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HOUSTON Patients admitted to Houston Methodist Hospital get a monitoring device about the size of a half-dollar affixed to their chest and an unwitting role in the expanding use of artificial intelligence in health care.

This story also ran on Fortune. It can be republished for free.

The slender, battery-powered gadget, called a BioButton, records vital signs including heart and breathing rates, then wirelessly sends the readings to nurses sitting in a 24-hour control room elsewhere in the hospital or in their homes. The devices software uses AI to analyze the voluminous data and detect signs a patients condition is deteriorating.

Hospital officials say the BioButton has improved care and reduced the workload of bedside nurses since its rollout last year.

Because we catch things earlier, patients are doing better, as we dont have to wait for the bedside team to notice if something is going wrong, said Sarah Pletcher, system vice president at Houston Methodist.

But some nurses fear the technology could wind up replacing them rather than supporting them and harming patients. Houston Methodist, one of dozens of U.S. hospitals to employ the device, is the first to use the BioButton to monitor all patients except those in intensive care, Pletcher said.

The hype around a lot of these devices is they provide care at scale for less labor costs, said Michelle Mahon, a registered nurse and an assistant director of National Nurses United, the professions largest U.S. union. This is a trend that we find disturbing, she said.

The rollout of BioButton is among the latest examples of hospitals deploying technology to improve efficiency and address a decades-old nursing shortage. But that transition has raised its own concerns, including about the devices use of AI; polls show the public is wary of health providers relying on it for patient care. The BioButton, a monitoring device, is being used in dozens of hospitals employing artificial intelligence to analyze patients vital signs. (Phil Galewitz/KFF Health News) Houston Methodist Hospital, just a few miles south of downtown Houston, is located amid a giant medical complex that includes several hospitals. (Phil Galewitz/KFF Health News)

In December 2022 the FDA cleared the BioButton for use in adult patients who are not in critical care. It is one of many AI tools now used by hospitals for tasks like reading diagnostic imaging results.

In 2023, President Joe Biden directed the Department of Health and Human Services to develop a plan to regulate AI in hospitals, including by collecting reports of patients harmed by its use.

The leader of BioIntelliSense, which developed the BioButton, said its device is a huge advance compared with nurses walking into a room every few hours to measure vital signs. With AI, you now move from I wonder why this patient crashed to I can see this crash coming before it happens and intervene appropriately, said James Mault, CEO of the Golden, Colorado-based company.

The BioButton stays on the skin with an adhesive, is waterproof, and has up to a 30-day battery life. The company says the device which allows providers to quickly notice deteriorating health by recording more than 1,000 measurements a day per patient has been used on more than 80,000 hospital patients nationwide in the past year.

Hospitals pay BioIntelliSense an annual subscription fee for the devices and software.

Houston Methodist officials would not reveal how much the hospital pays for the technology, though Pletcher said it equates to less than a cup of coffee a day per patient.

For a hospital system that treats thousands of patients at a time Houston Methodist has 2,653 non-ICU beds at its eight Houston-area hospitals such an investment could still translate to millions of dollars a year. Email Sign-Up

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Hospital officials say they have not made any changes in nurse staffing and have no plans to because of implementing the BioButton.

Inside the hospitals control center for virtual monitoring on a recent morning, about 15 nurses and technicians dressed in scrubs sat in front of large monitors showing the health status of hundreds of patients they were assigned to monitor.

A red checkmark next to a patients name signaled the AI software had found readings trending outside normal. Staff members could click into a patients medical record, showing patients vital signs over time and other medical history. These virtual nurses, if you will, could contact nurses on the floor by phone or email, or even dial directly into the patients room via video call.

Nutanben Gandhi, a technician who was watching 446 patients on her monitor that morning, said that when she gets an alert, she looks at the patients health record to see if the anomaly can be easily explained by something in the patients condition or if she needs to contact nurses on the patients floor.

Oftentimes an alert can be easily dismissed. But identifying signs of deteriorating health can be tough, said Steve Klahn, Houston Methodists clinical director of virtual medicine.

We are looking for a needle in a haystack, he said.

Donald Eustes, 65, was admitted to Houston Methodist in March for prostate cancer treatment and has since been treated for a stroke. He is happy to wear the BioButton.

