{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:45:11Z","timestamp":1760060711211,"version":"build-2065373602"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Future Internet"],"abstract":"<jats:p>The rapid adoption of Metaverse technologies in healthcare, particularly for elder safety monitoring, has introduced new security challenges related to the authenticity of virtual representations. As healthcare providers increasingly rely on avatars and digital twins to monitor and interact with elderly patients remotely, ensuring the integrity of these virtual entities becomes paramount. This paper introduces SAVE (Securing Avatars in Virtual Environments), an emerging framework that leverages environmental fingerprinting based on Electric Network Frequency (ENF) signals to authenticate avatars and detect potential deepfake attacks in virtual healthcare settings. Unlike conventional authentication methods that rely solely on digital credentials, SAVE anchors virtual entities to the physical world by utilizing the unique temporal and spatial characteristics of ENF signals. We implement and evaluate SAVE in a Microverse-based nursing home environment designed for monitoring elderly individuals living alone. We evaluated SAVE using a prototype system with Raspberry Pi devices and multiple environmental sensors, demonstrating effectiveness across three attack scenarios in a 30-minute experimental window. Through the experimental evaluation of three distinct attack scenarios, unauthorized device attacks, device ID spoofing, and replay attacks using intercepted data, our system demonstrates high detection accuracy with minimal false positives. Results show that by comparing ENF fingerprints embedded in transmitted data with reference ENF signals, SAVE can effectively identify tampering and ensure the authenticity of avatar updates in real time. The SAVE approach enhances the security of virtual healthcare monitoring without requiring additional user intervention, making it particularly suitable for elderly care applications where ease of use is essential. Our findings highlight the potential of physical environmental fingerprints as a robust security layer for virtual healthcare systems, contributing to safer and more trustworthy remote monitoring solutions for vulnerable populations.<\/jats:p>","DOI":"10.3390\/fi17090419","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T10:51:33Z","timestamp":1757933493000},"page":"419","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["SAVE: Securing Avatars in Virtual Healthcare Through Environmental Fingerprinting for Elder Safety Monitoring"],"prefix":"10.3390","volume":"17","author":[{"given":"Qian","family":"Qu","sequence":"first","affiliation":[{"name":"Department of Electrical and Computer Engineering, Binghamton University, Binghamton, NY 13902, USA"},{"name":"Department of Computer Science, Virginia State University, Petersburg, VA 23806, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1880-0586","authenticated-orcid":false,"given":"Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, Binghamton University, Binghamton, NY 13902, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6894-6108","authenticated-orcid":false,"given":"Erik","family":"Blasch","sequence":"additional","affiliation":[{"name":"MOVEJ Analytics, Fairborn, OH 45324, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"832","DOI":"10.3390\/smartcities5030043","article-title":"The social shaping of the metaverse as an alternative to the imaginaries of data-driven smart Cities: A study in science, technology, and society","volume":"5","author":"Bibri","year":"2022","journal-title":"Smart Cities"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1109\/MCE.2022.3223522","article-title":"Metaverse in healthcare: Applications, challenges, and future directions","volume":"12","author":"Musamih","year":"2022","journal-title":"IEEE Consum. 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