as we engage in clinical trials of our therapeutic candidates , we have compensated and intend to compensate all parties performing the trials or studies only on terms that are standard and customary in clinical study arrangements . to date , we have devoted substantially all of our resources to research and development efforts relating to our therapeutic candidates and biotherapeutic delivery systems , including conducting clinical trials , developing manufacturing and sales capabilities , in-licensing related intellectual property , providing general and administrative support for these operations and protecting our intellectual property . we have also generated modest revenues from sales of our approved products . we have funded our operations primarily through the sales of equity and convertible debt securities , and certain government and private grants . cardiamp cell therapy system we initiated our u.s. food and drug administration , or fda , accepted phase iii pivotal trial for cardiamp cell therapy in ischemic systolic heart failure , in december 2016. the cardiamp heart failure trial is a phase iii , multi-center , randomized , double-blinded , sham-controlled study of up to 260 patients at 40 centers nationwide , which includes a 10-patient roll-in cohort . the phase iii pivotal trial is designed to provide the primary support for the safety and efficacy of the cardiamp cell therapy system . the trial 's primary endpoint is a clinical composite of major adverse cardiac and cerebrovascular events and functional capacity as measured by six minute walk distance . based on the results achieved in the phase ii trial , our phase iii pivotal trial is designed to have more than 95 % probability of achieving a positive result with statistical significance . the ongoing cardiamp heart failure trial is enrolling today at 25 clinical sites . the trial investigators have enrolled 74 patients to date . on march 31 , 2020 , the company announced that the dsmb completed a prespecified data review , and that based on the dsmb 's review of all available safety data for patients randomized in the trial to date , there were no safety concerns and that the dsmb recommended continuing the trial as planned . in the fourth quarter of 2020 , a prespecified dsmb interim readout from the trial will include all patients enrolled at that time point , and include our first dsmb review of efficacy on 60 patients at the one year follow-up , which includes the primary endpoint . enrollment remains our primary focus and challenge . we have recently identified two barriers for patients to participate in the trial . the first of these is that prospective patients are interested in receiving therapy and are concerned about being in a non-treated control arm that does not have a path to receive therapy . secondly , the requirement for patient out of pocket copays in our medicare reimbursed trial presents an additional impediment to patient follow-up . to address these barriers to patient participation , we submitted an investigational device exemption ( ide ) supplement to the fda with changes to enable patients in the control arm to “ cross over ” to therapy after certain follow-up visits in the trial have been completed , which assures the trial control arm patients early access to therapy if the trial meets its primary endpoint and is deemed appropriate for the patients by their physicians , and to enable biocardia to cover the costs of all patient co-pays so that participation in the investigational trial is free for insured patients . the fda has recently approved this ide supplement . these changes , coupled with site specific plans intended to further accelerate enrollment , are being actively rolled out . we have been excited by an enormous uptick in the number of patient informed consents received for participation in the cardiamp heart failure trial in march 2020 and a number of centers finally coming online , however this solid progress has been delayed by covid-19 . 54 we are currently assessing the impact of covid-19 on the enrollment in the cardiamp heart failure trial . a number of clinical centers have already advised the company that they will not be performing elective procedures for some period of time . many centers may also delay patient follow-up visits during this period out of concern for patient exposure to covid-19 . in alignment with recent fda guidance on clinical trials , “ fda guidance on conduct of clinical trials of medical products during covid-19 pandemic guidance for industry , investigators , and institutional review boards ” , the company is taking steps to address unavoidable protocol deviations due to covid-19 illness and or covid-19 control measures . the fda has approved a second ide for the randomized controlled pivotal trial of the cardiamp cell therapy system in patients with refractory chronic myocardial ischemia for up to 343 patients at up to 40 