You never know what can happen here, and having an extra set of eyes looking at you is a good thing, he said from his hospital bed. After being told the device uses AI, the Montgomery, Texas, man said he has no problem with its helping his clinical team. This sounds like a good use of artificial intelligence.

Patients and nurses alike benefit from remote monitoring like the BioButton, said Pletcher of Houston Methodist. A nurse inside Houston Methodist Hospitals virtual intensive care unit monitors patients from afar. Nurses can track dozens of patients using technology that helps them supplement bedside care. (Phil Galewitz/KFF Health News) Sarah Pletcher, system vice president at Houston Methodist, stands inside the hospitals 24-hour virtual intensive care unit where patients are monitored by nurses and technicians. (Phil Galewitz/KFF Health News)

The hospital has placed small cameras and microphones inside all patient rooms enabling nurses outside to communicate with patients and perform tasks such as helping with patient admissions and discharge instructions. Patients can include family members on the remote calls with nurses or a doctor, she said.

Virtual technology frees up on-duty nurses to provide more hands-on help, such as starting an intravenous line, Pletcher said. With the BioButton, nurses can wait to take routine vital signs every eight hours instead of every four, she said.

Pletcher said the device reduces nurses stress in monitoring patients and allows some to work more flexible hours because virtual care can be done from home rather than coming to the hospital. Ultimately it helps retain nurses, not drive them away, she said.

Sheeba Roy, a nurse manager at Houston Methodist, said some members of the nursing staff were nervous about relying on the device and not checking patients vital signs as often themselves. But testing has shown the device provides accurate information.

After we implemented it, the staff loves it, Roy said. Houston Methodist this year plans to send the BioButton home with patients so the hospital can better track their progress in the weeks after discharge, measuring the quality of their sleep and checking their gait.(Phil Galewitz/KFF Health News)

Serena Bumpus, chief executive officer of the Texas Nurses Association, said her concern with any technology is that it can be more burdensome on nurses and take away time with patients.

We have to be hypervigilant in ensuring that we are nt leaning on this to replace the ability of nurses to critically think and assess patients and validate what this device is telling us is true, Bumpus said.

Houston Methodist this year plans to send the BioButton home with patients so the hospital can better track their progress in the weeks after discharge, measuring the quality of their sleep and checking their gait.

We are not going to need less nurses in health care, but we have limited resources and we have to use those as thoughtfully as we can, Pletcher said. Looking at projected demand and seeing the supply we have coming, we will not have enough to meet demand, so anything we can do to give time back to nurses is a good thing.

Phil Galewitz: pgalewitz@kff.org, @philgalewitz Related Topics States Health IT Hospitals Nurses Texas Contact Us Submit a Story Tip

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A well-done steak for Deion, medium for Dabo: How CFB chefs please everyone’s palates

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A well-done steak for Deion, medium for Dabo: How CFB chefs please everyone's palates

MICHAEL JOHNSON WAS trying to find a way home.

In 2019, Johnson was the executive chef of the Seattle Seahawks, but he wanted to get back to Baton Rouge, where his children and their mother lived. One late night, Johnson dove into a job search that yielded a surprising result.

“I googled ‘executive chef Baton Rouge,’ and the first job that popped up was a listing for the executive chef of LSU Athletics,” Johnson said. “I like to tell people that God found me this job.”

Johnson had applied for a culinary position with LSU before where he would be working at Tiger Stadium, but LSU’s response was that he was overqualified.

This new gig looked perfect, but first, Johnson had to prove himself. As part of his interview, he cooked for 35 people — executives, dieticians and other high-ranking LSU officials. Johnson served up his best: a carved tenderloin and Carolina-style barbecue shrimp and grits with a tomato broth to show how he could make comfort foods a little healthier, plus several other dishes that were Louisiana-themed with a twist. The feedback came quickly.

“I remember [executive deputy AD] Verge Ausberry asking me questions like ‘Why did you hold back the salt on this?'” Johnson said. “It was an intense moment, but I just remember smiling all the way through it. Even when I was being grilled, I was so happy to be there and had all the confidence.”

Less than an hour after the demo, LSU offered Johnson the job.

In the six years since, Johnson has helped head up the LSU performance nutrition center, which opened in July 2019, has around 50 employees — 35 of them report to Johnson — and feeds athletes three meals, five days of the week. For the first three years of his time in Baton Rouge, Johnson also traveled with the football team to ensure quality control.

