SCIENCE & MEDICAL % change 2003 2002 2003 2002 at constant £m £m € m € m currencies Turnover Elsevier  Science & Technology 789 746 1,144 1,186 5% Health Sciences 592 549 858 873 11% 1,381 1,295 2,002 2,059 8% Adjusted operating profit 467 429 677 682 8% Adjusted operating margin 33.8% 33.1% 33.8% 33.1% 0.7pts Elsevier has had another successful year against a background of considerable pressure on institutional budgets. Strong subscriptions renewals and growing online sales drove revenue growth in Science & Technology and a successful book publishing programme delivered good growth in Health Sciences. Underlying operating margins were improved by further actions to streamline operations. Continued investment in new publishing and in expanding ScienceDirect and other online services are expected to deliver future growth. Revenue and adjusted operating profits both increased by 8% at constant exchange rates, or 5% and 8% excluding the Holtzbrinck STM business acquired at the beginning of the year and other small acquisitions and disposals. Both the Science & Technology and Health Sciences divisions saw underlying revenue growth of 5%. In the Science & Technology division, growth was driven by strong subscription renewals and growing online sales including recently introduced back files and subject collections. Usage of ScienceDirect more than doubled to 175 million article downloads during the year, reflecting the dramatic increase in access and utility that this web based service provides. ScienceDirect now holds over 5 million scientific research articles that can be searched, accessed and linked at the click of a mouse, anywhere and at any time. Increasingly customers, either individually or through consortia, are subscribing to content hitherto outside their collections at attractive discounts. Electronic only subscriptions grew by 55% and now account for 23% of journal subscriptions by value. In Health Sciences, growth was driven by the strong book publishing programme with successful new titles and editions coupled with increased demand from the growing healthcare professions. Electronic 8 REED ELSEVIER ANNUAL REPORTS & FINANCIAL STATEMENTS 2003 OPERATING AND FINANCIAL REVIEW