Using Hubble Space Telescope Imaging of Nuclear Dust Morphology to Rule Out Bars Fueling Seyfert Nuclei

If AGN are powered by the accretion of matter onto massive black holes, how does the gas in the host galaxy lose the required angular momentum to approach the black hole? Gas easily transfers angular momentum to stars in strong bars, making them likely candidates. Although ground-based searches for bars in active galaxies using both optical and near infrared surface brightness have not found any excess of bars relative to quiescent galaxies, the searches have not been able to rule out small-scale nuclear bars. To look for these nuclear bars we use HST WFPC2-NICMOS color maps to search for the straight dust lane signature of strong bars. Of the twelve Seyfert galaxies in our sample, only three have dust lanes consistent with a strong nuclear bar. Therefore, strong nuclear bars cannot be the primary fueling mechanism for Seyfert nuclei. We do find that a majority of the galaxies show an spiral morphology in their dust lanes. These spiral arms may be a possible fueling mechanism.Comment: To be published in the Astronomical Journal, June 1999. 25 pages and 14 figures. Full resolution figures are available at ftp://www.ciw.edu/pub/mregan/fullfigs.tar.g

Total thyroidectomy: Complications and technique

During the 27-year period from 1957 to 1984, four hundred thirty patients underwent total thyroidectomies for malignant or benign disease of the thyroid gland at our institutions. Thyroid cancer was found in 83.4% of cases, and 47.2% of these had concomitant lymph node dissections. Transient recurrent laryngeal nerve injury occurred in 6.2% of the entire series. Permanent unilateral vocal cord paralysis occurred in 2.5% of the patients operated on, although only 1 patient (0.45%) sustained this complication in the past 14 years. No patient had permanent bilateral vocal cord paralysis. Transient hypoparathyroidism was seen in 16.8% of patients with permanent hypoparathyroidism occurring in 4.0%. The incidence of permanent hypoparathyroidism fell to 2.7% during the past 14 years and was directly related to the extent of thyroid cancer found at operation. Postoperative complications decrease with the experience of the surgeon and increase with reoperations and extensive disease. Total thyroidectomy continues to be our treatment of choice for thyroid cancer. Au cours d'une période de 27 ans de 1957 à 1984, quatre cent trente patients ont subi une thyroïdectomie totale dans notre établissement pour des lésions bénignes ou malignes du corps thyroïdien. Dans 83.4% des cas il s'agit d'un carcinome thyroïdien, nécessitant chez 47.2% d'entre eux un curage ganglionnaire associé. On observe une atteinte transitoire du nerf récurrent laryngé dans 6.2% des cas sur la totalité de la série. Une paralysie permanente unilatérale des cordes vocales survient chez 2.5% des patients opérés, alors que durant les 14 dernières années un seul patient présente cette complication. Aucun des cas de paralysie bilatérale permanente des cordes vocales n'est observé. Une hypoparathyroïdie transitoire est constatée chez 16.8% des patients avec hypoparathyroïdie définitive dans 4.0% des cas. L'incidence de l'hypoparathyroïdisme définitif tombe à 2.7% au cours des 14 dernières années et est directement liée à l'extension du cancer thyroïdien constaté lors de l'intervention. Les complications postopératoires diminuent avec l'expérience du chirurgien et augmentent lors des réinterventions et l'extension des lésions. La thyroïdectomie totale demeure pour les auteurs le traitement de choix du cancer thyroïdien. En el lapso de los 27 años entre 1957 y 1984, cuatro cientos treinta pacientes fueron sometidos a tiroidectomía total por enfermedad maligna o benigna de la glándula tiroides en nuestras instituciones. Cáncer tiroideo fue hallado en 83.4% de los casos, y 47.2% de éstos tuvieron disecciones ganglionares concomitantes. Lesión transitoria del nervio recurrente laríngeo ocurrió en el 6.2% de la serie total. Parálisis permanente unilateral de la cuerda vocal ocurrió en 2.5% de los pacientes operados, mientras sólo un paciente (0.45%) presentó esta complicación en los últimos 14 años. Ningún paciente presento parálisis bilateral permanente de las cuerdas vocales. Hipoparatiroidismo transitorio fue observado en 16.8% de los pacientes, y el hipoparatiroidismo permanente ocurrió en el 4.0%. La incidencia de hipoparatiroidismo permanente descendió a 2.7% en los ültimos 14 años y apareció directamente relacionado con la extensión del cancer tiroideo hallada en la operación. Las complicaciones postoperatorias disminuyen en relación a la experiencia del cirujano y se incrementan con las reoperaciones y con la enfermedad muy extensa. La tiroidectomía total continúa siendo nuestra forma preferida de tratamiento para cáncer tiroideo.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41277/1/268_2005_Article_BF01655238.pd