Now, Johnson stays back and helps manage the extensive operation, which is a collaborative effort among him, his four sous chefs and the four dieticians (one exclusively for football) on staff. Johnson’s job can also extend to include meals for recruiting visits and donor events, but his biggest task may be menu creation in a way that caters to everyone.

Johnson is one of a handful of executive chefs around the country who work directly with a college football team or athletic program. His headshot, along with the sous chefs’, is featured on the school’s athletic directory. A search through Power 4 school directories revealed that only 21 programs publicly feature a chef of some kind on their staff, and only 10 of those are in-house employees, including chefs at Colorado, Georgia, Clemson and Missouri.

“To be treated as an equal is everything,” Johnson said. “I’ve never felt like I wasn’t part of the team.”

What is largely a behind-the-scenes job, chefs at top-tier programs often work 10-12 hours a day, helping cook hundreds of meals while managing quality, a budget, evolving nutrition plans for athletes and the vexing challenge of pleasing people’s palates.

“I have gumbo on the menu every Monday, and it’s because I like my job,” said Johnson with a laugh. “It wasn’t an ask, it was a demand.”


CARL SOLOMON HAS worked in the restaurant business since he was 15 years old. He has cooked at fine-dining establishments from Portland, Oregon, to Denton, Texas, and his Instagram, which showcases the various farm-to-table dishes he crafts, is as clean as his plating. Yet nothing could have prepared him for becoming Deion Sanders’ personal chef.

That is not Solomon’s official title — that would be executive chef for Colorado Athletics — but it has become a part of his role. Their relationship is such that Solomon now makes Sanders’ meals two to three times a day.

“He comes into the kitchen daily, like hooting and hollering,” Solomon said. “He’s just an incredible human in every regard, and I get a lot of daily feedback and interaction from him.”

So what does Prime like to eat? Local, marinated roasted chicken. Well-done steak — high-quality New York strips that Solomon and his team cut and prepare in-house. Yellow rice, some broccoli, asparagus, watermelon and for dessert, a red velvet cake, cupcake or a chocolate chip cookie.

“He’s a man that knows what he wants,” Solomon said. “Which makes it a little easier for me to keep him happy.”

For a chef who had used the kitchen as a creative canvas, there was a learning curve for Solomon, who realized that variety and upscale were not always the goal when it came to Sanders. It’s emblematic of the progression Solomon has had to make over the past six years on the job as he orchestrates a system that produces roughly 800 meals a day for 330 student-athletes and about 250 athletics staff members, sometimes six days a week. The past five of those years for Solomon have come as an in-house Colorado employee — a change that he says made a dramatic difference.

“It’s huge, because I’m here every day, I’m serving the same folks every day,” Solomon said. “So I have accountability to these people I see, and my name is on this operation. That just creates this extra level of commitment and dedication you might not get otherwise.”

Solomon’s commitment and expertise can be seen in how he has set up every aspect of the dining experience. While others may gravitate toward a buffet setup, Solomon’s team cooks everything fresh and in smaller batches. The front-of-house staff Solomon manages serves the food banquet style, meaning each hot food plate is put together by a member of the team.

“I’m always on top of that, making sure we’re plating those plates nicely,” Solomon said. “I’m really proud of the fact that we bring all those fundamentals that a good restaurant has run on, we bring that to this setting.”

Then there’s the food itself. Solomon gets ample freedom to design his menus, which he crafts based on several factors, including locality, what’s in season and pricing. He also considers, as he puts it, the varying palettes and needs of a 300-pound football player versus a 100-pound track athlete.

“I’m looking for new stuff all the time,” Solomon said. “I’m very lucky in the sense that being able to do that in this setting is rare, and I take full advantage of that.”

The result is a bustling food hall with different daily options that get adjusted based on which sports are in season and which are not. And if an athlete isn’t feeling the taco bar on any given Tuesday, Solomon and his sous chefs are open to preparing them a made-to-order special item.

“We aren’t just putting out really high-quality food or great ingredients,” Solomon said. “We’re also tailoring it to specific athletes’ needs all day every day.”

Sanders’ arrival in Boulder three years ago and the attention it brought to the program trickled down to here, too, giving Solomon the kind of flexibility that allows him and his team to fabricate meats internally and source top-notch ingredients.

