“…The first methodology specifically designed to monitor a continuous process , the cumulative sum technique, or CUSUM, was proposed by Page in 1954 (65; see also Refs. 66,67,80), is applied to biological problems according to Ewan and Kemp (31), and was used in congenital anomalies surveillance in England and Wales (39) and, thereupon, in many other systems (10,41,76,77,81). CUSUM assumes a Poisson distribution of malformation frequencies, and is a form of sequential probability testing.…”