Albuminuria in a remote South Australian Aboriginal community: results of a community based screening program for renal disease

Australi

Hashimoto's thyroiditis revisited: The association with thyroid cancer remains obscure

Hashimoto's thyroiditis (HT) is an autoimmune disease of the thyroid associated with goiter and hypothyroidism. Although there exists a clear association between HT and lymphomas of the thyroid, the association between HT and thyroid cancer remains unclear. To evaluate this further, we retrospectively reviewed the pathology reports for all thyroidectomy specimens as well as the records of patients admitted to the University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A., over a 10-yearperiod (1975–1985) with the diagnosis of HT or chronic lymphocytic thyroiditis (CLT). Eight hundred and nine pathologic diagnoses were recorded for 816 thyroidectomy specimens from 793 patients. Furthermore, 180 of 228 patient chart records were available for review. Only 128 patients satisfied our criteria for the diagnosis of HT. HT or CLT were diagnosed in 147 (18.2%) of 809 thyroid specimens. HT occurred concurrently with thyroid cancer in 24% of all cases of HT, whereas, HT occurred concurrently with benign thyroid disease in 71% of all cases of HT in all thyroid specimens. Furthermore, HT was associated with 43 (22%) of 195 cases of thyroid cancer. There were 111 (87%) women and 17 (13%) men of 128 patients whose charts were reviewed. The mean age was 49±14 years. Ninety-eight (77%) of the patients presented with goiters and 57 (45%) presented with dominant thyroid masses, 38 (67%) of which were solitary nodules. One patient (0.8%) presented with a recurrent laryngeal nerve palsy (RLNP) and 12 (9%) presented with tracheal compression. Only 29 (38.2%) of 76 patients measured had positive antithyroglobulin (ATG) titers, whereas 65 (87%) of 75 patients measured had positive antimicrosomal (AM) titers. Seventy (55%) patients were evaluated with either a technetium or 131 I thyroid scan. There was a heterogeneous pattern to the scan in 75% of these patients. Niney-one (71%) patients were initially treated with thyroid suppression. However, 27 (21%) required thyroidectomy for initial management. Ultimately, 60% required thyroidectomy and 37% required none. The major indication for surgical intervention was the presence of a dominant mass in 40 (52%) of 77 patients. Only 17 (13%) patients were found to have thyroid cancer concomitant with HT and 3(2%) had lymphoma with HT. The incidence of minimal (occult) cancer in a study of 100 consecutive autopsies at this institution was 13%. We believe that these data suggest that the association of HT with thyroid cancer is relative, at best. It will be necessary to prospectively follow both a large group of patients with HT and a control group of patients without HT for the incidence of thyroid cancer in each before this issue can be appropriately addressed. La thyroïdite d'Hashimoto (TH) est une maladie autoimmune de la thyroïde qui provoque goitre et hyperthyroïdisme. Bien que l'association entre TH et lymphome de la thyroïde soit bien établie, celle entre TH et cancer de la thyroïde reste confuse. Pour essayer de mieux élucider cette question, les auteurs ont revu rétrospectivement les comptes rendus d'histologie de toutes les pièces de thyroïdectomie, et les dossiers de tous les patients admis pendant la période 1975–1985 avec le diagnostic de TH ou de thyroïdite lymphocytique chronique (TLC). Il y avait 809 diagnostics enrégistrés pour 816 pièces de thyroïdectomie provenant de 793 patients. En outre, 180 dossiers sur 228 étaient exploitables. Cent-vingt-huit patients seulement remplissaient les conditions diagnostiques de TH. TH ou TLC étaient diagnostiquées dans 147 (18.2%) pièces sur 809. La TH était associée avec un cancer dans 24% de tous les cas de TH, alors que la TH était associée à une maladie bénigne de la thyroïde dans 71% des cas de TH. La TH était présente dans 43 (22%) sur 195 des cas de cancer de la thyroïde. Il y avait 111 (87%) femmes et 17 hommes (13%). L'âge moyen était de 49±14 ans. Quatre-vingt-huit patients (77%) avaient un goitre et 57 (45%) une masse, 