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This high-volatility slot game has a Pay Anywhere option that rewards players when they land eight or more matching symbols on the reels. It also has a lucrative Free Spins feature with multipliers that can be as high as 500x the amount bet. Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which used a variety of investigators and participants from various geographical areas. This type of heterogeneity is required for practical trials to be valid and also helps reduce the chance of bias in the results. A high degree of heterogeneity, however can result in problems with the trial design. Pragmatic Play Pragmatic Play, one of the major players in the live casino market, provides a variety of classic table games, including Blackjack and Roulette. The live studios of the company in Romania and Malta provide customers with an authentic gambling experience, as well as a broad range of virtual betting options. 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Legality Pragmatic Play has gained a reputation for offering top-notch games and an exceptional user experience. Its software can be used on mobile devices and in a variety of languages. Despite its relative youth it has already established itself as a top gaming platform for casinos. The most recent releases include Wolves 5 reel video slot that has a healthy RTP and impressive graphics. The other notable titles include Wolf Gold and Chilli Heat. The purpose of pragmatic trials is to replicate real-life scenarios and gain maximum credibility externally. They are usually commissioned by practitioners and policy makers to guide their decision-making. They can also be a great method to determine the causal relationship between an intervention and its results. However, they should not be used to replace explanation studies. The concept of pragmatism is controversial and there are doubts about whether pragmatic trials can replace explanatory tests or if they should be an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which confirm the validity of a clinical or physiological hypothesis, and pragmatic trials, which inform the practice and policy decisions. They also suggested a framework for pragmatic trials, which they called PRECIS.2 This tool attempted to define the features of a pragmatic trial that include the recruitment process, the design and implementation of the intervention, as well as monitoring. There is a growing increase in the number of pragmatic trials that are published. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to keep in mind, however, that the majority were conducted in primary-care settings.