clinical sites in the united states . this therapeutic approach uses many of the same novel aspects as the cardiamp heart failure trial and is expected to leverage our experience and investment in the heart failure trial . we anticipate that many of the investigators and sites will be the same for both the heart failure and chronic myocardial ischemia indications . we are working to initiate this trial with a 5-patient roll-in cohort . timing is entirely dependent on the course of covid-19 and the response in the united states . cardiallo cell therapy system our second therapeutic candidate is the cardiallo cell therapy system , an investigational culture expanded bone marrow derived “ off the shelf ” mesenchymal cell therapy . story_separator_special_tag share-based compensation expense recognized in the statements of operations is based on awards at the time of grant and is reduced for actual forfeitures at the time that the forfeitures occur . compensation cost for employee share-based awards will be recognized over the vesting period of the applicable award on a straight-line basis . 57 results of operations the table set forth below summarizes our results of operations for the years ended december 31 , 2019 and 2018 ( in thousands ) . the results of operations from 2018 compared to 2017 and related discussion can be found in the company 's annual report on form 10-k for the year ended december 31 , 2018 , filed with the sec on april 2 , 2019 , and such results and related discussion are incorporated herein by reference . replace_table_token_1_th 58 revenue . revenue increased by approximately $ 85,000 in 2019 compared to 2018 primarily due to an increase in collaboration agreement revenues , which offset decreases in net product revenues . we expect collaboration agreement revenues to continue to increase modestly depending on progress in these existing collaborative programs and the initiation of new partnership relationships . net product revenue is expected to be limited during the year and will be subject to customer demand , the availability of production resources for our new morph product family members , and the timing of fda clearance for market release of different models and sizes during the year . cost of goods sold . cost of goods sold decreased by approximately $ 159,000 in 2019 compared to 2018 , primarily due to the decrease in net product revenue . we expect cost of goods sold to decrease in 2020 as manufacturing resources are focused on supporting clinical partners , development activities and the ongoing pivotal cardiamp heart failure trial . research and development expenses . research and development expenses increased by approximately $ 100,000 in 2019 compared to 2018 primarily due to expenses incurred in the execution of the pivotal cardiamp heart failure trial , development of the cardiallo cell therapy system and our other therapeutic programs , including fees paid to consultants and contract research organizations ( cro ) , additional personnel costs and increased stock compensation expense . we expect research and development expenses to increase moderately as we continue enrolling and treating patients in the cardiamp heart failure trial and further develop the cardiamp and cardiallo cell processing and delivery platforms . selling , general and administrative expenses . selling , general and administrative expenses increased by approximately $ 200,000 in 2019 compared to 2018 , primarily due to additional stock-based compensation expense related to the modification of certain stock option awards during the year coupled with higher corporate expenses , including business insurance premiums , additional accounting consulting staff and audit related fees . we expect selling , general and administrative expenses to decrease modestly in 2020 relative to 2019. other income ( expense ) . other income ( expense ) consisted primarily of amounts recognized in relation to the accounting for the convertible notes , including a gain on change in fair value of the embedded redemption feature of $ 52,000 , interest expense associated with the accretion of the debt discount of $ 104,000 , and a loss upon extinguishment of $ 521,000. there were no similar transactions entered into by the company during 2018. interest income of $ 87,000 and $ 112,000 was earned on cash and cash equivalents for the years ended december 31 , 2019 and 2018 , respectively . story_separator_special_tag the costs associated with securing , establishing and maintaining commercialization and manufacturing capabilities ; the number and characteristics of product candidates that we pursue , including our product candidates in preclinical development ; the ability of our product candidates to progress through clinical development successfully ; our need to expand our research and development activities ; the costs of acquiring , licensing or investing in businesses , products , product candidates and technologies ; our ability to maintain , expand and defend the scope of our intellectual property portfolio , including the amount and timing of any payments we may be required to make , or that we may receive , in connection with the licensing , filing , prosecution , defense and enforcement of any patents or other intellectual property rights ; the general and administrative expenses related to being a public company ; our need and ability to hire additional management and scientific , medical and sales personnel ; the effect of competing technological and market developments ; and our need to implement additional internal systems and infrastructure , including financial and reporting systems . 