38 (67%) étant un nodule solitaire. Un patient (0.8%) avait d'emblée une paralysie récurrentielle et 12 (9%) avaient une compression trachéale. Vingt-neuf (38.2%) patients seulement sur 76 avaient des anticorps antithyroglobuline thyroïdiens, et 67 (87%) des 75 patients avaient des anticorps antimicrosomiaux. Soixante-dix patients (55%) ont eu une scintigraphie au technetium ou à l'I 131: la thyroïde était hétérogène pour 75% d'entre eux. Quatre-vingt un patients (71%) ont eu une hormonothérapie suppressive en premier, alors que 27 (21%) ont eu une thyroïdectomie première. Ultérieurement, 60% des patients ont été thyroïdectomisés. L'indication principale de la chirurgie était la présence d'une masse, trouvée chez 40 (52%) des 77 patients. Seuls 17 (13%) patients avec une TH avaient un cancer simultané de la thyroïde; 3 (2%) avaient un lymphome associé à une TH. La fréquence de cancer occulte dans une étude de 100 autopsies consécutives dans notre établissement était de 13%. Nous pensons que ces résultats suggèrent que l'association TH cancer de la thyroïde n'est que fortuite. Il est nécessaire de suivre prospectivement un grand nombre de patients, divisés en 2 groupes, les uns avec TH, les autres sans, pour déterminer avec précision l'incidence de cancer dans chaque groupe avant de résoudre ce problème. La tiroiditis de Hashimoto (TH) es una enfermedad autoinmune de la tiroides, asociada con bocio e hipotiroidismo. Aunque existe una clara relación entre TH y linfomas de la tiroides, la relación entre TH y cáncer tiroideo no aparece clara. Con el fín de evaluar este asunto, hemos revisado en forma retrospectiva tanto los informes de patología de todos los especímenes de tiroidectomía, así como las historias clínicas de los pacientes admitidos al Centro Médico de la Universidad de Michigan, Ann Arbor, Michigan, con el diagnóstico de TH o de tiroiditis linfocítica crónica (TLC) en un período de 10 años (1975–1985). Se registraron 809 diagnósticos patológicos de 816 especímenes de tiroidectomía en 793 pacientes. Además, se dispuso de 180 de 228 historias clínicas para revisión. Sólo 128 pacientes satisficieron nuestros criterios para el diagnóstico de TH. TH o TLC fueron diagnosticadas en 147 (18.2%) de 809 de los Especímenes tiroideos. La TH ocurrió en forma concurrente con el cáncer tiroideo en 24% de todos los casos de TH, en tanto que la TH ocurrió en forma concurrente con enfermedad benigna de la tiroides en 71% de la totalidad de los casos de TH en todos los especímenes tiroideos. Se encontraron 111 (87%) mujeres y 17 (13%) hombres de 128 pacientes cuyas historias clínicas fueron revisadas: la edad promedio fue 49±14 años. Noventa y ocho (77%) de los pacientes presentaban bocio y 57 (45%) presentaban masas tiroideas dominantes, de las cuales 38 (67%) eran nódulos solitarios. Un paciente (0.8%) se presentó con parálisis del nervio recurrente laríngeo y 12 (9%) con compresión traqueal. Sólo 29 (38.2%) de 76 pacientes investigados tenían títulos positivos de ATG, mientras 65 (87%) de 75 tenían títulos AM positivos. Setenta (55%) fueron evaluados mediante escanografía con tecnecio o con 131 I; se observó un patrón heterogéneo en la gamagrafía en 75% de ellos. Noventa y uno (71%) fueron tratados inicialmente con supresión tiroidea. Sin embargo, 27 (21%) requirieron tiroidectomía en su manejo inicial. Al final 60% requirieron tiroidectomía y 37% no la requirieron. La indicación mayor para intervención quirúrgica fue la presencia de una masa dominante en 40 (52%) de 77 pacientes. Sólo 17 (13%) pacientes exhibieron cáncer tiroideo concomitante con TH y 3 (2%) presentaron linfoma con TH. La incidencia de cáncer mínimo (oculto) en un estudio de 100 autopsias consecutivas en nuestra institución fue 13%. Consideramos que estos datos sugieren que la relación entre TH y cáncer tiroideo es apenas relativa, en el mejor de los casos. Será necesario hacer el seguimiento prospectivo de un grupo grande de pacientes con TH y de un grupo control sin TH para detectar la incidencia de cáncer tiroideo en cada grupo para poder enfocar en forma apropiada este asunto.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41280/1/268_2005_Article_BF01655435.pd