“That’s another big impact that we’ve seen since [Sanders] has been here — I have a lofty budget,” Solomon said. His team has grown from five cooks to 12 in the past few years.

(Clemson executive performance chef Dalton Ledford, estimated the food budget for a high-profile football program alone can range anywhere from $2 million to $3 million per year, if not more.)

The responsibility that comes with the extra resources is one Solomon cherishes and tries to pay forward with local businesses and vendors. Recently, he made a connection with a local mushroom farmer who grows “some of the best gourmet mushrooms in the state” out of a train car that he refurbished. Anything to make a dish, a meal and an entire operation just a little bit better.

“I think we put out great food, of course I’m biased, but I have been around the block, and I have done my research, and I go out to eat all the time myself,” Solomon said. “I’d put us right up there with any restaurant in the city.”


MONDAY NIGHTS IN Athens, Georgia, are reserved for victory meals.

Kirby Smart’s team gathers around as executive chef Brandi Allen and her staff go all out and treat the team to a feast that includes items such as ribeyes, lobster tails, lobster mac and cheese and often a special dessert.

“This is Georgia,” Allen said. “So we don’t lose a lot of games.”

Since 2021, the Bulldogs have lost a total of five regular-season games in five seasons, four of which have been to Alabama, which beat Georgia 24-21 earlier this season in Sanford Stadium. In the aftermath, Allen had no choice but to change up the plans for Monday’s meal.

“We just turned it into a grill day with a more chill, laid-back vibe,” Allen said. “It was a bad game, but it’s not the end of the world.”

Allen, who has a culinary school degree and a background in cooking competitions, has been working for Georgia in some capacity going on 14 years now. Until this June, she was working exclusively in general dining services before she was handpicked to cook for the football program after the previous chef moved on to a job in the NFL.

Though she didn’t have a background in nutrition or working with athletes, Allen jumped into the job with eagerness. She took time to research what went into being a performance chef, met with the program’s culinary manager and team dietician, and most importantly, spoke with the players. If she was going to revamp the entire menu and program, she needed to know what her audience needed and wanted to eat.

“These are 18- to 20-year-old kids, honestly. It’s never a good idea to go too fancy — you gotta keep it simple, but also delicious,” Allen said. “So it’s figuring out ways to incorporate that into the diet so it’s beneficial to them and that they enjoy eating it.”

Allen tried to make sure players’ input was heard and that they knew what they were going to be eating and why. It helped that the feedback she received was easy to incorporate — after all, her background and specialty was in exactly the kind of cuisine more players were requesting. As Allen puts it: “comforting food for the soul.”

“We have a lot of Southern boys on our team and that is their background as well with comfort foods and Southern cuisine that their parents cook for them,” Allen said. “A lot of them miss home and they miss their parents’ cooking. We try to give them a home away from home.”

Football players, she says, are not “vegetable kids,” so she gets creative with meals, adding peas, green beans, broccolis and carrots to carbs as opposed to having them by themselves. Allen also divides the entire team into three buckets: those who need to lose weight, those who need to maintain weight and those who need to gain weight, providing different protein options for all of them.

After discussing with the team dietician, who is in contact with Smart about the cadence of any given practice week, Allen landed on a four-week cycle of different menus specifically crafted for the team. Then, she pays close attention to what players like and don’t like in order to adjust.

“It’s one of the biggest reasons why I kind of sit with them and ask them what it is that they would want to see on the menu,” Allen said. “That way I can try to make it more appealing to them so that they come and eat with us versus eating out.”

Allen knows she can’t please them all as she tries to make food for about 150 people a day, including staff and coaches, but she tries. So far, her jalapeño ranch fried chicken wing has been a runaway winner.

“It’s a hit, they love it,” Allen said. And the Georgia coaching staff? “They say it’s the best chicken in town.”


DALTON LEDFORD HAS been the executive performance chef at Clemson for three years. He has fed hundreds of players, seen many go on to the NFL, been part of two ACC titles and one College Football Playoff appearance. But his greatest accomplishment?

“It’s getting Coach [Dabo] Swinney to not eat a well-done steak,” Ledford said. “I finally talked him into eating a medium steak and he said, ‘Hey, it wasn’t leathery!'”

A lifelong Clemson fan, Ledford grew up working at Sticky Fingers, his dad’s rib joint in Fountain Inn, South Carolina. He went on to serve $300 plates at a five-star resort in Colorado Springs, Colorado, before landing back in his home state, where his excitement about the fact that he gets to cook for Swinney and the football team he roots for on Saturdays is palpable.

