 million , a change in fair value of derivative of $ 1.4 million , covid-19 related impairment charge of $ 0.6 million of our t2-owned instruments and components , an impairment of one of our operating lease assets of $ 0.5 million , amortization of bond premium of $ 0.1 million , and a net change in operating assets and liabilities of $ 6.5 million . the net change in operating assets and liabilities was primarily driven by a decrease in operating lease liabilities of $ 2.7 million , an increase in accounts receivable of $ 2.2 million due to higher consumable and instrument sales shipped near quarter end , a decrease in accounts payable of $ 1.6 million due to timing of payments , and an increase in prepaid expenses and other assets of $ 1.1 million primarily related to order deposits with our contract manufacturer and increased software subscriptions , partially offset by an increase in accrued expenses of $ 0.4 million primarily from bonus , $ 0.4 million of a decrease in inventory primarily due to increased sales and an increase in deferred revenue of $ 0.3 million primarily due to warranty and service performance obligations associated with the recent instrument sales . net cash used in operating activities was $ 45.4 million for the year ended december 31 , 2019 , and consisted primarily of a net loss of $ 59.0 million , an adjustment for non-cash items including stock-based compensation expense of $ 5.5 million , non-cash interest expense of $ 2.4 million , depreciation and amortization expense of $ 2.2 million , amortization of operating lease assets of $ 1.4 million , and a change in fair value of derivative of $ 0.3
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 Suspicious Activity Report : on august 2 , 2019 , cms granted approval for a new technology add-on payment ( ntap ) for the t2bacteria panel for fiscal year 2020 and in september 2020 , cms extended the approval for 2021. in september 2019 , barda awarded us a milestone-based contract , with an initial value of $ 6 million , and a potential value of up to $ 69 million , for the development of new direct-from-blood diagnostic panels that will run on the t2dx . in september 2020 , we completed the initial phase and barda exercised the first contract option valued at $ 10.5 million . the existing reimbursement codes support our sepsis products and anticipate the same for our lyme disease product candidates . the economic savings associated with our sepsis products are realized directly by hospitals . in the united states , we have a commercial team that is primarily targeting hospitals with the highest concentration of patients at risk for sepsis-related infections . internationally , we have primarily partnered with distributors that target large hospitals in their respective international markets . we believe our sepsis products , which include t2candida , t2bacteria , t2resistance , and t2cauris , will redefine the standard of care in sepsis management while lowering healthcare costs by improving both the precision and the speed to detection of sepsis-causing pathogens . according to a study published in the journal of clinical microbiology in 2010 , targeted therapy for patients with bloodstream infections can be delayed up to 72 hours due to the wait time for blood culture results . in another study published in clinical infectious diseases in 2012 , the delayed administration of appropriate antifungal therapy was associated with higher mortality among patients with septic shock attributed to candida infection and , on that basis , the study concluded that more rapid and accurate diagnostic techniques are needed . due to the high mortality rate associated with candida infections , physicians often will place patients on antifungal drugs while they await blood culture diagnostic results which generally take at least five days to generate a negative test result . antifungal drugs are toxic and may result in side effects and can cost over $ 50 per day . the speed to result of t2candida and t2bacteria coupled with their higher sensitivity as compared to blood culture may help reduce the overuse of ineffective , or even unnecessary , antimicrobial therapy which may reduce side effects for patients , lower hospital costs and potentially counteract the growing resistance to antimicrobial therapy . the administration of inappropriate therapy is a driving force behind the spread of antimicrobial-resistant pathogens , which the united states centers for disease control and prevention , or the cdc , recently called “ one of our most serious health threats . ” the addition of the use of our products , t2bacteria , t2candida , and t2resistance , which all run on the t2dx instrument , with the standard of care for the management of patients suspected of sepsis , enables clinicians to potentially treat 90 % of patients with sepsis pathogen infections with the right targeted therapy within the first twelve hours of development of the symptoms of disease . currently , high risk patients are typically initially treated with broad spectrum antibiotic drugs that typically cover approximately 60 % of patients with infections . of the remaining 40 % of patients , approximately 30 % of the patients typically have a bacterial infection and 10 % typically have candida infections . t2candida and t2bacteria are designed to identify pathogens commonly not covered by broad spectrum antibiotic drugs . we compete with traditional blood culture-based diagnostic companies , including becton dickinson & co. and biomerieux , inc. , as well as companies offering post-culture species identification using both molecular and non-molecular methods , including biomerieux , inc. ( and its affiliate , biofire diagnostics , inc. ) , bruker corporation , accelerate diagnostics , luminex , genmark , cepheid and beckman coulter , a danaher company . in addition , there may be a number of new market entrants in the process of developing other post-blood culture diagnostic technologies that may be perceived as competitive with our technology . karius , inc. offers a lab developed culture independent diagnostic test for the identification of pathogens that has not been cleared by the fda but may be perceived as competitive with our technology . we have never been profitable and have incurred net losses in each year since inception . our accumulated deficit at december 31 , 2020 was $ 423.0 million and we have experienced cash outflows from operating activities over the past years . substantially all of our net losses resulted from costs incurred in connection with our research and development programs and from selling , general and