Tumor exome sequencing and copy number alterations reveal potential predictors of intrinsic resistance to multi-targeted tyrosine kinase inhibitors

Multi-targeted tyrosine kinase inhibitors (TKIs) have broad efficacy and similar FDA-approved indications, suggesting shared molecular drug targets across cancer types. Irrespective of tumor type, 20-30% of patients treated with multi-targeted TKIs demonstrate intrinsic resistance, with progressive disease as a best response. We conducted a retrospective cohort study to identify tumor (somatic) point mutations, insertion/deletions, and copy number alterations (CNA) associated with intrinsic resistance to multi-targeted TKIs. Using a candidate gene approach (n=243), tumor next-generation sequencing and CNA data was associated with resistant and non-resistant outcomes. Resistant individuals (n=11) more commonly harbored somatic point mutations in NTRK1, KDR, TGFBR2, and PTPN11 and CNA in CDK4, CDKN2B, and ERBB2 compared to non-resistant (n=26, p<0.01). Using a random forest classification model for variable reduction and a decision tree classification model, we were able to differentiate intrinsically resistant from non-resistant patients. CNA in CDK4 and CDKN2B were the most important analytical features, implicating the cyclin D pathway as a potentially important factor in resistance to multi-targeted TKIs. Replication of these results in a larger, independent patient cohort has potential to inform personalized prescribing of these widely utilized agents

The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy

The purpose of this study was to evaluate the surgical outcome of completion thyroidectomy in patients with presumed unilateral well-differentiated thyroid cancer (WDTC). The medical records of all patients having had unilateral thyroid lobectomy for WDTC, who subsequently underwent completion thyroidectomy, were reviewed. From 1980 to 1991, 60 patients with WDTC underwent completion thyroidectomy. Forty-seven patients had presumed unilateral WDTC, with no evidence of residual disease prior to their completion thyroidectomy. Twenty-five (53%) of these patients were found to have residual neoplastic disease in the neck. In 20 (43%) of 47 patients, a focus of cancer was found in the remaining thyroid lobe and in 5 additional patients no cancer was found in the contralateral lobe, however, unsuspected nodal disease was found. The remaining 13 of the 60 patients presented with either regional recurrence (n=12) or distant metastases (n=1) at the time of their completion thyroidectomy. All (92%) but 1 of these 13 patients had cancer in the remaining thyroid lobe. Multifocal disease in the primary lobe was associated with bilateral thyroid cancer ( p <0.01). Complications were infrequent; transient hypocalcemia occurred in 5 (8%) patients, permanent hypoparathyroidism occurred in 1 (1.7%) patient, and transient recurrent laryngeal nerve palsy occurred in 3 (5%) patients. Residual WDTC was found in 37 (62%) of 60 patients undergoing completion thyroidectomy. Multifocal disease in the primary resected lobe was associated with a high incidence of contralateral thyroid cancer. Completion thyroidectomy is a safe procedure and may prevent the development of regional recurrence by eliminating an unsuspected focus of cancer. Le but de cette étude était d'évaluer l'évolution chirurgicale après thyroïdectomie totale des patients ayant un cancer thyroïdien présumé bien différencié et unilatéral (CTBD). Les données médicales de tous les patients ayant eu une lobectomie unilatérale de la thyroïde pour CTBD et qui ont eu secondairement une totalisation de la thyroïdectomie ont été revues. Entre 1980 et 1991, 60 patients ayant un CTBD ont eu une totalisation de la thyroïdectomie, quarante sept avaient un CTBD présumé unilatéral, sans argument pour une pathologie résiduelle avant la totalisation de la thyroïdectomie (groupe 1). Vingt cinq d'entre eux (53%) se sont avérés avoir un reliquat néoplasique persistant au niveau de la région cervicale. Chez 20/47 (43%) patients, on a retrouvé un foyer de cancer dans le lobe restant de la thyroïde. Chez 5 patients supplémentaires il n'a pas été retrouvé de cancer dans le lobe controlatéral mais une dystrophie nodulaire non suspecte. Les 13/60 patients restants présentaient soit une récidive régionale (12) soit des métastases à distance (1) au moment de la totalisation de la thyroïdectomie (groupe 2). Tous les patients du groupe 2 sauf un (92%) avaient un cancer dans le lobe restant. Une atteinte plurifocale dans le premier lobe était associée avec l'existence d'un cancer bilatéral ( p <0.01). Les complications ont été rares: une hypocalcémie transitoire est survenue chez 5 (8%) patients, une hypoparathyroïdie définitive est apparue chez 1 (1.7%) patient. Une paralysie récurentielle transitoire a été retrouvée chez 3 (5%) patients. Conclusions: Un reliquat de TCBD a été retrouvé chez 37/60 (62%) patients opérés d'une totalisation de thyroïdectomie. L'atteinte multifocale dans le premier lobe réséqué était associée avec une incidence élevée de cancer thyroïdien controlatéral. La totalisation de la thyroïdectomie est une procédure sans risque qui peut prévenir le développement d'une récidive régionale en éliminant un foyer de cancer non suspecté. El propósito del presente estudio fue valorar el resultado quirúrgico de completar a una tiroidectomía total la resección tiroidea realizada en pacientes con cáncer presumiblemente unilateral y bien diferenciado de la glándula tiroides (CTBD). Se revisaron las historias clínicas de todos los pacientes sometidos a lobectomía tiroidea unilateral por CTBD, en quienes subsiguientemente se completó la tiroidectomía, procedimiento que fue realizado en 60 pacientes con CTBD en el período 1980–1991. Cuarenta y siete pacientes tenían CTBD presumiblemente unilateral, sin evidencia de enfermedad residual antes de completarse la tiroidectomía (grupo 1); en veinticinco (53%) de estos pacientes se halló neoplasia residual en el cuello. En 20/47 (43%) pacientes se encontró un foco de cáncer en el lóbulo tiroideo remanente y en 5 casos adicionales aunque no se encontró cáncer en el lóbulo contralateral, se halló extensión ganglionar no sospechada. Los 13/60 pacientes restantes presentaron recurrencia (12) o metástasis distantes (1) en el momento de completarse la tiroidectomía (grupo 2). Todos los pacientes del grupo 2, excepto 1 (92%), presentaban cáncer en el lóbulo remanente. La presencia de enfermedad multifocal en el lóbulo primario apareció asociada con cáncer tiroideo bilateral ( p <0.01). Las complicaciones fueron raras; se presentó hipocalcemia transitoria en 5 (8%) pacientes, hipotiroidismo permanente en 1 (1.7%) y parálisis parcial y transitoria del nervio laríngeo recurrente en 3 (5%). Conclusiones: Se encontró CTBD en 37/60 (62%) pacientes en quienes se completó la tiroidectomía. La presencia de enfermedad multifocal en el lóbulo primario resecado apareció asociada con una alta incidencia de cáncer contralateral. El procedimiento de completar la tiroidectomía aparece como una operación segura que puede prevenir el desarrollo recurrencia regional al eliminar focos insospechados de cáncer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41292/1/268_2005_Article_BF02067365.pd