60 until such time that we can generate meaningful revenue from the sales of approved therapies and products , if ever , we expect to finance our operating activities through public or private equity or debt financings , government or other third-party funding , marketing and distribution arrangements , and other collaborations , strategic alliances and licensing arrangements or a combination of these approaches . to the extent that we raise additional capital through the sale of equity or convertible debt securities , the ownership interests of our common stock holders will be diluted , and the terms of these securities may include liquidation or other preferences that adversely affect the rights of our common stock holders . debt financing , if available , may involve agreements that include conversion discounts or covenants limiting or restricting our ability to take specific actions , such as incurring debt , making capital expenditures or declaring dividends . if we raise additional funds through government or other third-party funding , marketing and distribution arrangements or other collaborations , or strategic alliances or licensing arrangements with third parties , we may have to relinquish valuable rights to our technologies , future revenue streams , research programs , products or therapeutic candidates or to grant licenses on terms that may

liquidity and capital resources we have incurred net losses each year since our inception and as of december 31 , 2019 , we had an accumulated deficit of approximately $ 101.1 million . we anticipate that we will continue to incur net losses for at least the next several years . we have funded our operations principally through the sales of equity and convertible debt securities as well as the cash acquired through the merger . as of december 31 , 2019 , we had cash and cash equivalents of approximately $ 5.6 million . the following table shows a summary of our cash flows for the periods indicated ( in thousands ) : replace_table_token_2_th cash flows from operating activities . the decrease in cash used for operating activities of $ 1.6 million in 2019 compared to 2018 related primarily to increases in noncurrent customer deposits and deferred revenue , and board cash compensation that was deferred during the year , coupled with 2018 management bonuses being settled in equity in 2019 instead of cash . non-cash expenses recognized in 2019 in operations included reduction of the operating lease right-of-use asset of $ 440,000 , extinguishment of debt related to convertible notes payable of $ 521,000 , interest expense totaling $ 112,000 , which included accretion of the debt discount of approximately $ 104,000 , partially offset by a gain of $ 52,000 to mark derivatives to fair value upon settlement .


 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 net losses each year since our inception and as of december 31 , 2019 , we had an accumulated deficit of approximately $ 101.1 million . we anticipate that we will continue to incur net losses for at least the next several years . we have funded our operations principally through the sales of equity and convertible debt securities as well as the cash acquired through the merger . as of december 31 , 2019 , we had cash and cash equivalents of approximately $ 5.6 million . the following table shows a summary of our cash flows for the periods indicated ( in thousands ) : replace_table_token_2_th cash flows from operating activities . the decrease in cash used for operating activities of $ 1.6 million in 2019 compared to 2018 related primarily to increases in noncurrent customer deposits and deferred revenue , and board cash compensation that was deferred during the year , coupled with 2018 management bonuses being settled in equity in 2019 instead of cash . non-cash expenses recognized in 2019 in operations included reduction of the operating lease right-of-use asset of $ 440,000 , extinguishment of debt related to convertible notes payable of $ 521,000 , interest expense totaling $ 112,000 , which included accretion of the debt discount of approximately $ 104,000 , partially offset by a gain of $ 52,000 to mark derivatives to fair value upon settlement .