“Tajh Boyd is my favorite player ever,” Ledford said. “I remember fourth-and-16 like it was yesterday.”

When the previous executive chef left the program in 2023, Ledford. who was then working as a sous chef, but not in-house, volunteered to come up with menus for fall camp. One day, Swinney asked to talk to him. A scared Ledford thought his food had gotten someone sick and he was in trouble. He wasn’t. Swinney wanted to know if he’d be interested in the executive chef position. Ledford balked — he hadn’t attended culinary school and didn’t have a degree in nutrition. He told Swinney that he didn’t feel qualified.

“And the exact words Coach told me was, ‘Do you think I was qualified to take over the head coach job when I did?'” Ledford said. “He said, ‘I was young, I didn’t understand all of it yet, but I was given an opportunity and I was going to try my best in that opportunity to do everything I can for this program. You’ll figure it out. I trust you.'”

Like Allen at Georgia, Ledford works hand-in-hand with team dieticians to cater specifically to the football team and staff in the football operations building. Every player has access to an app called Notemeal, which Ledford uses to input the daily menu and macronutrients for each meal, and it allows players to order lunch in between classes or meetings.

But Ledford wanted to go beyond simply feeding the players; he wanted them to learn how to feed themselves, too. In the football facility kitchen, Ledford began hosting three-hour cooking demos once a month, showing players how to make everything from pizza to sushi to hibachi to grilling on a Blackstone.

“It’s a skill these guys are learning, but also for those that do get to go on to the next level, they already kind of have a base,” Ledford said. “If you’re a late-round pick, you really don’t have the money after taxes and depending on what state you live in and stuff like that, you don’t always have that available to you to be able to hire a chef and a nutritionist.”

At first, only 10 players participated. Now, attendance ranges from 60 to 70 players who take pride in showing Ledford a picture of a protein bowl or some other meal they made at home. It’s not just the players — coaches and staff members have wanted to get in on the experience, too.

“I did hibachi with the guys on Blackstone, and man, I had so many coaches come out and be like, ‘Yo, can I jump in with them and learn how to make this? I want to learn,'” Ledford said. “It ends up being a bonding moment between all of them.”

The demos, along with Ledford’s day-to-day food, also play a key role in recruiting. Ledford and his staff do all the food for recruiting events in-house, and when there is a player visiting campus with his parents, the recruiting staff has asked that Ledford meet with them to showcase their culinary experience.

“I always make the joke that Coach Swinney is going to make them into a man, and I’m going to feed ’em like it,” Ledford said. “A lot of these kids are coming from other states, across the country, across the world sometimes. As a parent, you want to know that you’ve got a group of people that are not just looking out for them on the field, but off the field, too.”


MISSOURI HEAD COACH Eli Drinkwitz does not have a difficult palate to please. But Joe Moroni, the Tigers’ executive performance chef, knows the one thing that Drinkwitz is particular about.

“He loves crispy bacon,” Moroni said.

Moroni knows all too well how things can get complicated inside a kitchen depending on who will be eating the meal he’s preparing. Moroni honed his craft in the Army as a cook and a staff sergeant for 11 years, eventually working his way up to the Pentagon, where he worked for the Joint Chiefs of Staff and concocted meals for an eclectic list of visitors including the New York Yankees, the Princess of Jordan and Robert De Niro.

After his stint in the Pentagon, Moroni was then selected as a general’s aid to four-star general Keith B. Alexander, whom he followed to the National Security Agency — where he cooked for Alexander and many foreign diplomats — until 2006, when Moroni moved back to Missouri.

Eventually, Moroni applied for a sous chef position in campus dining at Mizzou before ascending to his current position where he helped create a role that oversees all of athletic dining with an emphasis on football. Drinkwitz’s team gets an exclusive menu, meals six days a week and their own dining area on the south end of Faurot Field; it’s a nonstop affair and Moroni is right at the center of it.

“It’s a unique job. It’s one of those things that there’s just no schooling out there for it,” Moroni said, adding that his team is feeding someone at least 48 weeks out of the year. “I’ll tell you what, I had more days off at the Pentagon.”