An Unusual Transmission Spectrum for the Sub-Saturn KELT-11b Suggestive of a Sub-Solar Water Abundance

We present an optical-to-infrared transmission spectrum of the inflated sub-Saturn KELT-11b measured with the Transiting Exoplanet Survey Satellite (TESS), the Hubble Space Telescope (HST) Wide Field Camera 3 G141 spectroscopic grism, and the Spitzer Space Telescope (Spitzer) at 3.6 $\mu$m, in addition to a Spitzer 4.5 $\mu$m secondary eclipse. The precise HST transmission spectrum notably reveals a low-amplitude water feature with an unusual shape. Based on free retrieval analyses with varying molecular abundances, we find strong evidence for water absorption. Depending on model assumptions, we also find tentative evidence for other absorbers (HCN, TiO, and AlO). The retrieved water abundance is generally $\lesssim 0.1\times$ solar (0.001--0.7$\times$ solar over a range of model assumptions), several orders of magnitude lower than expected from planet formation models based on the solar system metallicity trend. We also consider chemical equilibrium and self-consistent 1D radiative-convective equilibrium model fits and find they too prefer low metallicities ($[M/H] \lesssim -2$, consistent with the free retrieval results). However, all the retrievals should be interpreted with some caution since they either require additional absorbers that are far out of chemical equilibrium to explain the shape of the spectrum or are simply poor fits to the data. Finally, we find the Spitzer secondary eclipse is indicative of full heat redistribution from KELT-11b's dayside to nightside, assuming a clear dayside. These potentially unusual results for KELT-11b's composition are suggestive of new challenges on the horizon for atmosphere and formation models in the face of increasingly precise measurements of exoplanet spectra.Comment: Accepted to The Astronomical Journal. 31 pages, 20 figures, 7 table

