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This game also comes with an Free Spins bonus with multipliers that can be as high as 500x your stake. A pragmatic trial that uses various investigators and participants from diverse geographical locations is the Home Blood Pressure Management study (HBPM). This type of heterogeneity is required for pragmatic trials to be valid and also helps reduce bias in the results. However, too much heterogeneity can result in problems with the design of the trial. Pragmatic Play is also a major player in the live casino market, offering an array of classic table games such as Blackjack and Roulette in various variations. The live studios of Pragmatic Play's offices in Romania and Malta offer customers an authentic gaming experience as well a full selection of virtual betting options. The company also has several game shows which make online gambling exciting and interactive. Some of these shows are broadcast live and others are hosted by famous personalities from the industry. 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Its software is designed to work on mobile devices and is compatible with various languages. It has earned itself the status of one of the leading gaming platforms in the casino industry despite its relative infancy. Wolves is one of its latest releases which is a five-reel slot machine with a healthy RTP and stunning graphics. Its other notable titles are Wolf Gold and Chilli Heat. Pragmatic trials are designed to replicate real-life situations and attain maximum external validity. They are usually commissioned by policy makers and practitioners to guide their decision-making. They can also be used to determine the causal relationship between an intervention and its results. However, they should not be used to replace explanatory studies. The pragmatism concept is controversial and there are concerns about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which confirm the physiological hypothesis or clinical hypothesis, and pragmatic trials that aid in the practice and policy decision-making. They also proposed a framework called PRECIS for pragmatic trials.2 This tool attempted to define the characteristics of a practical study which includes the recruitment, design, and delivery of the intervention and follow-up. The number of pragmatic trials is growing. A recent Medline search using the keywords naturalistic and pragmatic, limited to controlled trials randomized to control (RCTs) produced 34 articles, which are shown in red in Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to remember that the majority were conducted in primary-care settings.