```    
 Suspicious Activity Report : as we engage in clinical trials of our therapeutic candidates , we have compensated and intend to compensate all parties performing the trials or studies only on terms that are standard and customary in clinical study arrangements . to date , we have devoted substantially all of our resources to research and development efforts relating to our therapeutic candidates and biotherapeutic delivery systems , including conducting clinical trials , developing manufacturing and sales capabilities , in-licensing related intellectual property , providing general and administrative support for these operations and protecting our intellectual property . we have also generated modest revenues from sales of our approved products . we have funded our operations primarily through the sales of equity and convertible debt securities , and certain government and private grants . cardiamp cell therapy system we initiated our u.s. food and drug administration , or fda , accepted phase iii pivotal trial for cardiamp cell therapy in ischemic systolic heart failure , in december 2016. the cardiamp heart failure trial is a phase iii , multi-center , randomized , double-blinded , sham-controlled study of up to 260 patients at 40 centers nationwide , which includes a 10-patient roll-in cohort . the phase iii pivotal trial is designed to provide the primary support for the safety and efficacy of the cardiamp cell therapy system . the trial 's primary endpoint is a clinical composite of major adverse cardiac and cerebrovascular events and functional capacity as measured by six minute walk distance . based on the results achieved in the phase ii trial , our phase iii pivotal trial is designed to have more than 95 % probability of achieving a positive result with statistical significance . the ongoing cardiamp heart failure trial is enrolling today at 25 clinical sites . the trial investigators have enrolled 74 patients to date . on march 31 , 2020 , the company announced that the dsmb completed a prespecified data review , and that based on the dsmb 's review of all available safety data for patients randomized in the trial to date , there were no safety concerns and that the dsmb recommended continuing the trial as planned . in the fourth quarter of 2020 , a prespecified dsmb interim readout from the trial will include all patients enrolled at that time point , and include our first dsmb review of efficacy on 60 patients at the one year follow-up , which includes the primary endpoint . enrollment remains our primary focus and challenge . we have recently identified two barriers for patients to participate in the trial . the first of these is that prospective patients are interested in receiving therapy and are concerned about being in a non-treated control arm that does not have a path to receive therapy . secondly , the requirement for patient out of pocket copays in our medicare reimbursed trial presents an additional impediment to patient follow-up . to address these barriers to patient participation , we submitted an investigational device exemption ( ide ) supplement to the fda with changes to enable patients in the control arm to “ cross over ” to therapy after certain follow-up visits in the trial have been completed , which assures the trial control arm patients early access to therapy if the trial meets its primary endpoint and is deemed appropriate for the patients by their physicians , and to enable biocardia to cover the costs of all patient co-pays so that participation in the investigational trial is free for insured patients . the fda has recently approved this ide supplement . these changes , coupled with site specific plans intended to further accelerate enrollment , are being actively rolled out . we have been excited by an enormous uptick in the number of patient informed consents received for participation in the cardiamp heart failure trial in march 2020 and a number of centers finally coming online , however this solid progress has been delayed by covid-19 . 54 we are currently assessing the impact of covid-19 on the enrollment in the cardiamp heart failure trial . a number of clinical centers have already advised the company that they will not be performing elective procedures for some period of time . many centers may also delay patient follow-up visits during this period out of concern for patient exposure to covid-19 . in alignment with recent fda guidance on clinical trials , “ fda guidance on conduct of clinical trials of medical products during covid-19 pandemic guidance for industry , investigators , and institutional review boards ” , the company is taking steps to address unavoidable protocol deviations due to covid-19 illness and or covid-19 control measures . the fda has approved a second ide for the randomized controlled pivotal trial of the cardiamp cell therapy system in patients with refractory chronic myocardial ischemia for up to 343 patients at up to 40 clinical sites in the united states . this therapeutic approach uses many of the same novel aspects as the cardiamp heart failure trial and is expected to leverage our experience and investment in the heart failure trial . we anticipate that many of the investigators and sites will be the same for both the heart failure and chronic myocardial ischemia indications . we are working to initiate this trial with a 5-patient roll-in cohort . timing is entirely dependent on the course of covid-19 and the response in the united states . cardiallo cell therapy system our second therapeutic candidate is the cardiallo cell therapy system , an investigational culture expanded bone marrow derived “ off the shelf ” mesenchymal cell therapy . story_separator_special_tag share-based compensation expense recognized in the statements of operations is based on awards at the time of grant and is reduced for actual forfeitures at the time that the forfeitures occur . compensation cost for employee share-based awards will be recognized over the vesting period of the applicable award on a straight-line basis . 