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It has been estimated that 4-7% of civil aviation incidents and accidents can be attributed to fatigued pilots. "In the last 16 years, fatigue has been associated with 250 fatalities in air carrier accidents." Robert Sumwalt, NTSB vice chairman, said at an FAA symposium in July. Symptoms associated with fatigue include slower reaction times, difficulty concentrating on tasks resulting in procedural mistakes, lapses in attention, inability to anticipate events, higher toleration for risk, forgetfulness, and reduced decision-making ability. The magnitude of these effects are correlated to the circadian rhythm and length of time awake. Performance is affected the most, when there is a combination of extended wakefulness and circadian influences. A Federal Aviation Administration (FAA) study of 55 human-factor aviation accidents from 1978 to 1999, concluded accidents increased proportionally to the amount of time the captain had been on duty. The accident proportion relative to exposure proportion rose from 0.79