administrative costs associated with our operations . we have incurred significant commercialization expenses related to product sales , marketing , manufacturing and distribution of our fda-cleared products , t2dx , t2candida and t2bacteria . in addition , we will continue to incur significant costs and expenses as we continue to develop other product candidates , improve existing products and maintain , expand and protect our intellectual property portfolio . we may seek to fund our operations through public equity or private equity or debt financings , as well as other sources . however , we may be unable to raise additional funds or enter into such other arrangements when needed on favorable terms or at all . our failure to raise capital or enter into such other arrangements if and when needed would have a negative impact on our business , results of operations and financial condition and our ability to develop , commercialize and drive adoption of the t2dx instrument , t2candida , t2bacteria , t2resistance , t2sars-cov-2 and future t2mr-based diagnostics . story_separator_special_tag the increase was driven by a $ 1.2 million increase in consulting expenses primarily related to the barda contract , an increase of $ 0.2 million in lab and facility expenses primarily for the barda contract and our t2sars-cov-2 panel and higher study related expenses of $ 0.1 million for assay development . these increases were partially offset by a $ 0.8 million decrease in payroll related and travel expenses due to a reduction in headcount and lower materials costs of $ 0.1 million . selling , general and administrative expenses selling , general and administrative expenses were $ 21.3 million for the year ended december 31 , 2020 , compared to $ 27.3 million for the year ended december 31 , 2019 , a decrease of $ 6.0 million . the decrease is driven by a decrease in payroll related expenses of $ 3.8 million and travel expenses of $ 1.0 million , all of which are attributable to a reduction in headcount and travel restrictions as a result of the covid-19 pandemic . stock compensation expense decreased by $ 1.0 million due to the market based restricted stock units reaching the end of the derived service periods and a reduction in headcount . tradeshow and other marketing expenses decreased by $ 0.9 million , primarily due to the impact of the covid-19 pandemic cancellations . expenses related to systems restoration from the 2019 cyber-attack decreased by $ 0.7 million . there was $ 0.2 million less of conferences , primarily due to the covid-19 pandemic cancellations , and $ 0.1 million less dues and subscriptions . the decreases are partially offset by an increase of $ 0.6 million in it support and consulting primarily due to remediating the material weakness , an increase of $ 0.5 million in d & o insurance premiums , and a $ 0.5 million impairment charge from a vacated operating lease , and an increase of $ 0.1 million in consulting fees primarily related to temporary help related to final cyber-recovery efforts in early 2020 , compliance with section 404 of the sarbanes-oxley act and a board members search . interest income interest income was immaterial for the years ended december 31 , 2020 and 2019. interest expense interest expense was $ 5.5 million for the year ended december 31 , 2020 , compared to $ 7.3 million for the year ended december 31 , 2019. interest expense decreased by $ 1.8 million primarily due to the change in fair value of the derivative associated with the crg term loan agreement . 65 other income , net other income , net , was $ 0.1 million for the year ended december 31 , 2020 , compared to $ 0.4 million for the year ended december 31 , 2019. other income , net , decreased $ 0.3 million primarily due to decreased dividend and other investment income . liquidity and capital resources we have incurred losses and cumulative negative cash flows from operations since our inception , and as of december 31 , 2020 and 2019 we had an accumulated deficit of $ 423.0 million and $ 376.2 million respectively . having obtained clearance from the fda and a ce mark in europe to market the t2dx , t2candida , and t2bacteria , we have incurred significant commercialization expenses related to product sales , marketing , manufacturing and distribution . we may seek to continue to fund our operations through public equity or private equity or debt financings , as well as other sources . however , we may be unable to raise additional funds or enter into such other arrangements when needed on favorable terms or at all . our failure to raise capital or enter into such other arrangements if and when needed would have a negative impact on our business , results of operations and financial condition and our ability to develop and commercialize t2dx , t2candida , t2bacteria , t2sars-cov-2 and other product candidates . historically , we have funded our operations primarily through our august 2014 initial public offering , our december 2015 public offering , our september 2016 private investment in public equity ( “ pipe ” ) financing , our september 2017 public offering , our june 2018 public offering , our july 2019 establishment of an equity distribution agreement and equity purchase agreement ( note 7 ) , private placements of redeemable convertible preferred stock and debt financing arrangements . equity distribution agreement on july 30 , 2019 , we entered into an equity distribution agreement ( the “ sales agreement ” ) with canaccord genuity llc , as agent ( “ canaccord ” ) , pursuant to which we may offer and sell shares of common stock in an “ at the market offering ” as defined in rule 415 ( a ) ( 4 ) of the securities act , for aggregate gross sale proceeds of up to $ 30.0 million from time to time through canaccord . on march 9 , 2020 , we entered into an amendment to the sales agreement to increase the aggregate gross sales amount from $ 30.0 million to $ 65.0 million . on april 8 , 2020 , we entered into an amendment to the sales agreement to increase the aggregate gross sales amount from $ 65.0 million to $ 95.0 million . as of december 31 , 2020 , we had sold 101,606,667 shares of common stock with an aggregate gross sales amount of $ 95.0 million . we had agreed to pay canaccord for its services of acting as agent 3 % of the gross proceeds from the sale of the shares pursuant to the sales agreement . legal and accounting fees were reclassified to share capital upon issuance of shares under the sales agreement . purchase agreement on july 29 , 2019 , we entered into a $ 30.0 million purchase agreement ( the “ purchase agreement ” ) with lincoln park capital fund

