“…11 Specifically, when monthly baseline rates of 0.22, 0.39, and 8 were simulated, mean times to a false alarm, 41.1, 41.5, and 43.3 years, respectively, were comparable to the 41.7 years reported previously (Table 2). However, additional simulations of baseline rates and ''optimal'' k and h combinations, recommended but not reported, 11 produced a wide range (357-978 months) of mean time to first false alarm compared with the expected time of 500 months. These findings emphasize the need to closely evaluate the performance of the cusum technique prior to the adoption of ''optimal'' parameters.…”