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This high-volatility slot game has a Pay Anywhere option that rewards players when they hit 8 or more matching symbols anywhere in the reels. This game also features the Free Spins bonus with multipliers up to 500x your bet. Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which utilized a variety of investigators and had participants from various geographical areas. This kind of heterogeneity is essential for pragmatic trials to be valid and helps reduce the chance of bias in the results. However too much heterogeneity could result in issues with the design of the trial. Pragmatic Play is also a major player on the live casino market, providing an extensive selection of classic table games such as Blackjack and Roulette in various variations. The live studios of Pragmatic Play in Romania and Malta offer customers an authentic gaming experience and a wide selection of virtual betting options. 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The pragmatism idea is controversial, and there are questions regarding whether pragmatic trials could be used to replace explanation tests or if they are a complement to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove a physiological or clinical hypothesis, and pragmatic trials that inform the practice and policy decisions. They also suggested an approach to pragmatic trials, called PRECIS.2 This tool attempted to define the features of a pragmatic study that include the recruitment process, the design and implementation of the intervention, and monitoring. There is a growing increase in the number pragmatic trials that have been published. A recent Medline search using the keywords naturalistic and pragmatic, limited to randomized controlled trials (RCTs) produced 34 articles, as shown in red in Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. However, it is important to note that the majority of these studies were conducted in primary care settings.