Moroni now lives and dies with every Tigers football game, in part, because it determines what his job may look like on a given week. If Mizzou loses, the team usually gets a catered meal from an outside restaurant Sunday to avoid food fatigue. If they win, they get the catered meal plus a bonus — be it as extravagant as a filet mignon or as simple as a build-your-own nacho bar.

“We basically look at it like there’s 12 victories. So if those victories are victories, then we have 12 extravagant meals that they’re going to get,” Moroni said. “We all know that that doesn’t always happen. So if they don’t win, then we basically roll that victory menu to the next week, and we still feed them.”

Beyond the customary work with dieticians, Moroni, much like Allen at Georgia, takes pride in doing his research on the team ahead of a football season, talking to players about where they’re from and what foods they like. Whenever possible, he and his team will try to incorporate foods from specific regions of the country where a certain player may be from to provide a nostalgic meal.

“If I have somebody who’s coming from New Jersey, we might be trying to source something from the coast of New Jersey,” Moroni said. “Or if it’s someone from Texas and they’re looking for something like a specific type of way of cooking a brisket, we try to do those kinds of things.”

Moroni may no longer have the highest security clearance he once had in Washington D.C., or the chance to cook for dignitaries and celebrities. But in Columbia, he has witnessed firsthand how his cooking has brought teams and people from different parts of the country or the world together. Food is a love language for him just as it is for Solomon, Allen, Ledford and Johnson — the long hours they put in is in service of not just plying their craft, but creating those moments when a player sits down after a long day of practice and finds bliss in a bite of food.

“At the end of the day, we all want to feel loved, we all want to be warm, we all want a full belly,” Moroni said. “I never really got interactions with those particular celebrities. Whereas I cooked for [Mizzou QB] Brady Cook for four years, and I knew [linebacker] Nick Bolton and his mannerisms. And you get to know these people on a personal basis, you know what they like and don’t like, how they like to be, what their different mannerisms are when they win, how you help make them feel better if they drop that pass or had that fumble. So yeah, I like cooking for who I cook for right now.”

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Turkey urges US to act after accusing Israel of breaching Gaza ceasefire

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 Turkey urges US to act after accusing Israel of breaching Gaza ceasefire

Turkey has urged the US to take action after accusing Israel of violating the Gaza ceasefire deal.

The country’s president Recep Tayyip Erdogan said Washington and its allies should consider sanctions and halting arms sales to put pressure on Israel to abide by the agreement.

Turkey, a NATO member, joined ceasefire negotiations as a mediator, and increased its role following a meeting between Mr Erdogan and Donald Trump at the White House last month.

“The Hamas side is abiding by the ceasefire. In fact, it is openly stating its commitment to this. Israel, meanwhile, is continuing to violate the ceasefire,” Mr Erdogan told reporters.

“The international community, namely the United States, must do more to ensure Israel’s full compliance to the ceasefire and agreement,” he said.

Mr Erdogan was also asked about comments from Israeli Prime Minister Benjamin Netanyahu, who hinted that he would be opposed to any peacekeeping role for Turkish security forces in the Gaza Strip.

The Turkish president said talks on the issue were still underway, adding: “As this is a multi-faceted issue, there are comprehensive negotiations. We are ready to provide Gaza any form of support on this issue.”

Israel has accused Hamas of breaching the truce and previously said its recent military action in Gaza was designed to uphold the agreement.

Relations between former allies Israel and Turkey hit new lows during the Gaza war, with Ankara accusing Mr Netanyahu’s government of committing genocide, an allegation Israel has repeatedly denied.

A rally in support of Palestinians in Istanbul. Pic: Reuters
Image:
A rally in support of Palestinians in Istanbul. Pic: Reuters

Speaking during a visit to Israel on Friday, US Secretary of State Marco Rubio said that a planned international security force for Gaza would have to be made up of “countries that Israel’s comfortable with,” but declined to comment specifically on Turkey’s involvement.

Around 200 US troops are working alongside the Israeli military and delegations from other countries, planning the stabilisation and reconstruction of Gaza.

The US is seeking support from other allies, namely Gulf Arab nations, to build an international security force to be deployed to Gaza and train a Palestinian security force.

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Rubio warns against West Bank annexation

Mr Rubio said many nations had expressed interest, but decisions had yet to be made about the rules of engagement. He added that countries need to know what they were signing up for.