Infrared nanoscopy of Dirac plasmons at the graphene-SiO2 interface

We report on infrared (IR) nanoscopy of 2D plasmon excitations of Dirac fermions in graphene. This is achieved by confining mid-IR radiation at the apex of a nanoscale tip: an approach yielding two orders of magnitude increase in the value of in-plane component of incident wavevector q compared to free space propagation. At these high wavevectors, the Dirac plasmon is found to dramatically enhance the near-field interaction with mid-IR surface phonons of SiO2 substrate. Our data augmented by detailed modeling establish graphene as a new medium supporting plasmonic effects that can be controlled by gate voltage.Comment: 12 pages, 4 figure

KELT-7b: A hot Jupiter transiting a bright V=8.54 rapidly rotating F-star

We report the discovery of KELT-7b, a transiting hot Jupiter with a mass of $1.28 \pm 0.18$ MJ, radius of $1.53_{-0.047}^{+0.046}$ RJ, and an orbital period of $2.7347749 \pm 0.0000039$ days. The bright host star (HD33643; KELT-7) is an F-star with $V=8.54$, Teff $=6789_{-49}^{+50}$ K, [Fe/H] $=0.139_{-0.081}^{+0.075}$, and $\log{g}=4.149 \pm 0.019$. It has a mass of $1.535_{-0.054}^{+0.066}$ Msun, a radius of $1.732_{-0.045}^{+0.043}$ Rsun, and is the fifth most massive, fifth hottest, and the ninth brightest star known to host a transiting planet. It is also the brightest star around which KELT has discovered a transiting planet. Thus, KELT-7b is an ideal target for detailed characterization given its relatively low surface gravity, high equilibrium temperature, and bright host star. The rapid rotation of the star ($73 \pm 0.5$ km/s) results in a Rossiter-McLaughlin effect with an unusually large amplitude of several hundred m/s. We find that the orbit normal of the planet is likely to be well-aligned with the stellar spin axis, with a projected spin-orbit alignment of $\lambda=9.7 \pm 5.2$ degrees. This is currently the second most rapidly rotating star to have a reflex signal (and thus mass determination) due to a planetary companion measured.Comment: Accepted to The Astronomical Journa

KELT-8b: A highly inflated transiting hot Jupiter and a new technique for extracting high-precision radial velocities from noisy spectra

We announce the discovery of a highly inflated transiting hot Jupiter discovered by the KELT-North survey. A global analysis including constraints from isochrones indicates that the V = 10.8 host star (HD 343246) is a mildly evolved, G dwarf with $T_{\rm eff} = 5754_{-55}^{+54}$ K, $\log{g} = 4.078_{-0.054}^{+0.049}$, $[Fe/H] = 0.272\pm0.038$, an inferred mass $M_{*}=1.211_{-0.066}^{+0.078}$ M$_{\odot}$, and radius $R_{*}=1.67_{-0.12}^{+0.14}$ R$_{\odot}$. The planetary companion has mass $M_P = 0.867_{-0.061}^{+0.065}$ $M_{J}$, radius $R_P = 1.86_{-0.16}^{+0.18}$ $R_{J}$, surface gravity $\log{g_{P}} = 2.793_{-0.075}^{+0.072}$, and density $\rho_P = 0.167_{-0.038}^{+0.047}$ g cm$^{-3}$. The planet is on a roughly circular orbit with semimajor axis $a = 0.04571_{-0.00084}^{+0.00096}$ AU and eccentricity $e = 0.035_{-0.025}^{+0.050}$. The best-fit linear ephemeris is $T_0 = 2456883.4803 \pm 0.0007$ BJD$_{\rm TDB}$ and $P = 3.24406 \pm 0.00016$ days. This planet is one of the most inflated of all known transiting exoplanets, making it one of the few members of a class of extremely low density, highly-irradiated gas giants. The low stellar $\log{g}$ and large implied radius are supported by stellar density constraints from follow-up light curves, plus an evolutionary and space motion analysis. We also develop a new technique to extract high precision radial velocities from noisy spectra that reduces the observing time needed to confirm transiting planet candidates. This planet boasts deep transits of a bright star, a large inferred atmospheric scale height, and a high equilibrium temperature of $T_{eq}=1675^{+61}_{-55}$ K, assuming zero albedo and perfect heat redistribution, making it one of the best targets for future atmospheric characterization studies.Comment: Submitted to ApJ, feedback is welcom