57 results of operations the table set forth below summarizes our results of operations for the years ended december 31 , 2019 and 2018 ( in thousands ) . the results of operations from 2018 compared to 2017 and related discussion can be found in the company 's annual report on form 10-k for the year ended december 31 , 2018 , filed with the sec on april 2 , 2019 , and such results and related discussion are incorporated herein by reference . replace_table_token_1_th 58 revenue . revenue increased by approximately $ 85,000 in 2019 compared to 2018 primarily due to an increase in collaboration agreement revenues , which offset decreases in net product revenues . we expect collaboration agreement revenues to continue to increase modestly depending on progress in these existing collaborative programs and the initiation of new partnership relationships . net product revenue is expected to be limited during the year and will be subject to customer demand , the availability of production resources for our new morph product family members , and the timing of fda clearance for market release of different models and sizes during the year . cost of goods sold . cost of goods sold decreased by approximately $ 159,000 in 2019 compared to 2018 , primarily due to the decrease in net product revenue . we expect cost of goods sold to decrease in 2020 as manufacturing resources are focused on supporting clinical partners , development activities and the ongoing pivotal cardiamp heart failure trial . research and development expenses . research and development expenses increased by approximately $ 100,000 in 2019 compared to 2018 primarily due to expenses incurred in the execution of the pivotal cardiamp heart failure trial , development of the cardiallo cell therapy system and our other therapeutic programs , including fees paid to consultants and contract research organizations ( cro ) , additional personnel costs and increased stock compensation expense . we expect research and development expenses to increase moderately as we continue enrolling and treating patients in the cardiamp heart failure trial and further develop the cardiamp and cardiallo cell processing and delivery platforms . selling , general and administrative expenses . selling , general and administrative expenses increased by approximately $ 200,000 in 2019 compared to 2018 , primarily due to additional stock-based compensation expense related to the modification of certain stock option awards during the year coupled with higher corporate expenses , including business insurance premiums , additional accounting consulting staff and audit related fees . we expect selling , general and administrative expenses to decrease modestly in 2020 relative to 2019. other income ( expense ) . other income ( expense ) consisted primarily of amounts recognized in relation to the accounting for the convertible notes , including a gain on change in fair value of the embedded redemption feature of $ 52,000 , interest expense associated with the accretion of the debt discount of $ 104,000 , and a loss upon extinguishment of $ 521,000. there were no similar transactions entered into by the company during 2018. interest income of $ 87,000 and $ 112,000 was earned on cash and cash equivalents for the years ended december 31 , 2019 and 2018 , respectively . story_separator_special_tag the costs associated with securing , establishing and maintaining commercialization and manufacturing capabilities ; the number and characteristics of product candidates that we pursue , including our product candidates in preclinical development ; the ability of our product candidates to progress through clinical development successfully ; our need to expand our research and development activities ; the costs of acquiring , licensing or investing in businesses , products , product candidates and technologies ; our ability to maintain , expand and defend the scope of our intellectual property portfolio , including the amount and timing of any payments we may be required to make , or that we may receive , in connection with the licensing , filing , prosecution , defense and enforcement of any patents or other intellectual property rights ; the general and administrative expenses related to being a public company ; our need and ability to hire additional management and scientific , medical and sales personnel ; the effect of competing technological and market developments ; and our need to implement additional internal systems and infrastructure , including financial and reporting systems . 60 until such time that we can generate meaningful revenue from the sales of approved therapies and products , if ever , we expect to finance our operating activities through public or private equity or debt financings , government or other third-party funding , marketing and distribution arrangements , and other collaborations , strategic alliances and licensing arrangements or a combination of these approaches . to the extent that we raise additional capital through the sale of equity or convertible debt securities , the ownership interests of our common stock holders will be diluted , and the terms of these securities may include liquidation or other preferences that adversely affect the rights of our common stock holders . debt financing , if available , may involve agreements that include conversion discounts or covenants limiting or restricting our ability to take specific actions , such as incurring debt , making capital expenditures or declaring dividends . if we raise additional funds through government or other third-party funding , marketing and distribution arrangements or other collaborations , or strategic alliances or licensing arrangements with third parties , we may have to relinquish valuable rights to our technologies , future revenue streams , research programs , products or therapeutic candidates or to grant licenses on terms that may