“Under what authority are they going to be operating? Who’s going to be in charge? What is their job?” said Mr Rubio.

Read more:
British troops deployed to Israel to ‘monitor ceasefire’
US takes centre stage in show of diplomatic power

The secretary of state also reiterated his earlier warning to Israel not to annex the occupied West Bank, land that Palestinians want for part of an independent state.

A bill applying Israeli law to the West Bank won preliminary approval from Israel’s parliament on Wednesday.

US Secretary of State Marco Rubio speaks with US military personnel in Israel. Pic: Reuters
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US Secretary of State Marco Rubio speaks with US military personnel in Israel. Pic: Reuters

“We don’t think it’s going to happen”, Mr Rubio said, adding that annexation “would also threaten this whole process”.

“If [annexation] were to happen, a lot of the countries that are involved in working on this probably aren’t going to want to be involved in this anymore. It’s a threat to the peace process and everybody knows it”, he added.

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US ramps up ‘drug boats’ operation by sending in aircraft carrier to region

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US ramps up 'drug boats' operation by sending in aircraft carrier to region

The US has announced it is sending an aircraft carrier to the waters off South America as it ramps up an operation to target alleged drug smuggling boats.

The Pentagon said in a statement that the USS Gerald R Ford would be deployed to the region to “bolster US capacity to detect, monitor, and disrupt illicit actors and activities that compromise the safety and prosperity of the United States homeland and our security in the Western Hemisphere”.

The vessel is the US Navy’s largest aircraft carrier. It is currently deployed in the Mediterranean alongside three destroyers, and the group are expected to take around one week to make the journey.

There are already eight US Navy ships in the central and South American region, along with a nuclear-powered submarine, adding up to about 6,000 sailors and marines, according to officials.

It came as the US secretary of war claimed that six “narco-terrorists” had been killed in a strike on an alleged drug smuggling boat in the Caribbean Sea overnight.

A still from footage purporting to show the boat seconds before the airstrike,  posted by US Secretary of War Pete Hegseth on X
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A still from footage purporting to show the boat seconds before the airstrike, posted by US Secretary of War Pete Hegseth on X

Pete Hegseth said his military had bombed a vessel which he claimed was operated by Tren de Aragua – a Venezuelan gang designated a terror group by Washington in February.

Writing on X, he claimed that the boat was involved in “illicit narcotics smuggling” and was transiting along a “known narco-trafficking route” when it was struck during the night.

All six men on board the boat, which was in international waters, were killed and no US forces were harmed, he said.

Ten vessels have now been bombed in recent weeks, killing more than 40 people.

Mr Hegseth added: “If you are a narco-terrorist smuggling drugs in our hemisphere, we will treat you like we treat al Qaeda. Day or NIGHT, we will map your networks, track your people, hunt you down, and kill you.”

While he did not provide any evidence that the vessel was carrying drugs, he did share a 20-second video that appeared to show a boat being hit by a projectile before exploding.

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Footage of a previous US strike on a suspected drugs boat earlier this week

Speaking during a White House press conference last week, Donald Trump argued that the campaign would help tackle the US’s opioid crisis.

“Every boat that we knock out, we save 25,000 American lives. So every time you see a boat, and you feel badly you say, ‘Wow, that’s rough’. It is rough, but if you lose three people and save 25,000 people,” he said.

Read more:
Survivors reported after boat strike
US destroys ‘drug smuggling submarine’

On Thursday, appearing at a press conference with Mr Hegseth, Mr Trump said that it was necessary to kill the alleged smugglers, because if they were arrested they would only return to transport drugs “again and again and again”.

“They don’t fear that, they have no fear,” he told reporters.

The attacks at sea would soon be followed by operations on land against drug smuggling cartels, Mr Trump claimed.

“We’re going to kill them,” he added. “They’re going to be, like, dead.”

Some Democratic politicians have expressed concerns that the strikes risk dragging the US into a war with Venezuela because of their proximity to the South American country’s coast.

Others have condemned the attacks as extrajudicial killings that would not stand up in a court of law.

Jim Himes, a member of the House of Representatives, told CBS News earlier this month: “They are illegal killings because the notion that the United States – and this is what the administration says is their justification – is involved in an armed conflict with any drug dealers, any Venezuelan drug dealers, is ludicrous.”

He claimed that Congress had been told “nothing” about who was on the boats and how they were identified as a threat.

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